[A case of myasthenia gravis accompanied by large thymoma and anti-GAD antibody].

A 61-year-old woman had repeated episodes of muscle weakness of face, neck and limbs for 18 years. She was diagnosed as having myasthenia gravis (MG) by the positive anti-acetylcholine receptor antibody and findings of electromyogram. Simultaneously, she was noticed to have diabetes mellitus with high titers of anti-glutamic acid decarboxylase (GAD) antibody. Magnetic resonance imaging showed a large thymoma. In spite of the improvement of MG after thymectomy, the insulin secretion slowly exacerbated during next two years. The clinical course of her disease was characteristic as slowly progressive insulin dependent diabetes mellitus (SPIDDM). She continued to have positive autoantibody against beta-cell of pancreas. Recently, anti-GAD antibody is detected in patients with SPIDDM and stiffman syndrome (SS) in high rate, and it is closely associated with the cause of these syndromes. The patient did not reveal the symptoms of SS. From the clinical course, MG and SPIDDM in this patient may be caused by a common underlying autoimmune abnormality resulting from the long presence of the thymoma. MG and SPIDDM may be derived from organ-specific autoimmunopathy from the defect of self-tolerance.

[Combined hepatic resection and removal of portal vein tumor thrombi].

Portal thrombectomy with extended hepatectomy for extensively progressive primary liver cancer (Vp 3), in which the tumor thrombus has spread beyond the first portal branches, will make other non-surgical treatments possible and improve patients quality of life. We have performed extensive resections in 15 cases of such Vp 3 liver cancer. One patient with huge HCC involving retrohepatic IVC underwent in situ extended left hepatectomy without reconstruction of IVC, resulting in postoperative renal failure because of thrombosis in the bilateral renal veins, but 14 other patients' postoperative courses were uneventful. Ten of 14 patients relapsed within one year, but these patients underwent non-surgical treatments, resulting in improvement in the quality of life. The 1-, and 3-year survival rates were 55.6% and 32.5%, respectively.

An on-line reduction HPLC/chemiluminescence detection system for nitropolycyclic aromatic hydrocarbons and metabolites.

Various metal powders were batch screened as possible on-line reducers for nitropolycyclic aromatic hydrocarbons (NPAHs), in particular 1,3-dinitropyrene (1,3-DNP, 1,8-DNP and 1-nitropyrene (1-NP) and it metabolites. Zinc was found to be an excellent reducer in chemiluminescent compatible mobile phases without any associated disposal problems. Zinc reducer column parameters, namely pH, buffer concentration, packing composition (zinc:glass beads or zinc:silica gel) and column length were all optimized for the HPLC determination system with chemiluminescence detection, named NPAH analyser. The system consisted of three pumps, sample injector, reducer column packed with zinc:glass beads switching valve with a cutting loop, separation column (ODS), chemiluminescence detector and integrator. The mobile phase for the separation column and chemiluminescence reagent solution were respectively acetonitrile:imidazole-HClO44 and acetonitrile containing bis(2,4,6-trichlorophenyl)oxalate and H2O2. When the reducer column was introduced before the separation column, 1,3-, 1,6- 1,8-DNPs and 1-NP in benzene:ethanol extracts from airborne particulates were separately determined with detection limits of 2-50 fmol, respectively, in a 100 microL sample. When the reducer column was introduced just after the separation column, 1-NP, 1-nitrosopyrene and 1-aminopyrene in the incubation mixture of 1-NP and the Salmonella typhimurium YG1021 strain were separately determined with detection limits as low as sub fmol levels. 1,8-DNP and its metabolite were also separately determined in the incubation mixture of 1,8-DNP and the S. typhimurium TA98 strain.

Prevalence rate of thyroid diseases among autopsy cases of the atomic bomb survivors in Hiroshima, 1951-1985.

To examine the radiogenic risk of latent thyroid cancer, thyroid adenoma, colloid/adenomatous goiter and chronic thyroiditis, the data for 3821 subjects collected in the course of autopsies of atomic bomb survivors in Hiroshima from 1951 to 1985 by the Radiation Effects Research Foundation (RERF) were analyzed using a logistic model. About 80% of the autopsies were performed at RERF and the remainder at local hospitals. The frequencies of the above diseases were not associated with whether the underlying cause of death was cancer. However, note that our results may be influenced by potentially biasing factors associated with autopsy selection. The relative frequency of latent thyroid cancer (greatest dimension < or = 1.5 cm but detectable on a routine microscopic slide of the thyroid gland) increased as the radiation dose increased and was about 1.4-fold greater at 1 Gy than in the 0-Gy dose group. The relative occurrence of thyroid adenoma also increased as radiation dose increased, and was about 1.5-fold greater at 1 Gy than in the 0-Gy dose group. Sex, age at the time of the bombing or period of observation did not significantly modify the radiogenic risks for thyroid adenoma or latent thyroid cancer. No statistically significant association was found between radiation exposure and the rates of colloid/adenomatous goiter and chronic thyroiditis. The possible late effect of atomic bomb radiation on the frequency of benign thyroid diseases is discussed on the basis of these data.

