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Background: Vascular dementia (VaD) has been considered to be more prevalent than Alzheimer disease in Japan. However, this might be the result of overdiagnosis stemming from some problematic diagnosis of VaD or of the frequent use of magnetic resonance imaging to detect cerebrovascular disease in older adults. Objectives: We investigated the prevalence of dementia and the ratios of dementing diseases. The effects of different criteria for VaD (DSM-IV, Alzheimer's Disease Diagnostic and Treatment Centers [ADDTC], and National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS-AIREN]) were considered. Hippocampal atrophy and vascular contribution to dementia were evaluated using magnetic resonance imaging findings. Methods: We targeted all residents 65 years and older (n = 3207) in Tajiri, Japan, and examined 1654 (participant group 1). Of these, 564 (participant group 2) were randomly selected, and 497 underwent magnetic resonance imaging and diagnosis of dementing diseases. Results: We found the overall prevalence of dementia to be 8.5% (141/1654) in participant group 1. Of these, 21 (14.9%) had a history of stroke. Of the 113 participants who had a history of stroke independent of dementia, 18.6% (21/113) were demented. For participant group 2 (n = 497), 32 were demented. The ratio among the dementia for probable VaD based on the NINDS-AIREN criteria was 18.8% (6/32), whereas that for ischemic vascular dementia was 31.3% (10/32) according to the ADDTC criteria. Conclusion: We confirmed the overall prevalence of dementia in adults 65 years and older to be 8.5%. We found that VaD was not a common disorder according to the NINDS-AIREN criteria. Rather, the condition of possible Alzheimer disease with cerebrovascular disease was more common. [ABSTRACT FROM AUTHOR]

A 69-year-old woman visited our outpatient clinic due to abdominal pain and anorexia. She received initial diagnostic workup, and was admitted to the hospital as an inpatient because of ileus. CT showed tumor with a diameter of 3cm in upper left abdomen, liver metastasis, peritoneal fluid localized in the pelvic cavity, and peritoneal node. Upper and lower gastrointestinal endoscopy showed no abnormalities, and percutaneous liver biopsy confirmed adenocarcinoma. PET showed a focal abnormal uptake in proximal jejunum, but no abnormalities in pancreas and biliary tract. We diagnosed the patient with small bowel cancer. It was considered unresectable, and FOLFOX chemotherapy was initiated. However, during FOLFOX chemotherapy after 1st course, CT showed that exacerbation of primary lesion and liver mass, and significant increase in ascites. She subsequently died of pneumonia day 32 after the start of chemotherapy. Autopsy findings revealed primary small bowel adenocarcinoma with proximal jejunum. Histological response was Grade1a. The incidence of small bowel adenocarcinoma (SBA) is very low, accounting for 0.1%-0.3% of all gastrointestinal malignant neoplasms. Many cases have been reported to be within 50 cm of Treitz ligament or Bauhin valve. For diagnosis of SBA, some reports suggest small bowel series, gastrointestinal endoscope, CT, and PET are useful. However, in many advanced cases it is difficult to apply curative therapy at the time of discovery. There is no standard treatment especially for unresectable small bowel cancer, and the prognosis is poor. In this case SBA was confirmed by metastatic lesion biopsy and exclusion diagnosis. Because the disease was already advanced at the time of diagnosis and furthermore time was necessary for diagnostic workup, it caused deterioration of the general condition. As a result, adequate chemotherapy could not be performed. There is a need for further case studies to establish diagnosis and treatment of SBA. [ABSTRACT FROM AUTHOR]

Background: The Great East Japan Earthquake and subsequent tsunami devastated the northeastern part of Japan. Low back pain is thought to increase after a natural disaster and is related to various factors. The aim of this study was to examine the influencing factors of "Living environment" and "Subjective economic hardship" on new-onset of low back pain in the chronic phase for the survivors of the earthquake evaluated by a self-report questionnaire.Methods: A panel study was conducted with the Great East Japan Earthquake survivors at 2 and 3 years after the disaster. New-onset of low back pain was defined as low back pain absent at the 1st period (2 years after the earthquake) and present at the 2nd period (3 years after the earthquake). Living environment was divided into 4 categories (1. Living in the same house as before the earthquake, 2. Living in a prefabricated house, 3. Living in a new house, 4. Others: Living in an apartment, house of relatives or acquaintance). Subjective economic hardship was obtained using the following self-report question: "How do you feel about the current economic situation of your household?" The response alternatives were "Normal", "A little bit hard", "Hard", and "Very hard". A univariate and multivariate logistic regression models were used.Results: 1357 survivors consented to join this study. There was no significant association between new-onset of low back pain and living environment. There was significant association between new-onset of low back pain and "A little hard" (OR = 1.6, 95% CI = 1.07-2.40), "Hard" (OR = 2.2, 95% CI = 1.56-3.74), and "Very hard" (OR = 3.19, 95% CI = 1.84-5.53) in subjective economic hardship.Conclusions: Subjective economic hardship was significantly associated with new-onset of low back pain in the chronic phase for survivors of the Great East Japan Earthquake. [ABSTRACT FROM AUTHOR]