Tomomichi Kurosaki

Chiba Children's Hospital, Tiba, Chiba, Japan

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Publications (28)13.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Bacterial meningitis is a rare complication of adenotonsillectomy. We present a case of meningitis due to nontypeable Haemophilus influenzae and Streptococcus pneumoniae after adenotonsillectomy. Pulsed-field gel electrophoresis patterns indicated that the oral cavity was the source of H. influenzae and S. pneumoniae isolated from the cerebrospinal fluid. BLOOD CULTURE STUDY: As bacteremia is thought to be one of the etiologies of meningitis, we prospectively investigated the rate of bacteremia as a complication of adenotonsillectomy. Of the 46 patients included in the study, mean age of five years old, 11 (24%) had positive blood cultures during the operation. H. influenzae was the commonest organism grown (seven cultures), three of seven produced beta-lactamase, followed by S. pneumoniae (one culture), H. parainfluenzae (one culture), Peptostreptococcus micros (one culture), and Veillonella spp. (one culture). The bacteria were composed of tonsil or adenoid surface cultures in eight of 11 patients (73%). We present a rare case of meningitis complicating a adenotonsillectomy procedure, in a three years old boy. Meningitis is a rare complication of adenotonsillectomy, but bacteremia which may lead to meningitis occurs frequently, as the results.
    The Japanese journal of antibiotics 08/2013; 66(4):205-10.
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    ABSTRACT: The efficacy of 3-day treatment with a combined clavulanate/amoxicillin preparation (Clavamox combination dry syrup for pediatric cases) and 10-day treatment with amoxicillin against pediatric pharyngolaryngitis and tonsillitis caused by Group A β-hemolytic Streptococcus was compared. Among the patients included in the efficacy evaluation (54 from the clavulanate/amoxicillin group and 43 from the amoxicillin group), the clinical response rate on completion of treatment was 98.1 % in the clavulanate/amoxicillin group and 92.9 % in the amoxicillin group, thus supporting the equivalent efficacy of these two therapies. The Group A β-hemolytic Streptococcus eradication rate at approximately 1-2 weeks after completion/discontinuation of treatment was 65.4 % in the clavulanate/amoxicillin group and 85.4 % in the amoxicillin group. Even in cases from which the pathogen continued to be isolated, relapse/recurrence of clinical symptoms was seldom seen. Urinalysis, conducted to assess the presence or absence of acute glomerulonephritis, revealed no abnormality in any patient. These results suggest that 3-day treatment with this clavulanate/amoxicillin preparation is expected to provide a valid means of treating pediatric pharyngolaryngitis and tonsillitis caused by Group A β-hemolytic Streptococcus.
    Journal of Infection and Chemotherapy 07/2012; 19(1). DOI:10.1007/s10156-012-0444-1 · 1.49 Impact Factor
  • J Tanaka · N Ishiwada · A Wada · B Chang · H Hishiki · T Kurosaki · Y Kohno ·
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    ABSTRACT: The 7-valent pneumococcal conjugate vaccine (PCV7) is reported to decrease the incidence of community-acquired pneumonia (CAP) in children. To determine the annual incidence of CAP before the introduction of PCV7, we counted the number of children hospitalized with CAP between 2008 and 2009 in Chiba City, Japan. We investigated serotype and multilocus sequence typing (MLST) for Streptococcus pneumoniae isolates in CAP cases. The annual incidence of hospitalized CAP in children aged <5 years was 17.6 episodes/1000 child-years. In 626 episodes, S. pneumoniae was dominant in 14.7% and 0.8% of sputum and blood samples, respectively. The most common serotypes were 6B, 23F and 19F. The coverage rates of PCV7 were 66.7% and 80% in sputum samples and blood samples, respectively. MLST analysis revealed 37 sequence types. Furthermore, 54.1% of the sputum isolates and 40% of the blood isolate were related to international multidrug-resistant clones.
