[Resection under Endoscopic Guidance of Papillary Fibroelastoma in the Left Ventricular Outflow Tract:Report of a Case].

A 76-year-old man was admitted to our hospital for a thorough examination of a suspected cardiac tumor on transthoracic echocardiography. Transesophageal echocardiography demonstrated a 9.4×8.1 mm mobile stalk-like mass in the left ventricular outflow tract. A preoperative electrocardiogram revealed paroxysmal atrial fibrillation. Tumor resection and pulmonary vein isolation were performed to prevent embolism and confirm the diagnosis. The tumor was resected using an endoscope because it was difficult to evaluate the tumor under direct view from the aortic valve. Pathological diagnosis was cardiac papillary fibroelastoma. Postoperative echocardiography showed no residual tumor or aortic regurgitation. One year and eight months passed since the surgery, and no recurrence of the tumor was detected. In cases like this one, where direct observation of the tumor is difficult, we suggest that the use of an endoscope may be effective because it has the advantage of sharing information with other surgeons.

A case report of SARS-CoV-2 confirmed in saliva specimens up to 37 days after onset: Proposal of saliva specimens for COVID-19 diagnosis and virus monitoring.

We present the case of a 71-year-old man who, despite becoming asymptomatic after having some mild symptoms of COVID-19, had SARS-CoV-2 RNA detected for 37 days after onset, from his concentrated and purified saliva specimens using sugar chain-immobilized gold nanoparticles. It was suggested that the early morning saliva specimens were more likely to show positive results than those obtained later in the day.

[Other viral food poisoning (hepatitis A and E)].

Hepatitis A and E viruses are spread via the fecal-oral route. In the endemic area, restaurant and school outbreaks due to contaminated water or food have been reported. The clinical signs and symptoms in patients with typical hepatitis A and E are similar to those seen with other forms of acute viral hepatitis. Hepatitis A tends to be more severe when acquired at older ages. Hepatitis E appears to be relatively severe compared with hepatitis A. Although both hepatitis are self-limited illness, severe hepatits are rarely observed. Hepatitis A and E can be prevented by improved sanitary conditions, handwashing, heating foods appropriately. Avoidance of water and foods from endemic areas is also effective.

Extrapulmonary pneumocystosis in an antiretroviral therapy-naïve, HIV-positive patient.

Pneumocystis jirovecii is a common opportunistic fungal pathogen that commonly affects immunocompromised individuals and can cause P. jirovecii pneumonia. Extrapulmonary P. jirovecii infections are extremely rare. Herein, we present a case of an HIV-positive, antiretroviral therapy-naïve patient who had extrapulmonary pneumocystosis (EPC). He presented with complaints of decreased appetite, abdominal fullness, and weight loss. Computed tomography (CT) revealed multiple low-attenuation masses in the spleen, liver, and both adrenal glands but no pulmonary involvement. A core-needle biopsy of a splenic lesion confirmed the diagnosis of EPC. The patient was initiated on intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and CT-guided percutaneous catheter drainage of the splenic lesion was performed. Intravenous TMP-SMX therapy was completed in 3 weeks and intravenous pentamidine (250 mg daily) therapy was commenced. Pentamidine was completed after 3 weeks, and antiretroviral treatment (ART) was initiated with dolutegravir 50 mg and Descovy HT (emtricitabine [200 mg] and tenofovir alafenamide fumarate [25 mg]). After starting ART, the patient's clinical condition improved, and the abscesses gradually reduced. TMP-SMX is commonly used to treat EPC; however, there is no standard method of treatment. ART may become the key to EPC treatment in individuals with HIV infection.

Three-year prospective, observational study of central line-associated bloodstream infections in a 600-bed Japanese acute care hospital.

BACKGROUND: Central line-associated bloodstream infection (CLABSI) is an important concern associated with central venous catheter (CVC) use. The objective of this study was to determine the influences of CVC access sites, CVC types, and presumed causative microorganisms on CLABSI occurrence in an acute care hospital. METHODS: We conducted a prospective, observational study of CLABSI occurrence for 3 consecutive years in a 600-bed Japanese acute care hospital. Data collected included patient characteristics, CVC access sites, CVC types, and microorganisms isolated by blood culture. RESULTS: For 1,650 CVCs used for 1,237 patients, 39 cases of infection were identified. Most infections had occurred within 1 month of CVC insertion. Maximal sterile barrier precautions had been used for most cases (97.3%). The average CLABSI occurrence days with internal jugular vein access were shorter than those with subclavian vein access and femoral vein access. CLABSI rates were 1.1 and 0.7 for single- and multilumen CVCs, respectively. CLABSI occurrence tended to be shorter when gram-positive cocci were isolated and tended to be longer when fungi (Candida spp) were isolated. CONCLUSION: Most CLABSI cases had occurred within 1 month of CVC insertion. Longer CVC duration increased chance of fungal infection.

