Gastric mass survey in Miyagi prefecture

Journal of Gastroenterology -     

Post-tsunami outbreaks of influenza in evacuation centers in Miyagi Prefecture, Japan

We describe 2 post-tsunami outbreaks of influenza A in evacuation centers in Miyagi Prefecture, Japan, in 2011. Although containment of the outbreak was challenging in the evacuation settings, prompt implementation of a systemic approach with a bundle of control measures was important to control the influenza outbreaks.     

Early Gastric Cancer in Japan

In Japan the mortality rate of gastric cancer is very high, 57.3 per cent in males. Because of such a high mortality our clinicians and investigators have been making efforts to detect the early gastric cancer cases. We experienced a remarkable increase in diagnosed cases in these years, which was attributed to the spread of endoscopic and cytologic diagnosis.

The roentgenologic signs of early gastric cancer are so minute in many instances that they can only be detected by a careful and skillful roentgenologic examination team.

The double contrast method employs the proper ratio of barium to air and changes the position of the patient in order to obtain the best view of the mucous fold.

Surgical intervention in the detected early gastric cancer cases in Japan has been greatly improved, as indicated in Table VI. We have in fact achieved the excellent five-year survival rate of 98 per cent.     

Significance of a Gastric Mass Screening Survey

We analyzed the rate of occurrence of gastric cancer in a population of 39,250 by mass screening survey. In 0.123% of the total subjects gastric cancer was detected, 0.064% was at early stage and 0.059% at an advanced stage. The incidence of gastric cancer in the newly examined persons was 0.17%, 0.08% was at early stage and 0.09% at advanced stage. Of the frequently examined persons 0.07% was found to have gastric cancer, 0.043% at early stage and 0.027% at an advanced stage. The rate of occurrence of early gastric cancer was significantly higher than that of advanced gastric cancer within a 1 1/2 year interval of screening. From these results, gastric mass screening survey is considered to be effective in detecting asymptomatic gastric cancer in the "newly examined persons," and also to be beneficial in detecting "early" gastric cancer at intervals of 1 1/2 years of screening.     

Metabolic improvement of male prisoners with type 2 diabetes in Fukushima Prison, Japan

Imprisonment often improves metabolic control in prisoners with type 2 diabetes; however, the reasons for this remain unclear. Here, we investigated the metabolic control of male prisoners with type 2 diabetes in Japan. Retrospective analysis of 4385 medical charts of male prisoners in Fukushima Prison from 1998 to 2004 revealed 109 prisoners (all Asian) with type 2 diabetes (mean+/-S.D.: 51+/-10 years). All were followed up during their imprisonment (14+/-10 months). During imprisonment, mean fasting plasma glucose and hemoglobin Alc (HbA1c) levels dramatically decreased from 184+/-74 to 113+/-38mg/dl (p<0.001) and 8.4+/-2.1 to 5.9+/-1.2% (p<0.001), respectively. In addition, 5 of 18 prisoners (28%) treated with insulin and 17 of 34 (50%) treated with oral hypoglycemic agents were able to discontinue their treatment and maintain good metabolic control. Most prisoners in Japanese prisons work 8h a day 5 days a week, consuming a high dietary fiber diet including boiled rice with barley, "Mugimeshi". These findings suggest that a well-regulated lifestyle and long-term intake of high dietary fiber may have beneficial effects on metabolic control in patients with type 2 diabetes.     

Mass screening for hepatocellular carcinoma: Experience in Hokkaido, Japan

Abstract Mass screening for liver cancer based mainly on abdominal ultrasound was begun in major cities of Hokkaido, Japan, in November 1981, to enable early detection and treatment of hepatocellular carcinoma (HCC). Serum alpha-fetoprotein levels were also measured to minimize false negative studies. Examinees included those who sought liver disease screening as well as high risk individuals: hepatitis B surface antigen carriers and those with a past or current liver disease, history of blood transfusion, family history of liver cancer, and more recently those with positive anti-hepatitis C antibodies. The examination was carried out on each Saturday and Sunday as one round, and by February 1992 48 rounds had been performed. A total of 8090 individuals were investigated, and HCC was detected in 91 with a detection rate of 1.12%. This rate was 1.6% among 5684 individuals who were selected for high risk. Cumulative rates of survival among these patients were 79.0% at 1 year, 43.8% at 3 years, 19.3% at 5 years and 15.4% at 7 years. These survival rates were comparable with those for the patients with HCC diagnosed during follow-up of chronic liver disease and treated at our hospital. The cost for detecting one HCC patient in this programme was ¥ 2 660 000 (∼US$25 000), which was less than those for some other types of cancer in a similar setting. Considering the high detection rate in this programme, we feel that similar programmes should be encouraged and supported.     

