Age as a prognostic factor for late local recurrence of early tongue cancer treated with brachytherapy

BACKGROUND

We aimed to examine predisposing factors on late local recurrence of early oral tongue cancer (T1-2N0).

METHODS

We analysed 152 patients with no evidence of disease 2 years after interstitial radiation therapy without external radiation.

RESULTS

Multivariate analysis showed age to be the only significant prognostic factor for late local control (p = 0.03). We then examined the influence of age by comparing the results between 36 older patients (age more than, or equal to, 65) and 116 other control patients (age less than 65). Aged patients showed poor local control rates of 62% at 10 years after treatment, whereas the corresponding figures for control patients were 90% (p = 0.003). The cause specific survival rate at 10 years was also lower in elderly patients (75%) than in control patients (93%, p = 0.02).

CONCLUSIONS

Age is a predisposing factor for late local recurrence in patients free from disease 2 years after treatment.

The effect of imidazoline receptors and alpha2-adrenoceptors on the anesthetic requirement (MAC) for halothane in rats

BACKGROUND

Recent evidences have documented that several pharmacologic actions of alpha2-adrenoceptor agonists are mediated via activation of not only alpha2-adrenoceptors, but also by imidazoline receptors, which are nonadrenergic receptors in the central nervous system. However, the effect of imidazoline receptors on the anesthesia is not well known, and it is important to clarify the effects of both receptors on anesthesia.

METHODS

Seventy-two rats were anesthetized with halothane, and the anesthetic requirement for halothane was evaluated as minimum alveolar concentration (MAC). The MAC for halothane was determined in the presence of dexmedetomidine (0, 10, 20, and 30 microg/kg, intraperitoneally [IP]), a selective alpha2-adrenoceptor agonist with weak affinity for imidazoline receptors. Then, the authors evaluated the inhibitory effect of rauwolscine (20 mg/kg, IP), an alpha2-adrenoceptor antagonist with little affinity for imidazoline receptors, on the MAC-reducing action of dexmedetomidine (30 microg/kg). Further, the effect of rilmenidine (20, 50, 100, 1000 microg/kg, IP), a selective imidazoline receptor agonist, on the MAC for halothane was also investigated.

RESULTS

Dexmedetomidine decreased the MAC for halothane dose-dependently, and this MAC-reducing action of dexmedetomidine was completely blocked by rauwolscine. Rilmenidine alone did not change the MAC for halothane.

CONCLUSIONS

The present data indicate that the anesthetic sparing action of dexmedetomidine is most likely mediated through alpha2- adrenoceptors, and the stimulation of imidazoline receptors exerts little effect on the anesthetic requirement for halothane.

Assessment of left atrial operative mean stiffness using simultaneous recordings of left ventricular pressure and M-mode echocardiography of the left atrium and mitral valve

Left atrial (LA) operative mean stiffness was measured using simultaneous recordings of the left ventricular (LV) pressure and M-mode echocardiography of the LA and mitral valve. The LA operative passive mean stiffness value was obtained during LV systole using LV pressure at the mitral valve opening and the pre-atrial contraction where the LV and LA pressure curves cross each other. Before the LA stiffness measurement, the LA volume calculated by biplane left atriography was compared with the dimension of the LA M-mode echocardiogram at three points (maximum volume, pre-atrial contraction and minimum volume) in another 23 patients (5 normal subjects, 4 patients with angina pectoris, 14 patients with myocardial infarction), and the regression equation was obtained by power fitting (y = ax3+ b). Using this equation, the LA volumes were calculated and used for the measurement of LA operative mean stiffness. Eleven normal subjects (C group), 14 patients with myocardial infarction (ejection fraction: EF > or = 55%; NF group), and 12 patients with myocardial infarction (EF < 55%; F group) were studied. The measured operative mean stiffness values based on the LA dimension and LV pressure [K(D)] were 0.69 +/- 0.40, 1.0 +/- 0.37, and 2.0 +/- 0.61 mmHg/mm, respectively (p < 0.01 in C vs F). The mean stiffness values calculated with LA volume [K(V)] were 0.48 +/- 0.23, 0.42 +/- 0.19, and 0.66 +/- 0.25 mmHg/ml, respectively (p < 0.05 in NF vs F). In F group, both the K(D) and K(V) values were high. The K(D) value can thus be used clinically as an easily obtained index of the LA operative mean stiffness. The high LA operative mean stiffness in F group appeared to be related to the increased LA pressure at the mitral valve opening. This method of measurement of the LA operative mean stiffness can be easily applied and used as a routine measurement providing additional information regarding left ventricular function.

