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Kazunari Kumasaka

Publications and source records attributed to Kazunari Kumasaka.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of serological diagnosis tests for tuberculosis in hemodialysis patients.

Patients receiving hemodialysis are generally considered to be at increased risk of developing tuberculosis. In the current study, in order to evaluate the usefulness of serological tests in dialysis patients, serum antibodies for tuberculous glycolipids antigen (TBGL) and for lipoarabinomannan (LAM) were measured in hemodialysis patients. The present study included 243 hemodialysis patients. Serum antibodies for TBGL and LAM were measured. Tuberculin skin tests were carried out and chest X-rays evaluated at the same time. There were no patients with active tuberculosis at the time of blood sampling. Thirty-six patients (14.8%) and 25 patients (10.3%) were positive for anti-TBGL antibody and anti-LAM antibody, respectively. One hundred and fifty-five patients (63.8%) were positive for tuberculin skin testing and 123 patients (50.6%) had old pulmonary tuberculosis on their chest X-ray. There was no significant correlation between the results of anti-TBGL antibody and anti-LAM antibody. There were no relationships among the results of tuberculin skin test and the two serological tests. However, positivity of anti-TBGL antibody and anti-LAM antibody was significantly higher in patients with findings of old tuberculosis on the chest X-ray than those without findings. The current results show that these serological tests are positive more frequently in hemodialysis patients without any proof of active tuberculosis than in healthy subjects (2%) and careful interpretation is necessary for relevant results.

Adult↗
PubMed2006

[Interpretation of the results of blood culture and interventional role by clinical laboratory physicians].

Blood culture has long been recognized as the gold standard for the definitive diagnosis of bacterial and fungal infections. However, fewer blood cultures have been tested and their results have not been fully used in Japan. Clinical laboratory physicians should play an interventional role, such as recommending blood culture tests in patients with infectious disease or fever of unknown origin. In our hospital, clinical laboratory physicians act as on-call consultants. The yearly number of consultations is between 500 and 700, and consultations concerning infectious disease have increased up to 40% in the past 5 years. As a result, the number of blood cultures and the percentage of 2-set blood collections have increased in order to increase the positivity rate and determine whether the results obtained were contaminated. However, physicians sometimes misunderstand the results of blood culture, and they assume that the identified organism was causative, or that sepsis did not exist if the culture is negative. Clinical laboratory physicians should act as consultants more frequently, concerning the interpretation of blood culture results, and the choice of antimicrobial agents, because the inappropriate use of antimicrobial agents leads to higher mortality and higher medical costs. Finally, collaboration between clinical laboratory physicians and co-medical staff such as the infection control team, nurses and pharmacists is necessary.

Anti-Infective Agents↗
PubMed2005

[The clinical usefulness of a newly rapid diagnosis kit, detection of respiratory syncytial virus].

ImmunoCard STAT! RSV (Meridian Bioscience, Inc, USA) is a rapid immunoassay method newly developed for detection of respiratory syncytial virus (RSV) by immunochromatography. We carried out an evaluation of the ImmunoCard STAT! RSV. One hundred fifty-nine nasal wash samples and nasopharyngeal aspirates from patients were used to evaluate three different kits, which are ImmunoCard STAT! RSV, RSV testpack (Abbott JAPAN) and Directigen EZ RSV (Nippon Becton, Dickinson and Company) . One hundred twenty-eight samples showed equivalent results. When nested reversed transcription-PCR (nested RT-PCR) results for 31 samples showing discrepancies among three kits, 10 samples were positive, and 21 samples were negative by nested RT-PCR. Compared to Nested RT-PCR results, ImmunoCard STAT! RSV showed a sensitivity of 90.5% (19/21) and a specificity of 80.0% (8/10), as well as RSV testpack showed a sensitivity of 10.0% (2/21) and a specificity of 100% (10/10), Directigen EZ RSV showed 95.2% (20/21) and 0.0% (0/ 10), respectively. Furthermore, the detection limits were also evaluated by using ACTT No. VR1540 for RSV A-2 strain, and ACTT No. VR1401 for Wash strain. The detection limit of ImmunoCard STAT! RSV was 5.15 x 10(6) TCID50/mL in subgroup A strain and was 7.58 x 10(5) TCID50/mL in subgroup B strain. This result was similar to RSV testpack, and was better than the detection limit of Directigen EZ RSV. It is concluded that ImmunoCard STAT! RSV is useful in detecting RSV in a clinical setting with equivalent performance to conventional other detecting kits.

