[Effect of smoking cessation on body mass index, blood pressure and serum lipids in middle-aged male workers].

The purpose of this study was to examine the effects of smoking cessation on body mass index (BMI), blood pressure and serum lipids in middle-aged male workers considering the effect of BMI which would increase by smoking cessation. The subjects were 1431 middle-aged men who worked in an enterprise in Hiroshima prefecture. Cross-sectional data measured in 1989 and longitudinal data measured from 1985 to 1989 were used in this analysis. The effect of smoking cessation on BMI, blood pressure and serum lipids were evaluated by two models of analysis of covariance (PC-SAS: GLM procedure) for the cross-sectional data and longitudinal data. In analysis of the cross-sectional data, model 1 was controlled for BMI and model 2 was not controlled for BMI. In analysis of the longitudinal data, model 3 was controlled for BMI change and model 4 was not controlled for BMI change. The main results are summarized as follows: 1. BMI was increased over the short period by smoking cessation, but over the long period BMI of ex-smokers remained at almost the same level as non-smokers'. 2. Blood pressure was increased over the short period by both the effect of smoking cessation and BMI increase from abstention from smoking. But over the long period blood pressure of ex-smokers remained at almost the same level as non-smokers. 3. Triglycerides (TG) and atherogenic index (AI) tended to decrease and HDL-cholesterol (HDLC) tended to increase over the short period by smoking cessation, but the concomitant BMI increase may have blunted any independent beneficial effect of smoking cessation on TG, AI and HDLC. But over the long period TG, AI and HDLC of ex-smokers recovered to almost the same level as non-smokers', and remained at that level. 4. These results suggest that smoking cessation have beneficial effects for health promotion in middle-aged men.

Circulating activated T lymphocyte subsets in patients with silent thyroiditis.

In order to investigate the immunological aspects of silent thyroiditis, T lymphocyte subsets were analyzed by two-color flow cytometry in 10 patients with silent thyroiditis in the thyrotoxic phase, 12 patients with silent thyroiditis in the recovery phase, and 11 healthy volunteers as a control. The percentages of CD3+, CD4+, and CD8+ cells were similar in all three groups. In contrast, activated matured T (HLA-DR+CD3+), activated helper/inducer T (HLA-DR+CD4+) and activated suppressor/cytotoxic T (HLA-DR+CD8+) cells were more numerous in both the thyrotoxic and the recovery phases of patients with silent thyroiditis when compared with healthy controls. In a serial study of 6 patients with silent thyroiditis, the percentage of activated helper/inducer T (HLA-DR+CD4+) cells was higher in the thyrotoxic phase than in the recovery phase. These data indicate that the activation of T cells, especially of helper/inducer T cells, might be important for the induction of silent thyroiditis.

[Effect of habitual physical activity on physical fitness and serum cholesterol in middle-aged male workers].

The effects of habitual physical activity on physical fitness parameters and serum cholesterol profile were studied in middle-aged male workers. The subjects were 3376 middle-aged men (age: 30-59 yrs) who worked at two enterprises in HIROSHIMA Prefecture. As for physical fitness parameters, grip strength, vertical jump, side step, and step test scores were measured. Atherogenic index was calculated as (total Chol-HDL Chol)/(HDL Chol). Because daily physical activity mainly consists of physical activities during leisure time and working time, by using a questionnaire, physical activity during leisure time was assessed and categorized by frequency into three categories: 'frequently', 'sometimes', and 'seldom': and physical activity during work was categorized as 'high' or 'low' according to the average walking time per day during work. The effect of these physical activities on physical fitness parameters and serum cholesterol profile was evaluated by analysis of covariance (PC-SAS: GLM procedure) adjusting for several confounding factors such as age, body mass index, type of job, smoking and drinking habits. The main results are summarized as follows: 1) Physical activity during leisure time was positively related to vertical jump, side step, and step test score, independent of physical activity during working time, and 2) physical activity during leisure time was negatively associated to LDL-C and AI in the group with 'low' physical activity during work. These results show that in middle-aged male workers, even moderate or light physical activity during leisure time has some beneficial health promoting effects through changes in physical fitness and serum cholesterol profile.

[Cigarette smoking and physical fitness].