Intensive Case Management Before and After Prison Release is No More Effective Than Comprehensive Pre-Release Discharge Planning in Linking HIV-Infected Prisoners to Care: A Randomized Trial

Imprisonment provides opportunities for the diagnosis and successful treatment of HIV, however, the benefits of antiretroviral therapy are frequently lost following release due to suboptimal access and utilization of health care and services. In response, some have advocated for development of intensive case-management interventions spanning incarceration and release to support treatment adherence and community re-entry for HIV-infected releasees. We conducted a randomized controlled trial of a motivational Strengths Model bridging case management intervention (BCM) beginning approximately 3 months prior to and continuing 6 months after release versus a standard of care prison-administered discharge planning program (SOC) for HIV-infected state prison inmates. The primary outcome variable was self-reported access to post-release medical care. Of the 104 inmates enrolled, 89 had at least 1 post-release study visit. Of these, 65.1% of BCM and 54.4% of SOC assigned participants attended a routine medical appointment within 4 weeks of release (P > 0.3). By week 12 post-release, 88.4% of the BCM arm and 78.3% of the SOC arm had at attended at least one medical appointment (P = 0.2), increasing in both arms at week 24–90.7% with BCM and 89.1% with SOC (P > 0.5). No participant without a routine medical visit by week 24 attended an appointment from weeks 24 to 48. The mean number of clinic visits during the 48 weeks post release was 5.23 (SD = 3.14) for BCM and 4.07 (SD = 3.20) for SOC (P > 0.5). There were no significant differences between arms in social service utilization and re-incarceration rates were also similar. We found that a case management intervention bridging incarceration and release was no more effective than a less intensive pre-release discharge planning program in supporting health and social service utilization for HIV-infected individuals released from prison.     

Comparison of the efficacy of reperfusion therapies for early mortality from acute myocardial infarction in Japan: registry of Miyagi Study Group for AMI (MsAMI).

The current reperfusion strategy in Japan for acute myocardial infarction (AMI) is that the majority of early arrival patients are treated with primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI, intravenous thrombolysis (IV-T), intracoronary thrombolysis (IC-T) and rescue PCI has not been compared in the clinical situation. In the present study, 3,258 cases of AMI in 1992-2000 from the data base of the Miyagi Study Group for AMI were analyzed. These patients were hospitalized within 6 h of the onset of symptoms. IV-T and IC-T were initially performed in 120 and 441 patients, respectively, and 41 and 199 rescue PCI procedures, respectively, were needed. Primary PCI was performed in 1,822 cases, and no reperfusion therapy was done in 875 patients. The crude 30-day in-hospital mortality was 12.7% for IV-T, 3.7% for IC-T, 4.8% for primary PCI, 7.9% for rescue PCI, and 14.1% in patients who did not undergo reperfusion therapy. The covariate-adjusted odds ratio (95% confidence interval) was 0.38 (0.28-0.52) for primary PCI, 0.30 (0.15-0.60) for IC-T, 1.04 (0.51-2.10) for IV-T and 0.77 (0.46-1.30) for rescue PCI. The present data verify that primary PCI is superior to other reperfusion strategies in the real clinical situation and justifies the current unique strategy of reperfusion therapy for AMI used in Japan.     

