Search

Background: The skills of individuals to find and apply adequate information needed to make health decisions have been conceptualized as health literacy (HL). However, limited studies have examined the association between HL and healthy lifestyle characteristics among patients with lifestyle related disorders. Methods: This cross-sectional study examined associations between HL and healthy lifestyle characteristics among Japanese outpatients with lifestyle related disorders. Participants were 207 men and 254 women who visited Tokorozawa Medical Clinic in Tokorozawa City, Japan, from April to May 2015. Information on five items for functional HL, five items for communicative HL, and four items for critical HL, and healthy lifestyle characteristics was collected by self-administered questionnaires. Results: Mean age was 68.1 years among men, and 70.3 years among women. In multivariate logistic analysis, a higher HL was significantly associated with having 6–7 healthy lifestyle characteristics among men [Odds ratio (OR) = 2.19, 95% Confidence interval (CI) = 1.09–4.41]. Moreover, functional, communicative, and critical HLs were significantly associated with having 6–7 healthy lifestyle characteristics among men [(OR = 2.34, 95% CI = 1.09–5.02), (OR = 2.37, 95% CI = 1.15–4.88), (OR = 2.78, 95% CI = 1.36–5.70)]. No association was observed between total HL score and healthy lifestyle characteristics among women. Conclusion: Our study revealed a positive association between HL and healthy lifestyle characteristics among male outpatients with lifestyle related disorders, suggesting that men, but not women, are likely to engage in health-promoting behaviors based on several aspects of HL. Further studies will be needed to confirm this gender discrepancy.

Objective To assess the rate of successfully achieving treatment goals among Japanese men with hyperuricemia/gout and identify factors influencing the success rate. Methods This cross-sectional study, conducted from January to December 2012, examined the serum uric acid (SUA) levels and clinical characteristics of 2,103 men with hyperuricemia/gout selected from an initial population of 136,770 individuals who participated in a workplace health checkup. The success rates (defined as SUA ≤6.0 mg/dL) were calculated, and a multivariate analysis was used to identify factors associated with "therapeutic failure" to achieve target SUA levels. Results The rate of successfully achieving the target SUA level was 37.5%. The body mass index (BMI) was significantly associated with therapeutic failure [25.0≤ Category (C) 2

This cross‐sectional study from January 2012 to December 2012 aimed to examine the sex‐specific association between serum uric acid (SUA) levels/hyperuricemia and hypertension among Japanese patients. SUA level, medical histories, and lifestyle‐related items were collected from 85,286 of 136,770 participants. Among those with hyperuricemia, the median age was 46 years and 97% were men, which was significantly different than those without hyperurecemia (44 years and 56%, respectively; P

AIM We retrospectively evaluated blood culture results in elderly patients (≥65 years) with a fever due to infection. METHODS We examined the bacteria isolated from blood cultures and compared them to bacteria detected in infected lesions that caused bacteremia. We compared the types of bacteria isolated in the two groups (the community-acquired group and the hospital-acquired group). RESULTS Blood cultures were obtained from 638 patients. Bacteria were detected in 182 patients (28.5%), including 66 (36.3%) patients in the community-acquired group and 116 (63.7%) patients in the hospital-acquired group. There were 259 positive samples (25.1%). In arterial blood specimens, 153 (30.9%) samples were positive, while in venous blood specimens, there were 106 (19.8%) positive samples (P

Summary Aim We aimed to evaluate the association between abdominal fat distribution (e.g., abdominal visceral fat area [VFA], subcutaneous fat area [SFA], and total fat area [TFA]), waist circumference (WC), or body mass index (BMI) and atherosclerotic changes in the carotid artery after adjusting for common risk factors. Methods The present study is a hospital-based, cross-sectional study. Study participants included 223 Japanese individuals who underwent a medical health checkup at Juntendo University Hospital, Tokyo, between December 2005 and August 2011. Multivariate logistic regression analysis was used to examine the association between abdominal VFA, SFA, TFA, the VFA/SFA ratio, WC, or BMI and intima-media thickness [IMT] (mean IMT≥1.1mm or maximum IMT≥1.2mm) as atherosclerotic changes in the carotid artery. Results Multivariate logistic regression analysis showed that VFA (OR for ≥150cm 2 versus 2 , 3.88; 95% CI, 1.39–10.85), BMI (OR for ≥27.6kg/m 2 versus 2 , 5.22; 95% CI, 1.69–16.16), and TFA (OR for 200–285cm 2 versus 2 , 4.15; 95% CI, 1.34–12.86: OR for ≥285cm 2 versus 2 , 5.53; 95% CI, 1.76–17.35) were significantly associated with atherosclerotic changes in men. After adjustment for BMI, only TFA (OR for ≥285cm 2 versus 2 , 3.76; 95%CI, 1.03–13.79) in men was significantly associated with atherosclerotic changes in the carotid artery. Conclusions Our results indicate that VFA, TFA, and BMI are independently associated with atherosclerotic changes in Japanese men. TFA may be considered as a valuable measure of atherosclerotic changes.

