Anatomic relations between ankle arthroscopic portal sites and the superficial peroneal and saphenous nerves

Ankles from 100 cadavers were dissected to evaluate the risk of nerve injury from an arthroscopic procedure. A total of 65 cadavers (104 ankles) were examined to assess the course of the peroneal nerve, and 35 cadavers (77 ankles) were examined for the saphenous nerve (SN). In 82% of specimens, the superficial peroneal nerve ran between the lateral border of the talocrural joint and the peroneus tertius tendon at the talocrural joint level, where the anterolateral portal was placed. Therefore, the superficial peroneal nerve was at high risk for injury with anterolateral portal placement. At the anteromedial portal site, between the medial border of the talocrural joint and the tibialis anterior tendon, the SN coursed an average of 6 +/- 5 mm medial to the medial border of the talocrural joint. SNs in this area were all terminal branches; therefore, anteromedial portal placement avoids nerve injury.

Rice has two distinct classes of protein kinase genes related to SNF1 of Saccharomyces cerevisiae, which are differently regulated in early seed development

We have isolated five cDNA clones (osk1-5) for protein kinases from rice which are related to SNF1 protein kinase of Saccharomyces cerevisiae. Based on the sequence homology, these cDNAs can be classified into two groups, group 1 (osk1) and group 2 (osk2-5). The products of these genes were demonstrated to be functional SNF1-related protein kinases by in vitro and in vivo experiments. Recombinant proteins expressed from both groups of genes were fully active as protein kinases and could phosphorylate SAMS peptide, a substrate specific for the SNF1/AMPK family, as well as themselves (autophosphorylation). Moreover, expression of osk3 cDNA in yeast snf1 mutants restored SNF1 function. Northern blot analyses showed differential expression of these two gene groups; group 1 is expressed uniformly in growing tissues (young roots, young shoots, flowers, and immature seeds), whereas group 2 is strongly expressed in immature seeds. SNF1-related protein kinases have been reported from different plant species, such as rye, barley, Arabidopsis, tobacco, and potato, while the type of gene strongly expressed in immature seeds is known only in cereals such as rye, barley, and, from our findings, in rice. Expression levels of the group 2 genes were further analyzed in seeds during seed maturation. Expression is transiently increased in the early stages of seed maturation and then decreases. The expression peak precedes those of the sbe1 and waxy genes, which are involved in starch synthesis in rice. Taken together, these findings suggest that group 2 OSK genes play important roles in the early stages of endosperm development in rice seeds.

A cross-sectional study on the relationship between depression and left ventricular hypertrophy

BACKGROUND

Despite a large number of studies, the relationship between depression and cardiovascular disease remains ambiguous. This study is the first to investigate the relationship between depression and left ventricular hypertrophy (LVH) as detected by electrocardiogram.

METHODS

The subjects were 346 male Japan Self-Defense Forces personnel ages 49 to 55 years. LVH was assessed by electrocardiogram. Depression was measured by the Self-Rating Depression Scale (SDS). Other selected risk factors were measured. Odds ratios for LVH in relation to selected variables were calculated. A logistic regression analysis was used to adjust for possible confounding variables.

RESULTS

High level of depression (SDS score > or = 34) showed a high risk of LVH occurrence. After adjusting for BMI, systolic blood pressure, and/or diastolic blood pressure, there was a tendency toward a positive association of LVH with high level of depression.

CONCLUSIONS

Our present study demonstrated that depression is closely related to LVH. Since LVH could be a predictor of fatal cardiovascular disease, this is of direct relevance to the prescription of preventive measures.

Epidemiologic study of the relationship between schistosomiasis due to Schistosoma japonicum and liver cancer/cirrhosis

In Yamanashi Prefecture, one of the former areas in Japan endemic for Schistosoma japonicum, there have been no cases of schistosomiasis since 1978. We attempted to find out in this study whether there was still a chronic effect of schistosomiasis, e.g., liver cancer or liver cirrhosis present in this region. The subjects studied were the population in Yamanashi Prefecture from 1973 through 1992. We divided the population into residents in an area endemic for schistosomiasis and those in a nonendemic area. We calculated the standardized mortality ratios (SMRs) for liver cancer and liver cirrhosis in both areas. The schistosome egg-positive rate of liver cancer and liver cirrhosis specimens from the patients in these two endemic areas was also calculated. Male SMRs for liver cancer in the endemic area were 188.5% in 1985 and 188.0% in 1990. Even today, many years after the last case of schistosomiasis, schistosome eggs can be found in the livers of deceased liver cancer and cirrhosis patients. The chronic effect of S. japonicum could contribute to the current high mortality rate for liver cancer in the endemic area, although we need to consider the other etiologic factors of liver cancer, e.g., hepatitis B virus, hepatitis C virus, and alcohol intake.

