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Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area.

OBJECTIVE: To investigate the management of women with asymptomatic ovarian masses, to determine the appropriate duration of follow up, and to identify diagnostic indicators of growing cysts. DESIGN: Review of women's hospital records. SETTING: Tokyo Metropolitan Cancer Detection Center, Japan. POPULATION: Two hundred and twenty-five pre- and postmenopausal women with a diagnosis of ovarian cyst < 6 cm in diameter and normal serum level of CA125, diagnosed between 1 October 1990 and 25 December 1991. MAIN OUTCOME MEASURE: Change in size of cyst as shown by ultrasound. RESULTS: Seventy-five months after initial diagnosis, 29 (13%) of the masses had progressed, 31 (14%) had persisted, and 165 (73%) had regressed. One hundred and nine masses (48%) had regressed within six months of the initial diagnosis. In univariate analysis transvaginal ultrasonographic assessment of morphology findings, cyst diameter, carcinoembyronic antigen (CEA) and CA19-9 were associated with the prognosis of the cyst. Multivariate regression analysis demonstrated that only the initial serum CA19-9 level and serum CEA level were significant predictors of ovarian masses that regressed (P for trend = 0.004 and 0.02, respectively). CONCLUSION: Simple ovarian cysts in patients with a normal level of CA125 have a low risk for ovarian cancer. Vaginal ultrasound at six months will identify regression of most simple cysts. CA19-9 and CEA at the initial diagnosis are useful parameters to predict future regression of ovarian cysts.

Adult↗

Amoxicillin resistance in Helicobacter pylori: studies from Tokyo, Japan from 1985 to 2003.

BACKGROUND: Previous reports revealed no resistant strains of amoxicillin (AMPC), which is usually used in eradication therapy for H. pylori infection. However, the frequency and evolution of natural AMPC-resistant strains in the Japanese population remains unknown. AIM: To assess the prevalence of H. pylori resistance against AMPC in the Tokyo area, a collection of 648 H. pylori strains isolated from patients with GI diseases from 1985 to 2003 was tested for their sensitivity to AMPC. METHODS: The susceptibility of the strains was assessed by determination of the minimal inhibitory concentration (MIC) using the E-test and/or the Dry-plate method. The susceptibility breakpoints of AMPC for H. pylori were: sensitive (AMPC-S); MIC < 0.04 microg/ml, intermittent resistance (AMPC-I); 0.04-1, resistant (AMPC-R); > 1. RESULTS: No AMPC-R strains were detected in the strains isolated between 1985 and 1996, while the rate of resistance was determined to be 1.1%, 2.1%, 5.4%, 5.6%, 0%, 8.8%, and 1.5% every year, respectively, from 1997 to 2003. The percentage of AMPC-I strains increased from 2000 to 2003. The total eradication rate of H. pylori in the patients who received triple therapy containing AMPC was 81.4% (214/263). Classified as above, the rates of AMPC-S, AMPC-I, and AMPC-R were 84.6%, 77.8%, 25%, respectively. CONCLUSION: H. pylori resistance to AMPC is still rare in Japan, although the percentage of AMPC-I strains has increased over the last 4 years. The frequency of isolation of strains showing true resistance to AMPC may increase in the future, along with an increase in the frequency of isolation of AMPC-I strains.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Prevalence and incidence of epilepsy in Tokyo.

