A study on the effects of countermeasures for vibrating tool workers using an impact wrench.

The aims of this study were (1) to measure frequency-weighted vibration acceleration and (2) to study the effects of introducing a vibration-proof impact wrench on VWF in workers. The subject pool was 383 male workers who were regularly using an impact wrench and taking special medical examinations for vibration syndrome in a factory from 1982 to 1999. The prevalence of workers with VWF increased gradually after 1982, reached a peak value (4.8%) in 1986, gradually decreased after 1987, and disappeared in 1994. Sixteen subjects who had had VWF at least one time during the observation period were selected for this study. The stages of VWF were at stage I on the Stockholm Workshop scale in all subjects. After the vibration-proof impact wrench was introduced in 1986, the vibration acceleration of the impact wrench measured on the handle decreased from 8.6-11.1 m/s2 to 5.1-7.1 m/s2. The actual time per day that subjects were assumed to use the impact wrench was 108 minutes. The subjects actually used an impact wrench more than the occupational exposure limit allowed. However, VWF disappeared after the introduction of a vibration-proof impact wrench. This might have resulted from the combined effect of introducing the vibration-proof impact wrench and certain countermeasures that were taken against cold working environments.

Peripheral hemodynamics evaluated by acceleration plethysmography in workers exposed to lead.

To clarify the effect of lead exposure on peripheral hemodynamics, acceleration plethysmography (APG) was performed for 48 male subjects occupationally exposed to lead (exposure group) and 43 male subjects with no history of occupational exposure to lead (control group). In the exposure group, the blood lead concentration (Pb-B) was also measured. Each APG parameter was assessed by comparing measured data with the standard aging curves. A significant negative correlation was obtained between the parameter--b/a and Pb-B. The exposure group showed significantly lower values of parameters--b/a (p < 0.01) and d/a (p < 0.05) than the control group. The parameter--b/a in the exposure group dose-dependently decreased with increases in length of working career (duration of exposure to lead) and Pb-B. The parameter--b/a significantly (p < 0.05) decreased in subjects with working careers of 5 years or more and in subjects whose Pb-B was 40 micrograms/100 ml or more. These results suggest that lead exposure affects peripheral hemodynamics as evaluated by APG.

Transferrin is not involved in initial uptake process of iron in rat duodenal mucosa. Ultrastructural study by x-ray energy spectrometry.

The role of transferrin in iron absorption by the duodenal mucosa in rats with iron deficiency and controls was evaluated immunohistochemically. Ferric iron was administered to each rat using a metallic gastric tube. Transferrin was stained by an immunoperoxidase method and iron with Prussian blue in the same duodenal sections and observed by light microscopy. The localization of transferrin differed from that of ferric iron both in rats with iron deficiency and in controls. In iron-deficient rats, transferrin was weakly stained after iron administration but was strongly stained after saline administration. In contrast, in controls, transferrin was weakly stained after saline administration but was strongly stained after iron administration. By electron microscopy, x-ray energy spectrometric analysis of the transferrin-positive areas showed no iron peak. In iron-deficient rats, accumulation of electron-dense transferrin-negative microgranules was observed in some of the duodenal columnar epithelium. X-ray energy spectrometric analysis of this area revealed iron, indicating iron absorption. These results suggest that mucosal transferrin does not act as a shuttle protein in iron absorption via the rat duodenal columnar epithelium, and the function of this protein may be to inform the absorptive cells of the iron status of the body as observed in other organs.

A micro-suspension-test for evaluation of disinfectants against human immunodeficiency virus.

We devised a micro-suspension-test to evaluate disinfectants against human immunodeficiency virus type-1 (HIV-1) and confirmed its reliability. Suspensions of persistently HIV-1-infected Molt-4 cells were used as targets of disinfectants and residual infectivity was measured by an infectivity assay: after cocultivation with uninfected Molt-4 cells reverse transcriptase activity (RTA) in the supernatant and giant cell formation (GCF) were monitored. Our new infectivity assay consists of a short-term assay, that is RTA and GCF monitoring on the second day of co-culture, and a long-term assay, that is RTA monitoring up to the 28th day of co-culture. The sensitivity of the short-term assay was 1 x 10(3) infected cells and that of the long-term assay 1 x 10(1) infected cells. All the chemical disinfectants examined in this study showed dose- and time-dependent inactivation of HIV-1. By 5-minute contact with ethanol, glutaraldehyde, formalin, sodium hypochlorite and povidone-iodine, HIV-1 was effectively inactivated at concentrations of 20, 0.01, 5, 0.05 and 0.1%, respectively. Since the micro-suspension-test is easy and sensitive, we recommend it as a method for evaluating disinfectants against HIV-1.