    Epidemiology and Infection 08/2011; 140(6):1111-21. DOI:10.1017/S0950268811001592 · 2.54 Impact Factor
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    ABSTRACT: Members of the Japanese Society of Pediatric Pulmonology and the Japanese Society for Pediatric Infectious Diseases developed the Guidelines for the Management of Respiratory Infectious Diseases in Children with the objective of facilitating the appropriate diagnosis and treatment of childhood respiratory infections. To date, a first edition (2004) and a revised edition (2007) have been issued. Many problems complicate the diagnosis of the pathogens responsible for bronchopulmonary infections in children. The Guidelines were the first pediatric guidelines in the world to recommend treatment with antimicrobials suited to causative pathogens as identified from cultures of sputum and other clinical specimens collected from infection sites and satisfying assessment criteria. The major causative microorganisms for pneumonia in infants and children were revealed to be Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. This manuscript describes the Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan 2007, with a focus on pneumonia.
    Pediatrics International 04/2011; 53(2):264-76. DOI:10.1111/j.1442-200X.2010.03316.x · 0.73 Impact Factor
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    ABSTRACT: The aim of the present study was to investigate the efficacy of i.v. immune globulin (IVIG) therapy combined with corticosteroids for additional treatment of acute Kawasaki disease (KD) unresponsive to initial IVIG treatment. In 50 prospective KD patients, six IVIG non-responders without clinical improvement within 24-48 h after completion of initial IVIG, received 2 g/kg IVIG concurrently with 2 mg/kg i.v. prednisolone sodium succinate (PSL) until normalization of C-reactive protein level. Treatment was then changed to oral PSL, which was tapered over time. Clinical and coronary artery lesion (CAL) outcomes were compared with those of 13 IVIG non-responders who received additional heterogeneous therapies in 125 retrospective KD patients. In addition, the scoring system of Kobayashi et al. for prediction of non-responsiveness to initial IVIG treatment was retrospectively verified in 175 KD subjects, consisting of 50 prospective and 125 retrospective patients in order to evaluate the efficacy of the re-treatment regimen. Incidence of CAL in the study patients was lower than in the control patients, although differences were not significant both in the acute stage (within 1 month: 1/6, 16.7% vs 7/13, 53.8%; P= 0.177) and in the convalescent stage (after 1 month: 0/6, 0.0% vs 4/13, 30.8%; P= 0.255). According to the non-responder prediction system, the scores of six study and 13 control patients before initial IVIG treatment were similar (7.2 ± 1.9 vs 5.3 ± 3.1; P= 0.200). No serious adverse effects related to each treatment were noted in patients of either group. Additional IVIG combined with concurrent PSL appears to be safe and worth evaluation for the treatment of acute KD unresponsive to initial IVIG treatment.
    Pediatrics International 02/2011; 53(5):729-35. DOI:10.1111/j.1442-200X.2011.03338.x · 0.73 Impact Factor
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    ABSTRACT: Population-based studies on community-acquired pneumonia (CAP) are rare in Japan. Among 984 Chiba City children admitted with CAP to 19 local hospitals in 2005, 854 were younger than 5 years old. The annual CAP incidence among children < 5 years old was 19.7 per 1,000. Five, 4 of whom were under 5 years old, had pneumococcus isolated from blood. The incidence of CAP with pneumococcal bacteremia was 9.21 per 100,000 among those < 5 years old.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 11/2008; 82(6):624-7. DOI:10.11150/kansenshogakuzasshi1970.82.624
  • Naruhiko Ishiwada · Tomomichi Kurosaki · Itaru Terashima · Yoichi Kohno ·
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    ABSTRACT: The purpose of the study is to evaluate the incidence, spectrum of clinical manifestations and outcome of invasive pneumococcal disease (IPD) in children in Chiba prefecture, Japan. To determine the precise incidence of IPD in Chiba prefecture, we implemented a retrospective survey of the period from 2003 to 2005. A written questionnaire was sent to 45 hospitals that have pediatric wards, and information was obtained from all hospitals. The questionnaire included the clinical diagnosis, patient's age, underlying disease, prognosis and antimicrobial susceptibility of the isolated strains. During the 3 study years, 130 patients were diagnosed with IPD. The mean annual incidence rates of IPD among children <2 and <5 years were 19.5-23.8 and 12.6-13.8 per 100,000, respectively. Among 130 patients with systemic infection, 66 patients had bacteremia, 39 had pneumonia and 16 had meningitis. Five patients had neurological sequelae and 2 patients died. Seventy-four out of 115 isolates (64.3%) exhibited resistance to penicillin G. The annual incidence of pediatric IPD has remained constant during the study period. Two-third of isolated strains were at least partially resistant to penicillin G. Establishment of appropriate antibiotic therapy against IPD due to penicillin-resistant strains and the introduction of pneumococcal conjugate vaccines are emergent issues in Japan.
