Impact of Geographical Variations on the Prevalence of Multidrug-Resistant Organisms in Japan.

Emergence and spread of multidrug-resistant organisms (MDRO) is an urgent social and public health problem. Here, we carried out an epidemiological survey to clarify the geographical characteristics and factors influencing the prevalence of MDRO. Data on the prevalence of MDRO in 47 prefectures in Japan were extracted from the Japanese Nosocomial Infection Surveillance, a nationwide database for infection control. Potential factors for MDRO were analyzed using data selected from the pharmacological, medical service, infection control, environmental, social, and food-related categories, based on the characteristics of each organism and the correlations between them and MDRO prevalence. Statistical data for potential factors were obtained from public domains. The use of antibiotics was found to be correlated with the prevalence of penicillin-resistant Streptococcus pneumoniae, 3rd-generation cephalosporin- and fluoroquinolone-resistant Escherichia coli, and methicillin-resistant Staphylococcus aureus. Negative correlation between the consumption of food such as kelp and fermented soybeans that facilitate the growth of lactic acid bacteria and the prevalence of 3rd-generation cephalosporin- and fluoroquinolone-resistant E. coli suggested an association between the intestinal microflora and MDRO colonization. In addition to the use of antibiotics, lifestyle, food culture, and social factors such as tobacco smoking, average atmospheric temperature, prevalence of three-generation households, ratio of elderly population, average duration of tourist stay, chicken and fermented soybean consumption, and the competency of healthcare services may also affect MDRO prevalence.

Two years' intensive training in endoscopic diagnosis facilitates detection of early gastric cancer.

OBJECTIVE: Early detection of gastric cancer by screening endoscopy facilitates endoscopic treatment in place of open surgery. The aim of this study was to evaluate whether 2 years intensive training improved the detection of gastric cancer by screening endoscopy. METHODS: An endoscopist who had trained for 6 years as a general physician, performed screening endoscopy at Imari Arita Kyoritsu Hospital before (group I) and after (group II) intensive training in the diagnosis of early gastric cancer in consecutive patients. RESULTS: Background characteristics, including age (61.6 vs. 62.2 years) and sex, did not differ between the groups. Before training, 10 gastric neoplasms were detected in 937 patients in group I: four early gastric cancers, one gastric adenoma, and five advanced gastric cancer. After training, 36 gastric neoplasms were detected in 937 patients in group II: 18 early gastric cancers, 11 gastric adenoma, five advanced gastric cancer, and one each of gastric carcinoid and malignant lymphoma. The detection rate for early gastric cancer was significantly improved by training [group I: 4/937 (0.4%) vs. group II: 18/937 (1.9%)], although the detection rate for advanced gastric cancer did not differ before and after training. The proportion of early gastric cancer + adenoma to advanced cancer was higher in group II (5/5 vs. 29/5 in group I). CONCLUSION: Intensive training in upper gastrointestinal endoscopy screening dramatically improved the detection rate for early gastric cancer, although the detection rate for advanced gastric cancer was not affected.

Colorectal cancer screening with odour material by canine scent detection.

OBJECTIVE: Early detection and early treatment are of vital importance to the successful treatment of various cancers. The development of a novel screening method that is as economical and non-invasive as the faecal occult blood test (FOBT) for early detection of colorectal cancer (CRC) is needed. A study was undertaken using canine scent detection to determine whether odour material can become an effective tool in CRC screening. DESIGN: Exhaled breath and watery stool samples were obtained from patients with CRC and from healthy controls prior to colonoscopy. Each test group consisted of one sample from a patient with CRC and four control samples from volunteers without cancer. These five samples were randomly and separately placed into five boxes. A Labrador retriever specially trained in scent detection of cancer and a handler cooperated in the tests. The dog first smelled a standard breath sample from a patient with CRC, then smelled each sample station and sat down in front of the station in which a cancer scent was detected. RESULTS: 33 and 37 groups of breath and watery stool samples, respectively, were tested. Among patients with CRC and controls, the sensitivity of canine scent detection of breath samples compared with conventional diagnosis by colonoscopy was 0.91 and the specificity was 0.99. The sensitivity of canine scent detection of stool samples was 0.97 and the specificity was 0.99. The accuracy of canine scent detection was high even for early cancer. Canine scent detection was not confounded by current smoking, benign colorectal disease or inflammatory disease. CONCLUSIONS: This study shows that a specific cancer scent does indeed exist and that cancer-specific chemical compounds may be circulating throughout the body. These odour materials may become effective tools in CRC screening. In the future, studies designed to identify cancer-specific volatile organic compounds will be important for the development of new methods for early detection of CRC.

