[Epidemiology of pancreatic cancer]

Pancreatic cancer has been increasing in recent years in Japan. The number of pancreatic cancer deaths in 1990 was 13,318, accounting for 6.1% of all cancer deaths in Japan. The increasing trend of pancreatic cancer mortality is observed more markedly in the elderly population over 60 years of age, and especially in persons over 80. Possible reasons for the increase of pancreatic cancer were discussed. The geographic distributions of pancreatic cancer mortality in Japan and around the world indicate that the mortality is higher in northern Japan and even higher as the latitude increases. Some possible reasons for the inverse relationship between the pancreatic cancer mortality and the latitude were discussed. From epidemiological studies several risk factors for pancreatic cancer were reported; smoking, drinking, excess intake of meat and cholesterol, coffee, radiation, cholecystectomy, etc. However, more epidemiological studies are needed to identify and confirm risk factors for pancreatic cancer and to promote primary prevention of pancreatic cancer.

Effectivity and safety of mannitol treatment for acute hepatic failure in rats

In rats with D-galactosamine-induced hepatic failure, 14C-D-mannitol transport into the brain was accelerated through an increase of vesicular transport via the blood-brain barrier and thus brain mannitol contents increased. However, the osmolarity of the brain tissue changed little and the mortality was decreased by mannitol infusion to acute hepatic-failure rats. Experimental data indicate the effectivity and safety of hypertonic mannitol therapy for cerebral edema in acute hepatic failure.

A prospective study of atrophic gastritis and stomach cancer risk

The relation of atrophic gastritis, other gastric lesions and lifestyle factors to stomach cancer risk was prospectively studied among 3,914 subjects who underwent gastroscopic examination and responded to a questionnaire survey at the Aichi Cancer Center Hospital. During 4.4 years of follow-up on average, 45 incident cases of stomach cancer were identified at least three months after the initial examination. If the baseline endoscopic findings indicated the presence of atrophic gastritis, the risk of developing stomach cancer was increased 5.73-fold, compared with no indication at the baseline. The risk further increased with advancing degree of atrophy and increasing extension of atrophy on the lesser curvature. These trends in the relative risks were statistically significant (P = 0.027 and P = 0.041, respectively). The risk of developing stomach cancer was statistically significantly increased among subjects with gastric polyps, but not among those with gastric ulcer. Stomach cancer cases tended to consume more cigarettes, alcohol, rice, pickles and salted fish gut/cod roe and less fruits and vegetables and to have more family histories of stomach cancer than noncases, although these differences were not statistically significant. The results of the present study provide additional evidence on the relation between atrophic gastritis and stomach cancer and suggest a need for intensive follow-up of patients with atrophic gastritis and gastric polyps.

[Factors associated with levels of physical activity at work and during leisure time]

Factors associated with levels of physical activity at work and during leisure time were analyzed among 577 subjects who had been selected as population controls for a case-control study by random selection from telephone directories. The intensity of physical activity at work was inversely associated with body mass index, the proportion of professionals & managers, consumption of western style breakfast, coffee, butter/margarine, and whisky; and positively associated with rice intake. Frequency of physical activities during leisure time was positively associated with consumption of vegetables, fruits, mushrooms, milk, cheese and coffee, and moderation in eating; and inversely associated with rice intake and the prevalence of gastrointestinal symptoms and medication. The association of physical activity with these factors should be considered in studying its relationship to disease risk.

[Lifestyle differentials by occupational group]

Mortality and morbidity differ by occupational group. To clarify factors which account for these variations, lifestyle and other health habits were analyzed according to a subject's main occupation for 12,130 men and 12,759 women. Intake of Western-style foods and fruits and vegetables increased and those of Japanese-style foods and instant foods decreased in the following occupational order; (1) professionals & managers, (2) clerical, (3) sales, (4) service & transportation and (5) agricultural, forestry, fisheries, mining & production process workers. The prevalence of cigarette smoking by subjects themselves and by their parents were higher in service workers than in the other workers for both men and women. Clerical workers, professionals and managers participated more frequently in stomach cancer screening tests than the other workers, and women in these occupational groups had higher prevalences of early menarche and late first childbirth. These differences in characteristics of occupational groups may contribute to the inequalities in health.

[An epidemiological evaluation of the efficacy of mass screening for uterine cancer in Japan. The relationship between coverage rate of mass screening and reduction in death rate from uterine cancer]

To evaluate the efficacy of mass screening for uterine cancer, the relationship between the coverage rate of mass screening and the reduction in mortality rate from uterine cancer was analyzed. The percent change in the AADR (Age-adjusted death rate) from 1979-1983 to 1984-1988 were compared between the high coverage rate areas and the control areas with relatively lower coverage rates, and among the high coverage rate areas with varied coverage rates. The main results were: (a) the decreases of AADR from uterine cancer were greater in three groups of high coverage rate areas than in control areas with low coverage rates. (b) Among three groups of high coverage rate areas with variation in coverage rates (> or = 20%, > or = 30%, > or = 40%), the higher the coverage rate was, the greater was the percent reduction (-45.9%, -52.3%, -63.5%) of AADR. These results suggest that systematic mass screening may be effective in reducing mortality from uterine cancer.

Atrophic gastritis and stomach cancer risk: cross-sectional analyses

The relationship between atrophic gastritis and stomach cancer risk was investigated in case-control analyses involving 387 cases with stomach cancer and 5,422 control subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April, 1985 to March, 1989. The presence of atrophic gastritis, the degree and extension of the atrophy and the presence of granularity and erosion were diagnosed endoscopically by six gastroenterologists. The prevalence of atrophic gastritis increased with age and was higher in males than in females. The relative risk (RR) of stomach cancer was 5.13 (95% confidence interval (CI): 2.79-9.42) if a subject had any type of atrophic gastritis. The risk further increased with advancing degree of atrophy and increasing extension on the greater and lesser curvatures. The RR associated with severe atrophy was 7.73 (95% CI: 3.95-15.12). These associations remained significant when analyzed by sex and age. The presence of granularity and erosion did not much affect the estimated risks. A clear difference in risk appeared in the analyses by histological type of cancer. The RR associated with atrophic gastritis was 24.71 (95% CI: 3.46-176.68) for the intestinal type and 3.49 (95% CI: 1.77-6.87) for the diffuse type. These findings may suggest a need for intensive follow-up of patients with severe atrophic gastritis.

