Epstein-Barr virus DNA load in nasopharyngeal brushings and whole blood in nasopharyngeal carcinoma patients before and after treatment.

PURPOSE: Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and highly prevalent in Indonesia. EBV-DNA load can be used for early diagnosis and may have prognostic value. In this study, EBV-DNA load was evaluated in minimal invasive nasopharyngeal (NP) brushings and whole blood for initial diagnosis and therapy assessment against the standard-of-care diagnosis by biopsy with EBV-RISH and standard EBV-IgA serology. EXPERIMENTAL DESIGN: NP brushings and blood samples were collected from 289 consecutive ENT patients suspected of NPCs and 53 local healthy controls. EBV-DNA load was quantified by real-time PCR and serology by peptide-based EBV-IgA ELISA. Tissue biopsies were examined by routine histochemistry and by EBER RNA in situ hybridization. RESULTS: Repeated NP brushing was well tolerated by patients and revealed high viral load in the 228 NPC cases at diagnosis than 61 non-NPC cancer cases and healthy controls (P < 0.001). The diagnostic value of EBV-DNA load in blood and EBV-IgA serology was inferior to the NP brush results. The level of EBV-DNA load in brushes of patients with NPC was not related to T, N, or M stage, whereas elevated EBV-DNA load in blood correlated with N and M stage. EBV-DNA levels in brushings and whole blood showed a significant reduction at 2 months after treatment (P = 0.001 and P = 0.005, respectively), which was not reflected in EBV-IgA serology. CONCLUSIONS: NP brush sampling combined with EBV-DNA load analysis is a minimal invasive and well-tolerated diagnostic procedure, suited for initial diagnosis and follow-up monitoring of NPCs.

Product stewardship of Paraquat in Indonesia.

In Indonesia, paraquat products play an important role in controlling weed in plantation estates, small-holders farming land and potentially in tidal swamp areas to be converted to tidal rice farming. Laboratory and field data which showed that paraquat did not cause a health hazard to users/farmers if used normally or as recommended, and the virtual absence of environmental impact, were important information conveyed to the customers in the product stewardship activities. Education and training have been implemented in 11 provinces, covering 4934 farmers group, 206 Zeneca field staffs and 100 local government staffs since January 1993. Using interactive method and field practicals, significant improvements in the knowledge and skill of safe and effective use of pesticide have been achieved. The success of this stewardship initiative lies upon good relationship with government authorities and informal local leaders, besides careful planning.

A model for quantitative follow-up studies of cervical lesions.

A model for follow-up studies of cervical lesions is described in which the specimen were taken in a noninvasive way using Cytobrushes and in which automatic measurement of the abnormal nuclei in the sampled epithelial fragments was possible because 2-microns thin Feulgen-stained plastic sections were prepared. The planimetric parameters AREA, PERIMETER, FORM PE, and FORM ELL, and the densitometric parameters optical density (OD) and integrated optical density (IOD) were assessed. The mean total volume and the mean total DNA were calculated using stereological methods. The moderate dysplasias differed from the carcinoma in situs for all the densitometric parameters except for OD, and from the invasive carcinomas for IOD and 5cER. In the moderate-dysplasia group, there were three types of DNA histograms: a highly abnormal type resembling the histograms of the carcinoma group, a normal type, and an intermediate type. Changes in DNA histograms can be established during follow-up studies of dysplasias without having disturbed the lesion due to the efficient and elegant noninvasive sampling method that was not used in earlier quantitative studies.

Nasopharyngeal carcinoma: correlation of histopathology with radiation response.

Forty-nine cases of NPC were evaluated histopathologically and the radiation responses of the tumor types were assessed. The overall radiation response were as follows: CR 40.8%, PR 14.3%, NC 42.9%, PD 2.0%. The distribution of tumor types were: Squamous cell carcinoma (WHO type I) 4.08%; Non-keratinizing carcinoma (WHO type II) 4.08%; Undifferentiated carcinoma (WHO type III) 91.84% var. Lympho-epitheliomatous (LE), Anaplastic (A), Spindle cell (SC), Clear cell (CC). 94.38% of the cases were classified as clinical stage II, III and IV (tumor found beyond the nasopharyngeal space). The radiation response rate of the tumor in the lymphnode was reversed to the clinical stage and extent of node involvement, namely the higher stage and node involvement, the less rate of radiation response. Twelve cases received radiation dose of less than 4000 cGy, which comprised 11 NC cases and 1 PD case. Of the 37 cases who got 4000 cGy and over, the response rate was 72.97%. Of these WHO type I was not evaluated because of insufficient radiation dose; WHO type II showed 50% response rate; WHO type III showed 74.29% response rate. Radiation response (as assessed from the cervical lymphnode involvement) of NPC was influenced by tumor burden and histologic type of the tumor, namely the less differentiated tumor responded better than the more differentiated one. No definite conclusion can be drawn yet of the different behaviour (if any) of the variants of undifferentiated carcinoma (WHO type III) toward irradiation.

Some experience with in vivo staining of early laryngeal cancer in Jakarta, Indonesia.

Laryngeal cancer, clinically as well as pathologically, usually does not pose a difficult problem in diagnosis. The problem lies in the clinical diagnosis of early laryngeal cancer. We began to study and develop the in vivo staining technique for laryngeal lesions in our clinic, using toluidine blue, an acidophilic metachromatic dye. This preliminary study comprised eight cases of laryngeal lesions, five of which were carcinoma. Among these latter cases, besides carcinoma, we were able to detect dysplasia in two cases, carcinoma in situ in one case, and a false-positive area in one case. Noncarcinoma cases consisted of dysplasia, dysplasia in postradiation for carcinoma, and carcinoma in situ. In two cases of carcinoma, the tumor margin was accurately defined by positive staining area. This experience suggests that in vivo staining may be a useful method for early detection of laryngeal cancer used as an adjunct to microlaryngoscopy.

A clinico-pathologic study of cases with Schistosoma japonicum infection in Indonesia.

Combined clinico-pathological and laboratory examinations were carried out on 52 S. japonicum infected patients from an endemic area in Central Sulawesi, Indonesia. All of these patients exhibited signs and symptoms of chronic hepato-splenic schistosomiasis. None of the patients showed evidence of liver cirrhosis on histopathological examination. However, varying degrees of portal fibrosis were exhibited. The correlation between the degree of fibrosis and the clinical and laboratory findings were presented and discussed. Based on the results, liver biopsy proved to be a vaulable method of diagnosis in this particular type of infection. This study provides new information on S. japonicum infection in the area and may support a more solid basis for treatment.