Efficacy of a belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields

PURPOSE/OBJECTIVE

Acute and chronic small bowel toxicity associated with pelvic irradiation limits dose escalation for both chemotherapy and radiotherapy for rectal cancer. Various surgical and technical maneuvers including compression and belly board devices (BBD) have been used to reduce small bowel volume in treatment fields. However, quantitative dose volume advantages of such methods have not been reported. In this study, the efficacy of BBD with CT-simulation is presented with dose-volume histogram (DVH) analyses for rectal cancer.

METHODS AND MATERIALS

Twelve consecutive patients referred to our department with rectal cancer were included in this study. Patients were given oral contrast 1.5 h prior to scanning and instructed not to empty their bladder during the procedure. The initial CT scan without BBD was taken in the prone position with an immobilization cast. A second CT study was performed with a commercially available BBD consisting of an 18-cm thick hard sponge with an adjustable opening (maximum 42 x 42 cm2). All patients were positioned prone over the BBD so that the opening was above the treatment volume and usually extended from the diaphragm to the bottom of the fourth lumbar spine. Image fusion between both sets of CT scans (with and without BBD) was performed using common bony landmarks to maintain the same target volume. The critical structures including small bowel and bladder were delineated on each slice for DVH analysis. On each study, a three-field optimized plan with conformal blocks in beams-eye-view was generated for volumetric analysis. The DVHs with and without BBD were evaluated for each patient.

RESULTS

The median age and body weight of 12 patients (4 females and 8 males) were 57.5 years and 82.7 kg, respectively. The changes in posterior-anterior (PA) and lateral separation with and without BBD at central axis slices were analyzed. The changes in lateral separation were minimal (<0.8 cm); however, the PA separation was reduced by 11.3 +/- 3.3% when BBD was used. The reduction in PA separation was directly related to the reduction in small bowel volume. The small bowel volume was significantly reduced with a median reduction of 70% (range 10-100%) compared to the small bowel volume without BBD. The small bowel volume reduction did not correlate either with body weight, age, gender, or sequence of radiation treatment with surgery (pre-op vs. post-op). The DVH analysis of small bowel with BBD showed significant volume reduction at each dose level. For 50% patients, the DVH analysis demonstrated an increase in bladder volume with BBD. All patients treated with the BBD completed their treatment without any break and without significant acute gastrointestinal or genitourinary toxicity.

CONCLUSIONS

For rectal cancers, small bowel is the dose-limiting structure for acute and chronic toxicity. The use of the BBD should improve the tolerance of aggressive combined modality treatment by reducing the small bowel volume within the pelvis compared to the prone position alone. The BBD provides an easy, economical, comfortable, and noninvasive technique to displace small bowel from pelvic treatment fields. The small bowel volume is dramatically reduced at each dose level. The volume reduction does not correlate with gender, age, weight, pelvic separation, and sequence of radiation treatment vs. surgery.

Using minimum deviation of a secondary rainbow and its application to water analysis in a high-precision, refractive-index comparator for liquids

A new method for measuring the refractive-index difference of a liquid has been developed. The liquid to be measured is contained in a 60-mm-diameter, cylindrical glass cell, and a He-Ne laser light is passed into the cell so that the laser light incidence fulfills the condition of minimum deviation. In this condition, the beam emerging from the cell has a fine interference fringe. The position of the interference fringe is read out as a marker to measure the deflection of the laser light. Directly reading the peak shift of the interference fringe makes it easy to obtain the refractive index difference of the liquid with a fairly high precision of at least 6 x 10(-6). Further high precision is potentially expected to be realized by use of an improved data analysis treatment of the overall interference fringe pattern.