[Endoscopic surgery for early gastric cancer by endoscopic mucosal resection (EMR)].

Endoscopic mucosal resection (EMR) enables one to examine resected specimens histologically and judge the curability by the histological findings. A mucosa and a part of submucosa can be resected by EMR. Therefore, mucosal cancers are indications for EMR. The present study showed that better indications for EMR were as follows: lesions less than 10 mm in size, lesions without ulceration, and lesions in the antrum or at the greater curvature. However, it is difficult to judge correctly before EMR whether the lesions are completely resected or not. The lesions with better indications are not always resected completely, and, conversely, the lesions more than 11 mm in size are completely resected at times. Therefore, it is most important to know how to deal with resected specimens. Specimens must be dealt with in strict conformity with the regulations. At present, when EMR may be regarded as the least invasive modality of curative sugeries, a new systematic treatment combining surgical laparotomic treatment and EMR is desirable for curative treatment of early gastric cancer.

Intestinal protein loss and bleeding assessed by fecal hemoglobin, transferrin, albumin, and alpha-1-antitrypsin levels in patients with colorectal diseases.

Four fecal proteins (hemoglobin, transferrin, albumin, and alpha 1-antitrypsin) were measured by enzyme-linked immunosorbent assay (ELISA) in patients with colorectal diseases. Levels of all 4 proteins were significantly increased in patients with colonic cancer and ulcerative colitis (UC) compared to levels in control subjects, while fecal alpha 1-antitrypsin was particularly elevated in colonic Crohn's disease (CD). That is, the fecal protein pattern of CD was distinct from those of colonic polyps, colonic cancer, and UC. To investigate whether levels of these fecal proteins reflect disease activity in UC and CD, comparative evaluation of fecal proteins in the active and inactive phases was performed. In UC, differences in the fecal concentrations of all 4 proteins were significant between the active and inactive phases of the disease. In CD, however, the difference in alpha 1-antitrypsin concentration was significant. Our results suggest that measurements of these 4 fecal proteins would be useful in the screening of colorectal diseases. In addition, these markers can also be used as indicators of disease activity in inflammatory bowel diseases.

Duodenitis--distinguishing features in a retrospective endoscopic and histological study.

Routine films of 596 upper GI endoscopies with the diagnosis of duodenitis were reviewed and a classification was made into granular (G), multi-polypoid (MP), reddened (R) and erosive (E) types. Two hundred and thirty-four histological specimens from 117 of the patients, as well as 100 specimens from 50 controls, were analyzed for villous obliteration, Brunner's gland dilatation and mucus depletion, erosion, mucosal hemorrhage and edema, atypia of the surface epithelium and gastric surface epithelial metaplasia. Inflammatory cell counts for polymorphonuclear and mononuclear cells in the epithelium, in the lamina propria together with a histological score was also made. On the basis of this study and a review of classifications of duodenitis in the literature, it is concluded that some endoscopical features like erosions and redness may represent more acute phases of duodenitis, mucosal elevations representing more hyperplastic changes and that the endoscopic classification into G, MP, R and E types seem relevant to use in clinical practice.

Effects of 16, 16-dimethyl prostaglandin E2 on lysosomal membrane stability in rat stomach.

The lysosomal membrane encloses numerous hydrolytic enzymes and prevents the cytoplasm from being damaged by these enzymes. It is possible that the fragility of this membrane may be implicated in the pathogenesis of gastric mucosal damage. We investigated the effects of 16,16-dimethyl prostaglandin E2 (dmPGE2), which is known to protect the gastric mucosa from various noxious agents, on lysosomal membrane stability in the rat stomach. Sodium taurocholate (TC) was used as the damaging agent. To assess lysosomal membrane stability in the gastric mucosa, we assayed acid phosphatase released from lysosomes isolated from a gastric mucosal homogenate. To assess lysosomal membrane stability in gastric surface epithelial cells, we used laser scanning confocal microscopy to observe the fading of red fluorescence in living cells vitally stained with acridine orange. Exogenous dmPGE2 enhanced lysosomal membrane stability in the gastric mucosa, whereas TC decreased it. In gastric surface epithelial cells, exogenous dmPGE2 protected the cells against TC-induced damage and prevented TC-induced decreased lysosomal membrane stability. It was concluded that a decrease in lysosomal membrane stability seemed to be closely involved in the pathogenesis of gastric mucosal damage. Moreover, it appears that stabilization of the lysosomal membrane by exogenous dmPGE2 may contribute to its protective effect in the gastric mucosa, both at the level of gastric surface epithelial cells and in regard to the entire gastric mucosa.