OBJECTIVE The causes of fever of unknown origin (FUO) vary depending on the region and time period. We herein present a study of patients with classic FUO where we investigated differences based on patient background factors, such as age and causative diseases, and changes that have occurred over time. METHODS We extracted and analyzed data from the medical records of 256 patients ≥18 years old who met the criteria for classic FUO and were hospitalized between August, 1994 and December, 2012. RESULTS The median age of the patients was 55 years (range: 18-94 years). The cause of FUO was infection in 27.7% of the patients (n=71), non-infectious inflammatory disease (NIID) in 18.4% (47), malignancy in 10.2% (26), other in 14.8% (38), and unknown in 28.9% (74). The most common single cause was human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (n=17). NIID and malignancy were more common in patients ≥65 years old than in patients

Introduction One consequence of population aging is an increase in the number of elderly patients with diabetes mellitus. These elderly patients often experience atherosclerotic complications, and diabetes prevention and management are strongly desired to promote health and reduce the financial burden on the healthcare system. In this study, we conducted an age-specific evaluation of the effectiveness and safety of comprehensive management with newly initiated insulin therapy over a 1-year period in elderly (≥65 years) compared with non-elderly (≤64 years) Japanese patients with uncontrolled diabetes [glycated hemoglobin (HbA1c) ≥ 8% for ≥ 3 months]. Methods This retrospective single-center cohort study was conducted in Japan. We screened all outpatients with diabetes mellitus who visited the clinic for diabetes treatment between December 2006 and March 2011. Of these patients, 132 with type 2 diabetes who were newly initiated on insulin therapy for continued poor glycemic control and undergoing comprehensive management through self-monitoring of blood glucose (SMBG) were registered to the study. Results Thirty-two of 132 registered patients were excluded from the analysis. Among the 100 patients (67 non-elderly, 33 elderly) included in the analysis, median age and proportion of male patients was 69 years and 66.7%, respectively, among the elderly, and 52 years and 68.7%, respectively, among the non-elderly patients. After initiation of insulin therapy, median HbA1c levels improved from 9.6% to 7.2% in elderly patients, and from 10.8% to 7.3% in non-elderly patients at baseline and 12 months. Severe hypoglycemic events were not observed in either patient group; however, uncontrolled diabetes was ongoing in 31.8% of non-elderly and 15.4% of elderly patients, and obesity was associated with poor glycemic control. Conclusion Our results indicate that the effectiveness and safety of newly initiated insulin therapy are similar between elderly and non-elderly Japanese patients with uncontrolled diabetes, and highlight the importance of comprehensive management using SMBG to avoid hypoglycemia. Better glycemic control supported by adequate intensive management is required to improve mortality and morbidity. Electronic supplementary material The online version of this article (doi:10.1007/s13300-013-0049-4) contains supplementary material, which is available to authorized users.

AIM To investigate the current status of elderly dementia patients with physical illnesses and identify optimal care strategies for this growing population. METHODS This retrospective study included elderly dementia patients who (i) received in-patient treatment for a physical comorbidity at the dementia ward of the Juntendo Tokyo Koto Geriatric Medical Center, and (ii) who were discharged from April 2009 to March 2011. RESULTS The study population was 390 patients (144 males, 246 females), with a mean [±SD] age of 80.5 [±8.1] years. Two hundred thirteen of the patients had Alzheimer's disease; the remaining 177 had other types of dementia. The comorbidities necessitating admission were: malignant neoplasms (n=65), respiratory conditions (n=57), genitourinary conditions (n=50), trauma or fracture (n=41), and other (n=177). Among the 239 subjects who were hospitalized from their homes and who were discharged alive, 157 (65.7%) returned to their homes. The hospital stays of patients who were discharged were significantly shorter (P

Antiretroviral therapy alters lipid metabolism in HIV-infected patients. However, interpreting the impact of HIV infection on lipid metabolism is difficult because of various associated factors, including antiretroviral drugs and demographic characteristics. A few studies have associated HIV infection with lipid metabolism in antiretroviral-naïve HIV-infected patients. Because there were no data in this regard from Japan, the present study examined the impact of HIV infection, as well as demographic and clinical features, on lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. We performed a cross-sectional study to examine the impact of HIV disease, demographic and clinical characteristics on lipid metabolism among 168 HIV-infected Japanese men who were antiretroviral naïve and who did not have hemophilia, including patients who took medication for dyslipidemia. The mean age of the patients was 45.7 years; 0.6% of the patients took medication to dyslipidemia. The mean CD4 lymphocyte count was 289/μL, the mean baseline log10 HIV viral load was 4.2 HIV-1 RNA copies/mL, and 22% of the patients had a history of AIDS-defining events. A higher HDL-C concentration was associated with a higher CD4 lymphocyte count (p=0.043). Also, a higher LDL-C concentration was associated with a higher CD4 lymphocyte count (p=0.003). Infection with HIV was associated with dyslipidemia in antiretroviral-naïve patients. More advanced HIV disease was associated with less favorable lipid homeostatic profiles. These results are similar to findings from other countries.

