Influence of using history of immune checkpoint inhibitor therapy for neutropenia caused by combination therapy of ramucirumab and docetaxel

Recently, pretreatment with immune checkpoint inhibitors (ICIs) has been shown to enhance the therapeutic effects of the combination therapy of ramucirumab (RAM) and docetaxel (DTX); however, its influence on the drug's side effects remains unclear. This study investigated the influence of pretreatment with ICIs on the incidence of neutropenia caused by RAM + DTX therapy in patients with non-small cell lung cancer (NSCLC). Patients with NSCLC who received RAM + DTX therapy at Gifu Prefectural General Medical Center between April 2016 and December 2020 were enrolled. Retrospective data regarding age, sex, performance status and detailed treatment history, among others, at treatment initiation were collected from the patients' electronic medical records. Additionally, data on the course number of RAM + DTX therapy, supportive therapy and blood biochemical parameters, including leukocyte and neutrocyte counts, during the treatment period were collected. We identified 41 patients receiving RAM + DTX therapy. Among the more than grade 3 adverse events caused by this therapy, neutropenia was the most common (78.1%). Despite the fact that all previous risk factors influencing this incidence rate had corresponded, the only factor influencing the incidence rate of neutropenia more than grade 3 was ICI treatment history. A difference in the incidence of neutropenia more than grade 3 in the Kaplan-Meier curve was observed between patients with and without ICI pretreatment history (p = 0.037). The pretreatment history of ICI therapy affects the incidence of neutropenia caused by RAM + DTX therapy in patients with NSCLC.

Dermal mast cells reduce progressive tissue necrosis caused by subcutaneous infection with Streptococcus pyogenes in mice

A single subcutaneous (s.c.) infection with 1×10(7) c.f.u. GAS472, a group A streptococcus (GAS) serotype M1 strain isolated from the blood of a patient suffering from streptococcal toxic shock syndrome, led to severe damage of striated muscle layers in the feet of mast cell (MC)-deficient WBB6F(1)-Kit(W)/Kit(W-v) (W/W(v)) mice 72 h after infection. In contrast, no damage was recognized in striated muscle layers in the feet of the control WBB6F(1)-Kit(+/+) (+/+) mice 72 h after infection. In addition, adoptively transferred MCs reduced progressive tissue necrosis of the feet of W/W(v) mice after infection. However, there was no significant difference in the mortality rates between the W/W(v) and +/+ mice, or between the human CD46-expressing transgenic (Tg) mouse bone marrow-derived cultured MC-reconstituted W/W(v) and non-Tg mouse bone marrow-derived cultured MC-reconstituted W/W(v) mice after infection. Consequently, although MCs can help to reduce the severity of necrosis of the feet caused by s.c. infection with GAS472, such reduction of tissue necrosis scarcely improves the mortality rates of these mice. Moreover, human CD46 does not play a crucial role in the MC-mediated innate immune defence against GAS infection.

Use of the QuantiFERON-TB Gold test for screening tuberculosis contacts and predicting active disease

OBJECTIVE

To evaluate the performance of the QuantiFERON(R)-TB Gold (QFT-G) test for screening tuberculosis (TB) contacts and estimating their risk of progressing to active TB disease.

METHODS

Data on clinical progression to active disease were collected from public health centres 2 years after close contacts of TB cases had been QFT-G-tested.

RESULTS

Among 3102 contacts observed, 419 were QFT-G-positive, and isoniazid (INH) treatment was initiated in 323. Twenty (4.8%) of these 419 developed TB disease. Among 2683 QFT-G-negative persons, 19 were diagnosed with TB (0.7%) during the average follow-up period of 1.6 years. The estimated sensitivity of QFT-G in detecting contacts who would progress to active TB was 51%, or 64% allowing for the effects of INH treatment. Among the QFT-G-negative contacts, all those who developed TB disease were contacts of highly infectious cases. Large-scale tuberculin skin testing was not available.

CONCLUSIONS

TB incidence among QFT-G-positive contacts was higher than among QFT-G-negative contacts, but the number of TB cases among QFT-G-negative contacts is non-negligible, especially among contacts of highly infectious cases.

Microcirculatory alteration in low-grade gastric mucosa-associated lymphoma by Helicobacter heilmannii infection: its relation to vascular endothelial growth factor and cyclooxygenase-2

BACKGROUND

There are clinical reports that Helicobacter heilmannii, as well as Helicobacter pylori, has been clinically reported to cause gastric low-grade mucosa-associated lymphoid tissue-type (MALT) lymphoma, although its precise mechanism remains to be clarified. Thus, the present study was undertaken to elucidate the alteration of the microcirculatory structure and the relation to angiogenetic factors in mice infected with H. heilmannii for 3 and 6 months.

METHODS

Immunohistochemical studies have been performed by FITC-dextran intra-aortic infusion or CD31, vascular endothelial growth factor-A, cyclooxygenase 2 antibodies using our recently established model of gastric mucosa-associated lymphoid tissue-type gastric B-cell lymphoma in C57BL/6 mice.

RESULTS

Increased microcirculatory network was recognized surrounding the MALT lymphoma tissues by both the FITC-dextran infusion method and CD31 immunoreactivity. Vascular endothelial growth factor-A immunoreactivity was recognized within the lymphoma tissues as well as in the marginal area, while cyclooxygenase-2 immunoreactivity was localized in the area surrounding the MALT lymphoma tissues.

CONCLUSION

Increased microvascular network as well as enhanced VEGF-A immunoreactivity was shown to be related to expansion of the MALT lymphoma formed by Helicobacter heilmannii infection.

Comparative efficacies of different antibiotic treatments to eradicate nontypeable Haemophilus influenzae infection

Background

Nonencapsulated and nontypeable Haemophilus influenzae (NTHi) is a major cause of human respiratory tract infections. Some strains of NTHi can cause invasive diseases such as septicemia and meningitis, even if H. influenzae is not generally considered to be an intracellular pathogen. There have been very few reports about the therapeutic efficacy of antibiotics against respiratory tract infection caused by NTHi in mice because it is difficult for H. influenzae to infect mice. Therefore, we evaluated the efficacy of antibiotics against NTHi in both a cell culture model and a mouse model of infection.