[Pulmonary distribution of 99mTc-technegas--a comparative study of radioactive inert gases]

99mTc-technegas (99mTc-gas), which consists of fine particles, is produced in carbon crucibles burned at 2500 degrees C. On this study, the particle size of 99mTc-gas was measured and the pulmonary distribution of 99mTc-gas was assessed in 28 patients with various pulmonary diseases. Most particles were 5-30 nm in diameter as determined by electron microscopy. In a clinical study, about 37 MBq of 99mTc-gas was inhaled three times during deep breathing in a sitting position. In a comparative study with radioactive inert gases (133Xe, 81mKr), 99mTc-gas showed a similar distribution to the inert gas in most patients, although some with obstructive disease showed hot spots in the lung fields. In patients with severe obstructive change, marked deposits of 99mTc-gas was noted in the central airways, but 99mTc-gas penetrated to the peripheral lung field. This result suggests that 99mTc-gas can be used to evaluate ventilatory function even in patients with chronic obstructive pulmonary diseases.

[Factors associated with the improvement of lifestyle among a middle and advanced aged male population]

Factors associated with improvement of lifestyle (diet, smoking, drinking, exercise and health check-up) were studied among 3,503 males aged 40 or more, based on data obtained by two questionnaire surveys which were conducted at about a five year interval in a mountainous area of Aichi Prefecture. Age was positively associated with the improvement of every habit except for health check-up. Developing diseases was associated with the improvement of every habit except for exercise, with strong associations existing between liver diseases and improvement in drinking habits and between diabetes and improved nutritional balance. Improved dietary habits was inversely associated with frequent use of instant foods and irregular eating habits. Moderation in eating was associated with a balanced diet, frequent intake of yellow/green vegetables, fats & oils, and non-smoking at the time of the initial survey. Cessation of smoking was positively associated with fruit intake and inversely associated with irregular meal times, number of cigarettes per day and alcohol intake at baseline. An increase in frequency of exercise was positively associated with consumptions of fruits and dairy products and inversely associated with frequent use of instant foods at time of the initial survey, while an increase in frequency of health check-up was observed among men who had a balanced diet. The improvement of each habit was associated with the improvement of one or more other habits. These results suggest that likelihood for improving lifestyle is higher among men who have a health consciousness and that improvements in these habits are independent.

The role of socioeconomic factors in the survival of patients with gastrointestinal cancers

The relations between type of occupation, marital status and residential area and survival from gastrointestinal cancers were examined among 4485 cases of stomach cancer and 2618 cases of colorectal cancer diagnosed between 1983 and 1988 and recorded in the Aichi Cancer Registry. In univariate analyses, the cumulative five-year survival rates of both cancers were highest among professionals and managers and lowest among service workers, in males. They were highest among professionals, managers and clerical workers and lowest among housewives, in females. For both men and women, single people had a lower survival rate than married, and patients living in a metropolis had a higher survival rate than those living in other areas. Multivariate analyses, based on Cox's proportional hazards model, revealed occupation to have a statistically significant effect on prognosis for both sexes, although the effect of extent of disease was definitive. The analyses also confirmed the unfavorable effect of a single marital status and the favorable effect of residing in a metropolis, in women. The results suggest that socioeconomic factors may have a role to play in the survival of patients with gastrointestinal cancers.

The risk and predictive factors for developing liver cancer among patients with decompensated liver cirrhosis

Patients with decompensated liver cirrhosis (n 1441) and those with post-transfusion hepatitis (n 343), whose medical expenses were subsidized by the Aichi Prefectural Government, were followed up for three years by record linkage with the Aichi Cancer Registry. During the follow-up period, 122 incident cases of liver cancer were identified. Compared with the general population, patients with decompensated liver cirrhosis were at a 64.9 times greater risk (50.5 times in males and 100.4 times in females) and those with post-transfusion hepatitis were at a 9.4 times greater risk (8.9 times in males and 13.7 times in females) of developing liver cancer. Information on prognostic factors for 1,068 patients with decompensated liver cirrhosis was also collected in a questionnaire survey by the physicians in charge. Patients positive to hepatitis B surface antigen (HBs Ag) and those positive to HBe Ag had a significantly increased risk of subsequent liver cancer. The risk of developing liver cancer was positively associated with base-line levels of GPT and AFP and age and, inversely associated with total alcohol intake and female sex. In multivariate analyses, the associations with HBe Ag, AFP, sex and age remained statistically significant, whereas the associations with GPT, total alcohol intake and HBs Ag were of borderline significance.

Trends in cancer mortality, incidence and survival in Japan

Cancer has been the leading cause of deaths since 1981 in Japan and is still on the increase accounting for 27% of all causes of deaths in 1989. The crude death rate of cancer has been increasing in both sexes, but the age-adjusted death rate has been stable in males and decreasing in females. Among various cancers cancers of the stomach, uterus, liver (females only), and esophagus (females only) have been decreasing. Leukemia and bladder cancer also tend to show a declining trend. Other cancers, especially cancers of the lung, colo-rectum, pancreas, biliary tract liver (males only), prostate, ovary, and breast are increasing in Japan. Trends in the cancer incidence are similar to those of cancer mortality. Causes of the marked secular trends in the cancer mortality and incidence are not clear, but the major causes are suspected to be changes in dietary habits, smoking and drinking habits, and other socio-environmental factors such as marital and reproductive factors. The five year survival rates of several cancers have been improved in the last decades. Thus, progresses in the diagnostic and therapeutic techniques and promotion of cancer screening may have also contributed to the decrease of cancer deaths. If the present trends in cancer mortality and incidence continue, cancer deaths/incidences will still increase and cancers of the lung, colo-rectum, liver (males only), pancreas, biliary tract, etc. will become major cancers in Japan in the future. To combat with ever increasing cancer it is necessary to further promote cancer research, cancer screening, programs for primary prevention of cancer, especially smoking control and improvement of dietary habits.

Two phosphorylation reactions induced by murine beta interferon in BALB/c-3T3 cells

Treatment with 1000 units/ml of murine beta-interferon enhanced an adenylate kinaselike activity and markedly increased the level of L-alpha-phosphatidyl inositol 4-monophosphate in quiescent BALB/c-3T3 cells. The addition of platelet-derived growth factor (22 units/ml) or poly(I).poly(C) (0.3-1 microgram/ml) to the phosphorylation reaction mixture did not alter this interferon action.

