The incidence of internal malignancies in pemphigus and bullous pemphigoid in Japan

To evaluate the significance of the association of malignancy with autoimmune blistering diseases, we studied the incidence of internal malignancies in pemphigus and bullous pemphigoid based upon 496 cases of pemphigus and 1113 cases of bullous pemphigoid in Japan. Results showed that (1) an association between internal malignancies and pemphigus was observed in 25 out of 496 cases (5.0%), while that with bullous pemphigoid was seen in 64 out of 1113 cases (5.8%). Such association ratios were significantly higher than that of the controls aged over 70 years old (0.61%); (2) The average ages of pemphigus/bullous pemphigoid with malignancy were 64.7 and 69.2 years, respectively. The association ratio of malignancy with pemphigus increased by age, while that with pemphigoid was not correlated with aging; (3) Lung cancer was most common in pemphigus and gastric cancer in bullous pemphigoid; (4) There were no significant differences in the titers of circulating antibody, the presence or extent of mucous involvement or annular erythema between bullous pemphigoid patients with malignancy and without malignancy. Our results indicated that detailed examination for internal malignancy is essential for those patients with pemphigus or bullous pemphigoid.

[Treatment of middle and lower ureteral stones with ESWL: evaluation of the results of 190 solitary stones in comparison with those of upper ureteral stones]

We analyzed the results of treatment with extracorporeal shock wave lithotripsy (ESWL) (Dornier HM-3) for middle and lower ureteral solitary stones from April 1986 to March 1993 in our hospital. A total of 238 sessions of ESWL were done for 71 cases of middle ureteral stones and 119 cases of lower ureteral stones. The findings were compared with those obtained on the upper ureteral solitary stones. The final stone-free rate of the upper ureteral stones by ESWL alone were 91.9%, whereas those of middle and lower ureteral stones were 86.2% and 85.2%. We conclude that ESWL is equally useful for middle and lower ureteral stones to upper ureteral stones.

[Health locus of control and acquisition of health-related information]

Relationships between acquisition of health-related information and Health Locus of Control (HLC) were investigated in 204 women aged 29-45 years, using Horige's Japanese version of Health Locus of Control (JHLC) Scales. The acquisition behavior of health-related information was obtained from the question "How often do you get health-related information by newspaper, television or magazine?" The results were as follows: 1) Women who perceived the information related directly to their personal health, acquired health-related information more often than those who did not perceive personal application of the information. 2) The technical school or junior college graduate group had the most health-related information acquisition scores. 3) The university graduate group had fewer Chance HLC beliefs and Supernatural HLC beliefs. 4) Family HLC mean scores were significantly higher in the "high family value" group than in the "high health value" group. 5) Internal HLC mean scores were significantly higher in those self-rated as "very healthy" than in those self-rated as "healthy" group. 6) Women acquiring health-related information the most had Internal HLC mean scores significantly higher than the others. Health-related information acquisition scores correlated significantly with Internal HLC mean scores and Family HLC mean scores.

Salt- and pH-dependent hemagglutination with Kasba virus, a member of the Palyam serogroup of the genus Orbivirus

Kasba virus grown in BHK21-WI2 cells was tested for hemagglutination (HA) with erythrocytes of a variety of species at 4 degrees C, 25 degrees C and 37 degrees C. HA was observed at all temperatures with cattle, sheep and goat but not with swine, chicken, and goose erythrocytes. The HA was dependent on not only the NaCl concentration but also the pH of the diluent. The HA titer significantly improved by increasing the NaCl molarity to 0.6 M and standardizing pH to 7.5. The HA titer was 16- or 32-fold higher in 0.4 M or 0.6 M solution than in 0.2 M solution of not only NaCl but also several other salts. The HA reaction was inhibited by specific antibody.

Isolation of porcine adenovirus as a candidate of 5th serotype

A strain of cytopathic virus, named strain TG/K79, was isolated from the brain of a newborn piglet, pure Hampshire breed, which died shortly after birth. The physicochemical property of virus was considered to be that of the family Adenoviridae. A significant difference between our isolated and 4 reference porcine adenoviruses was demonstrated by cross-seroneutralization test. Differences between TG/K79 and other porcine adenoviruses were also seen in electrophoretic patterns of viral DNA in agarose gel after digested by restriction endonucleases. Two SPF pigs, 2-month-old, experimentally infected via intranasal showed a fever and a hemorrhagic enteritis. A serological survey indicates that at least swine in the farm where the virus was isolated have been highly contaminated.