Methods

We used six strains of NTHi isolated from adult patients with chronic otitis media, namely three β-lactamase-negative ampicillin (AMP)-resistant (BLNAR) strains and three β-lactamase-negative AMP-susceptible (BLNAS) strains, to evaluate the efficacy of AMP, cefcapene (CFPN), levofloxacin (LVX), clarithromycin (CLR), and azithromycin (AZM) in both a cell culture infection model and a mouse infection model. In the cell culture infection model, strains that invade A549 human alveolar epithelial cells were treated with each antibiotic (1 μg/ml). In the mouse infection model, female C57BL/6 mice were intraperitoneally injected with cyclophosphamide (200 mg/kg) three days before intranasal infection with 1 × 10⁹ colony-forming units (CFU) of NTHi and on the day of infection. After infection, the mice were orally administered each antibiotic three times daily for three days, except for AZM, which was administered once daily for three days, at a dose of 100 mg/kg/day.

Results

In the cell culture infection model, it was found that two BLNAR strains were able to enter the cell monolayers by the process of macropinocytosis, and treatment with LVX yielded good bactericidal activity against both strains inside the cells. In the mouse infection model, no bacteria were detected by means of plating the lung homogenates of LVX-treated mice at day 4 after infection, while more than 10⁵ CFU of bacteria per tissue sample were detected in nontreated mice.

Conclusion

Our findings show the outcome and rich benefits of fluoroquinolone treatment of respiratory infections caused by either invasive or noninvasive BLNAR strains of NTHi.

Waning of the specific interferon-gamma response after years of tuberculosis infection

HYPOTHESIS

Memory T-cell responses to specific antigens wane over time in subjects with tuberculosis (TB) infection.

SETTING

Accumulated evidence indicates that QuantiFERON-TB Gold (QFT-G), a specific whole-blood interferon-gamma (IFN-gamma) based assay, can detect recent TB infections with superior sensitivity and specificity.

OBJECTIVE

We applied this technique to the adult population of a Japanese community to determine its epidemiological usefulness.

METHOD

A total of 1559 subjects attending periodic health screening volunteered to participate in the study.

RESULTS

The QFT-G positive rates were 3.1% for those aged 40-49 years, 5.9% for those aged 50-59 and 9.8% for those aged 60-69. The expected infection prevalence estimated by the authors from a series of studies was 11.1%, 29.6% and 53.1% for those aged 40-49, 50-59 and 60-69 years, respectively. This wide gap between the expected and observed positivity suggests that the IFN-gamma response waned substantially with time after infection. Those with X-rays suggestive of old TB lesions exhibited positivity rates well below 100%.

CONCLUSION

The specific IFN-gamma response may wane considerably with time after infection. Longitudinal studies are required to investigate long-term dynamics of cell-mediated immunity in infected donors.

ExpressedSalmonellaantigens within macrophages enhance the proliferation of CD4+and CD8+T lymphocytes by means of bystander dendritic cells

ATP-dependent Lon protease-deficient Salmonella enterica serovar Typhimurium (strain CS2022) appeared to invade successfully the mesenteric lymph nodes (MLN) and Peyer's patches (PP) of BALB/c mice and appeared to be easily eradicated by the host after oral immunization. As detected by flow cytometry, the population of major histocompatibility complex class I (MHC-I)-expressing macrophages and dendritic cells (DCs) was increased in the PP of mice immunized with CS2022 on day 6 after immunization. Thereafter, the population of splenic surface CD69(+) T lymphocytes prepared from mice immunized with CS2022 6 weeks prior to measurement increased as a result of the administration of the extracellular vesicles of RAW264.7 macrophage-like cells derived by Salmonella challenge. In addition, the proliferation of CD8(+) and even of CD4(+)T cells isolated from mouse spleens immunized with CS2022 was enhanced after cocultivation with naive DCs in the presence of the extracellular vesicles. These findings indicate that the extracellular vesicles prepared from the Salmonella-challenged macrophages carried salmonellae antigens to bystander DCs, thereby stimulating T-cell responses. Therefore, as antigen presentation after phagocytosis should be a central process in the T-cell activation that occurs in response to Salmonella infection, an oral immunization with CS2022 sufficiently induces T cell-mediated immunity in mice.

An oralSalmonellavaccine promotes the down-regulation of cell surface Toll-like receptor 4 (TLR4) and TLR2 expression in mice

A single oral immunization with the Lon-protease-deficient Salmonella enterica serovar Typhimurium (strain CS2022) induced protective immunity in mice against a subcutaneous challenge with virulent Listeria monocytogenes as well as virulent Salmonella serovar Typhimurium. The populations of cell surface Toll-like receptor 4 (TLR4) and TLR2 on peritoneal macrophages decreased at week 6 after immunization. This population decrease was not reversed after a challenge with either Salmonella or Listeria. These results suggest that oral immunization with CS2022 induced immune tolerance correlated with the down-regulation of cell surface TLR expression. This down-regulation may in part account for the development of cross-protection against a Listeria challenge by immunization with CS2022.

Use of QuantiFERON-TB Gold to investigate tuberculosis contacts in a high school

BACKGROUND AND OBJECTIVE

QuantiFERON-TB Gold (QFT-G) was employed in a contact investigation in a high school to evaluate its performance in adolescents.

METHODS

Students of the same school grade as the index case were screened with tuberculin skin test (TST) and CXR examination as an initial contact investigation. QFT-G was performed for students demonstrating a positive TST (erythema larger than 30 mm).

RESULTS

Of 349 students whose TST was completed, 95 had positive TST responses, although the distribution of TST responses was similar for both high and low exposure groups. In contrast, only four of the 88 TST-positive students tested with QFT-G were positive by this test, and three of these were from the high exposure group. Chemoprophylaxis was provided to only those four QFT-G-positive students. Follow up of the 91 students who were TST-positive, but QFT-G-negative (or not tested), for more than 3.5 years revealed that none have developed active tuberculosis.

CONCLUSIONS

QFT-G appears more specific than TST as contacts with positive TST and negative QFT-G responses were not offered prophylaxis and none developed tuberculosis during 3.5 years of follow up. The replacement of TST with QFT-G, or perhaps combined use of TST and QFT-G, may be more useful in diagnosing true infection and thus reducing the number of subjects indicated for chemoprophylaxis.

