[Studies on the systems for the better settlement of medical malpractice conflicts].
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Biomedical subjects
Publications and source records attributed to S Kamiyama.
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On the comparison of stomach cancer mortality between Akita and Iwate prefectures which locate neighboring in northern Japanese mainland shows marked difference, the former very high and the latter very low. Dietary mutagenicity of inhabitants in the two areas were assayed by Rec-assay using B. subtilis and by Ames test using Salmonella TA 100 and TA 98. Both of the results showed the frequencies of positive mutagenicity were significantly higher in Akita than in Iwate. The food composition of the diets tested was compared among the three groups of mutagen-positive, -probable and -negative diets. The positive diet was significantly frequent in broiled meat, grilled fish, salted fish intestine, cooked beans, fried bean curd, sautéed vegetables, salted bracken and sautéed onions. On the other hand, the mutagen-negative diet was significantly frequent in fresh vegetables, cooked potatoes, cooked carrots, milk, bean curd, devils' tongue and confections. The former was called the mutagen-positive food group and the latter the mutagen-negative food group. The mutagenicity tests of each food which belongs to both the groups revealed that the combination of the mutagenic factors and the mutagen-depressive factors in the above mentioned cooked foods caused the variety of mutagenicity of the diet of the inhabitants. A method to evaluate the mutagenic pattern of diet was developed.
The activities of A, B and H in serous cells (S-cells), mucous cells (M-cells) and excretory duct cells were examined in a large number of paraffin sections of three major salivary glands obtained from 91 corpses, using the immunofluorescence technique. The results are: By taking H activity in S-cells of the submandibular gland or A, B and H activity in M-cells of the sublingual gland as an indicator, the salivary glands were classified as Type I showing activity and Type II showing no activity. No glands corresponding to the intermediate type, as seen in the case of saliva, were noted at all. Among 91 corpses, 70 cases were classified as Type I and 21 as Type II. The results matched well with those of Lewis type tested on blood. The frequencies of the typing (Type I; 76.9%, Type II; 23.1%) were approximately in concordance with those of secretor and nonsecretor in Japanese saliva. From these results, it was assessed that the former corresponded to the secretor type in the case of saliva, and the latter to the nonsecretor type. Even in the same individual, both S-cells and M-cells exhibited different productivities of substances, depending on the glands to which they belonged. Namely, only S-cells in the submandibular gland belonging to Type I showed only H activity independent of the blood group of the individual, but the other S-cells in the other major glands did not show any activity for A, B and H. M-cells exhibited strong activity for H and/or A and/or B in the sublingual and submandibular gland and belonged to Type I, but little activity in the sublingual gland belonged to Type II. In the submandibular gland of Type II, some M-cells showed activity and others did not. On the basis of the above results, we discuss the applicability of the present genetic theory concerning the secretor and nonsecretor type in saliva to salivary glands and cells, and further refer to the reasons for appearance of the weak secretor type or intermediate type in saliva.
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Three major esteroproteases, proteases A and D and P-esterase, obtained from the glands were studied kinetically and chemically; two (proteases A and D) were identified. Protease A is composed of a single subunit, molecular weight (27,600) similar to the native molecule (27,000); protease D consists of three subunits, approximate molecular weights of 9200, 7600 and 4600. P-esterase contains two subunits, approximate molecular weights of 7100 and 14,000. Protease A exhibits a strong kinin-releasing activity; the other two enzymes have low activity. Protease D binds to low molecular weight-epidermal growth factor, forming a complex which has an electrophoretic mobility similar to that of high molecular weight-epidermal growth factors. When beta-nerve growth factor was incubated with protease A, the amino-terminal amino acid, serine, was lost from the growth factor and a new amino-terminal amino acid, methionine, appeared. These data indicate that proteases D and A are the same proteins as epidermal growth factor-binding protein and beta-nerve growth factor endopeptidase, respectively. From a comparison of the peptide maps of trypsin-digests of the enzymes, the proteases A and D were inferred to have a similar primary structure.
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Several workers have associated fecal neutral steroids with colon cancer frequency. They suggested that the risk for colon cancer increases with a rise in the level of total and certain neutral steroids. The Japanese in Hawaii, who are at high risk for this cancer, had a higher concentration of cholesterol and total animal steroids in their fecal specimens than did the people in Akita, Japan, who are at low risk. However, the rest of the findings on neutral steroids were unremarkable or inconsistent in comparison with those of other studies. These data are suggestive but not strongly supportive of a relationship between fecal neutral steroid patterns and colon cancer risk.
Of 1,749 volunteers in a screening program for gastric cancer in Japan, 206 men and 181 women received a systematic gastroscopic examination and responded to a dietary questionnaire estimating their quantitative intake of 33 food items during the past weeks. When diet was correlated with intestinal metaplasia (a precursor lesion of gastric carcinoma) found in gastroscopic biopsies, it was observed that more dried fish consumption and less vitamin A intake increased the extent of intestinal metaplasia in men. For women, there was a significant negative association of ume (pickled plum) intake with intestinal metaplasia. The implications of these findings were discussed in relation to gastric cancer.
Human feces from 223 Japanese in Hawaii at high risk for colon cancer and feces from 166 Japanese of northern rural Japan at low risk for colon cancer were shown to contain mutagenic activity under five different test conditions. The first assay, using the Ames TA98 and TA100 Salmonella test, detected ether-soluble mutagens in the presence and absence of rat liver microsomes. Of these, the TA98 direct-acting mutagens are present more frequently in the feces of the high-risk population than the low-risk population at a high level of statistical significance (p less than 0.01). TA98 mutagens activated by rat liver microsomes also occur significantly more frequently in the feces of the Japanese from Hawaii (p less than 0.05). Mutagens detected by TA100 in the presence and absence of rat liver microsomes are not commonly found in either Japanese population. The second bacterial test system used to detect fecal mutagens uses Escherichia coli rec-. This system detects water-soluble fecal mutagens which are also present more frequently in the high-risk population than in the low-risk population (p less than 0.05).
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Some workers have associated fecal bile acids with colon cancer frequency. They suggest that the risk for colon cancer increases with a rise in the level of total and degraded fecal bile acids. The Japanese in Hawaii, who are at high risk for this cancer, had higher concentrations of deoxycholic acid (a degraded bile acid) in their fecal specimens than did the people in Akita, Japan, who are at low risk. However, the findings for the other bile acids were unremarkable or inconsistent. These data were suggestive, but not strongly supportive, of a relationship between fecal bile acid patterns and colon cancer risk.
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It has been suggested that the risk of cancer, polyposis, and diverticulosis of the large bowel increases with bowel transit-time. Hence, Japanese inhabitants of Hawaii, in whom the risk of these diseases is high, would be expected to have longer transit-times than Japanese in Japan, in whom such risks are low. However, bowel transit-times were similar in Japanese groups. Stools from the Hawaii Japanese did weight significantly less than the specimens from Japan, and this factor may be indirectly related to the risk of colorectal cancer, polyposis, or diverticulosis in the Japanese.
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