Associations between anthropometric indices of adiposity and atherogenic risk factors in Japanese working women aged 21-40 years

This study was conducted to explore whether anthropometric indices of obesity are associated with atherogenic risk factors in young adult working women in Japan. The subjects were 492 women in an occupational setting. Predictor variables were body mass index (BMI), the sum of triceps and subscapular skinfold thickness (SFT), and the waist to hip ratio (WHR). Outcome variables were serum total cholesterol, triglyceride and blood pressures. The average age of the subjects was 26.3 (SD 3.9) years. The upper quartiles of BMI and SFT were significantly associated with all atherogenic risk factors, while the upper quartiles of WHR were not. Multiple comparisons revealed the 4th quartiles of BMI (> 22.25) and SFT (> 39 mm) to have significantly higher values for all atherogenic risk factors. We found that BMI and skinfold thickness were more relevant to the prediction of atherogenic risk factors than WHR in young adult Japanese women.

Signet ring cell carcinoma of the stomach: a clinicopathological comparison with the other histological types

A retrospective analysis was carried out on 93 patients with signet ring cell carcinoma of the stomach operated on between 1985 and 1995, to review the clinicopathologic characteristics from the database of gastric cancer at Sendai National Hospital. The results were compared with those for 590 patients with other types of gastric carcinoma. Women were afflicted as commonly as men in the signet ring cell carcinoma group. These patients tended to be younger and to have larger tumors. The histological type was commonly scirrhous and infiltrative. The survival of patients with signet ring cell carcinoma was worse than that of patients with other types of gastric cancer but the difference was not statistically significant. Patients with early signet ring cell carcinoma had a good prognosis, similar to that of the other groups. However, prognosis of patients with advanced signet ring cell carcinoma was poor compared with patients with other types of this disease. In multivariate analysis, the statistical significant prognostic factors were vascular microinvasion and tumor location. These findings suggest that signet ring cell carcinoma of the stomach should be regarded as a distinct type of gastric cancer.

Inhibitory effect of tranilast on hypertrophic collagen production in the spontaneously hypertensive rat heart

Tranilast, N-(3,4-dimethoxycinnamoyl) anthranilic acid, a widely used antiallergy drug in Japan, has been shown to inhibit transforming growth factor-beta1 release from fibroblasts and reduce collagen synthesis in keloid cells. In the present study, we have investigated the effect of this drug on cardiac hypertrophy in spontaneously hypertensive rats (SHR), with a focus on the cardiac collagen matrix, which is associated with myocardial stiffness. Twenty-four-week-old SHRs and Wistar Kyoto rats (WKYs) were administered tranilast (300 mg/kg) orally once a day for 4 weeks. This treatment significantly suppressed increases in left ventricular collagen concentration (P < 0.05) and the left ventricular weight/body weights ratios (P < 0.05) in SHRs, and tranilast was ineffective on collagen concentration and ventricular weight/body weights ratios in WKYs. Tranilast did not affect systolic or diastolic blood pressure, end-diastolic left ventricular pressure and heart rate in both SHRs and WKYs, and the agent did not change positive dp/dt or cardiac output in SHRs. The pressure-volume relationship curve was shifted to the left by the drug; the slope (k) of the logarithm of the pressure-volume relationship curve was significantly increased (P < 0.05) in SHRs. It is concluded that the suppression of increases in cardiac collagen and left ventricular mass by tranilast results in a corresponding prevention of cardiac stiffness as studied in the SHR.

Lymph node metastasis in early gastric cancer: how can surgeons perform limited surgery?

