POS0597 PREDICTORS OF PERCEIVED RISK IN FIRST DEGREE RELATIVES OF RHEUMATOID ARTHRITIS PATIENTS

Background

Risk of rheumatoid arthritis (RA) is 3-5 times higher in first-degree relatives (FDRs). Efforts are increasing to develop preventive interventions for this at risk group. Risk perception is a key predictor of health behaviours, including FDRs’ interest in predictive testing1 and preventive intervention for RA. Effective risk communication is essential for RA prevention studies and clinical translation2.

Objectives

To define variables associated with perceived risk of developing RA in FDRs of RA patients.

Methods

RA patients attending outpatient clinics (West Midlands, UK) were asked to invite their FDRs to complete a cross-sectional printed survey. Patients were also invited to complete a survey. Unique survey numbers enabled linkage of FDR and proband responses. FDRs’ perceived absolute risk, comparative risk, experiential risk, and worry about risk were assessed using 5-point Likert scales. Predictor variables included demographics, the Single Item Literacy Screener, Brief Illness Perception Questionnaire, Brief Approach/Avoidance Coping Questionnaire, Life Orientation Test Revised and the Short Health Anxiety Inventory. Patient predictors of FDR perceived risk included demographics, time since RA diagnosis and Rheumatoid Arthritis Impact of Disease Score.

Outcome measure responses were grouped into ‘low’ and ‘high’ for regression analyses. Univariable analysis used independent samples T-tests, chi-square tests and Mann-Whitney U Tests. Backwards stepwise binary logistic regression examined the relationship between FDR characteristics and perceived risk of RA. Generalised Estimating Equations assessed whether patient variables predicted FDR’s perceived risk.

Results

396 FDRs returned a survey. Paired data from 213 patients were available for 292 of these FDRs.

The distributions of risk perception scores are shown in Figure 1. All measures of perceived risk were inter-correlated (p<0.001; ranging from r=0.48 to r=0.80).

65.2% of FDRs perceived themselves to be ‘Likely’ or ‘Very Likely’ to develop RA in their lifetime. FDR’s ethnic group, deprivation index, employment status, education level, smoking status, cohabitation with index patient status, coping style and dispositional optimism were not significantly different between high and low perceived risk groups. Characteristics significant in univariable analyses were used in multivariable analyses (Table 1). Children were 3.89 times more likely than siblings to perceive themselves at high risk of RA. Higher health anxiety scores were associated with increased perceived risk. Female gender, and beliefs that RA would last a long time, and cause higher concern and negative emotional impact predicted increased risk perceptions. Higher perceptions of how well treatment would control RA was associated with a reduced likelihood of perceiving oneself at high risk.

Index patient characteristics did not associate with FDRs’ risk perceptions.

Table 1.

Multivariable analysis

FDR CharacteristicPerceived Risk [Odds Ratio (95% Confidence Interval)]AbsoluteComparativeExperientialWorry about RiskGender1.98 (1.19-3.27)* Male$ FemaleRelationship to index patient2.80 (1.70-4.61)***3.43 (2.04-5.78)***3.89 (2.24-6.75)***2.26 (1.30-3.94)** Child Sibling$Health Literacy1.50 (1.00-2.25)Illness Perceptions0.89 (0.79-0.99)*1.25 (1.05-1.48)*1.17 (0.99-1.38)0.84 (0.74-0.94)** Timeline0.91 (0.81-1.01)0.87 (0.77-0.98)*1.36 (1.13-1.63)** Treatment control1.20 (1.02-1.40)* Concern EmotionHealth Anxiety1.04 (1.01-1.07)*1.05 (1.01-1.07)*1.07 (1.03-1.11)**1.06 (1.02-1.09)**

*p<0.05, **p<0.01, ***p<0.001, $ Reference

Conclusion

FDRs’ perceived risk of RA was high. Key predictors included being a child of a patient with RA, higher health anxiety and lower perceptions of RA treatment control. An understanding of these predictors will inform the development of effective risk communication and preventive strategies.

