Cost-Effectiveness Analysis of the Diagnosis and Treatment of Primary Aldosteronism in Japan.

Approximately 10% of cases of hypertension in Japan are caused by primary aldosteronism (PA), amounting to about 4 million patients in total. Primary aldosteronism due to unilateral aldosterone hypersecretion is potentially curable by adrenalectomy. The clinical benefits of identifying and treating PA have been reported internationally, but its cost-effectiveness is unclear. We examined whether diagnosing and treating hidden PA in hypertensive population was cost-effective compared with suboptimal treatment. Our hypothetical patient was a 50-year-old man diagnosed with stage I-III hypertension. We established a Markov decision model based on plausible clinical pathways and prognoses of PA. We applied cost-effectiveness analysis comparing a comprehensive diagnostic strategy for PA (measurement of plasma aldosterone/renin ratio, 2 loading tests, imaging, and selective adrenal venous sampling) with a suboptimal strategy to manage hypertension by medication unless the typical signs of PA or other complication were manifest. Outcome measures were expected costs, expected effectiveness, and incremental cost-effectiveness ratio. The robustness of the findings was established by one-way and scenario sensitivity analyses. The comprehensive PA diagnostic strategy increased the expected costs by 64 004 JPY and expected life-years by 0.013 compared with standard treatment. The incremental cost-effectiveness ratio for the diagnosis of PA was 4 923 385 JPY per year. Our findings were sensitive to the outcomes of screening and treatment, and the costs of continuous or periodic medication for hypertension and the treatment of stroke and its complications.

A case of bilateral aldosterone-producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery.

Primary aldosteronism due to unilateral aldosterone-producing adenoma (APA) is a surgically curable form of hypertension. Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral idiopathic hyperaldosteronism (IHA) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old man with marked long-standing hypertension was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked hypertension, hypokalaemia, elevated plasma aldosterone concentration (PAC) of 45.1 ng dl(-1) and aldosterone renin activity ratio of 90.2 (ng dl(-1) per ng ml(-1 )h(-1)), which was still high after 50 mg-captopril loading. CT revealed bilateral adrenocortical tumours of 10 and 12 mm in diameter on the right and left sides, respectively. S-AVS confirmed excess aldosterone secretion from a tumour segment vein and suppressed secretion from a non-tumour segment vein bilaterally, leading to the diagnosis of bilateral APA. The patient underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2 ng dl(-1) confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from IHA by direct evaluation of intra-adrenal hormone production.

Increased o- and p-cresol/hippuric acid ratios in the urine of four strains of rat exposed to toluene at thousands-ppm levels.

Rats (Fisher, Wistar, Donryu and Sprague-Dawley strains) were exposed to 5 approximately 3500 ppm toluene for 8 h, and urine samples were analyzed for hippuric acid and cresols. While hippuric acid increased in proportion to the exposure concentration, a sharp increase in o-cresol excretion was observed at high toluene concentrations so that the o-cresol/hippuric acid ratio was elevated after 500 approximately 3500 ppm exposures. Changes in the p-cresol: hippuric acid ratio were less marked. There were strain differences in toluene metabolism. Fisher rats were highest and Sprague-Dawley rats lowest in o-cresol excretion and in the o-cresol: hippuric acid ratio, whereas Wistar rats excreted p-cresol most abundantly.

Blood cadmium levels in the populations of 3 Chinese cities.

Blood samples were collected from male and female factory workers aged greater than or equal to 16 years (with no occupational exposure to metals including cadmium) in the 3 cities of Hefei (323 subjects), Shenyang (78 subjects), and Jinxi (137 subjects) in China from 1985 to 1987. The samples were analyzed for cadmium in a single laboratory by automated flameless atomic absorption spectrophotometry under strict quality control. The effect of smoking was evident in Hefei, Shenyang and Jinxi, while the effect of aging was not apparent. There were no sex or regional differences in blood cadmium levels in non-smokers in the 3 cities (e.g., 1.2, 1.3 and 1.4 micrograms/l as geometric means in non-smoking women in Hefei, Shenyang and Jinxi, respectively). There was general agreement in blood cadmium levels between the present results and the values reported in the literature, although the latter values were generally based on small study populations.

Blood cadmium levels in the populations of Masan, Korea, and Miyagi, Japan: an inter-regional comparison.

Blood samples were collected from factory workers (with no occupational exposure to metals including cadmium) in Masan (167 subjects), Korea, in 1986, and Miyagi prefecture (270 subjects) Japan, in 1987. The samples were analyzed for cadmium in a single laboratory by flameless atomic absorption spectrophotometry under strict quality control. The effect of aging was detected in Masan and possibly also in Miyagi. The effect of smoking was evident among male smokers in Miyagi. Comparison with findings in a sister study on blood cadmium levels in China (taking the effects of smoking and aging into account) showed regional differences: the levels were lower in China, higher in Korea and probably highest in Japan. The smoking-associated increase in blood cadmium level per cigarette was 2-3 times higher in China than in Japan. The blood cadmium levels in the study regions appeared to be associated with the cadmium content of local rice as well as with local rice-eating habits.

Possible ethnic difference in toluene metabolism: a comparative study among Chinese, Turkish and Japanese solvent workers.

