Number of subjects suffered from allergic diseases including bronchial asthma, allergic rhinitis and atopic dermatitis has increased dramatically in recent years, as to reach 30-40 % of the whole population. It is quite important to identify newly-onset allergic patients and/or subjects with high-risks to develop diseases, which in turn early introduction of preventive measures and of optimal medications possible. From this point of view, an attempt will be made in this brief communication, to propose that IgE antibody measurements to search and determine causative allergen (s) should be incorporated in multiphasic health checkup systems.
Objectives To determine whether fatty liver is associated with risk factors of metabolic syndrome independently of body mass index (BMI) . Design A cross-seectional study. Setting and Participants A total of 8, 555 subjects, who consulted our institute for health screening between January 2001 and December 2001. Measurement and Results Among the risk factors of metabolic syndrome, overweight, hyperlipidemia, hyperglycemia, and hypertension, in that order, were significantly associated with fatty liver in multiple logistic regression analyses. The odds ratios (95% Confidence Interval) were 6.3 (5.6-7.1), 2.4 (2.1-2.7), 1.8 (1.5-2.2), and 1.4 (1.2-1.6), respectively. Fatty liver was significantly associated with an increase in the risk factors for metabolic syndrome. However, the increase in the odds ratios was rather limited on multivariate analyses when BMI was added compared to that on univariate analyses; nevertheless, subjects with 4 risk factors for metabolic syndrome had approximately 4 times (95% Confidence Interval: 2.1-6.5) the risk of fatty liver compared with that of those without any risk factors. BMI increased the odds ratios of having 2 or more risk factors for metabolic syndrome in subjects both with and without fatty liver. Subjects with fatty liver had approximately 2 times the risk of having 2 or more risk factors compared with that of those without fatty liver in each BMI group. Conclusions These results suggest that individuals with fatty liver, even if they were not overweight, are probably complicated by the risk of metabolic syndrome, that is, a fatty liver per se also has clinical significance. However, since these pathological findings were also dependent on BMI, we believe that it is possible to reduce the risk of metabolic syndrome by reducing body weight, even if a person has a fatty liver.
In 89 breast cancer lesions found during clinical breast cancer screening with combined usage of mammography (MMG) and Ultrasonography (US) between February 1995 and August 2002, we found 20 cases were negative for MMG and 13 were negative for US detection. In this study we reexamined those cases of breast cancer undetectable either by MMG or breast US. The 11 of the 20 MMG negative cases, lesions were still undetectable by secondary extended examination using MMG, however, we found 9 lesions were positive for MMG by refined technique of delineation. In the 12 US negative lesions, a secondary extended examination performed using US showed 7 lesions were positive for detection; the remaining 5 lesions were still negative for US examination. In summary, of the 89 breast cancer lesions it failed to detect 14 lesions (15.7%) by MMG, and 10 lesions (11.5%) by US in a course of clinical breast cancer screening.
Background The incidence of brain tumors or cerebral aneurysms remains unknown on repeated brain check-up. Purpose We studied the incidence of brain tumors or cerebral aneurysms in large number of individuals who reccceived brain checkup more than twice in PL Tokyo Health Care Center, Japan. Method In our center, 9, 538 participants received brain check-up between August 1995 and July 2002. We analyzed 2, 175 participants (1, 598 men and 577 women) who had brain and physical check-ups more than 2 times. Mean age of subjects was 53.4 (SD 10.4) years in all, 53.1 (SD 10.3) years in men and 54.2 (SD 10.6) years in women. Subjects who were diagnosed as brain tumors or cerebral aneurysms on the first brain check-up were excluded. Brain check-up was produced by 1.5-tesla superconducting system (Stratis II, Hitachi Medical, Japan) . Conventional magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) using three-dimension time-of-flight sequence were undertaken in all subjects. The incidence and the clinical features of brain tumors or cerebral aneurysms were studied. Results The frequency of repeated brain check-up was 22.8%. The intervals between brain check-ups were 277 to 728 days. The times of brain check-up were two to sex. The analysis of brain tumor was diagnosed as meningioma in one woman. The incidence of brain tumors was 0.05% in total subjects and 0.17% in women. The duration between the first and the 2nd brain check-up was one year in this case. Cerebral