Background-Although polypoid lesions ofthe gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography. Aim-The natural history of polypoid lesions ofthe gall bladder was investigated using ultrasonography. Subjects-Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study. Methods-The subjects were followed up by ultrasonography once or twice a year until 1994. Results-Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size ofthe lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter ofthe polypoid lesions and patients' sex or age. Conclusion-Most polypoid lesions of the gall bladder detected by ultrasonography are benign. (Gut 1996; 39: 860-862) Keywords: gall bladder carcinoma, gall bladder polyp, prognosis, ultrasonography.Ultrasonography has been widely used in clinical medicine, and its usefulness has been reported in the diagnosis of calculous gall bladder disease.' Mass surveys for abdominal disease have recently been performed using ultrasonography, and polypoid lesions of the gall bladder have been one of the most common findings.There are several studies that describe the prevalence of gall bladder polyps.2A6 One epidemiological study in Japan shows that the prevalence of gall bladder polyps was 6.28% in men and 3.5% in women,2 and another showed 5.3%/o in men.3 In Denmark, the prevalence was 4.6% and 4.3% in men and women, respectively,4 and 5.9% and 5.8% in men and women, respectively, in a 70 year old population.5 The prevalence was as low as 1.3% in the United Kingdom.6 However, the only report on the prognosis ofpolypoid lesions of the gall bladder is an old study using cholecystography. Therefore, the natural history of patients with polypoid lesions of the gall bladder was studied in this study. MethodsUltrasonographic examinations were carried out on 4343 patients in the outpatient clinic of the Department of Internal Medicine, Tsuchiura Kyodo Hospital from 1 January to 31 December 1988. Among these patients, 1 1 1 were diagnosed as having polypoid lesions of the gall bladder. Two of them had gall bladder carcinoma. The remaining 109 subjects (58 females; age: median 54, range 25-89) were enrolled in this study. After an overnight fast, ultrasonographic examination was performed by a radiology licensed :echnician using an Aloka Echo Camera SSD-650CL equipped with a 3.5 MHz tran...

BackgroundAn increasing number of older adults require improvements in their quality of life. Physical activities, particularly walking ability, are of primary importance for older adults. The influence of season on physical activity has not been sufficiently studied among older adults. Therefore, this report compared the physical activity and walking of older individuals between summer and winter seasons using a longitudinal study design in a community in a mid-latitude area.MethodsParticipants in the study comprised 39 healthy community-dwelling adults ranging in age from 65 to 80 years. Physical parameters and activities as well as the preferred speed of walking were measured at half-year intervals.ResultsSignificant seasonal differences from summer to winter and from winter to summer were detected. Specifically, body fat percentage, single-leg stance, walking speed, cadence, stride length, and trunk and head-trunk pitch ranges were greater in winter than in summer, whereas grip strength and steps per day were greater in summer. Temperature and total activity level were considered to be related to body fat percentage. Grip strength was thought to be affected by outdoor temperature. The possibility of relationships between increased activity per unit time in older adults and increased preferred walking speed, cadence, and stride length in winter temperatures was discussed.ConclusionThe seasonal climatic environment of the geographic area of this study affected the activity level of the participants. These results indicate that seasonality should be considered when analyzing physical activity and walking in older adults.

The free gait of 52 healthy elderly persons was examined. All the subjects were volunteers, aged 65 years or older, and lived in the community in the Kaga area, Ishikawa Prefecture, Japan. They were healthy and active enough to attend the study location by themselves. The comparison group of young adults consisted of 20 volunteer students. The percentages of females and males were similar in the two groups. The healthy elderly walked more slowly than the young adults. Their slower speed was largely caused by their shorter stride length. Differences were still observed between the young and elderly groups when gait parameters were presented in the form of dimensionless numbers. The elderly were weaker in grip strength and had shorter single-leg balance with eyes open than the young adults. The number of steps per day correlated negatively with age within the elderly group. Negative correlations between age and walking speed, as measured directly or in terms of dimensionless numbers, and between age and stride length were also observed within the elderly group. The relative stance phase duration correlated positively with age within the elderly group. Slow speed may be related to low daily activity, reduced muscle power, and diminished balance ability. Long stance phase duration and slow speed in the elderly could be an adaptive characteristic in response to impaired balance.

Abstract. The prevalence of hepatitis C virus (HCV) infection is high in patients who are on chronic hemodialysis, but the role of HCV infection and HCV-related liver disease in the mortality of these patients has not been shown. Therefore, we conducted a prospective cohort study of 1470 patients who were on chronic hemodialysis (17 to 89 yr old) from 16 dialysis centers in Japan. Among them, 276 patients (18.8%) were positive for anti-HCV antibodies and 1194 patients were negative. The patients were followed for 6 yr from 1993 to 1999. Only one case, a patient from the anti-HCV-antibody-positive group, was lost to the follow-up during this period. The mortality was higher in the anti-HCV-antibody-positive group (91 of 276 patients died) than in the anti-HCV-antibody-negative group (277 of 1193 died) (33.0% versus 23.2%, P < 0.01). A Cox proportional hazard examination showed that positivity for anti-HCV antibodies was one of the risk factors for death with an adjusted relative risk of 1.57 (95% confidence interval, 1.23 to 2.00). As a cause of death, hepatocellular carcinoma and liver cirrhosis were significantly more frequent in the anti-HCV-antibody-positive patients than in the anti-HCV-antibody-negative patients (5.5% versus 0.0%, P < 0.001; 8.8% versus 0.4%, P < 0.001, respectively). These findings show that the mortality is increased in anti-HCV-antibody-positive patients who are on chronic hemodialysis. Hepatocellular carcinoma and liver cirrhosis are factors that may influence the mortality.

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