Height, weight, and alcohol consumption in relation to the risk of colorectal cancer in Japan: a prospective study.

Colorectal cancer incidence in relation to body size, smoking, and alcohol consumption was studied in a cohort of 29 051 city residents of Japan. In 1992, each participant completed a self-administered questionnaire on sociodemographic characteristics, drinking, cigarette smoking, diet, exercise, and reproductive and medical histories. The response rate was 92%. From 1993 to 2000, 161 men and 134 women were diagnosed with colorectal cancer at two major hospitals in the city. Relative risks and 95% confidence intervals were calculated by using Cox proportional hazard models. A positive relation between height and colorectal cancer was seen in both sexes, controlling for age, body mass index (BMI), smoking and drinking habits, and years of education. The findings were statistically significant only for men (relative risk 2.13 for the tallest compared with the shortest height tertile; 95% confidence interval=1.26-3.58). Body mass index was also associated positively with colon cancer risk for men, whereas the pattern for women was not clear. There was a positive association between pack-years of cigarette smoking and the risk of rectal cancer in men. A positive dose-response relation between alcohol consumption and colon cancer risk was observed for men and women.

Diet and colorectal adenoma in Japanese males and females.

PURPOSE: The purpose of this study was to assess the relationship between risk of colorectal adenoma and dietary intake of nutrients and foods. METHODS: In 1992, diet was assessed by a semiquantitative food-frequency questionnaire in a cohort of the Takayama Study in Japan. Patients were 181 male and 98 female cohort members who were newly histologically proved to have colorectal adenoma at colonoscopic examination between January 1, 1993, and December 31, 1995. Controls were 12,607 males and 15,754 females who had no history of colorectal polyp, adenoma, and cancer at baseline (1992) and were not diagnosed to have these diseases during the follow-up period. RESULTS: In males, the risk of adenoma was significantly associated with intake of animal protein and vitamin A (relative risk, 1.42; 95 percent confidence interval, 1.00-2.04; and relative risk, 1.51; 95 percent confidence interval, 1.04-2.20, for the highest vs. lowest tertiles, respectively; P for trend = 0.048 and 0.03, respectively) after controlling for age, years of smoking, and alcohol intake. A significantly inverse association was observed for carbohydrate intake after controlling for the covariates (relative risk, 0.52; 95 percent confidence interval, 0.32-0.82, for the highest vs. lowest tertiles; P for trend = 0.02). Intakes of animal fat and cholesterol were marginally associated with risk of adenoma. CONCLUSION: Some dietary components such as animal protein and carbohydrate, which have been associated with risk of colorectal adenoma or cancer in western populations, were also associated with risk of colorectal adenoma in the Japanese population.

Cigarette smoking, alcohol use, and colorectal adenoma in Japanese men and women.

PURPOSE: The aim of this study was to examine the relationships between smoking and alcohol use and risk of colorectal adenoma. METHODS: Information about smoking, alcohol use, and other lifestyle variables were obtained prospectively from 14,427 male and 17,125 female residents in a city of Gifu Prefecture, Japan, by a self-administered questionnaire in September, 1992. Colorectal adenomas were newly diagnosed in 181 men and 78 women in this cohort between January, 1993 and December, 1995 by colonoscopic examination at two major hospitals of the city. Gender-specific and site-specific relative risks and 95 percent confidence intervals adjusted for age and for age plus other potential confounding factors were calculated by using logistic regression models. RESULTS: Thirty or more years of smoking was significantly associated with risk of adenoma in general compared with never having smoked in both men and women (relative risk, 1.60; 95 percent confidence interval, 1.02-2.62 and relative risk, 4.54; 95 percent confidence interval, 2.04-9.08, respectively). Effect of smoking was stronger in the proximal colon. After adjusting for age and carbohydrate intake, total alcohol intake was not associated with risk of adenoma in any site in the colon in men. Sake drinkers were at significantly increased risk of adenoma in general, but the dose-response relationship was not statistically significant. Risk of adenoma in the rectum was not significantly increased for those who consumed >30.3 g/day of ethanol (relative risk, 5.7). CONCLUSION: These data suggest that smoking is a risk factor of adenoma in Japanese men and women. The role of alcohol, however, is less clear.

[Acute promyelocytic leukemia accompanied by scrotal Fournier's gangrene during ATRA treatment and relapsed as external ear tumor].

A 43-year-old man was admitted because of gingival bleeding. A diagnosis of acute promyelocytic leukemia (APL) was made. He was given combination chemotherapy including all-trans retinoic acid (ATRA). During the myelosuppression stage, the patient developed Fournier's gangrene of the scrotum. He achieved complete remission and underwent a hemicastration procedure. Seven months later, bilateral external ear tumors developed. Biopsy specimens of the tumors revealed infiltration of APL cells. A second remission was obtained by chemotherapy including ATRA. However, bilateral ear tumors developed again 5 months later despite indications of normal marrow without proliferation of leukemic blasts. Irradiation successfully reduced the ear tumors, but the patient died of cerebral hemorrhage from a left frontal extramedullary tumor. This was a rare case of APL accompanied by Fournier's gangrene of the scrotum during ATRA treatment, and by extramedullary tumors of the external ear and brain during leukemic relapse.