"Candidatus Helicobacter heilmannii" from a cynomolgus monkey induces gastric mucosa-associated lymphoid tissue lymphomas in C57BL/6 mice

Both Helicobacter pylori and "Candidatus Helicobacter heilmannii" infections are associated with peptic ulcers, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphomas. However, good animal models of H. pylori clinical diseases are rare. In this study, we aimed to establish an animal model of "Candidatus Helicobacter heilmannii" gastric MALT lymphoma. We used a urease-positive gastric mucosal and mucus homogenate from a cynomolgus monkey maintained in C57BL/6 mouse stomachs. The bacterium in the homogenate was identified as "Candidatus Helicobacter heilmannii" based on a DNA sequence analysis of the 16S rRNA and urease genes. Mucosal and mucus homogenates were used to inoculate C57BL/6 mice, which were then examined for 24 months. We observed a gradual increase in the surface area of protrusive lesions in almost all infected C57BL/6 mouse fundic stomachs 6 months after infection. Light microscopic observations revealed an accumulation of B lymphocytes along with destruction of glandular elements and the presence of lymphoepithelial lesions consistent with low-grade MALT lymphomas. Electron microscopic observation revealed numerous "Candidatus Helicobacter heilmannii" bacilli in the fundic glandular lumen, the intracellular canaliculi, and the cytoplasm of intact cells, as well as damaged parietal cells. In conclusion, "Candidatus Helicobacter heilmannii" induced gastric MALT lymphomas in almost 100% of infected C57BL/6 mice after a 6-month period associated with the destruction of parietal cells.

Screening for tuberculosis infection using whole-blood interferon-gamma and Mantoux testing among Japanese healthcare workers

OBJECTIVE

To examine the hypothesis that results of the QuantiFERON-TB Gold assay (QFT-G), a whole-blood test for detection of tuberculosis infection, are more significantly related to known risk factors for tuberculosis infection in healthcare workers (HCWs) who have received bacille Calmette-Guerin vaccine than are results of the Mantoux tuberculin skin test (TST).

DESIGN

All HCWs (approximately 510) from a 370-bed general hospital in Tokyo where patients with and patients without tuberculosis are treated were invited to participate in the study. All study participants completed a questionnaire about their Mycobacterium tuberculosis infection risk factors as HCWs at the general hospital. They were then tested for LTBI by means of the QFT-G, followed by the TST. Statistical analyses were performed to compare results of each test with M. tuberculosis infection risk factors (age, length of employment in the healthcare industry, history of working with tuberculosis-positive patients in a tuberculosis ward or in the outpatient department of the hospital's tuberculosis clinic for more than 1 year, chest radiograph evidence of healed tuberculosis, history of performing bronchoscope procedures, and job classification), and for TST-positive HCWs, to compare the QFT-G result with the TST induration diameter.

RESULTS

A total of 332 HCWs (95% of whom had been vaccinated with BCG) participated in the study, and 33 had positive QFT-G results, suggesting a prevalence of LTBI of 9.9%. Of 304 HCWs who underwent TST, 283 (93.1%) had an induration diameter of 10 mm or more. Multiple logistic regression analysis revealed that positive QFT-G results were significantly associated with age and with a history of working in a tuberculosis ward or an outpatient department of a tuberculosis clinic. TST results were not correlated with any of the tuberculosis infection risk factors we evaluated.

CONCLUSIONS

Positive QFT-G results were closely associated with the presence of risk factors for LTBI in a hospital setting, suggesting that the QFT-G can detect LTBI in a population composed predominantly of BCG vaccinees. Because most HCWs worldwide have been vaccinated with BCG, the QFT-G offers a significant improvement over the TST in tuberculosis screening programs and minimizes unwarranted use of tuberculosis prophylaxis.

Evaluation of the Lon-deficient Salmonella strain as an oral vaccine candidate

We evaluated the efficacy of CS2022 (the Lon protease-deficient mutant strain of Salmonella enterica serovar Typhimurium) as a candidate live oral vaccine strain against subsequent oral challenge with a virulent strain administered to BALB/c and C57BL/6 mice. CS2022 persistently resided in the spleen, mesenteric lymph nodes, Peyer's patches, and cecum of both strains of mice after a single oral inoculation with 1 x 10(8) colony-forming units. Finally, CS2022 almost disappeared from each tissue sample by week 12 in BALB/c mice, whereas CS2022 still resided in each tissue type at week 12 after inoculation of C57BL/6 mice. A significant increase in the serovar Typhimurium lipopolysaccharide-specific secretory immunoglobulin A (s-IgA), as measured for one of the mucosal immune responses, was detected in bile and intestinal samples of both strains of immunized mice at week 4 after immunization. In addition, the expression of gamma interferon mRNA in the spleens of both strains of immunized mice, especially those of C57BL/6 mice, was significantly increased at week 4 after immunization and was boosted during the following 5 days after the challenge was administered to the mice. Furthermore, peritoneal macrophages isolated from immunized mice at week 4 after immunization exhibited an increase in intracellular killing activity against both virulent and avirulent Salmonella. The present results suggested that salmonellae-specific s-IgA on the mucosal surfaces induced by immunization with CS2022 generally prevented mice from succumbing to an oral challenge with a virulent strain. Simultaneously, CS2022 promoted the protective immunity associated with macrophages in both strains of mice.

[Detection of tuberculosis infection using a whole blood interferon gamma assay in a contact investigation--evaluation using quantiFERon TB-2G]

OBJECTIVE

The purpose of this study was to evaluate the usefulness of a novel method of detecting tuberculosis infection, QuantiFERON TB-2G (QFT), in a large scale contact investigation when an outbreak of mass tuberculosis infection was suspected.

SUBJECTS AND METHODS

The index case was a health-care worker who worked in a maternity hospital. The investigated contacts were categorized as follow according to the grade of closeness of contact; the "very close" contact group (11 subjects), the "close" contact group (33 subjects), and the "non-close" contact group (3,791 subjects). For the former two groups, tuberculin skin test (TST), chest X-ray examination and QFT were conducted. For the last contact group, TST and chest X-ray examination were conducted only to subjects who aged less than 29 years old, while only chest X-ray examination was conducted to those aged 30 years or older. The QFT test, i.e., a whole blood interferon-gamma assay using Mycobacterium tuberculosis-specific antigens, was performed to the "very close" and "close" contacts, and for strong tuberculin reactors among the "non-close" contacts.

RESULTS

The number of infected subjects in the "very close" contact group, the "close" contact group, and the "non-close" contact group were 7, 7, and 277, respectively, based on TST results. On the other hand, the number of infected subjects in each group were 3, 2, and 5, respectively, based on the QFT test.