A prospective study of stomach cancer among a rural Japanese population: a 6-year survey

Stomach cancer mortality was prospectively studied among 9753 Japanese men and women who first responded to a mailed questionnaire in 1985 and were then followed through May 31, 1991. During this follow-up period, 57 stomach cancer deaths were identified. Current smokers had an increased risk of deaths from stomach cancer compared with never smokers (relative risk (RR) = 2.29, 95% confidence interval (CI): 1.15-4.56), but there was no dose-response to amount of cigarettes smoked. Daily alcohol drinkers who consumed 50 ml or more of alcohol per day also had a greater risk than nondrinkers (RR = 3.05, 95% CI: 1.35-6.91). There was no association between stomach cancer mortality and individual food consumption except a positive association with fruit intake. However, frequent use (greater than or equal to 3-4/week) of broiling of meats and traditional style Japanese salad preparation in their cooking procedures were positively associated with stomach cancer mortality. The RR values compared with infrequent use (less than or equal to 1-2/month) were 2.27 (95% CI: 1.06-4.85) and 3.10 (95% CI: 1.40-6.85), respectively. A positive family history of cancer, especially stomach cancer, significantly increased the risk of stomach cancer deaths (RR = 2.01, 95% CI: 1.12-3.63). The effects of these variables remained after adjustment for other variables.

Murine ST2 gene is a member of the primary response gene family induced by growth factors

The murine ST2 gene, which encodes a protein remarkably similar to the extracellular portion of murine interleukin 1 receptor types 1 and 2, is expressed in growth-stimulated BALB/c-3T3 cells in the presence of 50 micrograms/ml of cycloheximide. The treatment with 1,000 U/ml of purified native murine beta-interferon superinduced, rather than suppressed, the ST2 mRNA expression as in the cases of c-myc and JE mRNAs. These results suggested that the murine ST2 gene belongs to the family of primary response genes induced by growth factors. Furthermore, a longer ST2-related mRNA was found in BALB/c-3T3 cells that were stimulated to proliferate in the presence of cycloheximide.

Unusual rapidly growing gastric myxoid neurofibroma: a case report

A 62-year-old man was first found to have a gastric tumor in the fornix during a routine health examination 16 months previously. The case was not associated with von Recklinghausen's disease. Initially, the tumor was approximately 4 mm in diameter, but grew very rapidly to 20 mm in 13 months, and to 30 mm in the following month, without manifesting clinical symptoms. Malignancy was suspected because of the rapid growth and the endoscopic findings: a rough-granular elevated lesion with a wide stalk, and with erosions and mucus on its surface. Although endoscopic biopsy was done several times, the routine histological examinations were inconclusive. Endoscopic resection was therefore carried out. Examination of the resected specimen showed that the main elements consisted of wavy, long-spindled cells, which crossed irregularly, and whose interstitium was myxomatous. Immunohistochemically the specimen showed strongly positive reaction for S-100 protein and positive reaction for neuron specific enolase (NSE). Based on these immunohistochemical findings, a final diagnosis of gastric myxoid neurofibroma was made, which showed rapid growth due to myxomatous change. The patient showed a good postoperative course and no recurrence has been recognized by follow-up endoscopy.

Diet, nutrition and cancer in Japan

A number of epidemiological and experimental studies have revealed that dietary habits and nutrition are one of the major risk factors for cancer. Dietary habits and nutrition are related to cancer in various ways and many factors are involved in the development of cancer. These include large intakes of salted foods and pickled vegetables, and too low intakes of fresh vegetables and fruits which are known to be major risk factors for stomach cancer. A large intake of green-yellow vegetables is known to be a protective factor against cancer of the stomach, lung and some other sites. In Japan the westernization of dietary habits and nutrition may have contributed to the changes in the mortality of several kinds of cancers which have been observed in Japan in recent years. Further improvements of dietary habits and nutrition intake are important and will be effective for primary prevention of cancer.

The effect of breast self-examination on early detection and survival

To investigate the effect of breast self-examination (BSE), we compared the stages, survival, and the risk of death for 355 patients with breast cancer detected by BSE with those for 1,327 patients with breast cancer detected by chance. The early stages of the disease were found to be more common among the symptomatic breast cancer patients detected by BSE than those by chance. The 5-year overall survival rate was 94.4% for the symptomatic patients detected by BSE, and was significantly higher by 8.7% than that (85.7%) for patients detected by chance (P less than 0.001). The 10-year survival rate was 81.6% for patients detected by BSE, and 76.6% for cases detected by chance (the difference was not significant). The overall difference between the two survival curves was statistically significant by the logrank test (P less than 0.01). A multivariate analysis using the Cox proportional hazards model showed that the risk of death for patients detected by BSE was smaller by 0.570 times than that for patients detected by chance, which was statistically significant (P less than 0.05). The effect of biases inherent to BSE in the survival analysis cannot be controlled completely even after conducting multivariate analysis. These results suggest that BSE may contribute to the reduction of the risk of death through early detection of breast cancer. However, further examination should be conducted by other methods to obtain conclusive evidence.

Molecular cloning of the murine ST2 gene. Characterization and chromosomal mapping

The genomic locus of the murine ST2 gene was isolated based on homology with a murine ST2 complementary DNA sequence and its complete nucleotide sequence was determined. The locus is composed of eight exons and seven introns and is approx. 9 kilobase pairs in size. Two Sp1 binding sites are present in the 5' flanking region. The murine ST2 gene, which was expressed only in the growth-stimulated BALB/c-3T3 cells, was mapped to mouse chromosome one, very tightly linked to the interleukin 1 receptor-type 1 locus.

Passive smoking by pregnant women and fetal growth

STUDY OBJECTIVE

The aim was to investigate the effect of passive smoke exposure during pregnancy on fetal growth in the Japanese population.

DESIGN

The study comprised a community based interview and clinical survey of pregnant women in Aichi Prefecture, Japan.

SETTING

Participants attended for delivery at 146 private and public practices and hospital clinics in the Prefecture.

SUBJECTS

Participants were 6831 women who delivered a live singleton without malformation during the three consecutive months from June 1987, and comprised about 34% of total deliveries in the Prefecture during the period.