Spontaneous healing of pancreatic abscess after fistulization to the duodenal bulb.

A 70-year-old man was admitted to the hospital because of sudden, upper abdominal and back pain. Laboratory and image data indicated acute pancreatitis. Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A month later, spontaneous fistulization of the pancreatic abscess to the duodenal bulb was found by gastroduodenal fiberscopy. Injection of contrast medium into the duodenal orifice showed that the fistula was draining the abscess and that no other fistula formed from the abscess. Endoscopic retrograde cholangiopancreatogram indicated no fistula formation to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 months later and thereafter. Closure of the duodenal orifice was ascertained by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. Pancreatic abscess usually necessitates operative treatment, even with fistulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontaneous healing process.

GB virus C and hepatitis C virus infections in hemodialysis patients in eight Japanese centers.

RNA of a putative non-A to E hepatitis virus, designated GB virus C (GBV-C), was detected in 40 (6.2%) of 645 hemodialysis patients, at a frequency significantly higher than in 3 (0.9%) of 336 blood donors in Japan (p < 0.001). A history of transfusion was more frequent (88 vs. 58%, p < 0.001), the duration of dialysis was longer (13.2 +/- 7.9 vs. 7.9 +/- 6.5 years, p < 0.001), and the detection of hepatitis C virus RNA was more often (38 vs. 18%, p < 0.01) in the 40 patients with GBV-C RNA than in the 605 patients without it. The prevalence of GBV-C RNA varied widely from 0 to 10% among the 8 dialysis centers. These results indicate that hemodialysis patients would be at increased risk of GBV-C transmitted by transfusions. The detection of GBV-C RNA in the 5 patients without a history of transfusion and a high prevalence restricted to certain dialysis centers would reflect nosocomial infection.

Case report: silent thyroiditis developed during alpha-interferon therapy.

Alpha-interferon (IFN-alpha) was used for the treatment of chronic active hepatitis C in a 30-year-old woman who was euthyroid but had low titers of antithyroid antibodies before treatment. Two months after the initiation of IFN-alpha therapy she became thyrotoxic. She had nontender diffuse goiter. A laboratory examination revealed elevated levels of serum free thyroid hormones and a suppressed concentration of serum thyrotropin. Titers of antimicrosomal antibodies increased. The anti-thyrotropin receptor antibody was negative. A 99mTcO- scintigram of the thyroid showed reduced uptake. During the IFN therapy free thyroid-hormone levels started to decline. The IFN-alpha therapy was completed 1 month after the onset of thyrotoxicosis. Two months after the completion of the therapy the patient became euthyroid and 99mTcO- uptake was normalized. It is likely that preexisting chronic thyroiditis was exacerbated to cause silent thyroiditis during IFN-alpha therapy. None of the other 11 patients with chronic hepatitis C who had had no anti-thyroid antibodies and were treated with IFN-alpha showed anti-thyroid antibodies and thyroid dysfunction after the therapy. It is advisable to assess anti-thyroid antibodies and thyroid function in patients who are going to receive IFN-alpha treatment.

Autoimmune hepatitis and hypothyroidism associated with anti-thyroid hormone autoantibodies.

A 40-year-old hypothyroid female who had been treated with synthetic thyroxine was admitted to our hospital in October 1988 due to abnormal liver function tests. She had low serum free triiodothyronine (T3; 2.3 pg/ml) and high serum thyrotropin (TSH; 20.8 microU/ml) concentrations. On the other hand, the serum free thyroxine (FT4) level was inappropriately high, being 2.46 ng/dl. Immune precipitation of radiolabeled thyroid hormones with her serum disclosed the binding of 125I-T3 and 125I-T4 to the extent of 9.5% and 11.3%, respectively (normal ranges for 125I-T3 and 125I-T4 binding are less than 6.3% and 5.9%, respectively). 125I-T4 binding to the patient's serum gamma globulin was completely displaced with the addition of unlabeled T4. Further examination disclosed that anti-T4 antibodies in her serum belong to IgG kappa class immunoglobulin.

[Two cases of Graves' disease with anti-thyroid hormone autoantibodies: the effect of subtotal thyroidectomy on the titers of anti-thyroid hormone autoantibodies and anti-Tg antibodies].

