Bronchiolitis obliterans organizing pneumonia (BOOP) after thoracic radiotherapy for breast carcinoma

Common complications of thoracic radiotherapy include esophagitis and radiation pneumonitis. However, it is important to be aware of uncommon post-radiotherapy complications such as bronchiolitis obliterans organizing pneumonia (BOOP). We report on two patients with carcinoma of the breast who developed an interstitial lung disease consistent with BOOP. BOOP responds to treatment with corticosteroids and the prognosis is generally good despite of the need for long-term administration of corticosteroids as relapses can occur during tapering of steroids. This report provides guidelines for the evaluation and treatment of patients with pulmonary infiltrates after radiotherapy.     

Incidence of hepatitis among students at a university in Taiwan

The incidence of hepatitis in a general open population of Asian adults was estimated for the first time in this study. A group of 2445 students were first tested when they enrolled at National Taiwan University in 1977; approximately one third were susceptible to hepatitis A and another third to hepatitis B. Most of these students (92%) were retested shortly before their graduation in 1981 to determine the frequency of serologic conversions and clinical hepatitis which had occurred in the 3 1/2 years since they had entered the university. Among 704 susceptible to hepatitis A, 12 (1.7%) had undergone serologic conversions, 33% of which were associated with clinical illness diagnosed as hepatitis. Among 738 susceptible to hepatitis B, 39 (5.3%) had undergone serologic conversions, 12.8% of which were associated with clinical hepatitis. The annual incidence of new infections was 0.5% for hepatitis A and 1.5% for hepatitis B. An additional eight students among the 17 who had clinical hepatitis had no associated conversion of hepatitis A or hepatitis B markers, and were considered to have non-A, non-B hepatitis. No factors could be identified which were predictive of hepatitis risk. No difference in incidence was observed according to sex, type of residence, place of food consumption, or receipt of acupuncture or blood transfusion. Among the 39 students who experienced hepatitis B infections while at the university, there were 2.7% who became hepatitis B surface antigen (HBsAg) carriers. Thus the carrier frequency following hepatitis B infection among Chinese adults is the same or lower than that among Caucasian adults.     

Association of genetic polymorphisms of claudin‐1 with small vessel vascular dementia

The most recent hypothesis of the development of small vessel vascular dementia (VaD) emphasises the role of blood‐brain barrier (BBB) dysfunction. It is hypothesised that certain genetic polymorphisms of the BBB tight junction claudin‐1 protein, in combination with adverse environmental risk factors, increase the risk of BBB dysfunction and small vessel VaD. In this case‐control study, 97 control participants, with a mean Mini Mental State Exam (MMSE) score of 29.1, and 38 VaD participants were recruited and completed a questionnaire on their medical history and lifestyle factors. Blood was also collected and two single nucleotide polymorphisms (SNPs), rs17501010 and rs893051 of claudin‐1 genotyping, were analysed by real‐time polymerase chain reaction (PCR) assay. A significantly higher frequency of all rs893051 SNP genotypes (GC and CC) was found in the VaD population (OR=4.8, P=0.006 and OR=6, P<0.001 respectively). Patients with TT genotype of rs17501010 were also more likely to have VaD (OR=3.25, P=0.022). Stratification analysis revealed that having combined haplotype GC+CC of rs893051 and lipid disorders was associated with higher risk of VaD (OR=9.9, P<0.001). For patients with type 2 diabetes the odds ratio of VaD increased significantly in GC+CC genotypes of rs893051 (OR=12.57, P<0.0001) and GT+TT of rs17501010 (OR=5.33, P=0.01).     

Mathematical Modelling of Convection Enhanced Delivery of Carmustine and Paclitaxel for Brain Tumour Therapy

Purpose

Convection enhanced delivery (CED) is a promising method of anticancer treatment to bypass the blood–brain barrier. This paper is aimed to study drug transport under different CED operating conditions.

Methods

The convection enhanced delivery of chemotherapeutics to an intact and a remnant brain tumour after resection is investigated by means of mathematical modelling of the key physical and physiological processes of drug transport. Realistic models of brain tumour and its holding tissue are reconstructed from magnetic resonance images. Mathematical modelling is performed for the delivery of carmustine and paclitaxel with different infusion rates, solution concentrations and locations of infusion site.

Results

Modelling predications show that drug penetration can be improved by raising the infusion rate and the infusion solution concentration. The delivery of carmustine with CED is highly localised. High drug concentration only can be achieved around the infusion site. The transport of paclitaxel is more sensitive to CED-enhanced interstitial fluid as compared to carmustine, with deeper penetration into tumour interior. Infusing paclitaxel in the upstream of interstitial fluid flow leads to high spatial averaged concentration and relatively uniform distribution.

