[Effect on duration of antibiotic therapy and drug cost by introducing critical pathway for patients with CAP in Japan].

The aim of this study was to assess whether Marrie's critical pathway is an effective approach to reduce the duration of antibiotic intravenous therapy and drug cost in patients with community-acquired pneumonia (CAP) in Japan. We conducted a retrospective cohort study in patients with CAP who were admitted to a community hospital or a university hospital. We collected clinical and economic data from medical records and medical fee receipts and estimated drug cost for switching the dosage form using Marrie's critical pathway. Outcomes of this study were change in duration of intravenous therapy and drug cost. Fifty patients with CAP were selected from two hospitals. Actual days of antibiotic intravenous therapy were 9.5+/-4.2 days; in contrast, estimated days were 1.2+/-3.0 days (p<0.001). Actual drug cost was 37148+/-28791 yen; in contrast, estimated drug cost was 8364+/-18356 yen (p<0.001). Average reduction of days of therapy and drug cost were 8.3 days and 28704 yen, respectively. This study suggests that the implementation of Marrie's critical pathway may be an effective approach to reduce medical resources used for CAP treatment in Japan.

[Assessment of dihydropyrimidine dehydrogenase and thymidylate synthase expression in gastric carcinoma and colonic carcinoma].

We measured DPD activity and TS content in cancer and normal mucosa obtained from 23 patients with colorectal carcinoma and 7 patients with gastric carcinoma. DPD activity in colorectal carcinoma cases was significantly decreased in cancer tissues compared to those in adjacent normal mucosa (p<0.001), while TS content was significantly increased in cancer tissues (p<0.01). No significant correlation was found between cancer and adjacent normal mucosa in DPD activity and TS content of gastric carcinoma cases. Immunohistochemically, DPD and TS overexpression were found in 11 out of 23 patients (47.8%) and 3 out of 23 patients (13%) in colorectal carcinoma cases, respectively. In gastric carcinoma cases, DPD and TS overexpression were found in 3 out of 7 patients (42.9%) and 3 out of 7 patients (42.9%), respectively. No significant correlation was found between quantitative measurement and immunohistochemical overexpression in colorectal and gastric carcinoma cases. DPD and TS protein were partially overexpressed in some cases. Heterogeneity of the tumor is thought to be one of the reasons for the discrepancy between quantitative measurement and immunohistochemical overexpression.