The aging of society has brought about an urgent need to review the examination procedures for gastric cancer in the elderly. This report examines the status quo of, and possible future improvements to be made to gastric cancer examination for the elderly, from the viewpoints of mass surveys and individual check-ups. A mass survey revealed that people aged sixty-five or older comprise approximately 40% of the total number of examinees. The detection rate for gastric cancer increases with age, and the early detection rate for the elderly was the same as that for people under sixty-five. The examination efficiency was found to have improved through the use of high-concentration barium, and the implementation rate of endoscopic mucosal resection (EMR) for the elderly has shown a tendency to increase. However, a decrease in diagnostic accuracy and an increase in accidental symptoms have become significant issues in X-ray examinations of the elderly. In contrast, the serum pepsinogen test (PG) performed at individual check-ups demonstrated higher consultation and detection rates, as well as better cost-effectiveness than X-ray examinations. In conclusion, it is recommended that PG should be introduced as the first step in the examination of an elderly patient, as it will raise the consultation rate and lead to the performance of an endoscopy when necessary.

View full abstract

The outcome of hepatitis C virus (HCV) infection varies among individuals. To elucidate the host genetic factors involved in the outcome, we conducted a population-based association study in which 238 individuals positive for anti-HCV antibody were genotyped for single nucleotide polymorphisms (SNPs) in the selected candidate genes. Those were seronegative for HBs antigen and had no history of anti-viral therapy. Allelic and genotypic analyses of SNPs were performed between the subjects with and without viremia. Twelve SNPs in 10 genes were listed as candidate genetic polymorphisms that might influence the viremia status. These may reflect the genetic variations in HCV-infected individuals that are associated with susceptibility to infection, viral replication and immunity against HCV. It is important to define the function of these genes with regard to HCV infection.

View full abstract

Transnasal endoscopy is becoming more widely used as a painless screening method for gastric cancer checkup. We gathered information through a questionnaire regarding transnasal endoscopy from 38 patients undergoing cancer checkup. The results of the questionnaire indicated that (1) there were both high expectations and concerns that there would be difficulties before the inspection.(2) There were no patients who complained that the procedure would be unbearable, although pain in the nasal cavity occurred in about 40 percent of the subjects during the examination.(3) Marked support for the procedure was gained subsequent to pain relief and mitigation of nausea and the pharyngeal reflex. Patients who selected the transnasal method as the preferred method for next year accounted for 84.2%, while only 2.6% of patients preferred the conventional transoral method.(5) Many patients (57.9%) expected a medical checkup by transnasal endoscopy only, and none of the patients expected a combination of transoral endoscopy and direct radiography. As indicated above, although further evaluation of the diagnostic ability of transnasal endoscopy is yet to be performed, we think that it is necessary to present this method to the patients, so that they understand that transnasal endoscopy as is a valid alternative examination method.

View full abstract

Questionnaire studies concerning gastric mass surveys were carried out among 243 technicians who were authorized by the Tokai-Hokuriku division of the Japanese Society of Gastroenterological Mass Survey. The newly drafted X-ray gastric exposure method (comprised of direct and indirect investigative methods) was known of by 83% of the above members. On the other hand, indirect photo fluoroscopy was practiced by 16% of the technicians and direct photography was practiced by 37%. Additional exposures were performed by 99% of the technicians. Reports of findings were prepared by 31% of technicians performing indirect photo fluoroscopy and by 51% of technicians performing direct photography. Standardized practice of the exposure techniques in institutions was undertaken by over 80% of all technicians. 44% of the technicians participated in the case conferences. It emerged that a renewal of authorization as qualified technicians would be asked for by 82% of the technicians. Specializations in barium enema examination and ultrasound examination are cited as the new Qualification areas for which authorization is sought.

View full abstract

Recently, colonoscopes with zoom function have been used even at health screening centers for the purpose of classifying colon lesions more definitively. But, the old type of colonoscope, the OLYMPUS CF 200Z, has had some problems in the areas of hardiness and picture quality. In order to solve these problems, a new type of colonoscope, the OLYMPUS PCF Q240ZI, has been developed. We compared the performance of the new type with that of the old type in the same 49 polyp cases, and the colonoscopes were followed by endoscopes so that the timing of applying the zoom function and the quality and brightness of the pictures could be assessed. The results showed that the zoom function of the new colonoscope took effect more quickly than that of the old type, giving clearer and brighter pictures than the old type. Thus, these results suggest that the new type is easier to use and gives pictures of higher quality than the old type. Moreover, we assume that the examinees experienced less pain with the new colonoscope than with the old one. We think that the OLYMPUS PCF-type Q240ZI is suitable for colon screening.

View full abstract

In Japan, community-based HCV screenings were introduced in 2002, as a new item of mass medical checkup. In preparation therefor, we conducted HCV antibody testing on all persons who participated In a thorough physical checkup in 2001 and those who were residents of the town of Yamaga.
The results of the thorough physical checkup were compared with the results of the mass checkup for the town of Yamaga. Persons from whom we did not obtain consent for HCV inspection were asked to fill out a questionnaire. The group of people who underwent a thorough physical check was comprised of 1304 persons, and the subjects positive for the HCV antibody (middle-high titer) accounted for 7.9 %. On the other hand, in the town mass medical checkup of 1000 individuals, 218 needed to be tested for the HCV virus, but only 135 gave their consent (61.9%). Among those tested, 9 were positive for the HCV antibody (middle-high titer)(0.9%). According to the questionnaires half of the people were not informed of this examination or the fact that it was free of charge. Some did not understand the significance of this test. The other half was aware that testing for HCV antibody was introduced in mass screenings, but they found it tiresome, or simply thought that it was not necessary for them to undergo such a test. We concluded that more detailed information should be given to the public, and that better public relations and a more effective system of mass medical checkup is needed.

View full abstract

Out of 11272 subjects who visited our center for annual health check-up, 3913 (34.7%) were diagnosed as having fatty liver by ultrasonography. The prevalence of hyperlipidemia, obesity, hypertension, and diabetes mellitus was significantly higher in subjects with moderate or severe fatty liver than those in subjects with mild fatty liver. Thirty-two point two percent of subjects with fatty liver had alanine aminotransferase (ALT) or aspirate aminotransferase (AST) elevation. The subjects having fatty liver with ALT or AST elevation had higher prevalence of hyperlipidemia, obesity, hypertension, and diabetes mellitus than those having fatty liver with normal ALT and AST levels. Out of 200 subjects with fatty liver, 31 (31.5%) had progressed, 106 (53%) had not changed, and 63 (15.5%) had improved after three years retrospectively. The change of body mass index (BMI), body fat ratio, and serum level of triglyceride significantly correlated with the change of degree of fatty liver. These results suggest that the severity and the change of degree of fatty liver and ALT or AST elevation, are closely associated with lifestyle-related diseases, and that individuals with fatty liver should be actively managed in diet, alcohol intake, and exercise.

View full abstract