aneurysms were seen in 6 subjects (2 men and 4 women) . All subjects had no clinical symptoms without a family history of subarachnoid hemorrhage. The total number of aneurysms was 8. Aneurysms were located in the internal carotid artery (n=2), the anterior cerebral arteries (n=3), the middle cerebral artery (n=3) and the basilar artery (n=1) . Two women had two aneurysms. The incidence of aneurysms was 0.28% in total subjects, 0.13% in men and 0.69% in women. The mean age of subjects with aneurysms was 57.7 (SD 6.7) years in all, 64.0 (SD 6.7) years in men, and 54.5 (SD 5.4) years in women. The interval between the first and the 2nd brain check-up was one to five years and the mean duration was 3.0 years (SD 1.7) in 6 subjects with aneurysms. The prognosis was excellent in those five subjects. Subarachnoid hemorrhage occurred in one woman with multiple aneurysms although we strongly recommended neurosurgical procedures for enlarging aneurysms. Conclusion The underdiagnosis of brain tumors and cerebral aneurysms on the first brain check-up contributed to sizes and portions of lesions, radiological technique and reviewers of neuroim-ages. To make the early and correct diagnosis of both fatal diseases, we should compare between the initial and repeated data, including resource imaging of MRA. Radiological technicians always investigate the monitor of MRI and MRA. Cooperation with neurological reviewers and radiological technicians is important to make the early diagnosis of brain tumors and cerebral aneurysms. Our stud-ies indicate that brain check-up should be repeated within a few years, in order to discover asymptomatic brain tumors and unrup-tured aneurysms.
Background Pulse wave velocity (PWV) is a useful and noninva-sive tool for evaluation of arterial stiffness. In PL Tokyo Health Care Center, we attempt to perform physical and brain check-up combined with PWV. Purpose Multiphasic health test, including physical and brain check-up, is usually finished within three hours. PWV must be measured in the same day before or after gastrography with scopolamine Butylbromide. We need to confirm whether this anticholinergic drug has effects on PWV. The purpose of this study is to evaluate serial changes of PWV after treatment with scopolamine butyl-bromide. Method We analyzed serial PWVs in nine volunteers (men) . The range of age was 28 to 59 years and the mean age (mean±SD) was 51.1±9.4 years. The first brachial-ankle PWV (baPWV) was measured at noon before injection of scopolamine butylbromide. Scopolamine Butylbromide (20 mg) was administered intramuscularly at 1 PM. baPWV was performed at 30, 60, 120 and 180 minutes after administration of scopolamine butylbromide. baPWV was applied by form PWV/ABI sphygmograph, Colin AT company, Japan. Results Heart rate was increased approximately 8.8% at 30 minutes after injection of scopolamine butylbromide. Afterwards, heart rate returned to the baseline levels. baPWV was increased slightly at 30 minutes after injection, but baPWV did not significantly change after 60 minutes of injection. Conclusion Intramuscular administration of scopolamine butyl-bromide transiently increased heart rate but did not significantly act on baPWV. Our results indicate that heart rate is most sensitive marker on sphygmography after injection of scopolamine butylbro-mide. baPWV can be measured at least 60-90 minutes after injection of scopolamine butylbromide. We should carefully interpret heart rate for evaluation of baPWV after gastrography with scopolamine butylbromide.
The aim of the present study was to investigate the relationship among the clinical and laboratory signs in response to insulin resistance evaluated by a homeostasis model (HOMA-IR) in Japanese non-obbbbese men working abroad. A significantly positive correlation was observed between body mass index (BMI) and HOMA-IR values in the normal weight (r=0.34; p<0.0001) and the obese group (r=0.52; p<0.0001), but not in the lean group (r=0.16; p=0.28) . There was a significantly positive correlation between fasting plasma glucose values and HOMA-IR in three groups. Plasma alanine transferase (ALT), γ-glutamyltranspeptidase (γ-GPT) and Cholinesterase (Ch-E) values were significantly lower in the lean group than those in other groups; ALT: 18.7, 24.2, 42.3 IU/l; γ-GTP: 36.0, 51.0, 74.3 IU/l; Ch-E: 268, 310, 353 IU/l, respectively. There was a significantly positive correlation between HOMA-IR and plasma ALT or Ch-E values in three groups, but other liver functions values were not correlated with HOMA-IR in three groups. These data indicated that insulin resistance was present in almost all men with fatty liver, and insulin resistance was never associated with obesity, hyperdyslipemia in the non-obese men, and the mechanism for underlying insulin resistance in the non-obese men might be different from that in the obese men.