Visual evoked potential and electroencephalogram of healthy females during the menstrual cycle

Flash visual evoked potential (VEP) and electroencephalogram (EEG) changes during the menstrual cycle were studied using healthy females having regular menstruation, with 21 at the follicular phase (FP) and 23 at the luteal phase (LP). The following results were obtained. (1) The waveforms of Group Mean VEPs of both groups had approximately similar triphasic contours, consisting of 16 components of P 1-N 8 up to 500 msec of latency. (2) Latencies tended to be longer in LP. (3) Interpeak amplitudes tended to be larger in LP, and one VEP interpeak amplitude (P 5-N 7) of long latency component was significantly larger at LP after eliminating the effect of body height by ANCOVA for 2 CH. (4) Quantitative analysis of EEGs between FP and LP resulted in a tendency for increased alpha, and decreased beta power % at LP. Since estrogen increases the VEP amplitude, and decreases the VEP latency and the alpha activity of EEGs, the large VEP amplitude, the tendency for prolonged VEP latency, and the tendency for increased alpha power % at LP observed in this study indicate that the VEP amplitude at LP reflects the effect of estrogen, and that the VEP latency and EEGs at LP reflect the effect of progesterone.

Interactions between neuronal histamine and halothane anesthesia in rats

Using an in vivo microdialysis method, we measured the release of histamine in the anterior hypothalamic area (AHy) of rats under several concentrations of halothane anesthesia (1, 0.5, and 0.2%). The release of histamine increased to 341 and 325% at halothane concentrations of 0.5 and 0.2%, compared with the basal level at anesthesia induced by 1% halothane. alpha-Fluoromethylhistidine (100 mg/kg i.v.), a specific and irreversible inhibitor of histidine decarboxylase, reduced the histamine release to <35% of the basal value at 1% halothane anesthesia in the AHy, and also decreased the anesthetic requirement for halothane, evaluated as the minimum alveolar concentration (MAC), by 26%. Furthermore, pyrilamine (20 mg/kg i.v.), a brain-penetrating H1 antagonist, and zolantidine (20 mg/kg i.v.), a brain-penetrating H2 antagonist, reduced the MAC for halothane by 28.5 and 16%, respectively. Although thioperamide (5 mg/kg i.v.), an antagonist of presynaptic H3 autoreceptor, induced an approximate twofold increase in the level of histamine release in conscious freely moving rats, the same dose of thioperamide had little effect on the release of histamine under 1% halothane anesthesia in the AHy. Furthermore, thioperamide did not change the anesthetic requirement (MAC) for halothane. The present findings indicate that halothane anesthesia inhibits the release of neuronal histamine and that histaminergic neuron activities change the anesthetic requirement (MAC) for halothane through H1 as well as H2 receptors.

Comparison of the long-term results of brachytherapy for T1-2N0 oral tongue cancer treated with Ir-192 and Ra-226

BACKGROUND

The authors report the compatibility of iridium-192 (Ir-192) to Radium-226 (Ra-226) based on the clinical results of three-decades.

METHODS

From 1967 through 1985, 119 patients with early oral tongue cancer (T1-2N0) were treated with conventional Ra-226 needles and 135 patients with Ir-192 hair pins.

RESULTS

Local control rates at 10 years for T1 and T2 tongue cancer were 79% and 61% for patients treated with Ra-226, 83% and 68% with Ir-192. The 10-year cause-specific survival rates for the T1 and T2 patients with Ra-226 were 76% and 63%, and those with Ir-192 were 77% and 68%, respectively.

CONCLUSIONS

Ir-192 showed good possibilities as a substitute for Ra-226 in brachytherapy for early oral tongue cancer.