Immunochemical detection of human lactoferrin in feces as a new marker for inflammatory gastrointestinal disorders and colon cancer.

We have developed a new immunochemical test for fecal lactoferrin (LF) utilizing an enzyme-linked immunosorbent assay (ELISA). The ELISA had a sensitivity of about 10 micrograms/L of lactoferrin and the measurable range was 10.0-1000.0 micrograms/L (1.0-100.0 micrograms LF/g feces). The stability of lactoferrin in feces was greater than that of myeloperoxidase and leucocyte elastase. The fecal concentration of lactoferrin (mean +/- SD) in 35 normal subjects was 0.75 +/- 0.83 microgram/g feces, whereas that in 24 patients with colon cancer was 74.4 +/- 88.3 micrograms/g feces. The fecal lactoferrin concentration of 38 patient with active ulcerative colitis was 307.4 +/- 233.9 micrograms/g feces, and that in 36 patients with active Crohn's disease was 191.7 +/- 231.1 micrograms/g feces. The ELISA for human fecal lactoferrin might be useful in the diagnosis of colon disease.

The effect of acid secretagogues on mucin synthesis using primary monolayer culture of the guinea pig gastric mucous cells.

Mucin plays a principal role in protecting the gastric mucosa against injury. We investigated the effect of acid secretagogues on mucin synthesis using a primary gastric mucous cell monolayer culture system of guinea pig. Significant increases in mucin synthesis were observed in response to the secretagogues pentagastrin (10(-8)M, 10(-7)M) and carbachol (10(-4)M, 10(-3)M), but not to histamine. After pretreatment with indomethacin (10(-5)M), 10(-8)M pentagastrin significantly increased mucin synthesis to 125.6 +/- 3.9%, but carbachol did not. Prostaglandin E2 release into the culture medium was significantly increased by 10(-4)M carbachol to 118.0 +/- 5.9%, but there was no change after application of pentagastrin. These findings suggest that pentagastrin and carbachol may act directly on mucous cells, and that part of the mucin synthesis-promoting action of carbachol is mediated by prostaglandins. There were no changes in intracellular cAMP concentration after the addition of these acid secretagogues. However, calcium ionophore (A23187) produced an increase in mucin synthesis, suggesting a Ca++ involvement in mucin synthesis. No differences were found in the sugar side chain structures of newly synthesized mucin glycoprotein as a result of exposure to acid secretagogues by histochemical or biochemical methods using lectins.

Kimura's disease (angiolymphoid hyperplasia with eosinophilia) associated with ulcerative colitis.

We treated a 35-year-old Japanese woman who had Kimura's disease associated with ulcerative colitis. Kimura's disease is an uncommon chronic inflammatory disease considered to be of allergic origin based on the presence of eosinophilia and IgE hyperimmunoglobulinemia, and may be a manifestation of a systemic immunologic disturbance. Some immunological complications such as nephrotic syndrome have been reported in association with Kimura's disease, but the present case is the first associated with ulcerative colitis.

Endoscopic evaluation of the therapeutic effect of sclerotherapy for esophageal varices.

The rebleeding rate after endoscopic injection sclerotherapy was studied in 237 patients with esophageal varices, and the optimal outcome of treatment was determined. Two new categories, RC(2-) and F0, were added to the classification scheme of endoscopic findings of varices in Japan. RC(2-) represents a state in which no veins, not even small vessels, are observed by endoscopy after endoscopic injection sclerotherapy, and F0 represents a state in which no localized venous dilations in the esophagus exist. The criteria for defining the other categories were not altered, and the R-C sign was expressed as RC(2-), RC(-), or RC(+); the degree of dilation was classified as F0 to F3. By combining the R-C sign and the F number, endoscopic findings were classified 1 to 4 weeks after endoscopic injection sclerotherapy into groups designated RC(2-)F0, RC(-)F0, RC(-)F1, and RC(+)F1-RC(+)F2. The four groups were observed to determine the incidence of esophageal stricture and rebleeding. In the RC(2-)F0 group, the incidence of stricture was high, but the rebleeding rate was low. In the RC(-)F0 group, both the incidence of stricture and rebleeding rate were low. We conclude that the optimal outcome of endoscopic injection sclerotherapy is RC(-)F0.

Substrate specificity and distribution of UDP-GalNAc:sialylparagloboside N-acetylgalactosaminyltransferase in the human stomach.

