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Kunihiko Ito

Publications and source records attributed to Kunihiko Ito.

At least 19 recordsLinked to original sources
PubMed2006

[Comparison of sputum positive rate between bilateral and unilateral lung tuberculosis].

PURPOSE: Comparing sputum smear/culture positive rate between unilateral lung tuberculosis and bilateral ones with similar extent of lesion. SUBJECT AND METHOD: Retrospective review of patients' records in the author's hospital from Jan. 1/2002 to Sep. 30/2003. RESULTS: In unilateral (N=58) and bilateral (N=82) lung tuberculosis of "Gakkai classification" (= chest X-ray classification of lung tuberculosis according to the Japanese Society for Tuberculosis). II 2 (cavitary lung tuberculosis with moderate extent), positive rates of the initial sputum investigation by smear/Ogawa culture/MGIT were, 84.6% vs. 74.0%/ 88.5% vs. 93.2%/93.5% vs. 97.1%, respectively, and no significant difference was found. Similarly, in Gakkai classification III 1 (non-cavitary lung tuberculosis with minimal extent) and in Gakkai classification III 2 (non-cavitary lung tuberculosis with moderate extent), no significant differences were found in sputum bacilli positive rates between unilateral and bilateral lung tuberculosis. CONCLUSION: Sputum smear and culture positive rates of bilateral lung tuberculosis showed no significant differences with that of unilateral one with similar extent.

Humans↗
PubMed2006

[Tuberculosis control in health care facilities for the elderly, from the viewpoint of risk management].

OBJECTIVES: To discuss the optimal TB control system in health care facilities for the elderly where the periodic TB screening is currently not obligatory. METHODS: A study was conducted in three health care facilities for the elderly in Tokyo during the period from 2002 to 2004, and 212 admitted elderly persons were enrolled in this study. Medical charts were analyzed to identify informations about mental and physical conditions and TB risk factors. Questionnaire-based interviews were conducted in 58 residents who had no dementia or no serious conditions. TB mass screening was carried out with a mobile vehicle equipped with computed radiography, financially supported by the Tokyo Metropolitan Government. Since this mobile vehicle is equipped with a special wheelchair for chest X-ray examination, most elderly persons were able to receive chest X-ray examination. Medical chart review and interview were conducted at around the time of TB mass screening. The screening results of 183 elderly residents who received X-ray examination were reviewed. RESULTS: Of the 212 persons admitted to the facilities, 73.1% were women. The mean ages of men and women were 80.7 and 84.2 years, respectively. Mental disorders were observed in 42.9% and dysfunction of extremities in 54.7%. At the time of admission, chest X-ray records were submitted by the attending doctors in 73.1% of the residents, but this proportion differed among facilities. From these records, old TB was found in 12.3%; however this proportion was 20.8% according to the TB mass screening results. A history of TB was more prevalent in the group interviewed than in the non-interview group (24.1% vs. 6.5%; p < 0.001). Two facilities had conducted TB screening for three consecutive years and comparative reading of chest X-ray films could be done in 35.8%. The remaining facility conducted TB screening for the first time, and comparative reading was not possible. The proportion of cases requiring further investigations was higher in the facility where TB screening was conducted for the first time (2.8% vs. 13.0%; p = 0.008). No active TB patient was detected in this study. CONCLUSION: From the viewpoint of risk management for tuberculosis, it is important to establish a system of early case finding for the aged persons admitted to health care facilities for the elderly. Therefore, the information on risk factors should be collected properly at the time of admission, and careful attention should be paid to the residents with risk factors, for the possible development to active disease. X-ray records submitted by the attending doctors or by screening would provide useful informations for early diagnosis, when abnormal shadows are found on chest X-ray films.

Aged, 80 and over↗
PubMed2006

[Number of concentrated sputum smears needed to adequately assess infectivity of patients with pulmonary tuberculosis].