Factor VIII Ise (R2159C) in a patient with mild hemophilia A, an abnormal factor VIII with retention of function but modification of C2 epitopes

We found a patient with mild hemophilia A who had no detectable factor VIII antigen (FVIII:Ag), as shown by two-site ELISA using inhibitor alloantibodies (TK). We then analyzed A2, A2/B, and C2 antigen of the patient's DDAVP-induced FVIII using several anti-FVIII monoclonal antibodies. Factor VIII activity (FVIII:C) was increased from 12 to 42 U/dl by the administration of DDAVP. The DDAVP-induced increases in the A2 and A2/B antigens were 40 and 36 U/dl, respectively. However, the increase in the C2 antigen was only 7.5 U/dl. SSCP analysis and subsequent sequencing demonstrated an Arg to Cys transition at codon 2159. The anti-FVIII:C titer of monoclonal antibody, NMC-VIII/5 which recognized the C2 domain, against normal plasma was 450 Bethesda U/mg of IgG. However, the titer against DDAVP-treated patient's plasma was only 15 Bethesda U/mg. We also tested DDAVP-induced increase in the FVIII:Ag in another mild hemophilia A patient with the same mutation at Arg2159. Increase in his C2 antigen levels was only 19% of those in the A2 and A2/B antigen. We designate this abnormal FVIII as FVIII Ise. Our results show that a missense mutation at Arg2159 to Cys modifies the antigenicity of the C2 domain.

Effects of Albunex infusion on left ventricular inflow velocity in dogs

This study examined the effects of Albunex (sonicated 5% human serum albumin) infusion on left ventricular inflow velocity by Doppler echocardiography. Left ventricular pressure and left ventricular inflow velocity were recorded simultaneously under eight different conditions in dogs: 1) baseline 1 (control), 2) Albunex 0.2 ml/kg, 3) baseline 2, 4) Albunex 0.5 ml/kg, infusion of dextran 100 ml, 5) baseline 3, 6) Albunex 0.2 ml/kg, 7) baseline 4, and 8) Albunex 0.5 ml/kg. In the normal state (no dextran), Albunex (0.2 ml/kg) caused no hemodynamic changes or inflow velocity changes. In contrast, infusion of Albunex (0.5 ml/kg) caused time velocity integrals of early filling to increase from the baseline (5.51 +/- 1.13 vs 7.19 +/- 1.14 cm, p < 0.05). After dextran infusion (100 ml), Albunex (0.2 ml/kg) caused peak early filling velocity to increase (62.4 +/- 6.9 vs 67.3 +/- 9.4 cm/sec, p < 0.05), and infusion of Albunex (0.5 ml/kg) also caused peak early filling velocity to increase from baseline (64.6 +/- 8.5 vs 73.7 +/- 14.5 cm/sec, p < 0.05). Infusion of Albunex (0.5 ml/kg) after dextran infusion caused increases in left ventricular pressure at the mitral valve opening (12.7 +/- 3.1 vs 15.2 +/- 3.3 mmHg, p < 0.05) and in left atrial driving force (13.5 +/- 3.6 vs 16.7 +/- 5.9 mmHg, p < 0.05). Clinicians should be cautious about using Albunex at doses of greater than 0.2 ml/kg when evaluating the pressure gradient of the left ventricle in patients with elevated left ventricular diastolic pressure. In patients with normal hemodynamics, Albunex infusion at doses of less than 0.2 ml/kg apparently did not affect the velocity measurement.

Initial clinical assessment of CT-MRI image fusion software in localization of the prostate for 3D conformal radiation therapy

PURPOSE

To assess the utility of image fusion software and compare MRI prostate localization with CT localization in patients undergoing 3D conformal radiation therapy of prostate cancer.

