Cross sectional observation of the effects of carbon disulphide on arteriosclerosis in rayon manufacturing workers

OBJECTIVE

A prospective cohort study was designed to clarify the relations between occupational exposure to carbon disulphide (CS2) and its effects on arteriosclerosis in workers in 11 Japanese rayon manufacturing factories. This report is a cross sectional baseline observation in the first study year.

METHODS

Study subjects were 432 male rayon workers (mean (range) age 35.5 (19.1-47.8); duration of exposure 13.4 (0.3-29.0)) and 402 male referent workers (age 35.8 (18.9-49.8)). Exposure to CS2 was assessed by determining the concentration of 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine. Mean (SD) TTCA was 3.42 (2.73) mg/g creatinine (Cr) (n = 422). About a quarter of the urine samples were > 5 mg/g Cr, a biological exposure index recommended by the American Conference of Governmental Industrial Hygienists. Health effects on arteriosclerosis were evaluated by measuring blood pressure, serum lipids, pulse wave velocity of the aorta, stiffness and blood flow of the carotid artery, and blood coagulation and fibrinolysis indices, and by use of brain magnetic resonance imaging, electrocardiogram (at rest and after exercise), ophthalmograph, and Rose's questionnaire. Information on potential confounding factors was collected by self administered questionnaire.

RESULTS

Prevalence of microaneurysm of the retinal artery was significantly higher in workers exposed to CS2 (8.1%) than in referent workers (3.4%), and increased with age. Other examinations did not show any differences between the two groups even after allowance for confounding factors.

CONCLUSIONS

Significant effects of CS2 on arteriosclerosis were not found in current rayon manufacturing workers, with the exception of induction of microaneurysm of the retinal artery.

Cross sectional observation of the effects of carbon disulphide on the nervous system, endocrine system, and subjective symptoms in rayon manufacturing workers

OBJECTIVES

A prospective cohort study was initiated to clarify whether the current level of exposure to carbon disulphide (CS2) is low enough to prevent occurrence of subclinical health impairments or to ameliorate health effects due to past high exposure. This paper describes the effects of exposure to CS2 on the nervous and endocrine systems, and the subjective symptoms in a baseline observation.

METHODS

The effects were evaluated of CS2 on the median nerve conduction velocity, neurobehavioural and psychological tests, and subjective symptoms related to solvents in 432 male workers exposed to CS2 and 402 reference workers from 11 rayon factories in Japan. Adjustment was made for potential confounding factors such as age or alcohol drinking. Exposure to CS2 was either dichotomised or categorised into three groups by job type.

RESULTS

Reductions were observed in motor (-1.9 m/s) and sensory (-0.91 m/s for orthodromic and -1.1 m/s for antidromic) nerve conduction velocities in the workers exposed to CS2 at the spinning and refining processes. Small but significant increases were found in self rated depression scale score and decrease in digit span (backward) in the workers exposed to CS2. Of 54 subjective symptoms many were increased--namely, heavy feeling in the head, light headedness, fainting after suddenly standing up, tremor, dullness, and increased sensitivity of skin in the extremities, reduced grasping power, reduced sexual desire, and increased rough skin. The endocrinological indicator--the concentration of glycosylated haemoglobin--was also increased in the workers exposed to CS2.

CONCLUSIONS

Subclinical effects on the nervous system and on glucose metabolism were found in the workers exposed to CS2. One interpretation is that relatively higher exposure to CS2 in the past may induce these, but the effects are still not entirely ameliorated under the current exposure to CS2. Another possibility is that the current exposure to CS2 may cause these positive findings. A follow up observation is necessary to clarify these questions.

Evidence on N-acetyltransferase allele-associated metabolism of hydrazine in Japanese workers

Hydrazine (N2H4), which has been categorized as a weak carcinogen, is a chemical with the one of the largest production rates in Japan. We have investigated the effects of acetylation phenotypes on the metabolism of hydrazine. Genotypes of N-acetyl transferases, NAT2*, were determined using polymerase chain reaction for 297 male workers. Biological and exposure monitoring were also conducted. The rapid and intermediate acetylators accounted for 45% each, and the slow acetylators accounted for 10%. Biological half-lives were significantly different among the three acetylation phenotypes (analysis of variance, P < 0.05): 3.94+/-1.70 hours for slow acetylators, 2.25+/-0.37 hours for intermediate acetylators, and 1.86+/-0.67 hours for rapid acetylators. Among Japanese, rapid and intermediate acetylators are the major phenotypes, which is in sharp contrast with those among Caucasians. We conclude that biological monitoring should take genetic factors, which may vary dramatically among different populations, into account.

