Cancer mortality of male workers exposed to benzidine and/or beta-naphthylamine

The risk of cancer was analysed in a cohort of 604 male workers who had been engaged in manufacturing and/or handling benzidine and/or beta-naphthylamine during the period 1945-71 at two factories located in the city of Osaka. The cohort was followed up from 1 January 1970 to the date of death or 31 December 1986. The mean follow-up time was 16.1 years. A total of 84 deaths was found compared with 112.66 expected based on the mortality of the Osaka population. Thirty-six were found to be dead of malignant neoplasms; 9 stomach, 2 colon, 1 rectum, 3 liver, 1 bile duct, 1 pancreas, 1 maxillary sinus, 6 lung, 8 bladder, and 2 ureter neoplasms as well as 1 case of myeloid leukemia. Seven cases were ascertained on death certificates as neoplasms of uncertain behaviour, all of which were tumors of genitourinary organs except for one case of brain tumor. Cancers of genitourinary organs and tumors of uncertain behaviour showed statistically significant increased standardized ratios (SMR = 12.20, 4.89). The mean age of death of those having genitourinary organs including cancer was 59 years old, and the latent period between the first exposure and the occurrence of the disease was 19.7 years on average. Non-significant increased risks of cancers of the colon, rectum, liver and lung were observed among the workers exposed to benzidine. Among the 7 histologically confirmed cases of these cancers, there were 2 adenocarcinomas of the lung, 1 adenocarcinoma of the rectum, 2 hepatocellular carcinoma and 1 adenocarcinoma of the bile duct. Seven patients with genitourinary tumors were found to have died of other primary cancers.     

Different effects of casein and soyabean protein on gastric emptying of protein and small intestinal transit after spontaneous feeding of diets in rats.

The effects of dietary casein and soyabean-protein isolate (SPI) on gastric emptying and small intestinal transit were observed in rats fed on an 80 g casein or 80 g SPI/kg diet. After a 24 h fast, rats were given 2 g of both the test diets containing 10 g guanidinated casein/kg diet as a marker protein. The amounts of the marker protein remaining in the stomach of the rats fed on the casein or SPI diet were similar and decreased to about 50% after 20 min. The emptying rate then slowed, especially in the casein group, so that the amount leaving the stomach after 1 h in the SPI group was slightly higher (P < 0.05). The small intestinal transit of chyme was estimated by a bolus injection of colloidal carbon suspension or of colloidal carbon and 3H-labelled polyethylene glycol through an implanted duodenal catheter 6 min before death. The average value of transit at 12, 20, 40 and 60 min after feeding of SPI diet was about 25% faster than that after casein diet. The transit velocity of the SPI group was also faster than that of the non-protein group 40 min after feeding. These findings reveal that SPI enhances the small intestinal transit of the liquid phase of chyme. There was no correlation between the gastric emptying of homarginine and small intestinal transit. This result suggest that the small intestinal transit of lumen contents is controlled by the dietary protein regardless of the gastric emptying of protein.     

An echovirus type 18 outbreak in a neonatal intensive care unit

We describe an outbreak of echovirus type 18 infection involving 20 neonatal intensive care unit (NICU) patients and the results of virological investigations are presented. RT-PCR demonstrated a widespread transmission of the virus in NICU patients during the outbreak. Separation care and additional infection control measures seemed to be effective in preventing further spread of the virus.     

Diagnosis of Paroxysmal Nocturnal Hemoglobinuria: Recent Advances

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disorder with its protean clinical manifestations. This is due to partial or complete absence of ‘glycophosphatidyl-inositol-anchor proteins’ (GPI-AP). The main aim of this review is to highlight various diagnostic modalities available, basic principle of each test and recent advances in the diagnosis of PNH. Recently among various tests available, the flow cytometry has become ‘the gold standard’ for PNH testing. In order to overcome the difficulties encountered by the testing and research laboratories throughout the world, International Clinical Cytometry Society has come up with guidelines regarding the indications for testing, protocol for sample collection, processing, panel of antibodies as well as gating strategies to be used, how to interpret the test and reporting format to be used. It is essential to test at least two GPI-linked markers on at least two different lineages particularly on red cells and granulocytes/monocytes. The fluorescent aerolysin combined with other monoclonal antibodies in multicolour flow cytometry offered an improved assay not only for diagnosis but also for monitoring of PNH clones. It is equally important to diagnose this rare entity with high index of suspicion.     

Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms

Journal of Gastroenterology -     

Evaluation of pre-surgical models for uterine surgery by use of three-dimensional printing and mold casting

We propose an approach to supporting pre-surgical planning for the uterus by integrating medical image analysis and physical model generation based on 3D printing. With our method, we first segment the patient-specific anatomy and lesions of the uterus on MR images; then, we create a 3D physical model, an exact replica of the patient’s uterus in terms of size and softness, with transparency for easy observation of the internal structures of the uterus. In our experiments, we created pre-surgical models of hysterectomy for five patients who had been diagnosed to have uterine endometrial cancer. An experienced radiologist, the surgeons, and all of the patients cooperated in our experiment for carrying out subjective evaluations of the usefulness of our model. The accuracy of the physical models was evaluated quantitatively by comparison between the MR images of the patients and the CT images of the models. The results showed that the mean values of the errors in gap ranged from 1.19 to 2.22 mm, which was satisfactory for the surgeons. The feedback from both surgeons and patients demonstrated the usefulness and convenience of the models for efficient patient explanation understanding and pre-surgical planning by surgeons.     

Three-dimensional microstructural analysis of human trabecular bone in relation to its mechanical properties.

The purpose of this preliminary study is to explore the relationship between elastic modulus, bone mineral density (BMD), and trabecular microstructure in three dimensions. Twenty cubes of trabecular bone were processed from two lumbar vertebrae obtained from one individual. The BMD of each cube was measured by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Each cube was serially scanned by microcomputed tomography to produce three-dimensional data sets. By analyzing these data sets, three-dimensional trabecular microstructural indices of connectivity density and fractal dimension were calculated as well as histomorphometric parameters. The cubes were tested mechanically in a nondestructive manner for measurement of their elastic modulus. This preliminary study showed that: (1) bone mass index is correlated with mechanical properties, with coefficients of correlation ranging from 0.552 to 0.601; and (2) when controlling for BMD, no association could be detected between measures of structural complexity (connectivity density and fractal dimension) and elastic modulus in the craniocaudal direction of human vertebral bodies.     

A case of disseminated atypical mycobacteriosis with multiple bronchial polyps

A 55-year-old male was admitted with fever, productive cough and dyspnea for a month. Chest X-ray revealed infiltration in the right lower lung field and right pleural effusion. Cultures of sputum, bone marrow and peripheral blood disclosed mycobacterium avium-intracellulare complex. The specimens of the liver, gallbladder wall and mesenterium obtained on cholecystectomy revealed epithelioid granulomas. Fifteen months after the admission, bronchoscopic finding showed a pedunculated polyp in the right main bronchus, and three other bronchial polyps in the truncus intermedius, right basal bronchus and B6. These bronchial lesions improved with combination chemotherapy containing cycloserine (CS) and other antituberculosis drugs. He was discharged 36 months after the admission. Perforation of the involved hilar lymph-nodes was considered to play an important role in the development of the multiple bronchial polyps. Cases of disseminated atypical mycobacteriosis accompanied with multiple bronchial polyps are extremely rare.     

A case of aprindine-induced pneumonitis

A 73-year-old man had been treated with Aprindine because of paroxysmal atrial fibrillation. On July 13, 1987, five months after the commencement of aprindine administration, he developed dyspnea and low grade fever. His chest X-ray revealed multiple infiltrative shadows in both lung fields. He was treated by various antibiotics, but the infiltrative shadows increased. BALF showed increased percentage of lymphocytes and a decrease in the OKT4/T8 ratio, and the histological findings of TBLB carried out on August 6, 1987, showed alveolitis with Masson bodies. The lymphocyte stimulation test by drugs was positive only for aprindine. After cessation of Aprindine administration, his complaints and laboratory data improved, but his abnormal shadow on chest X-ray did not diminish completely. Open lung biopsy was performed for differential diagnosis of BOOP, on Sep. 14, 1987. The histopathology of specimens of the lung was compatible with drug-induced pneumonitis. The administration of 30 mg of prednisolone was started on Oct. 14, 1987, and the dosage was decreased gradually. The abnormal shadow on chest X-ray improved. To our knowledge, there has been no reported case of Aprindine-induced pneumonitis, and this could be the first report.     

Malignant lymphoma diagnosed by the pericardial biopsy

The biopsy findings of malignant lymphoma involving the pericardium in a 69-year-old male were reported. The initial presenting symptoms were heart failure followed by rapidly progressive complete heart block. Pacemaker was inserted. Chest roentgenogram showed a marked left pleural effusion. An echocardiogram demonstrated pericardial fluid. The diagnosis of lymphoma was suggested by gallium isotope study with markedly increased isotope uptake in heart, and was subsequently confirmed by pericardial biopsy. After chemotherapy the pleural effusion was decreased and the uptake of gallium disappeared. While the diagnosis of cardiac involved lymphoma was hard antemortem, experience in this case suggests that gallium isotope study and pericardial biopsy are helpful in establishing the correct diagnosis.