Cigarette smoking and the risk of colorectal cancer among men: a prospective study in Japan.

The association between cigarette smoking and the risk of colorectal cancer remains controversial. We examined this association using a population-based prospective cohort study in Miyagi, Japan. In 1990, we delivered a self-administered questionnaire on cigarette smoking and other health habits to 25 279 men who were 40-64 years of age and lived in 14 municipalities of Miyagi Prefecture. A total of 22 836 men responded (90.3% response rate). During 7 years of follow-up (158 376 person-years), we identified 188 patients of colorectal cancer. Relative risks and 95% confidence intervals were estimated by the Cox proportional-hazards regression analysis with adjustment for potential confounders. The multivariate-adjusted relative risks (95% confidence interval) of colorectal cancer for past smokers and current smokers compared with those who had never smoked were 1.73 (1.04-2.87) and 1.47 (0.93-2.34), respectively. Among current smokers, both a higher number of cigarettes smoked per day and an earlier age at which smoking had started were associated with a significant linear increase in risk (P for trend <0.05). Our findings are consistent with the hypothesis that cigarette smoking is associated with a higher risk of colorectal cancer in men.     

Long-term estrogen replacement therapy is associated with improved exercise capacity in postmenopausal women without known coronary artery disease

BACKGROUND: Short-term estrogen administration improves vasodilation and has been shown to improve exercise capacity. However, it is unknown whether long-term estrogen replacement therapy is associated with improved exercise capacity in postmenopausal women without known coronary artery disease. METHODS AND RESULTS: We studied 248 postmenopausal women without known coronary artery disease (mean age 63.5 years); 158 (64%) were current or past hormone replacement therapy (HRT) users and 108 (44%) were current users of HRT. Attributes potentially affecting exercise capacity and cardiac risk factors were carefully measured. These included duration of estrogen replacement therapy, all variables in the Framingham risk index, physical activity level, body mass index, waist-to-hip ratio, presence of osteoporosis, and family history of heart disease. We measured maximal oxygen uptake (MVO (2)) and anaerobic threshold as objective markers of exercise capacity. The relation between exercise capacity and use of HRT was analyzed with the use of logistic regression, controlling for confounding variables. We found that fitness, as measured by MVO (2) and anaerobic threshold, was significantly greater in women who had used HRT currently or in the past compared with women who had never used HRT. This difference in fitness was not confounded by age or physical activity level. CONCLUSIONS: Estrogen replacement therapy is associated with increased exercise capacity as measured by MVO (2) and anaerobic threshold in postmenopausal women without coronary artery disease. This finding is consistent with the beneficial effect of short-term estrogen administration on improved endothelium-dependent and endothelium-independent vasodilation.     

Pulmonary Fibrosis with Megakaryocytoid Cell Infiltration and Chronic Myelogenous Leukemia

The relationship between fibrosis and megakaryocytic infiltration in the lungs of patients with Philadelphia-chromosome (Ph¹)-positive chronic myelogenous leukemia (CML) is the focus of this review. Ph¹-positive megakaryocytes are thought to reach and accumulate in the pulmonary vasculature through the marrow-blood barrier. In 21 autopsied patients with accelerated phase or blastic crisis of CML, megakaryocytic infiltration to the lungs was demonstrated in 10 patients, myelofibrosis in 12 patients and both in 5 patients. In 2 of the 10 patients with increased megakaryocytes in the lungs, relatively new fibrosis and alveolar damage in the acute phase were demonstrated with the simultaneous occurrence of myelofibrosis-“myelopulmonary fibrosis.” Leakage of mitogenic factors resulting from an abnormality in the packaging mechanism of alpha-granules in these cells termed acquired grey platelet syndrome could cause Fibrosis in the lungs as well as the bone marrow.     

Basic Fibroblast Growth Factor as a Candidate Tumor Marker for Renal Cell Carcinoma

The present investigation was conducted to determine serum levels of basic fibroblast growth factor (FGF) by enzyme immunoassay in patients with various urogenital tumors. Renal cell carcinoma had a higher tendency (28 of 52, 53.8%) toward increased serum levels of basic FGF than any of the other urogenital tumors, and increased serum basic FGF was detected more frequently in patients with advanced renal cell carcinoma. Analysis of histological pattern indicated that renal cell carcinoma with a solid or tubular component is more likely to produce basic FGF. However, no significant difference was seen between the percentage of clear cell type tumor patients with increased serum basic FGF (50.0%) and the percentage of granular cell type tumor patients with increased serum basic FGF (66.7%). Five of 8 patients with renal cell carcinoma who underwent selective renal venous sampling before nephrectomy showed increased serum basic FGF in the renal vein from the affected kidney. After resection of the affected kidney to remove the cancer, serum basic FGF disappeared within 2 weeks. However, residual huge tumor or postoperative disease prolonged the increased levels of basic FGF in 2 patients, indicating that basic FGF is produced from and secreted by tumor tissue itself. These findings suggest that serum basic FGF can be useful in the diagnosis, and in evaluating the prognosis, of patients with renal cell carcinoma.     

Hepatocyte growth factor levels in bone marrow plasma of patients with leukaemia and its gene expression in leukaemic blast cells.

Hepatocyte growth factor (HGF) has been known as a multiple function factor, which also stimulates early haematopoiesis. In this study, we found that HGF was expressed at both the RNA and protein levels in acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). In patients with AML (n = 20) and CML (n = 5), bone marrow plasma HGF concentrations were 20.44 +/- 6.26 (mean +/- s.e.) ng ml-1 and 7.17 +/- 0.53 ng ml-1 respectively. These were significantly higher (P < 0.01) than the value for normal subjects (n = 26): mean 0.92 +/- 0.09 ng ml-1. Constitutive HGF production was observed in freshly prepared leukaemic blast cells from three patients with high HGF levels of bone marrow plasma. Expression of HGF mRNA was correlated with bone marrow plasma HGF levels. After complete remission was obtained in six patients, bone marrow plasma HGF levels were significantly decreased. In contrast, the HGF mRNA was less abundantly expressed in acute lymphoid leukaemia (ALL). In patients with ALL (n = 5), bone marrow plasma HGF concentration (0.69 +/- 0.14 ng ml-1) remained low within the value for normal subjects. These results suggest that some populations of myeloid lineage cells have the ability to produce HGF.     

A Case of Nephrotic Syndrome With Tetany

Abstract A 7-year-old girl with nephrotic syndrome had several attacks of tetany during the relapses. The attacks, acccompanied by hyperventilation, responded to re-breathing with a vinyl bag. However, other episodes of attacks which were not accompanied by hyperventilation, did not respond to re-breathing but responded to the intravenous administration of calcium gluconate. The serum concentrations of total calcium and ionized calcium were low and no calcium-binding protein was found in the serum from the patient, using chromatographic study. The serum concentration of 1, 25(OH)₂ vitamin D was within the normal range, but showed a tendency for the value to be lower in relapse than in remission. Urinary, Ca/Cr ratio in relation to serum calcium was high in this patient and a low threshold of calcium excretion in the kidney was demonstrated.
It is suggested that the impaired vitamin D metabolism and calcium loss in the urine might have contributed to tetany in this patient.
Administration of a calcium preparation and vitamin D may be necessary for a frequentrelapser on long-term glucocorticoid therapy.