Objective: In order to standardize the diagnosis in ningen dock, we established and implemented a computer-aided osteoporosis diagnostic-support system, in which information obtained from interviews and the examination results are integrated, and diagnosis is made in accordance with the diagnostic criteria for primary osteoporosis (issued by the Japanese Society for Bone and Mineral Research in 2000). Here, we report on our practice with a discussion. Methods: We created a program that provides a diagnosis including the presence/absence of postmenopausal osteoporosis, a leading cause of osteoporosis, by integrating the information on bone density measurements, presence/absence of fragility fracture, presence/absence of menstruation, presence/absence of a history of bilateral oophorectomy, presence/absence of a history of total hysterectomy, and age. The program was designed so that, if subjects are on medication for osteoporosis, it will evaluate the therapeutic effects by bone density measurements and offer second opinions. Results and Conclusion: Utilization of this system may yield the following benefits: 1. Consistent diagnoses can be obtained, generating less variation among diagnosing doctors, and among participants.2. By building the diagnostic logic in accordance with the diagnostic criteria issued by an academic society, even doctors who are not familiar with the particular field can offer evidence-based diagnosis, and thus, standardization among institutions can be ensured.3. It provides an opportunity for doctors to learn about the diagnostic criteria.4. Automatic printing of the doctor's instructions replaces the doctor's handwriting, which may be difficulr to read.5. Automatic input of the diagnosis and instructions reduces the doctor's work-load.

View full abstract

Objective: We see some reports about the change accompanying aging of the laboratory value. However, most reports are based on a group, not on pursuit of each example, so the laboratory values have no continuity. So it is hard to think that the change accompanying aging is shown. Then, we investigated the laboratory data in each example for those who are continuing and taking a through-physical-check(tpc) of the Kanto Rosai hospital Medical screening center (this center), and considered the influence of aging. Method: The cases are men who take a tpc in this center 16 times or more before April 2006, and age at the first time taking tpc was 60 or less-year-old. Differences of the first time to five averages of the laboratory data and last five averages of the laboratory data were evaluated with Student's paired t test (p<0.05). Result: The laboratory data which changed significantly more than a half example was HbA1c, HDL-C and LDH. About other laboratory data, the example which showed significant change was below a half. Conclusion: The laboratory data considered changing accompanying aging were HbA1c, HDL-C and LDH. The necessity of creating the reference value according to age about HbA_1c, HDL-C and LDH should consider. About other laboratory data the necessity of creating the reference value according to age was not shown.

View full abstract

Objective: To analyze the malignant lymphoma cases screened by Fluoro-deoxy-glucose-Positron Emission-Tomography (FDG-PET) cancer dry dock of Koga 21 Hospital PET Imaging Center. Subjective: Between April 2003 and March 2006, whole-body FDG PET was used as a human cancer dry dock modality in 9256 healthy subjects. Five malignant lymphoma cases (4 Males,1 Female, range 53 to 73 yrs)demonstrating FDG accumulation in the thyroidal, inguinal or abdominal lymphnods were hystopathologically diagnosed. Methods: Whole-body 2D FDG-PET scans were performed using the Advance NXi (GE Medical Systems) to collect both the 1 minute transmission and 2 minutes emission data per a bed at 60 minutes and approximately 120 minutes (delayed scan) following the i. v. administration of 3.7MBq/kg FDG. PET reconstructions were done using the OS-EM reconstruction method while attenuation corrections were made using the SAC method. Results: Five malignant lymphoma cases included one thyroidal diffuse large B cell (DLBCL) case of stage TIE, one inguinal DLBCL case of stage II, and three follicular (FL) cases of stage IV. All cases, except thyroidal one, were thought to be malignant lymphoma of their first FDG-PET findings. Two FL cases appeared solitary abdominal high FDG accumulation and finally diagnosed from laparoscopic lymphnode resection. In addition, all cases were performed chemotherapy and survived without recurrence until today. Conclusion: FDG-PET cancer dry dock was thus found to be useful for identifying such malignant lymphoma while early clinical stage and/or curative state.

View full abstract

Objective: This study was carried out to investigate the utility of measuring plasma amino acid as stress testing in ningen dock. Methods: The plasma amino acid measurements were made on 767 subjects by means of HPLC (High Performance Liquid Chromatography). The severity of stress was evaluated by using the stress interview sheet. The major depression was diagnosed by DSM-IV(Diagnostic and Statistical Manual of Mental Disorder,4th ed. ). Results: Depressed subjects had significantly lower lysine (p<0.01) and tryptophan (p< 0.05) compared with healthy controls. The results suggest that the depression is accompanied by change of plasma amino acids, such as lysine and tryptophan. Conclusions: Measuring plasma amino acid can be said to be useful as early screening for stress disorders.

