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Takashi Yoshiyama

Publications and source records attributed to Takashi Yoshiyama.

At least 19 recordsLinked to original sources
PubMed2006

Exercise training for the improvement of exercise performance of patients with pulmonary tuberculosis sequelae.

OBJECTIVE: To examine whether exercise training using nontreadmill walking is effective for the improvement of exercise performance of patients with pulmonary tuberculosis sequelae (PTS) characterized by restrictive ventilatory defect. PATIENTS AND METHODS: Fourteen patients with stable PTS hospitalized for assessment of exertional dyspnea in Fukujuji Hospital from April 1997 to March 1999 were enrolled in this observational study. All patients underwent baseline pulmonary function tests, arterial blood-gases analysis and exercise tests for initial assessment. Four patients were excluded because of hypoxemia during the initial treadmill test. The remaining 10 patients who stopped exercising because of symptom limitations became candidates for the exercise training. The patients were instructed to perform daily walking exercise training in a hallway in the hospital for 2 weeks. The training was started at their maximum walking speeds during the treadmill test, and walking speed was gradually increased as the patients gained confidence. After finishing the exercise training, the patients performed pulmonary function tests, arterial blood-gases analysis was done, and exercise tests were conducted in identical fashion to the baseline protocol. RESULTS: There were no significant changes in pulmonary function tests and arterial blood-gases analysis after the exercise training. Exercise tolerance improved with a significant increase in peak oxygen uptake (from 13.6+/-2.8 to 14.8+/-2.8 ml/kg/min, p<0.01) and distance covered in a 6-minute walk (from 399+/-62 to 467+/-65 m, p<0.01) after the exercise training. CONCLUSION: The exercise training we conducted is shown to be a safe and effective modality for the improvement of exercise performance of patients with PTS.

Adult↗
PubMed2006

[Clinical studies on the pathogenetic factors of cavitary and nodular bronchiectatic types in pulmonary Mycobacterium avium complex disease].

We investigated the clinical, laboratory and radiological findings of 273 newly diagnosed cases of pulmonary Mycobacterium avium complex (MAC) disease, who were diagnosed in our hospital during 7 years from January 1996 to December 2002. Radiological findings of all cases were classified at the time of diagnosis into 2 patterns, the cavitary (Cav) type and the nodular bronchiectasis (NB) type. Clinical and laboratory findings at the time of diagnosis of 44 death cases were compared with those of 273 newly diagnoses cases, to analyze the prognostic factors of this disease. MAC disease cases showed a marked increase in number in recent years, but only in women. Mean age at the first visit was 65.7 years in men and 63.2 years in women, and when limited to fatal cases, it was 72.3 years in men and 69.4 years in women. Low body weight in terms of body mass index (BMI) and moderately low serum albumin level were found at the time of the first hospital visit in all the newly diagnosed and death cases. In the fatal cases, the peripheral blood lymphocyte counts revealed a relatively smaller number than the normal range, and the PPD skin test showed a negative reaction in 57.7% of all cases, suggesting the presence of lowered cell-mediated immunity at the time of diagnosis. Whether malnutrition occurs as a result of MAC disease or the individuals with lower nutrition level are easy to develop to MAC disease remains to be clarified. In regard to radiological findings, many cavitary (Cav) type cases were found in men and nodular bronchiectasis (NB) type in women among newly diagnosed cases, while the cavitary type was observed in many in both men and women fatal cases. The mean duration period from diagnosis to death was 28.3 months in men and 60.2 months in women, showing a longer survival after diagnosis, perhaps due to earlier hospital visits by women. The average age at death was 74.4 years old in men and 73.8 years old in women, and the two radiological patterns did not change throughout the entire disease course.

Aged↗
PubMed2006

[Twice-weekly intermittent chemotherapy during the maintenance phase of the short-course treatment for new patients with pulmonary tuberculosis].

