Family history in participants of breast cancer screening

Of 12,337 participants of mass screening for breast cancer (screenees) in Gunma Prefecture between 1980 to 1985, 1,000 participants' records in Gunma Prefecture were investigated. The records of screenees who had already developed breast cancer were excluded. The rate of screenees who had a family history (FH) of cancer in first- and second-degree relatives was compared with that of 1,248 breast cancer patients (controls) using the conditional logistic regression model. The mean age of screenees (49 y.o.) was similar to that of controls (51 y.o.). The number of screenees with positive FH of cancer including other malignancies was 530 with the odds ratio of 2.68. This was statistically significant with chi-square test. The rates of screenees with positive FH of cancer were quite similar in the seven districts. Screenees had a significantly larger number of relatives with a positive FH of breast cancer compared with the controls. The rate of positive breast cancer history in parents of screenees was significantly higher than in the parents of controls. Rates of positive breast cancer history in grandmothers and aunts of screenees were also significantly higher than that in the controls. The rate of breast cancer history in sisters was not different between the two groups. Screenees had a higher rate of positive FH of cancer in parents, especially in mothers. Family histories of stomach, liver, lung, and uterus cancer in parents were more frequently observed in screenees compared with the controls and those cancer histories were also frequently observed in other family members of screenees. These data showed that a FH of cancer is one of the primary motivations of participation in the breast cancer screening program. Participants seemed to be intrinsically a high risk group of breast cancer.     

Combination chemoendocrine therapy containing vindesine for refractory metastatic breast cancer

Metastatic breast cancer has ultimately failed to respond to the multiple prior therapies, and thus new therapeutic regimens are required. Nine patients with metastatic breast cancer previously treated with multiple therapeutic regimens were enrolled. The treatment schedule was as follows: vindesine was given intravenously at a dose of 2 mg/m(2) every four weeks. Etoposide and medroxyprogesterone acetate was orally administered at a dose of 25 mg/day for 14 consecutive days and 600 mg/day every day. Only one patient with exclusive bone metastasis showed partial response and the objective response rate for the combination of agents was 11%. Pain derived from the metastatic lesions was reduced in four (80%) among five patients with bone metastasis. For patients with refractory breast cancer, especially with bone metastasis, chemoendocrine therapy containing vindesine might have therapeutic efficacy with low toxicity and favorable quality of life.     

A case of progressive supranuclear palsy presenting mouth opening difficulty with tonic contraction of the orbicularis oris muscle]

A 72-year-old man developed supranuclear ophthalmoplegia, bradykinesia, rigidity, unsteady gait, dementia, dysphagia, retrocollis, grasp reflex and apraxia of eyelid opening. These findings were compatible with progressive supranuclear palsy (PSP). At the age of 66, he presented a peculiar phenomenon characterized by simultaneous tonic contraction of the orbicularis oris muscle (OOM) and the palatal muscles elicited by pronouncing "pa", which resulted in difficulty of voluntary opening of the mouth and the rhinopharynx. Therefore, the respiration air reciprocated between the lung and the closed mouth. The expiratory pressure puffed out the cheeks, while the lips remained tightly closed. While the respiratory movements and the pressure increased by degree, the OOM contracted more strongly in proportion to the pressure. Sixty to ninety seconds after the elicitation, the pressure overcame the contraction of the OOM and the course of the phenomenon was completed. The electromyograms showed that the OOM activity was prolonged after initial voluntary contraction, remaining thus after a tracheostomy for pneumonia at the age of 72, and that it increased in response to the pressure. Apraxia of eyelid opening, one of the other symptoms, resembled this phenomenon in terms of the aspect of difficulty of voluntary mouth opening. The "holding" phase of grasp reflex, yet another symptom, resembled it in the recruitment of the OOM activity. The phenomenon is not common in patients with PSP. However, we concluded that it may be included among the symptoms of PSP because it has similar characteristics to apraxia of eyelid opening and grasp reflex, which are not uncommon in patients with PSP.     