MEASUREMENTS AND MAIN RESULTS

35% of the women had been exposed passively to cigarette smoke for 2 h or more per day at home, in the work place, or in other places during pregnancy. At this level of passive exposure among non-smoking women with term deliveries (greater than or equal to 37 weeks), a small effect on fetal growth was observed; mean birth weight was reduced by 10.8 g, and the relative risk of growth retardation (less than 2500 g birth weight) was 1.0 (95% CI: 0.7-1.5), after adjusting age, parity, height, alcohol drinking, occupation, and gestation.

CONCLUSIONS

The results suggest that the reduction of fetal growth associated with passive smoke exposure during pregnancy may be small in Japanese population.

Synergistic effect of bile acid, endotoxin, and ammonia on brain edema

The effects of cytotoxic substances such as ammonia, bile acids and endotoxin, all of which increase in the circulating blood during fulminant hepatic failure (FHF), on the blood-brain barrier (BBB) permeability and development of brain edema were examined in the rats. Direct intracarotid injection of various bile acids resulted in the staining of the cerebral hemisphere with Evans blue as well as the increase of brain water contents. Elevation of ammonia was also observed in the cerebral hemisphere where the reversible opening of the BBB was induced by deoxycholate under hyperammonemic conditions. To see the synergistic significance of cytotoxic substances (ammonia, bile acid and endotoxin) under the more physiological condition as FHF, they were simultaneously injected into a peripheral vein. Brain uptake index of 14C-inulin and brain water content increased, and electron micrographs showed the swollen astrocytic foot processes surrounded brain capillary, but not opening of tight junction, the same as an animal model of fulminant hepatic failure. The results suggest that ammonia, bile acids and endotoxin might have a possible synergistic role in the pathogenesis of the brain edema, mainly cytotoxic, and vasogenic due to acceleration of vesicular transport, in FHF.

Choroid plexus metastasis of lung carcinoma--case report

Metastatic tumors in the choroid plexus are generally considered to be very rare. The authors present a case of lung large cell carcinoma with a single metastatic tumor in the choroid plexus of the lateral ventricle trigone. Precontrast computed tomographic (CT) scans showed an isodensity mass with extensive peritumoral edema, which was considerably enhanced on the postcontrast CT scans. Magnetic resonance (MR) images demonstrated the mass as a low-intensity area on the T1-weighted image and an iso-intensity area on the T2-weighted image. The tumor was clearly differentiated from the peritumoral edema by both CT and MR imaging. The diagnosis was confirmed by surgery.

The effect of mass screening for breast cancer: results of a multivariate analysis

To evaluate the life-prolonging effect of mass screening for breast cancer, we compared the risk of death for the patients detected by mass screening with that for the patients diagnosed in out-patient clinics, after adjusting for other relevant factors simultaneously by using the Cox regression model. A multivariate analysis using the Cox regression model in which clinical staging of disease was taken as one of the independent variables, showed that the risk of death for patients detected by mass screening was smaller by 0.765 times than that for patients found in out-patient clinics although the reduction was not statistically significant. This small reduction might be partly due to the effect of mass screening through early detection even within the same stage, and partly due to length bias, lead time bias and self-selection bias. When clinical staging of disease was removed from the independent variables, the risk of death for patients detected by mass screening was reduced from 0.765 times to 0.677 times that for patients diagnosed in out-patient clinics, which was statistically significant (P greater than 0.01). For asymptomatic patients detected by mass screening, such as reduction of the risk of death was from 0.789 times to 0.555 times that for patients found in out-patient clinics (P less than 0.05). These results suggest that mass screening for breast cancer may contribute to the reduction of the risk of death, although the effect of biases inherent in periodic screening was not removed completely in the present analysis.

A comparative case-control study of colorectal cancer and adenoma

We conducted a comparative case-control study of colorectal cancer and adenoma involving 221 cases with colorectal cancer, 525 cases with colorectal adenoma and 578 neighborhood controls. Daily vegetables intake was associated with lower risks of distal colon adenoma (relative risks (RR) = 0.59, 95% confidence interval (CI): 0.39-0.89) and rectal cancer (RR = 0.46, 95% CI: 0.25-0.84). Daily beans intake was associated with lower risk of colon adenoma (RR = 0.58, 95% CI: 0.37-0.91 for the proximal colon and RR = 0.63, 95% CI: 0.45-0.88 for the distal colon) and daily intake of seaweeds was associated with lower risk of rectal cancer (RR = 0.42, 95% CI: 0.22-0.82). Daily intake of fish and shellfish also showed an inverse association with the risk of colon adenoma (RR = 0.67, 95% CI: 0.45-0.99 for the proximal colon and RR = 0.70, 0.52-0.94 for the distal colon). Generally, intakes of animal or vegetable fat-rich foods, especially meats, were associated with decreases in risks of both adenoma and cancer, though the association of cancer was not statistically significant. Other than dietary factors, daily alcohol drinking was associated with an increased risk of adenoma in the proximal colon (RR = 1.95, 95% CI: 1.15-3.29) and ex-drinkers showed higher risks for colon adenoma and colorectal cancer. Sports or occupational activities and coffee drinking were inversely associated and family history of colorectal cancer was positively associated with the risk of both colorectal adenoma and cancer.

[Epidemiology of lung cancer--recent topics]

Lung cancer has been increasing markedly in recent years in Japan. It is estimated that the number of lung cancer deaths will exceed that of stomach cancer deaths by around 1995. The reason of the marked increase of lung cancer deaths is not clear, but the following factors may have contributed to the increase of lung cancer in Japan: 1) the increase in accuracy of diagnosis of lung cancer (a decrease in number of overlooked lung cancer cases), 2) an increase in number of aged population (this factor has been considered in the age adjusted mortality rate), 3) an increase in consumption of cigarettes and an increase of other risk factors of lung cancer. A number of studies have been conducted on the relationship between husband's smoking habit and lung cancer in non-smoking wives. The results of these studies implicate the effect of passive smoking on lung cancer, but more studies are needed to confirm the casual relationship. A recent study by Kawajiri et al on the DNA polymorphism of the cytochrome P450IA1 gene in lung cancer cases implicates a variation of the individual susceptibility to lung cancer.

