Adenocarcinoma of the uterine corpus following irradiation for cervical cancer.
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Biomedical subjects
Publications and source records attributed to R M Scott.
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Serum specimens drawn at random from three geographically defined populations of healthy Thais were tested for antibody to the hepatitis A virus (anti-HAV) by radioimmunoassay. A total of 746 specimens were tested. The age by which 50 per cent were antibody positive was 4-5 years for residents of an urban Bangkok housing project, 8-9 years for rural villagers, and 10-11 years for urban Bangkok government school pupils. Overall, specimens from 97 per cent of Thai adults 16 years of age or older were anti-HAV positive. These data suggest widespread distribution of HAV in Thailand.
To determine the incidence of clinical and inapparent hepatitis in a US military population stationed in Thailand, the authors prospectively studied a cohort of 326 men during one year. Clinical hepatitis A occurred in one man (clinical attack rate = 3.1/1000 men/year), and clinical hepatitis B was found in four men (clinical attack rate = 12.3/1000 men/year). No non-A, non-B hepatitis was identified. There was no serologically identified inapparent hepatitis A but inapparent hepatitis B occurred in 17 men. The apparent/inapparent ratio for hepatitis B was 1:4.25. Serotype analysis suggested that hepatitis B virus largely originated from Thai contacts, although 23% of cases were derived from western sources. To determine the relative contribution of 16 statistically significant (out of 67 studied) behavioral variables to the transmission of HBV, a factor analysis and a multivariate correlation analysis were employed. Factor analysis indicated that social and sexual contact with the indigenous population, including prostitutes, residence within the Thai community and marijuana use were behavioral areas that were associated with the acquisition of hepatitis B. Residence in the Thai community during the first four-month period in Thailand, sexual contact with a prostitute during the third four-month period, and ever having maintained a Thai mistress were found to be significant and independent risk factors by multiple regression analysis.
The treatment results in a series of 30 patients with parotid gland carcinoma are reported. Postoperative irradiation to the parotid bed and regional lymph node appears to improve the result of treatment. No difference in the results or complications was found between the group of patients treated by external irradiation or external irradiation combined with radium implantation. Irradiation of residual disease was more effective than irradiation of the recurrences.
Histocompatibility antigen (HLA) A and B typing on lymphocytes from 87 unrelated Thai children who had been hospitalized with dengue shock syndrome (DSS) and/or dengue hemorrhagic fever (DHF) was compared with that found in 138 controls who had not been hospitalized with clinical dengue infection. These data are presented as descriptive information; however, a statistical analysis was performed to identify potentially important relationships for future study. Several deviations (P less than 0.05) were detected in the distribution of four HLA-A and three HLA-B antigens. The prevalence of one HLA-A antigen and two HLA-B antigens appeared to relate to the development of DSS, with a positive association seen for HLA-A2 and HLA-B blank and a negative relationship for HLA-B13. These findings require confirmation, but they do suggest that genetic susceptibility may be important in the development of DHF/DSS and indicate that further broader studies of genetic markers might be rewarding.
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An adolescent military dependent population, 86% of whom had documented history of rubella immunization, was screened by two commercially available rubella hemagglutination inhibition tests. All those who were R-HAI antibody negative were immunized, and postvaccination sera were examined for the development of rubella-specific antibody (R-IgM). R-IgM was not found in any of the previously immunized subjects despite the lack of R-HAI antibody. R-IgM was detected in two seronegative subjects who had no documentation of previous rubella immunization. Thus, although the R-HAI antibody had waned, the engrams of previous immunization remained, resulting in a secondary response on re-exposure. The development of a secondary immune response, despite the absence of detectable r-HAI antibody, casts doubt on the validity of R-HAI as a screening test to determine rubella immunity. The data support continuing mass immunization of preschool children and vaccination of all older females who lack documentation of rubella immunization.
Local failure (in the cervix and pelvic wall) continues to be a major reason for poor results following conventional radiation treatment of Stage IIIB (FIGO) carcinoma of the cervix. Attempting to minimize this local failure, in 1975 and early 1976, the Radiation Therapy Department, University of Maryland Hospital, began using a parametrial implant technique in a selected group of patients who had met the criteria for implant in Stage IIIB carcinoma of the cervix. Essentially, prior to radium implant, all patients received whole-pelvis irradiation (4000-5000 rad TP/four to five weeks) plus an appropriate parametrial boost to the affected side (pelvic wall to 5500 rad/over five and a half weeks). Two types of radium were given: 1) a protruding tandem with parametrial implant by means of radium needles; and 2) a radium implant to the lower segment of uterus and affected parametrium plus a vaginal colpostat in cases of severe shortening (or absence) of the uterine cavity or when we were unable to identify the uterine cavity. A total of 31 cases were treated with one or the other of these techniques and have been followed for a minimum of three years. Results show an absolute disease-free survival rate of 64.5% (20 of 31) with a determinate disease-free survival rate of 71.4% (20 of 28). The overall local control rate is 84% (26 of 31). Analysis of local and paraaortic failures as well as distant metastases and complications are presented in detail.
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The prevalence of HBSAg in a cross-sectional serosurvey of a rural Thai village was nearly 8%. The corresponding antibody prevalence was approximately 35%. The prevalence of antigenaemia was significantly higher for adult males than for adult females. Possible dynamics of hepatitis B virus transmission in this rural village are explored, but tend to rely on a differential handling of antigenaemia by males and females. A considerable proportion of the hepatitis B virus exposure appears to be associated with malaria prophylaxis programmes.
