[A Serious Case of Pseudomembranous Colitis in which Treatment with Endoscopic Vancomycin Sprinkling Got a Good Result].

We report herein on a 71-year-old man who developed pseudomembranous colitis (PMC). He was treated with oral metronidazole and vancomycin prescription, but deteriorated, and developed a toxic megacolon. Under paralytic ileus condition, per os and enema treatment efficacy was thought to be limited. Sprinkling with vancomycin via colonoscopy was therefore performed, resulting in therapeutic success. Additionally, participation in infection control should be carried out with severe PMC cases like this.

Ribavirin concentration in the later stages of 48 week pegylated interferon-alpha2b plus ribavirin therapy for chronic hepatitis C is useful for predicting virological response.

OBJECTIVES: The current standard of care for chronic hepatitis C patients is a pegylated interferon-α plus ribavirin combination treatment. This study was carried out to determine the relationship between ribavirin concentration in the later stages of treatment and virological relapse. PATIENTS AND METHODS: Serum ribavirin concentration of 183 chronic hepatitis C patients (genotype 1) treated with pegylated interferon-α2b plus ribavirin for 48 weeks was prospectively measured by HPLC at weeks 4, 12, 24, 36 and 48. Patients with undetectable serum hepatitis C virus (HCV) RNA 24 weeks after the end of treatment were designated as having sustained virological response (SVR). Patients with undetectable HCV RNA during the treatment but with virological relapse after the end of treatment were designated relapse. RESULTS: The mean ribavirin concentration at each testing point of patients with SVR (1401, 1725, 1803, 1811 and 1901 ng/mL) was significantly higher than that of relapse patients (998, 704, 607, 643 and 654 ng/mL) at weeks 4, 12, 24, 36 and 48, respectively (all P < 0.001). Multivariate regression analysis for relapse extracted ribavirin concentration at week 36, but not cumulative ribavirin dosage. The cut-off value by receiver operating curve analysis for predicting a relapse was 1503 and 1562 ng/mL at weeks 36 and 48, respectively. CONCLUSIONS: Ribavirin concentration in the later stages of treatment is an important marker of viral relapse.

Secondary Syphilis with Pulmonary Involvement.

A 39-year-old Japanese man presented to our hospital complaining of left chest pain and rash on the hands and feet. Plain thoracic computed tomography (CT) revealed multiple nodular shadows in the left lower lobe of the lung. A diagnosis of secondary syphilis was made based on the appearance of the rash and positive serologic tests for syphilis. The patient was started on amoxicillin but was switched to minocycline due to amoxicillin-induced rash on both forearms. Thoracic CT after five months of treatment revealed that the multiple lung nodular shadows had contracted, and secondary syphilis with pulmonary involvement was diagnosed.

Plasma glycated albumin level and atherosclerosis: results from the Kyushu and Okinawa Population Study (KOPS).

BACKGROUND: Glycated albumin (GA) is a measure of the mean plasma glucose concentration over approximately 2-3 weeks. This study was done to test the hypothesis that GA can serve as a marker for atherosclerosis, similar to glycosylated hemoglobin A1c (HbA1c). METHODS: HbA1c, plasma GA and serum high-sensitivity C-reactive protein (hs-CRP) levels were measured for 1575 residents (age range 26-78 years) of a suburban town in Japan. Carotid artery intima-media thickness (IMT) was measured by ultrasound for each participant. RESULTS: GA levels had significantly positive correlation coefficients with HbA1c level, hs-CRP level, and max-IMT (all P<0.001). Receiver operating characteristic curve analysis indicated a GA level of ≥ 15.5% to be optimal for predicting diabetes. A GA level of 15.5% corresponded to an HbA1c level of 5.8%. The hs-CRP and max-IMT values of participants with GA ≥ 15.5% were significantly higher than the values of those with GA <15.5% (median hs-CRP: 2.4 vs. 2.3mg/L, P=0.048; mean max-IMT 0.852 vs. 0.759 mm, P=0.003, respectively). Among obese participants, the hs-CRP and max-IMT values of those with GA ≥ 15.5% (7.5mg/L and 1.014 mm) were significantly higher than the values of those with GA <15.5% (4.7 mg/dL and 0.823 mm) (P=0.024 and P=0.001, respectively). CONCLUSIONS: Increased IMT and hs-CRP levels were associated with a high GA level, especially for obese participants, suggesting that GA would be as a useful biomarker for assessing the risk of atherosclerosis.

The utility of visceral fat level by bioelectrical impedance analysis in the screening of metabolic syndrome - the results of the Kyushu and Okinawa Population Study (KOPS).

AIM: A simple, non-invasive medical device, using bioelectrical impedance analysis (BIA) for the evaluation of visceral fat level (VFL) was developed recently. The aim of this study was to investigate the utility of VFL by BIA in the screening of metabolic syndrome (MetS). METHODS: VFL was measured by the BIA device in 1,451 Japanese residents (546 men and 905 women, age range 30-69 years). RESULTS: VFL had significant positive correlations with waist circumference (WC) and body mass index (r=0.772 and 0.849, all P < 0.0001). The overall MetS prevalence using Japanese Diagnosis Criteria was 19.8%: men 36.3% and women 9.8%. The mean VFL of the participants with MetS was significantly higher than those without MetS (men; 12.1 and 9.4, women; 13.3 and 8.7) (both P < 0.001). VFL significantly correlated with blood pressure, lipid profiles, fasting plasma glucose, and hemoglobin A1c (all P < 0.001). Receiver operating characteristic curve analysis for a diagnosis of two or more MetS risk factors excluding WC resulted in the same cutoff values for the VFL (10.0) of men and women. CONCLUSIONS: The VFL by BIA is useful for the detection of MetS because it is correlated with all metabolic parameters and shows the same normal limit in both sexes.