CONCLUSION

If the indication of chemoprophylaxis was determined based on TST test, this case would have been regarded a large tuberculosis outbreak. However, the use of the QFT test greatly reduced the number of the infected persons, so that the possibility of such massive TB outbreak was denied. Thus, the use of QFT, with which TB infection could be detected more accurately, seems to be very beneficial in contact investigations.

[Basic characteristics of a novel diagnostic method (QuantiFERON TB-2G) for latent tuberculosis infection with the use of Mycobacterium tuberculosis-specific antigens, ESAT-6 and CFP-10]

PURPOSES

To determine the optimum cut-off level of a newly developed method for diagnosing tuberculosis infection based on whole-blood interferon-gamma measurement, and to study the basic characteristics of the method.

STUDY SUBJECTS

1) A total of 220 young, healthy individuals having no apparent exposure to tuberculosis infection, most of whom have had a vaccination with BCG vaccine. 2) One hundred eighteen tuberculosis patients who were diagnosed by positive Mycobacterium tuberculosis on culture. 3) A group of 75 youngsters exposed to an infectious tuberculosis patient and who showed a strong tuberculin reaction (with erythema diameter of 30 mm or more).

METHOD

Whole-blood specimens of donors were stimulated with antigens, i.e., ESAT-6 and CFP-10, and then cultured. Plasma concentrations of interferon-gamma discharged were then determined with QuantiFERON-CMI. Correlation between interferon-gamma concentrations in response to ESAT-6 and CFP-10, and their correlation with Mantoux test results were analyzed for various categories of donors. The Receiver Operating Characteristics analysis was performed considering the loss due to misclassification. [

RESULTS AND DISCUSSION

The optimum cut-off level was determined as 0.35 IU/ml for both ESAT-6 and CFP-10. This gave the test a sensitivity of 89.0% and specificity of 98.1% in detecting tuberculosis infection. The correlation of interferon-gamma response with tuberculin tests among BCG-vaccinated individuals was low, which suggested that the test was not influenced by previous BCG vaccination. The low correlation between ESAT-6 and CFP-10 tests suggested that the simultaneous use of the two tests was beneficial. As in the case of clinical tests in general, the cut-off should be set at a lower level when the test is applied to high prevalence situation and vice versa.

[Usefulness of a novel diagnostic method of tuberculosis infection, QuantiFERON TB-2G, in an outbreak of tuberculosis]

OBJECTIVE

The purpose of this study was to evaluate QuantiFERON TB-2G (QFT), a novel method of detecting tuberculosis infection among contacts of a tuberculosis patient by determining the whole-blood interferongamma response to the specific antigens.

SUBJECTS AND METHODS

A teacher of a college who had been coughing for the preceding two months was diagnosed with smear-positive tuberculosis. About 270 students of the college were considered to have been exposed to tuberculosis infection, of whom 73 were in closer contact with the index case because they participated in a one-week group excursion attended by the teacher. Two of the contact students developed active tuberculosis shortly thereafter. Tuberculin tests were conducted to almost all students, and QFT was performed for only those with tuberculin reactions having erythema diameters of 30 mm or larger.

RESULTS

Tuberculin tests of students, all of whom had been vaccinated with BCG at least once, revealed that the distribution of the close contact group was slightly shifted to right (larger side) than those with less close contacts. The QFT positive rate for close contacts was 45.5%, while that for less close contacts was only 7.1%, which obviously indicates that QFT is hardly affected by the tuberculin allergy due to past BCG vaccination. The distribution of interferon-gamma measurements (log-transformed) of the close contacts showed typical bimodality, one mode representing the infected, another the non-infected. This was not clear for the less close contacts. The correlation of interferon-gamma measurements (log-transformed) with tuberculin reaction erythema size was weak, if not non-significant.

CONCLUSION

It was concluded that QFT was a useful method for diagnosing tuberculosis infection and was unaffected by the BCG-caused tuberculin allergy. In the case of the outbreak mentioned above, QFT greatly reduced the indication of chemoprophylaxis, from 28% of all the contacts solely based on tuberculin test to only 7%. Although there remains some problems to be overcome for QFT to be widely used with high confidence, this technology will provide a high possibility for wider and more accurate indication of chemoprophylaxis and will be one of the essential tools of tuberculosis control of the 21st century in Japan.

Characterization of M. Tuberculosis-derived IL-12-inducing material by alveolar macrophages

We have investigated the substance derived from Mycobacterium tuberculosis (Mtb) that induces interleukin (IL)-12 production by alveolar macrophages (AMs) in vitro. The cytosol fraction of live Mtb H37Rv induced IL-12 production by AMs in a dose-dependent manner. The addition of interferon-gamma (IFN-gamma) augmented IL-12 production. IL-12-inducing activity by AMs (termed as surely active keeping rescue antigen, SAKRA) was purified by gel filtration and ion exchange column chromatography, and the molecular weight of SAKRA was estimated by gel filtration to be more than 700 kDa. SDS-polyacrylamide gel electrophoresis (PAGE) and Western blotting of SAKRA using rabbit anti-SAKRA antibody suggested that SAKRA is composed with several low molecular weight proteins. Amino acids sequence analysis of several bands after SDS-PAGE suggested that SAKRA is a part of ribosomes. RT-PCR showed that SAKRA induced not only expression of IL-12 p40 mRNA, but expression of tumor necrosis factor (TNF)-alpha and inducible nitric oxide synthase (iNOS) mRNA at least 6 h after stimulation, suggesting that SAKRA activates the bactericidal activity of macrophages. To investigate the potential use of SAKRA as a vaccine against tuberculosis, SAKRA was administered to BALB/c mouse that had been immunized with BCG for 18 months, and mouse were infected with Mtb H37Rv via a respiratory route. Replication of Mtb in lungs and spleens was examined 6 weeks after infection. Administration of SAKRA to BCG-vaccinated mice significantly reduced the numbers of Mtb in lungs and spleens as compared with BCG-vaccinated control mice. Taken together, these results suggest that SAKRA is one of the Mtb-derived immunomodulatory substances which induce IL-12 production during infection and also increases mycobactericidal activities of macrophages, and that SAKRA may be a promising new vaccine candidate against tuberculosis.

Altered expression of genes in experimentally induced myopic chick eyes

PURPOSE

To identify a casual pathway between the alteration in visual experience, due to form deprivation and hyperopic defocus, and the increase in eye growth, we searched for candidate genes having regulatory effects on eye growth under myopic conditions.