BACKGROUND AND OBJECTIVE: Various types of intermittent chemotherapy regimens have been applied for the treatment of tuberculosis worldwide, but, in Japan, any type of intermittent treatment has not been adopted currently as the standard regimens for the treatment of tuberculosis. Intermittent regimens have a great advantage to facilitate directly observed therapy (DOT). To introduce DOT more extensively in Japan, we conducted the present clinical trial to assess the effectiveness and safety of intermittent chemotherapy. PATIENTS AND METHODS: This is a non-randomized trial to compare twice-weekly intermittent therapy under DOT with daily therapy by self-administration. Newly diagnosed patients with pulmonary tuberculosis who completed the initial intensified phase of 2 months with 4 drugs were enrolled. Supervision of drug administration was carried out by the pharmacists who cooperated to the study (Pharmacy DOT). RESULTS: Total 385 patients were enrolled in this trial, of which 135 patients were treated by twice-weekly intermittent maintenance chemotherapy under the supervision by pharmacists and remaining 250 patients were treated by daily maintenance chemotherapy without supervision (self-administration). Treatment success-rates were 97.6% for intermittent treatment group and 95.6% for daily treatment group. Relapse rates after the completion of the treatment course were 3.73/ 100 person-year and 1.76/100 person-year, respectively. The difference between the two groups was not statistically significant. Adverse events required the modification of treatment schedule occurred only in 0.2% of the intermittently treated patients. CONCLUSIONS: After the successful completion of the initial intensified phase of tuberculosis chemotherapy, twice-weekly intermittent chemotherapy during the maintenance phase under the supervision by pharmacist is as effective and safe as the daily therapy, and is conveniently accepted by the patients. The pharmacy DOT with the intermittent therapy during maintenance phase adopted in this trial, should be widely introduced in Japan.

Adolescent↗
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

[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↗
PubMed2006

[Bacteriological and pathological analysis on the pathogenetic factors for cavitary and nodular bronchiectatic type of pulmonary Mycobacterium avium-intracellulare complex disease].

A total of 101 strains of Mycobacterium avium complex (MAC), consisting of 86 M. avium and 15 M. intracellulare strains, were examined by DNA sequencing. The frequency of radiological types [cavitary (Cav) type and nodular bronchiectatic (NB) type] was similar in each species, thus, both species are equal causes of the two radiological types of MAC disease. We also examined serovars of the isolated strains using extracted glycopeptidelipid antigens and thin layer chromatography. Cav type patients discharged a single serovar MAC, while NB type patients discharged two serovar MACs simultaneously. RFLP pattern obtained by the use of IS1245, revealed no clustering of the strains specific for Cav type and NB type. Histopathological examinations of the bronchial lesions in 40 MAC cases and 49 multi-drug resistant tuberculosis (MDR-TB) cases were performed on the surgically removed lung specimens. Lymphocytic infiltration, epithelioid cell granuloma formation, epithelial desquamation and ulceration, as well as smooth muscle atrophy as a cause of bronchiolectasis, were observed more often and were more severe in the peripheral bronchial walls of the NB type than the Cav type of MAC, and as compared with those of MDR-TB cases.

Diagnosis, Differential↗
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

[Treatment results of multi drug resistant tuberculosis, a hospital based study].

SETTINGS: Fukujuji Hospital, Japan. PURPOSE: To evaluate treatment results of multi drug resistant tuberculosis cases. METHOD: Retrospective review of 100 multi drug resistant tuberculosis cases who started treatment in 1990-1999 at Fukujuji Hospital. Life table analysis and analysis of longterm treatment results were done. RESULT: Observation for more than 3 years after starting treatment revealed cure in 62, chronic excreters in 2, and died cases with positive culture in 10, and treatment completed with shorter observation period in 8. The remaining 18 cases were either transfer-out, defaulted or died with other causes. The older age, cavitary lesions (bilateral>unilateral>no), resistance to more drugs, interruption of treatment due to side effects to second line drugs and the complication of diabetes mellitus were independent risk factors for unfavorable results. The treatment results improved with the increase of the number of effective drugs used for 6 months or more. The surgical intervention improved the proportion of favorable treatment results for those that were culture positive after 5 months of treatment. DISCUSSION: Treatment results of MDR TB was not satisfactory. Diabetics was the risk factor of unfavorable results. The conditions for the indication of surgical intervention among culture negative cases after 5 months of medical treatment needs to be further investigated.

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

A patient with a Mycobacterium avium complex infection complicated by systemic lupus erythematosus.

A 41-year-old woman was admitted to our hospital because of fever and polyarthralgia. A diagnosis of systemic lupus erythematosus (SLE) was made based on the findings of polyarthritis, leukocytopenia, lymphocytopenia, proteinuria, and positive reactions for antinuclear antibody (ANA) and anti-double strand (ds)DNA antibody. She had also been suffering from a pulmonary Mycobacterium avium complex (MAC) infection with such symptoms as cough and sputum for the past 3 years. Antimicrobial drugs for MAC infection were administered first, and later she was given cyclophosphamide pulse therapy, consisting of methylprednisolone (8 mg/day) and mizoribine (100 mg/day). Owing to these therapeutic regimens, SLE was successfully treated without an exacerbation of the MAC infection. The risk factors for MAC infection and SLE are also discussed.

