Objective: Metabolic syndrome (MS) is a combination of health disorders: obesity, hypertension, dyslipidemia and diabetes. Many studies have shown that MS causes arteriosclerosis and a variety of other diseases. In this study, we investigated the relationships between BMI/waist circumference (WC), MS and 4 digestive diseases related to obesity.
Methods: The subjects were 2,068 males and 1,305 females who underwent medical screening at our health examination center from April 2007 to March 2008. We diagnosed reflux esophagitis (RE) and esophageal hiatus herniation (EHH) by gastroscopy, and gallstone (GS) and fatty liver (FL) by ultrasonography. Two diagnostic criteria for MS were used, the difference between them being whether a large WC was included or not. We analyzed the medical screening results for correlations between BMI/WC, MS and prevalence of RE, EHH, GS and FL.
Results: In both sexes, BMI (independent of WC) was correlated with the prevalence of GS and FL, and WC (independent of BMI) was correlated with the prevalence of FL. In males alone, WC was correlated with RE and EHH. MS (both criteria) was correlated with the prevalence and severity of FL in both sexes.
Conclusions: BMI could be a predictor of GS and FL,WC a predictor of RE, EHH and FL, and MS a predictor of FL severity. Effective countermeasures should therefore be taken, for example, early detection and intervention for digestive diseases in the case of subjects with a large BMI/WC and strict disease control for those with MS and FL.

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Aim: To compare correlations between obesity indices and metabolic risk factors by age and gender in non-diabetic apparently normal Japanese.
Methods: Partial correlation coefficients between obesity indices and metabolic risk factors controlled for age, smoking status, and drinking status were compared between men and women, between younger (age ≤ 50 years) men and younger women, between older (age > 50 years) men and older women, between younger men and older men, and between younger women and older women in non-diabetic Japanese without antihypertensive or antihyperlipidemic medication, or any history of cardiovascular disease.
Results: Correlations between metabolic risk factors and obesity indices were not significantly different among body mass index, percentage body fat, and waist circumference. However, correlations between obesity indices and triglycerides, high-density lipoprotein (HDL) cholesterol, gamma glutamyltransferase (GGT), and alanine aminotransferase (ALT) were significantly stronger in men than in women. Furthermore, correlations between obesity indices and fasting glucose were significantly stronger in younger women than in younger men, but significantly stronger in older men than in older women.
Conclusions: Correlations between obesity and triglycerides, HDL cholesterol, GGT, and ALT were significantly stronger in men than in women, and the correlation between obesity and fasting glucose was significantly stronger in younger women than in younger men.

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Objective: We organized a training program for improving the gastric cancer diagnosis skills of endoscopists and evaluated its results.
Methods: Patients were examined by endoscopy and biopsy for 2 periods: 1997 - 2000 when 13,436 patients were examined, and 2005 - 2007 when 7,448 patients were examined. The endoscopic diagnoses were compared with the pathological diagnoses obtained from biopsies. Between the 2 periods, for the purpose of training, we devised a standard gastric endoscopy screening method and started double checking of endoscopic pictures by 2 physicians and periodical case-conferences using false negative or false positive pictures.
Results: The endoscopic biopsy rate decreased from 36.1% for the period 1997 - 2000 and to 27.9% for the period 2005 - 2007. The false negative rate decreased from 34.8% to 23.9% for doctors who received training and their positive prediction rates (56.4% for 1997 to 2000, 60.9% for 2005 to 2007) were higher than those of doctors who did not receive training.
Conclusions: We observed an improvement in the gastric cancer endoscopy diagnosis skills after training and therefore recommend that endoscopists in health check-up centers receive such training.

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Objective: Serum uric acid levels are known to be low in diabetic patients, due to an increase in urinary uric acid secretion. In the present study, we investigated a relationship between serum uric acid levels and markers for glycemic control [fasting plasma glucose, HbA1c and 1,5-anhydroglucitol (1,5-AG)].
Subjects: The subjects were 39 patients with type 2 diabetes (Age: 55.7±4.1 years, fasting plasma glucose 124±32 mg/dl, HbA1c 6.5±1.2%, 1,5-AG 12.1±7.5 μg/ml, serum uric acid 6.4±0.9 mg/dl) among persons undergoing health checks at our hospital. Patients taking medication for hyperuricemia and/or gout were excluded.
Results: In stepwise multivariate analysis, 1,5-AG, as well as triglycerides and HDL cholesterol, were independently associated variables for serum uric acid. Further, serum uric acid, as well as HbA1c, were independently associated variables for 1,5-AG. Serum uric acid was significantly correlated with 1,5-AG (R=0.406, p=0.0104), though not with fasting plasma glucose and HbA1c. (R=-0.225, p=0.1694; R=-0.230, p=0.1594, respectively).
Conclusion: Our findings suggested that serum uric acid levels and 1,5-AG levels are regulated by a common mechanism mediated by urinary glucose excretion in patients with type 2 diabetes.

