[Microalbuminuria--laboratory methods and implications].
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Albuminuria↗
Biomedical subjects
K Kumasaka
Publications and source records attributed to K Kumasaka.
[A study on wounds caused by cats as basic materials of cat scratch disease].
Between October, 1992 and March, 1993, the incidence of bite or scratch by the cat, was surveyed by questionnaire in 1,619 peoples who were veterinarians, veterinary technicians, students and the general population (male 652, female 967). The wound rate by cat: Veterinarians, veterinary technicians, students of veterinary college, students of veterinary technician school were significantly higher than the general population. Incidence of bite or scratch in the cat owner were significantly higher than the non cat owner, and the incidence of wounds in cat owners was more than 90%. Most injuries for veterinarians were of the occupational nature. Their injuries clearly differed from those of the other groups. In our survey 33 cases were suspected to have CSD; 19 of 102 veterinarians, 4 of 45 veterinary technicians, 2 of 517 students of veterinary college, 1 of 400 students of veterinary technicians, 7 of 555 in the general population. Of the seven cases suspected for CSD among the general population, four were proven to have cat-scratches, suggesting that injuries can be prevented by clipping the cat's nails at home. However, most of the injuries suffered by veterinarians are caused by bites, prevention poses a more serious problem. It is therefore important to educate people in all fields to fully understand sanitation and zoonosis including CSD, and teach them to handle their pets appropriately.
Adolescent↗
[Lp(a) serum concentrations in diabetes mellitus].
Lp(a) has been considered as an independent risk factor for atherosclerosis, mainly for coronary heart disease. Recent epidemiologic studies have demonstrated elevation of Lp(a) serum concentration in diabetes mellitus. Atherosclerosis is the most common cause of death in diabetic patients, but there is little information available concerning the importance of Lp(a) in these patients. We investigated the relationship between Lp(a) serum concentration and the presence of chronic diabetic complications. Lp(a) was determined in 14 IDDM patients and 62 NIDDM patients. Median Lp(a) serum concentration in diabetics was 21.8 mg/dl, which was significantly higher than in nondiabetic controls described before. Glucose, HbA1c, fructosamine, total cholesterol, triglycerides, HDL-cholesterol, apolipoprotein A1, B and E were not associated with raised Lp(a) values. With increasing Lp(a) levels, higher prevalences of retinopathy and of albuminuria were observed. We conclude that in diabetic patients, Lp(a) levels are elevated compared with non-diabetic subjects, and that higher Lp(a) levels are associated with higher prevalences of retinopathy and of albuminuria.
Adult↗
[Revised objectives of postgraduate clinical training in JSCP].
Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insufficient. In 1979, the educational committee of the Japan Society of Clinical Pathology (JSCP) proposed the objectives of postgraduate training for clinical pathologist, and the minimal training period should be 5 years of which at least 1 year should be completed in internal medicine or anatomic pathology or clinical physiology. The field of clinical pathology seen dramatic development since 1979. Therefore, we here present the revised objectives of basic clinical training in 1993. This training in general internal medicine should be the precondition for further postgraduate training in clinical pathology or laboratory medicine. It is emphasized that clinical trainees should have basic clinical skills which include interviewing techniques, skills in physical examination and communication skills to other doctors and other medical co-workers in POS (Problem Oriented System).
Curriculum↗
A case of benign familial hyperphosphatasemia of intestinal origin.
We recently encountered a case of hyperphosphatasemia, in which > 90% of serum alkaline phosphatase (ALP) was of intestinal origin. The patient, a 51-year-old man, was found to have hyperphosphatasemia (2,341 U/L) during a routine medical check-up. All other laboratory tests and physical findings were normal. The agarose gel electrophoresis pattern of the patient's serum ALP was identical to that of common intestinal ALP from healthy adults, and only a single band of intestinal ALP was detected by immunoaffinity electrophoresis. In addition, 89% of total ALP was defined as intestinal ALP by an immunoprecipitation method. The molecular mass of the ALP was 154 kDa, almost identical with that of adult duodenal ALP. Analysis of the sugar chain structure showed an increased la fraction (74%) compared with adult duodenal ALP. Genealogical study revealed that two persons in the 5 members of the proband's family had hyperphosphatasemia of intestinal origin, indicating possible autosomal dominant inheritance.
Adult↗
Improvement in survival rate of patients with acral melanoma observed in the past 22 years in Sendai, Japan.
