Elevation of serum CA 19-9 in parallel with HbA1c in a diabetic female with the Lewis(a+b-) blood group

We report a 66-yr-old diabetic female with her serum CA 19-9 levels elevated in parallel with her hemoglobin A1c (HbA1c) levels. She was initially suspected of having pancreatic cancer, but this was later proved to be false. Her serum CA 19-9 levels varied between 58 and 235 U/ml over a 3-yr period, and correlated significantly (r = 0.68, P less than 0.01) with her HbA1c levels (7.2-13.3%). She belonged to the Lewis (a+b-) blood group. Serum CA 19-9 levels were also assessed in 73 diabetic patients (36 males and 37 females) in relation to sex and Lewis blood group. The mean level of serum CA 19-9 was higher in females than in males in each Lewis blood group, and it was the highest in patients with Le(a+b-) and the lowest in Le(a-b-). Patients with a higher level of HbA1c showed a higher level of serum CA 19-9 in Le(a+b-), but patients with Le(a-b-) showed a low level of serum CA 19-9 irrespective of HbA1c level. Patients with Le(a-b+) appeared to intermediate between the patients with Le(a+b-) Le(a-b-). Thus, the elevation of serum CA 19-9 level due to hyperglycemia was indicated to be affected by sex as well as Lewis blood group. The biosynthesis of CA 19-9 seemed to be accelerated in hyperglycemic diabetic patients, especially in females. Consequently, it was considered that the present case was a diabetic female with the Le(a + b -) blood group, which led to showing a relatively high level of serum CA 19-9 correlated with HbA1c level.

A prospective study of tardive dyskinesia in Japan

A large-scale, prospective study of tardive dyskinesia (TD) was performed in 11 psychiatric facilities in Japan. A total of 1595 psychiatric patients were enrolled in this study in 1987. The progress of these patients, with the exception of 490 dropouts, has now been followed up to 1988. The prevalence of TD at study entry was 7.6%, the annual incidence rate was 3.7% and the annual remission rate was 28.7%. Newly developed TD patients tended to be older, to have undergone more psychosurgery, and to have had lower neuroleptic doses than the patients who had not developed TD, whereas no specific variable could be detected as a factor associated with remission of TD. The results suggest that the incidence of TD is lower in Japan than that in Europe and North America.

Ultrasound diagnosis of lymph node metastasis in head and neck cancer

The role of ultrasonic (US) examination in the detection of cervical lymph node metastasis from head and neck cancer has been evaluated. The subjects were 57 patients with carcinoma of the oral cavity, maxillary sinus or oropharynx who underwent radical neck dissection. The preoperative US and postoperative histopathological findings were compared in 181 lymph nodes (LNs) of 5 mm or more in diameter. LNs were evaluated by US with reference to their size, shape, boundary and internal echoes. The histologically positive rate was higher for larger LNs on US scans: 96% (44/46) of LNs of 15 mm or more were positive. On the other hand, 95% (18/19) of the flat LNs were negative. The positive rate was higher for well delineated than poorly delineated LNs, but similar among the homogeneous, heterogeneous and reflective core patterns of internal echoes. No LNs were detected by US in six of the 57 patients, of which four were true negative and the other two false negative. In the two false negative patients, histopathological examination showed a total of four LNs with two showing extensive extranodal spread of tumour and fibrosis of the surrounding tissue due to previous radiotherapy. Whether LNs are metastatic or not is difficult to determine directly by US. However, the positive rate can be enhanced by evaluation of the size, shape and boundary of the LN. US is indispensable for diagnosing cervical lymph node metastasis in patients with malignant head and neck tumours.

[Insufficiency fracture of the sacrum]

Three cases of insufficiency fracture of the sacrum are reported. Cortical disruption and linear sclerosis with or without linear fracture line at the upper sacral segment parallel to the sacroiliac joint are characteristic. Bone scintigram is suitable for screening, but plain radiographic and CT findings are diagnostic. Insufficiency fracture of the sacrum should not be confused with other conditions, such as metastatic disease.

