Radiation therapy of CNS lymphoma

A retrospective analysis of 22 patients with central nervous system (CNS) non-Hodgkin's lymphomas seen from 1978 to 1989 at Hamamatsu University Hospital was carried out. These were corresponding to 16% (22/137) of non-Hodgkin's lymphomas treated by irradiation during the same period. Six patients had primary intracranial involvement, six had secondary one, five had leptomeningeal involvement and five had spinal cord compression. Median survival of these groups 29 months, 7 months, 6 months and 4 months, respectively. On the case primary intracranial involvement, neurological signs and symptoms and performance status (PS) were improved in most patients. Whole brain irradiation with a dose of 45 Gy to 50 Gy followed by systemic chemotherapy was considered as effective treatment modalities. On the other hands, for the secondary intracranial lymphomas, clinical symptoms and PS were excellently improved by radiation therapy, however these were not reflected to survival. The conditions having primary site on gastrointestinal tract and relapse as systemic dissemination were considerable risk factors for the control of CNS involvement. For these patients, prophylactic chemotherapy should be necessary. Improvement of PS on patients with leptomeningeal lymphomas was obtained in only 3 of 5 cases. These were treated by irradiation on whole spine or neuroaxis and intrathecal MTX injection. We observed 2 cases dying from cerebrovascular accident and one case from leukoencephalopathy. This showed that such combination therapy should be carefully attempted. Five patients having spinal cord compression suffered from paraplegia and none of them had been improved on their symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimation of a drug effect by a simplified radioaerosol inhalation lung cine-scintigraphy: bromhexine on mucociliary clearance mechanisms

A proposed simplification of radioaerosol inhalation lung cine-scintigraphy, namely 60 min measurement of radioactivity without repeating measurement at 24 hr later and calculation of alveolar deposition ratio (ALDR) by the regression formula of ALDR = -48.08 + 0.47 X FEV1.0% + 0.59 X LRR60, was found useful and applicable even to the evaluation of a drug on mucociliary clearance mechanisms. The simplified method indicated a very similar evaluation of the effect of bromhexine on airway clearance efficiency with those actually revealed by the original method.     

Radiation therapy of the para-aortic lymph nodes in carcinoma of the uterine cervix: the concurrent use of cimetidine to reduce acute and subacute side effects from radiation

A prospective study of the effects of radiation therapy (RT) on para-aortic lymph nodes in uterine cervical cancer was conducted. As part of the study, cimetidine (800 mg daily) was administered during RT to relieve and prevent adverse reactions of the gastrointestinal tract caused by RT. In half of the patients, cimetidine (400 mg daily) was continued after RT was finished. The RT field was 7 to 8 cm wide and covered the area from the 4th lumbar to 11th thoracic vertebrae. The total dose administered was 45 Gy in 25 fractions over a five-week period. From September 1986 through October 1987, 89 patients were entered in this study. During RT, only slight gastrointestinal symptoms, such as nausea, vomiting, appetite loss, fatigue, and epigastralgia, were observed. These symptoms increased when cimetidine was withdrawn, but not in the patients who continued to receive cimetidine. It is concluded that cimetidine during and after RT can reduce the acute and subacute side effects of RT.     

New enzymatic determination of sialic acid in serum

This enzymatic method for determination of sialic acid involves use of neuraminidase (EC 3.2.1.18), N-acetylneuraminate lyase (EC 4.1.3.3), acylglucosamine 2-epimerase (EC 5.1.3.8), N-acetylhexosamine oxidase (from Pseudomonas sp.), and peroxidase (EC 1.11.1.7). Because the method does not require pyruvic acid in the assay medium, interference by pyruvic acid in serum can be avoided. This simple, accurate assay is little affected by other substances in serum.     

