[A patient with gastric cancer with para-aortic lymph node metastases surviving for 9 years after effective preoperative chemotherapy and radical operation].

A 63-year-old male patient with type 3 advanced gastric cancer was referred to our hospital. Preoperative examination by CT-scan revealed swollen para-aortic lymph nodes and cancer invasion to the pancreas. The patient was treated pre-operatively with intravenous 5-FU, 500 mg/body/day, continuous infusion for 1 week. Immediately after the chemotherapy, the patient underwent total gastrectomy, splenctomy, left-adrenectomy and resection of the body and tail of the pancreas, along with para-aortic lymph node dissection. Microscopic examination revealed that the tumor was a moderately differentiated tubular adenocarcinoma, which displayed invasion to the pancreas with lymph node metastasis up to the level 3 lymph node. Histologically, the effect of preoperative chemotherapy showed a grade 2 effect on the main tumor, but a grade 3 chemotherapeutic effect was observed at the para-aortic lymph nodes. The patient has subsequently remained disease free for 9 years. In this case, it is considered that the preoperative chemotherapy by 5-FU and potentially curative radical operation yielded a good outcome.

Delays and continuation of hospital visits among HIV-infected persons and AIDS cases in Japan.

This study attempts to clarify the distribution patterns of delay between HIV transmission and the first hospital visit among HIV-infected persons and AIDS cases in Japan except those infected through blood products. Such hospital visit patterns were analyzed, and the rates of reporting for HIV/AIDS surveillance among diagnosed HIV-infected persons and AIDS cases in hospitals were shown. From 1991 to 1997, a survey and subsequent follow-up were conducted among HIV-infected persons and AIDS cases diagnosed at 74 hospitals in Tokyo. The numbers of HIV-infected persons and AIDS cases were 590 and 208, respectively. The percentage of patients whose estimated date of HIV transmission was obtained ranged 23-41% among Japanese and non-Japanese HIV-infected persons and AIDS cases. Among these patients, 28% to 86% showed a 3-year delay between HIV transmission and their first hospital visit. The rate of HIV-infected persons who continued to visit hospitals within 1 year after their first visit was 77% for Japanese and 45% for non-Japanese; among those after 1 year or more following their first hospital visit the rate was more than 80% among Japanese and over 70% among non-Japanese. The rate of reporting to HIV/AIDS surveillance among diagnosed HIV-infected persons and AIDS cases was 90% or more after 1994 in Japan. The delay between HIV transmission and the first hospital visit was suggested to be very long. Not a few patients stopped visiting hospitals after only a short time. Most diagnosed HIV-infected persons and AIDS cases were reported to the surveillance system of Japan.

1998 results of the first series of follow-up studies on Japanese thorotrast patients and their relationships to an autopsy series.

The 1998 survey of the first series of epidemiological studies of Japanese Thorotrast patients revealed that 18 (6.9%) were alive and 244 (93.1%) had died among 262 war-wounded veterans to whom Thorotrast had been administered intravascularly. Of 1,630 age- and sex-matched controls, 525 (32.2%) were alive and 1,105 (67.8%) had died. These results indicated a shortening of the life span in patients who had received Thorotrast compared to their controls. Of the patients in the Thorotrast group, the main causes of death were liver malignancies (79, 30.2%), liver cirrhosis (20, 7.6%), blood diseases (9, 3.4%), and cancers of the extrahepatic bile duct (5, 1.9%). Statistical analyses by the chi(2) test and estimation of the relative risk (risk ratio) showed that the incidences of these disorders were significantly higher in the Thorotrast group than in the controls. In the 54-year period from 1945 to 1998, our autopsy series was enlarged to include 398 individuals: 386 injected with Thorotrast intravascularly and 12 injected by other routes. Results of analyses of the 386 autopsy cases given Thorotrast intravascularly were as follows: 263 cases (68.1%) of liver malignancies, 28 cases (7.3%) of liver cirrhosis, 29 cases (7.5%) of blood diseases, 16 cases (4.1%) of lung cancer, 4 cases (1.0%) of malignant peritoneal tumors, 2 cases (0.5%) of bone sarcomas, and 1 case (0.3%) of hemangiosarcoma of the spleen. The relative risks of liver malignancies, blood diseases, bone sarcomas, malignant peritoneal tumors, and hemangiosarcoma of the spleen manifested significantly higher ratios in the Thorotrast autopsy cases (ratio of proportion) than in the autopsy control cases. Histological studies of these autopsied cases revealed that Thorotrast-induced liver malignancies showed remarkable differences in the proportions of histological types of tumors from those of non-Thorotrast liver malignancies since 1975. However, in this survey, we noted a remarkable increase in the incidence of liver malignancy of multiple histological types compared to that in histological controls. Based on the results of our 1998 survey, we estimated attributable risks of Thorotrast-inducedliver malignancies and blood diseases in the life span. Results showed 523 liver malignancies per 10(4) person Gy and 150 blood diseases per 10(4) person Gy for Japanese male Thorotrast carriers (wasted dose 10 years).

