[An autopsy case involving severe sepsis due to Capnocytophaga canimorsus infection].

Capnocytophaga canimorsus, a commensal bacterium from the carine mouth, causes septicemia in human beings through bites or scratches. We report a case of a 60-year-old man contracting septicemia due to C. canimorsus infection after a dog bite who died less than 12 hours after admission. We observed neutrophils with intracytoplasmic bacilli in the peripheral blood smear. We discuss clinical presentation and autopsy findings.

Analysis of inhaled corticosteroid selection in patients with bronchial asthma using a questionnaire survey--effects of age, gender, and disease severity.

BACKGROUND: Inhaled corticosteroid (ICS) has played an important role in the management of asthma. Although several kinds of ICSs are currently available, there is no established strategy for ICS selection. METHODS: Using the data from the 2004 questionnaire surveys by the Niigata Asthma Treatment Study Group, we analyzed relationships between each patient and the ICS employed on the basis of patient background, asthma control and treatment, and indicated characteristics of ICS selection by the physician. RESULTS: Of 2852 cases, 2279 (79.9%) were ICS users, and 1513 (66.4% of ICS users) were classified as being in the fluticasone propionate (FP) group, 438 (19.2%) in the budesonide (BUD) group, and 240 (10.5%) in the hydrofluoroalkane-beclomethasone (HFA-BDP) group, indicating that FP was a standard ICS in this study. The mean age was significantly lower in the BUD group (52.3+/-18.2 years) and was significantly higher in the HFA-BDP group (59.9+/-17.0 years) than that in the FP group (55.8+/-16.6 years). The proportion of female patients was significantly higher not in the HFA-BDP (46.5%) but in the BUD group (59.0%) than in the FP group (51.1%). These results indicated that BUD was frequently prescribed to young female and HFA-BDP was employed in the elderly patients irrespective of gender compared with FP. CONCLUSIONS: Our study indicates that ICS selection is reasonably adapted to each patient's background at least in the surveyed area. We need to elucidate the characteristics of ICS selection further in the future as new ICS and devices are developed.

Spontaneous resolution of thoracic radiation therapy-induced organizing pneumonia: A case series.

We retrospectively analyzed the data of 9 patients with organizing pneumonia induced by radiation therapy. Radiation therapy had been administered for breast cancer in 8 patients and for lung cancer in 1 patient. Symptoms were detected in 8 patients; however, none of the patients developed hypoxemia or respiratory failure, and the clinical course was good. Steroid therapy was administered to 3 patients; however, all 3 patients developed recurrence. In contrast, none of the 6 patients who received symptomatic treatment developed recurrence. Steroid treatment is often provided for patients with organizing pneumonia; however, the effect of steroid administration on recurrence rate needs to be examined. In addition, none of the patients died and only 1 patient with lung cancer required mechanical ventilation. Therefore, considering the serious side effects of steroid use, initial symptomatic treatment, and not steroid administration, may be best for patients. One exception would be for patients with hypoxemia or those whose symptoms adversely affect the activities of daily living. The incidence of radiation therapy-induced organizing pneumonia in lung cancer patients is higher and its severity is greater than that in breast cancer patients; however, the time to onset may be longer in lung cancer patients. Therefore, more attention should be paid towards the diagnosis and treatment of radiation therapy-induced organizing pneumonia in patients with lung cancer as compared to that in patients with breast cancer.

[Severity classification and prognosis in hospitalized elderly patients with community-acquired pneumonia].

AIM: Community-acquired pneumonia (CAP) remains a common and serious illness. CAP can be a major cause of morbidity and mortality in elderly patients. This study aims to investigate the precision of disease severity staging scales such as Pneumonia Outcomes Research Team (PORT) Severity Index (PSI) and A-DROP (Age, Dehydration, Respiratory failure, Orientation disturbance, shock blood Pressure) in elderly patients with CAP. For this study, 111 elderly CAP patients admitted to our hospital during a two-year period were recruited and stratified using these scales. METHODS: We reviewed the precision of the above-mentioned scales in the 111 patients aged 65 years or above, and investigated the disease severity classifications, initial treatment, and clinical course of these patients. RESULTS: The mean age of the patients was 82 (+/-7.6) years. Among these patients, 15% were aged between 65 and 75 years, 50% were older with their ages ranging from 75 to 84 years, and 35% were extremely old with their ages over 85 years. The mortality rates for the patients with the A-DROP score of 0, 1, 2, 3, 4, and 5 were 0%, 0%, 2.2%, 17.2%, 20.0%, and 40.0%, respectively, and those for the patients with PSI class I, II, III, IV, and V were 0%, 0%, 0%, 0%, and 36.0%, respectively. CONCLUSIONS: PSI is a useful method for estimating the prognosis in elderly CAP patients. On the other hand, the A-DROP score may be inadequate in terms of judging the disease severity in these patients. With regard to the severity of pneumonia in elderly patients, we should consider not only the A-DROP score but also the underlying diseases such as malignancy, cardiac failure, cerebrovascular disease, liver disease, or renal disease.

Necrotising Candida oesophagitis after thoracic radiotherapy: significance of oesophageal wall oedema on CT.

Although oesophageal candidiasis is usually a superficial mucosal infection, necrotising Candida oesophagitis has been reported to cause oesophageal perforation or lung abscess. We report the case of an elderly Japanese man presenting with painless dysphagia after thoracic radiotherapy for oesophageal cancer. Non-contrast CT demonstrated segmental and oedematous thickening of the oesophageal wall. Endoscopy revealed white plaques on the oesophageal mucosa. The patient's oesophagitis responded to systemic antifungal therapy, and did not lead to oesophageal perforation. He died of recurrent oesophageal cancer several months later. The importance of severe radiation-induced oesophagitis without pain, our pathophysiological hypothesis on the local oedema caused by Candida infection and the usefulness of CT in evaluating abnormal thickening of the gastrointestinal tract are discussed separately in the article.

The impact of the Chuetsu earthquake on asthma control.

The Impact of the Chuetsu Earthquake on Asthma Control.

Rapid detection of causative pathogen of peritonitis using in-situ hybridization in a patient with continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is a common problem in patients on peritoneal dialysis, and the bacteriological diagnosis is important for the treatment of this condition. We used Hybrizep (a method for detecting the genes of bacteria ingested in phagocytes), to detect the causative bacterium in a 50-year-old woman receiving peritoneal dialysis who was admitted our hospital with bacterial peritonitis. The test, using peritoneal dialysis fluid, was positive for Streptococcus epidermidis. Vancomycin administration led to a good outcome for this patient. The Hybrizep method (which is available on the Japanese National Health system only for the diagnosis of septicemia) was a useful diagnostic approach for a patient on peritoneal dialysis who had peritonitis.