Tatsuro Ueno

An epidemiological study with risk analysis of liver diseases in the general population living in a methyl mercury polluted area.

STUDY OBJECTIVE--The aim was to determine the actual prevalence of liver disease and to investigate the contribution of various risk factors to liver disease among the population in a methyl mercury polluted area. DESIGN--The study was a population based cross sectional mass screening survey. A case-control study was designed to estimate the role of various risk factors for liver diseases. SETTING--The study was confined to a small rural town 10 km north of Minamata City. SUBJECTS--1406 persons aged 50 to 69 years were examined (78.3% of the total population of this age in the locality). MEASUREMENTS AND MAIN RESULTS--Measurements of liver disease were made on the basis of haematological, physical, and ultrasonographic examinations. Data on liver risk factors were collected by questionnaire, and by measurement of body height, weight (obesity), and hepatitis B surface antigen (HBsAg). The prevalence rate of liver tumour was 0.5% in males, liver cirrhosis was found in 0.5% of males and 0.1% of females, and hepatitis was seen in 5.4% of males and 1.0% of females. Frequency rates of risk factors for liver disease among subjects with obesity were significantly higher in the female patient group, and the frequency rate among subjects with alcoholic drinking habits was significantly higher in the male patient group. The odds ratio of past history of blood transfusion showed the highest value among other related factors (7.73) and the attributable risk for this was very high (87.1%); HBsAg was next in rank (odds ratio 3.04; attributable risk 67.1%). CONCLUSIONS--The prevalence of liver disease in this methyl mercury polluted area was not increased, contrary to what was expected based on the standard mortality ratios. The main risk factors for liver disease in this area appear to be alcoholic drinking habits and a history of blood transfusion.

Recent trends in bagassosis in Japan.

The only workers presently exposed to bagasse dust in Japan are the employees of sugar refineries and lacquerware factories. A follow up study of six former cases of bagassosis from among the retired employees of a paper board factory, closed since 1973, showed that none of the subjects still had bagassosis. Examinations of 70 employees of a sugar refinery for allergic reactions also showed no case of bagassosis. Seven cases with suspicious shadows of bagassosis on chest radiographs and four cases with positive serum precipitin to stored bagasse were, however, found among those 70 subjects. The results show the disappearance of a past episode of bagassosis and the possibility of a new occurrence of bagassosis among the employees of sugar refineries and lacquerware factories in the near future in Japan.

Comparison of unitages for total free erythrocyte protoporphyrin (total EP) in anemia screening

The presence of free protoporphyrin in erythrocytes was previously reported by Hymans van den Bergh and Hyman [l]. In addition, increased free erythrocyte protoporphyrin is often observed in some diseases [2]. In iron-deficiency anemia, free erythrocyte protoporphyrin also increases, because heme synthesis cannot be completed and a relative excess of the unused ‘free’ protoporphyrin accumulates in the erythrocytes [3]. Lamola and Yamane, however, reported that the fluorescent porphyrin in the erythrocytes of patients with lead intoxication or with iron-deficiency anemia is zinc protoporphyrin that easily dissociates into free protoporphyrin and zinc ions in acidic solvents [4]. In another report, Piomelli [5] developed a micromethod for free erythrocyte protoporphyrin determination in which protoporphyrin in erythrocytes is extracted with an acidic solvent then determined as a free type of protoporphyrin, therefore the method determines free and zinc protoporphyrin, the so-called total erythrocyte protoporphyrin (total EP). Since then, the measurement of total EP has been recognized as a sensitive indicator for lead intoxication in children and is a simple procedure for any clinical laboratory. The total EP can be determined and calculated as four different units: pg/dl-blood, pg/dl-packed cell volume (pcv), pg/g-heme and pg/g-hemoglobin (Hb). The aim of the present study is to detect which unit is the most useful to evaluate or screen for the presence anemia.

Marked cardiomegaly in a patient with familial amyloidotic polyneuropathy after orthotopic liver transplantation: a case study

Hepatocyte‐derived mutant amyloidogenic transthyretin (ATTR) causes familial amyloidotic polyneuropathy (FAP), for which orthotopic liver transplantation is an established curative treatment. However, some patients with FAP have cardiac amyloidosis after transplantation. Here, we describe a man with an autonomic disorder diagnosed as FAP ATTR Val30Met and marked cardiomegaly after liver transplantation. He underwent orthotopic liver transplantation at 49 years of age and was prescribed prednisolone to prevent graft rejection. Two years later, autonomic dysfunction and severe heart failure gradually developed. He died suddenly at 59. The autopsy revealed marked cardiomegaly (heart weight: 1020 g). Histological and ultrastructural examinations demonstrated massive amyloid deposition and unusual myocardial hypertrophic injury associated with nuclear translocation of the glucocorticoid receptor (GR). No other FAP patients without heart failure showed GR nuclear translocation. GR is a nuclear transcription factor that leads to myocardial hypertrophy, and cumulative prednisolone doses may promote marked cardiomegaly and severe cardiac amyloidosis.