All children 3 years of age on January 1, 1975 in the Fuchu area of Tokyo were neurologically examined for 6 years (number examined: 17,044). The cumulative incidence of epilepsy (i.e., recurrent nonfebrile seizures) was 4.3/1,000 and that of occurrence of a single nonfebrile seizure (NS) was 4.7/1,000. Febrile convulsions (FCs) were observed in 82/1,000 in this population. The population was followed for 6-11 years after the first examination. During the follow-up (a) 4 of 80 children who had a single NS before age 3 years developed recurrence after age 3 years; (b) development of epilepsy was found in three of 1,323 randomly (10%) selected healthy children for comparison (2.3/1,000); (c) among 1,406 children with FCs, epilepsy developed in 24 (17/1,000) and a single NS occurred in 28 (20/1,000); and (d) the total cumulative incidence of epilepsy was 8.2/1,000 in the population aged 9-14 years. Age-specific annual incidence of epilepsy was highest in the age range 0-1 year (1.9/1,000), gradually falling with advancing age. The point prevalence for active epilepsy (having had a seizure within the past 5 years) was 2.8/1,000; that for inactive epilepsy was 5.4/1,000 (total 8.2/1,000). Epilepsy developed by age 14 years in (a) one-half of children with NS, (b) approximately 2% children with FCs, (c) 0.2% of healthy children with no seizure before age 3 years, and (d) an estimated 2% of potential epileptic carriers (having spike EEG abnormality by age 3; 15% of the population) who had not had a seizure by age 3 years.

Adult↗

The Tokyo subway sarin attack: disaster management, Part 2: Hospital response.

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The authors report how St. Luke's Hospital dealt with this disaster from the viewpoint of disaster management. Recommendations derived from the experience include the following: Each hospital in Japan should prepare an emergent decontamination area and have available chemical-resistant suits and masks. Ventilation in the ED and main treatment areas should be well planned at the time a hospital is designed. Hospital disaster planning must include guidance in mass casualties, an emergency staff call-up system, and an efficient emergency medical chart system. Hospitals should establish an information network during routine practice so that it can be called upon at the time of a disaster. The long-term effects of sarin should be monitored, with such investigation ideally organized and integrated by the Japanese government.

Disaster Planning↗

Season of birth in mental disorders in Tokyo, Japan, by year of birth, year of admission and age at admission.

Seasonal distribution of births of schizophrenics and manic-depressives born in Tokyo between the years of 1841 and 1940 and first admitted between 1879 and 1973 was examined by year of birth, year of first admission and age at first admission. In both mental disorders, a fall-excess of births could be seen among those born up to the latter part of the 19th century, after which the distribution changed to show a spring-excess. The distributional pattern seemed to depend upon both year of birth and year of admission, rather than on age at first admission.

Adult↗

Children's dental health: British expatriate residents in Tokyo, Japan.

AIM: To identify in expatriate British parents resident in Tokyo, Japan, their levels of dental health knowledge, patterns of dental health behaviour, and caries status of their children compared to Japanese children. METHODS: 223 parents with children at one school were asked to complete a structured questionnaire. Data were collected on: parental knowledge and behaviours with respect to caries prevention, and sweet consumption of the children. The caries status of the children was established by a clinical examination, using standard criteria. RESULTS: The questionnaire response rate was 66.8%. The mean age of the children was 7.6 years (range 3-11 years). The responses related to 51 British, 21 Japanese, and 20 children who had British and Japanese mixed parents. 33% of British and none of Japanese children had sweet foods frequently. Fluoridated toothpaste was used by 67% of British and 10% of Japanese children. British parents knew about dental caries more than Japanese. 13% of British and 38% of Japanese children were found in the higher caries experience group. CONCLUSION: Parental access to information in the UK and to fluoridated toothpaste in Japan could have helped to prevent dental caries in these expatriate British children.

Cariostatic Agents↗

[Serovars, antimicrobial resistance and conjugative R plasmids of Salmonella isolated from human during the period of 1966-1986 in Tokyo. Research Group for Infectious Enteric Diseases].