Collection of mobilized peripheral blood stem cells from a donor with severe iron deficient anemia

We report a 45-year-old woman with iron deficient anemia (IDA) who underwent a collection of allogeneic peripheral blood stem cells (PBSCs) induced by granulocyte-colony stimulating factor (G-CSF) after a rapid improvement of IDA by iron replacement. Her peripheral red blood cells (RBCs) after iron therapy were composed of two different-sized subpopulations; one consisted of microcytes, which were iron deficient RBCs, and another of normocytes, which were produced after iron replacement. On the first day of PBSC collection, the interface setting was maintained aiming at 2% hematocrit as usual; however, PBSCs could not be collected adequately. Sedimentation of iron deficient, lighter RBCs under centrifugation within a blood cell separator could be similar to that of mononuclear cells, and the lighter RBCs could contaminate the mononuclear cell layer, resulting in the collection of the lighter layers of mononuclear cells than desired. On the second day, we succeeded in obtaining enough PBSCs by collecting heavier layers than those collected on the first day by using a 4% hematocrit and monitoring white blood cell counts of the collection line serially. It should be noted that the lighter RBCs from a donor with a history of IDA could complicate collection of PBSCs.     

Novel Ultrasonographic Scoring System of Sinusoidal Obstruction Syndrome after Hematopoietic Stem Cell Transplantation

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a well-documented complication after hematopoietic stem cell transplantation (HSCT). Transabdominal ultrasonography (US) enables the visualization of blood flow abnormalities and is therefore useful for the diagnosis of SOS/VOD. We herein prospectively evaluated accuracy of a novel US diagnostic scoring system of SOS/VOD based on US findings. We carried out US in 106 patients on day 14 and when SOS/VOD was suspected after allogeneic HSCT. Among 106 patients, 10 patients (9.4%) were diagnosed as SOS/VOD by Baltimore or Seattle criteria. According to univariate analysis of 17 US findings (US-17 screening), we established a novel scoring system (HokUS-10) consisting of 10 parameters, such as gallbladder wall thickening, ascites, and blood flow signal in the paraumbilical vein. The sensitivity and specificity were 100% and 95.8%, respectively. Diagnostic performance of the HokUS-10 was significantly better than US-17 screening. In 4 of 10 patients US detection of SOS/VOD preceded to clinical diagnosis. The HokUS-10 scoring system is useful in the diagnosis of SOS/VOD; however, our results should be validated in other cohorts.     

Identification and detection method for genetically modified papaya resistant to papaya ringspot virus YK strain

Unauthorized genetically modified (GM) papaya (Carica papaya LINNAEUS) was detected in a commercially processed product, which included papaya as a major ingredient, in Japan. We identified the transgenic vector construct generated based on resistance to infection with the papaya ringspot virus (PRSV) YK strain. A specific detection method to qualitatively monitor papaya products for contamination with the GM papaya was developed using the real-time polymerase chain reaction.     

Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group

Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4(+) cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.     

The development of a gene vector electrostatically assembled with a polysaccharide capsule

The purpose of this study was to develop a gene vector electrostatically assembled with a polysaccharide capsule. We used pDNA/polyethylenimine (PEI) complexes as efficient non-viral vectors. The pDNA/PEI complex was electrostatically encapsulated with various polysaccharides such as fucoidan, λ-carrageenan, xanthan gum, alginic acid, hyaluronic acid, and chondroitin sulfate (CS). The pDNA/PEI complex was shown as nanoparticles with positive ζ-potential, although the ternary complexes encapsulated with polysaccharides were shown as nanoparticles with negative ζ-potential. The pDNA/PEI complex showed high agglutination activity and cytotoxicity, although the ternary complexes encapsulated with polysaccharides had no agglutination activities and lower cytotoxicities. The pDNA/PEI complex showed high uptake and high transgene efficiency in B16-F10 cells. On the other hand, most of the ternary complexes show little uptake and gene expression. The ternary complex encapsulated by CS, however, showed comparable transgene efficiency to the pDNA/PEI complex. The uptake and gene expression of the ternary complex encapsulated by CS were significantly inhibited by hypothermia and the addition of CS, suggesting that the ternary complex was taken by CS-specific receptor-mediated energy-dependent process.