Objective: We studied the usefulness of contrast-enhanced ultrasonography in assessment of protruding lesions of the gallbladder detected in ultrasonographic mass screening.

Patients and Methods: Twenty-eight patients were suspected to have gallbladder carcinoma based on screening examinations using non-contrast abdominal ultrasonography that detected protruding gallbladder lesions (pedunculated and at least 10 mm in diameter, 25; sessile, 3). We performed contrast-enhanced ultrasonography as a further examination in such patients, and diagnosed malignancy when the findings included high echogenicity, irregularly distributed flow of contrast medium, and a dendriform pattern, while low echogenicity and presence of microcystic structures suggested a benign lesion. We made the final diagnosis based on histopathologic examination of resected specimens or ultrasonographic findings after follow-up for at least 12 months. We determined the diagnostic performance of contrast ultrasonography and extent of surgical resection avoidance achieved with this method.

Results: Sensitivity of contrast ultrasonography in identifying neoplasms was 100% (4/4), specificity was 70.8% (17/24), and overall accuracy was 75.0% (21/28). Surgical intervention was avoided in 64.3% of patients (18/28).

Conclusion: Contrast ultrasonography represents a useful, minimally invasive method for evaluating protruding gallbladder lesions suspected to be cancer in abdominal ultrasonography.

Objective: We documented outcomes after introducing elective total colonoscopy at our health care center, and investigated the utility of colonoscopy as a method of cancer screening.

Methods: Subjects were 55 patients who underwent elective colonoscopy at our center. Occult blood was detected using a fecal occult blood (FOB) immunoassay (2-day method). The carcinoembryonic antigen (CEA) level and lifestyle habits were used as health check-up data. We investigated a relationship between these results and the colonoscopy findings.

Results: Polyps were observed in 21 subjects. We found that out of the 55 subjects, 5 (9.1%) tested positive for FOB and 2 of them (40.0%) had polyps requiring follow-up observation and treatment. Among 44 subjects testing negative for FOB, 6 (13.6%) had polyps needing treatment and 4 of them were diagnosed with adenomas. Eight subjects negative for FOB had polyps that needed follow-up observation. Polyps requiring treatment and follow-up observation were detected in 14 (31.8%) of the 44 subjects negative for FOB. There was no relationship between the CEA levels and colonoscopy findings. In terms of lifestyle habits, subjects with significant lesions observed in colonoscopy usually had a smoking habit, frequent consumption of alcohol, and a tendency to exercise less.

Conclusion: The proportion of subjects with polyps requiring treatment who tested negative for FOB was high. Going forward, we believe that elective colonoscopy will be useful for the early detection of lesions and will be followed by decreasing colorectal cancer morbidity and mortality rates.

Background: Subclinical atherosclerosis is a latent precursor of clinical cardiovascular disease (CVD). Several studies have examined the comorbidity of polyvascular disease (PVD) in patients with CVD, but the comorbidity of PVD in asymptomatic subjects has not been fully investigated.

Methods: Vascular screening was performed using MRA for the coronary and renal arteries and ultrasonography for the carotid artery. The calcium score for the coronary artery was analyzed by CT, and the ankle brachial index (ABI) was used for screening of peripheral artery stenosis. The prevalences of carotid, coronary, renal artery and peripheral artery diseases were analyzed in 655 subjects during a health check-up at our institution.

Results: Of the 665 subjects, 434 (65.3%) were males, the mean age was 60 years old, 55.2% had a history of hypertension, 61.7% had dyslipidemia, 13.2% had diabetes mellitus, and 41.2% were current or former smokers. A total of 63 lesions were detected in 58 subjects (8.7%), with 5 subjects (0.75%) having PVD: coronary and carotid lesions in 3 subjects, coronary and renal artery lesions in one, and carotid and renal artery lesions in one.

Conclusion: This is the first study on the prevalence of multiple atherosclerotic lesions in an asymptomatic Japanese population free from clinically apparent CVD. The present study revealed that 8.7% of asymptomatic subjects examined in a health check-up at our institution had multiple atherosclerotic lesions.

Objective: Nonalcoholic fatty liver disease (NAFLD) is a condition in which fat accumulates in the liver, and it is considered the hepatic manifestation of metabolic syndrome (MetS). The diagnostic criteria for MetS in Japan require abdominal obesity (AO). Both NAFLD and AO are significant predictors of cardiovascular disease. The purpose of our study was to determine whether NAFLD or AO is more closely associated with arteriosclerosis based on the results of an analysis of carotid intima media thickness (IMT).

Methods: Between June 2011 and December 2013, 3,648 individuals undergoing a health check-up who had no history of liver disease underwent abdominal ultrasonography (US), and 752 subjects underwent carotid US. After excluding subjects with an alcohol consumption >20 g/day or a history of hypertension, diabetes, dyslipidemia and/or hyperuricemia, 368 subjects (202 males and 166 females, aged 29 to 87 years) remained. Using simple and multivariate analyses, the parameters associated with NAFLD, AO, and an increased maximum IMT were examined. Furthermore, we analyzed differences between subjects with NAFLD but not AO and those with AO but not NAFLD.

