This report is biased on 1,139 patients with gastric cancer (GC) detected by mass screening conducted by the Center for Adult Diseases, Osaka during 1961-1985. Early GC totalled 527 patients and advanced GC totalled 6121 patients. In 859 patients curative resection was performed. Their vital status was traced yearly and six patients were lost to follow-up. Relative survival rates of screening-detected GC patients were 69-70% and almost constant after 5 years from operation/diagnosis. The survival curve in which only death from GC was counted as a death was almost equal to the relative survival curve in its shape and value. The hazard rates of screening detected GC patients decreased rapidly within 7 years and remained low affter 7 years. It was confirmed by this long-term follow-up study that about two thirds of GC patients detected by screening were successfully cured of their disease. Cancer 63:613-617, 1989. N JAPAN mass screening for stomach cancer has been I carried out for over 25 years mainly with photofluo-rographic radiography, and 5.2 million people were examined in 1985. The main purpose of this screening is to detect as many curable gastric cancers (GC) as possible in the asymptomatic phase:, and to reduce the number of deaths from GC. In order to evaluate this screening program , it is necessary to follow up the detected GC patients for a long period and to know their prognosis. At the Department of Mass Examination for Stomach Cancer in the Center for .4dult Diseases, Osaka, yearly followup surveys on all screening-detected patients have been carried out and the causes of death have been investigated for dead patients. Based on the results of this survey we calculated the survival rate of GC for a 15-year period, and analyzed the causes of death by years froh operation/diagnosis. Materials and Methods The subjects of our follow-up study were a total of 1,139 GC patients detected by mass screening conducted by the Department of Mass Screening of the Center for Adult Diseases, Osaka during 196 1 to 1985. Two hundred twenty patients were detected by the examination in the detection clinic of the Center with roentgenogram taken on a full size film, and the other 919 patients were examined in automobile units mounted with the x-ray apparatus where photofluorogram was taken on a 100 mm width roll film. Table 1 shows the sex and age distribution of our study subjects which consisted of 826 men and 313 women. The major age groups of detected patients were forties, fifties, and sixties. Table 2 shows the number of study subjects by cancer type and by method of treatment. Early GC totalled 527 cases. According to the classification of the Japanese En-doscopy Society, early GC is gastric cancer, the infiltration of which is limited to the mucosa or submucosa. The majority of the early GC in Table 2, i.e., 509 cases out of 527 were confirmed as early GC by examining resected stomach. For the remaining 18 patients, however, operation had not been conducted because either they refused it or they had other diseas...

Objective: Studies on the outcomes of lower limb amputation have been limited by the use of selected study populations and small sample sizes. Although reamputation is an important outcome following lower limb amputation, the risk factors for reamputation remain to be elucidated. The present study was performed to identify risk factors for in-hospital death and reamputation following lower limb amputation. Methods: Using a national inpatient database in Japan, we identified 13,774 patients who underwent lower limb amputation. We examined the patients' backgrounds and employed a multivariable logistic regression analysis to identify factors associated with in-hospital death or reamputation. Results: The average age of the 13,774 patients was 72.4 years, and 63.1% (n=8694) were male. The overall in-hospital mortality rate was 10.8% (1481/13,774). The reamputation rate was 10.1% (782/7779) for patients who initially underwent foot or transtibial amputation (18.2% [391/2148] for foot amputations and 6.9% [391/5631] for transtibial amputations). Multivariable logistic regression analysis revealed higher age, male sex, peripheral vascular disease, use of insulin, hemodialysis, and higher numbers of comorbidities as significant risk factors for reamputation or in-hospital death. Use of hemodialysis was the strongest risk factor (odds ratio, 2.10; 95% confidence interval, 1.87-2.35). Conclusions: The in-hospital mortality and reamputation rates following lower limb amputation were considerably high, reflecting the severely ill conditions of patients with advanced chronic diseases. Risk factors for in-hospital death and reamputation following lower limb amputation were identified. These should aid surgeons in determining a patient's risk of a poor outcome and deciding on the level of amputation.

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