View full abstract

Objective: To clarify the occurrence and changes of funduscopic findings associated with long-term influence by hypertension, data from a longitudinal survey for cardiovascular risk factors were explored. Methods: Subjects were men aged 30 to 59 years who underwent mass examination including ocular fundus examination in Ikawa town, Akita prefecture; the early cohort (434 men,1963-1966 at baseline and followed to 1978-1981)and the later cohort (492 men,1986-1989 at baseline and followed to 2001-2004). The hypertensive change in fundus was defined as the greater value than I degree by Scheie's classification. Results: The prevalence of hypertensive changes in fundus significantly increased from 33% at baseline to 45% after 15-years follow-up in early cohort (p< 0.001), whereas from 13% to 15% in later cohort (not significant). In later cohort, the proportion of subjects having had no hypertensive findings through 15-years was higher, while those of subjects with continuous or deteriorating hypertensive findings during the follow-up were lower than those in early cohort; these results were apparent in hypertensive subjects (those with normotension at baseline and hypertension at terminate of follow-up, or with hypertension at both periods). The later cohort had higher prevalence of using of anti-hypertensive medication and lower blood pressure levels than the early cohort. Conclusion: The present findings showed that the prevalence of hypertensive changes of funduscopic findings have been influenced by hypertension control in a community.

View full abstract

Objective: Hepatic hemangioma is commonly detected in health check-up using ultrasonography. It is well known that ultrasonography sometimes fail to reveal the lesion in the follow-up ultrasonography for the patients with hepatic hemangiomas. In this paper, we analyzed the ultrasonographic detection rate and serial changes of ultrasonographic findings of hepatic hemangiomas in health check-up. Methods: We investigated the detection rate and ultrasonographic findings of hepatic hemangiomas in 47,557 examinees who were undergone ultrasonography in health check-up between April 1996 and March 2005. We also investigated the serial changes of ultrasonographic findings of hepatic hemangiomas in 243 patients who had the health check-up between April 2001 and March 2002. In these 243 patients, ultrasonography was performed in almost once a year after April 2002. Results: Hepatic hemangioma was detected in 2,571 out of 47,557 examinees. The detection rate was 5.4%. The lesion was hyper echoic in 87.2% lesions and hypo echoic in 10.7% lesions. The mixed echo level was observed in 2.1% lesions. Although ultrasonography could reveal 139 out of 243 lesions every year, ultrasonography could not reveal 23 lesions after April 2002. As to the rest 26 lesions, ultrasonography could or could not reveal the lesions through the years. Conclusion: We must pay attention to the history of the ultrasonographic findings in examinees, when we perform ultrasonography in health check-up.

View full abstract

Objective: We investigated the significance of 75g oral glucose tolerance test(OGTT) and its correlation with other components in life-style related diseases study included screening program so called “Ningen Dock” conducted in our health care center. Methods: The 243 subjects aged 30-78 years old: average is 52.6±9.3. We classified the subjects into normal (NL), impaired glucose tolerance (IGT) and diabetes mellitus type (DM) according to 75g OGTT. We compared IGT and DM with NL on body mass index (BMI), systolic blood pressure (SBP), total cholesterol, triglyceride (TG), uric acid (UA), liver function (LF) and fatty liver (FL). Results: The subjects were characterized as follows: 52.7% NL,26.3% IGT and DM 21.0%. In subjects with fasting plasma glucose (FPG) level <110mg/dl,75g OGTT showed 20.0% of IGT and3.0% of DM. IGT were characterized by significantly higher levels in BMI, SBP, TG, UA and also DM in SBP, TG than NL, respectively (p< 0.05). Proportion of those with liver dysfunction, FL and multiple risk factors was significantly higher in subjects with IGT and DM. Conclusions: Even in subjects with FPG level<110mg/dl,75g OGTT on Ningen Dock revealed a large number of subjects with IGT and DM, When we find subjects with abnormality in BMI, SBP, TG, UA, LF and FL, even though their FPG level is normal, we should suspect metabolic syndrome and examine them by 75g OGTT. It is important to improve life style of multiple risk factors by conducting health care advice, which subsequently leads to prevention of progression to DM and cardiovascular diseases.

