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Biomedical subjects

T Mitsuda

Publications and source records attributed to T Mitsuda.

At least 37 records · Page 2Linked to original sources
PubMed1997

Mixed connective tissue disease in childhood: a nationwide retrospective study in Japan.

Sixty-six children with mixed connective tissue disease (MCTD) were analyzed by a nationwide prospective study. The diagnostic significance of Raynaud's phenomenon and positive anti-RNP antibody was confirmed, and additional symptoms including swelling of fingers, facial erythema, and polyarthralgia, and laboratory findings such as positive rheumatoid factor, hypergammaglobulinemia, and increased levels of myogenic enzymes, were variably positive. These clinical and laboratory characteristics of MCTD were critically different from those of systemic lupus erythematosus, indicating that MCTD is an independent entity of disease.

Adolescent↗
PubMed1997

[Analysis of children with tuberculosis in the past 20 years].

To characterize the clinical features of childhood tuberculosis, we analyzed the symptoms, signs, and laboratory findings of the 89 children with tuberculosis admitted to the Yokohama City University Hospital from 1975 to 1994. Compared with the numbers of patients admitted from 1975 to 1979, those of patients of the past 5 years (from 1990 to 1994) were reduced by half. Of the 89 subjects, 56.2% were below 3 years of age and 24.7% were under 1 year of age. 51.7% had primary complex and 20.2% had serious tuberculosis (tuberculous meningitis 14.6%, miliary tuberculosis 3.4%, and bone and joint tuberculosis 2.2%). Tuberculous children below 3 years of age consisted of primary complex (60.0%) and serious tuberculosis (32.0%). The majority (86.0%) of tuberculous children below 3 years of age had not received BCG vaccination. In 55 (61.8%) of 89 subjects, the sources of tuberculosis were clarified. Of these subjects, 83.6% were infected in the family. The rate of BCG inocluation tended to decrease with decreasing age, especially that of children below 3 years of age was 14.0%. Of the 89 subjects, only 16.9% proved to be smear-positive. Taken together, in order to eliminate tuberculous children below 3 years of age, the following is necessary; (1) BCG inoculation in early infancy, (2) early diagnosis of index cases with adult tuberculosis, and (3) prompt and appropriate family contact examination.

Adolescent↗
PubMed1997

[A case of macrophage activation syndrome developed with systemic juvenile rheumatoid arthritis].

We reported a child of macrophage activation syndrome (MAS) associated with the course of systemic juvenile rheumatoid arthritis (sJRA). The clinical and laboratory findings in our case was ascribed to the overproduced inflammatory cytokines especially TNF-alpha by activated macrophages. Moreover, macrophage-colony stimulating factor (M-CSF) was also elevated in the active phase of the disease, and decreased in the convalescent phase, indicating that M-CSF can be the most potent stimulator of macrophages to produce inflammatory cytokines. Cyclosporine A along with plasmaexchange and corticosteroid, instead of VP16 or other immunosuppresive agents, was effecting in the management of this severe, life-threatening MAS.

Anemia↗
PubMed1996

Demonstration of mother-to-infant transmission of Staphylococcus aureus by pulsed-field gel electrophoresis.

UNLABELLED: We assessed mother-to-infant transmission of Staphylococcus aureus. Anterior nares swabs of 466 pregnant women, vaginal swabs of 305 of these women and anterior nares swabs of 305 6-day-old infants were examined for the presence of S. aureus. The results showed that 7.5% of the vaginal swabs from the pregnant women and 10.1% of the anterior nares swabs from the infants were positive for S. aureus. Six of the 466 pregnant women (1.3%) and 12 of the 305 infants (3.9%) carried methicillin-resistant S. aureus (MRSA) in the anterior nares site, but none of the vaginal specimens were positive for MRSA. Analysis of SmaI digested chromosomal DNA analysis using pulsed-field gel electrophoresis (PFGE) showed that methicillin-sensitive S. aureus (MSSA) strains obtained from four pairs of pregnant women and their infants were completely identical, which strongly suggests [correction of suggesting] mother-to-infant transmission of S. aureus. CONCLUSION: This study elucidated the prevalence of S. aureus carriage among pregnant women and newborn infants. Mother-to-infant infection of S. aureus was demonstrated phenotypically and genetically. PFGE is a useful tool to detect infection routes including mother-to-infant infection.