[Analysis of trace elements in biological materials by microwave induced plasma-mass spectrometry]

Analytical conditions have been established for determination of trace elements in biological materials by microwave induced plasma-mass spectrometry (MIP-MS). Possible elemental contaminants were checked in the water and reagents used, and during the wet-ashing process. Among 72 elements tested, contamination by Na, Mg, K, Ca, Fe, Ba, and Pb were observed. This contamination was estimated to occur mainly during the process of preparing samples due to the water, reagents and surroundings. Contamination by Ca, Mg, Zn and Pb from tubes for storage was also observed. Adequate conditions for multielement analyses in plasma and bone samples were evaluated. Both plasma and bone samples were digested by the wet-ashing technique before applying MIP-MS. The recovery rates of elements added were decreased depending on the contents of plasma or bone samples in the measuring solutions. The interfering effects of matrix modification due to organs were improved by correction with an internal standard. Recovery rates of elements added, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Rb, Sr, Mo, Cd, Sn, Ba, Pb and fourteen lanthanide elements (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, and Lu) were within 100 +/- 5% in analytical samples containing 1% volume of human plasma when Ga or Tl was used as the internal standard. Recoveries of Sn and Zn in the bone samples containing 0.1% bone as the original bone material, however, were 100 +/- 10% even after correction by the internal standard, suggesting the necessity of combined use of standard addition methods. The concentrations of V, Cr, Mn, Fe, Cu, Zn, Rb, Sr, Mg, and Ca in plasma from two healthy women were determined by MIP-MS. The data were consistent with the values reported elsewhere, and agreed very closely with those obtained by atomic absorption spectrometry. The accuracy of the values obtained by this method was confirmed using standard reference materials. These results indicate that MIP-MS is a useful method for multielement determination of biological materials.

[Ultrastructural consequence of shock wave exposure on VX2 cancer implanted to the urinary bladder]

In order to clarify the ultrastructural consequence of the VX2 cancer cell exposed to underwater shock waves. The VX2 cancer implanted to the urinary bladder of rabbit was received the shock waves (1000 shots, 100 MPa, 5/sec.) generated by the piezo-ceramics. Damage to the cancer cell were manifested by the three kind of findings: the one was the cell junction failure which caused the isolated cells; the second was the destruction of organelle which seemed to form the vacuole in cytoplasm; and the last finding was the emergence of moth eaten appearance in the exposed cell. We conclude that underwater shock wave exposure induces lethal injury in VX2 implanted cancer.

[The value of hepatic arterial infusion chemotherapy for liver metastases--discussion from viewpoints of prevention of hepatic death and QOL]

The value of hepatic arterial infusion chemotherapy for liver metastases was discussed from the viewpoints of the prevention of hepatic death and the negative effect on QOL, based on the results of repeated hepatic arterial infusion chemotherapy for 128 patients with unresectable liver metastases employing implantable catheter and port system. In 70% of patients, hepatic death due to metastases was prevented by this therapy, and the negative effect on QOL by this therapy was limited. Thus, in spite of the limited effects on the prolongation of survival compared with systemic chemotherapy, there is a reasonable basis for the use of hepatic arterial infusion chemotherapy as a treatment for unresectable liver metastases.

Serum pepsinogen as a new marker for gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.

METHODS

Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.

RESULTS

The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.

CONCLUSIONS

These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.

Replication of virulent and attenuated strains of Aujeszky's disease virus in swine alveolar macrophages

In vitro and in vivo replication of Aujeszky's disease virus (ADV) in swine alveolar macrophages (AM) was studied using two virulent strains and a vaccine strain with deletions in the thymidine kinase and gIII genes. In vitro, AM were highly permissive to virulent ADV infection. Virus progeny titers of virulent strains in the cell phase and in the fluid phase were higher than 10(7.3) TCID50/ml at 84 hr post-inoculation (PI). For vaccine strain infection, AM were less permissive, yielding virus titers of 10(2.3) TCID50/ml at 84 hr PI. To study in vivo replication of ADV in AM, virus isolations were made from AM collected at intervals from pigs inoculated intranasally with both the virulent and vaccine strains. Virus was isolated from AM samples collected from all pigs infected with the virulent strain from days 2 to 22 PI. On the contrary, no virus was detected in AM samples collected from pigs infected with the vaccine strain. The results presented suggested that in vivo virulent ADV replicates for a relatively long period in swine alveolar macrophages.

Serum pepsinogen as a new marker for gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.

METHODS

Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.

RESULTS

The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.

CONCLUSIONS

These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.