    The Journal of infection 10/2008; 57(6):455-8. DOI:10.1016/j.jinf.2008.09.029 · 4.44 Impact Factor
  • Nobue Takeda · Tomomichi Kurosaki · Naruhiko Ishiwada · Yoichi Kohno ·

    01/2008; 19(2):137-147. DOI:10.5701/jjpp.19.137
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    ABSTRACT: We summarize 41 cases of bacterial meningitis in the last 11 years caused by Haemophilus influenzae. All isolates were serotype b strain (Hib). Initial chemotherapy was started with ceftriaxone (CTRX) in 22 cases, ampicillin plus cefotaxime (CTX) in 9, CTRX plus panipenem/betamipron in 5, and CTX in 2. Some 31 cases were treated mainly with CTRX. Although therapeutic antibiotics showed good susceptibility for isolates, 8 complicated cases (19.5%) occurred. Sequalae were observed in 7 (17.1%) but none were fatal. Five strains with elevated MIC of CTX (0.12 to 1 microg/mL) recovered after 2001, and 3 of 5 strains also showed elevated MIC of CTRX (0.12 to 0.5 microg/mL), but all were cured completely with CTRX. At present, no treatment failures due to antibiotic resistance have been observed, and CTRX remains suitable as initial therapy for Hib meningitis. A decline in susceptibility for third-generation cephalosporin against beta-lactamase-nonproducing ampicillin-resistant H. influenzae is emerging, however, so it will be necessary to consider combination therapy with CTRX given the foreseeable trend in MICs.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 02/2007; 81(1):51-8. DOI:10.11150/kansenshogakuzasshi1970.81.51
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    ABSTRACT: This aim of this study was to reveal annual changes in antibiotic susceptibility, especially the macrolide susceptibility of Streptococcus pyogenes. A total of 755 strains of S. pyogenes were clinicaly isolated from throat swabs of children from 1995 through 2004 in Chiba Municipal Kaihin Hospital. All isolates were fully susceptible to benzylpenicillin, cefotaxim and cefaclor. The rate of resistance to erythromycin (EM) was over 10% every year after 2001 and 19% in 2004, and the rate of high resistance (MIC > or =16 microg/mL) has been increasing. A significant increase in EM resistance was observed over a 10-year period. There were 118 strains (15.6%) that persisted after treatment with beta-lactams. In the past few years it has been discovered that some S. pyogenes can be internalized by human cells of respiratory tract origin and survive within them. Since beta-lactams do not reach high intracellular concentrations, this ability of S. pyogenes may be related to treatment failure. Since macrolides can enter eukaryotic cells and remain active in intracellular compartments, they will be effective for these S. pyogenes. In case of pharyngitis which againist treatment with beta-lactams, there is a possibility macrolides are effective. Macrolides may be effective in pharyngitis resistant to treatment with beta-lactams. However, macrolide resistance is not rare, susceptibility must be tested.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 12/2005; 79(11):871-6. DOI:10.11150/kansenshogakuzasshi1970.79.871
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    ABSTRACT: The prevalence of beta-lactamase-nonproducing ampicillin-resistant (BLNAR) Haemophilus influenzae (H. influenzae) has been increasing in recent years. Piperacillin (PIPC) is one of a few beta-lactams possessing good activity against BLNAR H. influenzae. We studied clinical efficacy of piperacillin and its beta-lactamase inhibitor, tazobactam/piperacillin (TAZ/PIPC) in children with lower respiratory tract infection caused by H. influenzae including resistance strains. Subjects were 20 children with lower respiratory tract infection caused by H. influenzae treated with PIPC 100mg/kg/day (7 cases) or TAZ/PIPC 125mg/kg/day (13 cases). We selected cases from which resistant H. influenzae strains might be detected. Patients received prior antimicrobial therapy within two weeks before admission, or with underlying diseases. We examined patient profiles, clinical efficacy, susceptibilities for 6 beta-lactam antibiotics [PIPC, TAZ/PIPC, ampicillin (ABPC), cefotaxime (CTX), ceftriaxone (CTRX), and meropenem (MEPM)] and analyzed 6 genotype patterns of beta-lactam resistant genes by PCR. Efficacy