Tuberculosis in Japan at present and in near future

The high incidence of tuberculosis in the elderly people and no decrease in the incidence rate of the young people are two main features of current tuberculosis problem in Japan. To examine the near future prediction of the incidence rate and the rate of clinical breakdown by age group, the incidence rates of the newly registered tuberculosis cases of the cohorts born before 1918, in 1919-28, 1929-38, 1939-48, 1949-58 and 1959-68 were studied every ten years. The curves of incidence rate in each cohort were extrapolated to the future to obtain the incidence rates in 2008 and 2018. The numbers of predicted new cases in 2008 and 2018 were estimated to be some 31,000 and 23,000, respectively. The percentage of the cases above 60 y.o. was estimated to be 59%, 59% respectively. As the number of new cases in 1998 was 41,000, 55% of which was above 60 y.o., it will steadily decrease from now on, but the elderly people more than 60 y.o. will continue to occupy high percentage of the new cases. The incidence rate of the new cases will also decrease from 32.4 (per 100,000 populations) in 1998 to 24.5 in 2008 and 19.4 in 2018, and Japan in 2018 will still be a middle prevalence country in the world as now. The rate of clinical breakdown is obtained from dividing the incidence rate by the prevalence of tuberculosis infection. The latter is theoretically calculated from the annual risk of tuberculosis infection assuming that it doesn't depend on age. In Japan the annual risk of infection was supposed to be constant and about 4% till 1947. Since then it declined by some 10% annually till around 1977. Thereafter the annual speed of its decline was estimated to have slowed down. But we cannot know the true annual risk of tuberculosis infection, as BCG vaccination hinders the interpretation of the result of tuberculin skin testing in Japan. We postulated it declined 5% annually (Model A) or it was constant to be 0.17% since 1977 (Model B). Using these models of annual risk of tuberculosis infection, the prevalence of tuberculosis infection by age group was calculated in every calendar year. The incidence rate of each age group was assumed to be equal to that of median age in each age group. For example, the incidence rate of the cohort born in 1919-28 was assumed to be equal to that of the cohort born in 1923. In this way, the annual rates of clinical breakdown of the cohorts born in 1923, 1933, 1943, 1953, 1963 and 1973 were calculated. The rates of clinical breakdown for the cohorts born in 1923, 1933 and 1943 were similar with each other and were approximately 100 per 100,000 in both models. The rate of clinical breakdown at 25 years old for the cohort born in 1953 was 0.64 times smaller than that for the cohort born in 1943. It might due to the improvement of nutritional state and the effectiveness for adult tuberculosis of compulsory BCG vaccination which has been done after World War II in Japan. But for the cohort born after World War II, the later the cohort was born, the larger its rate of clinical breakdown was in both models. And, for example, the rate of clinical breakdown at age 25 years old for the cohort born in 1973 was 2.4 times (in Model A) or 1.7 times (in Model B) larger than that for the cohorts born in 1953. This may imply that there has been some factor(s) which facilitates tuberculous disease after tuberculous infection in young people in modern Japan. One explanation for this is the possibility that immune ability to tuberculosis might be weakened in young generations by some factor(s) such as environmental pollution.     

Gastric Carcinoid Tumors Without Autoimmune Gastritis in Japan: A Relationship with Helicobacter pylori Infection

In Japan, most cases of gastric carcinoid tumor (GCT) are unassociated with either autoimmune gastritis (AIG) showing type-A chronic atrophic gastritis (CAG-A) or Zollinger-Ellison syndrome (ZES). However, the pathogenesis of this tumor remains unknown. Recent studies have determined that Helicobacter pylori infection induces gastric carcinoid in Mongolian gerbils and that H. pylori lipopolysaccharide exerts a mitogenic effect on ECL cells. We examined five patients with histologically diagnosed GCT, 40 patients with H. pylori-positive gastric ulcer (Hp+GU), 24 patients with H. pylori-positive duodenal ulcer (Hp+DU), and 12 patients with AIG showing CAG-A topographically. We compared the prevalence of H. pylori infection, and the levels of gastrin and pepsinogen (PG) in the serum of patients with GCT with those of patients with Hp+GU, or Hp+DU, and AIG. We also investigated the histological characteristics of the tumor and the gastric corpus mucosa in the GCT patients. The levels of serum gastrin and PG I and II were measured using an RIA kit. In all five (100%) patients with GCT, H. pylori infection was present, without any evidence of AIG or ZES. The serum levels of gastrin in the GCT patients were higher than those in either Hp+GU or Hp+DU patients and lower than those in the AIG patients. In contrast, serum PG I levels and the PG I/II ratio were lower in the GCT group than in the Hp+GU or Hp+DU groups. Histologically, all GCTs were ECL cell tumors and peritumoral corporal mucosal atrophy was observed in four of the five patients with GCT. In conclusions, H. pylori infection and hypergastrinemia were found in the patients with GCT without AIG. This finding suggests that H. pylori infection may induce corporal mucosal atrophy and hypergastrinemia that can produce a GCT with time.