MATERIALS AND METHODS

After a phantom study was performed to ensure the accuracy of image fusion procedure, 22 prostate cancer patients had CT and MRI studies before the start of radiotherapy. Immobilization casts used during radiation treatment were also used for both imaging studies. After the clinical target volume (CTV) (prostate or prostate + seminal vesicles) was defined on CT, slices from the MRI study were reconstructed to precisely match the CT slices by identifying three common bony landmarks on each study. The CTV was separately defined on the matched MRI slices. Data related to the size and location of the prostate were compared between CT and MRI. The spatial relationship between the tip of urethrogram cone on CT and prostate apex seen on MRI was also estimated.

RESULTS

The phantom study showed the registration discrepancies between CT and MRI smaller than 1.0 mm in any pair in comparison. The patient study showed a mean image registration error of 0.9 (+/- 0.6) mm. The average prostate volume was 63.0 (+/- 25.8) cm3 and 50.9 (+/- 22.9) cm3 determined by CT and MRI, respectively. The difference in prostate location with the two studies usually differed at the base and at the apex of the prostate. On the transverse MRI, the prostate apex was situated 7.1 (+/- 4.5) mm dorsal and 15.1 (+/- 4.0) mm cephalad to the tip of urethrogram cone.

CONCLUSIONS

CT-MRI image fusion study made it possible to compare the two modalities directly. MRI localization of the prostate is more accurate than CT, and indicates the distance from cone to apex is 15 mm. CT-MRI image fusion technique provides valuable supplements to CT technology for more precise targeting of the prostate cancer.

Serial histopathologic myocardial findings in a patient with ectopic atrial tachycardia-induced cardiomyopathy

A 17-year-old woman was found to have ectopic atrial tachycardia by her physician. Echocardiography and cardiac catheterization revealed findings resembling dilated cardiomyopathy at the time of initial presentation. The tachycardia was controlled with atenolol only at a dose of 50 mg/day. However, at the age of 22, the presence of ectopic atrial tachycardia was once again confirmed. We successfully performed catheter ablation for persistent ectopic atrial tachycardia. Serial echocardiographic findings showed the left ventricular dimension and function appeared to return to normal 1 year postablation. However, despite pharmacologic control and catheter ablation therapy, histopathology revealed myocardial fibrosis presumably representing permanent damage of the heart secondary to tachycardia 1 year postablation.

Sex differences in visual evoked potential and electroencephalogram of healthy adults

Sex differences in flash visual evoked potentials (VEPs) and electroencephalograms (EEGs) were studied in 200 healthy adults (100 females and 100 males). Following results were obtained. (1) Waveforms of Group Mean VEPs of each sex had roughly triphasic contour, consisted of components P1 approximately N8, within 500 msec of latency. (2) Latencies of VEP components by t-test, (3) By analysis of covariance, sex differences in peak-to-peak amplitudes were still significant after eliminating effects of body height, body weight or age, but not those in latencies after eliminating the effect of body height. (4) Quantitative analysis of EEGs resulted in significantly smaller absolute amplitudes, and significantly larger theta, larger beta 1 and smaller alpha 2 power % in females. (5) Peak-to-peak amplitudes of later components in VEPs for 5CH (O1-->Cz) were significantly and positively correlated with EEG absolute amplitudes within each sex group. (6) There were few significant differences in VEP components between follicular phase and luteal phase in females. The sex differences in VEPs verified in this study may be attributed to genetically determined sex differences in neuroendocrinological systems.

Short communication: CT-MRI image fusion for 3D conformal prostate radiotherapy: use in patients with altered pelvic anatomy

We describe the application of CT-MRI fusion software for 3D conformal radiotherapy in two patients with localized prostate cancer who had significantly altered pelvic anatomy due to prior surgery. Patient A had a hemipelvectomy for fibrosarcoma and Patient B had an abdominoperineal resection (APR) for rectal carcinoma. Using the Picker AcQSIM 3D treatment planning software equipped with CT-MRI fusion capabilities, we were able to construct 3D conformal treatment plans for the two patients. The CT-MRI fusion was invaluable in the 3D conformal treatment planning of these cases with distorted pelvic anatomy. It allowed for accurate identification of the clinical target volume (CTV) and was also able to better visualize normal structures so that the radiation beams could be placed to minimize toxicity to the normal tissues.