Evaluation of the subacute pulmonary and testicular inhalation toxicity of diborane in rats

This study aimed to clarify the subacute pulmonary and testicular inhalation toxicity of diborane (B2H6, CAS: 19287-45-7) in rats. Male Wistar rats were exposed for 8 weeks to 0.11 or 0.96 ppm of diborane for 6 hr/day, 5 days/week. The control group was exposed to filtered air. Bronchoalveolar lavage fluid (BALF), hematological, biochemical, and histopathological examinations were conducted. Sperm counts and spermatic morphological changes were examined in epididymides, and histopathological examination was carries out in testes. BALF examinations revealed that the percentage of neutrophils increased in a dose-dependent manner and that of macrophages decreased in rats exposed to 0.96 ppm. Quantities of total and individual phospholipids in BALF increased in rats exposed to 0.96 ppm. The proportion of phosphatidylglycerol plus sphingomyelin decreased, and phosphatidylethanolamine and phosphatidylinositol increased in rats exposed to 0.96 ppm. LDH increased in rats exposed to 0.96 ppm, and ALP showed a dose-dependent increase. In serum, alpha 1-antitrypsin and superoxide dismutase activities increased in rats exposed to 0.11 or 0.96 ppm. These changes showed dose-dependent effects on the lung in rats exposed to diborane, possibly indicating that the hyperenergia of type II cells with proliferation and/or hypertrophy without histopathological changes occurred even in rats exposed to 0.11 ppm. Testicular examinations revealed no particular findings. The TLV-TWA of diborane (0.1 ppm) seems to be high and possibly unsafe, considering that the no-observed-effect level over 8 weeks for rat lung was under 0.11 ppm.

Changes in serum levels of metalloproteinases and their inhibitors by treatment of chronic hepatitis C with interferon

We treated 18 patients with chronic hepatitis C by recombinant interferon-alpha (6 MIU for 24 weeks). In seven patients, serum aminotransferase levels declined to normal (responders). To evaluate the effect of interferon on matrix metalloproteinases (MMPs) and their inhibitors, namely tissue inhibitors of metalloproteinases (TIMPs), the serum levels of these enzymes were determined by enzyme immunoassay (EIA) using a specific monoclonal antibody. In responders, there was a tendency, but not a significant one, towards either an increase in serum MMP 1 levels or a decrease in serum TIMP 1 levels. In contrast, in nonresponders, both a significant decrease in MMP 1 and MMP 3 and a significant increase in TIMP 1 were observed. The number of cases of either increase in serum MMP levels or decreased in serum TIMP levels was significantly larger in responders than in nonresponders. Furthermore, the ratio of MMP 1 to TIMP 1 significantly increased in responders, suggesting that the balance between matrix formation and degradation in hepatic fibrosis tended to move toward degradation. These data indicate that interferon may exert a beneficial effect on hepatic fibrosis in parallel with improvement of aminotransferase activity.

Inhalation toxicity of diborane in rats assessed by bronchoalveolar lavage examination

Changes in bronchoalveolar lavage fluid (BALF) and blood were examined to assess the toxic effects of diborane (B2H6, CAS: 19287-45-7) on the lung. Male Wistar rats were exposed to diborane at 20 ppm (intended concentration) for 4 h (phase I study) to evaluate time-course changes up to 14 days, and at 10 or 1 ppm (intended concentrations) to assess the dose-effect relationship after 3 days (phase II study). BALF parameters [leukocyte counts, alpha 1-antitrypsin (alpha 1-AT), superoxide dismutase (SOD), total protein, phospholipids etc.] were examined and biochemical and histopathological studies were also carried out. In the phase I study, neutrophils (%) in BALF increased on the day of exposure and then decreased gradually for 3 days. Rapid and marked increases in alpha 1-AT and SOD activity in BALF were detected on the day of exposure, and phospholipids had sharply increased on day 3. After 14 days, these parameters in the exposed rats had returned to their background level and alpha 1-AT decreased significantly. In the phase II study, total protein, alpha 1-AT activity and phospholipids in BALF showed dose-dependent increases, and serum alpha 1-AT activity increased significantly. Alveolar capillary and alveolar cell damage were confirmed in rats exposed to 20 ppm, 10 ppm or 1 ppm diborane for 4 h by evaluating the parameters examined. The protection system appeared to start operating immediately after exposure, and the recovery mechanism seemed to start operating 1 day after exposure and cease by day 14. The no-observed-effect level could not be observed.

