[in Japanese]

View full abstract

Objective: We examined a screening procedure for glaucoma in health check-ups where Frequency Doubling Technology Perimetry (FDT) was conducted together with fundus examination (exam) and tonometry.
Methods: In the period from June 2011 to December 2014, 6,930 of 49,442 persons undergoing ophthalmologic exams (FDT, fundus exam, tonometry) in health check-ups at Omiya City Clinic were observed to have abnormalities. These were our subjects and we retrospectively compared the final diagnoses made in subsequent more precise ophthalmologic exams.
Results: We found that the final diagnosis was glaucoma in 1,159 subjects and in 485 of them the glaucoma was newly diagnosed. The numbers of persons with abnormalities in each exam were 426 for FDT, 428 for fundus exam and 5 for tonometry. The numbers of examinees with abnormalities in FDT only, fundus exam only and tonometry only were 57, 52 and 1, respectively. The feature of persons with abnormalities in FDT only was that signs of glaucoma tended to be difficult to detect from fundus photographs due to a myopic fundus. That of persons with abnormalities in fundus exam only was a tendency toward narrowing of the retinal nerve fiber defect region in fundus photographs. The positive predictive value for each exam was 30.6% for FDT, 58.2% for fundus exam and 42.4% for tonometry, and for people who were finally diagnosed with glaucoma, abnormality detection rates for FDT, fundus exam and tonometry were 89.5%, 88.4% and 1.0%, respectively.
Conclusions: FDT was considered to be useful in glaucoma screening in health check-ups. On the other hand, as there were many examinees who were normal in FDT but had an abnormality in fundus exam only or were normal for fundus exam but had an abnormality in FDT only, in the present situation, the 2 exams should be conducted together.

View full abstract

Objective: For persons needing more detailed examinations based on the results of cancer screening at our center, follow-up management consists of mailing the results sheet to the person together with a referral letter for the detailed examination. To people who have not undergone the detailed examination, we send an encouragement to undergo it by mail, at 2 and 5 months after screening. However, currently, the rate of undergoing detailed examinations with respect to stomach X-ray screening results is lower than for other cancer screening, despite the periodic sending of encouragements. In view of this, for persons requiring more detailed examinations based on stomach X ray screening results, we prepared a pamphlet with messages tailored to individual screening results with the aim of raising the detailed examination rate. In this study, we examined its effectiveness.
Methods: We divided 300 persons requiring detailed examinations into 3 groups - A, B and C. A Group received a doctor’s explanation of the screening results, B Group was sent the pamphlet encouraging the person to have the detailed examination and a referral letter but no doctor’s explanation and C Group was sent a referral letter but no pamphlet or doctor’s explanation. We compared rates of undergoing detailed examinations and the time taken to have the detailed examination among the groups.
Results: Rates for undergoing detailed examinations were: A group 68%, B group 65% and C group 55%. Thus, the pamphlet was similar in effectiveness to a doctor’s explanation as a means of encouraging people to have detailed examinations. In the A group, B group and C group, at least 70% of people underwent detailed examinations within 2 months.
Conclusions: The pamphlet was considered to be an effective tool for raising the rate of undergoing detailed examinations. Also as recommendation of early examination was thought to be a factor in raising the detailed examination rate, the use of a pamphlet encouraging early examination and a thorough doctor’s explanation of the results should further increase the detailed examination rate.

View full abstract

Objective: We evaluated the utility of immunochemical fecal occult blood (IFOB) levels in screening for colorectal cancer in health check-ups.
Subjects: From January 2007 to September 2014, a cumulative total of 36,284 persons underwent the IFOB test, and 2,719 persons (7.5%) were determined to be positive. (We measured IFOB levels, and set a level of 80 ng/ml or greater as positive.) Among the IFOB-positive persons, the findings from 617 who agreed to undergo total colonoscopy at Nissay hospital were analyzed regarding a relationship between IFOB levels and colorectal cancer incidence.
Results: Thirty-one persons (19 men and 12 women)(5% of all examined by colonoscopy) were diagnosed as histologically confirmed colorectal cancer. IFOB levels of persons with colorectal cancer were found to be significantly higher than those without colorectal cancer (504±332 vs 326±285, p=0.001). Among persons with an IFOB level of 900 ng/ml or over, colorectal cancer was found in 12.5%. The incidence of colorectal cancer in patients with such high IFOB levels was significantly higher than that for all persons.
Conclusions: The IFOB level was higher in persons with colorectal cancer than those without colorectal cancer. However, we considered that not only positivity but also the actual IFOB level should be taken into consideration when determining if colorectal cancer is present or not.