Evaluation Studies as Topic↗
PubMed2005

[The role of regional research laboratories of the local government in administering regional EQA programs].

In 1981, the Japanese Ministry of Health and Welfare revised the enforcement of regulations of the Medical Technologists' Act. The amendments stipulate that all independent laboratories are legally obliged to introduce laboratory quality assurance programs and are responsible for the quality of all test results. To ensure adherence to these regulations, regional research laboratories of local governments such as the Tokyo Metropolitan Research Laboratory of Public Health should conduct regional external quality assessment (EQA) programs. We did a survey, in the form of a questionnaire, of the regional research laboratories of public health across the country. We found that commitment to the regional EQA in almost all of these public laboratories is insufficient. The main problem is that restructuring of local governments has resulted in lower budgets and so they are short of human resources. Nationwide EQA programs are only able to detect gross errors and use invalid methods for evaluating routine performance. We conclude that the regional EQA should be further developed.

Japan↗
PubMed2004

Improvement of chronic nonspecific symptoms by long-term minocycline treatment in Japanese patients with Coxiella burnetii infection considered to have post-Q fever fatigue syndrome.

OBJECTIVE: To address the presence of post-Q fever fatigue syndrome (post-QFS) in Japan, and to evaluate the efficacy of minocycline for this condition. PATIENTS AND METHODS: In 20 Coxiella burnetii (C. burnetii) seropositive patients with persistent nonspecific symptoms including general fatigue, low-grade fever, myalgia and arthralgia, changes in subjective symptoms, C. burnetii antibody titers and C. burnetii DNA were evaluated after antibiotic treatment. RESULTS: After treatment mainly with minocycline (100 mg/day for 3 months), the clinical picture improved in all 20 patients as evidenced by decreases in body temperature (13/17), general fatigue (20/20) and headache (9/12). The mean performance status (PS) score improved from 5.0 to 1.8 (p<0.01). All 7 who had been positive for C. burnetii DNA, became negative together with an improvement in subjective symptoms. Indirect immunofluorescence tests demonstrated 6 of the 20 patients to be positive for C. burnetii IgM antibody to phase II antigen (1:32), and 18 to be positive for IgG antibody (1:128, 1:256). Antibody titers of both IgM (6/6, 1:16) and IgG (18/18, 1:16) decreased markedly after treatment. CONCLUSION: These results of an open label study in Japan suggest that minocycline administration is useful for improving chronic nonspecific symptoms considered to be post-Q fever fatigue syndrome caused by C. burnetii infection.

Adult↗
PubMed2004

[An attempt for standardization of serum CA19-9 levels, in order to dissolve the gap between three different methods].

It is well known that serious method-related differences exist in results of serum CA19-9, and the necessity of standardization has been pointed out. In this study, differences of serum tumor marker CA19-9 levels obtained by various immunoassay kits (CLEIA, FEIA, LPIA and RIA) were evaluated in sixty-seven clinical samples and five calibrators and the possibility to improve the inter-methodological differences were observed not only for clinical samples but also for calibrators. We supposed an assumed standard material using by a calibrator. We calculated the serum levels of CA19-9 when using the assumed standard material for three different measurement methods. We approximate the CA19-9 values using by this method. It is suggested that the obtained CA19-9 values could be approximated by recalculation with the assumed standard material would be able to correct between-method and between-laboratory discrepancies in particular systematic errors.

Biomarkers, Tumor↗
PubMed2004

[Evaluation of renal damage using urinary ATP analysis].

