We have done the questionnaire about patients with hepatocellular carcinoma in Yamaguchi prefecture. The result was that 304 cases were answered. The mean age was 62.1 years old, and the ratio of male to female was 3.7 to 1. Abdominal ultrasonography was examined most frequently, and the next was computed tomography as the method of diagnosis. The serum α-fetoprotein level showed less than 400ng/ml in cases of 49.3%. HBs antigen was positive in cases of 15.9%. Positive cases were significantly lower in the mean age as compared with negative cases, and the ratio of male to female was 8.2 to 1. Liver cirrhosis was complicated in cases of 84%.

A first case is a 43-year-old male. He was admitted after hard drinking, and died two days later for hepatic coma. It is thought that this case applies to a diagnostic criteria of severe alcoholic hepatitis made by a Japanese reserch group about the relation of alcohol to liver. A second case is a 45-year-old male. He was also admitted after hard drinking, but he recovered rapidly. This case was diagnosed as Zieve's syndrome, because hyperlipemia and hemolytic anemia were found.
Volumes of liver and spleen in these two cases were examined by computed tomography. Volumes of liver were more increased and those of spleen were more decreased than those of controls. In a second case a volume of liver was decreased gradually, and that of spleen was increased with recovery from sickness. It is thought that a volume of liver is increased in a patient with alcoholic hepatitis, because liver cells fall into ballooning. But the cause is unknown as yet that a volume of spleen is decreased.

The ratio of men to women was studied in 331 patients hospitalized into our department for the past three years for various liver diseases. Two factors seemed to affect the sex difference in the morbidity of liver disease. One was a history of drinking, the other a positive ratio of HBs antigen. So, heavy drinkers and HBs antigen positive cases were excluded from the patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, and the male/female ratio was studied again. The ratio of men to women in the patients with liver cirrhosis was 1.3: 1, 4. 1: 1 in the patients with hepatocellular carcinoma and 2.0: 1 in the patients with chronic hepatitis. The male ratio was strikingly high in the case of hepatocellular carcinoma. It is thought that liver cirrhosis is a cause of hepatocellular carcinoma. And then differences in the results of liver function tests between men and women were studied in the patients with liver cirrhosis. However, no remarkable difference was found between men and women.

We gathered information of both drinking and smoking habits by questionnairing. The subjects of our study were 116 men around Yanai City. They were divided into five groups. 1st: neither drinking nor smoking habits (23 cases). 2nd: 20 or 40 grams of ethyl alcohol daily and no smoking habit (31 cases). 3rd: more than 40 grams daily and more than 10 cigarettes (32 cases). 4th: 20 grams daily and more than 10 cigarettes (16 cases). 5th: no drinking habit and more than 10 cigarettes daily (14 cases).
The 1st group was a control group, and was compared with the 2nd, 3rd 4th and 5th groups. Consequently both systolic and diastolic blood pressure levels rose significantly only in the 3rd group. Only systolic blood pressure level rose significantly in the 4th group. And so it was suggested that both drinking and smoking habits raised both systolic and diastolic blood pressure levels.

The subjects are 223 women who participated in a mass medical examination. Their ages are between 40 and 79 years. We divided them into four age groups, and studied how aging and obesity influenced their physical health. The results showed the obesity index and serum total protein level were significantly low in the 70-to-79 age group. The serum total cholesterol level was significantly high in the age group between 40 and 50, and it was thought that the elevated cholesterol levels were due to menopause. Thus in females this suggests that a great physical change occurs first in the age group between 40 and 50, and second in the age group between 60 and 70.
Using 165 female cases whose ages were between 40 and 69 years were subdivided into four obesity index groups, we studied how the obesity influenced their physical health. The results showed that the problems include the elevation of diastolic blood pressure levels and serum uric acid levels.

To find a link between lifestyle and arteriosclerosis, the serum lipid values were studied in those who had entered our hospital for a thorough physical examination. The subjects were 136 men and 31 women. They were divided into six groups. 1st: neither drinking nor smoking habits (24 cases). 2nd: 20 or 40 grams of ethyl alcohol daily and no smoking habit (45 cases). 3rd: more than 40 grams daily and more than 10 cigarettes (21 cases). 4th: 20 grams daily and more than 10 cigarettes (25 cases). 5th: no drinking habit and more than 10 cigarettes daily (21 cases). 6th: women who had neither drinking nor smoking habits (31 cases).
The 2nd group was a control group, and was compared with each group. It was found that only TG values were significantly high in the 3rd group. HDL-C values were significantly low in the 5th group. There were no significant differences in the 1st and 4th groups. T-CHO and LDL-C values were significantly high in the 6th group. These facts suggest that it is difficult to correlate both drinking and smoking habits with the incidence of arteriosclerosis. And perhaps it is the same in women, because LDL-C values were high in women, but at the same time HDL-C values were high.

STUDY DESIGN: Case control study. PURPOSE: To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis. OVERVIEW OF LITERATURE: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial. METHODS: We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/µL at 4 days postoperatively. RESULTS: Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/µL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p=0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7). CONCLUSIONS: A lymphocyte count of <1,000/µL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI.
Biomarkers* ; C-Reactive Protein ; Case-Control Studies ; Early Diagnosis ; Humans ; Leukocyte Count ; Leukocytes ; Logistic Models ; Lymphocyte Count ; Lymphocytes ; Lymphopenia* ; Neutrophils ; Odds Ratio ; Retrospective Studies ; Spinal Diseases ; Surgical Wound Infection*

STUDY DESIGN: Case-control study. PURPOSE: To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). OVERVIEW OF LITERATURE: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. METHODS: We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/µL at 4 days postoperatively. Statistical analysis was via Fisher's exact test and a p-value of <0.05 was considered significant. RESULTS: In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. CONCLUSIONS: A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/µL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis.
Biomarkers ; C-Reactive Protein* ; Case-Control Studies ; Diagnosis ; Early Diagnosis ; Humans ; Leukocyte Count ; Lymphocyte Count ; Lymphocytes ; Lymphopenia* ; Mass Screening ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Spine

STUDY DESIGN: Case-control study. PURPOSE: To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). OVERVIEW OF LITERATURE: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. METHODS: We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/µL at 4 days postoperatively. Statistical analysis was via Fisher's exact test and a p-value of <0.05 was considered significant. RESULTS: In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. CONCLUSIONS: A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/µL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis.
Biomarkers ; C-Reactive Protein* ; Case-Control Studies ; Diagnosis ; Early Diagnosis ; Humans ; Leukocyte Count ; Lymphocyte Count ; Lymphocytes ; Lymphopenia* ; Mass Screening ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Spine

Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient. Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations. Conclusions The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.