PURPOSE: Investigating the usefulness of 3rd concentrated sputum smear for assessments of infectivity of pulmonary tuberculosis patients. OBJECT AND METHOD: Retrospective study of the results of diagnostic 3 consecutive concentrated-sputum-smear (fluorochrome stain) of culture-proven pulmonary tuberculosis cases at our hospital from Jan. 2002 to Sep. 2003. RESULT: Altogether 362 cases were available for analysis, and 306 (84.0%) cases were smear-positive on 3 consecutive sputum tests. Of these cases, 26 cases (8.6% of smear-positive cases) were firstly smear-positive by the 3rd sputum. Of 278 cases that were already smear-positive at first and/or second sputum smear, 40 cases (13.2% of smear-positive cases) showed the highest smear-positive grade at 3rd sputum-smear, but only 6 cases (2.0% of smear-positive cases) had smear-positive grade higher by two-grade (+/- to more than 2+, or 1+ to 3+). CONCLUSION: From the results of this study together with literature review, sensitivity of 2 concentrated sputum-smear tests by fluorochrome stain is presumed to be same as, or better than that of 3 direct sputum-smear tests by Ziehl-Neelsen stain. We have to re-consider the number of concentrated sputum smear tests needed to assess the infectivity of pulmonary tuberculosis.

Adolescent↗
PubMed2006

[The role of simultaneous combination culture with solid and liquid media for diagnosis of pulmonary tuberculosis].

PURPOSE: To study the usefulness of simultaneous combination culture with egg-based Ogawa medium (1 slant) and MGIT (Mycobacterium growth indicator tube/Becton-Dickinson) for detection of M. tuberculosis from sputum in sputum-culture proven pulmonary tuberculosis patients. OBJECT AND METHOD: Retrospective study of sputum-culture-positive pulmonary tuberculosis cases in our hospital (with tuberculosis ward) from Jan. 2002 to Sept. 2003. RESULT: In 1103 sputum culture for the diagnosis of 370 sputum-culture proven pulmonary tuberculosis cases, 86.0% were MGIT positive and 79.5% were Ogawa positive. Among sputa contaminated on MGIT, 56.1% (23/41) were positive on Ogawa. Among sputa culture-negative on MGIT, 2.7% (3/113) were positive on Ogawa. Those 3 sputa were obtained from 3 different patients, and in 2 of them, other sputa were positive on MGIT. Frequency of "M. tuberculosis strain which can be cultured only by Ogawa" was supposed to be at maximum 0.27% (1/370). Of 41 sputa contaminated on MGIT, 15 sputum specimens were re-treated and re-cultured by MGIT. Of these specimens 46.7% (7/15) were positive on Ogawa, and 73.3% (11/15) were positive on re-treated MGIT, and the difference was not statistically different. CONCLUSION: From the standpoint of detection of M. tuberculosis from sputum in sputum-culture proven pulmonary tuberculosis patients, simultaneous combination culture of Ogawa medium with MGIT is useful, mainly for risk management of MGIT contamination. But, if re-treated MGIT is done for cases of contaminated on MGIT, simultaneous combination culture of Ogawa medium with MGIT is not necessary.

Aged↗
PubMed2006

[Number of sputum cultures by MGIT system needed to diagnose pulmonary tuberculosis].

PURPOSE: To study the number of sputum cultures by MGIT system (Becton-Dickinson) needed to diagnose pulmonary tuberculosis. OBJECT AND METHOD: Prospective study of all patients who visited our hospital, and were strongly suspected of pulmonary tuberculosis during the period from Jan. 2002 to Sept. 2003. In these patients, 3 consecutive sputum cultures were done by both MGIT-system and egg-based Ogawa medium (1 slant). RESULTS: Altogether 290 cases of sputum-culture positive pulmonary tuberculosis were available for analysis. In 210 first-sputum-smear positive cases, incremental yield of 3rd sputum culture in 3 consecutive MGIT cultures was equal to or less than 1.0% and 98.1% of culture positive cases were detected by 2 consecutive MGIT cultures. In 80 first-sputum-smear negative cases, incremental yield of 3rd sputum culture in 3 consecutive MGIT cultures was equal to or more than 5.0%, and 90.0% of culture positive cases were detected by 2 consecutive MGIT cultures. This detection rate was almost the same as the calculated detection rate (91.4%) by 3 consecutive Ogawa (2 slant) cultures (previous standard method). CONCLUSION: It was suggested that 2 consecutive sputum cultures by MGIT were sufficient to detect M. tuberculosis in first-sputum-smear positive cases, but 3 consecutive sputum cultures by MGIT were relatively useful in first-sputum-smear negative cases.

