Employees' satisfaction and the influential process factors during regular health check-up by a contracted industrial health association]

This study aimed at identifying factors influencing satisfaction among employees who undergo health check-ups. Seven hundred and twenty two workers at a single working-site (669 male and 53 female) were recruited for a cross-sectional survey with a self-administered questionnaire that we newly developed through a pilot interview study. Multiple logistic regression analysis showed that overall satisfaction was significantly associated with the employee's age (p = 0.06), job type (p = 0.10), and waiting time during the examination (p < 0.01), the burden involved in filling out a check list before the examination (p = 0.06), and the courtesy of the health examination staff (p = 0.07). Our results may imply a role of satisfaction for quality assurance during work-site health check-ups.     

Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography

Objective

The purpose of this study was to compare the diagnostic accuracy of time-resolved MR angiography (TR-MRA) with that of conventional venography for the detection and grading of ovarian venous reflux, which aid in the diagnosis of pelvic venous congestion.

Methods

We performed a retrospective analysis of 19 consecutive patients who underwent TR-MRA and conventional venography. The images were analysed by two radiologists in a randomised “blinded” manner. With the use of conventional venography as a gold standard, the images were reviewed to determine if differences in the detection and grading of ovarian venous reflux were seen between TR-MRA and conventional venography; the sensitivity, specificity and accuracy of TR-MRA compared with that of conventional venography were evaluated. The McNemar test was performed to determine the significance of any differences. Interobserver agreement was analysed using generalised κ statistics.

Results

There was no significant difference between TR-MRA and conventional venography for grading ovarian venous reflux (p>0.05). The sensitivity, specificity and diagnostic accuracy of TR-MRA were found to be 66.7%, 100% and 78.9%, and 75%, 100% and 84.2%, respectively, for the two observers. The weighted κ-values indicated excellent agreement between the two observers for grading ovarian venous reflux on TR-MRA (κ=0.894).

Conclusion

TR-MRA is an accurate method for accessing pelvic venous congestion.Chronic pelvic pain is a common health problem among females, and this is characterised by non-cyclic pelvic pain lasting more than 6 months [1]. It has been reported that as many as 39.1% of females have had chronic pelvic pain at some time during their lives [2]. Pelvic congestion syndrome is defined as chronic pelvic pain caused by incompetent ovarian veins, with associated venous reflux and venous engorgement [3,4].Conventional angiography is currently considered the gold standard for the detection of pelvic congestion syndrome [5]. However, this procedure is time-consuming and invasive, and it necessitates the use of ionising radiation. Several non-invasive techniques are used for the work-up of pelvic venous congestion, including sonography, CT and MRI [6-10]. Time-resolved MR angiography (TR-MRA) has been proven to be a quick and non-invasive technique that allows evaluation of the physiological blood flow [11-14].There has been a study regarding the usefulness of TR-MRA for assessing ovarian venous reflux, but to the best of our knowledge [11] the correlation with conventional venography has not been used to access the result of TR-MRA for detecting ovarian venous reflux. The purpose of this study was to compare the diagnostic accuracy of TR-MRA with that of conventional venography for the detection and grading of ovarian venous reflux, which will help make the diagnosis of pelvic venous congestion.     

What is a reasonable surgical procedure for spinal extradural arachnoid cysts: is cyst removal mandatory? Eight consecutive cases and a review of the literature

Background  

Spinal epidural arachnoid cysts (EAC) are rare and may present with myelopathy, which can be completely curable with surgery. The majority of investigators believe that the repairment of dural defect is important to treat EAC. However, the necessity of excising EACs remains controversial. The purpose of this study was to find a reasonable surgical technique for treatment of EACs after considering the clinical outcome, recurrence, and complications.     

What is the ideal stent as initial intervention for malignant gastric outlet obstruction?

BackgroundSelf-expandable metal stents are effective palliation for malignant gastric outlet obstruction. The aims of study were to evaluate efficacy and safety of double-layered Comvi, uncovered and covered stent to find out protocols which enhance stent patency.MethodsWe retrospectively analysed data from 224 patients who underwent endoscopic stent placement for malignant gastric outlet obstruction caused by stomach cancer from 2006 to 2011. Technical and clinical success rates were evaluated and clinical outcomes were compared according to stent types and chemotherapy.ResultsThe overall technical and clinical success rates were achieved in 99.6% and 80.4%, respectively without immediate complications. The clinical success rate was not significantly different between three groups. The median stent patency time was 156 days [interquartile range 66–279] without differences between groups. The 4-, 8-, and 12-week patency rates were 89.4%, 77.3%, and 61.2%, respectively with no differences between groups. The re-stenosis of stent frequently occurred in the case of the uncovered stents, while migration was more likely to be observed for the covered and Comvi stent. Chemotherapy significantly lowered re-intervention rates, especially in uncovered stents.ConclusionsPatency rates are significantly improved by combining the use of uncovered stent with follow-up chemotherapy treatment, which retains the advantages of the mechanical and chemical aspects of stent and chemotherapy, respectively.     

A new stilbene glucoside from the roots ofPolygonum multiflorum Thunb.

One new stilbene glucoside (6), along with five known compounds (1-5), were isolated from the roots of Polygonum multiflorum Thumb., and their chemical structures established based on physicochemical and spectroscopic data. Of the compounds, compound 3 showed DNA topoisomerase I and II inhibitory activities.     

