Molecular-based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus-sensitized Japanese patients.

BACKGROUND: Distinguishing between patients with allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus (Af)-sensitized asthmatic patients without ABPA is sometimes difficult owing to the IgE-cross-reactivity between Af and other fungal allergens. OBJECTIVE: To establish the usefulness of molecular-based allergy diagnostics using allergen components from Af in distinguishing ABPA from Af-sensitized asthma without ABPA. METHODS: Sera from Japanese patients with ABPA (n = 53) and Af-sensitized asthma without ABPA (n = 253) were studied. The levels of IgE and IgG antibodies to allergen components from Af and IgE antibodies to different fugal allergen extracts were measured by ImmunoCAP. Comorbid atopic dermatitis (AD) was taken into consideration in the sensitization profile analysis. RESULTS: Patients with ABPA possessed significantly higher levels of IgE antibodies to Asp f 1, and Asp f 2 than asthmatic patients without ABPA. The areas under the receiver operating characteristic curves for the levels of IgE to Asp f 1 and Asp f 2 as diagnostic markers of ABPA were 0.75 and 0.78, respectively. The presence of IgE positivity to Asp f 1 and/or Asp f 2 resulted in increased sensitivity while losing little specificity. Comorbid AD was associated with higher levels of IgE to Asp f 6 (manganese superoxide dismutase from Af, a ubiquitous pan-allergen in fungi) and low but positive levels of IgE to other Af-components, which hampered the serological discrimination of ABPA. CONCLUSIONS AND CLINICAL RELEVANCE: The levels of IgE to Asp f 1 and/or Asp f 2 can effectively differentiate ABPA from Af-sensitized asthma, suggesting that the amounts of IgE specific for these molecules are markers for genuine Af-sensitization in ABPA. However, comorbid AD must be taken into consideration in the interpretation of high IgE to Asp f 6. Establishing of IgE-sensitization profiles using panel of Af-allergen components provides valuable information for distinguishing genuine vs. cross-reactive sensitization in Af-sensitized patients.

Combination radiotherapy of urinary bladder carcinoma with chemohyperthermia.

The combination therapy of urinary bladder cancer with radiation and hyperthermia with bleomycin was investigated. Immediately following daily external irradiation (40 Gy/4 weeks), patients were irrigated with a solution of warmed saline (intravesical temperature, 42-43 degrees C) containing 30 micrograms/ml bleomycin. Of a total of 56 patients, complete responses were observed in 25, and partial responses in 21. Among T2-T3 cases, an 84% response rate was noted in combination therapy, whereas a 56% response rate was observed after radiation alone (50-70 Gy). The side-effects of the combination therapy were limited to reversible bladder irritation, and bladder capacity could be maintained within normal limits. These results suggest that combination therapy represents an effective conservative therapy for the management of bladder cancer.

[Renal accumulation of technetium-99m-labeled bone imaging agents in patients treated with cisplatin].

As the routine follow-up studies in patients with malignant diseases, bone scintigraphy is often performed to detect bone metastasis, before, during and/or after the treatments. Among these patients who were treated, especially, with CDDP, we often encountered the markedly increased renal radioactivity during the follow-up period by bone scintigraphy. In this study, 68 patients with 76 bone scintigraphy performed within 30 days after the administration of CDDP were evaluated. Forty-five of the 76 bone scintigraphy (60.5%) in the 68 patients exhibited more prominent accumulation of the radionuclide in the kidneys than that normally seen. Among them, twenty-four cases (31.6%) showed markedly increased accumulation of the radionuclide in the kidneys so called the "hot kidneys", when the bone scintigraphy was performed later than 3 weeks after the treatment with CDDP. Moreover, the frequency of the "hot kidneys" were well correlated with the degree of renal damage in terms of serum creatinine levels. These findings suggest that the "hot kidneys" might represent the presence of transient renal damage caused by the administration of CDDP. As the causes of this finding called as the "hot kidneys", various factors and/or many causes are reported recently, however, the highest incidence of this phenomenon is thought to be occurred by CDDP as the factor of drug incidence.

[Thermochemotherapy of cancer of the stomach]. / Termokhimioterapiia raka zheludka.

Short-term results of chemo-hyperthermia of gastric carcinoma were reported. Complete regression was noted in 15%, partial regression in 42% of cases.

Carcinoma of the uterine cervix treated with external irradiation alone.

One hundred and four out of 2701 patients with carcinoma of the uterine cervix were treated with a curative intent by external irradiation alone at the National Cancer Center Hospital from 1962 to 1979. All patients were judged inappropriate for the combined treatment of intracavitary and external irradiation, which was the treatment of choice for patients with advanced carcinoma of the uterine cervix in the hospital. The 5-year survival rate was 17% overall and 36, 17, and 5% for patients with Stage II, III, and IV disease, respectively. The local control rate was 20%, at 2 years, for all patients. Major complications were observed in five patients. There were no major complications in patients given a total dose of less than 115 in the Time Dose Fractionation factor (TDF). External irradiation combined with interstitial irradiation and/or hyperthermia is being considered to improve the results.

Radiotherapy of brain metastases.