Adult↗
PubMed2004

[C-reactive protein in patients with bacteriological positive lung tuberculosis].

PURPOSE: To investigate the usefulness of measuring C-reactive protein in the diagnosis of lung tuberculosis. OBJECT: Tuberculosis patients treated by chemotherapy at Fukujuji Hospital from Jan./1/2000 to Dec./31/2001. METHOD: Chart review. RESULTS: CRP are negative in 13.3% (95%CI: 8.9-17.7%) in sputum smear positive lung tuberculosis patients (N = 226), and in 73.0% (95%CI: 62.0-84.0%) of sputum smear negative culture positive lung tuberculosis patients (N = 63). CONCLUSION: Usefulness of measuring C-reactive protein in the diagnosis of bacteriological positive lung tuberculosis is limited.

Bacteriological Techniques↗
PubMed2004

[Multi-drug resistant lung tuberculosis due to double infection of MDR strain].

The case is 47-year-old, homeless man. He was diagnosed as cavitary, sputum smear positive pan-sensitive lung tuberculosis, and admitted to TB ward of our hospital. At the age of 4-year-old he had tuberculous hilar lymphadenopathy and took medicine. He had no other associated disease, and HIV test was negative. He started standard chemotherapy and 2 months later his sputum culture was converted to negative. His adherence to medicine was thought to be good. But about 2 weeks after the sputum conversion, his sputum culture was re-converted to positive for Mycobacterium tuberculosis. Thereafter, during and after the completion of standard chemotherapy, his sputum culture had been intermittently positive. The drug sensitivity tests of the strain after re-conversion showed multi-drug resistance. RFLP analysis revealed that the strain before conversion was totally different strain from the strain after re-conversion to positive. The case was considered to be caused by the double infection of MDR strain of Mycobacterium tuberculosis during the course of treatment for tuberculosis due to a sensitive strain of Mycobacterium tuberculosis.

Antitubercular Agents↗
PubMed2004

[Drug resistance in recurrent cases of tuberculosis].

PURPOSE: Investigate drug resistant rate in recurrent cases after cure, or after drop-out from treatment, and the analysis of the risk factors for acquired drug resistance in these cases. OBJECT: Patients who were previously treated for tuberculosis that was drug sensitive or unknown about previous drug sensitivity, and were hospitalized to Fukujuji Hospital to start treatment for recurrent tuberculosis from Jan. 1, 1993 to Dec. 31, 2003. Primary drug resistant cases were excluded and cases were further divided into full sensitive cases and cases with drug sensitivity test results were unknown. METHOD: Chart review. RESULT: Drug resistant rate (any resistance to INH, RFP, SM, EB) in all recurrent cases (N=200) was 16.5%. Availability of previous drug sensitivity results affected on the drug resistant rate in recurrent cases. In previously pan-sensitive cases, drug resistant rate was 4.3% and it was lower than the rate in primary treated cases. No significant risk factor for acquired drug resistance was not found, including poor adherence to medication. CONCLUSION: Every effort should be made to know the previous drug sensitivity results because these results have a major impact on drug resistance rate at recurrence. Doctor's mismanagements of tuberculosis patients might be the major factor for acquired drug resistance in recurrent cases, and it is needed for the improvement of tuberculosis control program to implement the measures to control these mismanagements.

Adult↗
PubMed2004

[Estimation of the number of necessary beds for tuberculosis patients, in Japan].

OBJECTIVE: To estimate the number of necessary beds for tuberculosis patients in Japan from the view point of isolation of the source of infection. METHODS: We calculated the number of necessary beds for tuberculosis cases separately for the initial phase and for the chronic excreters. For the initial phase we calculated by multiplying the number of detected tuberculosis cases and the duration of hospitalization. The number of detected cases is based on the figures in 2002 and the duration of hospitalization is assumed to be 90 days for sputum smear positive cases and 60 days for sputum smear negative cases. We calculated the number of necessary beds using the Monte Carlo simulation for each prefecture on the assumption that the incidence and the duration of diseases will be under the effect of random fluctuation with the Poisson's distribution for the number of cases and with the log normal distribution for the duration of hospitalization. We also considered the seasonal fluctuation. RESULTS: Our calculation revealed that around 6,413 beds would be necessary for the initial phase and 200-400 beds for chronic excreters in Japan. There are several prefectures which only requires less than 30 beds. DISCUSSION: Currently, Japan has around 17,000 beds secured for tuberculosis patients. Our calculation showed that this was much more than needed. In many areas, one ward will provide more than sufficient number of tuberculosis beds. Specialist consultation system must be improved because of the reduction in the number of TB cases treated at hospitals with TB wards and TB specialists. For the treatment of non-infectious TB, ambulatory DOT system, TB shelter and nursing care facilities would be necessary to guarantee compliance to treatment.