[Comparative case-control analysis of gastric and duodenal ulcers]

A case-control analysis was conducted comparing gastric and duodenal ulcers involving 369 cases with gastric ulcer, 127 cases with duodenal ulcer an 3,104 control subjects based on a questionnaire survey of subjects who received gastroscopic examination at the Aichi Cancer Center Hospital from April, 1985 to March, 1989. Risk of gastric ulcer was positively associated with smoking (relative risk (RR) = 3.67, 95% confidence interval (CI): 2.63-5.13), irregular time of meals (RR = 1.39, 95% CI: 1.06-1.81) and milk intake (RR = 1.60, 95% CI: 1.25-2.04) and inversely associated with fruit intake (RR = 0.73, 95% CI: 0.57-0.95), while the risk of duodenal ulcer was positively associated with smoking (RR = 1.94, 95% CI: 1.16-3.26), a preference for foods that are not rich (RR = 1.55, 95% CI: 1.03-2.32), intake of pickled vegetables (RR = 1.76, 95% CI: 1.21-2.55) and presence of methods of diversion (RR = 1.77, 95% CI: 1.16-2.71). These results suggest that life style is involved in the etiology of both diseases and that there are some differences in the associations between both diseases.

A comparative case-control analysis of stomach cancer and atrophic gastritis

We conducted a comparative case-control analysis of stomach cancer and atrophic gastritis involving 427 cases with stomach cancer, 1414 cases with atrophic gastritis, and 3014 control subjects based on a questionnaire survey conducted for the subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April 1985 to March 1989. The risk of atrophic gastritis in both males and females was not associated with any environmental factors. The risk of stomach cancer compared with the control subjects was positively associated with an intake of salted fish guts or cod roe [relative risk (RR) = 1.52, 95% confidence interval (CI) = 1.08-2.15] and smoking (RR for 20 or more cigarettes per day = 2.84; 95% CI = 1.79-4.51) and inversely associated with Western-style breakfast (RR = 0.68; 95% CI = 0.48-0.96) in males. Additionally, the risk of stomach cancer was inversely associated with a daily intake of raw vegetables (RR = 0.56; 95% CI = 0.34-0.94) in males when compared with the patients with atrophic gastritis as controls. Several environmental factors, such as intake of green-yellow vegetables, fruit, and meat, and a family history of stomach cancer, were only associated with intestinal types of cancer in females, whereas a clear difference between diffuse and intestinal types was not observed in males. The results of the present study suggest that risk factors for stomach cancer may be different from those for premalignant lesions.

Descriptive epidemiology of subsites of cancers of the liver, biliary tract and pancreas in Japan

Recent time trends (1979-1987) and geographical distributions in mortalities from subsites of cancers of the hepato-biliary-pancreatic system have been investigated on the basis of the vital statistics of Japan. The corrected age-adjusted mortality rates (CAAMRs) were calculated to eliminate the influence of the proportion of subsite-unknown cancers. During the above period, the CAAMR for intrahepatic bile duct cancer increased by a relatively high extent (2.0-fold in males and 1.67-fold in females), and those for cancers of the gallbladder, extrahepatic bile duct and pancreas (head and other parts) increased to a moderate extent (1.2-1.4-fold). The CAAMR for primary liver cancer showed an increasing trend in males and a decreasing trend in females. The CAAMR for cancer of the ampulla Vater changed little during the period. A clear cluster of prefectures with high CAAMRs was observed in the northern part of Japan for cancers of the extrahepatic bile duct and pancreatic head. Clusters of prefectures with high CAAMRs for cancer of the gallbladder and ampulla Vater were observed in the mid-northern part of Japan, especially on the Japan Sea side. The CAAMR for primary liver cancer was high in the Island of Kyushu and some western parts of Japan, and low in the northern part of Honshu Island. No clear clusters of prefectures with high CAAMRs were observed for cancers of the intrahepatic bile duct and pancreas, other than for the pancreatic head.

Lung cancer prognostic factors from the Aichi Cancer Registry

Lung cancer prognostic factors have been evaluated on the basis of three-year survival rates for 2,830 lung cancer patients diagnosed between 1983 and 1986 and reported to the Aichi Cancer Registry. In the univariate analyses, the former in each pair of following factors showed a significantly better prognosis than the latter: early vs. late stage of disease, surgically-treated vs. non-surgically-treated cases, adenocarcinoma and squamous cell carcinoma vs. large cell and small cell carcinoma, cases detected by screening vs. others, young vs. old patients, females vs. males, non-smokers vs. smokers. The association of prognosis with these factors, other than smoking and histological type, remained statistically significant throughout multivariate analysis. When analyzed according to histological type, disease stage was the most important prognostic factor, across all histological types, and surgery was the second most important prognostic factor, except in cases of small cell carcinoma. Sex and method of detection were significantly associated with survival rates in adenocarcinoma and small cell carcinoma, and the association with smoking was of borderline significance for adenocarcinoma.

[Kinetics and clinical application of 99mTc-technegas]

Biological characteristics and clinical utilization of 99mTc-technegas were evaluated in three normal volunteers and 10 patients with various pulmonary diseases. 99mTc-pertechnetate (296 MBq (8 mCi] was injected in the crusible of 99mTc-technegas generator, and about 37 MBq (1 mCi) of 99mTc-technegas was inhaled in the lung by three times of deep inspiration. Blood activity was appeared immediately after inhalation of 99mTc-technegas and it was 0.2% of the inhaled dose/liter of blood after 2 hours. Urine activity was also increased after inhalation and cumulative dose was 4.96% of the inhaled dose after 24 hours. The tracer dose to distribution to the lung was about 95% of the total dose in whole body. Biological half time of 99mTc-technegas in the lung was 135 hours and pulmonary image was stable even after 24 hours. Radiation dose to the lung was 0.004 Gy/37 MBq (1 mCi). In patients with pulmonary disease, distribution of 99mTc-technegas was similar to that of 81mKr gas, although defect on 99mTc-technegas image was larger in severe obstructive disease. 99mTc-technegas study was superior over 133Xe gas study to identify the areas of ventilation abnormality more clearly, although quantitative evaluation was difficult in 99mTc-technegas study. On comparative study with 99mTc-aerosol, 99mTc-technegas distributed in more peripheral sites and both methods were cooperative for evaluation of ventilatory disturbance. These results suggest that 99mTc-technegas inhalation study is safe and useful method for ventilation study.