Comparative evaluation of urinalysis and blood analysis as means of detecting exposure to organic solvents at low concentrations

Summary One hundred and forty-three workers exposed to one or more of toluene, xylene, ethylbenzene, styrene, n-hexane, and methanol at sub-occupational exposure limits were examined for the time-weighted average intensity of exposure by diffusive sampling, and for biological exposure indicators by means of analysis of shift-end blood for the solvent and analysis of shift-end urine for the corresponding metabolite(s). Urinalysis was also performed in 20 nonexposed control men to establish the background level. Both solvent concentrations in blood and metabolite concentrations in urine correlated significantly with solvent concentrations in air. Comparison of blood analysis and urinalysis as regards sensitivity in identifying low solvent exposure showed that blood analysis is generally superior to urinalysis. It was also noted that estimation of exposure intensity on an individual basis is scarcely possible even with blood analysis. Solvent concentration in whole blood was the same as that in serum in the case of the aromatics, except for styrene. It was higher in blood than in serum in the case of n-hexane, and lower in the cases of styrene and methanol.     

Natural history of fibroadenomas based on the correlation between size and patient age

BACKGROUND: Several recent studies have reported that most fibroadenomas remain static or regress when they are managed conservatively; however, no such studies have evaluated the breast disorder in Japanese women. To understand the natural history of fibroadenomas in Japanese women, we examined the correlation between the sizes of the fibroadenomas and the women's age. METHODS: Fifty-eight consecutive patients (age range, 17-51 years; mean, 33.9 years) with histologically confirmed fibroadenoma were enrolled in this study. The sizes of the excised fibroadenomas were analyzed in relation to the women's ages. RESULTS: The fibroadenomas decreased significantly in size (Y, mm) with patient age (X, years) (P = 0.0012) according the equation Y = -0.340X + 27.0 (95% confidence limits for the slope, -0.139 to -0.540). From this equation, the mean sizes of the fibroadenoma in women aged 20, 30 and 40 years were expected to be 20.2 mm (95% confidence interval, 16.2-24.2 mm), 16.8 mm (95% confidence interval, 10.8-22.8 mm) and 13.4 mm (95% confidence interval, 5.4-21.4 mm), respectively. The mean annual decrease in the size of the fibroadenomas was 0.340 mm. CONCLUSIONS: Our results indicate that in Japanese women fibroadenomas increase in size more frequently in younger than in older women. Moreover, it is speculated that most fibroadenomas might stop growing when they reach an approximate maximum diameter of 20 mm, after which time they might remain static or regress.      

The relationship of the platelet 5-HT-induced calcium response to clinical symptoms in eating disorders

Clinical observations indicate that persons with eating disorders exhibit many psychopathologic symptoms such as difficulty with impulse control and depressed mood associated with impaired regulation of serotonin (5-HT) synaptic function in the central nervous system. In this study, we focused on the relationship between the 5-HT-induced calcium response in platelets and the clinical symptoms. While age, body weight, and severity of depressive symptoms were not correlated with 5-HT-induced response, there was an enhanced response in patients with bulimic symptoms or other impulsive behaviors. Moreover, patients with multi-impulsive behaviors had a significantly higher maximal increase than patients with uni-impulsive behavior, i.e., those who had only bulimic symptoms, as well as non-impulsive patients, and controls. Considering these results, the 5-HT-induced response may be related to difficulty with impulse control in general rather than bulimic eating attitudes specifically. Received: 12 June 1998/Final version: 26 August 1998     

Recent progress in akathisia]

Neuroleptic-induced akathisia should be definitely diagnosed as acute, tardive, withdrawal, and chronic. The diagnostic assessment must be identified from the subjective report and objective features. Various assessments of measuring akathisia can be clinically used by instrumental methods and rating scales. The pharmacological basis of neuroleptic-induced akathisia is the inhibition of the dopamine receptors in the brain. The pathogenesis of neuroleptic-induced akathisia may involve GABAergic hypoactivity, noradrenergic hyperactivity, and serotonergic dysfunction in CNS. Iron deficiency and hyperglycemia may be risk factors of neuroleptic induced akathisia in relation to the dopamine function in the brain. Neurological disorders may be associated with the development of a syndrome resembling drug-induced akathisia. The lesion of the thalamic nuclei would originally produce the syndrome. The difference between acute and tardive akathisia on the strategy of the drug treatment should be sufficiently comprehended. In particular, the long-term use of anticholinergic drugs and benzodiazepines should not be prevailed.