Directly Observed Therapy↗
PubMed2004

[Miss-management in treatment failure of pulmonary tuberculosis].

PURPOSE: To investigate the risk factor of treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from the standpoint of both clinical management and tuberculosis control. OBJECT AND METHOD: Retrospective chart review of patients who admitted to Fukujuji Hospital for treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from Jan. 1993 to Dec. 2003. RESULTS: Out of 24 treatment failure cases available for analysis, 4 cases were associated with chronic tuberculous empyema with broncho-pleural fistula, and among them, chronic empyema was considered to be the main cause of treatment failure in one case. In 6 cases, poor adherence to medication was confirmed or suspected, and 2 of these 6 cases was also associated with miss-management. In 9 cases miss-management was found without poor adherence or chronic empyema, and in 8 out of these 9 cases, miss-management was considered to be the main cause of treatment failure. In 5 cases no apparent risk factor was found, but in 2 out of these 5 cases the ignorance of the results of drug sensitivity tests (and, therefore, miss-management) was strongly suspected. Summing up, in 10 out of 24 cases (41.7%), the miss-management was considered to be the main cause of treatment failure, and it was more frequently seen than poor adherence to medication. CONCLUSION: Clinicians should be aware of these risk factors of treatment failure such as chronic empyema, weak regimen in bacteriological negative cases, rifampicin+ethambutol regimen, and miss-management of drug adverse effect. From the standpoint of tuberculosis control in Japan we considered that, in addition to DOT, strategy to secure the quality of tuberculosis treatment is by all means needed.

Adult↗
PubMed2004

[Are tuberculosis advisory committees well-functioning?].

PURPOSE: To evaluate the function status of TB advisory committee to assess treatments of tuberculosis. OBJECT AND METHOD: Estimate by questionnaire sheets to public health nurses attending to seminars on tuberculosis at Research Institute of Tuberculosis. RESULT: 137 answers are available for analysis. Of these, 57 (41.6%) TB advisory committees are estimated not to assess treatments of tuberculosis at all and/or to assess treatments without necessary informations on drug sensitivity in more than around half of the cases. In 13 (16.3%) committees of the other 80, many cases are in fact self-assessed. Number of committees that are estimated to functioning well is only 44 (32.1%). CONCLUSION: Many TB advisory committees are estimated to be malfunctioning from the stand point of assessments of treatment. As TB advisory committee is one of key agency to control drug-resistant tuberculosis, its reform and revitalization are urgently needed.

Advisory Committees↗
PubMed2004

[Process of acquiring drug resistance: retrospective review of records of MDR TB].

PURPOSE: To investigate the reasons of acquiring drug resistance among MDR TB cases and to learn lessons for the prevention of acquiring of drug resistance. METHOD: Retrospective review of 159 MDR TB cases who were treated at Fukujuji Hospital from 1990 January to 2003 August. RESULT: We found that among 159 cases, 48 cases were infected with multidrug resistant M. tuberculosis bacilli, 35 cases acquired drug resistance, 7 cases were with the history of tuberculosis treatment before 1970 only, and that remaining 69 cases were difficult to evaluate because of the lack of informations on previous drug susceptibility tests. Among 35 cases that acquired drug resistance, the drug susceptibility test patterns before becoming MDR TB were categorized as follows: 12 HR susceptible, 18 H resistant R susceptible, 3 R susceptible (H unknown), and 2 H susceptible R resistant. The factors that may have influenced to acquire MDR were lack of modification of the regimen after knowing drug resistance among H resistant R susceptible cases, and defaulting among cases that were not evaluated (15/69) and H resistant R susceptible cases (3/18). DISCUSSION: Control of MDR TB needs to be strengthened. Proper drug susceptibility test, proper choice of drugs at the beginning of treatment and modification of treatment after knowing drug susceptibility test results are important for the prevention of MDR TB. Ensuring patient adherence to treatment is important in the medical institutions where drug susceptibility test is not properly done, in particular, for H resistant R susceptible cases, and guidance to these institutions by the public health centers should be intensified.

Adult↗