Objective. To investigate the association between human T lymphotropic virus type I (HTLV‐I) infection and rheumatoid arthritis (RA) in Nagasaki, an area highly endemic for HTLV‐I infection. Methods. Sera from 113 female patients with RA and 19,796 female blood donors were screened for anti–HTLV‐I antibodies with a gelatin particle agglutination kit and confirmed using an immunoblotting kits. Results. The age‐adjusted summary odds ratio of HTLV‐I infection among RA patients, as compared with blood donors, was 2.8 (95% confidence interval [95% CI] 1.8–4.6). The etiologic fraction, i.e., the proportion of RA in the study population that is attributable to HTLV‐I infection, was estimated to be 13.2% (95% CI 5.1–21.2). There was no significant difference in the clinical and laboratory findings between HTLV‐I–infected and HTLV‐I–uninfected RA patients. Conclusion. These epidemiologic findings support the idea that HTLV‐I infection is a risk factor for RA, and suggest that ∼13% of the cases of RA in females living in Nagasaki are associated with HTLV‐I infection.
A prospective follow-up study was carried out to assess the prognosis of renal tubular function after reduction of environmental cadmium exposure. Time-related changes in urinary beta 2-microglobulin and cadmium excretion were followed from 1979 to 1989 in 102 residents of a cadmium-polluted area in Nagasaki, Japan. The average dietary cadmium intake among the study population was more than 200 micrograms/d in 1969, which decreased to approximately half that amount in 1983 because cadmium-polluted paddy fields were replaced with new soil in 1981. The geometric mean urinary beta 2-microglobulin concentration for 28 subjects aged 40 y or older in 1979 increased from 1,135.8 micrograms/g creatinine in 1979 to 1,999.7 micrograms/g creatinine in 1989. A similar tendency was also observed in 16 subjects with urinary beta 2-microglobulin concentrations greater than 1,000 micrograms/g creatinine in 1979, although the statistical significance of the difference did not reach the 5% level, probably because of the small sample size. In 48 persons examined in 1982, 1986, and 1989, the geometric mean of urinary cadmium concentration decreased from 8.49 micrograms/g creatinine in 1982 to 6.03 micrograms/g creatinine in 1989. The tendency for increasing beta 2-microglobulin excretion observed in the present study could not be explained by aging alone. Thus, it was concluded that renal tubular dysfunction caused by environmental cadmium was irreversible and slowly progressive, even after reduction of exposure. Six of 8 subjects who had severe renal dysfunction and who were included in the study died before 1986 and could not be followed. The implication of loss of subjects because of death is also discussed.
New insights into the immunology and genetics of malignant lymphomas have allowed the recognition of new entities and the refinement of previously recognized disease categories. The relative incidence of these subtypes of malignant lymphoma is also known to differ according to geographic location. In order to clarify the current status of malignant lymphomas in Japan and the relative incidences of their subtypes, 3194 patients were classified according to the new World Health Organization (WHO) classification. Among these were 3025 cases (94.71%) of non‐Hodgkin's lymphoma (2189 cases (68.53%) of B‐cell lymphoma, 796 cases (24.92%) of T‐cell lymphoma) and 141 cases (4.41%) of Hodgkin's lymphoma. The incidences of the major subtypes of non‐Hodgkin's lymphoma were 33.34% for diffuse large B‐cell lymphoma, 8.45% for marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue (MALT) type, 8.05% for plasma cell myeloma, 7.45% for adult T‐cell leukemia/lymphoma (ATLL), 6.7% for follicular lymphoma, 6.67% for peripheral T‐cell lymphoma of unspecified type, 2.79% for mantle cell lymphoma, 2.6% for nasal and nasal‐type T/NK cell lymphoma, 2.35% for angioimmunoblastic T‐cell lymphoma, and 2.35% for precursor B‐cell lymphoblastic leukemia/lymphoma, in decreasing order. The other subtypes comprised less than 2%, mainly precursor T‐cell lymphoblastic lymphoma/leukemia (1.72%), anaplastic large‐cell lymphoma of T‐ and null‐cell types (1.53%), and B‐cell chronic lymphocytic leukemia/small lymphocytic lymphoma (1.31%). The incidence of ATLL was influenced by its high percentage (19.20%) in the south‐western Japanese island, Kyushu, an endemic area of human T‐cell leukemia virus type 1 (HTLV‐1), but which appeared to be lower than that in a previous study. The nodular sclerosis and mixed cellularity types of Hodgkin's disease occupied 1.78% and 1.63%, respectively. These data are distinct from those in Western countries and similar in several ways to those in the East, although the relatively high rate of ATLL was attributed to the geographical difference in the etiologic factor, HTLV‐1.
Cadmium (Cd) from a zinc mine polluted Jinzu River basin, Toyama prefecture and produced a disease with severe bone pain (Itai-itai disease), from the early part of the 20th century. Cd caused renal tubular dysfunction and osteomalacia accompanied by osteoporosis. The main symptoms of the disease were bone pain, pseud fracture (Looser's zone), fracture, and renal tubular dysfunction. The pollution of paddy-field soil by Cd still remains and our epidemio1ogica1 studies of the inhabitants living in the Cd-polluted areas show the presence of renal tubular dysfunction and decrease of bone mass; characteristic of Itai-itai disease.
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