Objectives To elucidate sociodemographic, lifestyle, psychological, and physical factors associated with two subtypes of insomnia in Japanese male workers. Design A cross-sectional study using the annual health examination database of a Japanese company. Setting N/A Participants Middle-aged male participants in the 1998 health examination at an employee health management center of a Japanese company (n=22, 185) . Main outcome measures Self-reported insomnia, including difficulty initiating sleep (DIS) and difficulty maintaining sleep (DMS) . Results In the young age (<45 years old) group: Significant higher odds ratio (OR) for DIS was found in living alone, shift work, smoking, lack of having three meals, psychological problems, and hypertension, with significant lower OR in overtime work and alcohol drinking. Significant higher OR for DMS was found in living alone, alcohol drinking, psychological problems, and hypertension, with significant lower OR in overtime work. In the old age (≥45 years old) group: Significant higher OR for DIS was found in living alone, smoking, lack of having three meals, lack of exercise, and psychological problems, with significant lower OR in overtime work, alcohol drinking, and hypertension. Significant higher OR for DMS was found in alcohol drinking, lack of walk, psychological problems, and diabetes, with significant lower OR in overtime work and smoking. Conclusions Insomnia was associated with psychological and physical problems, besides lifestyles, in Japanese male workers.
Objectives To examine the association between insomnia and hypertension (HT) in Japanese male workers. Design A cross-sectional study using the annual health examination databaase of a Japanese company. Setting N/A Participants Middle-aged male participants in the 1998 health examination at an employee health management center of a Japanese company (n=21, 151) . Main outcome measures HT defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results The prevalence of HT in the young (<45 years old) and old (≥ 45 years old) age groups was 15.2% (1, 216/7, 988) and 25.1% (3, 303/13, 163), respectively. After adjusting for confounding factors (body mass index, diabetes, sociodemographics/lifestyles, and psychological complains), the odds ratios of “difficulty initiating sleep” and “difficulty maintaining sleep” for HT were 1.12 (95%CI: 0.91-1.38) and 1.22 (95%CI: 1.01-1.47), respectively in the young age group. Meanwhile in the old age group, those were 0.74 (95%CI: 0.64-0.86) and 1.17 (95%CI: 1.04-1.31), respectively. Conclusions Insomnia was independently associated with HT in Japanese male workers, but this association was different by age and subtypes of insomnia.
An analysis was made of factors related to death from coronary heart disease (CHD) and cerebrovascular disease (CVD) in diabetic patients. The study included 1, 939 patients (the mean age at entry was 52.8±11.1 years), 1, 200 males and 739 females, with type 2 diabetes mellitus. These patients entered the study between 1960 and 1979 and were followed until the end of 1993. The mean observation perrrriod was 14.9±6.6 years. At the end of the follow-up, 1, 000 patients (51.6%) were alive, 880 (45.4%) had died and 59 (3.0%) had been lost to follow-up. Among the deceased patients, 111 had died of CHD and 128 of CVD. The relationship of risk factors to death from CHD or CVD was analyzed in terms of the mortality rate per 1, 000 person-year and odds ratios (relative risks), as well as multiple logistic regression method. In our univariate analysis, we found that deaths from CHD were related to fasting plasma glucose level, blood pressure, ischemic ECG changes, serum cholesterol level, retinopathy, proteinuria and therapeutic regimen. Deaths from CVD were related to hypertension, proteinuria and therapeutic regimen. However, in subsequent multiple logistic analysis, only systolic blood pressure, ischemic changes in electrocardiogram (ECG) findings, serum cholesterol level and retinopathy remained significant with respect to mortality from CHD, while hypertension and fasting plasma glucose level were significant with respect to CVD, in addition to age. We found a much lower mortality from CHD, even in our diabetic subjects, than has been found in Western countries. Moreover, there seemed to be a substantial difference in terms of risk factors between mortality from CHD and from CVD.