In this review, previous studies regarding the effects of cigarette smoking on parameters of physical fitness such as endurance performance, muscle strength, step test score, body mass index, blood pressure, serum lipoprotein profile, etc., have been summarized with a special reference to the quality of life for middle-aged and elder men, including the result of recent studies by the present authors. Additionally the hypothesized mechanisms of cigarette smoking to atherosclerosis have been shown. It is concluded mainly from our recent studies that: 1) the smoking has an effect to impair not only the aerobic power, but also the anaerobic power, 2) the abstention from chronic smoking would be expected to improve the parameters of physical fitness, and 3) even though the duration from the onset of smoking is less than one year, i.e., a relatively short-term smoking habit, the smoking has a serious damage to the several parameters of physical fitness.

Graves' thyrotoxicosis and Moyamoya disease.

Cerebrovascular accidents due to Moyamoya disease, a disorder characterized by arterial stenosis at the base of the brain accompanied by typical net-like collateral vessels, occurred in two young Japanese women with Graves' disease when they were in thyrotoxicosis. In one patient, a second attack of cerebral infarction occurred with the recurrence of thyrotoxicosis. Association of Moyamoya disease and Graves' thyrotoxicosis is rare and the pathegenetic relationship is discussed.

Simultaneous development of insulin dependent diabetes mellitus and alopecia areata universalis.

Alopecia areata universalis developed gradually over nine months in a 25-year-old woman. When her scalp hairs were totally lost and other body hair began to fall out, the symptoms of insulin dependent diabetes mellitus, an organ-specific autoimmune disease, developed rapidly and progressed to diabetic coma. Alopecia did not regress after the metabolic state improved following insulin therapy. Biopsy of the scalp skin revealed significant reduction of the total number of hair bulbs and prominent lymphocyte infiltration into the remaining hair follicles. Insulin dependent diabetes mellitus and alopecia areata universalis are both thought to be related to the autoimmune mechanism and sometimes coexist. However, simultaneous development of these two disorders is extremely rare.

[Intra-arterial chemotherapy with cis-diamminedichloroplatinum (CDDP) for primary mediastinal seminoma].

Primary mediastinal malignant germinoma is a rare disease, and only about 15 patients have been reported in Japan. We treated a patient with this disease by intra-arterial CDDP infusion and observed good effects. A 29 year-old male was admitted to our hospital due to SVC syndrome in 1980. A right mediastinal tumor was detected, and the resection of this tumor was performed. Histological examination showed seminoma. Though postoperative Co irradiation was performed, radiation pneumonitis developed in the right lung. Subsequently, the tumor metastasized to the right kidney and spinal cord. After removal of the right kidney followed by Co irradiation, the clinical course was good. In 1987, a mass (10 x 6 cm) was detected in the left mediastinum, suggesting recurrence. Four courses of CDDP infusion into the left bronchial artery and left internal thoracic artery (1 course: 45-70 mg) were performed, and good effects were obtained. No side effects were observed, and the clinical course has been good until now. This case is of interest in evaluating the multidisciplinary treatment for mediastinal seminoma.

[The significance of serum fructosamine measurement in patients with thyroid diseases].

Serum fructosamine was measured in patients with Graves' disease and primary hypothyroidism. Fructosamine levels and fructosamine per albumin ratio were significantly lower in patients with Graves' disease than in normal subjects, while they were significantly higher in patients with primary hypothyroidism. Fructosamine levels were normalized by treatment in the euthyroid state in patients with Graves' disease. Along with the normalization of thyroid stimulating hormone levels, fructosamine levels returned to the normal range in patients with primary hypothyroidism with treatment. There were significant correlations between fructosamine levels and free triiodothyronine levels, free thyroxine levels, thyroid stimulating hormone levels, hemoglobin A1C levels, albumin levels, and creatine phosphokinase levels. We concluded that it was useful to measure serum fructosamine as an indicator of peripheral metabolic function in patients with thyroid diseases.

[Effectiveness of pharmacoangiography using nitroglycerin and angiotensin II].

An investigation of pharmacoangiography using a combination of nitroglycerin and angiotensin II demonstrated that it was useful due to the following reasons. First, good dilatation of the proximal portion of the arteries was demonstrated which enabled good clarity of the margin between the encasement and the normal portion of the arteries. Secondly, there was almost no change demonstrated in blood pressure immediately after administration. Thirdly, tumor vessels and intrapancreatic arteries were well recognized on the resulting images.

[Angiographic findings of gallbladder cancer].

The patients with gallbladder cancer often accompany with chronic cholecystitis. This fact leads angiographic diagnosis difficult. So the angiographic findings of the chronic cholecystitis are first analyzed precisely and subtracting the angiographic findings of the gallbladder cancer from these gives us the pure (true) angiographic findings of the gallbladder cancer. Characteristic angiographic findings of the gallbladder cancer only are stretched cystic artery encasement (27/37 cases) and short straight tumor vessels "bristly vessel" (36/37 cases).