The detailed substrate specificity of the UDP-GalNAc:sialylparagloboside N-acetylgalactosaminyltransferase to form the Sd(a+) blood group active carbohydrate determinant GalNAc beta 1-4(NeuAc alpha 2-3)Gal was studied using a membrane fraction prepared from human gastric fundic mucosa. Various sialosylated oligosaccharides and gangliosides were examined as acceptor substrates. Oligosaccharide substrates were fluorescence-labelled with 2-aminopyridine, and the transferase activity was quantified by h.p.l.c. using a reversed-phase column. The structures of the products were determined by glycosidase degradation and proton n.m.r. 3'-Sialyl-lactose (II3NeuAcLac), 3'-sialyl-lactotetraose (IV3NeuAcLc4), and 3'-sialyl-lactoneotetraose (IV3NeuAcnLc4) were good substrates for the beta 1-4GalNAc transferase in gastric fundic mucosa, but 6'-sialyl-lactoneotetraose (IV6NeuAcnLc4) or 6'-sialyl-lactose (II6NeuAcLac) were not. Gangliosides with a terminal NeuAc alpha 2-3Gal residue such as GM3, sialylparagloboside, GM1b and GD1a were also studied. The activity of beta 1-4GalNAc transfer to sialylparagloboside was much higher than that to GM2, GM1b or GD1a in spite of them having the same terminal residue. Measurement of the activity of the beta 1-4GalNAc transferase in biopsy specimens demonstrated that the activity was localized in gastric fundic mucosa and was absent in pyloric mucosa, intestinal metaplasia and gastric cancer tissue. Thus the beta 1-4GalNAc transferase present specifically in fundic mucosa required a NeuAc alpha 2-3Gal residue connected to either type-1-chain or type-2-chain oligosaccharides. In glycolipids, the acceptor specificity was restricted to NeuAc alpha 2-3Gal beta 1-4GlcNAc because the NeuAc alpha 2-3Gal beta 1-3GalNAc structure in ganglio-series glycolipids was not a good acceptor substrate.

Immunological determination of fecal hemoglobin and transferrin levels: a comparison with other fecal occult blood tests.

Immunological determination of fecal hemoglobin and transferrin levels was performed in inpatients on an unrestricted diet, including patients with colon cancer or polyps and a control group. When hemoglobin levels of 5.1 micrograms/g feces and transferrin levels of 0.4 microgram/g feces were designated as positive, 48 of the 60 fecal specimens from colon cancer patients were positive. This result was significantly superior to that for another fecal occult blood immunological test (FECA-EIA) (p less than 0.005), and similar to the results of two chemical tests (guaiac and Hemoccult). Twenty-eight of the 78 fecal specimens from patients with colonic polyps were positive, again a result superior to the FECA-EIA (p less than 0.005) and similar to the chemical tests. Three of the 99 control fecal specimens were positive, which was a similar result to that obtained with the FECA-EIA and significantly superior to the chemical tests (both p less than 0.005). Thus, combined detection of fecal hemoglobin and transferrin levels can be used as a fecal occult blood test in patients without dietary restriction.

Effects of anti-acid secretory agents on various types of gastric mucus.

Total, acidic, and sulfated mucus contents in the gastric mucosa were evaluated after administration to rats of ranitidine and pirenzepine, antagonists of gastric parietal cell receptors; omeprazole, a proton-pump/inhibitor; and misoprostol, a prostaglandin E1 preparation. Total gastric mucus content was significantly decreased by ranitidine, but contents of acidic mucus and sulfated mucus showed a slight increase. Total mucus and acidic mucus contents were slightly increased after administration of pirenzepine, whereas the sulfated mucus content was significantly increased. The total gastric mucus content was significantly decreased after administration of omeprazole, but acidic mucus increased slightly and sulfated mucus increased significantly. All mucus contents were unchanged after administration of anti-acid secretory dose of midoptodyol. After administration of either ranitidine or omeprazole, the neutral mucus content decreased, but the total acid and sulfated mucus contents were not decreased. Changes in various mucus contents following inhibition of acid secretion are different for different drugs, and it was suggested that production of neutral mucus and secretion of acid mucus were reduced by strong inhibition of acid secretion.

Haptoglobin prevents renal dysfunction associated with intravariceal infusion of ethanolamine oleate.

Endoscopic injection sclerotherapy (EIS) with ethanolamine oleate was performed in patients with esophageal varices either with (18 patients) or without (19 patients) pretreatment with haptoglobin. The serum levels of urea nitrogen, creatinine, and beta 2-microglobulin, the creatinine clearance, and the urinary levels of N-acetyl-beta-D-glucosaminidase and urinary beta 2-microglobulin were measured before and after EIS. Indices of the glomerular filtration rate (serum levels of urea nitrogen, creatinine, beta 2-microglobulin; creatinine clearance) showed no significant changes after EIS in either the haptoglobin-treated or untreated groups. However, the increase in the urinary parameters after EIS (which are indices of renal tubular function) was suppressed in the haptoglobin-treated group (p less than 0.005 for urinary beta 2-microglobulin). Our results indicated that the administration of haptoglobin has a prophylactic effect on renal tubular dysfunction associated with the use of ethanolamine oleate in EIS.