Clinical evaluation of monotherapy with cefpirome for infections complicating hematological disorders.

The clinical effects of cefpirome (CPR) monotherapy were evaluated in 38 infected patients with hematological diseases. The underlying diseases of the patients were chiefly acute leukemia, myelodysplastic syndrome, malignant lymphoma, and aplastic anemia, and 18 patients were clinically neutropenic (<500 neutrophils/µL). Septicemia, pneumonia, or an unexplained fever, were the predominant complicating infections. The clinical efficacy of CPR was satisfactory or improved in 89.5% of patients. When compared to empirical combination therapy with 2 antibiotics, monotherapy with CPR reduced the drip infusion volume and the frequency of antibiotic administration, resulting in a better quality of life due to less frequent night urination, a low cost/benefit ratio, and reduction in nursing responsibilities. Due to this high efficacy rate, monotherapy with CPR should be considered as a front-line therapeutic approach in patients with infections accompanying hematological diseases, particularly those with neutropenia. J Infect Chemother 1996;2:75-78.

Emergence of Nonalbicans Candida Species in Immunocompromised Leukemia Patients during Fluconazole Treatment.

The incidence of the emergence of nonalbicans Candida species during fluconazole treatment was surveyed in leukemia patients who were severely immunocompromised due to either intensive chemotherapy or bone marrow transplantation during the 3-year period from April 1993 to March 1996. Thirty-three patients received either prophylactic or therapeutic fluconazole administration for at least 7 days. In 7 of these 33 patients (21.2%), nonalbicans Candida including C. krusei, C. glabrata, C. maris, and C. inconspicua emerged during, or immediately after, fluconazole administration, with C. inconspicua the most prevalent Candida spp. Since these yeast strains are resistant to fluconazole, it is possible that selection occurred favoring Candida spp. resistant to fluconazole. Therefore, surveillance for yeast strains resistant to fluconazole should be performed as a routine procedure during fluconazole administration. In cases of resistance, other effective antifungal agents should be administered.

[Infection control in Hamamatsu Medical Center].

Since the department of Infection Control was established in Hamamatsu Medical Center, a 615-bed community teaching hospital, we have been practicing infection control program including surveillance, coping with needle stick injuries, introducing Interlink system, PPD testing and influenza vaccination to the health care workers. One of the obstacles in the practice of the hospital infection has been a cost, and the infection control does not progress as long as this can't be solved. The infection control, which we have been carrying out so far, seems to have a lot of unnecessary practices. If we stop those practices, considerable cost can be reduced because the hospital infection is achieved in the entire hospital and can be shifted to the practice which is necessary. Although identification of the unnecessary practices is very difficult, EBM (Evidence based medicine) provides us with useful information. "The re-distribution of the cost" referring to EBM seems to be very important to progress infection control.

[Long-term complete remission following allogeneic PBSCT in a case of relapsed lymphoblastic lymphoma after BMT from the same donor].

An 18-year-old man was diagnosed as having lymphoblastic lymphoma in January 1997, and treated with chemotherapy. At the 1st relapse, bone marrow transplantation from HLA-identical sibling was performed in June 1998 with only acute graft-versus-host disease (GVHD). At the 2nd relapse, peripheral blood stem cell transplantation from the same donor was performed in October 2000 with both acute and chronic GVHD, which has continued for 25 months, and complete remission has also been maintained.

[A case of chronic myelogenous leukemia responding to imatinib mesilate (Glivec) after relapse of blastic crisis following allogeneic bone marrow transplantation].

We report a patient with chronic myelogenous leukemia that responded to imatinib mesilate after relapse of blastic crisis following allogeneic bone marrow transplantation. The patient received an unrelated bone marrow transplantation in the 3rd chronic phase, after which the 3rd blastic crisis occurred 5 months later. Since the case was refractory to chemotherapy at that time, imatinib mesilate (600 mg/day) was given, which resulted in a complete cytogenetical remission (CCR). The CCR has maintained for 11 months.

[Infection prevention and safe practice (referring to CDC guideline)].

Recent nosocomial infections, such as HCV and tuberculosis, have stimulated interest in infection control practices in health care setting. Therefore, Infection Control Doctors (ICDs) have already started to make best strategies for infection prevention and safe practice. However, many obstacles lie ahead of them, with the cost as the most important. It has been believed that it takes a lot of money for the improvement of infection control. But, this aspect has been changed completely by introduction of EBM because EBM can point out and quite unnecessary practices, resulting in saving money. CDC has been published many guidelines which is evidence based. Therefore, it might be best strategy to introduce CDC guideline into the infection control in Japanese hospitals.