Diaphragmatic paralysis is commonly caused by surgical and traumatic injuries, malignant neoplasm, and neurodegenerative disorders. However, in rare instances, diaphragmatic paralysis due to herpes-zoster virus infection has been reported. Here, we describe an 85-year-old woman who developed left hemidiaphragmatic paralysis within 19 days of the appearance of a typical herpes-zoster rash involving the C4-5 dermatome on the left side. Clinical and radiological findings revealed no local causes of phrenic nerve lesion. The hemidiaphragmatic paralysis was thought to be caused by herpes-zoster virus infection.

Aim Pneumonia-associated deaths are the 4th leading cause of death in elderly people, and fatality tends to increase with age, especially after the age of 65. We aimed to further define convalescence in this patient population by examining the clinical characteristics of elderly pneumonia patients. Methods We retrospectively examined the data of 292 patients aged 65 years or older who had died of pneumonia. Analysis was performed according to the guidelines for the management of pneumonia of the Japanese Respiratory Society (JRSGMP), which retrospectively classifies pneumonia into a community-acquired type (c type) and hospital-acquired type (h type). In the present study, there were 110 cases of c type and 182 cases of h type. Results Among the factors that accurately predicted disease severity in the c type group, age was associated with the highest frequency (104; 94.5%). Furthermore, age was most frequently associated with a convalescence prediction factor in the h type group (150; 82.4%). The remaining factors collectively comprised approximately 50%. Except in mild cases in the c type group, deaths occurred in each of the disease severity groups for both pneumonia types. Dysphagia occurred in many cases in both groups, and in both pneumonia types the most common complication was dementia. In the h type group, cerebrovascular diseases were the second most common complication. Conclusion When assessing disease severity in elderly pneumonia patients, the JRSGMP may not allow accurate judgment of convalescence. It is very likely that dementia and cerebrovascular diseases cause dysphagia. Furthermore, very elderly patients are frequently at risk of developing aspiration pneumonia during treatment. For these reasons, it may be necessary to add the condition of a patient with these complications to the disease severity rating or convalescence prediction factor when considering the outcome of pneumonia in very elderly patients. It is necessary to consider all these factors when treating such episodes.

In this study, we compared Ma Huang Tang (maoto), a traditional Japanese medicine (Kampo), with antiviral drugs to evaluate their respective and combined effect on the duration of fever and other subjective symptoms of influenza. Forty-five patients enrolled in this randomized control trial had positive type A influenza on rapid influenza antigen test, provided written consent, and sought treatment at Juntendo University Hospital between November 2008 and March 2009. Using a computer-gen- erated list, patients were randomly assigned to one of the four intervention groups: 1): maoto (TJ-27), 9 subjects; 2): Tamiflu (oseltamivir), 13 subjects; 3): Relenza (zanamivir), 6 subjects; and 4): maoto/oseltamivir combination, 9 subjects. Six outcome measures were evaluated, including fever, myalgia, headache, arthralgia, fatigue, and cough. Statistical differences were determined by the Bonferroni-adjusted t-test for multiple comparisons. Our results showed that there were no significant differences among the four groups in the time-course profile of fever and the number of days until fever resolution since treatment was initiated. In addition, no significant intergroup differences were detected in the number of days until resolution of myalgia, headache, fatigue, and cough. However, the maoto group reported a more rapid improvement in joint pain than the oseltamivir group (P = 0.01). In conclusion, maoto showed comparable efficacy as antiviral medications in reducing fever and influenza symptoms. As serious concerns over the indiscriminate use, adverse reactions, and resistance to current antiviral drugs continue to grow, maoto may serve as an elegant option for the treatment of influenza.

Aim Community-acquired pneumonia remains a common and serious disease for elderly persons. The incidence and mortality rates of pneumonia are higher in the elderly. We analyzed the mortality and prognostic factors in 200 elderly patients with community-acquired pneumonia. Methods The subjects were 200 elderly patients aged 65 years or older who needed hospitalization after initial visit to Geriatric Medicine, Juntedo Tokyo Koto Geriatric Medical Center, between January 2005 and December 2006. The subjects were divided into two groups, those who died, and those who survived on admission, we examined mortality rates and compared the background, underlying disease, laboratory data, chest X-ray findings, severity classification using A-DROP, between the two groups. Results The mortality rate was 15.0%. Circulating diseases, cerebrovacscular diseases and dementia were the most common underlying diseases. It took a longer period to enter the hospital in the cases that died. In laboratory findings, total protein, serum albumin and percutaneous oxygen saturation were lower, and BUN was higher in the fatality group. There were many more patients who had extending infiltration shadow on chest X-ray films and severe condition on A-DROP classification in the fatality group. Conclusions We concluded that delay of diagnosis and treatment, dehydration, low levels of protein and albumin were important prognostic factors. The extent of infiltration shadow in chest X-ray findings was also important. A-DROP might be useful for estimating the prognosis in elderly patients with community-acquired pneumonia. We should consider the prognostic factors and severity at the initial stage when treating elderly patients with pneumonia.