Healing of chronic gastric ulcer depends on gastric mucosal prostaglandin synthesis

In the present study, the role of endogenous prostanoid synthesis in gastric mucosa in the healing of chronic gastric ulcers was investigated. Nineteen patients were divided into two groups in accordance with healing state after one month of treatment with cimetidine only: "healed group" and "unhealed group". Biopsy specimens taken from the mucosa around the ulceration (damaged gastric mucosa) and at a distance from the ulceration (normal gastric mucosa) at endoscopy prior to treatment were homogenized, and the mucosal prostanoid synthesis was determined using [14C]arachidonic acid. The mean value of prostaglandin E2 synthesis in the normal gastric mucosa of the healed group was 60% higher than in that of the unhealed group, but the difference was not significant. However, prostaglandin E2 synthesis in the damaged gastric mucosa of the healed group was 117% higher than in that of the unhealed group. The same tendency was observed for prostaglandin D2 and 6-keto prostaglandin F1 alpha synthesis as for prostaglandin E2. In our study it was demonstrated that there is a good correlation of prostaglandin synthesis in the damaged mucosa with healing of chronic gastric ulceration. Furthermore, our study indicated that prostaglandin synthesis, especially in damaged mucosa, might be important in the healing of gastric ulceration.

[A nation-wide survey on the occurrence of Vogt-Koyanagi-Harada disease in Japan]

A nation-wide survey was performed to estimate the frequency and distribution of Vogt-Koyanagi-Harada's disease (Harada's disease hereinafter). A questionnaire was mailed to the departments of ophthalmology in hospitals with at least 200 beds. The response rate was 489 out of 1,077 institutions, or 45.4%. The annual prevalence was estimated to be 15.5 per million and the incidence was 6.5 per million, based on the number of reported cases and the response rate per prefecture. It was estimated that 1,800 patients were treated for this disease annually and that there were about 800 new cases. Geographical distribution showed no special characteristics such as these seen with Behçet's disease. The results of the analysis of 1,833 cases showed that females were slightly more affected than males, with an age distribution on first visit which showed a peak in the fourth decade and with the median age being 42.3 years.

[Prostatic carcinoma with bilateral testicular metastasis: a case report]

A 77-year-old man was referred for the treatment of urolithiasis. The patient noticed the swelling of bilateral scrotal contents 2 weeks previously and had been suffering from bladder symptoms for several years, dysuria and pollakisuria. Therefore, he was admitted for the treatment of stones and further examination. By transrectal examination, prostatic carcinoma was suspected. Biopsy of the prostate and bilateral orchiectomy revealed the prostatic carcinoma and the metastatic adenocarcinoma of the bilateral testis. The histological or immunohistological examination indicated that the metastatic adenocarcinoma was prostate in origin.

Treatment of ureteral stones by extracorporeal shock wave lithotripsy: with ureteral catheter or in situ?

Many authors recommend that stone manipulation or catheter placement be attempted before SWL of ureteral stones. We tried to insert ureteral catheters before SWL on the unmodified Dornier HM3 machine in all patients treated for solitary ureteral stones between April 1986 and December 1991, succeeding in 77.5% (n = 395) of those for whom adequate follow-up is available for analysis. The stone-free rates with SWL alone in the series of 510 patients were 93% in patients with catheters and 75% in patients without catheters. An additional 6% of the patients in both groups became stone free with the aid of ureteroscopy. Eventually, only 0.5% of the patients with a catheter and 1.7% of the patients without a catheter had residual fragments. Among patients with a ureteral catheter after any procedure, 58.7% had no need for pain relief medication and no fever; the figure in the patients treated without a catheter was 74.4%. Although the success rate of SWL for ureteral stones is higher with a ureteral catheter in place, the incidence of complications also is higher. We recommend trying in situ SWL initially for patients with a ureteral stone.

Comparative study of methods for determining lanthanide elements in biological materials by using NAA, HPLC postcolumn reaction, and ICP-MS

Mice were injected intravenously with one of the following elements: Y, La, Ce, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, or Yb, at a dose of 25 mg/kg body wt. After 20 h, the various organs were taken out, and the element concentrations were determined by NAA, HPLC postcolumn reaction, or ICP-MS. The results by these three methods were within the acceptable range. About 85% of the amount administered of each element was found in liver, lung, and spleen.

Hepatic arterial infusion chemotherapy for liver metastases from breast cancer

Between 1985 and 1992, 56 patients with unresectable liver metastases from breast cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable port system. 5-Fluorouracil (5-FU) at 330 mg/m2 per week. Adriamycin (ADR) at 20 mg/m2 every 4 weeks, and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to 42 patients. The remaining 14 patients received 5-FU at 330 mg/m2 per week and epirubicin (EPIR) at 20 mg/m2 every 2 weeks. As a rule, the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (41%), hepatic arterial occlusion (23%), and gastric mucositis (20%), but no major toxicity was encountered. The response rate (CR+PR) of the evaluated patients as determined from CT scans was 81%. The overall median survival period was 12.5 months. Only 14% of the patients died due to regrowth of liver metastases, and in 70% of the total cases, death due to liver metastases was avoided by this treatment. Thus, repeated hepatic arterial infusion chemotherapy for liver metastases from breast cancer might be capable of prolonging the survival of patients via avoidance of death due to the liver metastases.