Personal and indoor/outdoor nitrogen dioxide exposure assessments of 23 homes in Taiwan

Indoor and outdoor nitrogen dioxide (NO2) concentrations of 23 homes from two areas in Taiwan, the city of Taipei and a rural village in central Taiwan, were measured concurrently from December 1987 to January 1988. NO2 measurements were carried out by Palmes tube for one week and filter badges for two days. In Taipei, the mean NO2 concentrations outdoors, in the kitchens, in the livingrooms, and in the bedrooms were 40.1 ppb, 34.4 ppb, 32.1 ppb, and 29.7 ppb for one week, and were 25.7 ppb, 25.6 ppb, 22.6 ppb, and 20.5 ppb for two days. In the village of central Taiwan, the corresponding concentrations were 23.5 ppb, 24.5 ppb, 20.4 ppb, and 17.5 ppb for one week, and 20.3 ppb, 24.7 ppb, 18.8 ppb, and 15.4 ppb for two days. The NO2 concentrations of all microenvironments in Taipei were significantly higher than those in the village of central Taiwan. The outdoor NO2 concentrations were significantly higher than the indoor NO2 concentrations in Taipei. The NO2 measurements in the kitchens were higher than all other measurements indoors and outdoors in the village of central Taiwan. The houses which used natural gas as cooking fuel had slightly higher indoor NO2 concentrations than the houses which used LPG as cooking fuel in Taipei city. Cement houses had slightly higher indoor NO2 concentrations than brick houses. The mean of housewives' exposures was 30.8 ppb in Taipei and 19.9 ppb in the village of central Taiwan. The explanation power of the housewife's exposure to NO2 was 72% by the time weighted-average model and 70% by the simple linear regression model.

The effect of abstinence from smoking on urinary excretion of hydroxyproline

The effect of abstinence from smoking on the urinary hydroxyproline to creatinine ratio (HOP ratio) was assessed in 49 smokers who participated in an anti-smoking course. Urine samples were collected at the beginning of the course and weekly during the subsequent 14 weeks in 1985. The subjects were divided into five groups depending on the number of cigarettes smoked daily before abstinence: 1-10, 11-20, 21-30, 31-40 and greater than 40 cigarettes. The urinary HOP ratio immediately after abstinence from smoking was proportional to the mean daily number of cigarettes smoked in the past. All groups showed decreasing HOP ratios with a longer period of abstinence. Half of the total decrease observed in the HOP ratios after 14 weeks was reached within 5 or 6 weeks. When using the Brinkman index to adjust for the number of smoking years, half of the maximum decrease in all groups was reached within 4 weeks. In an exponential decay model fitted to the data, the half-life time taken to reach the non-smokers' level was 9-10 weeks for all groups. The HOP level of smokers who smoked less than 41 cigarettes before cessation approached the HOP level of the control group after 61-74 weeks. The results suggested that the urinary HOP ratio was useful as a biochemical marker for short-term breakdown of lung collagen and lung elastin.

The role of oxygen free radicals in experimental acute pancreatitis in the rat

In order to elucidate the role of oxygen-derived free radicals in acute pancreatitis, scavengers and an inhibitor of production of these free radicals were administered to rats with experimentally-induced acute pancreatitis. Acute reflux pancreatitis was produced by the occlusion of the common bile duct (OCD). Catalase and superoxide dismutase (SOD) were used as scavengers, and allopurinol was used as an inhibitor of production of free radicals. Six h after surgery, serum amylase, lipase, and thiobarbituric acid (TBA) reactant levels were elevated significantly, and histological changes in the pancreas, consisting of edema, inflammatory cell infiltration, and necrosis, partially around the intralobular and interlobular ducts, developed in the control rats receiving no agent. However, serum lipase and amylase levels in the rats given each agent were significantly lower (p less than 0.05) than in the controls. The histological changes in the pancreas were less marked in agent-treated rats than in untreated rats. These results suggest that oxygen-derived free radicals participate in the development of acute pancreatitis.

Indoor/outdoor measurements of volatile organic compounds in the Kanawha Valley of West Virginia

The Kanawha Valley region of West Virginia which is comprised of Charleston and surrounding communities is the center of a heavily industrialized area known for its chemical manufacturing. As part of a larger study designed to investigate the impact of the chemical industry on human exposures to volatile organic compounds (VOC), a study of the relationship between indoor and outdoor concentrations was conducted. Thirty-five homes were selected for monitoring from among volunteers; approximately ten in each of three distinct population-industry centers and four outside the Valley to act as controls. Monitoring was performed using passive, badge samplers with a three-week monitoring period. Two separate questionnaires were administered: one for characterization of the residence; and one to characterize source use during monitoring. Participants were also asked to keep a record of their activities with respect to in-home, outdoors and other indoor environments. Analysis of the samplers was performed by solvent extraction followed by gas chromatography using a flame-ionization detector. Results suggest that indoor VOC concentrations are higher than outdoor concentrations. Additionally, certain ventilation-related parameters were identified that afforded some predictive power for indoor concentrations. No statistically significant differences between regions were identified.

Transverse septum-like plaque of Peyronie's disease in a young man

An unusual case of Peyronie's disease in a 22-year-old male is presented. The patient complained of sluggish erection of the pendulous portion of the penis. A fibrous plaque in the tunica albuginea at the base of the penis extended into the corpus cavernosum cross-sectionally. Histology was consistent with Peyronie's disease. Some improvement was obtained by partial excision of the plaque.