Bacterial Toxins↗
PubMed1996

[A case of staphylococcal scalded skin syndrome caused by exfoliative toxin-B producing MRSA].

We experienced a 6 month-old infant who suffered from staphylococcal scalded skin syndrome (SSSS), whose mother used steroid ointment for the infant's erythematous skin rash for 2 days. On the 3rd day, the infant was admitted to our hospital with fever, erythema on the trunk and extremities, and flaccid blisters and erosions at periorificial areas and the neck. Nikolsky's sign was positive. S. aureus was cultured from the throat, conjunctival inflammatory lesion and exudates. The biological characteristics of the isolates were coagulase type I, enterotoxin-nonproducing, TSST-1-nonproducing, protease pattern: D type, and plasmid profile: 563 kbp. The investigation of exfoliative toxin (ET) revealed negative for ET-A but positive for ET-B, proved by polymerase chain reaction (PCR). The isolated strain of S. aureus was demonstrated to be methicillin-resistant (MRSA), which was further defined to be positive for mec A gene by PCR method. It will be possible for such toxigenic ET-B producing MRSA to gain the dominant status in NICU or closed areas.

Base Sequence↗
PubMed1996

[Serial computed thermography for Raynaud's phenomenon of patient with progressive systemic sclerosis (PSS)].

We reported a case with progressive systemic sclerosis, a relatively rare disease in childhood. Raynaud's phenomenon (RP) of the patient was serially monitored by computed thermography for 1 year. Although clinically apparent RP manifested only in winter season, thermographical changes were documented through all season, suggesting that RP is a constitutional sign which may emerge in winter by provocation of atmosphere. Thus, we recommend to use the words, "Raynaud's phenomenon" and " Raynaud's symptom", in an appropriate meaning. RP of the patient, however, varied depending on the time determined, which indicated that the cause of RP is not due to the irreversible tissue degenerations, but due to the reversible functional factors. Computed thermography was proved useful for detecting RP objectively, and will be valuable for estimating the effects of medications for RP.

Adult↗
PubMed1995

Epidemiological analysis of strains of methicillin-resistant Staphylococcus aureus (MRSA) infection in the nursery; prognosis of MRSA carrier infants.

Forty-five neonates who carried methicillin-resistant Staphylococcus aureus (MRSA) were studied. Retrospective molecular analysis using pulsed-field gel electrophoresis showed three separate MRSA epidemics in the nursery. Strains of MRSA isolated from the neonates were also isolated from the hospital environment and health care providers. Clinical manifestations included skin pustules (eight patients), conjunctivitis (four patients), or other minor infections (two patients). No neonate developed systemic infection. The prevalence of MRSA decreased with age. At one year, three (14.3%) of 21 infants that had carried MRSA at six days remained carriers and only two (1.1%) of 180 infants in a control 'S. aureus-negative at six days' group carried MRSA.

Age Distribution↗
PubMed1994

One-step determination of herpes simplex virus types I and II by polymerase chain reaction.

A rapid and sensitive one-step polymerase chain reaction (PCR) assay was developed for use in identifying type I and type II herpes simplex virus (HSV). Although the nucleotide sequences of the two HSV subtypes are quite similar, common and type-specific sequences 20 nucleotides in length could be deduced in the thymidine kinase gene. Oligonucleotide primers targeted to the type-specific regions generated products of different sizes that served to distinguish two HSV types. Type-specific PCR amplification products were verified by restriction enzyme digestion. Specificity of the HSV PCR was established by the lack of amplification of other herpes-group viruses including cytomegalovirus, Epstein-Barr virus, and varicella zoster virus. Extraction of DNA from clinical materials (throat swabs, vesicular swabs, cerebrospinal fluid and eye discharge) yielded an amplification product of the predicted size for each HSV type. Thus, this PCR system provides a rapid, sensitive and specific assay that can supplement the currently available modalities for detecting and typing HSV.

Base Sequence↗
PubMed1994

[Analysis of children with tuberculosis in recent 10 years].