Cytotoxicity and DNA topoisomerase inhibitory activity of constituents isolated from the fruits ofEvodia officinalis

Four alkaloids (1-4), three quinolone alkaloids (5-7), and three flavanoid glucosides (8-10) were isolated from the fruits of Evodia officinalis Dode, and their structures were determined from chemical and spectral data. Compounds, 3, 8, 9 and 10 were isolated from this plant for the first time. Of these compounds, 1-3 and 5-7 exhibited moderate cytotoxicities against cultured human colon carcinoma (HT-29), human breast carcinoma (MCF-7), and human hepatoblastoma (HepG-2). Compound 8 showed strong inhibitory effects on DNA topoisomerases I and II (70 and 96% inhibition at a concentration of 20 microM, respectively).     

Preferences for medical collaboration: patient-physician congruence and patient outcomes

Patient participation in medical care and in decision-making is generally viewed as a precursor to positive health outcomes. Patient participation is not always possible or desirable, however, and not all patients want to take an active part in their own medical care. This study examines the degree to which physician-patient congruence in preference for patient involvement is related to self-reported satisfaction, adherence, and health. Results indicate that when patients and their doctors share similar beliefs about patient participation, patient outcomes tend to be more positive, with highest satisfaction found in cases in which both patient and physician desire more patient involvement.     

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (n = 40) and the non-operative group (n = 66) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurologic status and postoperative outcomes of patients, as indicated by their modified Japanese Orthopedic Association (mJOA) scores and recovery rate (RR), Modic changes, the axial (fused or non-fused) and sagittal (omega or beak) configurations of OLF, and the ratios of the cross-sectional area (CSA) and anteroposterior diameter (APD) of the most compressed level were studied. The most commonly affected segment was the T10–11 vertebral body level (n = 49, 27.1%) and the least affected segment was the T7–8 level (n = 1, 0.6%). The ratios of the CSA in non-fused and fused types were 77.3 and 59.3% (p < 0.001). When Modic changes were present with OLF, initial mJOA score was found to be significantly lower than those without Modic change (7.62 vs. 9.09, p = 0.033). Neurological status improved after decompressive laminectomy without fusion (preoperative vs. last mJOA; 7.1 ± 2.01 vs. 8.57 ± 1.91, p < 0.001). However, one patient exhibited transient deterioration of her neurological status after surgery. In the axial configuration, fused-type OLF revealed a significant risk for a decreased postoperative mJOA score (0–7, severe and moderate) (Odds ratio: 5.54, χ² = 4.41, p = 0.036, 95% CI: 1.014–30.256). The results indicated that the new categorization of axial-type of OLF is a helpful predictor of postoperative patient outcome and fused type was related with poor prognosis. In OLF cases free from ventral lesions compressing the spinal cord, decompressive laminectomy is enough for successful surgical outcome. Therefore, early surgical treatment will be considered in cases with fused-type OLF compressing spinal cord even though they do not have myelopathic symptoms.     

The detection and discrimination of malignant and benign focal hepatic lesions: T2 weighted vs diffusion-weighted MRI

Objective

The purpose of this study was to evaluate the use of diffusion-weighted imaging (DWI) for the detection and characterisation of focal hepatic lesions compared with the use of T₂ weighted imaging.

Method

45 patients with 97 hepatic lesions (51 malignant lesions and 46 benign lesions) were included in this retrospective study. Malignant hepatic lesions included 12 hepatocellular carcinomas, 26 metastases and 13 intrahepatic cholangiocarcinomas. Benign hepatic lesions included 19 haemangiomas and 27 cysts. The MRI protocol for the upper abdomen included T₂ weighted images, in- and opposed-phase T₁ weighted images and dynamic T₁ weighted images. Breath-hold fat-suppressed single-shot echo planar DWI was performed with the following parameters: 1338/66; b factors, 0, 50 and 800 s mm^–2. Two independent observers reviewed the T₂ weighted images and the DWI to detect and to characterise the hepatic lesions.

Results

For detection of malignant hepatic lesions, the use of DWI showed a significantly higher detection rate than the use of T₂ weighted images (p<0.05). However, there was no significant difference between the use of DWI and T₂ weighted images for benign hepatic lesions. For the differentiation between malignant and benign hepatic lesions, there was no significant difference in sensitivity, specificity and accuracy between the use of T₂ weighted images and the use of DWI.

Conclusion

The use of DWI was better for the detection of malignant hepatic lesions than the use of T₂ weighted images. However, for detection of benign hepatic lesions and characterisation of hepatic lesions, the use of DWI was equivalent to the use of T₂ weighted images.Accurate detection and characterisation of focal hepatic lesions is important for treatment planning in patients with hepatic tumours. For the detection and characterisation of hepatic lesions, CT and MRI are usually employed [1^,2]. MRI, T₁ weighted, T₂ weighted and gadolinium-enhanced T₁ weighted imaging have been commonly utilised [3^,4].With rapid progress of the use of parallel imaging techniques such as sensitivity encoding (SENSE), the quality of diffusion weighted single-shot echo-planar imaging has improved [5]. Diffusion-weighted MRI of the abdomen has become possible by the use of this technique, which reduces acquisition time, minimises echo-planar imaging artefacts and improves the quality of images [5].Several studies have characterised focal hepatic lesions by measurement of the lesion apparent diffusion coefficient (ADC) [6-11] and have evaluated detection of focal hepatic lesion by use of diffusion-weighted imaging (DWI) [12-16]. However, there is still controversy regarding the value of DWI for the characterisation of focal hepatic lesions as the ADC values of different types of lesions overlap [6-11]. Furthermore, a limited number of studies have been performed using DWI for the detection of hepatic lesions [12-16].The purpose of this study was to evaluate the use of DWI for the detection and characterisation of focal hepatic lesions compared with the use of T₂ weighted imaging.