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Sado, Japan

Sakai K.,Niigata University | Sakai K.,Kanazawa University | Hayashi S.,Niigata University | Sanpei K.,Sado General Hospital | And 2 more authors.
Neuropathology | Year: 2012

We report a 75-year-old man with a 3.5-year history of cerebral amyloid angiopathy (CAA)-related inflammation. His initial symptom was headache and sensory aphasia appeared 1 month later. BraMRI revealed features compatible with meningoencephalitis involving the right frontal, parietal and temporooccipital lobes. A brabiopsy sample from the right parietal lobe showed thickening of the leptomeninges, and granulomatous vasculitis with multinucleated giant cells and vascular Aβ deposits. No vascular lesions were evident by cerebral angiography. Serological examination revealed an elevated level of proteinase 3 anti-neutrophil cytoplasmic autoantibodies (PR3-ANCA). The patient was treated with corticosteroids, but this was only partially and temporarily effective. Autopsy revealed marked leptomeningeal thickening with inflammatory cell infiltrates and hemosiderdeposits, many superficial predominantly small infarcts at various stages the cerebral cortex and only a few cerebral active vasculitic lesions. Immunohistochemically, CAA showing widespread Aβ-positive blood vessels with double-barrel formations was demonstrated. conclusion, we consider that, although the association of PR3-ANCA with the pathogenesis of Aβ-associated vasculitis remained unclear, the present case represents a rare example of CAA-related inflammation at the chronic stage. © 2011 Japanese Society of Neuropathology. Source

Otsuka T.,Sado General Hospital
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2012

Haemophilus influenzae type b (Hib) remains the leading cause of invasive bacterial infection in Japanese children. More than 110 countries that have included Hib conjugate vaccines in their routine vaccination programs have seen dramatical decrease in the incidence of Hib infections. In Japan, the vaccine has been introduced for voluntary immunization since December 2008 and has been provided free of charge only since January 2011. This review reports the prevalence of Hib and its clones among healthy children and pediatric patients diagnosed with invasive or non-invasive Hib infections in Sado Island, Japan. Of 25 Hib isolates collected in this surveillance, 4 genotypic patterns (ST54-gBLPACR-III, ST54-gBLNAR-I/II, ST190-gBLNAS, and ST95-gBLPACR-I/II) were detected. These STs were double or triple-locus variants of each other. Under the same antimicrobial selective pressure, high prevalence of gBLPACR strain (76.0%) was confirmed in Hib isolates, while gBLPACR prevalence in nontypeable H. influenzae was very low (5.2%). These data suggested that each ST strain may be brought into Sado Island by different routes. We note that surveillance of healthy subjects to identify Hib carriers is important to understand their role in transmission of Hib. Source

Tsunoda K.,National Institute of Sensory Organs | Usui T.,Niigata University | Hatase T.,Niigata University | Yamai S.,Sado General Hospital | And 9 more authors.
Retina | Year: 2012

PURPOSE: To report the clinical characteristics of occult macular dystrophy (OMD) in members of one family with a mutation of the RP1L1 gene. METHODS: Fourteen members with a p.Arg45Trp mutation in the RP1L1 gene were examined. The visual acuity, visual fields, fundus photographs, fluorescein angiograms, full-field electroretinograms, multifocal electroretinograms, and optical coherence tomographic images were examined. The clinical symptoms and signs and course of the disease were documented. RESULTS: All the members with the RP1L1 mutation except one woman had ocular symptoms and signs of OMD. The fundus was normal in all the patients during the entire follow-up period except in one patient with diabetic retinopathy. Optical coherence tomography detected the early morphologic abnormalities both in the photoreceptor inner/outer segment line and cone outer segment tip line. However, the multifocal electroretinograms were more reliable in detecting minimal macular dysfunction at an early stage of OMD. CONCLUSION: The abnormalities in the multifocal electroretinograms and optical coherence tomography observed in the OMD patients of different durations strongly support the contribution of RP1L1 mutation to the presence of this disease. © The Ophthalmic Communications Society, Inc. Source

Urashima M.,Jikei University School of Medicine | Segawa T.,Fuji City General Hospital | Okazaki M.,Sado General Hospital | Kurihara M.,Kanagawa Rehabilitation Center | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2010

Background: To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physiciandiagnosed seasonal influenza. Objective: We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren. Design: From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D 3 supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen. Results: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D 3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006). Conclusion: This study suggests that vitamin D3 supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373. © 2010 American Society for Nutrition. Source

Otsuka T.,Sado General Hospital | Zaraket H.,St Jude Childrens Research Hospital | Okazaki M.,Sado General Hospital
Japanese Journal of Infectious Diseases | Year: 2011

SUMMARY: Since 2002, we have conducted a series of intervention programs in Sado Island, Japan, to increase awareness of the appropriate use of antimicrobials among public and health-care staff. The objective of our study was to determine the antimicrobial susceptibility of Staphylococcus aureus among children in a semi-closed geographic region with controlled antimicrobial use. The average hospital visitbased rate for antimicrobial drug prescription drastically decreased from 535 per 1,000 clinic visits before the intervention programs to 45-75 per 1,000 clinic visits after the intervention programs (P < 0.0001). We obtained 1,260 clinical isolates of S. aureus from 957 pediatric outpatients aged 0-15 years between 2002 and 2010 at Sado General Hospital. The prevalence of methicillin-resistant S. aureus (MRSA) in the final year of the study (2010, 7.9%) was significantly lower than that in the early period of the study (2003, 23.6%; P < 0.001). All tested S. aureus isolates were susceptible to trimethoprim/sulfamethoxazole, teicoplanin, linezolid, and vancomycin. The prevalence of gentamicinresistant S. aureus in isolates from skin lesions was significantly higher than in isolates from other lesions (41.3% versus 28.5%; P < 0.05). In conclusion, prevalence of MRSA in children in our study population could be decreased by eliminating unnecessary antimicrobial drug prescriptions. Source

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