was 7/7 in patients in PIPC group and 12/13 in patients in TAZ/PIPC group. Diminished efficacy was seen in only one case complicated with severe RSV infection. The susceptibility of all strains but one beta-lactamase producing, ABPC resistant (BLP) strain to PIPC and of all to TAZ/ PIPC was below 0.25 microg/mL. The genotype of the 15 strains isolated from the sputum on administration was as follows; beta-lactamase nonproducing, ABPC-susceptible (gBLNAS) strains were 4, gBLP strain was 1, beta-lactamase nonproducing, and ABPC-resistant (gLow-BLNAR) strains were 2, beta-lactamase nonproducing, ABPC resistant (gBLNAR) strains were 8. PIPC and TAZ/PIPC were useful against lower respiratory tract infection caused by H. influenzae including BLNAR in children.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 10/2005; 79(9):637-43. DOI:10.11150/kansenshogakuzasshi1970.79.637
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    ABSTRACT: We studied the effects of a new regimen consisting of intravenous immune globulin (IVIG) combined with dexamethasone (DEX) on clinical outcome and serum levels of vascular endothelial growth factor (VEGF) in the initial treatment of Kawasaki disease (KD). A total of 46 KD patients received 0.3 mg/kg per day DEX plus heparin i.v. for 3 consecutive days, together with 2 g/kg IVIG over 4 to 5 days (DEX group). Low-dose acetylsalicylic acid was started after completion of DEX therapy. The control group consisted of 46 KD patients retrospectively treated earlier with 2 g/kg IVIG over 4 to 5 days plus higher dose acetylsalicylic acid (CONTROL group). No serious adverse effect was noted in either group. There were no differences in baseline and post-treatment laboratory data except for C-reactive protein between the groups. Post-treatment C-reactive protein in the DEX group (median 0.9 mg/dl, range 0.0 to 24.7 mg/dl) was lower than that (1.2 mg/dl, range 0.2 to 19.5 mg/dl) in the CONTROL group ( P=0.033 by Mann-Whitney U test). In addition, the mean duration of fever after the first IVIG infusion was 2.2 days (median 1 day, range 1 to 12 days) in the DEX group and 2.8 days (2 days, 1 to 16 days) in the CONTROL group ( P=0.015 by Mann-Whitney U test). The new regimen did not reduce VEGF levels. Two patients in each group developed small- or medium-sized coronary artery aneurysms. CONCLUSION: Although this regimen did not affect coronary outcome, intravenous immune globulin therapy combined with dexamethasone for the initial treatment of Kawasaki disease was safe and may accelerate the resolution of systemic inflammation.
    European Journal of Pediatrics 05/2004; 163(4-5):229-33. DOI:10.1007/s00431-003-1386-5 · 1.89 Impact Factor
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    ABSTRACT: Several types of transient thyroid dysfunction in infants born to mothers with Graves' disease have been described, ranging from completely unaffected infants to those with hyperthyroidism or hypothyroidism, depending on maternal thyroid function, activity of maternal TSH receptor antibody (TRAb) and maternal antithyroid agents due to transplacental passage. We observed a premature neonate born to a mother with three-year-untreated Graves' disease, who developed transient central hypothyroidism in the immediate postnatal period. Placental transfer of thyroxine and TRAb from the thyrotoxic mother may cause fetal peripheral thyrotoxicosis resulting in suppression of the fetal pituitary-thyroid axis.
    Clinical Pediatric Endocrinology 01/2003; 12(2):93-97. DOI:10.1297/cpe.12.93
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    ABSTRACT: A 9-year-old girl presented central precocious puberty (CPP) with polycystic ovary syndrome (PCOS) simultaneously. She had obesity, hirsutism and acanthosis nigricans. Laboratory examination revealed high levels of serum LH, FSH (LH > FSH), testosterone and insulin. The response of dehydroepiandrosterone sulfate after administration of ACTH was normal for a female. She has been treated with GnRH analog and weight reduction. Excessive androgen production results from ovarian defect and therefore, functional ovarian hyperandrogenism and hyperinsulinemia might be major factor in the pathogenesis. This case is the first report of a PCOS woman demonstrating CPP simultaneously.