BACKGROUND

In Japan, the standard treatment policy for all potentially curable patients with gastric cancer is radical resection, including extensive lymph node dissection. The extent of lymph node dissection remains a controversial issue in the management of early gastric cancer. A recent trend in the surgical treatment of early gastric carcinoma has been to limit surgery such that a complete cure is achieved and the patient's quality of life is improved. However, approximately 10% of early gastric cancers are reported to be node positive and little is known about the protocol of surgical treatment most appropriate for the treatment of early gastric cancer. In this study, we examined the clinicopathological features that could distinguish node-positive cancer from node-negative cancer.

PATIENTS AND METHODS

The clinicopathological features of 26 patients with node-positive early gastric cancer were reviewed from the database of gastric cancer at the Department of Surgery, Sendai National Hospital. They were compared with those of 239 patients with node-negative cancer.

RESULTS

Tumor size, macroscopic appearance, depth of cancer invasion, histological growth pattern and lymphatic invasion were associated with lymph node metastasis. Node-positive patients with early gastric cancer had a poorer survival rate than node-negative patients (P<0.05).

CONCLUSION

Limited surgery, such as local resection without lymphadenectomy, can be performed for elevated or flat type cancer, or tumor <2 cm in diameter. Lymphadenectomy is recommended to achieve higher possible cure rates for other early gastric cancers.

Colony stimulating factor-inducing activity of isoflavone C-glucosides from the bark of Dalbergia monetaria

To obtain immunomodulating substances from Amazonian medicinal plants, hot water extracts from 21 samples available commercially were tested in terms of mitogenic and colony-stimulating factor (CSF)-inducing activities. Among them, Dalbergia monetaria exhibited the highest CSF-inducing activity. Orobol 8-C-glucoside (OCG-8) and orobol 6-C-glucoside (OCG-6) were isolated from the bark of D. monetaria as major constituents. The CSF-inducing activity of OCG-8 was higher than that of OCG-6 and a dose-dependent manner at a range of 0.1-10 mg/mouse. Serum CSF production induced by an intraperitoneal (i.p.) injection with 1 mg OCG-8 reached a peak at 4-6 h later, suggesting that OCG-8 would act on hematopoietic system.

Effects of FK506 on experimental membranous glomerulonephritis induced by cationized bovine serum albumin in rats

BACKGROUND

There have been no reports on the effect of FK5 06, a new immunosuppressive agent, on experimental membranous glomerulonephritis (MN) induced by an exogenous antigen. Therefore we investigated the effects of FK506 on MN induced by cationized bovine serum albumin (C-BSA) in rats.

METHODS

Two weeks after the rats were immunized with 1 mg of C-BSA and Freund's complete adjuvant, they received intravenous injections of 3 mg/kg of C-BSA 3 times weekly for 4 weeks. Rats were divided into four groups: group A (n = 5) received intramuscular injections of 3 mg/kg of FK506 daily for 5 days beginning 2 days before the first immunization; group B (n =4) received 1 mg/kg of FK506 daily for 2 weeks beginning 2 weeks after the first immunization; and group C (n =4) received 1 mg/kg of FK506 daily for 2 weeks beginning 4 weeks after the first immunization. Group D (n = 5) received no FK506 and served as the control group. Rats were sacrificed 8 weeks after the first immunization.

RESULTS

Administration of FK506 in the preimmunization stage almost completely suppressed the development of MN in group A. Histological findings in groups B and C were similar to those in group D, the control group. However, urinary protein excretion was significantly lower in group B (24+/-46 mg/day) and C (220+/-44 mg/day) than in group D (330+/-61 mg/day). Expression of intracellular adhesion molecule-1 in glomeruli and the number of leukocyte functioning-associated molecules-1 were significantly decreased in groups A, B, and C compared with the control group. Administration of FK506 was not associated with any significant side-effects or histological abnormalities. The whole-blood trough levels of FK506 in groups B and C were 9.1 ng/ml and 9.2 ng/ml respectively.

CONCLUSIONS

The efficacy of FK506 was significantly increased when the drug was administered in the early phase of immunization in this model. The present study suggests that FK506 may be useful in patients with intractable nephrotic syndrome such as MN.