An epidemiological study on occupation and cancer risk

The relation between occupation and cancer risk was examined on the basis of 17,164 male and 6,835 female cancer patients aged 30 years or over who were entered in the Aichi Cancer Registry during the period, 1979-1987. Controlling for age, the risk of developing lung cancer was significantly high in sales, transport-and-communications, mental, ceramics and construction workers in men, and service workers in women. The risk of developing liver cancer was significantly high in transport-and-communications and service workers in men. The risk of developing colon cancer was significantly high in professional people of both sexes and in clerical workers in men. The risk of developing female breast cancer was significantly high in professional women, administrative and clerical workers and hairdressers. The risk of developing stomach cancer was significantly high in male and female agricultural workers, while that of developing cancer of the mouth-and-pharynx was significantly high in construction workers in men and filature-and-spinning workers in women. Analysis of smoking and alcohol drinking habits, by occupation, suggested the increased risk of developing lung cancer to be associated with a greater percentage of smokers and the increased risks of developing cancers of the liver and mouth-and-pharynx to be associated with a greater percentage of daily alcohol drinkers. When the analysis was limited to smokers, the risk of developing lung cancer was still significantly high in metal, ceramics and construction workers in men.

[Pulmonary clearance of 99mTc-HMPAO aerosol]

The clearance rate of inhaled aerosols of a lipophilic substance, 99mTc-HMPAO (Hexamethyl propylene amine oxime) was studied and compared to that of hydrophilic substances in 6 normal volunteers and 18 patients with lung diseases. The subject in sitting position inhaled a single deep breath of 99mTc-HMPAO aerosols, and held his breath about 30 sec. Then he continued to breath aerosols again for about 3 min. Radioactivity rapidly falls down during breath holding, to about 60% of the peak value (fast phase), with T 1/2 of 3.75 +/- 2.22 sec in 6 normal volunteers. This rapid phase was not appeared in hydrophilic aerosols with 99mTc-DTPA and 99mTc-pertechnetate and in lipophilic aerosol with 123I-IMP aerosol. The clearance of residual activity of 99mTc-HMPAO was slow with T 1/2 of 17.4 +/- 4.0 min. The T 1/2 of 99mTc-DTPA, 99mTc-pertechnetate and 123I-IMP were 50.2 +/- 20.9 min, 11.4 +/- 4.3, and 62.5 +/- 20.8 min respectively. 99mTc-HMPAO may cross transcellularly using the whole alveolar surface. The clearance of aerosols in the fast phase is rapid and depend on the regional perfusion. On the other hand, hydrophilic aerosol pass by an intercellular pathway and the clearance will be diffusion limited. As conclusion, inhalation study of 99mTc-HMPAO might be a new method to evaluate perfusion following ventilation study.

Tumor growth rate and prognosis of breast cancer mainly detected by mass screening

To investigate the relationship between the tumor growth rate of the primary breast cancer and its prognosis, records for 122 breast cancer patients in 9 hospitals in Japan were retrospectively reviewed. These records contained at least two measurements of the same tumor mass in the breast. So the growth rate was estimated from these measurements taken at different points in time. The doubling time of the breast tumors showed an approximately log-normal distribution. The geometric mean of doubling times for all cases was 174 days. The solid-tubular histologic type of carcinoma had the shortest geometric mean of doubling time (126 days), the scirrhous carcinoma had the second shortest one (205 days), and the papillotubular carcinoma had the longest one (252 days). The patients with shorter doubling time of tumor tended to have a poorer prognosis. The Cox multiple regression analysis showed that the tumor growth rate was related significantly with survival, after adjusting for other covariates such as clinical stage, lymph node metastasis, age of patient, histological type, and year of treatment.

Personal exposure to nitrogen dioxide and its association with respiratory illness in Hong Kong

In 1985, 362 primary schoolchildren and their 319 mothers were surveyed in Hong Kong to study the possible relationship of air pollution to respiratory illnesses. Using nitrogen dioxide (NO2) measured by personal samplers as a measure of air pollution, the study aimed to identify the major sources of NO2 in the indoor environment and see whether its increased presence was associated with respiratory symptoms. The levels of NO2 among the mothers was found to increase by 21% if dust exposure was reported from the workplace, 18% if they used such cooking fuels as liquid petroleum gas or kerosene, 11% when kitchens did not have ventilating fans, and 10% when incense was burned at home. In terms of respiratory symptoms, an increase in NO2 levels of 19% was reported among those with allergic rhinitis and 18% among those with chronic cough. The levels of NO2 among children were correlated with levels measured in classrooms, all of which had opened windows so that the NO2 came from outdoors. No association was found between children's NO2 levels and respiratory symptoms. With the exception of smoking by the father and the children's NO2 levels, no association was found between smoking at home and NO2 levels.

Modulation of blood flow following excision of a high-flow cerebral arteriovenous malformation. Case report

The authors present a case in which a large high-flow arteriovenous malformation was totally excised. The success of the operation was in part attributed to the prevention of hyperperfusion breakthrough phenomena by the use of Selverstone clamps on the cervical carotid artery. Monitoring of cortical blood flow during surgery was found to be helpful.

Clinical trials of long-term RF local hyperthermia for advanced gastric cancer

The effect of local hyperthermotherapy (HT) using 13.56-MHz radiofrequency (RF) capacitive heating was evaluated in 25 patients with unresectable or recurrent gastric cancer. HT was carried out once to 3 times a week for a duration of one hour at each session. Patients who underwent RF-HT frequently showed maintenance of performance status, symptomatic improvement and a reduction in tumor size. Moreover, the survival time of 9 patients who had numerous metastases to the distant peritoneum was significantly high (p less than 0.01), compared with 42 historical control patients who also had massive peritoneal dissemination, but had not received HT. The results of this study therefore indicate RF-HT to be a favorable modality in the palliative treatment of patients with far-advanced gastric cancer.

