Background and Methods: To evaluate differences in the frequency of airflow obstruction between the presence and absence of emphysematous changes (CT emphysema) detected in low-dose CT screening, we performed a retrospective cohort study in males who annually underwent a health check-up (Ningen Dock) for employees over a long period. Among males with a smoking history (≥ 20 pack-years) who underwent low-dose CT screening in a health check-up between April 1998 and March 2006, those who also underwent check-ups between April 2009 and March 2012 were included as the subjects. The subjects consisted of 2,164 males (285 in the CT emphysema group and 1,879 in the non-emphysema group). Their mean age was 51.4 years, and the mean amount of smoking was 33.4 pack-years. Pulmonary function tests were performed 11.5 times during a mean period of 12.1 years.

Results: The cumulative frequency of moderate or severe airflow obstruction, which was defined as both forced expiratory volume % in one second (FEV₁%) < 70% and percent forced expiratory volume in one second (%FEV₁) < 80%, in the CT emphysema group was 37.2%, markedly higher than that (14.8%) in the non-emphysema group. Multivariate analysis revealed that the odds ratio of moderate or severe airflow obstruction due to CT emphysema was 3.21 (2.24–4.58), and that due to smoking continuation was 8.16 (3.54–18.81).

Conclusion: CT emphysema may be a radiological sign of future airflow obstruction risk.

Objective: Several studies have indicated that there is a link between atherosclerosis and bone metabolism. We investigated a cross-sectional relationship between bone mineral density (BMD) and metabolic biomarkers among postmenopausal women who underwent a comprehensive health check-up.

Methods: Three hundred and eighty-six postmenopausal women, mean age 63.3 ± 8.3 years, were enrolled in this study. BMD at the lumbar spine and unilateral proximal total hip was measured by dual-energy X-ray absorptiometry, and the percentage of young adult mean (%YAM) was calculated. The lower %YAM of the two sites was used for analysis. We performed logistic regression analyses to evaluate factors related to the risk of low BMD, defined as %YAM < 80. Plausible variables, i.e. age, body mass index (BMI), blood pressure, fasting plasma glucose, triglycerides (TG), low-density lipoprotein cholesterol, alkaline phosphatase, C-reactive protein, smoking habit, drinking habit, and exercise habit were included in the model.

Results: One hundred and twenty-six participants were considered to have low BMD. Univariate logistic analyses adjusted for age and BMI revealed that TG was related to the risk of low BMD (odds ratio and 95% confidence interval; log TG by 1SD increase: 1.335 (1.038–1.707), p< 0.05). In the multivariate models adjusted for all other confounders, this significant relationship remained (odds ratio and 95% confidence interval; log TG by 1SD increase: 1.385 (1.056–1.818), p< 0.05).

Conclusions: These results suggest that, in addition to age and BMI, TG is a risk factor contributing to low BMD.

Background: Albumin is reported to be a potent inhibitor of angiotensin converting enzyme (ACE) and its inhibiting potency is tissue-dependent, while a decrease in serum albumin is reported to be a predictor of incident hypertension.

Methods: This was a retrospective 5-year follow-up study in a health screening population including 2,045 subjects. The mean (SD) serum potassium and incidence of hypertension in the first (lowest), second, third and fourth (highest) quartiles of serum albumin (Q1, Q2, Q3 and Q4) were calculated. The hazard ratios (HRs) of hypertension for each 1 SD increase in serum albumin and for Q1, Q2 and Q3 compared with Q4 were calculated and adjusted for baseline blood pressure and other confounders.

Results: During 5 years of follow-up (mean: 3.8 years), 400 subjects developed hypertension (3.9%/year). The incidence of hypertension was 4.7%/year, 3.8%/year, 3.8%/year and 3.4%/year, respectively (p for trend<0.001), in Q1, Q2, Q3 and Q4. The mean (SD) serum potassium levels for Q1, Q2, Q3 and Q4 were 4.26 (0.28) mEq/L, 4.33 (0.32) mEq/L (p=0.004), 4.34 (0.32) mEq/L (p=0.003) and 4.39 (0.36) mEq/L (p<0.001), respectively (p: compared with Q1). The adjusted HRs of hypertension for each 1 SD increase in serum albumin and for Q1, Q2 and Q3 compared with Q4 were 0.79 (p<0.001), 1.73 (p=0.003), 1.45 (p=0.017) and 1.18 (p=0.350), respectively.

Conclusions: Serum albumin is positively correlated with serum potassium and inversely associated with incident hypertension.

Background: The management of asymptomatic pneumonia-like opacity detected by CT has not been clarified.

Methods: We reviewed 12 cases of asymptomatic pneumonia-like opacity from 2,762 chest CTs performed at our check-up center between 2012 and 2014. Cases under treatment for respiratory disorders and those suspicious of specific infections were excluded.

Results: In all 12 cases, CT findings of pneumonia-like opacity disappeared without chemotherapy.

Conclusion: Patients with asymptomatic pneumonia-like opacity can be managed by observation if chronic respiratory disorders and specific infections have been ruled out.

  A 76-year-old woman was hospitalized with an asymptomatic liver tumor detected by ultrasonography during a health check-up. A physical examination produced no pertinent findings. Blood test results were negative for hepatitis virus markers and tumor markers. Ultrasonography showed a hypoechoic tumor in segment 6 of the liver with a distinct margin and smooth contour, measuring 10×10 mm in diameter. Computed tomography demonstrated contrast enhancement in the periphery of the tumor. From pathologic examination of a needle biopsy specimen a necrotic hepatocellular carcinoma could not be ruled out, so resection was performed. The final diagnosis was solitary necrotic liver nodule, a rare mimic of hepatocellular carcinoma. Although this is a rare disease, it is necessary to consider it as one of the differential diagnoses if an atypical neoplastic lesion differing from typical hepatocellular carcinoma is detected intrahepatically on imaging.

  Simultaneous occurrence of malignant lymphoma and malignant gastric cancer in a single patient is rare. Such cases may be positive or negative for H. pylori infection. A 60-year-old-man was examined at our clinic for evaluation of abnormal shadows in upper gastrointestinal radiography. Endoscopy of the upper gastrointestinal tract revealed early cancer in the fornix and mucosa-associated lymphoid-tissue (MALT) in the antrum of the stomach. At Toranomon Hospital, endoscopic submucosal dissection (ESD) was performed under a diagnosis of early gastric carcinoma. Histological findings for the upper gastric lesion were compatible with early moderately differentiated tubular adenocarcinoma of type 0-IIc, while those for the lesion in the antrum corresponded to MALT lymphoma. H. pylori was detected. The patient declined surgery and is currently under close observation. H. pylori infection may have had a major role in the development of adenocarcinoma of the stomach and MALT in this case.