Summary of entire Japanese thorotrast follow-up study: updated 1998.

Updated data from two series in a cancer mortality study for a total of 412 Japanese Thorotrast patients were combined. The rate ratio for all deaths of Thorotrast patients, compared to controls, started to increase after a latent period of 20 years after injection of Thorotrast. Rate ratios for liver cancer, liver cirrhosis, leukemia and lung cancer were 35.9, 6.9, 12.5 and 2.0 times higher, respectively, than those for controls.

Trends in HIV and AIDS based on HIV/AIDS surveillance data in Japan.

BACKGROUND: In recent years a decline in the number of new AIDS cases has been observed in several industrialized countries. It is important to know whether these recent trends observed in North America and Europe are also occurring in Japan. METHODS: The number of people reported with HIV and AIDS by nationality, route of infection, and sex was calculated based on the HIV/AIDS surveillance data available in Japan through December 1997. The effect of reporting delay, which was defined as those HIV and AIDS cases reported in the calendar year following diagnosis, on the trends was examined. The coverage rate in reporting HIV cases was estimated as the ratio of the reported AIDS cases with prior report as an HIV-positive to the total number of reported AIDS cases. RESULTS: The cumulative number of reported cases of HIV among Japanese and non-Japanese residents of Japan up to the end of 1997 were 1,300 and 1,190, respectively. The cumulative number of reported cases of AIDS among Japanese and non-Japanese up to the end of 1997 were 758 and 298, respectively. The number of reported cases of HIV among Japanese was found to be still increasing, with the major contribution from male cases. The increasing trend in the number of reported AIDS cases among Japanese began to slow in 1996 and 1997. The number of reported cases of HIV among non-Japanese residents of Japan peaked in 1992, and has decreased since then, and remained constant after 1994. In contrast, the number of reported AIDS cases among these non-Japanese tended to increase gradually. There was a slight reporting delay for people with HIV and AIDS. The estimated coverage rate in reporting HIV cases tended to decrease in 1996 and 1997 (1/7.2, 1/10.2, respectively). We point out several reasons for this recent decline and suggest the possibility of an ostensible decline in the estimates. CONCLUSIONS: We suggest that the number of people with HIV among Japanese has continued to increase, and that the increase in the number of AIDS cases among Japanese is now slowing.

Problems in the health management of persons with spinal cord injury.

This study was conducted to clarify the features of complications attending spinal cord injury (SCI). A comparison was made of the prevalence of disease among patients with SCI (SCIP) with that in the general population in Japan (National Livelihood Basic Survey). For this purpose, a survey was conducted on 244 males at 8 Rosai Rehabilitation Centers (Workman's Accident Compensation Rehabilitation Workshops). The average age was 49.6 years. To eliminate age effects on this parameter, the prevalence rates were expressed as standardized outpatient morbidity ratios (SOMRs), with the value for the general population set at 100. The SOMR data for cystitis were particularly high (16,278, p < 0.01). The SOMRs for other diseases were also high: renal diseases, 2,642; disorders of the skin, 361; gastritis, 339; and hepatic disorders, 381 (p < 0.01). These disorders may be regarded as primary or secondary lesions associated with SCI. SCIP with diseases associated with aging, such as hypertension and diabetes mellitus, are on the increase in Japan. The SOMR for hypertension was 250 (p < 0.01), and for diabetes mellitus it was 323 (p < 0.01).

Morbidity rates of complications in persons with spinal cord injury according to the site of injury and with special reference to hypertension.