Parasites and related pathological lesions in the gastrointestinal tract of a seal (Phoka vitulina Linnaeus)

An immature seal, about one-year-old, died a natural death. At autopsy, a large number of Contracaecum osculatum and Pseudoterranova decipiens, as well as some of Anisakis simplex were found in the stomach together with numerous Corynosoma strumosum in the small intestine and colon. Histopathological examination revealed epithelial desquamation, congestion and hemorrhage in the mucosa. There were cellular infiltration and fibroplasia around the nematodes, collapsed nematodes and molted nematode cuticules in the stomach wall. The small intestine and colon underwent severe epithelial desquamation, catarrhal inflammation, and slight inflammatory response consisting mainly of lymhocytes. To the best of our knowledge, this may be the first report on Corynosoma strumosum in Japan.

Chronic double-level cauda equina compression. An experimental study on the dog cauda equina with analyses of nerve conduction velocity

STUDY DESIGN

Nerve conduction velocity was studied in the dog cauda equina subjected to chronic double-level compression.

OBJECTIVES

To analyze the effects of chronic double-level cauda equina compression.

SUMMARY OF BACKGROUND DATA

Double-level cauda equina compression produces more symptoms in patients and more changes in acute experimental set-ups than does single-level compression. However, there have been no controlled, experimental studies on chronic double-level compression.

METHODS

A total of 20 dogs were anesthetized. Two balloons were placed under the lamina of the seventh lumbar vertebra and the first sacral vertebra, respectively. One week (10 mm Hg, n = 5; 0 mm Hg, n = 5) and 1 month (10 mm Hg, n = 5; 0 mm Hg, n = 5) after inflation with a viscous substance, nerve conduction velocity was studied by local electrical stimulation and recording of muscle action potentials in the tail muscles.

RESULTS

Nerve conduction velocity was determined over the cranial balloon, the caudal balloon, and both balloons. The data were similar for all three recordings. After 1 week there was a significant reduction in nerve conduction velocity induced by 10 mm Hg, compared with that induced by 0 mm Hg, which showed normal conditions. However, after 1 month this initial reduction in nerve conduction velocity had recovered partially. The reduction was similar to that described for single-level compression in a previous study in which the same compression model was used.

CONCLUSIONS

Unlike the acute situation, chronic double-level compression does not induce more changes than single-level compression after 1 week, although the recovery after 1 month of compression is less complete after double-level compression. This less complete recovery may be a result of an adaptation of the nerve tissue and the vascularization of the cauda equina nerve roots to the applied pressure.

Direct innervation of sensory fibers from the dorsal root ganglion of the cervical dura mater of rats

STUDY DESIGN

Sensory innervation in the cervical dura mater of rats was investigated immunohistochemically in whole tissues and transverse sections of the decalcified vertebral column.

OBJECTIVE

To investigate the origin and distribution of sensory innervation in the cervical dura mater.

SUMMARY OF BACKGROUND DATA

It has been generally accepted that irritation of the cervical structures is one of the major causes of pain in the neck and the upper extremities. Sensory fibers in the cervical dura mater are possible mediators of pain. However, there is little information about sensory innervation in the cervical dura mater, including the epiradicular sheath.

METHODS

Ten Wistar rats were used for wholemount immunohistochemical observations of the cervical dura mater. The vertebral columns of five rats were processed for immunohistochemistry after decalcification. In all specimens, sensory fibers were demonstrated by the peptide immunohistochemistry, and sensory innervation was examined.

RESULTS

The cervical dura mater was arbitrarily divided into three areas: ventral, dorsal, dorsal root ganglion. A large number of fibers were in the dorsal root ganglion area and were distributed in the corresponding segments. Some calcitonin gene-related peptide immunoreactive fibers in the dorsal root ganglion were directly innervated from dorsal root ganglion area neurons and did not form nerve bundles, similar to the sinuvertebral nerve. Several immunoreactive fibers were seen in the ventral area; fibers were rarely observed in the dorsal area.

CONCLUSIONS

A large number of sensory fibers are segmentally distributed in the cervical dura mater, and some of them are directly traced from dorsal root ganglion neurons.

Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study

STUDY DESIGN

A retrospective case-control study was performed using the radiographs taken at the first hospital visit in two groups; in one group, spondylolisthesis developed after the first hospital visit, and, in the other, spondylolisthesis had not developed over 10 years.

OBJECTIVES

To determine possible radiographic differences between these two groups to clarify the pathoanatomic mechanisms of anterior slipping.

SUMMARY OF BACKGROUND DATA

The etiology of degenerative spondylolisthesis, for example, underlying pathoanatomic mechanisms such as dysfunction of the disc or horizontalization of the lamina and the facets, has been difficult to resolve, because radiographs taken before the occurrence of the slip have not been available in previous investigations.