We examined 4,739 isolates of Salmonella isolated from patients with gastroenteritis during the period of 1966-1986 in Tokyo for the incidences of serovars, antibiotic resistance and conjugative R plasmids. The period of study was divided into three: 1966-73 (early period), 1974-79 (middle period), and 1980-86 (late period). The predominant serovars were S. typhimurium (34.3%), Infantis (5.6%), Panama (4.9%) in the middle period, S. typhimurium (31.7%), Paratyphi B (9.4%), Litchfield (7.3%) in the late period. These results were consistent with serovars of isolates from healthy citizens. The frequency of resistant isolates was as high as 86.9% in the early period, mostly streptomycin (SM)- and tetracycline (TC)-resistant isolates, but decreased significantly in the middle and the late periods, to 53.3 and 39.4%, respectively. The percentages of ampicillin (ABPC)-, chloramphenicol (CP)-, and kanamycin (KM)-resistant isolates increased in the late period. Strains carrying conjugative R plasmids were isolated as frequently as 57.8% of the total isolates in 1973, but as less frequently as 6.7% in 1981 indicating that the rate was roughly proportional to the incidence of the drug resistant isolates. The rate, however, increased gradually after 1981. The predominant resistance pattern of the R plasmids was TC-resistance in the early period, gradually changed into multiple and finally to AP-, CP-, KM-, SM-, TC- and sulfonamides-resistance in the late period.

Conjugation, Genetic↗

[The first two cases of tsutsugamushi disease found in Toshima Island, Tokyo Metropolis].

It has been known that tsutsugamushi disease, so-called "Shichito-fever", is widely spread among the Izu Islands, Tokyo Metropolis. The cases were reported in Oshima Island, Niijima Island, Shikine Island, Kozu Island, Miyake Island, Mikura Island, and Hachijo Island previously, although no case has been reported in Toshima Island. In this paper, we report the first two cases of tsutsugamushi disease found in Toshima Island in December 1988 and December 1989. The first case was a 73 year-old male and the second case was a 83 year-old female, respectively. Fever, erythema and eschar were observed in both cases, while lymphadenopathy and hepatosplenomegaly were not detected. After tetracycline was administered, the fever immediately went down and erythema gradually disappeared in both cases. Specific immunofluorescence tests demonstrated that IgG antibody titers rose against Karp, Gilliam and Kato strains, and that IgM antibody titers rose only against Gilliam strain in both cases. Therefore, Gilliam-like strain of Rickettsia tsutsugamushi may play an important role in Toshima Island.

Aged↗

[Serovar distribution and drug resistance of Salmonella isolated from imported and domestic cases in 1980-1989 in Tokyo].

A total of 6,816 strains of nontyphoidal Salmonella isolated from oversea travellers (imported cases) and domestic healthy individuals and sporadic cases (domestic cases) in Tokyo from 1980 to 1989 were studied for their serovar distribution and antimicrobial sensitivity. The serological typing results showed that the Salmonella strains were classified into 22 O groups and 156 serovars. Among serovars identified, S. ser. Anatum, S. ser. Derby, S. ser. Blockley, S. ser. Agona and S. ser. Typhimurium were predominant in imported cases, while S. ser. Litchfield, S. ser. Typhimurium, S. ser. Hadar, S. ser. Infantis and S. ser. Thompson were predominant in domestic cases. It was also noticed that isolation rates of S. ser. Hadar and S. ser. Blockley have tended to increase noticeably in recent years in both cases. From antimicrobial sensitivity testing, 739 (28.1%) of 2,628 strains isolated from imported cases and 1,047 (25.0%) of 4,188 strains isolated from domestic cases were found to be resistant to any one of the drugs tested (CP, TC, SM, KM, ABPC, ST, NA, FOM and NFLX). From 1980 to 1983 the resistance rate was less than 20% for both cases and then the rate was increased year by year, and it became greater than 40% in 1989. Serovars of a high resistant rate during this period were S. ser. Hadar (96.3%), S. ser. Blockley (92.0%), S. ser. Typhimurium (75.7%), S. ser. Kentuckey (64.1%), S. ser. Krefeld (59.3%), and S. ser. Panama (58.3%) for the imported cases and S. ser. Hadar (97.5%), S. ser. Blockley (57.4%), S. ser. Litchfield (44.6%), S. ser. Enteritidis (44.4%), S. ser. Muenchen (42.2%) and S. ser. Typhimurium (40.9%) for the domestic cases. Drug resistance patterns of the resistant isolates varied up to as much as 50 patterns. Prevalent patterns recognized were TC.SM, CP.TC.SM.KM, TC, CP.TC.SM.KM.ABPC and SM for imported cases and TC.SM, TC, TC.SM.KM, SM, and CP.TC for the domestic cases. 21(12.4%) of 170 drug resistant strains were isolated from imported cases from 1988 to 1989 were found to have conjugative transmissible R plasmids.