Acute hepatitis in an adult with acquired rubella infection

We report a case of acute hepatitis in a 28-year-old male with acquired rubella infection. Serological tests revealed acute rubella virus infection and ruled out infection by other common viruses, including type A and type B hepatitis viruses. The patient showed not only marked increase of lactate dehydrogenase (LDH) activity, with only slight liver dysfunction, but also platelet and kidney injury, suggesting systemic rubella virus infection. Because the liver dysfunction was slight, liver biopsy was not performed. When a patient has mild, transient hepatitis accompanied by high LDH activity in comparison with both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, we should take a common viral infection such as rubella into consideration when making a diagnosis.

No-observed-effect level of diborane on the respiratory organs of male mice in acute and subacute inhalation experiments

In order to clarify the acute and subacute toxicity of diborane (B2H6, CAS: 19287-45-7) at low concentrations, male ICR mice were exposed to diborane for 1, 2, 4 or 8 h at concentrations of 1 or 5 ppm (phase I study), and for 6 h/day, 5 days/wk, over 2 or 4 wk at concentrations of 0.02 or 0.7 ppm (phase II study). Hematological and biochemical tests, and histopathological examinations of the cornea, nasal mucosa, respiratory tract and lung were carried out. All mice in both studies survived until they were sacrificed. In the phase I study, lung weight increased significantly in mice exposed to 5 ppm of diborane for 8 h. Histopathologically diffuse panbronchiolitis-like lesion was observed in mice exposed to 5 ppm of diborane for 2, 4 or 8 h. In the phase II study, slight infiltration of polymorphous neutrophil was observed mainly in the peribronchiolar region in mice exposed to 0.2 ppm or 0.7 ppm of diborane for 2 or 4 wk. In both studies, hematological and biochemical examinations failed to reveal any exposure-related changes. These results suggest that no-observed-effect level of diborane inhalation on the respiratory organs were 1 ppm in acute exposure, but 0.2 ppm of diborane inhalation for 2 or 4 wk seems to be unsafe.

Combination chemotherapy for a senile patient with adenoid cystic carcinoma of the esophagus: a case report

Adenoid cystic carcinoma of the esophagus with multiple liver metastases was found in a 77-year-old Japanese female in October, 1991. Combination chemotherapy, including etoposide (VP-16) and tegafur (FT) allowed the patient to survive for approximately a year after the onset of the initial symptoms. During her course of treatment, the patient improved greatly with minimal toxicity, and declines in the elevated levels of GOT and LDH were also noted. Since no other therapy, such as surgery or radiation, was given to the patient, the response to chemotherapy as well as the survival advantage for the patient have been evaluated.

Pharmacokinetics of the gastrokinetic agent mosapride citrate after single and multiple oral administrations in healthy subjects

The pharmacokinetics and dose proportionality of mosapride citrate ((+-)-4-amino-5-chloro-2-ethoxy-N-[[4- (4-fluorobenzyl)-2-morpholinyl]methyl]benzamide citrate dihydrate, AS-4370, CAS 112885-42-4) were investigated in healthy male volunteers. The subjects were given a single oral dose (5, 10, 20 and 40 mg, each of 5 subjects) and a multiple oral dose (20 mg t.i.d. for one day, and 10 and 20 mg t.i.d. for 8 days, each of 5 subjects). Food effect on the pharmacokinetics of mosapride was also evaluated after a single oral 10 mg dose by an open, two-way crossover method. Mean plasma levels of mosapride reached a peak 0.5-1 h after single dosing of 5, 10, 20 and 40 mg. The peaks were dose-related with values of 25.1, 51.2, 157.8 and 280.6 ng/ml, respectively, and were followed by a first-order decrease with apparent half-lives of 1.4-2.0 h. The Cmax and AUC increased in proportion to the dose, indicating linear pharmacokinetics of mosapride up to 40 mg. The Cmax of M-1, a des-4-fluorobenzyl metabolite, was 1/6 of that of the unchanged drug. Urinary excretion of the unchanged mosapride and M-1 during 48 h after single dosing accounted for 0.1-0.4% and 7.0-11.0% of the dose, respectively. There were no significant changes in the plasma concentration-time profiles and urinary excretions between single and multiple doses, indicating that the pharmacokinetics of mosapride in man was not altered by its multiple administration. Plasma levels of mosapride reached steady state on day 2 of multiple administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraocular barrier permeability in spontaneously diabetic Chinese hamster]