While the incidence of malignant melanoma is much lower in Japanese than in Caucasians, the commonest site of melanoma in Japanese has been reported to be the acral regions of the limbs. The survival rate for acral and nodular melanoma observed at the Department of Dermatology, Tohoku University Hospital in Sendai, Japan from 1969 to 1990 was reviewed. Among 150 melanoma patients 125 (83%) and 17 (11%) had primary cutaneous melanoma and mucous membrane melanomas, respectively. Frequent sites for cutaneous melanomas were the sole (31%) and subungual regions (15%). Comparison of the stages of plantar melanoma at diagnosis showed that the proportion of stages III and IV decreased after 1980 with a corresponding increase in those with a tumour thickness of less than 4 mm (stage II). Concurrently, the prognosis of plantar melanoma has improved; the 5-year survival rate in each of the three periods 1969-75, 1976-80 and 1981-85 was 21, 70 and 90%, respectively. This was also the case with subungual melanoma. Such improvements in the prognosis are thought to be mainly due to early detection through the growing public awareness of this life-threatening disease. By contrast cases of nodular melanoma increased sharply after 1980. Among these, the high proportion of patients in advanced stages (stages III and IV) remained static even after 1980, with a resultant low 5-year survival rate in the above mentioned periods of 33, 38 and 18%, respectively.
Female↗
[Studies on respiratory infection with Pasteurella multocida].
A questionnaire style survey on Pasteurella multocida infection was conducted at on 528 laboratories of hospitals. The questionnaire included the detection of Pasteurella multocida from sputum, the age distribution, underlying disease etc. of the patients. In Japan, infectious diseases caused by Pasteurella multocida were found in 179 cases in 67 (26.0%) of the 258 hospitals. The incidence of the infections tends to increase, 18 cases in 1989, 25 cases in 1990, 18 cases in 1991 (Jan.-Jul.). These 179 cases were broken down into 44 males (from 1 year old to 85 years old, mean 58.9 years old), 45 females (from 18 years old to 85 years old, mean 60.2 years old), and 90 patients whose sex was unknown. Underlying diseases were recognized in 72 cases. Diseases related to the respiratory organ were 61 (84.7%) cases. The cases of hemo-sputum had to be differentiated from malignant tumors Recurrent Pasteuralla multocida infections were recognized in 4 males and 4 females. And the 4 cases had been handling animals. There were only 26 cases who had contact with animals, the others were unknown. This result suggested that contact with animals may cause these infections. Recently, the detection of Pasteurella multocida from the sputum tends to increase. The elderly patient with chronic pulmonary disease, who is handling animals must be educated on hygiene and zoonosis.
Adolescent↗
[Current status of Pasteurella multocida infection in Japan].
Recently, the case reports of Pasteurella multocida infection has been increasing in Japan. In 1989, the Japanese Government, Veterinary Sanitation Division, Ministry of Health and Welfare officially communicated this infection as a zoonosis to related institutions. The current status of Pasteurella multocida infection is not well known in Japan. Because of this, a nation wide questionnaire survey on Pasteurella multocida was conducted to clarify the status. A questionnaire was sent to 380 laboratories of the hospitals, and 258 (67.9%) replied. An infectious disease caused by Pasteurella multocida was found in Japan in 369 cases in 115 (44.6%) of 258 hospitals, or an average of 3.2 cases per hospital. The 369 cases were broken down into 123 males (from 1 month old to 87 years old), 118 females (from 7 months old to 88 years old), and 128 patients whose sex was unknown. The incidence of the infections tends to increase year by year. This incidence is higher than our expectation. It is considered that the contact with pets will in increase the infection with this agents. The organism was isolated in as many as nineteen different body specimens, including the appendix and urine, which in Japan has not been reported as organs harboring this organism. Some of the nineteen cases were severely infected. This organism was isolated most often from the sputum (48.5%). Pus was the next most common site (27.1%). This order was reversed in the U.K. and the U.S.. Possible explanations for the reversal are given below.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Abnormal alkaline phosphatase of hepatic type in cerebrospinal fluid of a patient with intracranial metastasis from lung cancer.
High alkaline phosphatase (ALP) activity was found in the cerebrospinal fluid of a patient with intracranial metastases from adenocarcinoma of the lung. On agarose gel electrophoresis of the major ALP isoenzyme found in the cerebrospinal fluid, its mobility was different from those of the usual serum ALP isoenzymes. This abnormal mobility might be due to the linked glycan phosphatidylinositol anchor in the ALP molecule, as the mobility became the same as that of the common liver type ALP after treatment with phosphatidylinositol specific phospholipase. The immunochemical antigenicity of the cerebrospinal fluid ALP was identical with that of the common serum liver type ALP, but its sugar moiety was similar to the membranous liver-type ALP rather than the serum liver type ALP. The molecular size of the cerebrospinal fluid ALP was 140 kilodaltons, 12 less than the common serum liver type ALP, suggesting that the ALP in the patient's cerebrospinal fluid was derived from the intracranial metastatic carcinoma.