Antibodies, Bacterial↗

[Outbreaks of acute gastroenteritis caused by small round structured viruses in Tokyo].

Of 34 non-bacterial gastroenteritis outbreaks which occurred at day-care centers, kindergartens, elementary and secondary schools in Tokyo during the period from February 1985 to June 1991, 28 outbreaks from which small round structured viruses (SRSV) were detected in the patients' stool specimens by electron microscopy were subjected to an epidemiological investigation. The outbreaks tended to occur frequently in the cold season; twenty-two (79%) of these outbreaks from November through April. Though detailed epidemiological informations was not obtained from all outbreaks, the common source of infection were presumed to be present in many of the outbreaks, judged from the incidence as to time course of patients. Food doubted to be incriminated as transmission vehicles in these outbreaks was served at schools, kindergartens, and lodgings. In some outbreaks, SRSV was detected from stool specimens of food handlers, or they were seroconverted to SRSV, suggesting that food was incriminated as a transmission vehicle. The symptoms of patients differ slightly from age to age: in the age range of 0 to 6 years, vomiting 90%, fever 41% and diarrhea 32%; in the 6 to 12 year-olds, nausea 61%, vomiting 48%, abdominal pain 65%, diarrhea 20% and fever 29%; and in the 12 to 15 year-olds, nausea 69%, vomiting 42%, abdominal pain 60%, diarrhea 30% and fever 34%. The lower the age of patient vomiting was more frequently observed. In these lower age groups, the frequency of nausea and vomiting tended to exceed that of diarrhea.

Adolescent↗

[An outbreak of gastroenteritis due to group C rotavirus in Tokyo].

In April 1991, an outbreak of acute gastroenteritis due to group C rotavirus occurred at an elementary school in Tokyo. Fifty-one (13%) of 393 students became ill. The main clinical symptoms were diarrhea (100%), abdominal pain (68%) and vomiting (56%). No enteropathogenic bacteria were found in the fecal specimens. However, the virus particles morphologically indistinguishable from conventional rotavirus were detected in 6 of 11 fecal specimens by electron microscopy. Immune electron microscopy showed that these virions aggregated with anti-group C rotavirus serum. The RNA pattern of the virus particles involved in this outbreak showed a pattern similar to that of typical group C rotavirus on polyacrylamide gel electrophoresis.

Child↗

[On the outbreak of Shigellosis in Tokyo, 1992].

In 1992, the number of cases of shigellosis in Tokyo increased remarkably, and a total of 10 separate outbreaks were confirmed. Except for 1 series where the causative strains was Shigella flexneri 3a, the other 9 outbreaks were caused by Shigella sonnei. Of note, 7 outbreaks were familial with less than 5 patients. The remaining 3 outbreaks occurred in a restaurant, a school and the dormitory of an orphanage, in which the organism was detected in 6 to 14 patients. In 4 of the familial outbreaks occurring in distant areas during August, ark shell was presumed to be the vehicle by epidemiological investigations and laboratory examinations. Analysis of isolates such as the antibiotic resistance pattern, plasmid profile, or colicine type in Shigella sonnei was useful in clarifying the commonality of each case and identifying the vehicle or transmission.

Adult↗

[Shigella boydii strains having a provisional serovar isolated from travellers' diarrhea in Tokyo].