Dengue viruses were isolated by a plaque technique in LLC-MK2 cells from washed peripheral blood leukocytes of patients with hemorrhagic fever. In comparison with plasma, the use of peripheral blood leukocytes permitted greater than three times the recovery rate of viruses, allowed for the isolation of strains of virus from patients with high serum levels of antibody to dengue virus, and extended the period of detectable viremia. The use of peripheral blood leukocytes was especially useful for isolation of viruses from patients with hemorrhagic fever, in whom antibody titers were generally quite high during the acute phase of the disease. This method is recommended for use by laboratories with access to the appropriate acute-phase specimens. Of the peripheral blood leukocytes, adherent monocytes appeared to be the cells most likely affected; however, involvement of atypical lymphocytes, which are commonly found in patients with hemorrhagic fever, or polymorphonuclear leukocytes could not be excluded by this study. Only a small number of infected centers could be identified by infectious-center assays, but the marked augmentation of recovery of virus with the use of peripheral blood leukocytes indicated the presence in patients of a subpopulation of cells that permit dengue virus infection.
The ability of human semen and saliva to transmit hepatitis B virus (HBV) by parenteral and nonparenteral routes was studied. Semen, donated by a hepatitis B surface antigen (HBsAg)- and hepatitis B e antigen (HBeAg)-positive carrier, was administered to one gibbon by subcutaneous inoculation and to another by intravaginal instillation. Both developed HBsAg, followed by the development of antibody to HBsAg (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc). Saliva from two donors who were HBsAg- and HBeAg-positive was pooled and administered subcutaneously to two gibbons and orally to five others. The animals inoculated subcutaneously developed HBsAg followed by anti-HBs, but none of the gibbons exposed orally developed evidence of HBV infection. Thus, semen and saliva of HBsAg carriers can be infectious, and venereal transmission of HBV by semen can occur. Transmission of HBV in saliva can also occur through breaks in the skin, but experimental transmission of HBV by saliva administered orally has not been accomplished.
The use of irradiation by electron beam in the treatment of four cases of extensive basal-cell carcinomas of the skin of the head and neck is described. The technique of treatment is simple, convenient, well tolerated, and the treatment has good cosmetic and functional results. Local control has been excellent in the cases treated and there have been no complications from the electron-beam therapy.
Studies were undertaken in Indian rhesus monkeys (Macaca mulatta) to determine the safety, potency, immunogenicity, and mosquito infectivity of a small-plaque, temperature-sensitive variant of dengue type 2 (DEN-2) virus, a vaccine candidate. Fifteen monkeys were inoculated subcutaneously with the vaccine virus, ten receiving 10(3.1) plaque-forming units (PFU) and five receiving 10(4.5) PFU. After primary immunization, viremia was detected in only one monkey, a recipient of the higher dose of vaccine. The recovered virus had the same growth characteristics as the vaccine strain. Aedes aegypti mosquitoes did not become infected when they were allowed to feed on monkeys that received the lower dose of vaccine. As expected, the immunization produced no evidence of illness in any of the animals. A dose response to vaccine was detected; all five of the high-dose recipients developed neutralizing antibodies, whereas only five of ten low-dose recipients did so. In both groups, neutralizing antibody was often transient. Its presence at 30 days did not always correlate with protection from viremia in those animals challenged 4 to 6 months after vaccination with wild-type DEN-2 virus. However, immunized animals developed anamnestic antibody responses after challenge, and none demonstrated adverse effects to infection. Reimmunization of monkeys 4 months after primary immunization led to the production of low-titered but persistent neutralizing antibody which protected the animals from a wild-type virus challenge.
Peripheral leukocytes from 16 Thai children with dengue hemorrhagic fever were examined to determine the leukocyte composition on the day of presentation and on convalescent days 15 and 30. Mononuclear cells were isolated each time, and the concentrations of T, B, Fc receptor-bearing, and "null" cells were determined. On the day of hospitalization, in comparison to convalescent values, there was a significant increase in total lymphocytes, primarily due to concentrations of atypical lymphocytes. There was a significant loss of T cells with an increase in non-T, non-B, non-Fc receptor-bearing null cells. There were no changes in the concentrations of monocytes, B cells, or Fc receptor-bearing cells when acute and convalescent values were compared. During the convalescent period, a progressive increase in eosinophils was noted. Also, on day 15 but not on day 30 of the convalescent period, an increase was observed in the total leukocyte number due to an increase in granulocytes. There results indicate that in Thai children with dengue hemorrhagic fever, there are major shifts within several component cell subpopulations of the immune system.
The usefulness of thoracic irradiation was evaluated in 62 patients with asymptomatic Stage III carcinoma of the lung. In 48 patients, the disease was confined to the thorax, in eight supraclavicular nodes were involved, and in six there were distant metastases. Fourteen patients were in poor general conditions as well. Fourteen patients received a short course of irradiation (less than 3,000 rad [30 Gy]), while 48 received radical doses (5,500-6,000 rad [55-60 Gy]). Five patients (8%), all with carcinoma confined to the thorax, survived three years. Radical radiation therapy plays a positive role in the treatment of asymptomatic State III carcinoma of the lung, and may result in tumor control in those patients with no extrathoracic disease.
Hemagglutination inhibition tests for antibody against chikungunya virus and the four dengue viruses were performed on a rural Thai village population. The 50% and 90% prevalence indices fell at about ages 3 and 15 for dengue virus exposure. This is considerably earlier exposure than comparable urban populations. The prevalence of chikungunya virus antibody was also age related with 50% prevalence at about age 45.