Personal exposure and health effect relationship for NO2 with urinary hydroxyproline to creatinine ratio as indicator

Establishment of an exposure-effect relationship was attempted between personal nitrogen dioxide (NO2) exposure and urinary hydroxyproline to creatinine ratio of approximately 800 adult women, who were mothers of primary schoolchildren living in two communities around Tokyo. Daily average of the personal NO2 exposure (ENO2) was measured during wintertime by a newly developed personal monitor exposed for 24 hours. The hydroxyproline to creatinine ratio (HOP:C) in the urine sample collected early in the morning of the day for ENO2 measurement was used as a biochemical indicator of the health effect of NO2 exposure. The HOP:C was found to have significant correlation with ENO2 and number of cigarettes smoked actively and passively. ENO2, however, had no correlation with the intensity of the smoking levels; they might affect HOP:C independently. Stepwise multiple regression analysis revealed that HOP:C could be predicted by ENO2 and smoking habits at a high confidence level. The regression analysis of the active smokers' group indicated that a few cigarettes was enough to increase the HOP:C, while in the case of passive smoking, HOP:C increased proportionally to the number of cigarettes.

Treatment of bladder carcinoma in patients more than 80 years old

We reviewed 26 patients more than 80 years old with bladder carcinoma to determine if an active surgical policy is justified. Ten patients with superficial carcinoma were treated with transurethral resection; none died of cancer and half have survived 5 years. Of 16 patients with invasive carcinoma 9 underwent total cystectomy with urinary diversion and 2 underwent partial cystectomy. There was no operative mortality. Postoperative complications were not serious. Five of the 9 patients who underwent total cystectomy are alive, with a mean survival of 35 months. The 4-year crude survival rate was 50 per cent. Both patients who underwent partial cystectomy died within 2 years. One patient treated with radiotherapy alone and 1 without any treatment have survived 2 years. These results suggest that contrary to the general tendency towards conservative treatment, a curative operation is worth attempting in elderly patients with bladder carcinoma.

A comparative study on the health effects of smoking and indoor air pollution in summer and winter

This study was performed by a comparison between summer and winter for the purpose of demonstration the actual conditions of health effects of indoor air pollution with special reference to NO2 and smoking, on the subjects composed of 820 school children and their 546 mothers in the two areas with different ambient NO2 concentrations. In either case, examination was carried out with standardized questionnaire test for respiratory symptoms, personal NO2 exposure measurement using the filter badge by Yanagisawa, and analysis of urinary hydroxyproline and creatinine in two areas with different ambient NO2 levels. Personal NO2 exposure level in winter season was 2-3 times higher than that in summer, particularly NO2 level among residents living in homes with non-vented stove for space heating was substantially higher from those of residents with vented stove. Wives with vented stove had a moderate exposure level in winter season by the contribution of NO2 originated from the kitchen and poor ventilation rate. Since the hydroxyproline to creatinine ratio (HOP-ratio) of children increased more, their household location were nearer to any heavy traffic roads in summer, health effects from automobile exhaust were suggested only in summer season. In summer season, personal NO2 exposure level were almost the same with the ambient NO2 concentrations over both areas. These results suggest that indoor air pollution in winter season may be separated from outdoor air pollution. It was a matter of course that hydroxyproline to creatinine ratio in winter season was higher than that in summer, in any group and in any area, but the range of variation of hydroxyproline to creatinine ratio was smaller by far than that of personal NO2 exposure level. Judging from urinary hydroxyproline to creatinine ratio, health effects of active smoking and passive smoking increased with increasing the number of smoked, dose-dependently in any season. According to stepwise multiple regression analysis, hydroxyproline to creatinine ratio had significant relation to either NO2 and active or passive smoking, but personal NO2 exposure level had no relation to cigarette smoking. NO2 and cigarette smoke were seemed to make hydroxyproline to creatinine ratio increase, independently each other.

Personal exposure to nitrogen dioxide and its relation to indoor and outdoor air quality

An estimating equation of annual geometric average of personal NO2 exposure was proposed. The average could be calculated from three variables, that is, personal NO2 exposures in one winter and one summer month and ratio of winter period in a year. Ten housewives living in Suginami Ward, a residential area in Tokyo, were chosen as subjects of this study. They were asked to measure daily averages of the personal NO2 exposures with a filter badge. Measurements were performed on consecutive seven days in every month from January to December of 1982 for a total of 84 samples per person. Their activities, the amount of fuel consumption and other living conditions were recorded at the same time. Outdoor NO2 concentrations and maximum, minimum and average temperatures were also measured at the center of their living area. The personal NO2 exposure and its seasonal variation were found to depend mainly on the type of space heaters, frequency of ventilation fan usage in a kitchen, and the amount of fuel consumption.

