A case-control study evaluating occult blood screening for colorectal cancer with hemoccult test and an immunochemical hemagglutination test.

A case control study to evaluate the occult blood screening for colorectal cancer was conducted in a town where colorectal cancer screening had been performed by Hemoccult test during the early years and subsequently by an immunochemical hemagglutination test. All residents aged >/=40 years had been offered the annual screening. Case series consisted of 51 subjects with fatal colorectal cancer. Three controls per case were selected from the list of residents who were alive at the time of diagnosis of the corresponding case and had been living in the town, matched by gender and by age. The odds ratio (OR) of dying of colorectal cancer for those having their most recent screening histories with Hemoccult test or the immunochemical test during the preceding 1 year and 1-2 year segment before case diagnosis were 0.20 [95% confidence interval (CI): 0.08-0.49] and 0. 17 (95% CI: 0.04-0.75), respectively. The OR increased towards 1.0 as the number of years since the most recent screening increased. The OR of dying of colorectal cancer was calculated to be 0.19 (95% CI: 0.05-0.70) for those screened with the immunochemical test alone during the preceding 1 year after adjustment for previous screening histories with the Hemoccult test. Corresponding OR was 0.36 (95% CI: 0.11-1.17) for those screened with Hemoccult test during the preceding 1 year. These results suggest that screening for colorectal cancer by fecal occult blood testings or immunochemical test alone would reduce mortality and that efficacy of the screening would be higher for the immunochemical test than for Hemoccult test.

[A case of advanced esophageal cancer showing good partial response by combination therapy of low dose 5-FU and low dose CDDP].

A 66-year-old man with a complaint of dysphagia was diagnosed as advanced esophageal cancer. Barium swallow examination of the esophagus showed a narrowing 10 cm in length at Ei (type 3), and biopsy specimen from the lesion on endoscopic examination revealed adenosquamous carcinoma. Multiple lymph node metastasis were detected by CT scan. He was treated with a combination of low dose 5-fluorouracil (5-FU) and low dose cisplatin (CDDP). The regimen consisted of 5-FU (300 mg/body/day continuous infusion) and CDDP (10 mg/body/day continuous infusion) for 3 weeks. After 2 courses of this regimen, his symptoms disappeared, and only mild irregularity of the esophageal wall remained on Barium swallow examination. The effect of the therapy was evaluated as a partial response. No side effect was observed. From this case, the possibility that CDDP is able to function as a biochemical modulator for 5-FU was suggested.

An immunologic test for fecal occult blood by counter immunoelectrophoresis. Higher sensitivity and higher positive reactions in colorectal cancer than single radial immunodiffusion and hemoccult test.

A new immunologic fecal occult blood test has been developed employing counter immunoelectrophoresis (CIEP) with anti-human hemoglobin Ao antiserum (anti-HbAo). Minimum detectable hemoglobin in hemolysate was 7, 9, and 7 micrograms/ml by CIEP, single radial immunodiffusion (SRID), and Hemoccult test (SmithKline Beckman), respectively. The values in stool were 0.5, 1.0, 3.0 mg hemoglobin/g stool in the same order. CIEP was more sensitive than SRID in detecting hemoglobin both in hemolysate and in feces. Of 38 stools from the patients with colorectal cancer, 29 (76%) gave positive tests in CIEP, whereas 22 (58%) (P less than 0.005), and 18 (47%) (P less than 0.05) gave positive tests in SRID and Hemoccult test, respectively. In every stage and at every site of cancer, CIEP showed the highest positive tests. CIEP did not give any false-positive reaction in specimens from 20 patients without gastrointestinal lesion or from 34 asymptomatic healthy controls without diet restriction, whereas Hemoccult test gave one and three positive reactions in these groups. These results clearly indicate that CIEP is specific and more sensitive to human hemoglobin than any other previous methods. CIEP is expected to have a potential for mass screening of colorectal cancer.

Investigation of regional differences in water and electrolyte absorption across the human colon by in vivo perfusion method.