It has been reported that since 1982 the incidence in persons with spinal cord injury (SCI) of hypertension is commoner than it is in the general population of the same age groups in Japan. In the current study, we examined outpatient morbidity rates and standardised outpatient morbidity ratios (SOMR) according to the site of injury, as well as blood pressure levels and history of disease, and compared the incidences with those for the general population. The subjects consisted of 195 men with SCI. All were engaged in light work at special centres while living with other persons at the centres. The mean age was 49.5 years old, and the average post-injury period was 17.9 years. With respect to the site of injury, 19 patients had had injuries at the level of C-T5, 24 at T6-T10, 139 at T11-L1, and 13 at L2 or lower. The SOMR (general population = 100) for hypertension was closely related to the site of injury, i.e. 0 at C-T5, 250 at T6-T10, 221 at T11-L1 and 308 at L2 or below. Among the patients treated with antihypertensive agents (41 persons), 17.1% were under treatment for renal diseases, 4.9% for diabetes, and 4.9% for hepatic disorders. In 68% of the SCI persons examined, however no disease (such as renal disease, diabetes mellitus, hepatic disease or endocrine abnormality) could be regarded as a cause of secondary hypertension. In addition, the survey revealed that the body weight of SCI persons was lower than that of the general populations.

[Prediction of future trends of HIV infection and AIDS in Japan].

Current status and future trends of HIV infection and AIDS in Japan were estimated based on AIDS surveillance data up until 1992, excluding HIV infection from blood products and blood-borne transmission. The coverage rate of reports of HIV infection was estimated as the proportion of the reported AIDS cases who are also included in reports of HIV infection. Current numbers of HIV infected persons were then estimated to be the reported numbers divided by the coverage rate. Future numbers of HIV infected persons were predicted by extrapolation. Future numbers of AIDS cases were predicted based on the predicted numbers of HIV infected persons and the incubation distribution. The results were as follows: 1) The coverage rate of the reports of HIV infection was estimated to be 11.5%. 2) The numbers of HIV infected persons were estimated to be 2,900 in Japanese and 4,500 in foreigners by the end of 1992, and are predicted to be 7,700 in Japanese and 15,500 in foreigners by the end of 1997. 3) The numbers of AIDS cases were reported to be 125 in Japanese and 52 in foreigners by the end of 1992, and are predicted to be 1,100 in Japanese and 1,600 in foreigners (including AIDS cases developed after return to home country) by the end of 1997.

[Systems analytical investigation of the effect of countermeasures against the AIDS epidemic among homosexuals].

In Japan, the AIDS (Acquired Immunodeficiency Syndrome) epidemic among haemophiliacs has been the most urgent issue, because of the large number of haemophiliacs with AIDS. However, after governmental approval of the production of heated coagulating agents in 1985 and 1986, the prime object of prevention against the AIDS epidemic shifted from transmission through coagulation agents to that through sexual contacts. In order to investigate the most appropriate countermeasures against the AIDS epidemic among homosexuals in Japan, the numbers of HIV (Human Immunodeficiency Virus)-infected cases and AIDS cases in the future were estimated, and changes of the future numbers of HIV-infected persons and AIDS cases by behavior of homosexuals were compared using a systems analytical method. The methods of estimation and comparison are similar to those of R. M. Anderson and others, using numerical analysis of a mathematical model consisting of differential equations. They assumed a closed homosexual group whose members seldom have contact with members of other homosexual groups, but we assumed an open homosexual group whose members are being infected by other groups, because this assumption was more appropriate to the situation of homosexual society in Japan. The results showed that the prevalence number of HIV-infected cases would be about 1,800, that the prevalence number of AIDS cases would be about 100 among 100,000 homosexuals at 20 years after the beginning of the AIDS epidemic, and that the most effective countermeasure was reducing the frequency of sexual contacts among members or taking prophylactic measures during sexual contacts. These prevalence numbers of HIV-infected cases and AIDS cases would be reduced to between 1/4 and 1/2 of the above-mentioned calculated values by promotion of that countermeasure.

[A method of interval estimation for number of patients in the nationwide epidemiological survey on intractable diseases].

A method for estimating the intervals for the number of patients with intractable diseases from nationwide epidemiological surveys was developed under the assumption that response is independent of frequency of patients. This method is based on data utilizing the number of response hospitals classified by their reported number of patients. The approximate 95% confidence intervals of numbers of several intractable diseases patients were estimated using this method.

[Relation of baseline examination results to death from ischemic heart disease, cerebro-vascular disease and sudden death].

