Radiotherapy in the management of Graves' ophthalmopathy.

BACKGROUND: To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. METHODS: Fourteen female and six male patients with Graves' ophthalmopathy were treated with radiotherapy between 1989 and 1996. Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of 24-28 Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. RESULTS: Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. CONCLUSION: Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles.

Effect of radiation on the expression of carcinoembryonic antigen of human gastric adenocarcinoma cells.

The changes of antigenic expression of cultured human gastric adenocarcinoma MKN45 cells caused by irradiation were investigated to elucidate the immune responses to localized irradiation. The expression of carcinoembryonic antigen (CEA) showed remarkable increases in the culture supernatant and on the surface of the membrane of irradiated cells. The expression of major histocompatibility complex Class I antigen on the membrane also was enhanced by irradiation. In addition, the irradiated cell groups, when analyzed using a CEA-specific probe, showed remarkable increases in the CEA mRNA. These enhancements increased in the 10-Gy and 15-Gy irradiated populations compared with the 5-Gy irradiated population. These results suggest that the enhancement of expression of CEA by radiation takes place at the CEA gene expression (mRNA) level but not at the protein level.

[Radiation tolerance of normal lung-pulmonary radiation syndrome].

Radiation pneumonitis and radiation fibrosis are two distinct syndromes with probably different target cells. The ultrastructural changes occur rapidly and current evidence suggests that damage to the type II pneumocyte and the endothelial cell is linked to the pneumonia process than the fibrotic. The fibrosis process may be related to the basement membrane of both endothelial cells and alveolar type I cells. Dose time and volume data for tolerance dose are well documented in animals. Many antineoplastic agents enhances radiation lung damage. The pneumonitis and fibrosis will be discussed.

[Three dimensional CT reconstruction image using a personal computer].

Three dimensional (3D) images were reconstructed from axial CT slices using the personal computer. Some devices of the program made it possible to decrease the image processing time and to produce the realistic images with cubic effect. The thresholding in the conventional 3 D imaging was not practical especially in the display of the soft tissues. The employment of the volume rendering technique and MRI data will give a clue to the solution of these problems.