Factor VIII inhibitor antibodies with C2 domain specificity are less inhibitory to factor VIII complexed with von Willebrand factor

In order to clarify the potential role of von Willebrand factor (vWf) in attenuating the inactivation of factor VIII (fVIII) by those antibodies with C2 domain specificity, we investigated a panel of 14 human antibodies to fVIII. Immunoblotting analysis localized light chain (C2 domain) epitopes for four cases, heavy chain (A2 domain) epitopes in five cases, while the remaining five cases were both light and heavy chains. The inhibitor titer was considerably higher for Kogenate, a recombinant fVIII concentrate, than for Haemate P, a fVIII/vWf complex concentrate, in all inhibitor plasmas that had C2 domain specificity. In five inhibitor plasmas with A2 domain specificity and in five with both A2 and C2 domain specificities, Kogenate gave titers similar to or lower than those with Haemate P. The inhibitory effect of IgG of each inhibitor plasma was then compared with recombinant fVIII and its complex with vWf. When compared to the other 10 inhibitor IgGs, IgG concentration, which inhibited 50% of fVIII activity (IC50), was remarkably higher for the fVIII/vWf complex than for fVIII in all the inhibitor IgGs that had C2 domain reactivity. Competition of inhibitor IgG and vWf for fVIII binding was observed in an ELISA system. In 10 inhibitors that had C2 domain reactivity, the dose dependent inhibition of fVIII-vWf complex formation was observed, while, in the group of inhibitors with A2 domain specificity, there was no inhibition of the complex formation except one case. We conclude that a subset of fVIII inhibitors, those that bind to C2 domain determinants, are less inhibitory to fVIII when it is complexed with vWf that binds to overlapping region in the C2 domain.

Marked expression of plasma brain natriuretic peptide is a special feature of hypertrophic obstructive cardiomyopathy

OBJECTIVES

We examined whether plasma brain natriuretic peptide levels are abnormally elevated in hypertrophic obstructive cardiomyopathy compared with other cardiac diseases.

BACKGROUND

We previously reported that plasma brain and atrial natriuretic peptide levels were elevated in hypertrophic cardiomyopathy.

METHODS

We compared plasma concentrations of brain and atrial natriuretic peptide and hemodynamic and echocardiographic data in 50 patients with hypertrophic obstructive cardiomyopathy (n = 15, mean [+/-SD] intraventricular pressure gradient 37 +/- 16 mm Hg), hypertrophic nonobstructive cardiomyopathy (n = 15), aortic stenosis (n = 10, mean pressure gradient 41 +/- 18 mm Hg) and hypertensive heart disease (n = 10, mean systolic/diastolic blood pressure 203 +/- 16/108 +/- 11 mm Hg, respectively) and 10 normal subjects.

RESULTS

Plasma brain natriuretic peptide levels were higher in the hypertrophic obstructive cardiomyopathy group (397.1 +/- 167.8 pg/ml*) than in the hypertrophic nonobstructive cardiomyopathy (60.0 +/- 48.1 pg/ml*), hypertensive heart disease (53.9 +/- 31.4 pg/ml*), aortic stenosis (75.4 +/- 54.3 pg/ml*) and normal groups (9.8 +/- 6.4 pg/ml [*p < 0.05 vs. normal group, p < 0.05 vs. hypertrophic obstructive cardiomyopathy group]). Although plasma atrial natriuretic peptide levels were higher in the hypertrophic obstructive cardiomyopathy group than the other patient groups, the brain/atrial natriuretic peptide ratio in the hypertrophic obstructive cardiomyopathy group was higher (4.5 +/- 2.3) than those in the other three patient groups (1.1 to 1.4) and the normal group (0.7 +/- 0.5). Left ventricular end-diastolic pressure and left ventricular end-diastolic volume index were similar among the four patient groups. The interventricular septal thickness and the ratio of interventricular septal thickness to left ventricular posterior wall thickness were similar between the hypertrophic obstructive and nonobstructive cardiomyopathy groups.