Alkaline Phosphatase↗
The effect of topical tretinoin on the photodamaged skin of the Japanese.
Fifteen middle aged or elderly patients with chronic solar damage of the skin, eight patients with melasma and three patients with xeroderma pigmentosum were treated with topical tretinoin for 6 months. There was a significant improvement in fine surface lines in periorbital region, but no significant improvement was observed in deep furrows. No significant change was induced in melasma despite the improvement in smoothness of the skin surface. Global improvement was also seen in one patient with xeroderma pigmentosum. With regard to the functions of the stratum corneum that was assessed on the flexor surface of the forearms, values of water content as well as transepidermal water loss were found to increase one month after start of the application of tretinoin cream. On the other hand, there was no significant change in the amino acid content of the stratum corneum when measured after 4 months of the treatment. It is concluded that tretinoin cream is capable of partly reversing fine surface lines in photodamaged facial skin of the Japanese. However the irritation induced by 0.1% tretinoin cream was unexpectedly severe in the Japanese as compared to that reported in Caucasians.
Administration, Topical↗
[The past and future of the clinical microbiology].
The purpose of clinical microbiology is to provide accurate information about microorganisms in a given specimen. This information is of significance to the patient as well as to the clinician. In this symposium, we discussed ways in which the microbiological laboratory has contributed to controlling infectious diseases as well as the advanced technology needed in the laboratory of the to future to quickly identify suitable chemotherapy. First, Dr. Kudo reviewed the past activities of microbiological laboratories. Then Dr. Machida, Dr. Okada and Dr. Kanno discussed the current situation and existing problems in clinical microbiology. Following that, Dr. Inamatsu presented a paper on the clinician's view of which microbiological examinations are useful inpatient treatment. Lastly, Mr. Sugahara discussed advanced technology in the field of clinical microbiology, and Dr. Kobayashi described the activity of microbiological laboratory as a part of an infection control unit in the hospital.
Forecasting↗
[Review of quality control program for clinical microbiology developed by the Tokyo Metropolitan Government].
UNLABELLED: There are limitations or disadvantages in previous nation wide external quality control (QC) programs. Therefore, the Tokyo Metropolitan Government and the Tokyo Medical Association (TMA) initiated the first regional annual external QC program in 1982. The QC results in chemistry, hematology and immunology have shown rapid improvement. By contrast, some serious problems in microbiology have been revealed. METHODS AND RESULTS: The Tokyo Metropolitan external QC programs consist of so-called "open" and "blind" surveys. Simulated specimens were prepared for open and blind surveys and all laboratories were asked to examine the specimens using routine procedures. All participants were required to report not only their test results such as codes for computer analysis, but also to describe the process. Written answers included the following subjects, procedures, culture characteristics and others: number and type of selective media, incubation conditions, colonial morphology, microscopic and biochemical characteristics of the microorganisms, etc. The survey reports on the identification of some kinds of pathologic organism were inaccurate. Discrepancies between the number of media used for routine procedures and the number used in open survey were detected. CONCLUSIONS: Previous nationwide external QC programs using frozen-dried organisms have been valuable in promoting general improvement in clinical microbiology in Japan, but they have revealed only gross errors. Our 10-year experience has convinced us that additional important information is obtained when using simulated specimens for open and blind surveys. The turnaround time and other aspects of the reporting of results should be monitored. Due to possible legal ramifications of QC surveys, laboratories are now more afraid of making errors than before. The continuing education of laboratory personnel is essential.
Humans↗
Unilateral dermatomal pigmentary dermatosis: a variant dyschromatosis?
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Adult↗
Giant condyloma acuminatum in a baby boy.
A giant condyloma acuminatum developed on the penis of a one and a half-year-old Japanese boy in two months. The histological features of this tumor were compatible with those of ordinary condyloma acuminatum. Although we detected the presence of human papilloma virus (HPV) type 16 by using the polymerase chain reaction system, we could not rule out the possibility that this HPV was present concurrently with other HPV types that cause condyloma acuminatum. The lesion was successfully treated with cryotherapy and topical application of 5% fluorouracil ointment under occlusion.
Condylomata Acuminata↗
Malignant melanoma complicated by schwannoma.
We report two cases of malignant melanoma associated with a schwannoma. Case 1 is a 32-year-old Japanese man who had a nodular melanoma in his epigastrium, associated with one subcutaneous nodule on the neck and another on the right thigh, both of which were histologically-proven schwannomas. Case 2 is a 48-year-old Japanese woman with an acral lentiginous melanoma on her right sole who later developed a schwannoma of the cerebello-pontine angle. Of all 146 malignant melanoma cases found in our clinic during the past 20 years, 1.4% were associated with a neurogenic tumour, a significant association.