References

[1]Wells et al. Rheumatology. 2021 doi: 10.1093/rheumatology/keab890

[2]Mankia et al. Ann Rheum Dis. 2021;80(10):1286-98

Acknowledgements

S. Bunnewell and I. Wells are joint first authors.

Disclosure of Interests

None declared

POS1483-HPR A QUANTITATIVE ASSESSMENT OF THE LIKELIHOOD THAT PATIENTS WITH RHEUMATOID ARTHRITIS WILL COMMUNICATE INFORMATION ABOUT RHEUMATOID ARTHRITIS RISK TO RELATIVES

Background:

First-degree relatives (FDRs) of patients with rheumatoid arthritis (RA) are at increased risk of RA and are being recruited to studies of predictive and preventive approaches. Access to FDRs is usually via the proband with RA. Qualitative investigations have shown that communication of RA risk to FDRs is a complex and selective process. However, quantitative data are needed to develop a robust understanding of this process and its determinants to develop effective communication strategies and support for RA patients and their relatives.

Objectives:

To identify predictors of the RA patients’ reported likelihood of communicating RA risk information to their FDRs.

Methods:

Patients with RA were invited to anonymously complete a survey assessing patient characteristics including age, gender, duration of RA, information seeking and decision making preferences (Autonomy Preference Index1), interest in FDRs taking a predictive test for RA, dispositional openness, and the general functioning subscale of the McMaster Family Assessment Device2. Reported likelihood of communicating RA risk to each of the patients’ FDRs was assessed using a Likert scale ranging from extremely unlikely (0) to extremely likely (4). The median score across all FDRs was calculated for each patient. The association between patient characteristics and the median score was examined using univariate approaches.

Results:

Surveys were completed by 482 patients (median age 65 years, 72% female). Most patients reported being likely to communicate RA risk to their FDRs (median score=3). Those who reported their likelihood of communicating RA risk to both children and siblings were more likely to communicate risk to children than siblings (p<0.001). No significant difference was found for FDRs’ gender, or patients’ gender, on reported likelihood to communicate about RA risk (p=0.32 and p=0.87, respectively). Patients who were older and who had had RA for longer were less likely to communicate about RA risk with their relatives. Patients who had higher interest in their FDRs taking a predictive test for RA, information seeking preferences, openness to communicate, and family functioning were more likely to communicate about risk (Table 1).

Table 1.

Descriptive statistics and Spearman’s rank-order correlations for the association between patients’ characteristics and their median reported likelihood of communicating to their FDRs about RA risk

Patient characteristicsDescriptive statisticsAssociation with median likelihood to communicate risk to relativesTest statisticP valueAge; median (IQR)65 (55-72)-0.19<0.001*RA duration; median (IQR)10 (4-20)-0.180.001*Autonomy preferences Information seeking; median (IQR)84 (75-97)0.26<0.001* Decision making; median (IQR)54 (42-67)0.090.048Interest in children taking a test; median (IQR)3 (2-3)0.44<0.001*Interest in siblings taking a test; median (IQR)2 (2-3)0.44<0.001*Openness; median (IQR)2 (1-3)0.130.004*Family functioning; median (IQR)2 (2-3)0.23<0.001*

* p values significant at the Bonferroni adjusted value of 0.006.

Conclusion:

Respondents were willing to communicate RA risk to their FDRs, and were more likely to communicate about risk to their children than their siblings. Factors including information seeking preferences, dispositional openness, interest in FDRs taking a predictive test, and family functioning were associated with increased likelihood of communicating RA risk information to FDRs. Patients’ age and RA duration were associated with decreased likelihood. These findings increase understanding of communication about RA risk in families, and will inform the development of informational approaches to support family communication and access to FDRs.

References:

[1]Ende et al. Journal of General Internal Medicine. 1989; 4(1): 23-30.

[2]Epstein et al. Journal of Marital and Family therapy.1983; 9(2): 171-180.

Acknowledgements:

This work was supported by Versus Arthritis; Grant reference: 21560 and Riksbankens Jubileumsfond (The Swedish Foundation for Humanities and Social Sciences); Grant reference: M13-0260:1 ‘Mind the Risk’.

Disclosure of Interests:

Imogen Wells: None declared, Peter Nightingale: None declared, Gwenda Simons: None declared, Christian Mallen Grant/research support from: Keele School of Medicine have received funding to support BMS recruit to a non-pharmacological atrial fibrillation trial., Karim Raza Grant/research support from: KR reports grants from Abbvie and Pfizer, and personal fees from Abbvie, Pfizer, Sanofi, Lilly, Bristol Myers Squibb, UCB, Janssen, and Roche Chugai, all outside the submitted work., M. Falahee: None declared

OP0264-HPR PERSPECTIVES ON APPROACHES TO PREDICT THE DEVELOPMENT OF RHEUMATOID ARTHRITIS: A QUANTITATIVE ASSESSMENT OF PATIENTS AND THEIR FIRST DEGREE RELATIVES

Background:

There is considerable interest within the medical research community in the identification of individuals at risk of developing rheumatoid arthritis (RA), to identify those who may benefit from preventive interventions. However, it is important to understand the views of those who may be candidates for such predictive tests, to inform the development of effective approaches. First degree relatives (FDRs) of patients with RA are at an increased risk of developing RA. RA patients can provide access to FDRs. Qualitative investigations have explored the views of these groups about predictive testing for RA1,2, but quantitative approaches are needed to develop a robust understanding.