The characteristics of another small DNA virus isolated from a pig with diarrhea

A small DNA virus was newly isolated from the small intestines of a pig with diarrhea in 1987, in Japan. Concerning the physicochemical properties, hemagglutination and susceptibility of cell culture to the virus, the virus was identical to a formerly isolated small DNA virus, the H-45 strain and also physicochemically similar to the parvovirus group. In a serological test however, the virus was distinctly, antigenically different from the H-45 strain as well as each of porcine, bovine and canine parvoviruses.

Effect of heparin on hemagglutinin of herpes simplex virus type 1

Heparin inhibited the hemagglutinin activity of herpes simplex virus (HSV) type 1. The minimal inhibitory concentration of heparin required to inhibit 8 hemagglutination (HA) U of HSV ranged from 0.005 to 0.01 U/ml. Mouse erythrocytes failed to combine with the HA inhibitory factor of heparin. On the other hand, mouse erythrocytes treated with heparinase had greatly reduced agglutinability by HSV. Virus-heparin complex formation was observed by sedimenting heparin with the virus particles.

Distinction between Aujeszky's disease virus-infected and vaccinated pigs by hemagglutination-inhibition test

A hemagglutination-inhibition (HI) test was applied to distinguish virulent Aujeszky's disease virus infected pigs from those immunized with a glycoprotein gIII deletion vaccine. The vaccine strain, dlg92/dltk, did not have hemagglutination activity with mouse erythrocytes and the pigs vaccinated five times with the dlg92/dltk strain failed to develop HI antibody, although they developed neutralizing antibody with 128 to 512 titers to Aujeszky's disease virus. On the other hand, these pigs produced HI antibody 1 to 2 weeks after virulent virus inoculation. Thus the animals infected with virulent strain were easily differentiated from the animals immunized with the gIII deletion vaccine.

Risk of liver cirrhosis and hepatocellular carcinoma in subjects with hepatitis B and delta virus infection: a study from Kure, Japan

To investigate the effect of hepatitis delta virus (HDV) superinfection on the long-term outcome of Japanese subjects with chronic hepatitis B virus (HBV) infection, we examined the presence of antibodies to hepatitis delta antigen (anti-HD) in serial serum samples collected from 1127 subjects with chronic HBV infection. The subjects were followed for at least 36 months (mean: 121.3 months) between 1973 and 1991. Among 69 cases where anti-HD was detected, eight (12%) developed liver cirrhosis (LC) and six (9%) developed hepatocellular carcinoma (HCC). However, among 1058 cases without anti-HD, there were 43 patients (4%) who developed LC and 29 (3%) who developed HCC. The prevalence of LC and HCC was significantly higher among the cases with anti-HD than those without anti-HD. The proportion of LC and HCC per 1000 person years was 10.46 and 7.84, respectively among cases with anti-HD, and 4.05 and 2.73 among those without anti-HD, respectively. The overall relative risk of LC and HCC was 2.58 and 2.87, respectively; 95% confidence interval (CI): LC, 1.14-5.13; HCC, 1.03-6.23. These results indicate that in the Kure district in Japan, where HDV infection of persons infected with HBV is about 6%, such superinfection increases the risk of LC and HCC.

[A case of multiple ureteral polyps treated with ureteroscopy]

We report a case of multiple ureteral polyps treated with a rigid ureteroscope in a 27-year-old man with the chief complaint of left lower abdominal pain. The patient, who had left renal stones pointed out on his plain film, was referred for further examination and treatment of left hydronephrosis as suggested by drip infusion pyelography (DIP). DIP and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the upper third of ureter. An ureteroscopic inspection and biopsy was conducted. The pathological diagnosis was fibroepithelial polyps of the ureter, so we performed an ureteroscopic polypectomy for the treatment. The postoperative course has elapsed favorably, without ureteral stricture or recurrence of the polyps. Ureteroscopic procedures are considered to be useful for the preoperative diagnosis and treatment of ureteral polyps.

[Intermittent hepatic arterial infusion of high-dose 5-FU for liver metastases from colorectal cancer]

A phase II study of weekly intermittent hepatic arterial infusion of high dose 5-FU for liver metastases from colorectal cancer was carried out. Thirty-two patients with unresectable liver metastases from colorectal cancer were entered in this study. Nausea (< or = grade 2) was observed in 31% of the cases, mild elevation of rGTP in 13%, biloma in 9%, and hepatic arterial occlusion in 22%. However, no major toxicity occurred. The response rate evaluated by CT-scans was 75% (4 CR + 20 PR/32), and the overall median survival was 22 months. Significant differences of median survival were observed in the extra-hepatic lesions [extrahepatic lesions: (-) 16 months vs (+) 22 months]. This regimen showed high activity without major toxicity and the reduction of pts' QOLs caused by pumps. It confirmed by a study involving a large number of cases, this regimen will become a standard regimen for unresectable liver metastases from colorectal cancer.