AIM The goal of this study was to clarify how the post-discharge support by a full time psychiatric social worker (PSW) in a dementia ward affected the discharge status of dementia patients. METHODS Patients who were discharged from a dementia ward were examined for hospitalization, post-discharge status, nutrition methods, treatment drugs, and relationship with discharge support performed by the PSW. RESULTS A total of 192 cases met the requirements for this examination, and approximately half (94, 49.0%) of these patients had Alzheimer disease. Fifty-two patients (32.3%) moved to home care. Forty-five patients visited our hospital for treatment, while 17 visited other medical institutions for treatment. Thirty-four patients (17.7%) moved to other medical institutions, and the remaining 96 patients (50.0%) entered other institutions. About half of these patients entered insurance care facilities for the elderly, and the number of entered cases decreased in the order of special elderly nursing homes, paid homes for the elderly, and group homes. The highest mean support frequency per case was more than 50 occasions and 800 minutes for a paid home for the elderly. This support decreased in the order of special elderly nursing homes, insurance care facilities, and group homes. Cases treated at other medical institutions had the shortest hospitalization, but these cases had a greater mean support frequency than the cases treated at our hospital. The lowest mean support frequency was for oral meal intake while the highest mean support frequency was for nourishment by gastrostomy, with a significant difference between both (P

Background Few studies have examined Japanese with regard to the achievement rates for target blood pressure levels, or the relationship between these rates and healthy lifestyle characteristics in patients with hypertension as defined by the newly established hypertension management guidelines (JSH2014). The aim of this study was to elucidate achievement rates and examine healthy lifestyle characteristics associated with achievement status among Japanese. Methods This cross-sectional study, conducted in January-December 2012, examined blood pressure control and healthy lifestyle characteristics in 8,001 Japanese workers with hypertension (mean age, 57.0 years; 78.8% were men) who participated in a workplace health checkup. Data were collected from workplace medical checkup records and participants’ self-administered questionnaires. We divided into 5 groups [G1; young, middle-aged, and early-phase elderly patients (65–74 years old) without diabetes mellitus or chronic kidney disease (CKD) (

The sarin gas attack in the Tokyo subway system is reviewed from a clinical toxicology perspective. Based on the lessons learned from this attack, the following areas should be addressed on a global scale. First, an adequate supply of protective equipment is required, including level B protective equipment with a pressure demand breathing apparatus. In addition, a system should be established that enables a possible cause to be determined based on symptoms, physical findings, general laboratory tests, and a simple qualitative analysis for poisonous substances. If an antidote is needed, the system should enable it to be administered to the victims as quickly as possible. Preparation for a large-scale chemical attack by terrorists requires the prior establishment of a detailed decontamination plan that utilizes not only mass decontamination facilities but also public facilities in the area. A system should be established for summarizing, evaluating, and disseminating information on poisonous substances. Finally, a large-scale scientific investigation of the Tokyo sarin attack should be conducted to examine its long-term and subclinical effects and the effects of exposure to asymptomatic low levels of sarin.

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The St. Luke's International Hospital received 640 patients on the day of the attack. Reduction in plasma cholinesterase (ChE) activity was generally associated with the severity of acute signs of toxicity. With time and treatment, the value rose quickly. To evaluate possible residual signs of symptoms 1 year after the attack, we sent questionnaires to the victims; of 303 respondents, 45% still had some symptoms including eye problems, easy fatigability, headache, and fear. Therefore, we conducted a study in collaboration with investigators at the Tokyo University Department of Public Health to evaluate possible long-term neuropsychological sequelae. The findings suggest the need to closely follow such patients for possible persistent functional changes.

We experienced two cases of infectious mononucleosis-like syndrome associated with human herpesvirus 6 (HHV-6). One of the patients had been under medication for depression and the other one for schizophrenia. Both of them were taking carbamazepine for more than a week along with the other drugs. The manifestation of the symptoms of those two were almost same, such as high fever, generalized eruption, liver dysfunction, lymph-adenopathy, and existence of atypical lymphocytes. Serological tests for EB virus, cytomegalovirus and herpes simplex virus showed no significant change while the tests for HHV-6 showed increased titers of IgG antibody during the courses. We also examined HHV-6 DNA by real time quantitative PCR tests for HHV-6, and they appeared significantly high in the peripheral blood samples.