METHODS

Sixty-nine patients with spondylolisthesis in whom degenerative spondylolisthesis developed after the first hospital visit and for whom radiographs taken before the slip were available were studied retrospectively. In 63 patients slipping did not develop over 10 years, with or without intervertebral instability; these patients were studied as a control group. The radiographs taken before and after the occurrence of the slip in the patients with spondylolisthesis were examined and compared with those without spondylolisthesis. Dysfunction of the disc, horizontalization of the lamina and the facets, and the sagittal alignment of the facet joints were assessed in each group.

RESULTS

Patients in whom anterior slipping developed had signs indicating that horizontalization of the lamina and the facets had occurred before the slip. However, the patients in whom spondylolisthesis did not develop had no horizontalization of the lamina and the facets at the first hospital visit or during the follow-up period. There was no significant difference in dysfunction of the disc between the cases with and without spondylolisthesis. Sagittal alignment of the facet joints was seen more frequently in the patients in whom slipping occurred than in patients with no spondylolisthesis, but approximately 40% of the patients in whom slipping occurred did not demonstrate sagittal alignment.

CONCLUSION

Horizontalization of the lamina and the facets is a pathoanatomic risk factor that can predispose for the development of degenerative spondylolisthesis. If dysfunction of the disc occurs in addition to these conditions, spondylolisthesis may develop.

Autoimmune enteropathy with severe atrophic gastritis and colitis in an adult: proposal of a generalized autoimmune disorder of the alimentary tract

BACKGROUND

We describe the case of an adult with autoimmune enteropathy consistent with both severe atrophic gastritis accompanying antral stenosis and colitis.

METHODS AND RESULTS

The patient, positive for anti-intrinsic factor antibody, had intractable diarrhea and protein-losing enteropathy. In the ileum inflammatory cells were observed infiltrating the lamina propria along with villus atrophy, and similar inflammation was also found in the lamina propria of the colon and stomach, with complete loss of specialized glands. The myenteric ganglion cells of the hypertrophied muscularis propria in the stenosed antrum showed degeneration with surrounding T-lymphocyte infiltration. There were more CD8+ than CD4 lymphocytes in the lamina propria of the stomach and colon.

CONCLUSIONS

The CD8+ (suppressor-cytotoxic) T lymphocytes may have played an important role in the production of lesions in the stomach, small intestine, and colon, so we propose this case as an example of a generalized autoimmune disorder of the alimentary tract.

Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience

BACKGROUND/AIMS

The efficacy of palliative gastrectomy in gastric cancer with peritoneal metastases remains uncertain. The aim of the present study was to evaluate the benefits of gastrectomy on the postoperative course of patients with gastric cancer and simultaneous metastases to the distant peritoneum.

METHODOLOGY

A total of 122 patients who had gastric cancer and metastases to the distant peritoneum were studied with respect to survival.

RESULTS

The extent of peritoneal metastases did not significantly affect the prognosis. Moreover, multivariate analysis indicated that surgery without gastrectomy was the only significant prognostic factor (relative risk, 2.587).

CONCLUSIONS

Our results suggest that the decision to perform gastrectomy does not depend on the extent of peritoneal metastasis in gastric cancer. Furthermore, palliative gastrectomy, if feasible, seems to have a beneficial effect on the postoperative course and is indicated for patients regardless of metastasis to the peritoneum, if the primary tumor is surgically resectable and there is no evidence of liver metastasis.

Photochemically induced endothelial injury in the mouse as a screening model for inhibitors of vascular intimal thickening