To make an early diagnosis and decision for prompt treatment of the children with tuberculosis, we analyzed 61 cases in both inpatients and outpatients for the clinical and laboratory characteristics. One fourth of the 61 cases were below 1-year-old, and 43 cases (70.5%) had a positive family history. The tuberculin test revealed that all of the 61 cases were positive, and 18 of them had a strongly positive reaction (> or = 30 mm). Although the serum levels of inflammatory markers including white blood cells counts, erythrocyte sedimentation rate and CRP value increased only slightly in most cases, serum IgM levels in 59.0% of the children with tuberculosis were twice to three times higher than those in normal average levels. Especially in 96.2% of the children hospitalized for the need of isolation the IgM levels were demonstrated high. Thus, in children with tuberculosis the detection of serum IgM levels as well as family history, tuberculin reaction, and chest X-ray findings may be helpful for the early diagnosis and prompt decision of hospitalization.

Adolescent↗
PubMed1994

[A case of juvenile dermatomyositis with calcinosis universalis--remarkable improvement with aluminum hydroxide therapy].

Juvenile dermatomyositis (JDM) is a multisystem disease characterized by acute and chronic nonsuppurative inflammation of striated muscle and skin. JDM is classified into an independent entity in the classification of dermatomyositis, and it is marked by the development of calcinosis late in the course of the disease. Since an appropriate steroid therapy for the disease was established, the prognosis of the JDM has been improved except for a fulminant case. Frequency of calcinosis in JDM also has been decreasing because of the adequate steroid therapy. However, once calcinosis universalis occurs, this is the most troublesome and debilitating complication in JDM. Treatment of calcinosis universalis in JDM, so far, remains unsatisfactory. We report here a case of JDM, who suffered from at the age of 3 years, with calcinosis universalis that showed remarkable improvement to orally administrated aluminum hydroxide.

Adolescent↗
PubMed1994

[Thermographic assessment of Raynaud's phenomenon in childhood mixed connective tissue disease].

To assess Raynaud's phenomenon objectively, thermographic estimation of hands and fingers was performed before and after the disease- and Raynaud's phenomenon-directed therapy in 3 children with mixed connective tissue disease. All the cases were positive in Raynaud's phenomenon, and the surface temperature of their hands and fingers were decreased even before cold challenge. After the cold provocation test at 4 degrees C for 10 sec., the temperature of all or some of the fingers were rapidly decreased, and the recovery of surface temperature of these fingers were markedly delayed. Even after methylprednisolone pulse therapy the pattern of the finger temperature were essentially unchanged, suggesting that steroids are not effective in the treatment of Raynaud's phenomenon. The long-term administration of vitamin-E, oral prostaglandin E1, and/or serotonin-receptor inhibitor were also proved to be not beneficial in improving Raynaud's phenomenon. Thus, thermography is useful in diagnosing Raynaud's phenomenon objectively, in determining the efficacy of anti-Raynaud drugs, and in estimating long-term course of the phenomenon.

Adolescent↗
PubMed1994

[Familial Behçet's disease--a case report].

We reported a case of mother and child affected with Behçet's disease. Both had recurrent oral ulcer, erythema nodosum and arthralgia. Neither had gastrointestinal manifestation nor central nervous system involvement. The mother represented positive pathergy test, but the child did not. Laboratory data suggested no severe sign of inflammatory reaction and increased levels of immunoglobulin D. She was diagnosed as incomplete form, and he was diagnosed as suspicious form of Behçet's disease. On HLA examination, they had common haplotypes of HLA A24, B61, Cw1 and DR8. Additionally, haplotypes of HLA B7, Cw7, DR1, DQ1, were also detected in the mother, and HLA A2, Cw3, DR12, in the child. HLA-B51, which is primarily associated with Behçet's disease, was failed to be demonstrated. Familial involvement of Behçet's disease were described in only 20 cases, 11 of which had positive HLA B51. These findings suggest that molecular genetic examinations for both class I and II antigens will be necessary for a case of familial involvement.

Adult↗
PubMed1994

[Evaluation of serum C3 and CH50 levels as markers of disease-activity and indicators of efficacy of treatment of lupus nephritis in childhood].