CONCLUSIONS

Abnormal elevations of plasma brain natriuretic peptide levels are difficult to explain on the basis of hemodynamic and echocardiographic data and are a special feature of hypertrophic obstructive cardiomyopathy.

[Very rare case of adenoid cystic carcinoma of the hypopharynx]

We experienced a case of adenoid cystic carcinoma (cribriform type) of the hypopharynx treated with radiation followed by total laryngectomy and bilateral radical neck dissection. There have been no reports of adenoid cystic carcinoma of the hypopharynx in the last 30 years. In this case, the primary tumor and lymph node metastases, of the neck responded well to radiation therapy. Residual disease of the primary tumor and lymph node metastases, after a dose delivery of 50 Gy, were removed by radical surgery.

Renal cortical retention of contrast medium after angiography as assessed by delayed CT: a multivariate analysis

Renal cortical retention (RCR) of contrast medium discovered by delayed X-ray examination is sometimes reported in patients with problems in the urinary system. However, we frequently found RCR even in patients with normal renal function. Therefore, we examined the incidence and factors involved in RCR by delayed computed tomography (CT) 12-24 hours after angiography in 168 patients. RCR was found in 80 of 168 cases (48%). Ioxaglate (60%) and iohexol (60%) showed higher incidences of RCR than diatrizoate (37%) and iopamidol (37%). Multivariate logistic regression analysis was performed to determine the predisposing factors of RCR. Dose of administered contrast medium by body weight (p = 0.004), age (p = 0.009), sex (p = 0.013), type of contrast medium (p = 0.003), serum albumin (p = 0.011), and serum creatinine (p = 0.002) were identified as significant and independent predisposing factors of RCR. We suggest that RCR is not a rare phenomenon if delayed CT is carried out.

Side effects of high-dose interferon therapy for chronic hepatitis C

BACKGROUND/AIMS

Various side effects have been reported in patients treated with alpha interferon, but their incidence and prognosis remain unknown.

METHODS

Nine hundred and eighty-seven patients with chronic active hepatitis C received 6 to 10 MU of alpha interferon per day for 2 weeks and 3 times per week for 22 weeks. Autoantibodies, thyroid function tests, and fasting plasma glucose concentrations were evaluated prior to alpha interferon therapy.

RESULTS

Of the 987 patients, 310 were required reduction in the dose of alpha interferon to 3 MU/day or cessation of alpha interferon therapy because of adverse reactions such as flu-like symptoms, leukopenia, and thrombocytopenia. Of the remaining 677, five developed diabetes mellitus, 12 had hyperthyroidism, and six acquired hypothyroidism. Of the 18 with thyroid disorders, five demonstrated antimicrosomal antibodies before therapy. Forty-four patients revealed high or low concentrations of thyroid stimulating hormone at the end of alpha interferon therapy. Three patients developed interstitial pneumonia, one acquired systemic lupus erythematosus-like syndrome, two had autoimmune hepatitis, two developed rheumatoid arthritis, and one developed autoimmune thrombocytopenic purpura. No patients had a history of an autoimmune disorder. One patient experienced sudden hearing impairment and one had retinal detachment. Melena was seen in three patients; two of these cases were compatible with ischemic colitis. Symptoms of depression were seen in 23 patients, and one patient manifested memory loss.

CONCLUSION

High-dose alpha interferon therapy induces various adverse effects. Most of the side effects cannot be predicted, but are reversible.