METHODS

The expression of the brain-derived neurotrophic factor, neurotrophin-3, sonic hedgehog, nerve growth factor, Six-3 and the Lh-2 group of genes in the transcriptional level after experimentally induced myopia (form-deprivation by goggles and by hyperopic defocus using negative spectacle lenses) were evaluated by semiquantitative reverse transcriptional polymerase chain reaction and Northern blot analysis.

RESULTS

Results showed that only the sonic hedgehog gene was differentially expressed in the experimentally induced myopic retinal samples compared with controls.

CONCLUSIONS

The sonic hedgehog gene may have regulatory functions in the signaling of the cascade of events that leads to axial elongation and vitreous enlargement of the eye under myopic conditions.

Expression of Sonic hedgehog and retinal opsin genes in experimentally-induced myopic chick eyes

The purpose of this study was to evaluate changes in the expression of different genes in chick retinal tissues after induction of experimental myopia and to evaluate the roles of these genes in the regulation of postnatal eye growth and myopia. Form-deprivation using occlusive goggles and hyperopic defocus by negative spectacle lenses were used to induce myopia in hatched chicks. Expression levels of Sonic hedgehog, its receptor complex, and other retinal cell genes were evaluated by semi-quantitative reverse transcription-polymerase chain reaction. Levels of Sonic hedgehog protein were further evaluated by Western blot analysis. The induction of myopia caused significant increase in expression of Sonic hedgehog mRNA and protein and increased expression of blue and red opsin mRNA. In contrast, the expression of mRNA for Sonic hedgehog receptor complex (Patched-Smoothened), rhodopsin, vimentin, green opsin, violet opsin, and HPC-1 were unaffected by the induction of myopia. The increase in expression of Sonic hedgehog in chick retinas in experimentally-induced myopia suggests involvement in the retina control of postnatal eye growth. Furthermore, Sonic hedgehog may influence the expression of blue and red opsins under myopic conditions.

Differential expression of neuroendocrine-specific protein in form-deprived chick eyes

PURPOSE

To identify genes that are highly expressed in form-deprived retina-retinal pigment epithelium-choroid tissues. Neuroendocrine-specific proteins were found to be highly expressed.

METHODS

mRNAs enriched in retina-retinal pigment epithelium-choroid tissues from 3-, 7-, and 14-day form-deprived chick eyes were isolated by differential display technique with cDNA library screening. Neuroendocrine-specific protein A and C were cloned in control and form-deprived eyes. mRNA and protein levels, with respective regional localizations, were examined by Northern blot, Western blot, and immunohistochemical analyses, respectively.

RESULTS

The isolated clone included an insert with a sequence homologous to both chick neuroendocrine-specific proteins A and C. The increases in mRNA and protein levels were confirmed by Northern and Western blot analyses, respectively. Immunohistochemical localization of neuroendocrine-specific proteins A and C was detected in the layer of photoreceptor inner segments, presumably in the cone cells. Northern blot analysis using negative lenses showed that levels of neuroendocrine-specific protein A and C mRNAs were not altered using negative lenses.

CONCLUSIONS

The expression of both neuroendocrine-specific proteins A and C mRNAs in cone photoreceptor cells was upregulated within 14 days of form deprivation, but not in response to negative spectacle lenses. These data suggest that the increase in induction of neuroendocrine-specific proteins is not a secondary consequence of ocular elongation or myopic refraction. Induction of neuroendocrine-specific proteins in form-deprived eyes may be causally related to the development of myopia or may be an unrelated effect of form deprivation.

Up-regulation of crystallin mRNAs in form-deprived chick eyes

Form-deprivation of chicks during early postnatal development results in ocular enlargement and great myopic refractive error (form-deprivation myopia). Previous studies have indicated that the retina, RPE and choroid play important roles in ocular enlargement in form-deprivation myopia. We aimed to isolate genes up-regulated in the retina-RPE-choroid of form-deprived chick eyes. A suppression subtractive hybridization method was used to compare mRNA expression in the retina-RPE-choroid of form-deprived and control eyes. One up-regulated cDNA was isolated and identified as part of chick delta1-crystallin cDNA. Northern blot and RT-PCR analyses demonstrated that delta1-crystallin mRNA was up-regulated in the retina-RPE at day 7 after form-deprivation treatment. Semi-quantitative RT-PCE analysis of the expression of several transcription factors indicated that Sox1 and Sox3 were upregulated in parallel with delta1-crystallin mRNA in form-deprived eyes. Northern blot analysis demonstrated that alphaA-, betaA3/A1-, betaB1-, and betaB2-crystallin mRNAs were also up-regulated in form-deprived eyes. Although the detailed mechanisms and functions of the crystallin family genes in the retina-RPE-choroid of form-deprived eyes remain unclear, results of our study suggests that form-deprivation affects the expression of these genes in chick eyes.

[Roles of outpatient nurses in the care of cancer patients receiving MS Contin tablets]

Pain relief is very important to improve the QOL of cancer patients. Accurate pain assessment and offering suitable drug information on MS Contin tablets (MSC) are important roles of outpatient nurses for the effective use of MSC. We examined the present status of symptom relief among cancer outpatients and from this discuss the practice of outpatient nursing. Forty-eight outpatients receiving MSC were interviewed by mail with regard to pain relief, the side effects of MSC, and the drug information they had been provided. Cancer pain was well controlled in 68% of outpatients by MSC, but MSC was not effective in 13%. Some side effects were observed in 68% of patients, 10% of which were poorly controlled. Sixty-five percent of patients were informed about MSC, but only 47% were informed about measures against these side effects. The following conclusions were reached: 1) MSC should be explained individually and repeatedly, 2) exact informations on a patient's status should be collected using scales and charts, 3) nurse charts should record when MSC is initially administered and when the dosage is changed, and 4) the cases of poorly controlled patients should be studied and specialists consulted if necessary.

Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging

PURPOSE

This study was performed to evaluate magnetic resonance imaging (MRI) in determining the therapeutic effect of radiotherapy (RT) on cervical cancer.

METHODS AND MATERIALS

Serial MRI studies were performed in 42 patients with predominantly advanced cervical cancer before, during, and after radiotherapy. Patients underwent external irradiation combined with high-dose-rate intracavitary (HDR) brachytherapy. T-2 weighted spin-echo pulse sequences with long repetition and echo times were used at a field strength of 1.5 T. Multiple punch biopsies of the cervix were obtained from the high-signal intensity area in all patients at the same time as the MRI.