Culture Media↗
PubMed2006

[Comparison between direct smear by Ziehl-Neelsen and concentrated smear by fluorochrome stain].

PURPOSE: For the purpose of supporting more completely our assertion that two times concentrated sputum smear tests by fluorochrome stain are more sensitive than or at least equal to 3 times direct smear tests by Ziehl-Neelsen stain, we compare the sensitivity of concentrated smear by stain (conc-smear) and direct smear by Ziehl-Neelsen stain (di-smear). OBJECT AND METHOD: Retrospective study of sputum acid-fast smear tests in our hospital with tuberculosis ward from Jan. 1, 2003 to Sep. 30, 2005. RESULT: 170 of 899 sputums on which both conc-smear and di-smear were done, were smear positive by at least one of the two smear method. Of those 170, 167 (98.2%) were positive by conc-smear and 113 (66.5%) were positive by di-smear, and the difference was statistically significant (p<0.001). Of those 110 that were positive by both conc-smear and di-smear, in 65 (59.1%) smear grade by conc-smear were higher than that of di-smear, and in 3 (2.7%) smear grade by di-smear were higher than that of conc-smear. Smear grades in conc-smear were significantly higher than that of di-smear (p< 0.001). CONCLUSION: In sensitivity and smear grades, conc-smear was superior to di-smear. Together with previous report, 2 times conc-smear tests are supposed to be superior to 3 times di-smear.

Bacteriological Techniques↗
PubMed2006

[Liver damage in treatment of latent tuberculous infection by isoniazid].

PURPOSE: To study the frequency and degree of liver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people. OBJECT AND METHOD: Chart review of Japanese persons who started isoniazid preventive chemotherapy in the two clinics in Tokyo, from 2003/1/1 to 2004/12/31. RESULT: There were 779 cases who did not transiently or completely stop INH preventive therapy because of adverse effect, and 26 cases who stopped INH transiently or completely because of liver damage as adverse effect (total 805 cases). In 371 cases, of those 779 cases, AST (asparate aminotransferase) and ALT (alanine aminotransferase) was measured after starting INH at least once. In 14.9% (59/397) of these 391 cases (= 371 + 26), liver damage as adverse effect was found. In 1.51% (6/397), liver damage with AST and/or ALT higher than 400 IU/L was found. Clinical hepatitis, associated with clinical symptom of hepatitis, was seen in 0.37% (3/805). Hepatitis with liver failure was seen in 0.12%. There was no death due to liver damage. CONCLUSION: Liver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people is not rare.

Adolescent↗
PubMed2005

Microbiology of Bartholin's gland abscess in Japan.

This study was conducted to determine the current epidemiology concerning the causative organisms for Bartholin's gland abscess in Japan. Microbiological examination of 224 cases showed positive results in 219 cases and negative results in 5 cases. Of all of the bacterial isolates, 307 and 118 were aerobes and anaerobes, respectively. The most frequently isolated bacterium was Escherichia coli. Of the anaerobes, the most frequently isolated organism was Bacteroides species, followed by Prevotella species. The organisms related to respiratory infectious diseases, such as Streptococcus pneumoniae and Haemophilus influenzae, including resistant bacteria, were sometimes involved between 2000 and 2004.

Abscess↗
PubMed2005

[Risk of acquisition of RFP resistance out of INH resistant RFP susceptible tuberculosis].

