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Biomedical subjects

Toru Mori

Publications and source records attributed to Toru Mori.

28 records · Page 2Linked to original sources
PubMed2003

Pulmonary hilar lymph nodes in lung cancer: assessment with 3D-dynamic contrast-enhanced MR imaging.

PURPOSE: We performed 3D-dynamic MRI on patients with primary lung cancer to identify its usefulness for detecting hilar adenopathy shown at surgery. METHODS AND MATERIALS: 30 consecutive patients with peripheral lung cancer underwent preoperative 3D-dynamic Gd-DTPA-enhanced MRI. Two thoracic radiologists blinded to histopathologic findings reviewed those studies independently for hilar adenopathy visualization. The results were correlated with surgical and histopathologic findings. Interreader agreement for the detection of hilar adenopathy was assessed by means of the kappa statistic. RESULTS: Dynamic MRI demonstrated hilar adenopathy, with or without metastasis revealed at surgery, in all of 15 patients. Adenopathy without metastasis was shown in four patients. Dynamic MRI also revealed metastatic adenopathy in 11 of 12 patients with pathologically proven metastasis. There was only one case with lymph node metastasis that did not have adenopathy either on MRI or even at surgery. The diagnostic accuracy of dynamic MRI for adenopathy with or without metastases revealed at surgery were as follows; sensitivity, 100%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 100%, respectively. The diagnostic accuracy of dynamic MRI for hilar lymph nodes metastasis were as follows; sensitivity, 92%; specificity, 78%; positive predictive value, 73%; and negative predictive value, 93%. Interreader agreement was substantial (kappa=0.73) for detection of hilar adenopathy. CONCLUSION: Hilar adenopathy on 3D-dynamic MRI correlated well with that of surgical finding on patients with primary lung cancer. It may have the potential to make an accurate preoperative evaluation of hilar lymph node metastasis from lung cancer.

Adenocarcinoma↗
PubMed2003

[A new horizon of tuberculosis control and research].

In the 1990s, tuberculosis (TB) came to be recognized as one of re-emerging diseases and as a serious health issue worldwide. This has brought about many innovations for TB control and care. These include a series of bacteriological examination methods based on the nucleic acid amplification, immunological diagnostics for TB infection or active disease. The completion of the whole genome analysis of Mycobacterium tuberculosis opened the way to the development of novel modalities for therapeutics, diagnostics and vaccines. For TB control, WHO developed the DOTS strategy as a standard TB treatment programme that has been being expanded globally, in both developed and developing nations. Japan's TB control programme is being revised drastically in order to meet the change in the TB epidemiology, aiming at realization of the DOTS concept adapted into the Japanese setting of patient care.

Health Policy↗
PubMed2003

[Tuberculosis and society].

Brief review is made of the interconnections between tuberculosis and poverty and other social factors, with special emphasis on the current Japan's tuberculosis situation. In pre-war Japan, the tuberculosis had apparently an aspect of a socioecomic problem which led to lively discussions. With the progress in medical technology and control measures after the war, such aspect of the disease has become more masked and difficult to see. Often, it is viewed merely as a problem of a small and special fragment of the population such as homelessness, and its wide and diffuse connections with the society and economy are likely to be overlooked. Studies in tuberculosis, both basic and epidemiological, as well as multidisciplinary, should be further encouraged from such a point of view, in order to lay such interconnections bare, on which the new control strategy should be based.

Humans↗
PubMed2003

[A survey on the onset of tuberculosis in nursing homes].

PURPOSE: To obtain the informations how to promote early detection and prevention of nosocomial infection of tuberculosis in nursing homes for the elderly. SUBJECT: Fifteen elderly patients who developed tuberculosis from 1998 to 2002 at nursing homes within a certain health center jurisdiction area which has a total of 23 nursing homes were investigated. METHOD: We collected informations on these 15 patients concerning the clinical conditions, details of contact examinations and status of chemoprophylaxis by using TB registration card in the health center and interviewing with the members of staff of the nursing homes and hospitals, and case conferences conducted at the health center. RESULTS: Four patients died within 10 days after the diagnosis due to the delay in referring them to doctors. The most common symptoms leading to the detection was fever, followed by cough. DISCUSSION: Early diagnosis is the key to prevent early death and nosocomial infection of tuberculosis in nursing homes. A similar study will be useful at each health center or region to improve the tuberculosis control in nursing homes. CONCLUSION: Tuberculosis control programs in nursing homes should be strengthened. The staff of nursing homes should be trained for closer observations of the elderly about their health conditions such as fever and cough, and their early reference to physicians when such symptoms were observed. Two step tuberculin skin tests to the staff is also important for the contact investigations.

Aged↗
PubMed2002

[Tuberculosis in the patients undergoing haemodialysis in Japan, 1996].