Results: Although an increased maximum IMT was independently associated with NAFLD, there was no association between an increased maximum IMT and AO. The group with NAFLD but not AO had a significantly higher proportion of subjects with an increased maximum IMT than the group with AO but not NAFLD, after adjusting for gender and age.

Conclusion: Our analysis suggests that NAFLD is more strongly related to the progression of arteriosclerosis than is AO.

Objective: Cerebral arteriosclerosis is a major public health problem because it is one of the main causes of ischemic stroke. A paucity of material is available on factors associated with cerebral arteriosclerosis detected by magnetic resonance angiography (MRA) in a healthy population. The aim of this study was to determine what factors were associated with cerebral arteriosclerosis detected by MRA in persons undergoing a brain check-up.

Methods: We retrospectively investigated 5,897 people aged 40 and over who visited a hospital for a brain check-up. We obtained data on body mass index (BMI), blood pressure (BP), total cholesterol, triglycerides, and fasting glucose (FG). We performed logistic regression analysis to examine associations between vascular risk factors and cerebral arteriosclerosis.

Results: Cerebral arteriosclerosis was observed in 326 subjects (5.5%). After adjustment for other risk factors, BMI (odds ratio [OR], 1.066; 95% confidence interval [CI], 1.024–1.110), systolic BP (OR, 1.019; 95%CI, 1.014–1.025), and FG (OR, 1.005; 95%CI, 1.003–1.008) were significantly associated with arteriosclerosis. Obesity (BMI ≥ 25 kg/m²; OR, 1.622; 95%CI, 1.258–2.090), hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg; OR, 1.911; 95%CI, 1.503–2.429), and impaired FG (FG ≥ 110 mg/dL; OR, 1.411; 95%CI, 1.111–1.791) were independent predictors. Factors related to dyslipidemia were not associated with arteriosclerosis.

Conclusions: Obesity, hypertension, and impaired FG were independently associated with a higher risk of arteriosclerosis detected by MRA in study participants undergoing brain check-ups, while dyslipidemia, which is a common risk factor of arteriosclerosis, was not.

Background: Patients with thyroid dysfunction (PTDs) are likely to go undiagnosed. Therefore, we developed a new, low-cost screening method using a set of six routine tests to identify PTDs. This new method can predict the probability of thyroid dysfunction at the time of the screening. We found a lot of new PTDs through our screening method in general health check-ups and determined that an 85% threshold for the predicted probability was sufficient, instead of the 60% probability used in the screening. However, there were about three times the number of false positives compared to the number of true positives, mainly due to the effects of individual differences and background diseases.

Objective: The aim of the present study was to develop a method considering time-series variations in routine tests in addition to the predicted probability, which had only been used previously, to improve predictive accuracy.

Methods: The present study included 155 subjects (15 true positives and 140 false positives) who were suspected of having thyrotoxicosis in our screening, whose thyroid hormones were measured, and they also had previous visit records. We calculated the average rate of annual time-series variations (RATV) in each routine test between previous and current visits for each subject, and then plotted RATV and predicted probabilities together in a scattergram.

Results: By adjusting both thresholds on the scattergram, the following optimized thresholds were obtained: 98% for predicted probability or 20% for RATV. This combination significantly decreased the number of false positives from 140 to eight without yielding any false negatives for Graves’ disease.

Conclusions: The introduction of RATV markedly reduces the influence of individual differences and background diseases in routine tests.

Background: The reference range for leukocyte count is wide, and examination of factors affecting leukocyte count is important.

Methods: We conducted a cross-sectional study of apparently healthy Ningen Dock examinees who underwent a health check-up in 2012. Information regarding current medication and lifestyle habits was obtained via a self-reported questionnaire.

Results: Overall, 5,853 men and 4,447 women were included in the study. Multiple regression analyses revealed that leukocyte count in men was most strongly associated with the level of smoking, followed by body mass index (BMI), level of alcohol consumption, and frequency of exercise. Leukocyte count in women was most strongly associated with BMI, followed by level of smoking, age and level of alcohol consumption. When comparing groups stratified by age after adjusting for confounding factors, the mean leukocyte count in women was highest in the youngest group (age < 40 years; 5,295/μL) , gradually decreased as age advanced, and was lowest in those aged 50–59 years (4,638/μL). In contrast, the mean leukocyte count of men was constant (5,448–5,565/μL) across age groups. When comparing men and women in each age group, leukocyte count in women was lower in those aged =/> 50 years.

Conclusions: Leukocyte count was strongly associated with level of smoking and BMI in both men and women, but an association with age was observed only in women. We believe it is important to interpret leukocyte counts in Ningen Dock examinees, taking factors associated with leukocyte count into consideration.