OBJECTIVE: To investigate the prognosis of isoniazid (H) resistant rifampicin (R) susceptible tuberculosis cases with emphasis on the risk factors of developing MDR. METHOD: Retrospective review of H resistant R susceptible tuberculosis cases that were treated at Fukujuji Hospital in Japan between 1990 and 2000. RESULTS: Four cases developed drug resistance and became MDR. Seventy seven cases completed treatment with bacteriological confirmation of negativity during treatment and 2 years after treatment (cure). Other 38 cases completed treatment with confirmation of culture negativity at the end of treatment but one of them relapsed within 2 years and the remaining 37 cases were not followed up for 2 years. Fourteen cases died, 13 cases defaulted and 17 cases were transferred out. The comparison of the regimen of chemotherapy between cured cases and cases who became MDR showed that more cured cases were found among those who started treatment with 4 drugs or more than cases who started treatment with 3 drugs or less. Other factors that were related (but not significant) to cure rate were non-diabetics in comparison with diabetics and 4 drug standard regimen (HRZS, HRZE) in comparison with 3 drug standard regimen (HRS, HRE). DISCUSSION: Prevention of MDR could be achieved by wider use of 4-drug standard regimen and changes of chemotherapy regimen promptly responding to the results of drug susceptibility tests.

Adult↗
PubMed2005

[Reinfection of tuberculosis in HIV-negative persons].

To clarify our knowledge about exogenous reinfection of Mycobacterium tuberculosis in HIV-negative persons, we review the literatures on this issue as much as possible, and we deduce the following; 1) Risk of exogenous reinfection may be not rare in itself, but quantifiably determined by host factor, bacilli factor and intensity of exposure. 2) Generally, when already-infected persons are exposed to exogenous reinfection Mycobacterium tuberculosis, risk of disease due to the exposure is definitely lower than not-already-infected persons (estimated relative risk: 8.5%). But the protection rate can be similar with that of BCG vaccination under most favorable condition. 3) It cannot be concluded definitely that the tuberculosis disease in already-infected persons is almost always due to endogenous reactivation.

BCG Vaccine↗
PubMed2005

[Limits of chest X-ray investigation in the diagnosis of recurrent pulmonary tuberculosis].

PURPOSE: To investigate the usefulness of chest X-ray investigation for early diagnosis of recurrent pulmonary tuberculosis. OBJECT: Patients who start re-treatment at Fukujuji Hospital from 1993 to 2003 due to the recurrence of lung tuberculosis after the completion of standard chemotherapy. METHOD: Chart review. RESULT: Deterioration of chest X-ray was not observed in 19.5% (8/41) of recurrent pulmonary tuberculosis, and in 4 cases even improvement of chest X-ray finding was observed. Sensitivity of chest X-ray in all recurrent cases was around 80 %, and this figure did not increase in smear positive recurrent cases. Sensitivity of chest X-ray for symptomatic recurrent cases was 92.3%, and that for non-symptomatic recurrent cases 60.0%, which is significantly lower than that for symptomatic cases. CONCLUSION: Sensitivity of chest X-ray for early diagnosis of recurrent pulmonary tuberculosis is not very high, and bacteriological examinations are more important irrespective of chest X-ray finding. Especially in non-symptomatic recurrent cases, usefulness of chest X-ray is considerably limited. Method and necessity of regular follow-up in non-symptomatic persons after successful tuberculosis chemotherapy should be re-considered.

Adult↗
PubMed2005

[Should chemotherapy for pulmonary tuberculosis be started after the completion of pretreatment sputum examination?].

PURPOSE: Investigation on the influence of early start of chemotherapy on the results of sputum smear and culture (Ogawa medium and BACTEC MGIT960). OBJECT AND METHOD: Retrospective study for tubercle bacilli positive pulmonary tuberculosis cases in our hospital. RESULT: Starting chemotherapy before the completion of pretreatment sputum examination was found to have no adverse effect on smear positive rate and smear positive grade (246 cases), culture contamination rate on Ogawa medium and BACTEC MGIT960 (1128 sputums), culture positive rate and culture positive grade/time to confirm positive on Ogawa medium (245 cases), and culture positive rate on BACTEC MGIT960 (239 cases). Time to confirm positive on BACTEC MGIT960 was slightly, but significantly prolonged (1.16 days delay in cases with 1-3 days chemotherapy [228 cases], and 4.01 days delay in cases with 4-6 days chemotherapy [59 cases]). CONCLUSION: Unfluence of early start of chemotherapy on the results of sputum smear and culture is minor. In most of bacilli positive pulmonary tuberculosis cases chemotherapy can be started before the completion of pretreatment sputum examination.