Adult↗
[Studies on the giardiasis as the zoonosis. III. Prevalence of Giardia among the dogs and the owners in Japan].
To obtain the basic data on the route of Giardia infection as zoonosis, of many regions in Japan, the feces from 2218 dogs were examined for detection of Giardia cysts. Giardia cysts were detected in 239 of the 2218 dogs (10.9%), which was the same as previous reports from America. None were found from the owners of 51 dogs in which Giardia cysts were detected. The detection rates of each facilities were, 68 of 366 (18.6%) from the breeder's kennels, 169 of 1811 (9.3%) in individual houses, 2 of 42 (4.9%) from research institutes. The detection rate of the breeder's kennels was higher than the other two facilities (p less than 0.05, p less than 0.001). The detection rates of Kanagawa and Shizuoka prefectures among 17 regions in Japan were higher than the others (p less than 0.001, p less than 0.05). Especially in Shizuoka, the rate of the individual houses was higher than from breeder's kennels. In kanagawa the rates of the individual houses and the breeders kennels were higher than the mean in Japan (p less than 0.001). Therefore one must instruct the breeders when teaching health education to included zoonosis, and that the detection rate of the age groups of less than 3 years old was high-221 of 1276 (17.3%). Since the detection rates of Giardia cysts in the dogs were low, the possibility that human infection acquired from dogs was low. However, some of patients with giardiasis we encountered had never been abroad, and it is not yet clear whether Giardia is strictly host specific or not, so attention should be paid to the possibility of cross-infection between man and animals.
Animals↗
[Clinicobacteriological study of Pasteurella multocida as a zoonosis (1). Condition of dog and cat carriers of Pasteurella, and the influence for human carrier rate by kiss with the pets].
Pasteurella multocida is a gram-negative short rod-shaped bacteria, which is a part of the indigenous flora of the oral cavity of many animals other than man. The number of reports on cases of infections with this bacterium due to animal bites and/or scratches, bacterial infections of the respiratory tract, sepsis due to this organism and death caused by the bacteria have been increasing in recent years. We investigated P. multocida in the hair and oral cavity of 3 dogs and 29 cats according to the classification of Mutters et al.. We also studied the relationship between the carrier rate for Pasteurella in the oral cavity and kissing of pets in 24 pet owners (3 dogs and 11 cats). No P. multocida was isolated from the hair of neither dogs nor cats. One strain of P. multocida subsp. multocida and two strains of P. stomatis, were isolated from the oral cavity of dogs, and 35 strains of Pasteurella were isolated from the oral cavity of cats. Two strains of P. multocida subsp. multocida, whose biochemical properties were different, were detected in the oral cavity of one cat. In three cats, Pasteurella other than P. multocida subsp. multocida was isolated from the same oral cavity. No Pasteurella was detected in the oral cavity of 19 pet owners who had not kissed their cats, whereas P. stomatis was isolated from the oral cavity of one of 2 pet owners who had kissed their cats and in 2 of 3 pet owners who had kissed their dogs (the same bacteria was isolated from a dog that was being kept by some of these positive pet owners).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[The first report of human chronic sinusitis by Pasteurella multocida subsp. multocida in Japan].
A 53-year-old male visited our hospital due to nasal obstruction persisting for 6 months and constant rhinorrhea. Pasteurella multocida subsp. multocida was isolated from his nasal discharge and lavage fluid of the maxillary sinus, and also from the oral cavity of the dog he kept. The bacterial strains isolated from the patient and dog were identical in terms of biochemical properties, and drug sensitivity. Although serotype was different, the strain from the patient showed (A:6) and that from his dog showed (A:5). The microorganism is not present in the general environment. The patient had contact with his dog such as he kissed it frequently, gave it food with his chopsticks et al.. From the mouth of the people who kiss one's dog, we detected Pasteurella of the same character of bacteria as from the mouth of the dog. We detected two Pasteurella multocida of different character from only one mouth of a cat. Pasteurella multocida was checked in only one colony for sero type. Sero type A is the popular type for dogs and cats. The above suggest that their was a high possibility that the Pasteurella multocida subsp. multocida found in the patient was from his dog. In Japan, the incidence of Pasteurella multocida subsp. multocida infection has been increasing. In 1969, the Japanese Ministry of Health and Welfare officially communicated this infection as a zoonosis to related institutions. At both medical and surgical departments, wither the patient keeps a pet should be confirmed during interview, and guidance of pet keeping methods is important in some cases from the aspect of clinical bacteriology.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