Alpha-1-microglobulin: an indicator protein for renal tubular function

A comparison of urinary alpha 1-microglobulin concentrations to the behaviour of other indicators of renal tubular disorders, beta 2-microglobulin, retinol-binding protein and N-acetyl-beta-D-glucosaminidase (NAG) has been made. In acute tubular disorders the concentrations of urinary beta 2M and RBP are highly correlated (r = 0.89) but this is less marked for alpha 1M and beta 2M (r = 0.55) and alpha 1M and RBP r = 0.48. NAG tends to run a parallel course to alpha 1M concentrations but lags behind the recovery of low molecular weight protein reabsorption following injury of the tubular cells. The concentrations of alpha 1M, and in particular its stability at low pH suggest that this protein may be useful in screening for tubular abnormalities and detecting chronic asymptomatic renal tubular dysfunction. Urinary alpha 1M greater than 15 mg/g creatinine is strongly suspicious of a proximal tubular dysfunction. The distinction between pure tubular proteinuria and mixed glomerular and tubular proteinuria requires further analysis.

[Reproduction study of Guanabenz, a new antihypertensive agent (2) - teratological test in rats]

Guanabenz (WY-8678) was given to pregnant rats to examine its effects on dams, their fetuses, and offspring. The drug was administered orally to rats at 15, 5 and 1 mg/kg/day from the 7th days of gestation. The vehicle used was 5%-Arabic Gum at dose level of 5 ml/kg, and a control experiment where only the vehicle was administered was also conducted. The results obtained were as follows. 1. In the observation of the dams, the increase of body weight tended to be repressed in the 15 mg/kg group, and body weight decreased in the 30 mg/kg group. 2. The drug produced decreased spontaneous movement, sedation, and lacrimation of red exudate in dams. 3. Half of the 30 mg/kg group had a resorption, but there were no remarkable effects on length of gestation and nursing in the nursing group. 4. The weight of the thymus decreased dose-dependency. 5. No difference was observed in each group in the number of corpora lutea, the number of resorptions, the number of live fetuses, sex ratio, and mean placental weight of the fetuses. The mean body weight of the fetuses decreased in the 30 and among 15 mg/kg groups. 6. In observation of the fetuses, no difference was observed among groups regarding external and visceral malformations. In the skeletal observation, retardation of ossification of the forelimb and hind limb was observed in the 30 and 15 mg/kg groups, and retardation of ossification of the sternebra was observed in the 30 mg/kg group. 7. In observation of the offspring, the number of implantations, the number of live fetuses, delivery rate, and viability rate decrease in the 30 mg/kg group. No difference was observed among groups as to postnatal development symptoms, the faculties of sensation, and emotion. From these results, it is conducted that Guanabenz has no teratogenic potential in rats and the safe dosage levels seems to be below 5 mg/kg/day.

[Reproduction study of Guanabenz, a new antihypertensive agent (3) - perinatal and postnatal test in rats]

Guanabenz (WY-8678) was given to rats to examine its effects on dams and offspring in terms of influence on postnatal development emotion, learning and reproductive ability. The drug was administered orally to rats at 15, 8, 5, 2 and 1 mg/kg/day from the 17th day of gestation to the 21st post-partum day. The vehicle used was 5%-Arabic Gum at dose level of 5 ml/kg and a control experiment where only vehicle was administered was also conducted. The results obtained were as follows. 1. In observation of the dams, increase in body weight tended to be repressed after administration in the 8 mg/kg group, and in the 15 mg/kg group body weight decreased. Food consumption and water intake tended to be suppressed in the 15 mg/kg group. During nursing, changes of body weight, food consumption and water intake were not influenced by Guanabenz in each group. 2. The drug produced sedation, abnormal walking, decrease in a reflex test and lacrimation of red exudate in dams. 3. In the 15 mg/kg group, the length of gestation was prolonged. Furthermore, abnormal delivery and nursing were observed, and in one-third of dams in the 8 mg/kg group and in all dams of 15 mg/kg group, the still-birth of all offspring was observed. No difference was observed among groups as to the organ weights at weaning. 4. In observation of the offspring, differences were observed in the viability rate and the weaning rate. No difference was observed among groups as to the viability rate, changes of body weight, postnatal development, and behavioral development on the 7th day. No differences were observed in each group regarding emotion, motion, perception and learning. 5. No difference was observed among groups in the reproduction test. As to symptoms seen in gestation, the dams and fetuses were not influenced by dosage of Guanabenz. From these results, the safe dose level seems to be below 5 mg/kg/day.