Impact of underlying diabetes and presence of lung cavities on treatment outcomes in patients with pulmonary tuberculosis.

AIMS: We investigated the effects of diabetes and the presence of lung cavities on treatment outcomes in patients with pulmonary tuberculosis. METHODS: We conducted a retrospective review of the clinical records of all consecutive patients admitted to the Kanagawa Cardiovascular and Respiratory Centre with the diagnosis of pulmonary tuberculosis. The study outcomes examined were time to sputum culture conversion and percentage of patients with sputum culture conversion by the time 2 months of treatment, and these outcomes were compared between patients with and without diabetes. RESULTS: Of the 260 patients enrolled in the study, 69 were diagnosed as having diabetes mellitus, while the remaining 191 did not have diabetes. The percentage of patients with cavities was higher in the patients with diabetes (71.0%) than in those without (45.5%; P = 0.0003). The time to sputum culture conversion was significantly longer in the patients with diabetes than in those without (P = 0.0005), and the percentage of patients with a positive sputum culture at 2 months was higher in the patients with diabetes (43.5%) than in those without (18.8%; P = 0.0001). Multivariate analyses revealed that the presence/absence of lung cavities was a more important determinant of treatment outcomes than the presence/absence of diabetes. CONCLUSIONS: The presence of lung cavities was found to be a more important determinant of the treatment outcomes than that of diabetes per se in patients with pulmonary tuberculosis.

[Direct anti-tumor effect of recombinant human IFN-gamma evaluated in ovarian pseudomyxoma peritoneally transplanted into nude mice].

Different doses of recombinant human interferon gamma (IFN-gamma) between 1 X 10(6) and 2 X 10(7) U/kg were administered to nude mice for 21 days continuously. As a result, an anti-tumor effect was noted in comparison with a control group, although there was no significant difference between groups at each dose level. Serum CEA value was found to decrease in the groups as follows: 1 X 10(6) U/kg, 71.5 +/- 10 ng/ml; 3 X 10(6) U/kg, 90.6 +/- 4 ng/ml; 8 X 10(6) U/kg, 56.5 +/- 0.7 ng/ml; 2 X 10(7) U/kg, 47.4 +/- 12 ng/ml. Generally, the level was found to decrease in groups with high-dose administration. There was no difference in histological effect between groups at each dose level, and also no strong anti-tumor effect like that produced with other anti-cancer agents was noted with regard to histological change. It was revealed that recombinant human IFN-gamma was effective for suppression of tumor proliferation in human ovarian tumor, although its histological effect was less effective than that of anti-cancer agents such as Adriamycin and Cis-DDP.

[An experimental study of cisplatin and it's antidote, sodium thiosulfate, in ovarian pseudomyxoma implanted into nude mice abdominal cavity].

While Cisplatin was found to be effective in treating pseudomyxoma, its side effects, particularly on the kidneys, were very strong. Recently a "two channel therapy", in which it is used along with sodiumthiosulfate, has been reported to minimize the side effects. The authors used nude mice with pseudomyxoma implanted into the abdominal cavity in an experiment in which Cisplatin was introduced into the abdominal cavity and sodiumthiosulfate injected subcutaneously in a two channel procedure to determine the effect of sodiumthiosulfate on the action of Cisplatin on the pseudomyxoma and on the side effects of Cisplatin. The following results were obtained: The survival rate was improved when sodiumthiosulfate was administered with 40 mg/kg and 20 mg/kg of Cisplatin. Body weight loss was controlled when sodiumthiosulfate was administered with 20 mg/kg of Cisplatin. On the other hand, the histological effect of Cisplatin was also suppressed when sodiumthiosulfate was co-administered. In this study, we failed to observed any histological changes in the kidneys and liver attributable to Cisplatin.

[Studies of immunological function in patients with ovarian cancer].

Immunological function in patients with ovarian cancer was studied using parameters including peripheral blood lymphocyte counts, lymphocyte subsets, PHA-induced lymphoproliferative (PHA-LP) reaction, PPD skin test and immunoglobulin levels. The following results were obtained: The number of total lymphocytes, T cells (OKT 11+) and B cells (OKIa 1+) in peripheral blood were found to be decreased in patients with advanced carcinoma. The positive rate of PPD skin test was also lower in the patients. OKT8+ cells were significantly increased in the disseminated carcinoma (DC) group and the OKT4+/OKT8+ ratio in the DC group was markedly decreased when the results were compared with the control and the patients in the localized carcinoma (LC) group. PHA-LP reaction and serum IgM level in the patients in the LC and DC groups were found to be significantly lower than in the control group. The percentage of T cell (OKT11+), serum IgG and IgA levels were not altered in any clinical stage of the patients.

[Studies on immunosuppressive acidic protein (IAP) in ovarian tumors].

