Effect of Helicobacter pylori eradication on elder cases: Observational study in community-based medicine.

AIM: To examine the effect of Helicobacter pylori (H. pylori) eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community medicine. METHODS: Medical records (1 May 2013-31 January 2014) of 130 patients who underwent H. pylori eradication therapy with 2-year after-eradication observation in our institute were reviewed. Data on sex; age; body weight; body mass index (BMI); mean corpuscular volume (MCV); total protein; low-density lipoprotein cholesterol, triglyceride, haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps (GHPs) at eradication was extracted. Two-year after-eradication change in data was analysed by paired-sample t-test; relationship between GHPs and subclinical iron deficiency anaemia (IDA) improvement was evaluated. RESULTS: The mean patient age (median, interquartile range) at eradication was 69.6 (71.5, 64-77) years. Paired-sample t-tests showed that body weight, BMI and MCV increased by 0.52 kg (P = 0.018), 0.25 kg/m2 (P = 0.006) and 0.83 fL (P < 0.001), respectively. The nonparametric Mann-Whitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs (P = 0.892). CONCLUSION: H. pylori eradication therapy prevented weight loss and subclinical IDA in elderly individuals. GHPs were not associated with subclinical IDA.

Diagnosis and management of giant hepatic hemangioma: the usefulness of contrast-enhanced ultrasonography.

Giant hepatic hemangiomas, though often asymptomatic, may require intervention if rapid growth occurs. The imaging studies including the computed tomography, magnetic resonance imaging, and ultrasonography, and so on are effective for the diagnosis and the management of this tumor; however, due to its size and various patterns of these studies, we need to carefully consider the therapeutic methods. Compared to the cost needed for these modalities, recently developed and approved Perflubutane- (Sonazoid-) based contrast agent enhanced ultrasonography is reasonable and safe. The major advantage is the real-time observation of the vascular structure and function of the Kupffer cells. By this procedure, we can carefully follow the tumor growth or character change in a hemangioma and decide the timing of therapeutic intervention, since abdominal pain, abdominal mass, consumptive coagulopathy, and hemangioma growth are the signs for the therapeutic intervention. We reviewed recent reports about Sonazoid-based enhancement and also showed the representative images collected in our department. This is the first review showing the detailed findings of the giant hemangiomas using Perflubutane (Sonazoid). This review will help the physician in making the decision, and we hope that Sonazoid will gain widespread acceptance in the near future.

Cigarette smoking and mortality due to stomach cancer: findings from the JACC Study.

BACKGROUND: Several epidemiologic studies reported the positive association between cigarette smoking and stomach cancer. The prevalence of smoking in men remains high in Japan compared to other developed countries. It is therefore of great importance to determine the impact of cigarette smoking on stomach cancer among the Japanese population. The Japan Collaborative Cohort Study (JACC Study) provided an opportunity to examine the association between smoking and the risk of mortality due to stomach cancer. METHOD: A baseline survey was conducted throughout Japan from 1988 through 1990 among 110,792 inhabitants of 45 areas. Data retrieved for 98,062 participants (43,482 male and 54,580 female) who provided sufficient information about their smoking habits, without any history of caner at the baseline. Of total 970,251 person-years, 757deaths due to stomach caner were identified. RESULTS: Current smokers were at a higher risk of death due to stomach cancer than non-smokers (Hazard ratio=1.36; 95% confidence interval [CI]: 1.07, 1.73). The risk of stomach cancer for men who smoked 15 or more cigarettes per day was approximately 1.4-fold greater than that of non-smokers, and those who smoked 35 or more cigarettes per day had an approximately 1.7-fold higher risk of stomach cancer, although the dose-response trend among men was unclear (p for trend=0.063). No associations between smoking and stomach cancer were detected among women. CONCLUSION: The present results, together with previous findings, strongly support a hypothesis that cigarette smoking increases the risk of stomach cancer in Japanese men.

Mortality and incidence rates of stomach cancer in the JACC Study.

BACKGROUND: The objective of this study was to examine the mortality and incidence of stomach cancer in the Japan Collaborative Cohort Study (JACC Study), and compare them with those of the general population of Japan. METHODS: The cohort study involved 127,477 people living in 45 municipalities in Japan. The deaths due to stomach cancer were ascertained by death certificates. The age-adjusted mortality rate per 100,000 was calculated based on 110,792 subjects aged between 40 and 79 years at the baseline in all study areas. The incident cases were defined as the subjects in whom stomach cancer had developed, or subjects who died of stomach cancer during the observed period of survey for cancer incidence. The age-adjusted incidence rate per 100,000 was ascertained and calculated in 64,820 people aged 40-79 years at the baseline living in 24 study municipalities with cancer registries. Then, the mortality rate was compared with the mortality data published in vital statistics of Japan of 1995, and the incidence rate compared with the incidence data published in The Research Group for Populationbased Cancer Registration in Japan of 1992. RESULTS: During more than 10 years of follow-up, there were 582 male deaths and 287 female deaths due to stomach cancer. The age-adjusted mortality rate was 93.4/100,000 person-year (95% confidence interval [CI]: 84.6-102.2) in males and 31.1 (95% CI: 27.0-35.3) in females. There were 646 incident cases in males and 370 in females. The age-adjusted incidence rate was 245.3 / 100,000 person-year (95% CI: 221.6-268.9) and 94.8 (95% CI: 83.0-106.6) in males and females, respectively. CONCLUSION: The mortality rate of stomach cancer in the JACC Study was lower than that in the vital statistics in Japan. Similar incidence rate of stomach cancer seems to be found between data of the JACC Study and that of the Research Group for Population-based Cancer Registration, but care is needed to interpret this similarity, because it might be due to different degree of completeness of incidence survey between the 2 studies.