Circulating HCV-RNA, HCV genotype, and liver histology in asymptomatic individuals reactive for anti-HCV antibody and their follow-up study

The present study was aimed to clarify the virologic status, liver histologies, and the results of follow-up liver tests in symptom-free individuals with anti-HCV antibodies and normal liver tests. Forty-nine individuals with normal liver tests and positive second generation anti-HCV antibody assay were entered into this study. Cases with hepatitis C viremia were evaluated for HCV genotype, amount of circulating HCV-RNA, and liver histology and were followed-up for more than one year. Of the forty-nine individuals, 36 had hepatitis C viremia, indicated by polymerase chain reaction (PCR) assay. Liver histology was as follows: 3 had non-specific changes, 25 had chronic persistent hepatitis (CPH), and 8 had chronic active hepatitis (CAH). Twenty-four cases with CPH and CAH developed an elevated AST and/or ALT concentration (> 30 IU/l) between 12 and 32 months of follow-up. The amount of circulating HCV-RNA ranged from 10(2) to 10(7) copies/50 microliters serum. The distribution of HCV genotypes was nearly the same as that for symptomatic CAH. These data suggest that the histological examination and follow-up examination are very important for following symptom-free individuals with hepatitis C viremia because there are some candidates for interferon therapy among them. There are few individuals who will remain healthy among asymptomatic HCV carriers.

Late local recurrence after radiotherapy for tongue and early glottic carcinoma

BACKGROUND/AIM

Late local recurrence after radiotherapy for tongue and early glottic carcinoma is rarely discussed. In the head and neck cancer, approximately 90% of local recurrence occurred within 2 years after radiotherapy. However, we found that late local recurrence after radiotherapy for glottic cancer was not rare. Our aim was to evaluate the late local recurrence after radiotherapy for early glottic and tongue cancer.

PATIENTS AND METHODS

From 1967 through 1982, 633 patients with tongue carcinoma and 330 patients with early (T1T2N0) glottic carcinomas were treated at the Department of Radiology, Osaka University Hospital. Of these 821 patients, 329 patients with tongue carcinoma and 221 patients with early glottic carcinoma survived at 5 years after radiotherapy without local recurrence. For tongue carcinoma, patients were divided by T category. For early glottic carcinoma, patients were divided by the tumor response at 40 Gy.

RESULTS

Late local recurrence occurred in 23 of 329 patients (7%) with tongue carcinoma, and in 9 of 221 (4%) with early glottic carcinoma. For tongue carcinoma, late recurrence occurred in 19 of 249 patients (8%) in stage I and II, and 4 of 80 patients (5%) in stage III and IV. For glottic carcinoma, late recurrence occurred in 8 of 137 patients (6%) with tumor clearance at 40 Gy and 1 of 63 patients (2%) with tumor persistence at 40 Gy. The incidence of double cancer was also evaluated. Of 329 5-year survivors with tongue carcinoma, 39 patients (12%) had another malignancy, and 26 patients of 221 5-year survivors with early glottic carcinoma (12%) had also another malignancy. Of 39 double primaries of tongue carcinoma, 10 patients (26%) had head and neck malignancies, and none of 26 double primaries of early glottic carcinoma.

CONCLUSION

Late local recurrence was not rare in tongue and early glottic cancer. Poor prognostic group showed lower incidence of late recurrence than good prognostic group. This result suggests that secondary tumor at the same site of primary tumor is late local recurrence.

Focal residual contrast media in the kidney 24 hours after angiography

PURPOSE

To examine the relationship between focal renal cortical retention (FRCR) and contrast-associated nephropathy (CAN).

MATERIAL AND METHODS

We investigated the incidence of both phenomena in 105 patients. CAN was defined as an increase in the creatinine level > 0.3 mg/dl and > 20% on days 1, 3, or 7. We compared predisposing factors for FRCR and CAN. Serum creatinine and blood urea nitrogen (BUN) for renal function were determined on the morning of the day of the angiography. The BUN/creatinine ratio was used as an indicator of the degree of hydration.

RESULTS

FRCR was demonstrated in 17 patients (16%) by delayed CT 24 h after angiography, and CAN was found in 16 patients (15%). No significant relationship between CAN and FRCR was found. We found a correlation between high total volumes of contrast and FRCR. Advanced age, high blood urea nitrogen, high creatinine, and dehydration were risk factors for CAN.

CONCLUSION

Delayed CT showed a higher incidence of injury to the renal parenchyma than previously detected by conventional radiography.