Fluorophotometry was performed with normal and spontaneously diabetic Chinese hamsters (CHAD) in order to investigate differences in blood-ocular barrier permeability and lens autofluorescence. Blood-aqueous barrier permeability was evaluated by the fluorescence value in the anterior chamber which was corrected using both autofluorescence value and the concentration of fluorescein in the plasma. The results showed that the diabetic group had significantly higher values than the normal group (p less than 0.01). Blood-retinal barrier permeability was evaluated in the vitreous by the same method. There was no significant difference between the two groups. Lens autofluorescence values were also significantly higher for the diabetic group compared with the normal group (p less than 0.001). In these spontaneously diabetic Chinese hamsters, the permeability function of the blood-retinal barrier seemed to be maintained its normal level, while both the blood-aqueous barrier and lens were damaged by deleterious effects of diabetes.

Hyperplastic cellular components of a hemangiopericytoma. An ultrastructural study

Based on ultrastructural features of cellular components of a hemangiopericytoma, hyperplastic cells are classifiable into fibroblast-like (group I), endotheloid (group II) and pericyte-like (group III) cells. The transformation of the group I cells to the group II, or to the group III cells, is pronounced in our electron micrographs and this may imply that the group I cell is the principal cell of origin in this neoplasm. The smooth muscle-like (group IV) cells comprising the media of the arteries and veins in this neoplasm may represent modified, possibly de-differentiated smooth muscle cells reacted to the neoplastic proliferation of the surrounding adventitial (group I) cells.

Neovascularization in the pre- and postnatal rabbit corpora cavernosa penis: light and electron microscopy and autoradiography

In the late prenatal stage, the rabbit corpora cavernosa penis (cavernous bodies) are occupied by a large number of mesenchymal cells actively proliferating by mitosis. Most profiles of the cavernous sinuses show growing capillaries consisting of immature endothelial cells and enclosing a narrow lumen. Such growing capillaries are often associated with the mesenchymal cells that contact with each other and eventually with the endothelial cells. Between 1 and 7 postnatal days, the capillary network develops extensively and the maturation of the capillaries results in a flattened endothelium with a continuous basal lamina. The mesenchymal cells are also associated with the helicine arterial sprouts at this time period. No endothelial mitotic figures were observed within the growing capillaries in pre- and postnatal specimens examined. Single pulse labeling with 3H-thymidine in the postnatal rabbits demonstrates that the labeled endothelial cells of the growing capillaries increase in number at 48 hours after injection compared with those at 24 hours, whereas the labeled mesenchymal cells inversely decrease in number. These findings indicate that the incorporation of the mesenchymal cells as vessel-forming cells into the growing capillaries accelerates the neovascularization in the rabbit cavernous bodies.

Histamine disposition in endothelial specific granules of the toad aorta

High-performance liquid chromatography revealed that toad aorta delivered appreciable concentrations of histamine into the perfusate when perfused by Ringer's solution containing the histamine liberator. Electron micrographs of this vessel after the perfusion showed an expulsion of the endothelial specific granules into the vascular lumen. These results support to our previous hypothesis that the granules are a reservoir site of histamine and might take an important role in the regulation of vascular tone.

Bifid tail of the pancreas: a case presenting as a gastric submucosal tumor

A 49-yr-old male was admitted to our hospital because of epigastric discomfort and a suspected tumor of the stomach on barium meal examination at the Center for Automated Multiphasic Health Test and Services. The tumor shadow of the stomach was initially considered as the "type II" gastric carcinoma according to the Borrmann's classification. Multiple endoscopical and electrocautery cutting biopsies revealed that the tumor occurred in the submucosal layer and was composed of normal pancreatic tissue. A computed tomogram showed a large mass on the pancreatic body which was adjacent to gastric wall. Selective angiography of the celiac trunk revealed that the gastric submucosal lesion was supplied by the transverse pancreatic artery. Endoscopic retrograde pancreatography showed that Wirsung's duct had a divergence in the body of the pancreas and one of the branched ducts headed for the posterior wall of the gastric body. On the basis of these results, a diagnosis was made of the rare pancreatic anomaly, "bifid tail of the pancreas." One of the tails formed the gastric submucosal tumor. This report emphasizes the potential diagnostic value of combined study of endoscopic retrograde pancreatography and computed tomography in determining the presence of pancreatic anomaly.