Adolescent↗
PubMed2004

Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions.

Ultrasonography (US) of the thyroid gland has recently proved to be a useful clinical diagnostic method, and the newly developed high-resolution US with a color Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of a thyroid neoplasm. US can yield a diagnostic accuracy of more than 90% for thyroid carcinoma, especially papillary carcinoma. However, neither conventional B-mode US imaging nor aspiration biopsy cytology has delivered satisfactory results for follicular carcinoma. The aim of this study was to evaluate the clinical usefulness of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. A color Doppler scan was performed in 310 patients with a solitary cold nodule, and a combination of B-mode US and color Doppler findings, including tumor vascularity and results of a fast Fourier transform (FFT) analysis were used to create the following diagnostic grading system for differential diagnosis of follicular lesions: grade 1, benign follicular lesion [no color flow mapping (CFM) inside the nodule]; grade 2, benign peripheral type [CFM only in peripheral area, pulsatility index (PI) < 1.0]; grade 3, suspected follicular carcinoma (penetrating CFM, vascularity moderate); grade 4, follicular carcinoma (high-velocity penetrating CFM, PI = 1.0). All patients were subjected to surgical resection, and histologic examination was used to confirm the diagnosis. The grades of the 177 adenomatous nodules were as follows: grade 1, 46.9%; grade 2, 48.0%; grade 3, 5.1%; grade 4, 0%. The corresponding percentages for the 89 follicular adenomas were 16.9%, 49.4%, 30.3%, and 3.4%; and for the 44 follicular carcinomas they were 0%, 13.6%, 45.5%, and 40.9%. On the assumption that grade 1 and 2 lesions are benign and grade 3 and 4 lesions are malignant, 38 of the 44 follicular carcinomas and 227 of the 266 benign tumors had been accurately diagnosed, yielding a sensitivity of 88.9%, a specificity of 74.2%, and an accuracy of 81.0% for the grading system. Color Doppler imaging of 310 follicular tumors has revealed that high-velocity pulsatile blood flow penetrating the tumor is a characteristic finding of follicular carcinoma and is a new diagnostic criterion for performing color Doppler imaging. The differential diagnostic grading scores for color Doppler examinations and the results of FFT analysis demonstrate that US with the color Doppler function can play an important role in the differential diagnosis of thyroid tumors.

Adenoma↗
PubMed2004

SNPs in the promoter of a B cell-specific antisense transcript, SAS-ZFAT, determine susceptibility to autoimmune thyroid disease.

Autoimmune thyroid disease (AITD) is caused by an immune response to self-thyroid antigens and has a significant genetic component. Antisense RNA transcripts have been implicated in gene regulation. Here we have identified a novel zinc-finger gene, designated ZFAT (zinc-finger gene in AITD susceptibility region), as one of the susceptibility genes in 8q23-q24 through an initial association analysis using the probands in the previous linkage analysis and a subsequent association analysis of the samples from a total of 515 affected individuals and 526 controls. The T allele of the single-nucleotide polymorphism (SNP), Ex9b-SNP10 located in the intron 9 of ZFAT, is associated with increased risk for AITD (dominant model: odds ratio = 1.7, P = 0.000091). The Ex9b-SNP10 falls into the 3'-UTR of truncated-ZFAT (TR-ZFAT) and the promoter region of the small antisense transcript of ZFAT (SAS-ZFAT). In peripheral blood lymphocytes, SAS-ZFAT is exclusively expressed in CD19+ B cells and expression levels of SAS-ZFAT and TR-ZFAT seemed to correlate with the Ex9b-SNP10-T-associated ZFAT-allele, inversely and positively, respectively. The Ex9b-SNP10 is critically involved in the regulation of SAS-ZFAT expression in vitro and this expression results in a decreased expression of TR-ZFAT. These results suggested that the SNP-associated ZFAT-allele plays a critical role in B cell function by affecting the expression level of TR-ZFAT through regulating SAS-ZFAT expression and that this novel regulatory mechanism of SNPs might be involved in controlling susceptibility or resistance to human disease.