The value of IAP was measured in 64 patients with ovarioncus. The results obtained were as follows: The value of IAP in patients with malignant ovarioncus increased with the clinical progress of the disease. There was, however, no significant difference between the value in patients with malignant tumor in stage I or II and those with benign tumor. Therefore, the value has little usefulness for early diagnosis. In tissue typing of malignant ovarioncus, IAP was not positive in the case of intimoidal cancer, but it was almost on the same level in other cases. In terms of the relationship between IAP and plasma proteins or the immune index involved in various kinds of cancers, the value was closely correlated with the erythrocyte sedimentation rate and levels of CRP and mucoprotein, but not with the level of CEA, the LDH isozyme M/H ratio, or WBC and PPD skin reaction. Regardless of whether the tumor was benign or malignant, the value transiently increased postoperatively and then gradually decreased. Prognosis was poor in most cases with malignant ovarioncus, where the level of IAP remained high or rose again postoperatively. The level of serum IAP was almost correlated with the progress of the disease and is therefore useful as a marker in making a prognosis.

[The present status of tumor markers in malignant ovarian tumor].

Various serological data comprising 25 items were analyzed on 152 cases of malignant ovarian tumor and 124 cases of bening ovarian tumor. The results revealed that some differences were observed for of these 25 items between both benign and malignant tumors, and especially TPA, CA-125, etc comprised remarkable differences. On recent 99 cases examined for all these items, a synthetic judgment was passed in combination with these serological data. The results suggested that malignant diagnosis can most likely be established for more than 5 item-positivity.

[Assessment of cases with ovarian cancer stage I].

In the therapy of primary ovarian cancer in which the tumor is located in one ovary, radical operation including the uterus and contralateral ovary is performed in principle even in the case of young patients. However, there have been only a few results reported on the primary cases in our country, and the radical operation is adopted at present in line with western policy. In the present study, the authors examined mainly the prognosis of 49 patients with primary ovarian cancer (stage Ia, 25 cases; stage Ib, 2 cases; stage Ic, 22 cases), and the following results were obtained. Among 25 cases at stage Ia, the radical operation was performed on 14 cases, and only the conservative operation was performed on the remaining 11 cases. All of the latter are still well. Only one died among patients at stage Ia. Therefore, in these cases, complete treatments were done, including radical operation, postoperative irradiation and chemotherapy, and second look operation. The prognosis of the patients at Ic was worse than that at IIa + b. Therefore, it was felt to be necessary to treat them as progressive cancer. There was no difference between the prognoses of the conservative and radical operations even at stage Ic. Thus, problems such as functional maintenance were thought to be taken into consideration. Risk factors considered were tissue type, amount of ascites, capsular rhexis, and advanced age, etc. Since the prognosis after the second look operation was good, it was considered to be a treatment which should be introduced actively, even at stage I.

[Alteration of peripheral blood lymphocyte subsets in the patients with ovarian cancer before and after chemotherapy].

Peripheral blood lymphocyte subsets of 8 patients with ovarian cancer were analyzed before and after chemotherapy by using monoclonal antibody (OKT series) and laser flow cytometer (Spectrum III). The following results were obtained: There was no significant difference in the distribution of OKT3+ and 11+ cells before and after chemotherapy, and between the patient and the control groups. OKT4+ cells were significantly decreased in number after chemotherapy in the patient group when the results were compared with the control (p less than 0.001) and the pretreatment (p less than 0.05) groups respectively. OKT8+ cells were more markedly increased in number after chemotherapy in the patient group (p less than 0.05) than in the control group. OKIal+ cells were more increased in number after chemotherapy in the patient group (p less than 0.01) than the control group. The OKT4+/OKT8+ ratio in the patient group was significantly decreased after chemotherapy when the value was compared with the control (p less than 0.001) and the pretreatment (p less than 0.05) groups.

[Approach to the diagnostic colposcopy--a scoring method of colposcopic pattern].

In order to arrive at a final diagnosis of early cervical cancer by colposcopy alone, a colposcopic scoring system was applied to 172 patients with the disease. Each colposcopic pattern was scored from one point (for white epithelium) to 9 (for invasive cancer). The results obtained were as follows; 1) With these scoring criteria, stage 0 cancers were restricted to below 10 points and were characterized colposcopically by white epithelia with gland openings 2) In stage I-a lesion, atypical vessels, punctuation by irregular arrangement of the dots and concentration of abnormal gland openings were usually observed, and these findings were combined with each other to show a more complicated colposcopic pattern reflected in 11 to 18 points of the score 3) Frank invasions were indicated by 19 points or more, and punctuations or mosaics were seldom found in this stage, although the early "I-b" cancer was difficult to distinguish from I-a with this method 4) The diagnoses from this scoring system were identical with the final diagnoses confirmed by surgical methods in 66.7% of stage 0, 59.4% of I-a and 76.5% of I-b.