Toluene metabolism was studied in 192 Chinese workers in comparison with that in 130 Japanese and 17 Turks. Time-weighted average concentrations of toluene in the breathing zone of workers were measured utilizing passive dosimeters, and hippuric acid (HA) and omicron-cresol (omicron C) concentrations in shift-end spot urine samples by high-performance liquid chromatography (HPLC) and gas chromatography (GC), respectively. Under similar exposure conditions, male Japanese excreted almost twice as much HA as male Chinese, although such difference was less marked between female Chinese and Japanese. In contrast, the excretion of oC did not differ between the two ethnic groups. The ratio of oC over HA was highest among Turkish workers followed by Chinese, and lowest among Japanese. Possible roles of differences in toxicogenetics as well as in life patterns were discussed.

Blood lead levels of the general populations of three Chinese cities.

Blood samples were obtained from 537 adults (age greater than or equal to 16 years) living in three cities in China; in Hefei in 1985, and in Shenyang and Jinxi in 1987. The samples were subjected to blood lead (Pb-B) analyses. The subjects were factory workers either in solvent-synthesizing or solvent application plants with no known exposure to metals (including lead). Their smoking and drinking habits were confirmed in medical interviews. Blood lead was significantly higher in smokers than in non-smokers, although no dose-dependency was observed. The Pb-B values in non-smokers were log-normally distributed. The Pb-B among non-smokers was significantly higher in men [104.0 micrograms l-1 (1.428) 87] [geometric mean (geometric standard deviation) number of determinations] than in women [75.5 micrograms l-1 (1.358) 225] when the data from the three cities were combined. There was a significant difference in the Pb-B levels of non-smoking men in the three cities studied, suggesting that regional food habits should be considered as a possible contributory factor of a non-occupational nature. The present findings are compared with observations from Korea and Japan from the viewpoint of environmental health.

Absence of mutagenicity in peripheral lymphocytes of workers occupationally exposed to methyl methacrylate.

Chromosome aberration rates and sister chromatid exchange frequency were examined in the peripheral lymphocytes of 38 male workers who were engaged in organic glass production and exposed to methyl methacrylate (MMA) vapors at the concentrations of 0.9 ppm to 71.9 ppm. The results were compared with the findings in the concurrent nonexposed male subjects. Comparison of the exposed group with the nonexposed controls showed that there were no exposure-related changes in chromosome aberration rate. SCE frequency was higher in the exposed group than in the controls, but this was considered to be due to higher ages of the former group than that of the latter. In fact, selection of nonsmokers and further classification of the exposed nonsmokers into two groups of those with exposure below and above a median MMA concentration (ca. 4 ppm) failed to show any difference among the three nonsmoking groups in cytogenetic parameters, or any dose-dependency. The present results, although in a limited number of subjects, indicate that occupational methyl methacrylate exposure under the conditions studied is not associated with mutagenicity. This conclusion confirms the absence of mutagenicity of methyl methacrylate in humans, and is in general agreement with a majority of the results of studies on mutagenicity in vitro, animal carcinogenicity and occupational cancer epidemiology of methyl methacrylate.

Subjective symptom increase among dry-cleaning workers exposed to tetrachloroethylene vapor.

Subjective symptoms, hematology, serum biochemistry and other clinical signs were investigated in 56 dry-cleaning workers exposed to tetrachloroethylene at 20 ppm (as a geometric mean of 8-hr time-weighted average), and the results were compared with the findings in 69 non-exposed controls from the same factories. There were exposure-related increases in the prevalence of subjective symptoms during the work as well as in the past 3 month period, whereas there was no significant changes in hematology. Effects of the exposure on liver and kidney functions were also negative as judged by emission enzyme activities, BUN and creatinine in the serum.

Hepatitis B virus infection among women in a shoe factory in Korea.

One hundred and sixty five Korean women in a shoe factory in Masan, Korea were evaluated on hepatitis B virus infection by solid-phase radioimmunoassay in 1986. The participants were women of child-bearing ages, mostly in 20's and 30's. About two thirds (105/165) of the subjects had serological evidence of past or present hepatitis B virus infection, and 17% (28/165) were HBsAg-positive. In view of possible risk of vertical transmission of hepatitis B virus, further epidemiological study was considered necessary to establish preventive measures.

Hepatitis B virus prevalence in industrialized cities in China.

The prevalence of HBV infection was investigated by radioimmunoassay for HBsAg, anti-HBs and anti-HBc in over 1000 workers in large scale factories located in four industrial cities (Jinxi, Shanghai, Wuxi and Xian) in 1987 to 1990. The age dependency of the prevalence was not evident. The overall prevalence rate of those positive for any of the three markers was 62.6%. The rate was significantly (p < 0.01) higher than the rates found in Beijing in a previous study but lower than the values observed in earlier studies.

Prevalence of hepatitis B virus infection markers among factory workers in Beijing, China.

Nearly 1,000 serum samples were obtained from apparently healthy workers of both sexes in various factories in Beijing during 1988-1989 and were examined for hepatitis B virus infection markers by radioimmunoassay. The overall prevalence (all ages and both sexes combined) of cases positive for HBsAg, anti-HBs and anti-HBc were 3.7%, 36.6% and 37.7%, respectively and the rate of those negative to any of the three markers studied was 56.1%. The infection rate was lower than the values reported early in the 1980s for Beijing populations or the values for populations in other parts of China.