This study aimed to examine the associations between obesity and percentage vital capacity (%VC), as well as lifestyle-related disorders, among Japanese participants of a voluntary health checkup. Subjects were 7,892 individuals who participated in a medical health checkup from January to December 2007. Multivariate logistic regression analysis was performed to assess associations between low %VC (

In order to determine the factors responsible for the differentiation of cytomegalovirus (CMV) hepatitis and Epstein-Barr virus (EBV) hepatitis in previously healthy adults, the clinical features and laboratory data of both types of hepatitis were retrospectively analyzed. CMV hepatitis showed a tendency to increase in our department. In comparison with EBV hepatitis, CMV hepatitis occurred in significantly older hosts than EBV hepatitis. We found that lymphadenopathy, cough and sore throat was more common in EBV hepatitis than in CMV hepatitis. The number of peripheral white blood cell count and atypical lymphocytes, and serum GOT, GPT, LDH and CRP levels of CMV and EBV hepatitis showed no significant differences.

[Case report] A 65-year-old male war admitted to a local hospital because of fever. He was treated with piperacillin and clindamycin without noticeable effect. He began to complain of loss of vision on the third hospital day and culture of the blood specimen yielded Klebsiella pneumoniae. He was diagnosed as endophthalmitis and referred to our hospital for further examination. The hematological laboratory test showed leukocytosis (12,700/microliter) and increased CRP (20.4 mg/dl). A computed tomographic (CT) scan of the thorax revealed multiple lung abscesses. An abdominal ultrasonographic scan and a CT scan of the abdomen revealed multiple liver abscesses. We drained the abscess in the liver and Klebsiella pneumoniae was detected from the sample of aspirated fluid and his sputum. Meropenem was administered intravenously. Fever started to improve on the tenth hospital day and the size of both liver and lung abscesses were reduced. He has lost vision of his right eye. He was discharged after sixty days. He did not have any immunosuppressive underlying disease including HIV infection and diabetes mellitus which cause these lesions.

Objective To evaluate the diagnostic accuracy of the rapid influenza antigen detection test (RIADT) and determine which symptoms are relevant to results. Design Single-centre, cross-sectional study. Setting Primary care centre, Tokyo, Japan. Participants 82 consecutive outpatients presenting with upper respiratory symptoms and fever ≥37°C at any time from symptom onset, between December 2010 and April 2011. Main outcome measures Results of history and physical examination including age, sex, temperature, time of test from symptom onset, vaccination record and current symptoms (sore throat, arthralgia and/or myalgia, headache, chills, cough and/or throat phlegm, nasal discharge) were recorded. The RIADT and a fully automated respiratory virus nucleic acid test (Verigene Respiratory Virus Plus; VRV), the latter being the gold standard, were performed. Patients were divided into four groups: false negative (FN), RIADT− and VRV+; true positive (TP), RIADT+ and VRV+; true negative (TN), RIADT− and VRV−; and false positive, RIADT+ and VRV−. Groups were compared regarding age, sex, temperature, time of test from symptom onset, vaccination record and symptoms. Results RIADT sensitivity, specificity, positive predictive value and negative predictive value were 72.9% (95% CI 61.5% to 84.2%), 91.3% (79.7% to 102.8%), 95.6% (89.5% to 101.6%) and 56.8% (40.8% to 72.7%), respectively. Time from symptom onset to test was shorter for the FN group than the TP group (p=0.009). No significant differences were detected for the other factors assessed. Results revealed higher temperatures for FN than TN patients (p=0.043), and more FN than TN patients had chills (p=0.058). Conclusions The RIADT sensitivity was low, due to early administration of the test. In the epidemic season, the RIADT should not be used for suspected influenza until 12 h after symptom onset. A positive RIADT firmly supports the influenza diagnosis; a negative result does not confirm its absence. High fever and chills might indicate influenza, but additional tests are sometimes necessary.

Rapid influenza antigen detection tests (RIADTs) using immunochromatography are the most readily available tools for the diagnosis and management of influenza. This study was designed to assess whether near point-of-care administration by primary care physicians of the RIADT and a fully automated respiratory virus nucleic acid test (Verigene Respiratory Virus Plus®; RV+) would contribute to improved patient management. When viral culture and RT-PCR/bi-directional sequencing were used as the gold standard, sensitivities and specificities for RIADT and RV+ were 58.3% and 90.9%, and 97.2% and 100%, respectively. Within 12 hours from onset of fever, sensitivities were 44.4% and 94.4%, respectively, for RIADT and RV+. In clinical situations where a higher-sensitivity test is needed, such as during pre-admission evaluations, for testing of hospital employees during the prodromal phase of infection, during the therapeutic decision-making process, and during outbreaks, we suggest that patients testing negative by the RIADT can be reassessed with the RV+ test to achieve maximal diagnostic accuracy.