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Objective: To analyze data from uterine cervical cancer screening conducted at 5 centers in the Takeda Hospital Group, determine whether examinees requiring further examination were given appropriate follow-up instructions, and discuss future issues.
Methods: The results for 9,866 women who underwent screening from June 2007 to May 2008 were analyzed according to the classification of the Japan Association for Maternal Welfare, and the follow-up status of examinees requiring further examination was studied.
Results: 1. Examinees in their 40's accounted for the largest population (2,999 [30.4%]), followed by those in their 50's (2,586 [26.2%]); 2. Forty-five women (0.46%) required further examination (ClassⅢa: 37,Ⅲb: 4, IV: 2, V: 2); 3. Women in their 30's accounted for the largest population (16 [35.6%]) requiring further examination; 4. Medical consultation was recommended for examinees requiring further examination; 5. All examinees requiring further examination were from 3 centers. Of the 4 examinees given referrals, 1 was reported to have been examined and treated but the status of the 3 remaining subjects was unknown.
Conclusion: Of 9,866 examinees screened for uterine cervical cancer, those in their 40's accounted for the largest population (2,999 [30.4%]), and 45 (0.46%) were identified as requiring further examination (ClassⅢa or higher). Medical consultation was recommended to all examinees requiring further examination. However, most did not receive referrals and their follow-up results were not known. Thus, it is important to write referrals and obtain the results of final examinations

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Background: Piriform sinus fistula (PSF) is related to a persistent embryological third or fourth pharyngeal (ultimobrancheal) pouch which causes acute suppurative thyroiditis (AST) mainly in the pediatric period and rarely in adulthood. In health check-ups for adults, asymptomatic PSF is sometimes identified incidentally in upper gastrointestinal x-ray examinations and we have encountered 5 cases of asymptomatic PSF in adults in the last 3 years. From the point of view of preventive medicine, if findings are abnormal, it is important to be honest with the person concerning the risk of the disease, and give them useful cautions for daily life.
Methods: To obtain more information on asymptomatic PSF, we searched PubMed for literature in English and Igaku Chuo Zasshi for that in Japanese using the keywords "adult", "piriform sinus fistula" and "acute suppurative thyroiditis".
Results: In adults, the frequency of asymptomatic PSF and the risk of onset of AST due to PSF were very low so people should not be given any great cause for concern if anything abnormal is found. Also, there was no mention of any particular cautions that would be useful in daily life. However, as AST is sometimes misdiagnosed as subacute thyroiditis, which is more common in adults, people should be informed that abnormal findings might indicate PSF and AST. Although there are very few cases of AST in adults, our search revealed a few AST-related papers that had been published in Japan and other countries.
Conclusion: Giving information concerning PSF to the home doctor would be useful for the early diagnosis of AST in patients suffering from painful thyroid tumors or neck swelling.

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Objective: To assess the usefulness of the new criteria in the revised Guidelines for Evaluation of Health Check-up Results and Follow-up Guidance in Ningen Dock for evaluating pulmonary function test results through comparing evaluations for respiratory diseases with those based on the old criteria, for chronic obstructive pulmonary disease (COPD) in particular.
Methods: The percentage predicted forced expiratory volume in one second (FEV₁% predicted), percent vital capacity, and FEV₁% were calculated from accumulated data for 119,235 subjects (79,235 men [mean age, 50.4±10.7 years] and 40,000 women [mean age, 50.0±11.0 years]) who visited 7 ningen dock facilities belonging to the Japan Society of Ningen Dock according to both the new and old criteria, and the evaluations with respect to COPD were compared.
Results: According to the new criteria, the percentage of subjects in class D (consultation recommended) was 13.2% (men14.4%, women 10.7%), higher than the 0.9% (men 1.1%, women 0.5%) for the old criteria. When the data were classified according to presence or absence of smoking history and history of respiratory diseases, the highest percentages of subjects changing from Class C (active support) to class D were those with a history of respiratory diseases and a smoking habit, for both men (28.7%) and women (19.1%).
Conclusions: The introduction of the new criteria has facilitated earlier detection of COPD. This indicates that the use of the "FEV₁% predicted" criterion set forth in the new guidelines is indispensable to the evaluation of pulmonary function test results at ningen dock facilities.

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