We have established a mouse model of intimal thickening and assessed its suitability for experimental studies of intimal thickening. Neointimal formation was observed after endothelial injury by photochemical reaction between transluminal green light and systemically administered rose Bengal, which represents a nonmechanical approach to vessel wall denudation. Intimal thickening began 7 days after endothelial injury, reached a maximum after 21 days, and then remained unchanged for as long as 42 days. Furthermore, as a consequence of neointimal proliferation, the luminal area gradually decreased. The cells in the neointimal layer were identified as smooth muscle cells by immunohistochemical staining with an alpha-actin-specific antibody. Extracellular matrix deposition in the neointima was markedly increased beyond 14 days after injury. Smooth muscle cell proliferation, as measured by pulse labeling of 5-bromo-2'-deoxyuridine, was identified initially in the media 2 days after vessel wall denudation, with the proliferative activity's shifting almost exclusively to the neointima within 7 days. Endothelial regeneration, as indicated by Evans blue staining, was complete within 21 days after injury. To assess the suitability of this model for experimental studies on intimal thickening, the effect of tranilast, an antiallergy drug with a broad spectrum of pharmacological actions on intimal thickening, was investigated. Tranilast (100 mg x kg(-1) x d(-1) p.o.) significantly (P<0.05) reduced smooth muscle cell proliferation in the neointima and media 7 days after injury and neointimal formation 21 days after injury in treated mice compared with vehicle-treated mice. This simple experimental mouse model is suitable for studying factors promoting or inhibiting intimal thickening after endothelial injury and for developing therapeutic strategies against intimal thickening.

Liver transferase activity in healthy Japanese employees aged 18-39 years

The aims of the present study were to identify correlates of alanine aminotransferase (ALT or GPT) and aspartate aminotransferase (AST or GOT) activities among a healthy working population aged 18-39, and to discuss liver transferase abnormalities. Subjects included 1,009 employees of a company in Fukushima, Japan. Pregnant women, employees exposed to organic solvents, and employees with a history of liver diseases were excluded. Serum ALT and AST levels were measured by an enzymatic method. Other information including BMI, job type and lifestyles was recorded. Mean ALT and AST levels were significantly higher for males than females (P < 0.001). Multiple linear regression analysis revealed that sex and BMI explained 45% and 31% of the variability in ALT and AST, respectively. The prevalence of abnormal ALT levels (> 40 IU) was 16.3% for males and 0.4% for females. Sex, BMI, and shift work were independently associated with abnormal ALT levels by logistic regression analysis. It is concluded that ALT and AST levels are well-correlated with sex and BMI, and that abnormal liver transferase activity is prevalent in male employees but rare in females, suggesting that liver function tests should be introduced for male employees under 40 years of age.

The significance of oligoclonal bands in multiple sclerosis in Japan: relevance of immunogenetic backgrounds

We compared clinical and demographic features, MRI findings, and HLA profiles of 57 Japanese patients with multiple sclerosis (MS) between groups with and without oligoclonal IgG bands (OCB) in the cerebrospinal fluid (CSF). Patients with the optic-spinal form of MS (OpS-MS) or acute transverse myelopathy (ATM), which are distinctive and relatively common in Japanese MS, were excluded in this study. The OCB-positive rate was only 56.1% (32/57) among these 57 'conventional' MS patients, of whom clinical features were similar to those of Western MS patients. The demographic features, clinical course, disability, and cerebral abnormalities seen on MRI were similar in the OCB-negative and OCB-positive patient groups. HLA-DR2 antigen, which has been confirmed to be associated with MS in many populations, was more common in the OCB-positive than in the OCB-negative and control groups. Furthermore, DR4 antigen was statistically more common in the OCB-negative patient group. These results raise the possibility that the presence of OCB is related to the immunogenetic background of the patient, and that there may be at least two subpopulations in Japanese patients with 'conventional' MS from the viewpoint of immunogenetics. In one subpopulations, MS is associated with the DR2 antigen, and shows a stronger humoral immune response in the CSF, while in the other MS is associated with DR4, which has a milder humoral response. Further investigations involving more patients are warranted.

[A case of systemic AA amyloidosis complicating Crohn's disease]