Two Shigella strains (85-634 and 94-30) isolated from two sporadic travellers with diarrhea who returning to Tokyo from abroad, did not react to any antisera to Shigella prepared commercially. These strains had the typical biochemical characteristics of S. boydii and were biochemically identical, and were positive in the Serény test and other tests for invasiveness; these indicate that they can cause shigellosis in humans. The results of serological analyses using the antisera to 6 kinds of provisional Shigella serovars, showed that both strains had provisional S. boydii serovar E16553. Although the serovar has been reported by Gross et al in the United Kingdom, this may be the first report in Japan.

Child↗

[Species and serovar-distribution, and drug-resistance of Shigella strains isolated from imported and domestic cases from 1990 through 1994 in Tokyo].

A total of 446 Shigella strains consisting of 336 imported and 110 domestic strains isolated in Tokyo from 1990 to 1994 were examined for their species and serovar-distribution, and their drug-resistance. In both imported and domestic strains, S. sonnei was found to be the most prevalent species, followed by S. flexneri. In imported strains, however, the isolation frequency of S. flexneri, S. boydii and S. dysenteriae were higher than that of domestic strains, and the serovar of each species was distributed in a wider range than that of the domestic strains. Provisional new serovar Shigella strains were isolated from 8 imported cases and 2 domestic cases. The drug-resistance-test using 9 drugs (CP, TC, SM, KM, ABPC, ST, NA, FOM, and NFLX) showed that 82.7% of the imported strains and 89.1% of the domestic strains were resistant to any drugs examined. Drugs of a high resistant rate were SM, TC, ST for the both groups. Drug-resistance-patterns of the resistant isolates varied to 21 types. Among those, a triple drug-resistance-type with TC SM ST was found the most frequently in both groups. None of the strains were resistant to FOM or NFLX.

Anti-Bacterial Agents↗

[Evolution of susceptibilities of Campylobacter jejuni isolated from diarrhoeal cases to fluoroquinolones in Tokyo].

Recently, the increase in the number of resistant strains of Campylobacter jejuni to fluoroquinolone has been reported in European countries. We also studied antimicrobial susceptibilities of 600 clinical isolates of Campylobacter jejuni isolated during a 6 year period from 1989 through 1994 in four Tokyo Metropolitan Hospitals. The susceptibility to 6 antimicrobial agents, norfloxacin (NFLX), ofloxacin (OFLX), ciprofloxacin (CPFX), nalidixic acid (NA), erythromycin (EM) and tetracycline (TC) were examined. The overall resistant rates were as follows: NFLX, 45 strains (7.5%); OFLX, 45 strains (7.5%); CPFX, 44 strains (7.3%); NA, 62 strains (10.3%); EM, 4 strains (0.6%) and TC, 259 strains (43.2%). The number of resistant strains to fluoroquinolones and NA has increased significantly since 1993 in Japan, but the susceptibility to erythromycin has still remained the same level during the past 6 years. The susceptibility to TC was variable, and MICs gave a bimobal distribution, as pointed out previously. The resistance pattern of NFLX, OFLX, CPFX and NA were observed most frequently in those isolates.

Anti-Infective Agents↗

[Serovar-distribution and drug-resistance of Salmonella strains isolated from domestic and imported cases in 1990-1994 in Tokyo].