RESULT

In biopsies performed immediately after RT, no residual tumors were found in 36 patients (86%); in 6 patients, residual tumors were observed. The simultaneous MRI study demonstrated no high-signal intensity on T2-weighted images in 28 patients. A high-signal area was observed in 14 patients, and this disappeared 3 months after RT in 8 patients with a negative histological study. The sensitivity, specificity, and accuracy of MRI studies at 3 months after RT were 100%. When the relationship between reduction of tumor volume at 30 Gy and local tumor control was analyzed, every patient with a reduction under 30% gained local control. Also, patients with no residual tumors 3 months after RT gained local control.

CONCLUSION

MRI studies performed at 30 Gy of external irradiation and 3 months after RT were predictive factors of local control.

Development of grating acuity in infants with Retinopathy of Prematurity

PURPOSE

To evaluate the visual development in infants with stage 1 approximately 3 ROP and compare their visual results with healthy preterm infants.

PATIENTS AND METHODS

One hundred forty-four premature infants were recruited and were divided into 3 groups according to the stage of ROP. Randomly selected preterm subjects with no ROP were taken as controls. Ophthalmic examinations started 4 to 7 weeks after birth and were repeated as needed until the retina was fully vascularized or until any ROP that developed had resolved. Grating acuity was measured by acuity cards between 35-45 weeks of corrected age and by PL method at 12, 18 and 24 months of age.

RESULTS

Infants with stage 3 ROP had slightly lower visual acuity scores compared to other infants at most of the testing points throughout the 35-45 week period, which did not show statistical significance at any week. Infants with stage 2 and 3 ROP had similar visual acuity values but slightly lower acuity scores than infants with stage I or no ROP at the 12 month follow-up. The differences were not statistically significant. Stage 3 ROP infants had significantly lower acuity scores compared to infants with stage 1-2 or no ROP at the 18 and 24 month follow-up visits (p<0.0001).

CONCLUSION

We stress periodic monitoring of early visual acuity in infants with ROP because of the possibility of impaired visual development.

[Effect of low-dose sulpiride on dopamine metabolism in rat nucleus accumbens and locomotor activity: studies with intracerebral dialysis]

Changes in the concentration of dopamine (DA) and its metabolites, 3, 4-dihydroxyphenyl-acetic acid (DOPAC) and homovanillic acid (HVA), were determined sequentially in freely moving rats by using a brain dialysis method. The purpose of this study was to investigate the relationship between changes in the dopamine metabolism in the nucleus accumbens and locomotor activities following low-dose (5 mg/kg) sulpiride administration. The DA content in the dialysis fluid rose significantly 4 to 6 h after sulpiride administration. The DOPAC content rose significantly 6 h after sulpiride administration. The HVA content did not show a significant change. A slight increase of locomotor activity was found, but it was not statistically significant. The elevation of DA release in nucleus accumbens by sulpiride might relate to the clinical efficacy of low-dose administration of this drug for mood disorders.

[Terminal care of the cancer patient at home--patient and family spending the last moments together]

Some 129 cancer patients were taken care of at home by the visiting nurse team of our hospital since 1994 to 1997; 116 patients have already died, 50 of them at home (group A), and 66 at the hospital (group B). We analyze the differences the between two groups in nutritional assistance, pain control and manpower in looking after a patient. Twice as many patients in group A took nutritional medication (drip infusion or intravenous hyperalimentation, for example) than group B. More patients in group A used oral and suppository morphine than group B. In group A 70% of patients (56% in group B) had more than two persons looking after at home. The important factors for a good recuperation at home are: 1. Available nutritional assist available. 2. Good control. 3. Less burden and anxiety of the person looked after. To spend pain desirable last moments together, it is important for the visiting nurse team to take proper care and to confirm the wishes of the patient and family, considering the rapidly changing conditions of the individual patient.

[Radiotherapy for carcinoma of the buccal mucosa: analysis of prognostic factors]

The radiotherapeutic results of 55 patients with carcinoma of the buccal mucosa were analyzed to determine the prognostic factors and appropriate treatment modality. They were classified into 5 groups according to treatment modality: group A (preoperative radiotherapy followed by surgery), group B (interstitial implant), group C (electron therapy), group D (mainly external radiotherapy) and group E (external radiotherapy followed by mold therapy with remote afterloading system). The overall 5-year survival rates for groups A, B, C, D, E and the entire group were 50%, 61%, 67%, 29%, 25% and 48%, respectively. The cumulative 5-year local control rates for groups A through E were 81%, 94%, 75%, 33% and 25%, respectively. In univariate analysis, T stage (T1-2 vs. T3-4), N stage (N0 vs. N1-3), clinical stage (II vs. III-IV), histologic grade (well differentiated vs. moderately and poorly differentiated) and treatment modality (A-C vs. D-E) were significantly related to overall survival (p < 0.05). Multivariate analysis revealed that treatment modality (groups A-C) and N0 stage were significantly associated with favorable prognosis (p < 0.05). These results suggest that interstitial implants are comparable with surgery for T1 to early T3 lesions, with or without slight invasion to the bucco-alveolar sulci or retromolar areas, that can be treated with a single-plane implant.

Visual function following congenital cataract surgery

To evaluate the results of congenital cataract extraction and postoperative visual function, we retrospectively reviewed the records of 95 patients who underwent pars plana (plicata) lensectomy or aspiration surgery. Forty-nine percent of the patients with bilateral aphakia and 25% with bilateral pseudophakia had a Landolt visual acuity of 0.5 or above at the final visit. The figures were 31% and 66% for patients with unilateral aphakia and pseudophakia, respectively. Eight patients (16.3%) with bilateral and 2 patients (5.8%) with unilateral cataract for whom contact lenses were prescribed after surgery attained fine stereopsis. Five of 8 patients (62.5%) with unilateral cataract who had intraocular lens implantation ended up with gross or fine stereopsis. We stress that very early surgery and optical correction in the sensitive period of binocular visual development should be instituted, especially in the presence of dense opacities. A good postoperative visual outcome can be achieved in patients undergoing late surgery if the opacities are light or partial in nature. We also reemphasize the importance of aggressive and diligent visual rehabilitation and occlusion therapy against amblyopia.

Differential expression of nitric oxide synthase isoforms in form-deprived chick eyes

PURPOSE

To clarify whether nitric oxide synthase (NOS) is involved in development of myopia, we examined the influence of form deprivation on the expressions of NOS isoform mRNA.