Objectives:

To identify predictors of interest in predictive testing for FDRs and patients, and to assess the likelihood of patients communicating information about RA risk to their FDRs.

Methods:

Surveys were completed by 482 RA patients and 397 of their FDRs. Patients were invited to complete the survey and to provide another to their relatives. Spearman’s Rank Correlations were used to assess relationships between interest in predictive testing/ likelihood of risk communication and potential predictor variables.

Results:

FDRs had a median age of 41 years, 64% were female. 57% were definitely interested and 36% were probably interested in taking a predictive test for RA. Several predictors were found to be associated with interest (table 1).

Table 1.

Spearman’s correlations for relatives’ and patients’ interest in predictive testing. After applying a Bonferonni adjustment, p values were taken as statistically significant at p≤0.003.

FDRsPatientsPredictors of interest in predictive testingrsPrsPBrief Illness Perception Questionnaire0.110.030.090.05 Consequences0.16*0.002*0.100.03 Timeline0.090.07-0.050.28 Personal control-0.030.59-0.020.68 Treatment control-0.020.760.020.74 Identity0.090.090.120.01 Concern0.21*<0.001*0.16*<0.001* Coherence0.110.030.0070.88 Emotional0.120.020.110.02Information Seeking0.35*<0.001*0.22*<0.001*Decision making-0.050.330.070.13Health literacy0.030.520.020.62Health numeracy-0.060.23-0.020.72Brief Avoidance Coping Questionnaire0.120.02-0.010.76Optimism0.060.26-0.070.12Health anxiety0.16*0.001*--Perceived risk0.37*<0.001*--Rheumatoid Arthritis Impact of Disease--0.050.31

– not applicable

Patients had a median age of 65 years, 71% were female. 47% were definitely interested and 30% were probably interested in their children taking a predictive test. Several predictors were found to be associated with interest (table 1). On a Likert scale from extremely unlikely (0) to extremely likely (4), most patients indicated that they were likely to communicate RA risk information to their children (median score=3).

Conclusion:

Interest in predictive testing for RA was high amongst FDRs, and factors including information seeking preference, RA risk perception, concern about RA, perceived consequences of RA and health anxiety were significantly associated with interest. Patients were also willing to communicate information about RA risk to their children. These findings increase understanding of perceptual variation in those at risk of RA, and will inform the development of information to support decision making in individuals considering predictive tests and preventive interventions. We are currently extending this preliminary analysis by building multivariate models incorporating a range of attitudes about predictive testing, assessing predictors of patients’ likelihood of communicating to their FDRs about risk, and the relationship between patients’ and FDRs’ responses.

References:

[1]Stack RJ et al. BMJ open. 2016; 6(6):e010555.

[2]Falahee M et al. Arthritis care & research. 2017; 69(10):1558-65.

Acknowledgments:

This work was supported by Versus Arthritis; Grant reference: 21560.

Disclosure of Interests:

Imogen Wells: None declared, Gwenda Simons: None declared, Rebecca Stack: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Peter Nightingale: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, M. Falahee: None declared

Wireless Sensor Networks for monitoring underwater sediment transport

Monitoring of the coastline and coastal processes, in particular sediment movement, is vital to ensure that erosion response is appropriate given the dynamic nature of coastal systems. This should take place regularly over long periods and it is important that data are collected from submerged portions of the littoral zone, as well as the visible beach. This highlights two limitations in existing coastal monitoring techniques: 1. they require largely manual operation and 2. are limited to the visible beach, which results in an incomplete picture of what is happening in the coastal zone. Due to the current difficulties in gathering data beneath the sea surface, this paper reviews wireless sensor network (WSN) technology as a means to overcome these limitations. Analysis showed that WSNs are a promising technology for coastal monitoring, not only in terms of overcoming limitations, but also in terms of cost, safety, and the size of areas they are able to monitor. Previous work using WSNs in this environment is somewhat limited, especially as most current methods are largely limited to the visible beach, and do not consider submerged areas of the coastal zone. From consideration of the physical environment, geological and geographical processes, and informed by advances in technology, research gaps are identified, discussed and evaluated to provide strategies for implementation of WSNs to monitor sediment transport.