Conclusion

Results obtained in this study can be used to guide the design and optimisation of CED treatment regimens.

     

Long-term prognostic effects of plasma epstein-barr virus DNA by minor groove binder-probe real-time quantitative PCR on nasopharyngeal carcinoma patients receiving concurrent chemoradiotherapy

PURPOSE: To evaluate the long-term prognostic impact of plasma Epstein-Barr virus (EBV) DNA concentration measured by real-time quantitative polymerase chain reaction (RTQ-PCR) in nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT). METHODS AND MATERIALS: Epstein-Barr virus DNA was retrospectively measured from stock plasma of 152 biopsy-proven NPC patients with Stage II-IV (M0) disease with a RTQ-PCR using the minor groove binder-probe. All patients received CCRT with a median follow-up of 78 months. We divided patients into three subgroups: (1) low pretreatment EBV DNA (<1,500 copies/mL) and undetectable posttreatment EBV DNA (pre-L/post-U), (2) high pretreatment EBV DNA (> or =1,500 copies/mL) and undetectable posttreatment EBV DNA (pre-H/post-U), and (3) low or high pretreatment EBV DNA and detectable posttreatment EBV DNA (pre-L or H/post-D) for prognostic analyses. RESULTS: Epstein-Barr virus DNA (median concentration, 573 copies/mL; interquartile range, 197-3,074) was detected in the pretreatment plasma of 94.1% (143/152) of patients. After treatment, plasma EBV DNA decreased or remained 0 for all patients and was detectable in 31 patients (20.4%) with a median concentration 0 copy/mL (interquartile range, 0-0). The 5-year overall survival rates of the pre-L/post-U, pre-H/post-U, and pre-L or H/post-D subgroups were 87.2%, 71.0%, and 38.7%, respectively (p < 0.0001). The relapse-free survival showed similar results with corresponding rates of 85.6%, 75.9%, and 26.9%, respectively (p < 0.0001). Multivariate Cox analysis confirmed the superior effects of plasma EBV DNA compared to other clinical parameters in prognosis prediction. CONCLUSION: Plasma EBV DNA is the most valuable prognostic factor for NPC. More chemotherapy should be considered for patients with persistently detectable EBV DNA after CCRT.     

Penicillium marneffei infection in a non-HIV infected child

We report a case of Penicillium marneffei infection in a previously healthy 3.5 years-old Chinese boy and review the literature. The details of the case are described with emphasis on his immune function and treatment outcome. This boy had transient immunodeficiency involving phagocytic and NK cells due to P. marneffei infection which resolved after treatment with gamma interferon and amphotericin B. A prolonged course of fluconazole of 1 year was successful in preventing relapse. Gamma interferon, amphotericin B and a prolonged course of fluconazole may be useful in the treatment of life-threatening infection by P. marneffei.     

Outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with mebendazole and metronidazole use among Filipino laborers in Taiwan

OBJECTIVES: This study sought to identify the risk factors associated with an outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among Filipino laborers in Taiwan. METHODS: Forty-six SJS/TEN patients were matched to 92 controls according to month of arrival in Taiwan, sex, and age. RESULTS: The odds ratio for development of SJS/TEN was 9.5 (95% confidence interval [CI] = 3.9, 23.9) among workers who had used both metronidazole and mebendazole sometime in the preceding 6 weeks. In addition, a gradient increase in the occurrence of SJS/TEN was found with an increasing level of exposure to metronidazole. CONCLUSIONS: This outbreak highlights the risk of SJS/TEN resulting from the use of both metronidazole and mebendazole and the need for control measures.     

Enterovirus 71 outbreaks,Taiwan: occurrence and recognition

Enterovirus 71 (EV71) caused a large outbreak in Taiwan in 1998 with 78 deaths, and smaller outbreaks recurred in 2000 and 2001. The outbreak was recognized because of a large number of hand, foot, and mouth disease cases and the rapid deaths of children with the disease. Virologic and pathologic studies indicated that EV71 was the most important agent related to severe and fatal cases and that a neurogenic inflammatory response was involved in the pathogenesis of cardiopulmonary collapse resulting from fulminant EV71 infection. Seroepidemiologic study suggested that EV71 had circulated for at least 16 years and that the accumulation of susceptible hosts might have triggered the 1998 outbreak. However, a change in EV71 neurovirulence and host genetic susceptibility may also have affected the clinical outcome. The Taiwan outbreak shows that worldwide attention should be paid to such outbreaks, new antiviral drugs should be developed, and that vaccination of children under 5 years of age may be warranted.