Endothelial specific granules in the umbilical veins of the postnatal rabbit

A remarkable increase in number of endothelial specific granules was observed in the rabbit umbilical veins between 2 and 5 days after birth. Electron microscopy indicated that the granules were segregated in the Golgi complex of the endothelial cells and released into the vascular lumen during the postnatal obliteration stage of this vessel. Incubation of the postnatal vessels in Ringer solution containing a histamine-releasing compound induced remarkable morphological alterations of these cytoplasmic components; a reduction of their osmiophilia, swelling with a widened space separating the granular matrix from the limiting membrane, fusion to each other and expulsion of their contents into the vascular lumen, as in mast cell degranulation by this drug, were noted. High-performance liquid chromatography of the homogenized vessels demonstrated appreciable concentrations of histamine in the postnatal samples. There was a correlation between the histamine concentration and the quantity of granules in the respective postnatal samples. The present study strongly suggests that the granules are reservoirs of histamine and have an important role in the obliteration of this vessel.

Gastric emptying in patients with gastric ulcers--effects of oral and intramuscular administration of anticholinergic drug

In our previous report on gastric emptying, we noted that delayed gastric emptying might be one of the etiological factors of gastric ulcers. Gastric emptying was measured using the acetaminophen method. The gastric emptying value was indicated as "microgram/ml", the acetaminophen concentration 45 min after test meal ingestion. In this study, the effects of an anticholinergic drug on gastric emptying were investigated in gastric ulcer patients. Oral and intramuscular administrations of butropium bromide (BB) were studied. The following results were obtained; 1. Oral administration of 10 and 15 mg of BB accelerated gastric emptying to a statistically significant degree (p less than 0.05), compared with the placebo in delayed gastric emptying cases in a dose-dependent manner (r = 0.978). 2. Intramuscular administration of small doses of BB (0.25 and 0.5 mg) also accelerated gastric emptying in delayed gastric emptying cases, but in general, intramuscular administration of BB (0.25-2.0 mg/person) inhibited gastric emptying in a dose dependent manner (r = -0.999). 3. Intramuscular administration of BB (0.25-2.0 mg/person) inhibited gastric emptying in a dose dependent manner in rapid gastric emptying cases (r = -0.977).

Epidemio-hygieological aspects of gastric neoplasms in aged patients

A 100-year-old male who died of gastric carcinoma was discussed and illustrated epidemiohygieologically. According to dynamic population statistics of the Health and Welfare Ministry of Japan, 418 persons over the age of 100 years died in 1979. Among them, 157 (38%) died of cardiovascular diseases and 49 (12%) died of pulmonary diseases, but only six died of neoplasms including two with gastric carcinomas (0.48%). To our knowledge no such case has been reported previously in the literature.

Relation between esophagogastric junction and esophageal function in patients with reflux esophagitis

The relationship between the esophagogastric junction (Z-line pattern) and the functions of the esophagus was studied in patients with reflux esophagitis. We classified Z-line patterns as the Z0- type to Z4-type, depending on the shape and the level of the Z-line. Lower esophageal sphincter pressure (LESP) was measured by the open-tip infusion method and the acid clearance test was performed by Booth's method (15 ml of 0.1 HCL). The following results were obtained: 1. LESP was 15.5 +/- 5.6 cmH2O (M +/- SD) in normal subjects (Z0-type), it was 10.3 +/- 2.9 cmH2O in the Z1-type, 9.5 +/- 4.9 cmH2O in the Z2-type, 9.4 +/- 4.1 cmH2O in the Z3-type and 7.6 +/- 3.4 cmH2O in the Z4-type. There were statistically significant differences between the Z0-type and the other Z-line patterns (p less than 0.05, P less than 0.05, P less than 0.025, and P less than 0.025, respectively). 2. Acid clearance was expressed as the time until the pH returned to 5.0 due to swallowing at one-minute intervals. The results of the acid clearance test were 11.4 +/- 3.0 min in the Z0-type 18.3 +/- 7.0 min in The Z1-type, 20.3 +/- 5.6 min in the Z2-type, 24.1 +/- 5.7 min in the Z3-type and 24.5 +/- 7.4 min in the Z4-type. Acid clearances were significantly delayed along with the Z-line pattern (P less than 0.025, P less than 0.005 and P less than 0.005, respectively). 3. The patients with hiatal hernia consisted of five cases of the Z3-type and six cases of Z4-type. They had low LESP and delayed acid clearance. As mentioned above, the results of LESP ad acid clearance test were well correlated with Z-line patterns in patients with reflux esophagitis.