Snore site discrimination using statistical moments of free field snoring sounds recorded during sleep nasendoscopy

The non-invasive measurement of free field snoring sounds to estimate the site of snoring is an important development in the diagnosis, treatment and management of sleep-related breathing disorders. We investigated characteristics of the probability density function by testing the sensitivity of the statistical moments to amplitude patterns in the snoring acoustic signal. Snoring sounds from 15 patients were recorded whilst performing sleep (under anaesthetic) nasendoscopy evaluation. We demonstrated, using a fuzzy 2-means clustering method, that a combination of the statistical dimensionless moment coefficients of skewness and kurtosis could discriminate between pure palatal and non-palatal snoring subject groups.

Clinical content detection for medical image retrieval

Content-based image retrieval (CBIR) is the most widely used method for searching large-scale medical image collections; however this approach is not suitable for high-level applications as human experts are accustomed to manage medical images based on their clinical features rather than primitive features. Automatic detection of clinical features in a large-scale image database and realization of image retrieval by clinical content are still open issues. This paper presents a Markov random field (MRF) based model for clinical content detection. Multiple classifiers are applied to recognize a wide range of clinical features in a large-scale histological image database, and they are further combined to generate more reliable and robust estimation. Spatial contexts will cooperate with local estimations in the MRF based model to make a decision based on global consistency. The detected clinical features will provide a basis for image retrieval. Experiments have been carried out in a large-scale histological image database with promising results.

Endovascular embolization of varicoceles: resorption of tungsten coils in the spermatic vein

PURPOSE

To investigate whether resorption of tungsten coils occurs in patients with varicoceles treated by endovascular embolization of the spermatic vein.

METHODS

Patients who had previously had varicocele embolization were requested by letter to attend the radiology department. Blood levels of tungsten were compared with a group of controls. Fluoroscopic images of the coils were taken and compared with those obtained during the original procedures.

RESULTS

Nineteen patients attended, whose procedure had been done 19-57 months previously (mean 40 months). Blood levels of tungsten were raised in 18 patients compared with the controls. Radiographic evidence of loss of substance of the coils was seen in four patients.

CONCLUSION

Tungsten coil resorption occurs in varicocele embolization. In view of the unknown long-term effects of raised blood tungsten levels and the availability of alternative embolization agents, we feel that it is unwise to persist in the use of tungsten coils in this application.

Computerized strain-gauge plethysmography - An alternative method for the detection of lower limb deep venous thrombosis?

AIM

To test the ability of computerized strain-gauge plethysmography to act as a screening test for lower limb deep venous thrombosis (DVT).

MATERIALS AND METHODS

Over an 8-month period, all patients referred to our Medical Assessment Unit with suspected lower limb DVT were considered for inclusion in the study. Each patient underwent both plethysmography and ascending venography within 24 h, and the presence or absence of thrombus in the popliteal, superficial femoral or iliac veins was noted. The results of the two tests were then used to determine the accuracy of computerized strain-gauge plethysmography in detecting above knee DVT.

RESULTS

The screening tests and venograms of 239 patients referred with clinically suspected lower limb DVT were compared. The false negative rate of plethysmography was 15.4%, which is significantly different from the 4.8% claimed by the manufacturers of this device (P = 0.00003).

CONCLUSIONS

In a population of acute admissions with suspected lower limb DVT, computerized strain-gauge plethysmography is not suitable for use as a screening test due to an unacceptably high proportion of false negative screens.

Inactivation of prostaglandin endoperoxide synthase by acylating derivatives of indomethacin

Derivatives of the potent antiinflammatory agent and cyclooxygenase inhibitor indomethacin were synthesized in which the carboxylic acid moiety was converted into reactive acylating agents. Indomethacin imidazole (indomethacin-IM) and indomethacin N-hydroxysuccinimide (indomethacin-NHS) inactivated both the cyclooxygenase and peroxidase activities when incubated with the apo form of purified prostaglandin endoperoxide synthase (PGH synthase) at a stoichiometry of 1:1. Treatment of the inactivated enzyme with hydroxylamine at neutral pH led to recovery of all peroxidase and about 50% of the cyclooxygenase activity. Hydroxylamine did not regenerate the cyclooxygenase activity of indomethacin-inactivated protein. Reconstitution of the apoprotein with heme protected against inactivation by indomethacin-NHS. Visible spectroscopy established that indomethacin-NHS-inactivated apoenzyme had a reduced capacity to bind heme. Indomethacin-NHS also substantially protected the apoenzyme from cleavage at the trypsin-sensitive Arg277 site. Incubation of [2-14C]indomethacin-NHS with PGH synthase led to incorporation of radioactivity into the protein, but no adduct was detected by reversed-phase HPLC, suggesting it was unstable to the chromatographic conditions. Incubation of indomethacin-NHS with apoprotein followed by HPLC analysis led to the formation of greater amounts of the hydrolysis product indomethacin than did similar treatment of holoprotein. The results suggest that indomethacin-IM and indomethacin-NHS covalently and selectively label PGH synthase near the heme binding site, leading to loss of both catalytic activities of the enzyme.