Serum levels of complement components (C3 and C4) and its activity (CH50) were analysed in 20 children with lupus nephritis from view points of disease-activity and efficacy of therapy. After the initiation of prednisolone or methylprednisolone pulse therapy for children in active phases the depressed C3 and CH50 levels were rapidly recovered to normal ranges within 4 months and 2 months, respectively. On the contrary serum C4 levels were normalized later in 11 months. Increased levels of antinuclear antibody and anti-DNA antibody titers have reciprocally dropped in response to those therapy. However, in 9 of 20 children the titers of antinuclear antibody and anti-DNA antibody remained high. Proteinuria observed in active phases of lupus nephritis has disappeared by therapy in all but two exceptions: these two children were complicated with nephrotic syndrome. Histological improvement after therapy was not observed (WHO classification). These findings suggested that it is useful to monitor serum C3 and CH50 levels but not C4 levels to judge disease-activity, and to evaluate efficacy of therapy of lupus nephritis in childhood.

Adolescent↗
PubMed1994

[Behçet's disease in childhood--case reports and review of literature].

Two childhood with Behcet's disease were reported. To evaluate the clinical features of Behcet's disease in childhood, fifty eight case studies (domestic; 19 cases, world-wide; 39 cases) were examined from the literature including two cases in our clinics. Oral ulcers (100%), genital ulcers (82.8%), skin manifestations (77.6%), and articular involvement (51.7%) were frequently found as seen in adult cases. Gastrointestinal manifestations were more common in childhood than in adults (50.0% vs. 29.3%). However, ocular inflammatory disease was less frequently seen in pediatric patients as opposed to adults. Three fourth of children with Behçet's disease was effectively treated with oral or intravenous prednisolone. These findings suggested that the criteria for childhood Behçet's disease will be necessary for early and proper diagnosis.

Behcet Syndrome↗
PubMed1994

[Effects of combined administration of prednisolone and mizoribine in the course of remission for SLE children with nephritis].

Since oral steroid therapy was introduced for SLE, the long-term prognosis of the patients has been significantly improved. Adverse effects of the drug, however, are inevitable for these patients. The characteristic of the adverse effects especially for the child case is the suppression of linear growth. In order to prevent these undesirable effects and to improve their quality of life (QOL), we had introduced the methylprednisolone pulse therapy for SLE in children as both an initial and a relapse therapy. Although this therapy improved QOL of the patients significantly, there was little benefit for the growth disturbance. Then, we have introduced Mizoribine in addition to prednisolone (PSL) therapy for more than 18 months in three SLE children with lupus nephritis. In this trial, the combination therapy was effective for the decrease of urinary protein in one case, and for the reduction of a dosage of oral PSL in one case. In other case, MZR showed only partial immunosuppression. Thus, we concluded that there was a limitation with this combination therapy, however, it is one of the worthy therapy to be tried in SLE children with nephritis.

Adolescent↗
PubMed1993

Presence in Kawasaki disease of antibodies to mycobacterial heat-shock protein HSP65 and autoantibodies to epitopes of human HSP65 cognate antigen.

The central features of Kawasaki disease are immune activation and cytokine-mediated generalized vasculitis. To identify the predisposing factors, we examined the antibody response to BCG antigens, since reactivation of a previous BCG inoculation site is an early, specific manifestation of this disease. BCG antigens were separated on SDS-PAGE, transferred to membrane, and incubated with acute- and convalescent-phase sera of 21 patients with Kawasaki disease. Sera were also examined for the presence of antibodies to mycobacterial 65-kDa heat-shock protein (HSP65), and to its human homolog P1 antigen using synthetic peptides of nonhomologous region. To demonstrate the HSP65-sensitized T cells, in vitro proliferation assay was performed. All convalescent, but not acute phase, sera showed a strong antibody reactivity against 65-kDa protein. The reactivity was directed to recombinant HSP65. Non-cross-reactive sequences between rHSP65 and human HSP65 cognate were synthesized. The sera recognized these peptides of rHSP65 and autologous P1 antigen. Peripheral lymphocytes proliferated following the addition of rHSP65 (stimulation indices, 2.16-7.82; mean, 4.54). These findings suggest that HSP65 may be the most potent factor predisposing to Kawasaki disease, and that an autoreactivity to the epitope of the human HSP65 homolog may be related to the susceptibility to the disease.

Amino Acid Sequence↗