Kazuhisa Kobayashi

Ultrasonographic evidence of association of polyps and stones with gallbladder cancer

Objective:The purpose of this study was to evaluate the level of gallbladder cancer risk associated with polyps and stones of the gallbladder by ultrasound examinations.Methods:We investigated abdominal ultrasonographic findings for gallstones and polyps of the gallbladder and the relationship of these findings to malignancy in 194,767 asymptomatic participants in health screening examinations.Results:Gallstones were detected in 7,985 participants (4.1%), at a prevalence of 5.3% in male and 4.5% in female participants. The prevalence was highest in the participants’ seventh decade, followed by the sixth and the fifth decades, in both male and female participants. Polyps were found in 10,926 (5.6%), at a prevalence of 6.9% in the male and 4.5% in the female participants. In the male participants, prevalence was highest in the fourth decade, followed by the third and the fifth decades, whereas in the female participants it was highest in the fifth decade, followed by the fourth and third. High prevalence of polyps ≥10 mm in diameter was found in the fifth to seventh decades in both sexes. Nineteen participants (0.01%) were diagnosed as having gallbladder cancer, and many of them were in the sixth or seventh decade in both sexes. Patients with stones showed a higher prevalence of gallbladder cancer. This difference was shown to be statistically significant by age-adjusted analysis (p < 0.01). The age distribution of the participants with polyps ≥10 mm in diameter was correlated with that of patients diagnosed with gallbladder cancer. Furthermore, polyp incidence was significantly related to cancer by statistical analysis (p < 0.01).Conclusion:These results suggest an association between gallstone or polyp of the gallbladder and increased risk of malignancy, implying that an etiological association may also exist.

The relationship between gallbladder disease and smoking and drinking habits in middle-aged Japanese.

Background:Background: Few studies have investigated the association between smoking and ultrasonographically diagnosed gallbladder (GB) disease, and their results were uncertain. This study was conducted to examine the association between smoking and drinking and GB diseases. Methods: A total of 9947 subjects (age, 30–69 years; 4953 men and 4994 women) voluntarily received a paid medical check-up at our center in Yamanashi Prefecture in Japan. All of the subjects underwent abdominal ultrasonographic (US) examination, a demographic check, and a biochemical test, and answered a self-administered questionnaire asking about smoking habits and alcohol consumption. Of the 9947 subjects, 483 had gallstones, 819 had gallbladder polyps, and 169 were in a state of postcholecystectomy. We compared the findings in this group with the findings in 8417 people (4144 males and 4273 females) with normal gallbladder. Results: Multiple regression analysis among males showed that cigarette smoking was inversely related to GB polyps (odds ratio, [OR], 0.76; 95% confidence internal [CI], 0.59–0.98 and OR, 0.74; 95% CI, 0.56–0.98, respectively, for current and ex-smokers). Ex-smokers a showed positive association with the postcholecystectomy state (OR, 2.56; 95% CI, 1.18–5.52). Light drinkers showed an inverse relation to GB stones (OR, 0.69; 95% CI, 0.49–0.99), and heavy drinkers showed an inverse relation to GB polyps (OR, 0.68; 95% CI, 0.51–0.90). Current drinkers showed an inverse relation to the postcholecystectomy state (OR, 0.48; 95% CI, 0.28–0.83). Conclusions: Cigarette smoking was inversely related to gallbladder polyps in males and was positively related to the postcholecystectomy state. Drinking was inversely related to gallstones, GB polyps, and the postcholecystectomy state in males.

Quality of peptic ulcer healing induced by lansoprazole and roxatidine.

This study reports preliminary results of a controlled, multicenter trial on the quality of ulcer healing induced by lansoprazole (LPZ) or roxatidine (R) in gastric ulcer (GU) or duodenal ulcer (DU) patients. Group A received LPZ 30 mg q.d. and group B received R 75 mg b.i.d. All drugs were given for 8 weeks in GU and for 6 weeks in DU. Endoscopy and gastric biopsy were performed to detect Helicobacter pylori before and on completion of treatment. The healing rates of groups A and B were 100 and 69.2%, respectively, in GU and 100 and 70.0%, respectively, in DU. This difference (p < 0.01) was significant between the two groups in GU. There was no significant difference between the two groups in the S2 stage shift rate in GU and DU. The H. pylori clearance rates of groups A and B were 33.3 and 20.0%, respectively, in GU and 62.5 and 33.3%, respectively, in DU. The differences in treatment response (healing rates and S2 shift rates) between the LPZ group and the R group may be related to the differences in suppression of acid secretion and in bactericidal effects on H. pylori.

How to Decrease the Mortality from Lung Cancer

〔目的〕 以前から胸部X線や喀疾細胞診による肺癌検診が行われてきたが, それらによる肺癌死亡減少効果は少なく, 肺癌死亡率は増加し続けている。それを減少させるにはどうしたらよいかについて検診などの二次予防面と食生活などの一次予防面について検討した。〔方法〕 1.平成10年度から12年度までの3年間の当センターのX線, 喀疾及びCT検診による肺癌発見状況を比較検討した。II.平成7年度から12年度までの6年間に当センターの肺癌検診で発見された79例の肺癌症例と対象群について生活習慣についてアンケート調査を行い, 両群問の違いについて有意差検定を行った。〔結果〕 1.人間ドックヘリカルCTによる肺癌発見率は平成10, 11, 12年度がそれぞれ0.29%, 0.24%, 0.19%であった。人間ドック直接X線のそれは0.01%, 0.02%, 0.02%で喀疾検査のそれは3年間とも0%であった。CT発見癌は腺癌が多く (95.8%), 扁平上皮癌は少なかった。性・年齢別ではCTは50歳代女性, 60歳代男性の発見率が高かった。H.生活習慣についてのアンケート調査の結果は, 肺癌群は対象群に比べ, 有意に野菜摂取が少なかったが, 他の質問項目で有意差のあるものはなかった。〔結論〕 ヘリカルCTによる肺癌発見率は従来法より格段に高く, しかも発見癌は早期のものが多く, 極めて有望な検査法と考えられる。アンケート調査の結果では, 野菜摂取に有意差が認められ, 野菜を多く食べることが肺癌予防につながることが示唆された。

[A case of single splenic abscess with intra-peritoneal rupture].

34才,女性.左上腹部痛を主訴に当科入院.腹膜炎所見の他に一般検査で強い炎症所見があり,腹部超音波検査,腹部CT等の画像診断で脾下極の〓胞様病変を認め,ダグラス窩穿刺では膿汁が吸引された.以上より単発性脾膿瘍の腹腔内破裂と診断,摘脾術等を施行した.膿瘍は石灰化を伴う厚さ約5mmの被膜を持ち,膿瘍内よりStaphylococcus epidermidisが同定されたことから,陳旧性脾損傷に感染が生じ,膿瘍を形成したと考えられた.脾膿瘍は本邦では1946年以降自験例を含め28例が報告されている.従来,本症の術前診断は困難であつたが,近年は画像診断の進歩により早期の術前診断と摘脾が可能になり,予後は著明に改善してきている.