Acetylation of prostaglandin endoperoxide synthase by N-acetylimidazole: comparison to acetylation by aspirin

Treatment of prostaglandin endoperoxide (PGH) synthase apoprotein with a 100- or 1000-fold excess of N-acetylimidazole (NAI) led to time-dependent inactivation of both cyclooxygenase and peroxide activities. Reconstitution of apoprotein with heme prior to incubation with NAI substantially protected the enzyme from inactivation. Pretreatment of the protein with either acetylsalicylic acid (aspirin) or (+/-)-2-fluoro-alpha-methyl-4-biphenylacetic acid (flurbiprofen), which inhibit cyclooxygenase activity, did not alter the time course of peroxidase inactivation by NAI. Treatment of NAI-inactivated apoPGH synthase with hydroxylamine led to substantial regeneration of both cyclooxygenase and peroxidase activities. Quantitation of radioactivity following incubation of PGH synthase with [3H-acetyl]NAI indicated incorporation of 1.7 +/- 0.9 acetyl groups/70-kDa subunit. Cleavage of acetylated protein with trypsin under nondenaturing conditions followed by high-performance liquid chromatography analysis demonstrated that most of the radioactivity was incorporated into the 33-kDa fragment although significant radioactivity was also detectable in the 38-kDa fragment. Chymotryptic peptide mapping of acetylated protein revealed numerous potential sites of acetylation distributed in widely divergent regions of the protein. No apparent differences were observed between the chymotryptic maps of apo- and holoenzyme, suggesting that the adduct responsible for loss of catalytic activity is unstable to the chromatographic conditions. The different biochemical properties of PGH synthase acetylated by NAI or aspirin suggest that a major determinant of the specificity of aspirin for Ser530 is binding of the salicylate moiety to this region of the PGH synthase protein.

Plasma thyroid hormones, thyroid stimulating hormone, and insulin during acute hypometabolic states in man

Acute behavioral rest states in man are associated with marked hormonal and metabolic changes. In order to complete a hormonal profile of these states and to identify possible metabolic regulators, we measured thyroid hormones (T3 and T4), thyroid stimulating hormone (TSH), and insulin during the stylized mental practice of "transcendental mediation" (TM) and during ordinary unstylized eyes closed rest. Except for TSH, which declined acutely, hormone levels were normal and stable throughout the experiment. The stability of T3 and T4, and insulin make it unlikely that these hormones regulate the acute metabolic changes associated with these behavioral states. Decreased TSH, along with stable thyroid hormone levels, may suggest change of the set point for feedback control of TSH secretion during TM and is consistent with primarily neural modulation of TSH secretion by this behavior.

Renal carcinoma: duplex Doppler evaluation

Doppler ultrasound has a clearly defined role in the assessment of carotid and peripheral vascular disease. In these situations vessel pathology produces alterations in velocity and volume flow and in the flow-velocity spectrum. Flow in the renal arteries is affected not only by disease of the renal vessels but also by the peripheral resistance to flow within the kidney. Alterations in this peripheral resistance resulting from renal disease are reflected in the Doppler flow spectrum analysis. In 14 patients with renal carcinoma, three different blood flow patterns were observed, reflecting the differing vascularity of the renal tumours. These were compared with blood flow in normal kidneys and in kidneys containing renal cysts. Doppler ultrasound adds further information to the study of renal carcinomas, allowing the prediction of tumour vascularity, and may be useful as a preliminary investigation prior to angiography and embolisation.