Report of a case of Crohn's disease associated with hyper-creatine phosphokinase-emia.

A young male patient with myositis associated with Crohn's disease is reported. His serum creatine phosphokinase (CPK) level was markedly elevated, but he had no muscle symptoms. The serum CPK level was not correlated with the activity of Crohn's disease. Muscle biopsy showed myositis with only degeneration of the muscle fibers and infiltration of inflammatory cells. The etiology of myositis in this case was not clear. Diagnosis of myositis based on a muscle biopsy in patients with Crohn's disease showing an elevated serum CPK level without any discernible cause has not been reported previously. Careful attention to the serum CPK and muscle symptoms in patients with Crohn's disease is suggested.

[Possibility of endoscopic treatment for early gastric cancer].

Endoscopic therapy has been aggressively used for radical treatment of early gastric cancer, because endoscopic resection allows us to collect the removed tissue and to determine histopathologically whether the cancer lesion has been completely resected. In order to succeed in radical treatment, the complete resection of lesion and no lymph node metastasis are necessary. On the basis of thorough histopathological investigations into operated cases with early gastric cancer, the types of early gastric cancer which have no lymph node metastasis are considered to be as follows: 1) Intramucosal carcinoma type I type II a, measuring 30 mm or less type II b type II c, measuring 10 mm or less 2) carcinoma invading up to submucosal layer type II a + II c, measuring 10 mm or less type II a, measuring 20 mm or less type II b type II c, measuring 10 mm or less type II a + II c, measuring 10 mm or less However, indications of endoscopic resection should be more strictly decided due to diagnostic and technical problems. Eventually, it will be important to detect and resect intramucosal gastric carcinoma as small as possible in order that the lesion be completely resected. The success of curative treatment is evaluated by not only histopathological examination of resected tissue, but also through follow-up study. Therefore, various problems remain to be resolved in this treatment. A larger case sampling will serve to confirm the reliability of this form of therapy for early gastric cancer.

Clinical study of a new fecal occult blood test using a combination assay of hemoglobin and transferrin.

The applicability of a new immunological fecal occult blood test in which hemoglobin (Hb) and transferrin (Tf) are simultaneously assayed was evaluated. The mean absorbance and standard deviation (510/630 nm) obtained by this test was 0.840 +/- 0.805 in 51 fecal samples from patients with colon cancer, 0.248 +/- 0.305 in 95 samples from patients with colon polyps, and 0.104 +/- 0.053 in 110 samples from control patients; these values differed significantly (P less than 0.005). Hb and Tf concentrations were separately determined in the same fecal samples, and qualitative evaluation was performed with a cutoff value of 5.1 micrograms/g feces for Hb and 0.4 micrograms/g feces for Tf. Hb or Tf was positive in 41 of the 51 samples in the colon cancer group, 33 of the 95 in the colon polyp group, and 3 of the 110 in the control group. Qualitative analysis of the values obtained by the combination assay of Hb and Tf with a cutoff value of 0.200 revealed positive rates of 41/51 in the colon cancer group, 33/95 in the colon polyp group, and 4/110 in the control group. These results suggest the usefulness of a combination assay of Hb and Tf as a fecal occult blood test.

[Combination chemotherapy with etoposide, ADM, and CDDP (EAP) for advanced gastric cancer].

EAP therapy has been performed on 50 cases of advanced gastric cancer from January 1988 to September 1989. Adriamycin 20 mg/m2, Cisplatin 40 mg/m2 and Etoposide 100 mg/m2 were administered on day 1 and 7, 2 and 8, and 4, 5 and 6, respectively, with not less than 2 courses every 3 to 4 weeks. Complete success, PR, NC and PD were obtained in 48, 21, 20 and 7 cases, respectively, the rate of effectiveness being 43.8% with a confidence interval 95% of 30-58%. The rate of effectiveness by lesions for evaluation was high (30.4, 100, and 50% for primary lesion, Virchow's lymphnodal metastasis and liver metastasis, respectively). MST was 5.1 months for EAP therapy, which was highly effective but led to no prolonged survival period. Thus, it is thought that good control of leukopenia, a dose limiting factor remains to be examined.