View full abstract

Objective: To clarify the present status of non-alcoholic fatty liver disease in examinees in overnight Ningen docks of our hospital and obtain parameters for lifestyle interventions in the future, we evaluated impaired fat metabolism, high blood pressure, and fasting hyperglycemia as complications and insulin resistance in examinees with non-fatty liver and those with fatty liver showing a daily alcohol intake of less than 1 go (0.18 l). Methods: Between April and September,2005, there were 862 examinees in overnight Ningen docks of our hospital, of whom 522 after excluding examinees positive for HBs antigen/HCV antibody or showing an alcohol intake of ≥ 1 go (0.18 l) were enrolled in this study. Results: All evaluated items except HDL-C were significantly higher, and HDL-C was significantly lower in the subjects with fatty liver than in those with non-fatty liver. Among the subjects with fatty liver, those with impaired liver function showed a significantly higher fasting immunoreactive insulin (IRI) and homeostasis model of insulin resistance (HOMA-IR) than those with normal liver function. Among risk factors such as impaired fatty metabolism, high blood pressure, and fasting hyperglycemia, fasting hyperglycemia most markedly differed between the subjects with non-fatty liver and those with fatty liver associated with normal liver function (2.5-fold difference). Conclusion: In the subjects with non-alcoholic fatty liver, the complication rates of risk factors of arteriosclerosis were high. In particular, the subjects with fatty liver accompanied by impaired liver function frequently showed high insulin resistance. Therefore, using insulin resistance as a parameter, lifestyle interventions mainly involving exercise therapy for disease improvement may be necessary.

View full abstract

Objective: Previously, we identified a higher positive correlation between the fasting insulin concentration (F-IRI) and body weight than F-IRI and the stage of severity of diabetes mellitus in subjects in Ningen Dock, with the majority of them being healthy or at least showing no severe symptom of lifestyle related disease. We have also reported the significance of measuring F-IRI as a risk factor for lifestyle related diseases in the 1st World Congress on Ningen Dock in Okinawa. The present study was conducted to examine whether lifestyle itself really affect insulin resistance. Methods: A questionnaire about lifestyle, including exercise, drinking, and smoking were performed besides the usual measurement items in Ningen Dock to investigate the relationship between insulin resistance and lifestyle itself. Results: As we have reported before, BMI and FPG were selected as predictors of a high F-IRI. Both the habits of exercise and drinking were also selected as independent predictors. However, the habit of smoking did not affect insulin resistance. Conclusions: These results indicate that the habits of exercise and drinking borh affect insulin resistance. However, the habit of smoking does not affect if. It is still questionable what level of exercise and alcohol is suitable regarding insulin resistance, and whether any different effects on insulin resistance exist due to gender. However, it is a very important for us to guide subjects who undergo Ningen Dock appropriately. Therefore, we have to keep in mind that an excessive prescription of exercise and excessive restriction of the alcohol intake in healthy subjects may not necessarily help them maintain a healthy life.

View full abstract

We report two cases in which scoporamine hydrobrimide possibly induced acute attack of angle closure glaucoma (ACG). Casel. a 58 years old female initially visited our hospital for abdominal pain and scopolamine compound was prescribed for the purpose of pain relief on the September 24th 2006. She started to have rainbow vision on the October 9th and even right ocular pain on the next day. When she visited our department on the October 12th, ophthalmic examination revealed the following: 0.4 in the right and 0.8 in the left as corrected visual acuities,48mmHg in the right and 32mmHg in the left as intraocular pressures (IOPs), right pupil dilation, right conjunctival hyperemia, and the right corneal opacity, and the normal optic nerve in both eyes. Case2. A 75 years old female having a history of abdominal surgery experienced abdominal pain, nausea, and vomiting from the October. l6th,2005. A local physician diagnosed her having ileuses and injected scopolamine hydromide. Soon after, her left pupil started to dilate and she felt ocular pain consecutively. When she was introduced to our hospital the next day, her IOPs were 12mmHg in the right and 73mmHg in the left. Scanning peripheral anterior chamber analyzer (SPAC) judged that this patient had a high risk of ACG. Conclusion: Scopolamine hydromide is deeply involved in these two ACG attacks by the effect of dilating the pupil and some drugs potentially dilating the pupil may induce ACG attack as well. Therefore, subjects who are risk at ACG such as elderly person may be preferred to visit ophthalmologists or to have screening test using non-invasive methods such as Scanning Peripheral Anterior Chamber Analyzer (SPAC) to examine the possibility of ACG attack.

View full abstract