METHODS

NOS isoform cDNAs were amplified from total RNA extracted from control and 7-day-form-deprived chick retina-RPE (retinal pigment epithelium)-choroid, using competitive RT-PCR (reverse-transcription polymerase chain reaction). Each NOS isoform protein was also analyzed by Western blotting and immunohistochemistry.

RESULT

Expression of inducible NOS (iNOS) mRNA was highest in the control chick retina-RPE-choroid, followed by the expression of brain NOS (bNOS) mRNA. Expression of endothelial NOS (eNOS) mRNA was faint. The iNOS protein level, however, was only slightly higher than the levels of the bNOS and eNOS proteins and was found mainly in the outer part of the photoreceptor layer and inner and outer parts of RPE and choroid. bNOS alone was found in the outer nuclear layer. Although form deprivation reduced the iNOS and bNOS mRNA expressions, only the iNOS protein showed significant reduction.

CONCLUSION

All three NOS isoforms were expressed in chick retina-RPE-choroid. Predominant expression of iNOS, instead of bNOS and eNOS, suggested the existence of ocular tissue-specific regulation of the iNOS gene. In addition to differences in expression level, bNOS displayed regional differential expression. Moreover, only iNOS was reduced in response to form deprivation. It is suggested that NOS isoforms may be differentially involved in the mechanisms regulating the posterior eye tissues, including myopic eye growth.

[Evaluation by visiting nurse in end-stage cancers--family questionnaire for patients who died after visiting nurse]

Since April 1994, we have provided visiting nurse care for patients with end-stage of cancers. A questionnaire was sent to 72 families of patients who died of cancer and who received after visiting nurse care. The response rate to the questionnaire was 76.4% (55 patients). One group of 27 patients died at home (Group A), and the other group of 28 patients died in the hospital (Group B). Patients who knew they had cancer accounted for 85.2% in Group A, and 57.1% in Group B. Of all patients, 69.1% desired home nursing, with 77.8% in Group A, and 60.7% in Group B. The satisfaction of families with the visiting nurse was evaluated. In Group A, satisfaction was 66.7% and relative satisfaction was 18.5%. In Group B, satisfaction was 50.0% and relative satisfaction was 25.0%. Satisfaction of patients with the place of death was 81.5% in Group A, and 35.7% in Group B. Many families wished to have the nurse visit 2 times a week, and an hour at each visit. The great mental burden on the families who provide home care for patients with terminal cancer was clear for the questionnaire. Arrangement for a support system for patients and families, through visiting nurse services, is necessary in our hospital.

Thallium-201 single-photon emission tomography in the treatment follow-up of nasopharyngeal carcinoma

In order to assess the usefulness of thallium-201 single-photon emission tomography (SPET) in the treatment follow-up of nasopharyngeal carcinoma (NPC), a total of 75 201T1 SPET studies were performed in 18 patients with histologically proven NPC. The findings were compared with those of magnetic resonance imaging (MRI) before and after therapy. Four patients received radiotherapy alone while the other 14 received concurrent chemo-radiotherapy. Treatment response was classified as complete (CR) or partial (PR) based on the findings of MRI and 201T1 SPET. Intense 201T1 uptake by the tumour was seen in all 18 patients before treatment. After treatment, MRI showed seven CRs and 11 PRs, whereas 201T1 SPET showed 13 CRs and five PRs. In 12 patients, the results of 201T1 SPET were in agreement with those of MRI. In six patients MRI showed PR but 201T1 showed CR. Follow-up (mean 10.6 months) MRI and 201T1 SPET studies of these six patients revealed that tumour gradually decreased and finally vanished in three patients. This preliminary study indicates that 201T1 SPET has potential in the assessment of early response to treatment of patients with NPC when compared with MRI.

Preservation of photic blink reflex in Leber's hereditary optic neuropathy

PURPOSE

To examine whether the early response of photic blink reflex (PBR) is spared in patients with Leber's hereditary optic neuropathy (LHON).

METHODS

Twenty-six patients with bilateral optic neuropathy (visual acuity < or = 0.1) and central scotomata were divided into LHON group with one of three mitochondrial DNA mutations at nucleotide position of 3460, 11778, or 14484 and non-LHON group without them. Latencies of the PBR early response and those of the electrically evoked blink reflex (EBR) response were compared among the 26 patients and 20 healthy volunteers.

RESULTS

In controls, average latency of the PBR response was 50.3 +/- 2.4 msec and was in accordance with previous reports. Ten of eleven patients with LHON had normal PBR responses, whereas 12 of 15 controls without LHON had abnormal responses (P = 0.0005). Latencies of EBR responses were normal in all but one patient with LHON.

CONCLUSIONS

The afferent fibers of the PBR early response, as well as those of the light reaction, are reported to terminate presumably in the pretectum. Together with the reported evidence of the preserved light reaction in patients with LHON, we presume that W retinal ganglion cells may project common afferent fibers of these two neuronal pathways and may be preferentially spared in patients with LHON.

[Visiting nurse support for patients wishing to die at home]

Thirty-two (1994) and 55 (1995) patients in the terminal stage of many kinds of cancer were cared for satisfactorily at home by a visiting team of nurses from Niigata Cancer Center Hospital. A prostate cancer patient with multiple bone metastasis was suffering from morphine-resistant intractable pain, and highly dependent on medical care. We continued to take care of him by frequent visitation and psychological assist until he eventually died at home according to his wishes. It is important to create a suitable support team for the continual difficult home care of each terminal patient.

Retinal control on the axial length mediated by transforming growth factor-beta in chick eye

PURPOSE

To clarify retinal control on scleral growth in form-deprivation myopia (FDM) in the chick, the authors studied change in transforming growth factor-beta (TGF-beta) in the form-deprived eye and the effect of this growth factor on scleral cell proliferation and axial length.

METHODS

Change in TGF-beta in FDM in the chick was measured by reverse transcriptase polymerase chain reaction (RT-PCR), immunoblot, and immunohistochemistry. The effect of TGF-beta on [3H]thymidine uptake of scleral chondrocytes was determined by organ culture. Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) were administered to determine the effect of TGF-beta activation on the axial length in normal and FDM eyes.

RESULTS

The content of TGF-beta messenger RNA (mRNA) and the active form of TGF-beta protein were reduced in FDM eyes compared with the control specimen. Reduced immunoreactivity of TGF-beta in FDM eyes was found in the photoreceptor layer. The TGF-beta inhibited [3H]thymidine uptake into scleral chondrocytes. In the nondeprived eyes, the vitreous chamber depth and axial length were reduced after uPA treatment, whereas PAI-1 increased them. In the form-deprived eyes, uPA inhibited vitreous depth and axial length elongation, but PAI-1 had no effect.