Background Recently a quantitative fecal occult blood test has been developed. The aim of this paper is to show the usefulness of this method in detecting and treating colorectal cancer. Method Asymptomatic 40, 356 subjects were examined by a 2 day immunological occult blood test using a colloidal gold reagent. One hundred ng/ml was chosen as the cut-off value and the subjects who had this value or more at the first or/and 2nd day examination were recognized as positive. The higher value in the two examinations was chosen for statistical analyses. Positive cases, 3, 066 were inves-tigated by the reports from the physicians of affiliated facilities who had performed further work up. Results 1) The detection rate of colorectal cancers increased as the fecal hemoglobin values rose. 2) The cases whose fecal specimens were both positive had a greater probability of colorectal cancer and the cancers were more advanced than those in one-day positive group. 3) The mean hemoglobin values in colorectal cancer cases detected were higher than in cases without cancer. 4) The mean hemoglobin values in the advanced colorectal cancer cases were higher than in early cancers. 5) The hemoglobin values in the cancer cases located in the right hemi-colon were higher than those in the left one. 6) The cases of cancer detected at this year were almost negative by the fecal occult blood tests done one and 2 years previously. Conclusion By quantifying hemoglobin values in immunological fecal occult blood tests, we are able to estimate the probability, stage of progress, macroscopic appearances or location of colorectal cancer. It is strongly recommended to perform the fecal occult blood test annually.
Objectives To demonstrate the relationships between multiple risk factor syndrome (MRFS) and atherosclerotic events, comparing with hypercholesterolemia group (hTC), in male Japanese, by conducting a work-site cohort study. Methods From 1986 to 1992, 163 male subjects (MRFS group: n=87; hTC group: n=76) aged 30 years or more, working at a single department store in Tokyo were enrolled, and followed-up until 1998 to observe the occurrence of atherosclerotic events (coronary heart diseases, cerebral infarctions and retinal artery hemorrhages) . By using annual health-checkups data in Automatic Multiphasic Health Testing and Service (AMHTS), we defined MRFS group as subjects who met the following criteria: high blood pressure (diastolic blood pressure≥90 mmHg and/or systolic blood pressure≥150 mmHg, or the initiation of hypertension therapy), hypertriglyc-eridemia (serum triglycerides≥160 mg/dl), hyperglycemia (defined by the criteria by Japan Diabetes Society, 1970), and obesity (BMI: ≥24.0 kg/m2) at baseline. To compare MRFS group, we also defined hTC group as subjects whose serum total cholesterol level at baseline was 280 mg/dl or more. Results Eight coronary heart disease cases, 3 cerebral infarction cases and 4 retinal artery hemorrhage cases were observed in MRFS group. On the other hand, no atherosclerotic case was observed in hTC group during the period. Mantel-Haenszel procedure showed that age-adjusted atherosclerosis incidence was significantly higher in MRFS group than that in hTC group (p<0.05) . In MRFS group, proportion of both glucose intolerance (fast plasma glucose≥140 mg/dl) and obesity (BMI≥25 kg/m2) showed significant difference between atherosclerotic cases and non-cases. Conclusions MRFS group are more likely to experience atherosclerotic events compared with hTC group. Moreover, since proportion of both glucose intolerance and obesity in atherosclerotic cases is higher than those in non-cases among MRFS group, improved control of both plasma glucose level and body weight (BMI) are strongly recommended in MRFS in terms of preventing atherosclerotic outcome.
Whole saliva was collected by a spit out method from 52 dentulous subjects (21 to 31 years old) who had no systemic disease and were diagnosed to have normal periodontium by oral cavity examination and from 11 subjects (60 to 85 years old) who were completely edentulous and using complete dentures, and the concentration of total protein and protein fractions in collected whole saliva were measured using cellulose acetate membrane and the silver staining method developed by Shiba et al. Since this silver staining method is highly sensitive, prior concentration of saliva was not needed. The mean ± S.D. of the total protein concentrations obtained by dot blotting-silver staining was 1, 197.3 ± 698.5 mg/l for the group of all dentulous subjects and 2, 202.0 ±1, 625.0 mg/l for the group of all edentulous subjects, and these values were significantly different (p<0.05) . Sex difference was not significant in either group. In protein fractionation by means of cellulose acetate membrane electrophoresis, the following 8 protein fractions could be fractionat-ed clearly: (from the anode) albumin, pre-α1-globulin, α1-globulin, α2-globulin, β1-globulin, β2-globulin, IgA and γ-globulin. In all specimens analyzed, IgA and albumin fractions showed sharp peaks. The IgA fraction had the largest percentage area among the 8 protein fractions, which was 36.7 ± 5.6% (mean t S.D.) in dentulous subjects and 39.0 ± 4.6% in edentulous subjects. The albumin and β1-globulin fractions showed significantly greater percentage areas in dentulous subjects than in edentulous subjects, whereas the percentage area of γ-globulin fraction was significantly greater in edentulous subjects (p<0.01) . The concentration of individual proteins, which was calculated by multiplying the total protein concentration to the percentage fraction. Edentulous subjects showed significantly greater concentrations of IgA and γ-globulin (p< 0.05) . No sex difference was observed in the percentage area and the concentration of individual protein fractions in either group. Among salivary proteins, IgA and albumin were identified by immunofixation.