[The potential of cancer prevention]

Cancer prevention is an important cancer control strategy. It consists of primary and secondary cancer preventions. The former aims to prevent cancers by removing risk factors and supplementing protective factors. The latter aims to prevent cancer deaths by early detection-early treatment through periodic screening. The potential of cancer prevention in Japan was estimated statistically based on available data and assumptions. The main results obtained from the present estimation were as follows: 1) about 9-10% of cancers could be prevented if prevalence of adults smoker decreased to a half of the present level; 2) about 8-10% of cancer could be prevented by the improvement of dietary habits; reduction of salt intake and avoidance of excess intake of fats; 3) another 1-5% could be prevented by prevention of hepatitis B virus infection and improvements of work environment and air pollution; 4) a total of about 18-25% could be prevented if primary prevention is promoted extensively; 5) about 10-13% of cancer deaths could be prevented if periodic screenings for stomach cancer, cervical cancer, breast cancer, lung cancer and large intestinal cancer are widely conducted and the coverage rate of these cancer screenings reach to 30%; 6) a total of about 30-40% of cancer incidence/deaths could be prevented if both of primary and secondary preventions are promoted extensively in Japan. It is considered necessary to improve these estimates after considering time factors in primary cancer prevention and biases inherent to cancer screening in secondary cancer prevention.

[Migrant population life style and health status characteristics]

To clarify migrant population characteristics, we examined the relationship between out-migration from study areas during a 3 year follow-up period and health status, life style, and socioeconomic factors obtained at the initial baseline survey in a cohort study involving 15, 493 males and 17,440 females. Characteristics of inter-prefectural out-migrants were summarized as follows: 1) A significantly higher proportion of inter-prefectural out-migrants were employees of relatively large companies, family members of these employees, white collar workers in the case of males, and housewives in the case of females. 2) Inter-prefectural out-migrants had relatively good health status and high participation in cancer screening tests. 3) The dietary habits of inter-prefectural out-migrants were more westernized and well-balanced. 4) Male inter-prefectural out-migrants had a higher proportion of heavy smokers and daily drinkers, while females had lower proportion of smokers and drinkers. When comparing in-migrants to out-migrants, the characteristics were similar for males, but opposite for females.

A case-control study of male colorectal cancer in Aichi Prefecture, Japan: with special reference to occupational activity level, drinking habits and family history

The relationships of occupational activity level, drinking habits and family history of cancer to the risk of male colorectal cancer by subsites were investigated in a case-control study involving 1,716 cases with colon cancer, 1,611 cases with rectal cancer and 16,600 controls with other sites of cancer identified from the Aichi Cancer Registry, Japan 1979-1987. An occupation with a low activity level was associated with an increased risk of colorectal cancer; the age-adjusted relative risk (RR) compared to the high activity level group was 1.92 (95% confidence interval (CI): 1.38-2.67) for proximal colon cancer, 1.52 (95% CI: 1.19-1.94) for distal colon cancer and 1.38 (95% CI: 1.17-1.62) for rectal cancer. Beer drinkers showed an increased risk of colorectal cancer; the age-adjusted RR was 1.49 (95% CI: 1.13-1.95) for proximal colon cancer, 1.65 (95% CI: 1.34-2.04) for distal colon cancer and 1.88 (95% CI: 1.62-2.18) for rectal cancer. The RR for family history of colorectal cancer was 3.40 (95% CI: 2.19-5.29) for proximal colon cancer, 2.54 (95% CI: 1.73-3.75) for distal colon cancer and 1.78 (95% CI: 1.28-2.49) for rectal cancer. Multivariate analysis controlled for age, residence, marital status and smoking in addition to occupational activity level, beer drinking and family history of colorectal cancer did not materially change the RRs. When these three variables were combined, the RR was 15.72 (95% CI: 5.40-45.78) for proximal colon cancer, 10.55 (95% CI: 4.24-26.27) for distal colon cancer and 6.69 (95% CI: 3.12-14.36) for rectal cancer.

Correspondence in cancer history between husbands and wives

To study the effect of the environments shared by spouses on the development of cancer and some chronic diseases, we analyzed the correspondence of disease history in 21,592 fathers and mothers using the baseline data of a population-based cohort study. The observed number of cases (O) whose parents had the same disease history was statistically significantly greater than the expected (E); the O/E ratio was 1.53 (95% confidence interval (CI): 1.43-1.63) for all malignant neoplasms, 5.22 (95% CI: 2.81-9.70) for esophageal cancer, 1.63 (95% CI: 1.37-1.93) for stomach cancer, 3.01 (95% CI: 1.89-4.79) for colorectal cancer, 3.90 (95% CI: 2.75-5.53) for liver cancer, 3.14 (95% CI: 1.95-5.08) for lung cancer, 6.73 (95% CI: 2.53-17.87) for bladder cancer, 1.66 (95% CI: 1.54-1.78) for apoplexy and 1.67 (95% CI: 1.51-1.86) for heart disease. The results of the present study suggest that the environmental factors shared by family members for a long time may contribute to familial aggregation of cancer and some chronic diseases.

Bestatin in resected lung cancer. A randomized clinical trial

A randomized study with and without bestatin, a new biological response modifier, was conducted in order to evaluate its survival effect on resected lung cancer. A total of 153 patients (72 with squamous cell carcinoma, 66 with adenocarcinoma, and 15 with other types of cancer) were evaluated. Among the patients with squamous cell carcinoma, the bestatin-treated group had significantly prolonged survival compared to the control group. No significant difference between the two groups was seen in adenocarcinoma.

A case-control study of gallstones: a major risk factor for biliary tract cancer

Because of the strong association between gallstones and biliary tract cancer, we conducted a case-control study of gallstones at Niigata Cancer Center Hospital. Eighty-six cases with gallstones (33 males and 53 females) and 116 hospital controls (56 males and 60 females) were surveyed by means of a self-administered questionnaire. Gallstones were categorized into cholesterol stones (25 cases) and pigment stones (30 cases) based on the appearance of the stones. In multivariate analyses based on an unconditional logistic regression model, the risk of total gallstones was positively associated with a taste for salty food (relative risk (RR) = 2.31, 95% confidence interval (CI): 1.10-4.84), an intake of lettuce and cabbage (RR = 2.98, 95% CI: 1.47-6.06) and a family history of biliary diseases (RR = 5.63, 95% CI: 1.76-17.95), and inversely associated with an intake of salted and dried fish (RR = 0.16, 95% CI: 0.04-0.64). When analyzed by type of stones, cholesterol stones were associated with a taste for oily food (RR = 3.87, 95% CI: 1.36-11.03) and pigment stones were positively associated with professional or administrative occupation (RR = 4.74, 95% CI: 1.35-16.68) and inversely associated with a taste for less greasy food (RR = 0.28, 95% CI: 0.10-0.83). Some of these results are consistent with the results of our previous study on biliary tract cancer.