Colonic perfusion studies were performed to evaluate regional differences in water and electrolyte absorption across the human colon. In 19 healthy male volunteers, a 5-lumen tube with two balloons was inserted into the colon by the endoscopic retrograde bowel insertion (ERBI) method and a 25 cm segment of either the right or the left colon was perfused with an isotonic electrolyte solution simulating the fasting ileal content at a rate of 5 ml/min. Additionally into 5 subjects of the right colon and 5 subjects of the left colon, PSP solution was injected and mean transit time was calculated by the dilution method. Higher absorption rates of water, Na and Cl were observed in the right than in the left colon. Mean transit time was longer in the left than in the right colon. It was considered that the right colon had greater absorptive capacity than the left. The colonic perfusion study by the use of ERBI method made it possible to determine the absorption of water and electrolytes in the right and left colon directly in man, and would be useful to elucidate the pathophysiology of colonic diarrhea.

Correlation of age-adjusted incidence and age-adjusted death rate in colorectal cancer among municipalities in Aomori Prefecture.

To clarify to what extent death rate reflects the incidence of colorectal cancer, we calculated the age-adjusted death rates for colorectal cancer among municipalities in Aomori Prefecture for the period between 1983 and 1987, and examined the correlation with the age-adjusted incidences of the disease during different 5-year periods. In males, the age-adjusted death rate of rectal or colon cancer most correlated with the age-adjusted incidence in the preceding period by three or two years, respectively; however in females, the age-adjusted death rate best reflected the age-adjusted incidence of the same period. In males, significant correlation was lost if the interval exceeded seven years in both rectal and colon carcinomas. In females, the correlation became insignificant after an interval of four and five years in rectal and colon cancers, respectively.

Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test. A case-control study.

Fecal occult blood testing by immunochemical hemagglutination has been shown to be superior to the Hemoccult test, both in sensitivity and in specificity. The test has been widely used as a tool for population screening in Japan, but there has been no study to evaluate the efficacy of screening using this test. A case-control study to evaluate the screening was conducted in study areas where no previous and no other concomitant colorectal cancer screening had been performed. Case series in the study were 193 cases who died of colorectal cancer. Three controls were selected randomly from the list of individuals who were alive at the time of diagnosis of the corresponding case and had been living in the same area as the case, matched by gender and by age. Odds ratios (OR) of dying of colorectal cancer for those screened within 1, 2 and 3 years of case diagnosis vs. those not screened were 0.40 [95% confidence interval (CI) 0.17-0.92], 0.41 (95% CI 0.20-0.82), and 0.48 (95% CI 0.25-0.92), respectively. OR increased towards 1.0 as the duration during which screening histories were compared was extended, and showed similar tendencies when analyzed by number of years since the most recent screening history. These results suggest that colorectal cancer screening by the immunochemical fecal occult blood test would reduce mortality from colorectal cancer.

Eradication of Helicobacter pylori with lansoprazole and clarithromycin in gastric ulcer patients.

This study attempted to determine the efficacy of lansoprazole plus clarithromycin therapy in the eradication of Helicobacter pylori in gastric ulcer patients. The influence of H. pylori eradication on healing and relapse of ulcers was also studied. Thirty-nine patients received either lansoprazole 30 mg daily for 8 weeks (group 1) or clarithromycin 200 mg twice daily for 2 weeks and lansoprazole 30 mg daily for 8 weeks (group 2). Before treatment, H. pylori status was evaluated by a rapid urease test and histologic examination. H. pylori clearance and eradication were evaluated by a rapid urease test, polymerase chain reaction, and a [13C]urea breath test. Clearance of H. pylori was 0% in group 1 and was 33% in group 2. Eradication of H. pylori was 0% in group 1 and 21% in group 2. Although all five ulcers were healed in patients with H. pylori eradication, ulcers were not healed in the five patients without eradication. Relapse of ulcer was observed in three patients in whom eradication had failed. In this study, for H. pylori-positive gastric ulcer patients, better results were obtained when lansoprazole plus clarithromycin therapy was used, and H. pylori eradication was achieved.