In the Multiphasic Health Check-up System, medical laboratory testing has been changing lately to utilize a small and compact type of testing systems. The system uses heparinized blood for chemistry tests to reduce laboratory's workload and sample volume. The dana-paroid, a mixture of glycosamino-glycans (Heparan sulfate), has been used clinically for treatment of patients with disseminated intravascular coagulopathy instead of heparin sulfate. Heparin has been used for routine laboratory tests, although it has a strong activity of platelet aggregation. This study aimed to examine availability of Danaparoid for routine hematology tests as a substitute of heparin. Although Danaparoid induced platelet aggregation directly, the reaction was weaker than that of heparin. The platelet count of Danaparoid blood was decreased after five minutes of mixing. Addition of MgSO4 or of kanamycin sulfate to Danaparoid blood was able to prevent this decrease. When Danaparoid blood was applied to chemistry tests, major chemistry test data showed acceptable results, although level differences were observed slightly. It was concluded that Danaparoid would be a good candidate for a universal anticoagulant for both chemical and hematological laboratory tests.
Adrenal glands are usually not included objects of ordinary multi-phasic health testing system. Whereas, it is sometimes experienced that an adrenal abnormal lesion is detected during the health checkup unexpectedly. Between 1995 and 2002, we have examined 79, 051 people in our health care center and found only 5 adrenal abnormal-ities, 3 adrenal tumors, l calcification and 1 cystic lesion by abdominal utrasonographic (US) study. The frequency of detecting adrenal abnormalities in our center was about 0.015%. There were no difference of frequency between female and male and also their site of lesion. They have no symptoms and their laboratory data showed no special abnormalities. The mean size of four adrenal incidentalomas (except one calcification case), was 49 ± 14 mm (mean ± SD) . Among these 5 cases, case 1 showed unusually large (70 mm in diameter) cystic lesion, and was the first experience for us. This case had undergone precise examinations in the general hospital. The cystic lesion was not enhanced by contrast material in computed tomo-graphic (CT) study. Multiplaner magnetic resonance imaging (MRI) strongly suggested the mass was right adrenal origin, and it showed low intensity in T1 weighted and high intensity in T2 weighted method. The mass had a thin wall and a homogenous content. All these results suggested that the mass was an uncomplicated adrenal cyst except its size, therefore careful observation was decided to continue without doing any more invasive examinations.
We report neuroradiological findings in a unique case with mega-dolichobasilar artery and trigeminal neuralgia and neurogenic hypertension. A 39-year-old man with hypertension and trigeminal neuralgia received the first physical check-up in PL Tokyo Health Care Center. Physical check-up suggested moderate degree of obesity, severe degree of hypertension, hyperlipidemia and hyperuricemia. Neurological examination showed paresthesia in the right lower face, auditory disturbance in the right side and horizontal nystagmus to the right direction. Magnetic resonance imaging showed the dilated and tortuous basilar artery compressing the pons and the left ventrolateral medulla oblongata. Magnetic resonance angiography (MRA) demonstrated megadolichobasilar artery anomaly. The resource images of MRA revealed compression to the root entry zone of the right trigeminal nerve by the ectatic basilar artery and the neurovascular contact of the right vestibulocochlear nerve. Megadolichobasilar artery anomaly causes dysfunction of the cranial nerves, cerebral ischemia and hemorrhage. Our neuroimages indicate that the megadolichobasilar artery compresses the root entry zone of the ipsilateral trigeminal nerve, the vestibulocochlear nerve and the left ventrolateral medulla, leading to trigeminal neuralgia, vestibulocochlear deficits and marked hypertension in our patient. Thus, the resource images of MRA have benefits for pathognomonic evaluation of the neurovascular structure.