AIM The aim was to investigate the respective associations between lifestyle and proteinuria and the estimated glomerular filtration rate (eGFR). METHODS The lifestyle habits of 25,493 middle-aged participants were investigated in a cross-sectional study to find habits that are associated with a low eGFR (

We performed a cross-sectional study that included 100 HIV-infected Japanese men without hemophilia to examine the influence of smoking on HIV infection. History of smoking was obtained using a questionnaire. The percentage of current smokers was 40% and was the highest (50%) among men in their forties. The mean Brinkman index (BI, number of cigarettes smoked per day multiplied by years of smoking) was 450. The percentage of patients with a BI ≥600 was significantly higher in patients with an AIDS-defining event than in those without an AIDS-defining event. A BI ≥600 was associated with an AIDS-defining event. Reducing smoking appears to be critical to enhancing disease management efforts in Japanese men with HIV.

We reported earlier on culture filtrate antigens from A. fumigatus that had been incubated at 25°C for 1-10 weeks (Jpn J Med Mycol 34: 439-444, 1993). Additionally, we prepared five culture filtrate antigens from A. fumigatus ATCC26430 grown by shaking at 25°C for 11-15 weeks in Sabouraud liquid medium. We also prepared a polysaccharide antigen from the same strain by extracting mycelia and conidia. The growth of the fungi became weaker in cultures after 12 weeks, and by stopped at 14 weeks. Sixteen antigens were then employed in agar gel double diffusion (DD) tests against the sera of 18 aspergilloma patients. The results of DD showed three types (A, B, C) of precipitin pattern, with 9 patients belonging to type A, 6 to type B and 3 to type C. In all cases, precipitin lines were formed with the antigens obtained after 6-15 weeks of culture. To avoid contamination, inferior cultures and accumulation of waste, the incubation time should be as short as possible. Thus, as noted in our previous letter, we found that the antigen obtained from 6-week culture filtrates at 25°C is the most useful for demonstrating precipitin reactions against the sera of aspergilloma patients.

アスペルギルス感染症の抗体検出用抗原として, 筆者らは以前より培養濾液粗抗原を使用して血清診断を行っているが, 抗原液作製時に不溶物を生じるなどの問題点がある. これらを改良すると共により良い抗原の作製を目的として, 培養期間を変えた10種の粗抗原を調製し, 寒天ゲル内二重拡散法 (DD法) と免疫電気泳動法 (IE法) を行い患者血清との間に形成される沈降線の数と性状を比較した.その結果, 培養時間の延長に伴い沈降線数が増加し, DD法では6週間培養粗抗原でピークに達するが, 7週間培養以降の粗抗原では沈降線の形態が変化し, 培養中に成分に何らかの変化が起こっていることが推定された. 一方, IE法では9週間以上培養した濾液で沈降線が一本増しており, これについては今後さらに検討する余地がある.以上の事からアスペルギローム患者血清に対しては, これまで用いてきた3週間培養の培養濾液粗抗原より6週間培養濾液粗抗原の方が有用であることがわかった.

急性白血病に合併したPenicillium citrinumおよびPenicillium spp. による感染例を報告すると共に, Penicillium感染例を集計分析した結果を報告する.Penicillium感染症例は本邦例3例を含めて65例が報告されている. 検出菌種別ではP. marneffei40例, P. crustaceum5例, P. citrinum3例, P. chrysogenum2例などであった. 報告例を国別に集計すると中国12例, タイおよびアメリカ合衆国が各11例, 香港10例, ナイジェリア4例, 本邦とフランスが各3例, イギリス2例であった. 中国, タイおよび香港はP. marneffeiの流行地であり報告例も多かったほか, これらの地域を旅行して感染した症例が4例認められた. 基礎疾患別ではAIDS, 白血病, 貧血・リンパ節腫脹・肝脾腫大など免疫機構の破綻を伴った症例が多く見られた. 病型別では全身播種型が34例あり, そのうち33例がP. marneffeiによる感染であった. 気管支肺型19例では, 組織侵入型が17例, アレルギー性気管支肺ペニシリウム症が1例, 菌球形成が1例であった. 角膜および眼内炎が5例に見られた.65例中29例が, Penicillium感染が原因で死亡し, 27例が軽快していた. 治療にはamphotericin Bを主体としてflucytosineあるいはazole系薬剤の併用が多く用いられていた.Penicillium spp. は空中真菌の中でも多いものであり, 免疫不全状態下の症例に合併する疾患として, 今後注目すべきものと考えられた.