    Clinical Pediatric Endocrinology 01/2002; 11(2):77-86. DOI:10.1297/cpe.11.77
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    Nobue Takeda · Tomomichi Kurosaki · Akira Nakamura ·
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    ABSTRACT: We administered amantadine to 52 children for therapy and 3 children for prophylaxis of influenza A infection from January to March 1998. Among the 23 children in the therapy group with proven influenza A/H3N2 infection, 15 patients (60%) allayed fever within 3 days but 9 (40%) had persistent fever for more than 4 days after administration of amantadine. Seven of these nine patients (40%) received amantadine within 2 days after the onset of fever. Two of these nine had secondary bacterial infections. One child had insomnia as side effect. We concluded that administration of amantadine for therapy is safe and effective, if given to patients without secondary bacterial infections in the first 48 hours of the illness.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 02/2000; 74(1):6-11. DOI:10.11150/kansenshogakuzasshi1970.74.6
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    ABSTRACT: Of pediatric patients with purulent meningitis seen at the institutions listed in the title page of this paper between 1986 and 1994, 93 patients treated with antibiotics and dexamethasone (DXM) were compared with 91 patients treated with antibiotics alone. The patients receiving antibiotics with dexamethasone achieved overall improvement in inflammatory symptoms and signs and cerebrospinal fluid findings and became afebrile significantly earlier than those receiving antibiotics alone. However, some of the patients became febrile again. The secondary fever rate for the DXM group was much higher than that for the antibiotic alone group (p < 0.0001). In most of the rebounded cases, the body temperature rose above 38 degrees C and remained elevated for 2-4 days. Cerebrospinal fluid (CSF) was cultured daily in 54 and 32 patients receiving antibiotics with and without DXM, respectively. Although this study was not a controlled study in a strict sense, these patients compared. In both groups, the CSF became mostly culture-negative within 48 hours. In a few patients receiving DXM, however, it became culture-negative after 72 hours or longer. DXM caused an adverse effect in a patient with meningitis caused by Streptococcus pneumoniae. The adverse effect was mild gastrointestinal bleeding, which recovered spontaneously. From the findings described above, the use of DXM combined with antibiotic therapy was considered to accelerate the relief from fever and improvement of inflammatory symptoms and signs and CSF findings. The body temperature rose again in more than half of the patients receiving DXM, but fell to normal spontaneously without treatment. The elevation doubtlessly could not be distinguished from recurrence of the meningitis itself or complications. It seems to be likely that no treatment but careful observation is required even if the fever recurs as far as the CSF findings showed favorable progress with excelluent general conditions. When DXM is given, it is essential that CSF tests and culture are repeated during the early stages and the progress is monitored carefully.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 07/1999; 73(7):664-74.
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    ABSTRACT: We observed 266 children with purulent meningitis in 27 institutions in Japan during the 14 years from 1981 on dividing these years into 3 periods, 1981-1985, 1986-1990 and 1991-1994, and studied the trend of causative organisms identified in 254 among the 266 patients. Their ages were less than 3 months after birth in 50 children and 3 months or older in 216: there were 141 boys and 125 girls. The causative organisms were H. influenzae in 134 patients and S. pneumoniae in 50, most of them being aged 3 months or older. Next to the above bacteria ranked S. agalactiae in 29 and E. coli in 12, many of the patients were aged less than 3 months. Staphylococcus spp. was found in 7 patients and about 70% of them were aged 3 months or older. L. monocytogenes was found in 4 patients and N. meningitidis in 3 and they were aged 3 months or older in both patient groups. S. pyogenes, Enterococcus spp., Peptostreptococcus spp., P. Mirabilis and Enterobacter spp. were detected each in 1 patient. The causative organism was unknown in 21 patients and there was no double infection. H. influenzae were detected in 18 patients in 1981-1985 period (36.7%), in 56 in 1986-1990 (54.9%) and in 60 in 1991-1994 (63.8%) showing an increasing tendency, but S. pneumoniae exhibited neither an increasing nor decreasing tendency. There was a decreasing tendency with S. agalactiae and E. coli, but the details were not clear because there were few patients aged less than 3 months. Although the period of coexistence of 4 main bacterial species was not made clear in this study. Listeria is considered to develop mainly in the early childhood, and we believe that the conventional way of using a cephem preparation and ampicillin combined for patients under 6 years need not be altered. However, panipenem (phonetic) is likely to be effective for insensible S. pneumoniae for the time being.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 11/1997; 71(10):1017-24.