Although systemic AA amyloidosis complicating Crohn's disease has been found in 0.5 to 6% in America and Europe, it is relatively rare in Japan. We report a case of systemic AA amyloidosis complicating Crohn's disease. In 1979, a 26-year-old Japanese man presented with diarrhea, melena and perianal abscesses, and was diagnosed as having Crohn's disease. He was treated with oral prednisolone, salazosulfapyridine and diet therapy. However, the gastrointestinal symptoms recurred and he was hospitalized several times. In 1991, his thyroid gland was found to be swollen, but with normal thyroid function, and his thyroid gland became larger subsequently. In October 1995, he showed renal dysfunction (blood urea nitrogen 33.2 mg/dl; serum creatinine 1.5 mg/dl) with proteinuria. His renal function had been deteriorating rapidly. On September 13, 1996, he was admitted to the Tsukuba University Hospital. At the time of admission, his renal function showed a blood urea nitrogen of 129.5 mg/dl with a creatinine of 5.4 mg/dl. The urine contained 0.8 g of protein per 24 hours. He presented with diarrhea for several days before admission and was treated with central venous hyperalimentation. Despite supportive care, he developed end-stage renal failure, then hemodialysis was initiated on October 7. His condition was complicated by a complete auriculoventricular block on October 18. He died of hemoperitoneum on October 25. On postmortem examination, extensive amyloid deposits were found in multiple organs including kidneys, intestine, heart, thyroid gland, lungs, liver, spleen, pancreas, gall bladder, adrenal glands, testis, prostate, bone marrow and parathyroid glands. Analysis of amyloid protein in the autopsy specimens showed type AA.

Functional evaluation of inhibition of autonomic transmitter release by autoantibody from Lambert-Eaton myasthenic syndrome

The effects of the anti-voltage-gated Ca2+ channel (VGCC) antibody obtained from patients with Lambert-Eaton myasthenic syndrome (LEMS) on autonomic neurotransmission were studied in in-vitro experiments. The releases of acetylcholine (ACh) and norepinephrine from the autonomic nerves were evaluated by changes in the contractile responses of guinea pig taenia caeci and left atria to electric field stimulation, respectively. Incubations for 6 hours with LEMS serum and IgG, both of which contain anti-VGCC antibody, markedly suppressed the parasympathetic response but did not affect the sympathetic response. Pharmacological experiments with specific blockers to the VGCC subtypes showed that the Q-type VGCC is closely linked to the genesis of the parasympathetic response. We suggest that the anti-VGCC antibody from the LEMS patients specifically reduces the ACh release from the parasympathetic nerve by binding to the Q-type VGCC.

Increases in body mass index and waist circumference as outcomes of working overtime

This epidemiologic study was undertaken to determine whether working overtime is associated with anthropometric indices and serum lipids, risk factors for obesity, in white-collar workers. Non-management white-collar male workers were eligible. Body weight and height, waist circumference, skinfold thickness, serum total cholesterol and triglycerides were measured. Weight, height and waist circumference data obtained 3 years previously were also used. Lifestyle information was obtained by means of a self-administered questionnaire. Overtime hours correlated significantly with the 3-year change in body mass index (r = 0.206, p < 0.0017) and waist circumference (r = 0.218, p = 0.0091), but not with either the most recent anthropometric indices or serum lipids. Overtime hours were also intercorrelated (r = 0.436, p < 0.0001) with dinner time. The present study suggested that working overtime is associated with the increases in BMI and waist circumference over a 3-year period although the associations were weak. Additionally, eating habits of those with working overtime might reflect an intervening effect on the anthropometric changes.

[Effectiveness and feasibility of a strategy for increasing participation in the Japanese Stomach Cancer Examination programs by incorporating serum pepsinogen tests]

The number of people examined in "the Japanese Stomach Cancer Examination" programs under "Health Services Law for the Aged" has not increased, and a strategy is needed to increase participation in the programs. We have thought out a plan to persuade people to the programs by using serum pepsinogen tests without changing the framework of the programs. The plan is as follows: The subjects are those who undergo phlebotomy in "the General Health Examination" programs and who do not undergo the Stomach Examination programs. Serum pepsinogen levels are measured using the sera and those with high risk for stomach cancer are persuaded to attend "the Stomach Examination" programs. To estimate the effect of the plan, we asked several local governments to complete a questionnaire on the numbers of subjects. The ratio of the number of the subjects in the plan to the number of screenees in recent Stomach Examination programs was 0.61. An increase of about 15% was expected in screenees of the Stomach Examination Programs, if 40% of the subjects in the plan were diagnosed as high risk and 60% of the high risk subjects attended the Stomach Examination programs. From the economical stand point, it was expected that detection rate would increase and that the plan did not raise the cost for detecting a patient with stomach cancer. We also conducted a questionnaire survey of those who would be the subjects of the plan. Eighty-two percent of the subjects answered that they would attend the Stomach Examination programs, if they were told that their risk of stomach cancer was high by the serum pepsinogen tests. These results seem to suggest that more people would participate in cancer examination programs when informed that their risk for cancer is high as determined by blood tests.