Gastric acid secretion and plasma gastrin response to test meal in patients with gastric cancer

Gastric acid secretion and plasma gastrin response to test meals were examined in 110 patients with gastric cancer and a comparative study was made in accordance with depth of invasion, macroscopic shape, histological type, location and size of the lesion. Cases were classified into two large groups by the depth of invasion: early cancer (invasion was limited to the mucosa and submucosa) and advanced cancer (invasion reached the muscularis propria or deeper). Patients showed hypoacidity on the whole. Cases of early cancer showed significantly higher acid secretion than cases of advanced cancer, although no significant differences were observed in gastrin release. Among the cases of early cancer, cases of the elevated shape showed significantly lower acid secretion and higher gastrin release than cases of the depressed shape, and cases of the histologically differentiated type showed significantly higher acid secretion than cases of the undifferentiated type although no significant differences were observed in gastrin release. Among the cases of advanced cancer, cases with large carcinomas in the corpus tended to show low acid secretion and cases with large carcinomas in the antrum tended to show low gastrin release. High gastrin release was observed in cases of the Borrmann IV type with giant folds.

Esophageal ulceration in a patient with Behcet's syndrome

The gastrointestinal manifestation of Behçet's syndrome including colitis and esophageal ulceration has been reported in the past few years. However, esophageal ulceration associated with Behçet's syndrome is a rare condition. There appears to be only seven reports of esophageal ulceration associated with Behçet's syndrome. We have recently observed esophageal ulceration in a 64-year-old male known to be on case of untreated Behçet's syndrome (three major symptoms), who presented with epigastralgia and transient substernal discomfort just after swallowing food. In this patient, endoscopic examination revealed multiple esophageal ulceration and kissing-type gastric ulceration. The esophageal ulcers were not improved by frequent antacid therapy for six weeks, while gastric ulcers responded well to the therapy. Steroid therapy was begun and esophagoscopy revealed scarred ulcers after only two weeks. Therefore, steroid hormone therapy was thought to be of benefit in this patient. Esophageal ulceration associated with Behçet's syndrome, a rare condition, is reported and discussed in accordance with some reviews previously reported.

A comparative study on application of Nd-YAG laser radiation and electrocautery in canine gastric mucosa--magnified observations by dissecting microscopy and scanning electron microscopy, and histological examinations

The mucosal change, the depth of injury and the healing process in the canine gastric wall after Nd-YAG laser (YAG) exposure and electrocautery were studied comparatively by magnified observations. The results were as follows: 1. Mucosal changes caused by the YAG laser beam were more localized within the exposure area than those by electric current. 2. The depth of tissue damage to the canine gastric wall by YAG laser exposure was easy to control when compared to that caused by electrocautery. 3. The healing time of the ulcer caused by the YAG laser was shorter than that caused by high frequency current. 4. In the present study on the mucosal changes due to laser exposure and electrocautery using endoscopy, dissecting microscopy and SEM, it was found that these examinations appear to be helpful as experimental procedures to clarify the detailed appearance of the mucosal surface. It was suggested that endoscopic application of the YAG laser to the gastrointestinal tract was safe and effective when compared with other procedures which have been applied endoscopically for diagnosis and treatment.

The PFD test for pancreatic disease patients

The PFD test was performed on various pancreatic disease patients. The urinary PABA excretion rate was significantly lower in chronic pancreatitis patients and in pancreatic carcinoma patients than in the controls, but no difference was observed between PABA excretion in the two diseases. After surgery, PABA excretion values of pancreatic carcinoma patients were significantly lower than those of non-pancreatitis non-pancreatic carcinoma patients. This was thought to be caused by the difference in residual anastomosed pancreatic tissues. Mild to severe pancreatitis, fibrosis and/or fat necrosis were seen in the pancreatic tissues of carcinoma patients, but these changes were minimal in non-pancreatitis non-pancreatic carcinoma patients. The PFD test is useful in detecting decreases in pancreatic exocrine functions or measuring the grade of pancreatic disorders in various pancreatic diseases, although it can not be used to differentiate pancreatic diseases.