CONCLUSIONS

The authors' results suggest that TGF-beta mediates retinal control of ocular growth. Axial elongation in FDM probably is correlated with the reduction of TGF-beta in the retina, retinal pigment epithelium, and choroid. The uPA and PAI-1 treatment controls the activation of TGF-beta and affects axial length.

Binding of lithocholate and its glucuronide and sulfate by human serum albumin

In the present study, the binding affinities of lithocholate sulfate and glucuronide by human serum albumin were compared to that of lithocholate by equilibrium dialysis, and the binding sites of these bile acids on those of various fluorescent probes and bilirubin were also studied. The dissociation constants for the primary binding sites for lithocholate sulfate and glucuronide on human serum albumin were 0.057 and 0.24 microM, respectively, which were lower than that for lithocholate (0.82 microM). Lithocholate sulfate and glucuronide, as well as lithocholate, did not simply inhibit the binding of the site II and III fluorescent probes or bilirubin to albumin. Inhibition by these bile acids of the site I fluorescent probe binding to albumin suggested that the secondary binding sites of these bile acids are equal to site I. The results of simultaneous equilibrium dialysis using [3H]lithocholate and [14C]lithocholate sulfate indicated that these compounds have the same primary binding site. In conclusion, sulfation and glucuronidation may increase the binding affinities of bile acids to human serum albumin without changing their binding site.

Effect of p-chloroamphetamine administration on monoamine metabolism in the rat nucleus accumbens and locomotor activity: studies with intracerebral dialysis in freely moving rats

Changes in the level of dopamine (DA) and its metabolites [3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA)] and serotonin (5-HT) and its metabolite [5-hydroxyindoleacetic acid (5-HIAA)] were determined sequentially in freely moving rats by using a brain dialysis method. The purpose of the study was to find the relationship between changes in the monoamine metabolism in the nucleus accumbens and locomotor activities following PCA administration. Subsequently it was found that locomotor activity significantly increased 1 and 2 h after PCA administration (2 mg/kg, i.p.) while the DA content in the dialysis fluid rose significantly after 1 and 2 h. On the other hand, the 5-HT level did not show significant changes. The DOPAC, HVA, and 5-HIAA levels were significantly reduced 1 to 6 h after PCA administration. It was suggested that the increase in locomotor activity caused by PCA administration is an expression of abnormal behavior caused by DA release from the nucleus accumbens.

[Event-related potentials in anisometropic amblyopia]

Event-related potentials were recorded from 20 neurologically normal children with anisometropic amblyopia. Stimulation was performed with an 'odd-ball' paradigm counting Randolts' circle, and in all cases N200 and P300 were recorded as event-related potentials. The latencies of N200 showed statistically significant delay (p < 0.001: Wilcoxson signed rank test), but P100 and P300 were not delayed in the stimulus input from amblyopic eyes. The degree of delay has no relationship with visual acuity or anisometropic differences. The results suggest that the cortical sensory processing functions represented by P300 were not damaged in the amblyopic cases observed in this study.

Intraorbital arteriovenous malformation: case report

A case of intraorbital arteriovenous malformation presenting with visual loss, exophthalmos, and chemosis of the right eye is reported. Enhanced computer tomography and magnetic resonance imaging showed extraocular muscle enlargement and vascular abnormality in the right retrobulbar space. Angiography revealed an abnormal intraorbital vascular stain with an extremely dilated right ophthalmic artery. Total removal of the intraorbital contents was performed after unsuccessful endovascular and surgical treatment of arteriovenous malformation (AVM). Histopathological examination disclosed an AVM in the retrobulbar fatty tissue with extension into the extraocular muscles and optic nerve.

Evaluation of hepatic transport function by hepatobiliary scintigraphy

The transport kinetics of [99mTc]-pyridoxyl-5-methyltryptophan were studied by three-compartment model analysis for hepatobiliary scintigraphy in 45 patients with chronic viral liver diseases. Three-compartment model analysis was studied using the time-activity curves of the regions of the heart, liver, and biliary tract and intestine (excretory compartment). The k12 (hepatic uptake rate constant), k21 (hepatic efflux rate constant), and ke1 (hepatic excretion rate constant) were calculated by the nonlinear least-squares method. Among the three parameters obtained by model analysis, k12 values more prominently differed among diseases and correlated well with blood tests such as total bilirubin, total bile acids, or 15 min retention of ICG. In conclusion, three-compartment model analysis of the hepatic handling of [99mTc]-pyridoxyl-5-methyltryptophan is useful in evaluating hepatic transport function. k12 is the most sensitive parameter for this.

[Effect of chronic desipramine treatment on rat brain adrenergic alpha 2-receptor]

Clonidine has been reported to be effective as an alpha 2-adrenoceptor agonist. Locomotor activity was measured by Automex after clonidine (100 micrograms/kg ip) administration. A significant reduction of locomotor activity was found during the 30th-45th-min period of experiment. 3-Methoxy-4-hydroxyphenylethyleneglycol (MHPG)-total was decreased significantly at 60 min after clonidine administration in rat cerebral cortex, hippocampus and hypothalamus. This might suggest that MHPG content at 60 min after clonidine administration can be used as functional index of the presynaptic alpha 2-adrenergic receptor. Desipramine (DMI) (20 mg/kg) was injected ip once daily for 14 d and experiments undertaken 60 min after the clonidine administration. Chronic DMI treatment had an effect on rat brain steady state levels of serotonin (5-HT) system. Chronic DMI administration was shown to attenuate the effect of clonidine that reduced MHPG levels on rat brain. The results suggest that the chronic DMI treatment may diminish the clonidine-induced reduction of MHPG via the subsensitivity of presynaptic alpha 2-adrenergic receptor.

[Hemibody irradiation in the treatment of generalized metastases]

Eight sessions of upper and lower hemibody irradiation have been given to 7 patients with generalized metastases from various malignancies. In 5 patients with painful bony metastases, the pain responded to the radiation and in one case, a complete disappearance of pain was obtained. In 2 patients, the hematological suppression that resulted needed supportive care. Hypercalcemia from metastatic cancer was alleviated dramatically in two patients, but not for long duration. Hemibody irradiation seems to provide an effective means for the palliation of painful bony metastases and for hypercalcemia resulting from it.