We experienced two cases of Graves' disease associated with anti-thyroid hormone autoantibodies (Case 1: anti-T4, Case 2: anti-T3). Both cases underwent subtotal thyroidectomy, and titers of anti-thyroid hormone antibodies and anti-Tg antibodies were compared before and after operation. In case 1, titers of both anti-T4 and anti-Tg antibodies decreased after operation, whereas in Case 2, titers of both anti-T3 and anti-Tg were unchanged before and after operation. There was a significant positive correlation between titers of anti-T4 and anti-Tg antibodies in Case 1 (r = 0.90, P less than 0.01), and anti-T3 and anti-Tg antibodies in Case 2 (r = 0.64, P less than 0.01). These results strengthen the possibility that the antigen of anti-thyroid hormone autoantibodies in both cases is the Tg molecule.

[An autopsy revealing hepatocellular carcinoma with solitary metastatic gastric cancer].

This case concerns a 61-year-old man who had been determined as having rt-hypochondrialgia. The plasma AFP was found to have increased and an abdominal-CT revealed multiple low density areas in the liver. Endoscopic examination of the stomach revealed a Borrmann type III cancer and the specimens taken by punch biopsy demonstrated a tubular adenocarcinoma. Therefore, he had been diagnosed as having a gastric cancer with a metastatic liver cancer, or double cancer. Histologically, liver tumor proved to be a hepatocellular carcinoma (Edmondson: Gr III), and the histological findings of the gastric tumor was found to be identical with that of the liver tumor. The fact that this case has esophageal varices during the course of the disease suggested that metastasis to the stomach has likely occurred through the portal vein system.

A case of silent thyroiditis associated with idiopathic thrombocytopenic purpura.

A 51-year-old woman had symptoms of thyrotoxicosis which disappeared spontaneously within two months. She was diagnosed as a case of silent thyroiditis on the basis of both the clinical course and the laboratory data such as low uptake of radioactive iodine and technesium. She also had petechiae in her arms which were diagnosed as an idiopathic thrombocytopenic purpura (I.T.P.). This case would seem to expand the spectrum of the coexistence of autoimmune thyroid diseases and I.T.P. which is believed to be an autoimmune disease.

Genomic heterogeneity of hepatitis B virus in a 54-year-old woman who contracted the infection through materno-fetal transmission.

From the plasma of a 54-year-old woman, who acquired the persistent carrier state of hepatitis B virus through materno-fetal transmission, 49 clones of viral genomes were propagated. They did not reveal any differences in the size and number of cleavage products with any of 11 restriction endonucleases. Randomly selected 5 clones were classified into 3 groups by the variation at 4 positions in the nucleotide sequence of the envelope and core genes. The complete nucleotide sequences were determined for 3 of them, each representing a group, and they all had a genomic length of 3215 nucleotides. Variation was found in from 5 to 11 nucleotides. Assuming the infection with the common ancestor virus at birth, hepatitis B virus genomes in her plasma were estimated to have evolved at a rate from 1.4 to 3.2 x 10(-5) nucleotide substitutions per site per year. This value is 10(4)-fold greater than DNA genomes, 10(2)-fold less than human immunodeficiency virus but in the same order as most RNA viruses including certain retroviruses.

[An autopsy case of mucin-producing pancreatic cancer].

A 85-year-old woman with a mucin-producing pancreatic cancer is reported. The patient, who had been diabetic for 2 years, was admitted in March of 1984 to our hospital because of a fever and cough. On admission, a hard tumor was found on the right hypochondric region. Ultrasonogram and computed tomography revealed a cystic pancreas head tumor containing mucin and a dilated pancreatic duct. During an ERCP examination, Vater's papilla was found to be enlarged and a biopsy showed papillary adenocarcinoma. Also, the levels of CEA and CA 19-9 were elevated 11.3 ng/ml and 1300 U/ml, respectively. On Feb. 13, 1985, she died due to panperitonitis that resulted from a perforated duodenal ulcer. Microscopic examination of the pancreas showed a papillary adenocarcinoma producing mucin, a dilated pancreatic duct and atrophy of the islets. No metastatic lesion was found. The pathogenesis and the clinical characteristics of the mucin-producing pancreatic cancer are discussed.

Familiar hypercholinesterasemia. A case report.

A 58-year-old female who had a serum cholinesterase activity four times higher than normal is described. Investigation of her family revealed that five out of seven tested had high level of serum cholinesterase activity. The family distribution of the increased cholinesterase suggests that the inheritance is transmitted in a autosomal dominant manner. Analysis of the isoenzyme of serum cholinesterase of five cases including the patient showed that none of them had extracomponent (C5) of the cholinesterase. Examination of anti-cholinesterase antibodies in her serum was negative. Molecular weight of her serum cholinesterase by HPLC analysis was not different from that of a healthy subject. It was speculated that the overproduction of usual components (C1, C2, C3, C4), decreased clearance of cholinesterase by a certain mechanism(s), and/or the presence of cholinesterase which has more active catalysis could be responsible for her and her family's hypercholinesterasemia.