The relation of variables obtained from a baseline examination to death from ischemic heart disease (IHD), cerebro-vascular disease (CVD) and sudden death (SUD) was analyzed in a case-control study. From questionnaire survey of approximately 180,000 subjects who underwent baseline health examinations in 1971-1986 at Aichi prefectural center of health care, 148 deaths were selected for this study. The number of cases on IHD, CVD and SUD was 36, 60, and 52, respectively. Mean age of cases was 54.8 years old and the mean follow up interval between baseline examination and death was 3.7 years. Four controls matched according to year of baseline examination, age and sex were chosen arbitrarily for each case, and odds ratios for the three diseases were estimated. In some of the matched sets, odds ratios at a follow up examination were compared with that at the first examination. The results were as follows: 1) Variables showing positive relationships to death from each of the three diseases were hypertension, high fasting blood sugar, abnormality of cardio-thoracic ratio, ST-T abnormality in ECG, left ventricular hypertrophy in ECG. The odds ratio for ST-T abnormality in ECG was significant for all three causes of death. 2) High total cholesterol showed a significant positive relation only to death from IHD. As to death from CVD and SUD, albuminuria and sclerotic changes in fundus oculi were positively and significantly related. Risk factors differed for deaths from the three diseases. 3) In death from IHD and CVD, odds ratio at the second examination was apt to be higher than that at baseline examination. In death from SUD, however, odds ratios at the first and the second examination showed no significant difference.

[A note on methods for estimating the number of patients in the nationwide epidemiological survey on intractable diseases].

To find the most adequate method for estimating the number of patients in nationwide epidemiological surveys of intractable diseases, we examined six existing methods using reported data on 13 selected diseases. Estimated numbers of patients by the methods, except for methods with theoretical inadequacy or other problems, were almost equal to each other. The simple method, by which the number of patients is estimated as the reported one divided by the response rate, is recommended.

Epidemiological studies on the expectation of life for cats computed from animal cemetery records.

Based on the Chiang's method, the life table for cats was constructed from the death data of 3936 cats. They died in the Kanto area and were buried in an animal cemetery in Tokyo from June 1981 through May 1982. This life table seems to be the first one for domestic pet cats. The expectation of life for cats was 4.2 years at age 0, 5.0 years at age 1, 5.4 years at age 4, 5.3 years at age 5, 3.5 years at age 10, and 2.2 years at age 15. The maximum age at death was 22 years. From age 0 to age 5, the probability of dying for cats was higher than that for dogs, but over 6 years of age it seemed that Gompertz's equation was applicable to this life table for cats. From these results, if the probability of dying for cats at early ages decreases, the fundamental pattern of dying curve for cats seems to be a similar figure of dogs. The life table was constructed for different breeds and localities. Comparing the expectation of life at age 1 (e1) of the two populations divided by breeds or localities, there was significant difference in the e1 among different localities but not among different breeds. These facts suggest the existence of some factors which may influence the life span of cats among different localities.

[Clinical investigation of urinary activity of NAG and AAP in patients with various types of primary glomerulonephritis].

We investigated the activity of NAG and AAP in the urine of 36 patients with chronic glomerulonephritis (GN) with special reference to the relation between the levels of the enzymes and histopathological changes of the kidney. The subjects consist of 7 cases of minimal change nephrotic syndrome (MCNS), 3 cases of membranous GN, 5 cases of IgA. GN, 5 cases of membranoproliferative GN, 3 cases of focal glomerulosclerosis and 12 cases of chronic renal failure who had creatinine levels of more than 2 mg/dl resulting from chronic GN. Urinary levels of NAG and AAP were significantly higher in cases with GN than those in cases with chronic renal failure. In cases with GN, urinary levels of NAG and AAP correlated with the amounts of urinary protein, while those levels had no correlation with the classification of histopathological changes of glomeruli. The high value of NAG/mg.protein ratio, NAG by urinary protein, might be explained by the degree of tublointerstitial damage. We concluded that urinary levels of NAG and AAP reflects the proximal tubular damage caused by protein reabsorption.

Methylmercury exposure and mortality in Japan: a life table analysis.

The effects on life expectancy from elevated methylmercury (MeHg) exposure were studied in five coastal towns of southern Japan. Hair concentrations of MeHg in the study area were 3 to 6 times higher than the surrounding areas. From 1969-1972 to 1978-1982 life expectancy increased in the study area, with no appreciable difference between that area and the two control areas. When four major causes of death were deleted analytically in both study and control areas, malignant neoplasms contributed the most in recent years to potential gains in life expectancy for both sexes. For the duration of their working ages, however, accidents were the leading contributor for males, followed by malignant neoplasms, heart disease, and cerebrovascular disease. The relative contribution of these causes of death to gain in life expectancy in the study area population is discussed in the context of elevated MeHg exposure.