  • K Sugimoto · H Kuroki · M Kanazawa · T Kurosaki · H Abe · Y Takahashi · N Ishiwada · Y Nezu · A Hoshioka · T Toba ·
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    ABSTRACT: For the treatment of atopic dermatitis, a variety of therapies are used including folk medicine. At present, there is no single treatment which is effective to cure the symptoms of atopic dermatitis completely in all patients. We are drawing attention to the high isolation rate of Staphylococcus aureus when starting disinfectant treatment combined with topical steroid therapies for the purpose of killing S. aureus. As a result, we examined many patients in whom almost a complete remission was obtained even after short periods of therapy, though it had been difficult to obtain improvement by conventional treatments. In many patients, IgE values and reagin antibody titer decrease dramatically soon after starting treatment. As a disinfectant, 10% povidone-iodine solution was used. We investigated also the effect of iodine contained in the povidone-iodine solution on the thyroid gland.
    Dermatology 02/1997; 195 Suppl 2(2):62-8. DOI:10.1159/000246033 · 1.57 Impact Factor
  • Haruo Kuroki · Nobuyasu Ishikawa · Tomomichi Kurosaki · Hiroo Niimi ·
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    ABSTRACT: Two infants with intractable wheezing and moist cough were referred to Chiba Municipal Kaihin Hospital. Their symptoms were persistent even after the usual treatment for respiratory disease. No definite etiological agents were detected. They usually gagged while feeding and barium swallow tests revealed nasopharyngeal reflux and cricopharyngeal incoordination. One of the patients had remarkably high titers of IgE and IgE RAST of cow's milk before she received treatment with thickened formula. She also had peripheral eosinophilia and nasal eosinophilia. These findings were thought to be caused by nasopharyngeal reflux. Four months after therapy commenced, those titers and symptoms were greatly reduced. The clinical and roentgenographic findings in these infants, and their response to therapy, strongly support a causal relationship between nasopharyngeal reflux and wheezing. Therefore, nasopharyngeal reflux should be considered when a baby has intractable wheezing, even when there is no developmental problem.
    Acta paediatrica Japonica; Overseas edition 09/1996; 38(4):357-60. DOI:10.1111/j.1442-200X.1996.tb03506.x
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    Naruhiko Ishiwada · Tomomichi Kurosaki · Tsuyoshi Toba · Hiroo Niimi ·
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    ABSTRACT: In pediatric patients with community-acquired pneumonia, most of the patients have received antibiotics before admission. In this study, we tried to determine whether we could identify the etiology of pneumonia by clinical and laboratory findings on admission. The etiology of acute pneumonia was studied in 596 pediatric inpatients. A pathogen was identified in 384 (64.4%) episodes of pneumonia. These 384 episodes were divided into six groups as follows; I: pneumonia with blood culture positive or pneumonia with bacterial antigen positive in urine, II: pneumonia with dominant bacterial pathogens in washed sputum. III: Mycoplasma pneumonia, IV: viral pneumonia, V: bacterial (I, II) + viral pneumonia, VI: bacterial (I, II) + Mycoplasma pneumonia. These groups were analyzed by clinical symptoms, physical examination and simple laboratory findings on admission. Patients with Mycoplasma pneumonia have increased blood sedimentation rate, high value of positive C-reactive protein and normal white blood cell count. It was difficult to distinguish bacterial pneumonia from viral pneumonia only based upon clinical symptoms, physical examination and simple laboratory findings.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 04/1995; 69(3):284-90. DOI:10.11150/kansenshogakuzasshi1970.69.284

Publication Stats

114 Citations
13.38 Total Impact Points


  • 2005-2012
    • Chiba Children's Hospital
      Tiba, Chiba, Japan
  • 2011
    • Kitasato University
      • Kitasato Institute for Life Sciences
      Edo, Tokyo, Japan
  • 1995-2011
    • Chiba Kaihin Municipal Hospital
      Tiba, Chiba, Japan
  • 1991-2008
    • Chiba University
      • Department of Pediatrics
      Chiba-shi, Chiba-ken, Japan
  • 1994-1995
    • Teikyo University Hospital
      Edo, Tōkyō, Japan