A putative protein of a growth specific cDNA from BALB/c-3T3 cells is highly similar to the extracellular portion of mouse interleukin 1 receptor

A cDNA clone, which represents a species of mRNA that is expressed in growth-stimulated BALB/c-3T3 cells but not in resting cells, was found to encode a protein remarkably similar in sequence to the members of the immunoglobulin superfamily, especially to the extracellular portion of the mouse interleukin 1 receptor. The immunoglobulin superfamily is believed to be involved in cell adhesion and cell-to-cell interaction. The evidence that a member of this family is induced in the course of the initiation of cell proliferation is intriguing.

A case-control study of biliary tract cancer in Niigata Prefecture, Japan

A case-control study of biliary tract cancer was conducted in Niigata prefecture where the mortality of the cancer is the highest in Japan. The cases were 109 patients with gallbladder cancer and 84 with bile duct cancer, and the controls were 386 sex- and age-matched neighborhood controls. For gallbladder cancer, a past history of biliary tract disease, a positive family history of cholelithiasis and a taste for oily foods were high risk factors. Intakes of animal proteins and fats such as fish, eggs, meat, etc., ingestion of vegetables and fruits, and taking snacks were low risk factors for gallbladder cancer. For bile duct cancer, a past history of biliary tract disease, a family history of cerebral vascular accident, a thin constitution and taking a small amount of foods were high risk factors, and a family history of heart disease, obesity, intakes of alcohol, animal proteins and fats, or frequent intakes of vegetables and fruits were low risk factors.

Alcohol consumption and cancers of hormone-related organs in females

The relations between alcohol consumption and cancers of the breast, corpus uteri and ovary were investigated in a case-control study involving 1,740 cases of breast cancer, 239 cases of cancer of the corpus uteri, 417 cases of ovarian cancer and 8,920 controls with other cancer sites identified from the Aichi Cancer Registry, Japan 1980-1986. The age-adjusted relative risk (RR) of daily alcohol drinkers compared to non-drinkers was significantly increased for breast cancer (RR = 1.36, 95% confidence interval (CI) 1.04-1.78), that for cancer of the corpus uteri was lowered insignificantly (RR = 0.44, 95% CI 0.15-1.38) and that for ovarian cancer was significantly lowered (RR = 0.38, 95% CI 0.16-0.90). The increase in the risk of breast cancer associated with daily alcohol drinking was evident in the age range 50 and over, the risk specified by type of alcoholic beverage being highest for beer. Multivariate analyses controlled for age, residence, marital status, occupation, smoking habit and family history of breast cancer did not materially change the RRs of daily alcohol drinkers. Despite the several limitations of the study, the results were consistent with those of previous studies from other countries, suggesting that alcohol consumption may contribute to the risk of breast cancer in Japanese woman, as it dose elsewhere. The present study also suggested alcohol consumption not to be associated with elevated risks of cancer in other hormone-related organs in females, and possibly to be associated with a decreased risk of ovarian cancer.

[Biliary excretion and clinical efficacy of T-3262 (tosufloxacin tosilate) administered in the treatment of cholecystitis]

T-3262 (tosufloxacin tosilate), a new oral pyridone carboxylic acid agent, was investigated for its biliary excretion and clinical efficacy and safety to evaluate its usefulness in the treatment of cholecystitis. T-3262 was administered to a total of 4 healthy volunteers for 2 days at a dose of 150 mg every 8 hours, and A-, B- or C-bile were collected using the MELTZER-LYON method at 10-11 hours after the final administration. Bile concentrations of T-3262 in 3 cases were 0.33-2.05 micrograms/ml (A-bile), 6.13-9.50 micrograms/ml (B-bile) and 1.11-2.70 micrograms/ml (C-bile). Thus, T-3262 levels in B-bile were 15-34 times higher than serum levels (0.28-0.41 micrograms/ml). Only a trace of serum concentration of T-3262 was detected in another case with the concentration in B-bile was 0.132 micrograms/ml. A total of 10 patients with cholecystitis were treated with T-3262 at a dose level of 150 mg per dose 3 times daily for 1 to 20 days. The clinical efficacy was excellent in 1 case, good in 5 cases and fair in 2 cases and unevaluable in 2 cases, thus the clinical efficacy rate was 75%. Bacteriologically, Klebsiella pneumoniae, Enterococcus faecalis and Haemophilus parahaemolyticus were isolated from biles of 3 patients before treatment. Upon the treatment, E. faecalis was eradicated and K. pneumoniae was unchanged. The fate of H. parahaemolyticus was not known because of examination was not done after treatment. Side effects were observed in 2 cases with diarrhea in 1 case and epigastric pain in another case. But those symptoms disappeared after cessation of administration of T-3262. Abnormal laboratory test values were not observed.

Cathepsin B and L activities in gastric cancer tissue: correlation with histological findings

Cathepsin B and L activities in cancerous and noncancerous mucosal tissues from 29 patients with gastric cancer were determined with a small amount of tissue homogenate. Both enzyme activities were significantly higher in cancerous tissues than in noncancerous tissues. The cathepsin B activity was higher with decreasing differentiation of the cancerous tissues, and also with increasing depth of invasion and metastasis to regional lymph nodes. Significantly high cathepsin B activity was observed in specimens of poorly differentiated adenocarcinomas, as well as in specimens from patients with extensive metastasis to n2 or n3 lymph nodes. These results suggest that high cathepsin B activity is characteristic of gastric cancer which invades and metastasizes. Therefore, in cases of marked elevation of cathepsin B activity in cancerous tissues, relatively extensive resection may be necessary to obtain a cure.

Interferon alters the pattern of secreted proteins from Ehrlich ascites-tumour cells

Treatment of Ehrlich ascites-tumour (EAT) cells with interferon (IFN) abolished their ability to secrete a 32 kDa protein that was secreted by growing EAT cells. These IFN-treated cells secreted two proteins (molecular masses 100 and 89 kDa as estimated by SDS/polyacrylamide-gel electrophoresis) that were not detected in two-dimensional gel electrophoresis of the culture fluid of untreated EAT cells. The sequence of 20 amino acids from the N-terminal end of the 32 kDa protein was very similar to portions of sequences of mouse proviral gag proteins.