Association of IgE antibodies to sodium aurothiomalate and adverse reactions to chrysotherapy for rheumatoid arthritis

The relationship between adverse reactions to chrysotherapy and specific IgE antibodies to sodium aurothiomalate (auIgE) was studied in 67 patients with rheumatoid arthritis (62) or psoriatic arthritis (5). Thirty patients (45 percent) had such antibodies versus none of the 27 control patients. Of the 34 patients in whom reactions to chrysotherapy developed, 23 (68 percent) had auIgE versus 7 (21 percent) without reactions (p less than 0.001). Mucocutaneous lesions were significantly associated with auIgE (p less than 0.001). All five patients with thrombocytopenia, but only one of five with the nephrotic syndrome, had auIgE. The patients with IgE response had higher total serum IgE levels (p less than 0.005), were more likely to be atopic (four to one), and had more recently received chrysotherapy (mean 2.8 +/- 1.95 years versus 7.0 +/- 5.75 years, p less than 0.001) than those without response, but did not differ by either the gold product or the total dose used. Chrysotherapy is associated with the production of specific IgE antibodies to a gold salt, and some mucocutaneous and hematologic reactions may be immunologically mediated.

Incidence of fungal precipitins in patients treated with beclomethasone dipropionate aerosol

The authors followed the development of serum precipitins to aspergillus and Candida albicans in 14 asthmatic patients placed on beclomethasone dipropionate inhalation at a mean duration of five months. Three sera positive for aspergillus precipitins became negative during treatment. One patient had clinical oropharyngeal candidiasis and another patient's serum became positive for candida precipitin. The authors conclude that the incidence of oropharyngeal candidiasis and candida or aspergillus precipitins are rare among patients treated with beclomethasone.

Increased C1q binding and arthritis in primary biliary cirrhosis

Using the C1q binding assay, circulating immune complexes were detected in 31 of 50 (62%) patients with primary biliary cirrhosis and 17 of these had arthritis. This took the form of a seropositive inflammatory polyarthritis in 12 of 18 patients with C1q binding greater than or equal to 20%, whereas a milder seronegative arthritis associated with scleroderma and Raynaud's phenomenon was found in five of 13 patients with C1q binding < 20%. Only two of the 19 patients with normal binding had arthritis and this was of a mild and transient nature. There was a positive correlation between C1q binding and the serum concentrations of IgG and IgM. Results also supported the hypothesis that circulating immune complexes may be involved in the development of arthritis in patients with primary biliary cirrhosis.

The effect of endotoxin on the mast cell c'AMP system

To determine whether the endotoxin induced release of histamine is mediated via the mast cell c'AMP system, hamster mast cells were isolated and incubated (prior to endotoxin-serum stimulates (ET-S) with disodium cromoglycate, isoproterenol and aminophylline. All drugs caused significant inhibition of the ET-S histamine release. The authors conclude that ET-S utilizes the c'AMP system to release histamine.

Bronchocentric granulomatosis: a complication of allergic bronchopulmonary aspergillosis

Hypersensitivity to the fungal antigens of Aspergillus fumigatus may result in a spectrum of immune injury collectively known as allergic bronchopulmonary aspergillosis (ABPA). This report describes a 14-yr-old boy who presented clinical findings consistent with ABPA,including a history of asthma, blood eosinophilia, serum precipitins, and IgE antibodies to Aspergillus fumigatus. Sputum Aspergillus, pulmonary infiltrates, and dual types I and III skin reactions to Aspergillus fumigatus were observed also. Pathology of the resected right upper lobe revealed severe bronchial destruction with the findings of bronchocentric granulomatosis. Noninvasive septate fungal hyphae compatible with Aspergillus were identified. Cultures from sputum and surgical specimens grew Aspergillus and Mycobacterium intracellulare avium. The PPD-B (purified protein derivative-Batty) intradermal skin test produced a 6 mm induration (PPD-S was negative). The patient's condition has been well controlled with prednisone and several antituberculous drugs. In addition, inflammatory and immunologic parameters have begun to return to normal. The relationship between ABa and the atypical mycobacterial infection is not clear. The association of ABPA with the severe bronchial destruction seen in bronchocentric granulomatosis is emphasized to alert physicans to this serious sequelae of ABa seen in the asthmatic.

Aryl-hydrocarbon hydroxylase activity in lymphocytes from lung cancer patients and normal controls

A radiometric assay for the determination of AHH activity in lymphocytes is described. Subjects included eleven male patients with histologically verified lung cancer (nine squamous cell carcinoma and two adenocarcinoma) and eleven age- and sex-matched controls. Lung cancer patients exhibited considerably greater variation and elevated levels of both AHH activity per se and AHH activity adjusted for total cellular DNA than control individuals. Methodology for AHH determinations and implications for lung cancer epidemiology and control are discussed.