The coexistence of gastric cancer and duodenal ulcers

The records of 356 gastric carcinoma patients who were treated surgically were reviewed. Among them, six patients (1.7%) had duodenal ulcers. Five cancers of the six patients were "early" gastric cancers classified as type "IIc" or "IIc + III" according to "The general rules for the gastric cancer study in surgery and pathology". The cancers of the six patients were located in the lower half of the stomach. Gastric secretion activity was normal in four and above normal in two cases. Three had signet ring cell carcinomas, two had poorly differentiated adenocarcinomas and one had a well differentiated adinocarcinoma. Our results were similar to other results reported in many papers. In Japan gastric carcinomas coexisting with duodenal ulcers were more often confirmed in the "early" gastric cancer stage. This is probably because endoscopic examinations of the stomach were more often performed in Japan than in other countries because of te large number of gastric disease patients. In addition, it is assumed that the growth of gastric cancer in the stomach is slow because of the very active gastric secretion.

Hematemesis and Melena: gastritis

The records of a total of 60 gastritis patients who showed hematemesis and/or melena are reviewed. The mean age was 40. The ratio of males to females was two to one. During the examination, 19 upper G-I lesions were confirmed in addition to gastritis. Sixteen patients had severe underlying diseases which were thought to be the cause of the bleeding tendency. Thirteen patients took alcohol or drugs which induced bleeding. Prognoses of the patients were relatively good when they were treated medically.

The effect of test meals on the PED test

The effects of test meals on the PFD (pancreatic function diagnostant) test, which was introduced as "the B.T.PABA test" in the previous reports, were studied. The higher the protein in the test meal, the lower the urinary excretion value of p-aminobenzoic acid (PABA) and the first 3-h of PABA excretion. By using a test meal containing protein, the differences in digestion-absorption disorders between gastrectomy procedures (Billroth I and Billroth II) were clarified. Therefore, a test meal which contains a suitable amount of protein should be used in the PFD test to improve diagnostic accuracy.

Lesions of the upper gastrointestinal tract in patients with chronic renal failure

Endoscopy of the upper gastrointestinal tract was performed on 84 patients with end-stage chronic renal failure undergoing hemodialysis. Gastric acid secretion and fasting plasma gastrin levels were also examined in these patients. Hemorrhagic gastritis was most frequently observed (23 cases) followed by erosive gastritis (18 cases). No patients had gastric ulcers. Duodenal ulcers were observed in only two patients. Gastrointestinal bleeding was observed in 15 cases (17.9%). Thirteen of these 15 cases had hemorrhagic gastritis, one of which had a duodenal ulcer as a complication. Fasting plasma gastrin levels (359.6 +/- 336.5 pg/ml) were significantly higher than those of normal subjects (35.2 +/- 37.1 pg/ml), but no acceleration in gastric acid secretion was observed either in the basal condition (BAO 0.8 +/- 0.7 mEq/h) or following tetragastrin stimulation (MAO 9.0 +/- 6.9 mEq/h). Our results were inconsistent with the previous reports that high frequencies of peptic ulcers and increased gastric acid secretion were observed in patients with chronic renal failure. Our data suggest that the defensive factors rather than the aggressive factors of the gastroduodenal mucosa may be involved in chronic renal failure.

Hematemesis and melena: gastric ulcer

Differences in distribution of age, hemoglobin values, location and number of ulcers, activities of gastric secretion, associated conditions, treatment and prognoses between bleeding and non-bleeding gastric ulcer patients were studied. The ages of bleeding patients were distributed more widely than those of non-bleeding patients and the number of patients over 70 years of age was greater in bleeding patients than in non-bleeding patients. Associated conditions of bleeding patients were more serious than those of non-bleeding patients and some bleeding patients showed coagulation disorders. Fifteen out of 17 bleeding patients were treated and well controlled surgically, and seven out of 62 bleeding patients who were treated medically died. In this study, the exact cause which made the difference between bleeding ulcers and non-bleeding ulcers could not be found. Bleeding ulcer patients with associated conditions did not always die directly from bleeding, but the bleeding decreased their general condition and, as a result, they died. Therefore, surgical treatment is the first choice in these patients if their conditions will tolerate such treatment.