Urinary hippuric acid excretion in everyday life.

The biological monitoring for exposure to toluene is based on the measurement of urinary hippuric acid concentration (HA-U). In occupational health, workers exposed to toluene are examined for HA-U, because collection of urine samples is easy. The HA-U of some designers in a great household electrical products corporation who did not use toluene occupationally showed relatively high values. From statistical analyses, it was revealed that the HA-U values of the designers who lived without family members were higher than those with family members and that the values on Monday were higher than those on Friday. Some factors which elevate the HA-U level are considered in individuals living alone and/or in life at weekends. These may be to drink many soft drinks, especially low calorie ones, in which benzoic acid is used as a preservative.

Urinary hippuric acid excretion after use of spray ski-wax and remover.

The biological monitoring for exposure to toluene is based on the measurement of urinary hippuric acid concentration (HA-U). In occupational health, workers exposed to toluene are examined for HA-U, because collection of urine samples is easy. The HA-U data of an engineer who did not use toluene occupationally showed relatively high values. It was indicated that he went to ski every weekend in winter and had used spray ski-wax and remover which contained toluene. The ski-club members of Tokai University, School of Medicine who used such sprays were examined for HA-U at the ski training camp. It was revealed that the use of these sprays elevated the HA-U values remarkably. Therefore, the use of sprays, especially in the winter season, can be one of confounding factors for biological monitoring of occupational exposure to toluene based on measurement of HA-U.

[Factors affecting subjective symptoms of VDT workers].

In 1983, 285 (male: 129, female: 156) VDT workers and 60 (male: 30, female: 30) control subjects were examined in order to detect the factors affecting the subjective symptoms of VDT workers. Biological information (for example: sex, age), life histories, information about VDT work, tests (for example: visual acuity), symptoms and interferences to daily life of VDT workers and control subjects were collected. The following results were obtained. Female VDT workers experienced more fatigue from commuting to work, stiffness in shoulders, distant blurred vision complaints of visual acuity and sum of the scores of ocular complaints than female control subjects. Only among female VDT workers, the longer the daily working hours, the greater were their ocular symptoms. A remarkable relationships were observed between psychological burden factors (for example: self-control of VDT work, sensation of excessive VDT work) and subjective symptoms of the VDT workers (both sexes). In particular, VDT workers who considered VDT work to be excessive had marked by greater subjective symptoms than those who did not.

Rhabdomyosarcoma of the maxillary sinus. A case report.

A rare case of adult rhabdomyosarcoma originating from the left maxillary sinus is reported. A 22-year-old Japanese woman was referred to the Department of Otolaryngology, Hiroshima University, for investigation of the primary source of a metastatic tumor in the bone marrow. An X-ray of the sinuses revealed a tumor in the left maxillary sinus with extension into the nasal cavity, ethmoidal and sphenoidal sinuses. The patient was managed with a chemotherapeutic regimen consisting of high-dose methotrexate, adriamycin, vincristine, cyclophosphamide and prednisolone. After three courses of this chemotherapy, the tumor had decreased in size by about 90 per cent, as indicated by X-rays. The remaining tumor was removed by an extended Denker's operation. Following the surgery another seven courses of chemotherapy were given and during the eight months following the operation the patient has been free from any local recurrence.

A 10-year follow-up study of per oral glucose tolerance at annual physical examinations.

In order to elucidate the factors influencing glucose intolerance. 100 g oral glucose tolerance tests serially performed at annual physical examinations over a 10-year period were studied. On the initial examination in 356 subjects, 44.8% were normal and 7.1% diabetic according to the criteria of 100 g OGTT recommended by the Japan Diabetes Society in 1970. For the 10-year follow-up study, the subjects were classified into 2 groups, 30s and 40s, by age at initial examination. The prevalence of obesity in the 30s group the at the 10th year was significantly higher than that of the 40s at the baseline (p less than 0.05). The rate of normal OGTT in the 30s group at the 10th year was significantly lower than that in the 40s group at the baseline (p less than 0.01). When compared with 119 age- and sex-matched employees of a certain bank, the incidence of diabetic OGTT was identical, but obesity was less prevalent in the 40s group from SONY. These results indicate that obesity increases the rate of glucose intolerance in subjects under 40 years of age, but in subjects aged 41 years and over diabetic predisposition appears to play an important role.