Objective Patients with lupus nephritis receiving intravenous cyclophosphamide (IVCY) therapy were divided into groups according to their clinical course, and the long-term prognosis was evaluated. Patients and Methods A total of 67 patients with lupus nephritis were enrolled and divided as follow into the following groups: Group A: patients with fresh nephritis, Group B: patients with relapse nephritis, Group C: patients with nephritis as a transition of the main clinical manifestation. IVCY (500 mg or 750 mg) was administered every month, and continued for two to more than six months. Results The rate of remission was 78%; group A revealed a significantly higher rate of remission as compared with the other groups. Although long-term remission was revealed in most patients, some patients in Group B demonstrated a decreased rate of remission. Concerning the total dose administered, there was no relation to prognosis; a high dose was not required, especially for patients in Group A. On the other hand, the combination of steroid pulse therapy with IVCY revealed a moderate relation to the increased rate of remission in Group A. However, this combination therapy was not related to the maintenance of remission. There was no adverse effect at late onset. Conclusion The long-term prognosis of IVCY differed according to the patient's clinical course, and the result differed from those reported in other countries. Therefore, we should consider the clinical course and race specificity for the Japanese subject.

AIM The Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) is a community hospital catering for the health care needs of senior citizens, and 37.5% (120 beds) of its beds are psychiatric beds mostly for those with cognitive impairment. The purpose of this study was to analyze cause of death in a hospital like ours with its particular case mix. METHODS All patients who passed away in our hospital between June 1st 2002 and November 30th 2007 were surveyed with regard to their age distribution and causes of death were analyzed and compared with available national statistics. RESULTS The over 65 age group accounted for 93.5% of the total and consisted of 815 patients, including 461 men (56.6%) and 354 women (43.4%). The most common cause of death was malignant neoplasm, followed by pneumonia, cardiovascular diseases, cerebrovascular accidents, and renal failure. Among those who died from the primary disease diagnosed on admission, malignancy was most common (288 cases, 61.3%), followed by pneumonia, cerebrovascular accidents, cardiovascular diseases and renal failure. As for those who died from non-primary diagnosis on admission (patients dying due to any condition, not the direct reason of their admission), pneumonia was the most common diagnosis on admission (95 cases, 27.5%), followed by cardiovascular diseases, malignant neoplasm, sepsis and renal failure. In the general wards, above half of those who died due to the primary cause of admission was malignant neoplasm. On the other hand, 1/4 of those who died from causes other than the primary diagnosis on admission was pneumonia. In the mental health wards the most common cause of death due to the primary diagnosis was malignant neoplasm, followed by dementia of Alzheimer's type. The most common cause of death other than the primary reason for admission was pneumonia. More non-primary diagnosis deaths occurred in the mental health wards than in the general wards. CONCLUSION In our hospital, malignancy and pneumonia were the most common causes of death, rather than cerebrovascular or cardiovascular diseases, but otherwise, the ranking order of the causes of death was very similar to those in other areas of Japan. Causes of the both in our hospital were closely linked with the high incidence of in-hospital mortality in Japan, accounting for 80% of all deaths. Although the case mix of our in-patients is influenced by a particular distribution of health care institutions and nursing care facilities in our catchment area for secondary care, the study demonstrated that our geriatric service responds to the needs of a wide spectrum of indications suffered by elderly citizens at the end of their life.

Cyclospora cayetanensis is a coccidian protozoa that was newly recognized in 1979 in Papua New Guinea. We report the case of a 42-year-old French man who had visited Vietnam and presented with fever and watery diarrhea that had lasted for more than 2 weeks. The patient was diagnosed with C. cayetanensis infection by examination of a stool smear using UV fluorescence microscopy. Based on this rare case, we recommend that Cyclospora infection might be considered in the differential diagnosis of traveler's diarrhea in immunocompetent patients.

Triazole系抗真菌剤itraconazole (ICZ) をカンジダ症およびその疑い4例, 組織侵入型アスペルギルス症およびその疑い5例, 肺アスペルギローム2例, Paecilomyces lilacimsによる角膜潰瘍1例の合計12例に投与し, その臨床効果を検討すると共に, 検出されたAspergillus fumigatus2株, P.lilacims 1株に対するICZの最小発育阻止濃度 (MIC), ICZの血中および喀疾中濃度を測定した.臨床症状が改善あるいは治癒した症例は, カンジダ症では3例, 組織侵入型アスペルギルス症では4例で, 肺アスペルギロームの1例では長期間投与により, 菌の消失と菌塊の喀出をみた.しかしP.lilacimsによる角膜潰瘍1例は, 高齢で全身状態が悪かったこともあり無効であった.副作用は1例に見られ, ICZ増量後に便秘が出現したが, 緩下剤の投与で改善した.検出したA.fumigatus 2株, P.lilacinus 1株に対するICZのMICはそれぞれ0.2～0.39μg/ml, 0.79μg/mlと低かった.ICZの最高血中濃度は100mg投与例では投与6時間後の412 ng/ml, 200mg投与例では投与3時間後の944ng/mlであった.肺アスペルギローム2例での1日喀出疾中量は, 極めて低かった.ICZ投与量に比し低い血中濃度を示したが, 組織への移行が良く, 臨床効果が優れ, しかも副作用が少ないこともあって, アスペルギルス感染を含む真菌感染に有用な薬剤と考えられた.