Hematemesis and melena: Endoscopic examination

Today, gastrointestinal endoscopy has become a routine examination. In our "Endoscopy center", about five hundred gastroscopies are performed every month. It has been said in many reports that endoscopy, especially emergency endoscopy, is an effective method of discovering sources of bleeding. In this report, we also emphasize that emergency endoscopy is effective in diagnosing upper gastrointestinal bleeding on the basis of reviewing 318 endoscopic examinations.

Hematemesis and melena: Mallory-Weiss syndrome

The records of 29 patients with Mallory-Weiss tears diagnosed by endoscopy are reviewed. Ingestion of alcohol was a chief cause of bleeding. Single tears were the largest in number and 68% of the lacerations were seen just distal to the esophago-cardial junction. Lacerations occurred more frequently on the right lateral wall of cardia than on the left lateral wall. Most of these lesions were mild and could be treated medically except for two cases which were surgically treated.

Serum CEA levels in gastrointestinal diseases

Preoperative carcinoembryonic antigen (CEA) levels in 36 colorectal carcinoma patients were corrected in accordance with pathological stage and tumor location. Increasing levels of CEA were found in advanced stages of the disease. There were no significant differences among the CEA levels of right-sided colon tumors, left-sided tumors and rectal tumors.

B.T.PABA test: a new absorption test

B.T.PABA has been evaluated as a new pancreatic exocrine function diagnostant. In this study, it was used as a new absorption test. After ingestion of 1 gm of B.T.PABA and the test meal, PABA in 6-h collected urine was determined. The urinary PABA excretion rate in Billroth I type postgastrectomy patients, 8-14 days after surgery, was lower than that of controls and that in Billroth II patients, 10-14 days after surgery, was the lowest of the three. However, the PABA excretion values of postgastrectomy patients 10 months to 20 years after surgery recovered nearly to the normal level of PABA excretion. These decreases in PABA excretion were considered to be caused by postgastrectomy digestion-absorption impairment. In addition, there was a significantly high correlation between the conventional 131I-labeled albumin absorption test and the B.T.PABA test. Therefore, it was concluded that the B.T.PABA test can be used as a simple absorption test.

The therapeutics of peptic ulcers: clinical evaluation of C-Fe therapy

Ascorbic acid and ferrous sulfate were given to peptic ulcer patients (C-Fe therapy). In gastric ulcer patients, the healing index of the C-Fe therapy group was significantly higher than that of controls, but in duodenal ulcer patients, no significant difference was observed between the healing index of the C-Fe therapy group and that of controls. According to these results, it was concluded that C-Fe therapy was effective in healing gastric ulcers and that the cause of duodenal ulcers might depend more on aggressive factors than that of gastric ulcers.

Gastric emptying in normal subjects and patients with peptic ulcer: a study using the acetaminophen method

Gastric emptying in patients with peptic ulcer and normal subjects was studied using the acetaminophen method. The subjects consisted of 15 normal subjects, 52 gastric ulcer patients and 65 duodenal ulcer patients, who were studied in active stage of the ulcer. As an indicator of gastric emptying, the plasma acetaminophen concentration was measured by dye method (diphenylhydrazyl), as mcg/ml, at 45 minutes after ingestion of a high calory pasty test meal (200 ml) with 1.5 gr of acetaminophen. In normal subjects, the plasma acetaminophen concentration was 9.4 +/- 3.6 mcg/ml. In gastric ulcer patients, the concentration was 7.4 +/- 3.2 mcg/ml, which showed significantly delayed gastric emptying (P less than 0.05). In duodenal ulcer patients, the concentration was 11.6+/-3.3 mcg/ml, which suggested significantly rapid gastric emptying (P less than 0.05). In consideration of gastric secretion, gastric ulcer cases with lower acid secretion have more delayed gastric emptying. In duodenal ulcer cases with hypersecretion, gastric emptying is more rapid than normo-and/or hyposecretory cases (P less than 0.005). The delayed gastric emptying may play a role in etiology of gastric ulcer. On the other hand, the rapid gastric emptying with gastric acid hypersecretion may be important in the pathogenesis of duodenal ulcer.