A total of 3,647 non-typhoidal Salmonella strains consisting of 2,655 domestic strains and 992 imported strains isolated in Tokyo from 1990 to 1994, were examined for their serovar-distribution and their drug-resistance. The serological typing results showed that the domestic strains were classified into 15 O-groups and 96 serovars, and the imported strains were classified into 13 O-groups and 73 serovars. Among the serovars identified, Salmonella serovar Enteritidis (S. Enteritidis), S. Thompson, S. Hadar, S. Litchfield, and S. Tennessee were predominant in the domestic strains, whereas S. Hadar, S. Enteritidis, S. Anatum, S. Derby, and S. Blockley were predominant in the imported strains. The drug-resistance test using 9 drugs (CP, TC, SM, KM, ABPC, ST, NA, FOM, and NFLX) showed that 30.5% of the domestic strains and 40.5% of the imported strains were resistant to any of the drugs examined. The serovars of a high resistant rate during this period were S. Hadar (96.2%), S. Blockley (88.7%), S. Enteritidis (63.4%), S. Virchow (54.3%), and S. Typhimurium (51.3%) in the domestic strains and S. Krefeld (100%), S. Hadar (98.9%), S. Blockley (98.2%), S. Emek (83.3%), S. Kentucky (76.5%), S. Panama (69.2%), S. Derby (63.8%), S. Typhimurium (57.1%), S. Rissen (55.6%), and S. Agona (53.7%) in the imported strains. Drug-resistance patterns of the resistant isolates varied to 62 types. Prevalent patterns recognized were SM, TC.SM, TC.SM.KM, TC, TC.SM.KM.ABPC and CP.TC.SM.KM in the domestic strains and TC.SM, TC, CP.TC.SM.ST, TC.SM.KM, and CP.TC.SM.KM in the imported strains.

Diarrhea↗

[Bacteriological and virological studies on the cause of sporadic acute gastroenteritis in Tama, Tokyo (1991-1996)].

Between May 1991 and December 1996, bacteriological and virological investigations on the fecal samples from patient of infantile diarrhea (155 cases), or infectious gastroenteritis (1,409 cases) diagnosed with 9 medical institutions in Tama of Tokyo were carried out. Of 1,564 samples, 722 (46.2%) were enteropathogen positive cases, and mixed infection was also observed in about 15% of the positive cases. Among 13 different kinds of enteropathogens identified, the most prevalent one was pathogenic E. coli (20.7%), followed by Campylobacter spp. (10.0%), Rotavirus (8.8%), Salmonella spp. (3.9%), Adenovirus (1.9%), ECHO virus (0.9%), Vibrio parahaemolyticus (0.8%), Poliovirus (0.7%), Aeromonas spp. and Coxsackie B virus (both 0.6%). Furthermore, SRSV was confirmed in 82 out of 619 patients (13.2%) for 2 years (1995 and 1996). In addition, Shigella sonnei (3 cases), S. Paratyphi-A (1 case) and enterohemorrhagic E. coli O157: H7 (2 cases) were also detected. A higher detection ratio was recorded in February, August and November, reflecting respectively by month a highly frequency of Rotavirus, enteric bacteria causing food poisoning and SRSV. With reference to the isolates, the most of pathogenic E. coli belonged to enteropathogenic serotype E. coli (EPEC), and S. Enteritidis was most prevalent serotype.

Acute Disease↗

[Outbreak case caused by different colicin type of Shigella sonnei in a day nursery in Tokyo (1998)].

From October through December, 1998, person to person infection caused by Shigella sonnei had occurred in the day nursery in Hachioji-city Tokyo, and a total of 41 patients including 3 suspected cases and 3 carriers had been confirmed. Although one case was imported case which is one-year-old kindergarten child, the remaining was domestic case. Of patients, 33 cases (80.5%) were a three-year-old kindergarten children and their families, accounting for 20 and 13 cases, respectively. From the data of symptom onset of patients, epidemic could distinguish to the former part and the later part. The recur or reinfection, and re-detection case was observed in the later part. Clinical symptom of the patients was diarrhea (100%), fever (80%) and abdominal cramps (70%), and LVFX for adult or FOM for child was used for the therapy. In the colicin typing test and the antibiotic susceptibility test for 9 reagents, almost isolates in the former part were type 0 and susceptible, and MBC for FOM ranged from 6.25 to 100 micrograms/ml, whereas those in the later part was type 2 and resistant for the TC, and showed highly MBC for FOM with 50 or 100 micrograms/ml. However, both isolates showed same patterns in plasmid profiles and DNA fingerprints by RAPD analysis. On the other hand, the strain from imported case was also colicin 0, but it was different as regards resistant for ABPC and ST and two genetic analysis.

Adult↗