The effect of radiotherapy in 254 cases of brain metastases, treated between 1977 and 1984, were studied. The cases included 141 of lung cancer, 28 of mammary cancer, and 85 of other primary sites. The percentages of patients with improvement in clinical symptoms were 8, 39, and 66, respectively. These were groups of patients irradiated with less than 30 Gy, 30 Gy to 50 Gy, and more than 50 Gy. The 50% survival periods from the start of irradiation for the last group were as follows: for radiotherapy only, 4.1 months, radiotherapy and surgery, 4.2 months, radiotherapy and chemotherapy combined, 6.9 months, radiotherapy, surgery and chemotherapy combined, 12.1 months. The intervals between the initial diagnosis and brain metastases were different in lung cancer and mammary cancer, but the prognosis after brain metastases showed little difference between them.

[Interstitial irradiation with Ir-192 in carcinoma of the female genital tract--report of two cases].

Two patients treated with interstitial iridium-192 irradiation are presented. A patient with stage IV A adenocarcinoma of the uterine cervix was treated with external irradiation in combination with local hyperthermia prior to the interstitial irradiation. Another patient with stage III B squamous cell carcinoma of the vagina had a hysterectomy followed by irradiation 22 years prior to the treatment. Wires of Iridium-192 were put into place in the region of the tumor to give 40 Gy to the periphery of the tumor. The patient with carcinoma of the cervix died 15 months after the treatment. The patient with carcinoma of the vagina is well and has locally controlled disease 18 months after the treatment.

A case of advanced gastric cancer with long-term survival as the results of combined radiation therapy and chemotherapy.

A case report on a long-term surviving patient with advanced gastric cancer with supraclavicular lymph node metastasis treated by radiation and chemotherapy is presented. The Borrman type 2 of advanced gastric cancer was found on the greater curvature of the antrum at the first radiological examination. Radiation was administered to the supraclavicular lymph node at 60 Gy and to the stomach at 64 Gy. The patient received mitomycin C (24 mg) and Tegafur (230 g). After completion of the combined therapy the endoscopy revealed an irregular mucosal change with erosion and hemorrhage. Radiological examination revealed atrophic and hyperplastic areas throughout the stomach. These findings lasted more than six years. The patient died of unknown cause in February 1983. She had survived nine years and seven months after her initial diagnosis. Radiotherapy may play a role as a means of radical treatment in certain cases of advanced gastric cancer.

[Postoperative prophylactic irradiation of lung cancer].

Eighty-three patients with resected lung cancer were studied to determine whether postoperative prophylactic irradiation improves survival. All patients had mediastinal lymph node metastases and underwent relative curative surgery. Thirty patients received postoperative irradiation, and another 52 were followed without further treatment. The 5-year survival rate was 19.2% in the surgery alone group and 20% in the postoperative irradiation group. No increase in survival time was noticed in the postoperative irradiation group. The 5-year survival rate was not influenced by histologic types, presence or absence of subcarinal lymph node metastases and right or left thoracotomy in either group.

Clinical experience with the 22-MeV microtron at the National Cancer Center Hospital.

Experience with the 22-MeV microtron is presented. The maintenance and ease of operability of the system are satisfactory. The physical characteristics showed many clinical advantages. Fundamental measurement of dose distribution and depth dose curves were performed and clinically applied. The two-gantry system is very satisfactory and effective for irradiation by photons and electrons to treat many patients per day. The facility for intraoperative radiotherapy and the physical conditions for total body irradiation are also sufficient because of the well-designed building layout and the systematized facility with the microtron system.

Treatment of metastatic gastric cancer by combined radiation and hyperthermia (report of two cases).

Two patients with metastatic carcinoma of the stomach on the abdominal wall were treated by radiotherapy using cobalt-60 gamma-ray or megavoltage electrons combined with hyperthermia induced with a Thermotron (8 MHz). The total dosage was 44 Gy fractionated into 11 doses (twice a week), by cobalt-60 gamma-ray and 10 hyperthermia treatments for patient 1, and 32 Gy fractionated into eight doses (twice a week) given by megavoltage electrons and five hyperthermia treatments for patient 2. In patient 1, the shrinkage of the tumor was more than 50%. No tumor cells were observed histologically at the end of treatment. In patient 2, the tumors completely disappeared. These results encourage us in the use of radiotherapy combined with hyperthermia for rather radioresistant adenocarcinoma.

[Extra-abdominal desmoid tumor--report of a case].

A case of an extra-abdominal desmoid tumor in a 17-year-old female is reported. At the time of the first examination, the tumor was found to already involve the floor of the mouth, the submandibular region, both sides of the neck, the anterior chest wall and the mediastinum and hence was considered inoperable. The patient was treated by external irradiation and interstitial irradiation (Ir and Au). The therapeutic response was very slow, becoming noticeable 4 months after completion of the therapy and lasting for more than a year. Experience in this case indicates that in order for radiotherapy to prove successful in the treatment of desmoid tumor, it must be administered in relatively high doses. Since desmoid tumors reportedly have the potential for sarcomatous transformation, a long-term follow-up seems to be necessary in the management of patients with this neoplasm. It is considered that inoperable extra-abdominal desmoid tumors are a good indication for radiation therapy.

[Occurrence of carcinoma of the vulva and vagina following irradiation of cervix carcinoma].

Six patients with carcinoma of the vulva and 3 with carcinoma of the vagina following radiation therapy for cancer of the cervix were analyzed. The interval between irradiation and diagnosis of the second tumor varied from 5 to 23 years. Despite the lack of having detailed information on irradiation factors in all patients, circumstantial evidence from this study suggests that radiation therapy may have contributed to the development of carcinoma of the vulva and vagina in some of the patients. Close follow-up patients treated for squamous carcinoma of the genital tract must emphasize inspection for new lesions. The incidences previously reported in the literature are also reviewed for comparison.