B-Lymphocytes↗
PubMed2004

Association of the T-cell regulatory gene CTLA4 with Graves' disease and autoimmune thyroid disease in the Japanese.

Autoimmune thyroid disease (AITD) is caused by an immune response to self-thyroid antigen. The cytotoxic T-lymphocyte antigen-4 ( CTLA4) gene, encoding a negative regulator of the T-lymphocyte immune response, had been reported to be associated and/or linked to AITD. Recently, AITD susceptibility in the Caucasians was mapped to the 6.1-kb 3'UTR of the CTLA4 gene, in which the three single-nucleotide polymorphisms (SNPs) CT60, JO31, and JO30 were strongly associated with AITD. In order to determine the association of the CTLA4 gene with AITD in the Japanese, case-control association analysis for the four SNPs of the CTLA4 gene using 380 AITD patients and 266 healthy controls was done. Among the SNPs examined, the SNP JO31 was most significantly associated with AITD in the Japanese, whereas the association of the JO30 with AITD was not observed. The frequency of the disease-susceptible G allele of the JO31 of the Japanese control was higher than that of the Caucasians (67.1% vs 50.2%); however, the G allele of the JO31 was associated with Graves' disease (GD) (67.1% vs 76.3%, P=0.0013) and AITD in the Japanese (67.1% vs 74.2%, P=0.0055). Furthermore, the G allele of the JO31 was associated with the increased risk for GD [ P=0.0051, odds ratio (OR)=1.7] and AITD ( P=0.016, OR=1.5) in a dominant model. These results suggested that the CTLA4 gene is involved in the susceptibility for GD and AITD in the Japanese.

Alleles↗
PubMed2004

Adenolipoma of the thyroid gland: report of a case.

We report a case of adenolipoma of the thyroid gland, which is very unusual because thyroid adenoma rarely contains mature adipose tissue. A 55-year-old Japanese woman presented with a 1-month history of a neck mass. A blinded fine-needle aspiration biopsy showed benign follicular cells with no adipose cells, and we performed a left hemithyroidectomy. The specimen measured 7.0 x 4.4 cm and weighed 59.9 g. The cut surface of the tumor revealed a solid yellowish mass, and hematoxylin-eosin staining showed that the solid tumor was well separated from the adjacent thyroid tissue by a thin fibrous capsule. The tumor was found to be follicular adenoma composed of epithelial cells arranged in monotonous microfollicular patterns, intermingled with mature adipose tissue. No adipose tissue was found outside the tumor, and there were no signs of amyloid deposits in the tumor or adjacent thyroid tissue. The pathological diagnosis was adenolipoma of the thyroid gland. We discuss the pathogenesis of this entity and review the previously documented cases.

Adipose Tissue↗
PubMed2004

Surgical treatment of Graves' disease in children.

Thyroidectomy may be indicated in children with Graves' disease who have adverse reactions to antithyroid drugs or who relapse after antithyroid drug therapy. We investigated the characteristics of childhood Graves' disease from the standpoint of surgical outcome. Between 1989 and 1998, 1897 patients with Graves' disease underwent thyroidectomy and their thyroid function could be evaluated 2 to 3 years after thyroidectomy. The patients were divided into three groups according to age at thyroidectomy: 74 patients were 15 years old or less (children), 345 patients 16 to 20 years of age (adolescents), and 1478 patients 21 years of age or more (adults). The children included higher proportions of patients who had a large goiter (> 100 g), high thyrotropin-binding inhibitory immunoglobulin (TBII) level (> 50%), and small remnant thyroid (< 4 g). At 2 to 3 years after thyroidectomy, the overt recurrence rate of the children, adolescents, and adults was 9.5%, 4.9%, and 5%, respectively. The cumulative recurrence-free rate of the children, adolescents, and adults at 5 years after thyroidectomy was 82%, 90%, and 92%, respectively. Surgical complications were more frequently observed in children. Considering the aggressiveness of childhood Graves' disease, subtotal thyroidectomy with thyroid remnant less than 3 g is the procedure of choice for preventing recurrent hyperthyroidism.

Adolescent↗