It is reported that urinary ATP concentration analysis is useful for determining urinary tract infection and renal damage caused by drugs. By means of the firefly luciferin-luciferase method, we determined the reference value of urinary free ATP and evaluated the effects of urine sediments and conditions of storage. The reference value was established as 1.77 x 10(-10) to approximately 7.70 x 10(-9)M using urine samples obtained from 63 outpatients who seemed to have no renal disease. There was no significant difference in ATP concentration between 33 males and 30 females. No significant changes were observed in 11 healthy volunteers during a 1-year period. Within-run reproducibility of ATP was satisfying (8.28% and 11.4% of coefficient value in low and high concentration samples, respectively). ATP concentration was significantly decreased after centrifugation (p < 0.05) and after filtration (p < 0.01). The amounts of the red blood cells (RBC) and white blood cells (WBC) in samples whose ATP concentration was decreased after centrifugation or filtration were significantly higher than those in samples whose concentration did not decrease (p < 0.05). Urine containing many RBCs and/or WBCs might show an artificially higher ATP concentration if no preparations has been performed. There were significant positive correlations between the ATP concentrations before and after refrigeration, but no correlations before and after freezing. It is concluded that the reference value of urinary free ATP concentration was 1.77 x 10(-10) to approximately 7.70 x 10(-9) M and that care is required in the estimation of urinary ATP concentrations in samples containing many sediments, especially with WBC and RBC.

Adenosine Triphosphate↗
PubMed2003

Multibacterial sepsis in an alcohol abuser with hepatic cirrhosis.

An alcohol abuser with hepatitis C developed multibacterial sepsis. His mean 100% alcohol intake reached 400 ml/day. In January 2001, he suddenly experienced fever (39 degrees C) with no other symptoms. One week later, he was admitted to our hospital and was subsequently diagnosed with sepsis associated with four species of bacteria (Streptococcus constellatus, Fusobacterium mortiferum, Bacteroides thetaiotaomicron, and non-spore-forming anaerobic gram-positive bacillus). A drip infusion of imipenem/cilastatin was administrated, resulting in a successful therapeutic outcome. No underlying disorder was found except for gastric ulcers and hepatic cirrhosis. Damaged gastric mucosa was assumed to be the possible cause and route for the bacterial invasion.

Aged↗
PubMed2003

[Mandatory postgraduate medical training in Japan--present state of Nihon University as a private medical school].

This is a time of considerable uncertainty about the future of the postgraduate medical education policy of the Japanese government. Strong and visionary academic leadership of laboratory physicians in private medical schools is needed. The medical schools must not only adapt to a changing health care system, but also maintain excellence in education, patient care, and clinical research. In Japan, tradition has it that the comparatively few faculty members at national medical schools are mostly promoted only on the basis of research in experimental medicine, therefore, young medical graduates are increasingly drawn to bench work or molecular medicine, not to clinical practice. Single-minded specialization tends to produce single track minds, which may lack balanced judgment in approaching the appropriateness of both investigation and management. For continuity of care and containment of costs, a year or two of general professional training after graduation preceded by a broad medical education is an invaluable investment. All medical graduates, whatever their intended or unintended final destination (even if not clinical), should spend more than six months in medicine and four or five months in surgery, at least half of each to be spent in the general disciplines, including responsibilities for acute emergency admissions. As certified laboratory physicians we must attempt to attract graduates into laboratory medicine by developing imaginative training programs including common laboratory procedures such as Gram's stain, Wright-Giemsa stain and point of care testing at the patient's bedside or in ambulatory clinics, not only in central clinical laboratories.

Curriculum↗
PubMed2002

Pasteurella canis osteomyelitis and cutaneous abscess after a domestic dog bite.

The genus Pasteurella is part of the normal oral flora of many animals, including domestic cats and dogs. In humans, Pasteurella may cause complications ranging from cellulitis to septicemia but rarely causes osteomyelitis or septic arthritis after bites and/or scratches by cats and dogs. Although Pasteurella multocida is a common cause of infection, other Pasteurella species have also been cultured from wounds in humans. We describe here, a case of a cutaneous abscess and acute osteomyelitis associated with P canis after a domestic dog bite. To our knowledge, no previous case of P canis has been reported as the cause of acute osteomyelitis in humans.

Abscess↗
PubMed2002

Nephrotic syndrome with portal, splenic and renal vein thrombosis. A case report.