View full abstract

Objective: In order to verify the effect of specific health guidance in heavy drinkers, we examined drinking behavior and examination data in the period from the initial support in specific health guidance to 6 months afterwards.
Methods: Our subjects were 555 males from among people in the same health insurance association who had completed active support and were receiving specific health guidance for the first time. Alcohol consumption was determined at the time of the first support under specific health guidance (hereafter 1^st support). The subjects were divided into 3 groups according to alcohol consumption: heavy drinker group (≥40 g ethanol every day), moderate drinker group (<40 g ethanol every day), non-drinker group (occasional alcohol consumption) and specific health examination data compared among the groups. Intragroup examination data from before and after specific health guidance were also compared. We further divided the heavy drinker group into 2 subgroups according to whether there was a reduction in alcohol consumption of ≥20 g ethanol/day or not after 6 months and into 2 subgroups according to whether a drinking reduction plan had been made at the time of the first support or not, and compared the subgroups regarding changes in examination data up to 6 months. The specific health guidance procedure was the same for all 3 groups and at the first time it was conducted as group support.
Results: There were significant differences among the 3 groups for body weight, lipids, liver function and blood sugar at the time of the specific health examination. There were significant reductions in alcohol consumption and improvements in examination data for all 3 groups between before and after specific health guidance, Regarding the heavy drinker subgroups, there was a decrease in weight of 1.81±2.49 kg in the alcohol reduction subgroup (≥20 g reduction/day) as opposed to a 0.33±2.46㎏ reduction in the no appreciable alcohol reduction group, a significant difference. Changes in BMI, abdominal circumference, AST and γ-GTP were significantly greater in the alcohol reduction group. There were no significant differences between the subgroup with an alcohol reduction plan and the one without.
Conclusion: A definite effect of specific health guidance regarding alcohol reduction and improvement in examination data was observed, even in heavy drinkers. Improvements were particularly marked in the subgroup with an alcohol reduction of 20 g or more per day.

View full abstract

Objective: Since Ueyama, Yao et al proposed fundic gland type gastric adenocarcinoma as a new tissue subtype of gastric cancer showing differentiation toward fundic glands in 2010, many cases have been reported. We examined the clinical and pathologic features of cases of fundic gland type gastric adenocarcinoma cancer discovered in health check-ups at our center.
Subjects: The subjects were 5 persons diagnosed with fundic gland type gastric adenocarcinoma by means of upper endoscopy in health check-ups at our center from January 2012 to December 2014.
Methods: The items studied included presence/absence of Helicobacter pylori (H. pylori) infection, endoscopic findings and histopathological findings.
Results: All the subjects were male and their ages ranged from 46 to 61 years (mean age 55.6 years). All were negative for H. pylori infection but one had undergone eradication therapy. The site of origin was the U region in 4 subjects and the M region in 1 subject. The naked eye evaluation was 0-IIa in 4 subjects and 0-IIa+IIc in 1 subject. Tumor diameter did not exceed 10 mm in any subject. Treatment was by endoscopic submucosal dissection (ESD) in all 5 subjects. The evaluation of histopathological findings for all of them was fundic gland type, low-grade atypia carcinoma with infiltration into submucosa. All subjects were negative for vascular invasion and resection stumps. In immunohistochemistry, all subjects were positive for pepsinogen-I, positive for H⁺/K⁺-ATPase and positive for MUC-6 but negative for MUC-5AC and MUC-2.
Conclusion: In the future, with a decrease in H. pylori infection rates, there is a possibility of an increase in fundic gland type gastric adenocarcinoma. Therefore, even if gastric mucosa show no atrophy, keeping the features of this disease in mind, careful examination will be important.

View full abstract