Eight cases of diphyllobothriasis have been experienced in the Juntendo University Hospital. Seven of the 8 patients excreted tapeworm fragments. Eggs of Diphyllobothrium latum were found in the feces in 5 cases. One patient had a history of ingestion of raw trout (Sushi), and 2 raw salmon. One might have been infected in foreign countries, and 3 could not tell the source of infection. Bithoinol was administered orally to 7 patients. Four of the 7 excreted the worm and the scolex was recognized in three of the four. Neither recurrence nor abnormal findings have been recognized so far.

The author reviewed the records of 31 patients with asporogenic anaerobic empyema mostly seen in the wards of Internal Medicine, Juntendo University Hospital during the 27 years between 1961 and 1988, and obtained the following results. 1. There were 25 males and 8 females with an average age of 57.8 and 51.0 y/o (range, 25 to 79 y/o), respectively males more than forty years old occupied 74.2 percent of all cases. 28 patients (90%) had underlying conditions. 2. The cases of mixed infections with anaerobes and aerobes were only 22.6%. 3. The isolated bacteria were microaerophilic streptococcus, Bacteroides spp., Peptostreptococcus spp., Fusobacterium spp. etc. in this order. 4. There were no relationships between anaerobic infections with or without aerobes and putrid odor of pleural effusion. 5. Bacteroides spp. were isolated most in the group with putrid pleural effusion, however, they were not isolated in the group without putrid pleural effusion at all. This fact suggests that there is an intimate relationship between putrid odor and Bacteroides spp. 6. There was no deceased case which pleural effusion had been drained sufficiently with open or closed drainage. It suggests that sufficient drainage is the most important in therapeutic procedures of asporogenic anaerobic empyema.

AIM This study was done to clarify the characteristics of elderly patients with nontuberculous mycobacteriosis. METHODS We investigated the clinical features of 10 patients at an advanced age who had been given diagnosis of nontuberculous mycobacteriosis. RESULTS Mycobacterium avium intracellulare complex (MAC) were detected in all cases. The age of the patients ranged from 65 to 92. Four cases had underlying respiratory diseases (old pulmonary tuberculosis in 3 cases, pulmonary emphysema in 1 case, bronchiectasia in 1 case). Six cases suffered from dementia. The symptoms were relatively nonspecific, such as low grade fever, fatigue, appetite loss in almost all cases in this study. On computed tomography (CT) scans of the chest, mainly small nodular infiltrates were seen. MAC was detected in clinical samples such as sputum, gastric juice and bronchial lavage. The examination of gastric juice was performed in 6 out of the 10 cases. Gastric juice samples were smear-positive for acid-fast bacilli in 5 of 6, and culture-positive for MAC in 5 of 6. The detection of MAC in gastric juice samples was higher than that in sputum samples on admission. CONCLUSION Gastric juice might be useful to differentiate infection from casual isolation of MAC in elderly patients.

The seroprevalence of IgG antibodies to Toxoplasma gondii was assessed in 56 non-hemophiliac human immunodeficiency virus (HIV)-infected adult patients in Japan. Seroprevalence of T. gondii infection was only 5.4%, which is lower than reported for most other countries. Given these results, patients in Japan displaying lesions of the central nervous system and antibodies to T. gondii have a high probability of toxoplasmosis.

Legionella spp are well recognized as one of the etiologic factor in pneumonia, but it is difficult to distinguish the clinical features of Legionella infection from pneumonia due to other causes. The objective of the present study was to examine the clinical characteristics of community-acquired Legionella pneumonia in elderly patients. We reviewed the clinical, laboratory and radiographic findings in 8 patients diagnosed as having pneumonia caused by Legionella. The diagnosis was confirmed by the presence of urinary antigen, bacterial culture, polymerase chain reaction (PCR) and serum antibody. There were 6 men and 2 women, whose ages ranged from 76 to 85 years. All patients had fever and hypoxia, four patients had respiratory symptoms. The initial chest X-ray findings were varied--consolidation, ground glass opacity, pleural effusion and linear shadow. Urinary antigen was positive in 4 patients, bacterial culture in 2, PCR on the sputum in 3 and serum antibody in 2 patients. As pneumonia caused by Legionella often becomes life-threatening, especially in elderly people, it is imperative to diagnose it at the initial stage. In this study, urinary antigen proved to be the most useful diagnostic means. However, it is important to confirm the diagnosis through plural examinations.