UNLABELLED: We conducted a questionnaire survey on patients undergoing haemodialysis about the present situation of tuberculous incidence. They are immunocompromised hosts and are said to be at high risk of developing tuberculosis in many reports. (1) DESIGN Of the 167,192 patients on haemodialysis registered on December 31, 1996 in Japan, 71,411 patients were available for the questionnaire survey. Of the 2,893 hospitals used as the study subjects, 1,108 hospitals gave satisfactory replies. Of them, 141 hospitals reported that they had patients with tuberculosis in 1996, and 79 cases were collected by the detailed survey on tuberculosis patients conducted later. They included 45 male cases, 34 female cases for tuberculosis of all forms, 28 male cases, 15 female cases for pulmonary tuberculosis (PTB), 13 male cases, 4 female cases for tuberculosis bacilli positive pulmonary tuberculosis (TB positive PTB), and 17 male cases, 19 female cases for extrapulmonary tuberculosis. (2) RESULTS: In tuberculosis of all forms, the number of observed patients (O) against the number of patients expected (E) was calculated, and the standardized patients ratio (O/E ratio) was computed. It was 1.55 for male, 2.79 for female and 1.99 for total. The incidence of tuberculosis haemodialysis patients was significantly higher compared with the general population (p < 0.01). As to PTB, the O/E ratio was 1.01 for male, 1.40 for female and 1.16 for total; the incidence of PTB was not significantly higher compared with the general population. With TB positive PTB, the O/E ratio was 0.96 for male, 0.80 for female and 0.97 for total, and no significant difference was found. As for extrapulmonary tuberculosis, the O/E ratio was 13.45 for male, 13.07 for female and 12.97 for total; the incidence of extrapulmonary tuberculosis in haemodialysis patients was significantly higher (p < 0.01), but it was lower than these reported in the past literature. The seventy nine cases consisted of 52 primary treatment cases, 23 retreatment cases, and 4 unknown cases. Out of 79 cases, 36 cases developed tuberculosis almost at the same time or within 1 year after undergoing haemodialysis, and thereafter it decreased gradually. Underlying diseases for haemodialysis were mainly glomerulonephritis and diabetic nephropathy. There were many patients who failed to notify to the public health centers after the diagnosis of tuberculosis was made, and it is needed to improve such a situation in the future. The prognosis of tuberculosis undergoing haemodialysis was poor. Three out of 43 patients with PTB and 2 out of 13 tuberculosis pleurisy cases died. (3) CONCLUSION: The risk of developing PTB in patients undergoing haemodialysis was not high compared with the general population, however, the risk was much higher for extrapulmonary tuberculosis. Moreover, the treatment outcome was not satisfactory in patients with PTB and pleurisy. As patients undergoing haemodialysis have the factors which suppress the cell-mediated immunity, it is required to restudy the measures to prevent development of tuberculosis, management and treatment in the future.

Adult↗
PubMed2002

[Investigation on preventive measures of tuberculosis infection and onset of tuberculosis in nursing homes for the aged].

The need to strength on preventive measures of tuberculosis infection in Japanese medical institutions (include nursing homes) has been discussed in recent several years. The actual performance of measures to prevent the spread of tuberculosis infection among employees in hospitals has gradually become clearer, and various trials to improve the performance have simultaneously been made. However, actual performance of these preventive measures has not yet become clear in nursing homes for the aged. Therefore, we assessed actual status of preventive measures of infection and the incidence of tuberculosis among employees and residents in nursing homes for the aged where there are many elderly persons who are almost bed ridden, and we intended to solve problems in preventive measures for tuberculosis in welfare facilities for the aged. Measures to prevent infection were well considered in a few facilities, but these measures were in general not sufficient. The incidence of tuberculosis among employees and residents were lower compared with these in the age-matched general population, however, it could be possible that there was no responses from the welfare facilities where outbreak of tuberculosis was present. We outlined the essential points for concrete measures to prevent tuberculosis infection in nursing homes for the aged.

Adult↗
PubMed2002

[The present situation of daily life of tuberculosis patients treated in hospitals with beds for tuberculosis in Japan].

We sent a questionnaire to hospitals with beds for tuberculosis in Japan to know current situation of daily life of tuberculosis patients treated in hospitals. It was evident that some services of daily life facilities was delayed; e.g. the difficulty in using stores in a hospital, no dining rooms and no installation of a personal television set. The use of personal computers was not allowed in many hospitals. Tuberculosis patients were subjected to a marked restriction in the hospital in spite of their isolation from the family and the society. Patients were prohibited to go out from the ward except when they undergo certain examinations in the hospitals, to take a walk in the hospital compound and to go out or stay overnight outside the hospital. In the majority of hospitals, patients were allowed to take a walk or to stay overnight outside the hospital only after the negative conversion of tubercle bacilli in sputum. Judging from the above findings, it appears that many tuberculosis patients under hospital treatment are not spending a pleasant daily hospital life.

Health Facility Environment↗