394 Abstracts/Lung Cancer 14 (19%) 377-408

At current costs, the routine use of brain CT is not warranted in patients autoantibody production in this disorder. The antibodies so produced with lung cancer who have normal findings on a standardized clinical are implicated in the functional impairment of the Ca” channels evaluation for m&stases. characteristic of LES.

Role of transesophageal echocardiography in themanagement of patients with hronchogenic carcinoma invading the left atrium

Bronchioloalveolar carcinoma and congenital cystic adenomatoid malformation

Lynch M, Balk MA, Lee RB, Martin RP. Emory University Hospiral, 1364Clt~oonRoadN.E., Atlanta, GA30322. AmJCardioll995;76: llOl- 2.

Rihet ME, Copin M-C, Soots JG, Gosselin BH. Unit of Thoracic Surgery, Hopital Calmette. Universite de Lille, F 59037 Lille Ceder. Ann Thorac Surg 1995;60: 1126-g.

We describe 2 patients with bronchogenic carcinoma invading the left atrium in whom tmnsesophageal echocardiography played a signilicant role in their management by defining the extent of cardiac invasion. Transesophageal echocardiography should be considered in evaluating patients presenting with thomcic tumors believed to be encroaching on cardiac StNCtUreS, where consideration is being given to surgical resection of the tumor.

We report on a 42-year-old woman in whom was discovered a symptomless peripheral radiologic excavated lesion of the lung, which actually existed 3 years before. All investigations were negative. A segmentectomy was performed. Histopathologic examination proved a bronchioloalveolar carcinoma in contact with a type I congenital cystic malformation of the lung. Such a malformation can be diagnosed late in adult life. The epithelial cells of the malformation might predispose to slow proliferation and malignancy, enhanced by smoking habits.

Inhibition of calcium currents and exocytosis by Lambert- Baton syndrome antibodies in human lung cancer cells Viglione MP, O’Shaughnessy TJ, Kim YI. Department ofBiomedrcal Engineering. University Virginia School Medicine, Box 377, Charlottesville, VA 22908. J Physiol 1995;488:303-17.

Assessment of quality of life by clinicians - Experience of a practical method in lung cancer patients Abratt R, Viljoen G. Department of Radiation Oncology, Groote Schuur Hospital, Cape Town. S Afr Med J 1995;85:896-8.

1. Humansmall-cell hmgcancer(SCLC) cellsarebelieved toexpress the antigens responsible for the production of pathological antibodies in the Lambert-Eaton syndrome (LES), a Ca2’ channel disorder in which quanta1 transmitter release from the motor nerve terminal is impaired. Whole-cell patch-clamp techniques were used to study the voltage- dependent Cd’ channels expressed by H 146 SCLC cells and the effects of LES antibodies on these channels. The types of Caz’ channels were determined using biophysical properties and pharmacological sensitivity to several antagonists. 2. Whole-cell Ca2’currents (I@)) in SCLC cells ate sensitive to the dihydropyridine (DHP) nicardipine, omega-conotoxin GVIA (omega-CgTX GVIA) and omega-agatoxin IVA (omega-AgTX IVA). Nicardipine at 100 nM and 10 M reduced I(&) by 35 and 45 % (n = 38 cells), respectively, whileomega-CgTX GVIA (1 M) inhibited I(Ca) by 32 % (n = 3 1). Application of omega-AgTX IVA at 50 and 100 nM to the cancer cells decreased I(&) by 41 and 42 I, respectively (n = 22). 3. Measurement of cell membrane capacitance (C(m)) revealed that Ca2’-dependent exocytosis underlies the secretory activity of SCLC cells. Exocytosis, when induced by step depolarizing pulses and measured by increases in C(m), was markedly inhibited by nicardipine (10 M) and omega-AgTX IVA (100 nM). In contrast, omega-CgTX GVIA (1 M) was not as effective in altering increases in C(m). 4. From negative (-80 mV) and depolarized (40 mV) holding potentials, both peak and plateau I(Ca) were inhibited by the presence of LES antibodies (1 mg ml’ IgG). LES serum also reduced depolarization-induced increases in C(m) by 48 % (n = 15). 5. To determine whether the LES antibodies are downregulating a specific type(s) of Cd’ channel, nicardipine (10 M), omega-CgTX GVIA (1 M) or omega-AgTX IVA (100 nM) was applied to tumour cells that had been previously exposed to LES serum for 24 h. The most pronounced change was that omega- AgTX IVA was 38-8446 less effective at reducing I(&) after the IgG treatment. Theeffectiveness ofnicardipinewasdiminished by 18 46 after incubation with the LES antibodies, whereas the omega-CgTX GVIA was seen to be more effective. These results suggest that LES IgG downregulates P-type Ca2’ channels and, possibly, to a lesser extent L- type channels. 6. In view of recent evidence that P-type Ca” channels mediatecholinergic transmitter release at the mammalian neummuscular junction (NMJ), the expression of P-type Ca” channels in the SCLC cells and the reactivity of LES IgG with these channels support the hypothesis that P-type Ca2’charmels in these cancer cells may trigger the

Objective. To evaluate a practical method (brief scale) of assessing the quality of life in patients with lung cancer. Design. To compare the scores obtained by means of thebrief scale with those obtained on formal tests. The brief scale consists of an Outlook score (measuring psycho- logical status) and a Support score (measuring psychosocial support). The formal tests were the Hospital Anxiety and Depression Scale (HADS) for psychological status, and the Rotterdam Symptom Checklist (RSCL) and Spitzer QL-Index for quality-of-life assessment. Setting. Lung cancer follow-up clinic, Groote Schuur Hospital. Participants. A total of 40 patients selected by random sample. Main outcome measures. The correlation between the brief scale and standard formal tests. Results. The HAD.8 indicated that psychological morbidity was present in 30% of patients. Both the RSCL and the Spitter QL-Index indicated asignificantly poorqualityof lifein 25 96 ofpatients. The Outlook score correlated with both psychological status and quality of life. The Support score correlated with psychological status but not with the assessment of quality of life. It did, however, correlate with the independent evaluation of social support in the Spitxer QL-Index. Conclusions. The brief scale is a cost-effective and uselid tool for quality of life assessment in the clinical management of patients with lung and other cancers.

Diagnostic usefulness of five tumor markers in patients with primary lung cancer Toumbis M, Rasidakis A, Passalidou E, Dimitroulis J. Gaga M, Alchanatis M et al. Department of Respiratory Medicine, University of Athens, Chest Disease Hospital, 152 Mesogion Avenue, Athens 11527. Gncol Rep 1995;2: 1135-40.

Thymidine kinase (TK), carbohydrate antigen 19-9 (CA 19-9). carbohydrate antigen 125 (CA 125). squamous cell carcinoma antigen (SCC) and tissue polypeptide antigen (TPA), were evaluated in 104 untreated patients with primary lung cancer and 55 patients with benign lung disease. The mean concentrations of TPA and CA 125 were significantly higher in lung cancer patients than in benign controls (p<O.OOl). The concentrations of all the tumor markers were well correlated with the stage of lung cancer. In respect to sensitivity, specificity and accuracy, TPA was superior to the other tumor markers tested (70.246, 88.8% and 75.8% respectively). When TPA was combined with the other markers, sensitivity increased from 70.2% to 98%, but as thenumberofcombined markers becamelarger, specificity