[A study of the secretion capacity of TSH-beta in patients with pituitary disorders].

We studied the secretion capacity of TSH-beta in 63 patients with various pituitary disorders, carrying out the observation of TSH-beta changes after TRH administration. Serum TSH-beta concentrations were measured by radioimmunoassay according to the modified method of Kourides. Serum TSH concentrations were measured by immunoradiometric assay, and serum concentrations of free thyroid hormones were measured by radioimmunoassay. Basal TSH-beta concentrations were below 0.39 ng/ml in 17 patients with Acromegaly, below 0.56 ng/ml in 5 patients with Prolactinoma, below 0.68 ng/ml in 4 patients with Cushing's disease, below 0.48 ng/ml in 12 patients with non-functioning tumor, below 6.4 ng/ml in 16 patients with SITSH, and below 0.45 ng/ml in 9 patients with other pituitary diseases. TSH-beta changes after TRH administration differed from TSH changes in 4 patients (25%) with Acromegaly, in 2 patients (67%) with Prolactinoma, in 5 patients (71%) with non-functioning tumor, in one patient (33%) with Cushing's disease, in 4 patients (100%) with Rathke's cleft cyst, in one patient with suprasellar meningioma, and in one patient with suprasellar arachnoid cyst. 2 patients (67%) with Prolactinoma, 3 patients (43%) with non-functioning tumor, all 6 patients with non-neoplastic SITSH, and one patient with Rathke's cleft cyst showed exaggerated TSH-beta changes after TRH administration. In patients with some pituitary disorders, we thought the secretion and synthesis of TSH and TSH-beta differed from that of normal subjects. We concluded that it was necessary to investigate the mechanism of secretion of TSH-beta in patients with pituitary disorders.

[Reevaluation of serum TSH determination in various pituitary disorders using highly sensitive immunoradiometric assay].

In thirty-one patients with various pituitary disorders, their serum TSH levels were reevaluated using two kinds of highly sensitive immunoradiometric assays (IRMAs). TSH levels were measured by radioimmunoassay (RIA) supplied by Daiichi Radioisotope Laboratory and the IRMAs, which were RIA-gnost TSH Ultrasensitive and SUCROSEP TSH IRMA using two types of monoclonal antibodies. The sensitivities of them were 0.08 and 0.1 microU/ml, respectively. Free thyroxine and free triiodothyronine levels were measured by RIAs (Amerlex kits). There was a significant correlation between basal TSH levels and the maximum increase in serum TSH above baseline using the RIA and the IRMAs when responses to TRH (500 micrograms i.v.) was determined, but no correlation between basal TSH and thyroid free hormone levels. In their TRH tests, three patients showed absent responses to TRH which were measured by the RIA, although by the IRMAs slight responses were observed. In two patients, exaggerated responses to TRH were observed and the increase of TSH levels measured by the IRMAs showed 143 approximately 210% higher than that of the RIA. The IRMAs were able to handle their peak levels time in all the patients with responses, however, in some patients the RIA was not sensitive enough to distinguish it. These results indicated that measurement of TSH levels by the IRMAs might be useful in the evaluation of the TSH secretion capacity in patients with various pituitary disorders.

[Hyperthyroidism due to a TSH-secreting pituitary tumor].

A 28-year-old female with a 12-year history of goiter is presented. She had both clinical and laboratory evidence of hyperthyroidism, and her serum TSH was persistently and markedly elevated after treatment with antithyroid drugs. A TRH stimulation test resulted in no further rise in serum TSH after cessation of medication. Menses were regular and serum prolactin levels were normal. Serum LH and FSH responses to LHRH stimulation test were normal. No other evidence of pituitary or peripheral endocrine deficiencies existed. She underwent a subtotal thyroidectomy followed by 131I therapy three years later. A pituitary adenoma with sphenoidal and suprasellar extension was completely removed by transphenoidal approach. On light microscopy, it was mostly composed of chromophobic cells with occasional calcification showing sinusoidal pattern. On electron microscopy, most of the cells contained fine granules, which suggested thyrotroph. The immunoperoxidase technique revealed TSH beta in the cytoplasm of some adenoma cells. Three days postoperatively the patient's serum TSH levels returned to normal. TRH stimulation test produced a normal response in serum TSH. The patient was diagnosed hypothyroid by laboratory findings and is currently on thyroid replacement therapy. The patient became pregnant and delivered twice prior to the operation for pituitary adenoma. The previously reported TSH secreting adenomas associated with hyperthyroidism were reviewed.