BACKGROUND: Thromboembolism is known as a major complication of nephrotic syndrome, but only 4 cases of portal vein thrombosis have been reported as a complication of nephrotic syndrome. All of these 4 cases had acute symptoms, and 3 of 4 were in relapsing phase of nephrotic syndrome when thrombi were found. We describe here a case of 51-year-old woman with fresh nephrotic syndrome that was asymptomatically complicated by portal, splenic and renal vein thrombosis. CONCLUSIONS: In the presence of fresh nephrotic syndrome of minimal change, asymptomatic and widely distributed, including portal vein, thrombus formation occurred. If the clinical course shows resistance to therapy, we must consider the complication of venous thrombosis. Anticoagulant therapy with heparin and warfarin was effective and all thrombi disappeared without any other complications.

Acute Disease↗
PubMed2002

[Postgraduates' training as laboratory physicians/clinical pathologists in Japan--board certification of JSLM as a mandatory requirement for chairpersons of laboratory medicine].

The educational committee of the Japanese Society of Laboratory Medicine(JSLM) proposed a revised laboratory medicine residency curriculum in 1999 and again in 2001. The committee believes that present undergraduate clinical training is insufficient and that Japanese medical graduates need clinical training for two years after graduation. This two years training should be a precondition for further postgraduate training in laboratory medicine and should include fundamental clinical skills(communication skills, physical examination and common laboratory procedures such as Gram's stain, Wright-Giemsa stain and urinalysis). After the two years training, the minimal training period of laboratory medicine should be three years, and should include: 1) Principles, instrumentation and techniques of each discipline including clinical chemistry, clinical hematology, clinical microbiology, clinical immunology, blood banking and other specific areas. 2) The use of laboratory information in a medical setting. 3) Interaction of the laboratory physician with laboratory staff, physicians and patients. With good on-the-job training and 24 hours on-call duties, laboratory physicians are expected to perform their tasks, including laboratory management, effectively. They should have appropriate educational background and should be well motivated. The background and duties of the laboratory physicians often reflect the institutional needs and personal philosophy of the chairperson of their department. At the moment, few senior physicians in Japan have qualifications in laboratory medicine and are unable, therefore, to provide the necessary guidance to help the laboratory physicians in their work. I therefore believe that the board certification of JSLM should be regarded as mandatory for chairpersons of laboratory medicine. Our on-call service system can enhance the training in laboratory medicine, and improve not only laboratory quality assurance but patients' care as well.

Certification↗
PubMed2002

[The newly certified 105 Japanese medical technologists in clinical microbiology].

Interest in quality assurance(QA) in clinical laboratories in Japan has increased over the past 30 years. We have however been lagging behind countries such as the USA, Canada and the UK in QA of clinical microbiology. The main problem of QA in Japan is human resources. There are only about 400 laboratory physicians certified by the Japanese Society of Laboratory Medicine(JSLM). Almost no academics in microbiology are interested in QA and they mostly lack clinical competence. There is a small number of faculty positions, and promotions are mostly based on research productivity while medical graduates are increasingly drawn to bench work for basic, short-term research. The Japanese Society for Clinical Microbiology (JSCM) was established in 1990 in order to promote the development of clinical microbiology and its relevant fields in Japan. And 2001 was a milestone in sustained efforts of the JSLM to initiate qualifying examinations of medical technologists(MT) in clinical microbiology. 105 MT in clinical microbiology were newly certified by the Joint Committee of JSCM, JSLM, Japanese Association of Medical Technologists (JAMT) and College of Clinical Pathology of Japan(CCPJ). The certified MTs have appropriate educational background and are well motivated. With good on-the-job training, they are expected to perform effectively various tasks, including laboratory management. Recent radical changes in the health care delivery system have also had serious implications on laboratory services and QA of microbiological tests. The primary goal of the clinical microbiology laboratory is to provide accurate diagnostic testing and high-quality service at a low cost for its customers. It is believed that the Joint Committee and the newly certified MTs will contribute to narrowing the gap between Japan and other countries in clinical microbiology.

Certification↗