[Incidents at the Central Blood Center of Hirosaki University Hospital, Hirosaki University School of Medicine & Hospital, Clinical Laboratory Division].

As part of an initiative to expand the activities of the Clinical Laboratory Division at Hirosaki University School of Medicine & Hospital, the Central Blood Center, which is located within the division, began providing blood collection services to outpatients in collaboration with the nursing department from April 2000. The number of blood samples collected has tended to rise each year, and while the aim has been to enhance pre-consultation tests, the increase in the number of such tests has led to an increase in the number of associated incidents. Two recent illustrative cases are: (1) a patient becoming angry about the long wait caused by a doctor's oversight regarding a test order, and (2) oversight concerning a test due to the time lag between a revised test order time and the time the patient arrived at the hospital. A factor contributing to both cases was the busy work schedule of doctors. Ensuring that patients are satisfied with their treatment requires institutional measures; therefore, it is necessary to explore methods for reducing human error in the support service for consultations. The present study introduces representative cases, and examines their contexts and measures for dealing with them.

[Successful gefitinib every other day administration in an advanced lung cancer patient with brain metastasis after gamma knife radiotherapy and chemotherapy].

A 69-year-old female, who had been admitted to another hospital with a complaint of headache and there detected brain tumor, was referred to our hospital for further examination and therapy. The patient was diagnosed as having advanced lung cancer with multiple brain metastasis. She was treated with five courses of a combination of chemotherapy consisting of carboplatin and paclitaxel following gamma knife radiotherapy. She showed a remarkable response, however, she experienced the side effects of general fatigue and numbness in her extremities, which were intolerable. Then, therapy with gefitinib alone was chosen as second-line chemotherapy. After one month, this therapy was discontinued due to grade 3 skin trouble and rash. When her condition improved, every other day oral administration of gefitinib was resumed. She has been treated on an outpatient basis because of no severe adverse reactions. The patient is alive with good performance status (PS) 0 more than one year after taking gefitinib. Furthermore, the primary and metastatic tumors are not enlarged. Gefitinib orally administered every other day could be a promising regimen as second-line chemotherapy for patients with lung cancer and brain metastasis.

[A case report--complete disappearance of multiple intrahepatic recurrences and portal thrombus in a case of hepatocellular carcinoma treated with UFT-E].

Here, we present a case of recurrent hepatocellular carcinoma(HCC)with portal thrombus that disappeared within only two months by oral tegafur(UFT-E). A 82-year-old man had recurrent multiple HCCs, which caused liver dysfunction because of diminished portal flow by the portal thrombus. Hepatic arterial chemo-embolization and continuous arterial CDDP-infusion chemotherapy did not show any efficacy. Next, oral UFT-E administration(low-dose, 300 mg/day)was begun, and after 1 month, PIVKA-II decreased and liver dysfunction was normalized. His complete response continued for 8 months until his death due to aspiration pneumonia and progressive dementia. Low-dose UFT-E administration may be considered a candidate in a case of HCC with no alternative treatment.

Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia.

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.

Detection of anomalous origins of the coronary artery by means of multislice computed tomography.

BACKGROUND: Anomalous origins of the coronary artery are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is crucial for any imaging method that attempts coronary artery visualization and of those available multislice computed tomography (MSCT), which provides excellent spatial resolution, may be the most promising. METHODS AND RESULTS: In consecutive 1,153 patients, MSCT identified 5 patients (0.43 %) with an anomalous origin of the coronary artery. The left circumflex artery (LCX) originated from the right sinus of Valsalva in 1 patient, and the right coronary artery originated from the left sinus of Valsalva and coursed between the aortic root and the pulmonary artery in 3 patients. In 1 patient, MSCT identified the absence of the LCX and high-grade atherosclerotic stenosis in the right coronary artery. CONCLUSION: MSCT can detect the anomalous origin and course of the coronary artery in relation to the great vessels. It is also useful for identifying atherosclerotic coronary artery disease superimposed on the anomalous vascular system.