The first nationwide surveillance of antibacterial susceptibility patterns of pathogens isolated from skin and soft-tissue infections in dermatology departments in Japan.

To investigate the trends of antimicrobial resistance in pathogens isolated from skin and soft-tissue infections (SSTI) at dermatology departments in Japan, a Japanese surveillance committee conducted the first nationwide survey in 2013. Three main organisms were collected from SSTI at 30 dermatology departments in medical centers and 10 dermatology clinics. A total of 860 strains - 579 of Staphylococcus aureus, 240 of coagulase-negative Staphylococci, and 41 of Streptococcus pyogenes - were collected and shipped to a central laboratory for antimicrobial susceptibility testing. The patient profiles were also studied. Among all 579 strains of S. aureus, 141 (24.4%) were methicillin-resistant (MRSA). Among 97 Staphylococcus epidermidis strains, 54 (55.7%) were methicillin-resistant (MRSE). MRSA and MRSE were more frequently isolated from inpatients than from outpatients. Furthermore, these methicillin-resistant strains were also isolated more frequently from patients with histories of taking antibiotics within 4 weeks and hospitalization within 1 year compared to those without. However, there were no significant differences in MIC values and susceptibility patterns of the MRSA strains between patients with a history of hospitalization within 1 year and those without. Therefore, most of the isolated MRSA cases at dermatology departments are not healthcare-acquired, but community-acquired MRSA. S. pyogenes strains were susceptible to most antibiotics except macrolides. The information in this study is not only important in terms of local public health but will also contribute to an understanding of epidemic clones of pathogens from SSTI.

Predictive values of clinical parameters for severe Japanese spotted fever.

Japanese spotted fever (JSF) is severe and can progress to disseminated intravascular coagulation (DIC) with a poor prognosis. We considered whether patient factors are related to serious complications. Between August 1999 and March 2009, all patients with JSF and retrievable clinical data (age, gender, length of hospital stay, medication, comorbidities), vital signs (blood pressure, heart rate, temperature), and laboratory test results [blood cell count, liver function, renal function, electrolytes, blood sugar, C-reactive protein (CRP), CRP normalization period, and aspartate aminotransferase normalization period] from the Integrated Intelligent Management System (IIMS) database, were retrospectively analyzed by logistic regression. There were 51 JSF patients (24 men, 27 women) with a mean age of 63.0 years. Six patients (11.8%) had DIC, but there were no in-hospital deaths. The time between fever onset and initiation of medication was approximately 5 days, but this delay was not associated with disease severity. We identified values correlating with disease severity (p < 0.1) by univariate analysis and then applied logistic regression. We found renal dysfunction [serum creatinine (Cr) ≥ 1.5 mg/dl] at the time of initial presentation to be predictive of DIC. Cr was also predictive of a prolonged disease course. In patients with JSF, renal function must be carefully monitored when determining clinical management.

Chondrolipoma of the toe.

Chondrolipoma is a rare benign mesenchymoma composed of mature cartilage and adipose tissue. We present a 71-year-old man with a chondrolipoma of the great toe. On histological examination, the tumor contained both mature fat cells and chondrocytes. To our knowledge, this is the first report of a chondrolipoma on the toe. This case contributes to better awareness of an extremely rare lesion of the distal lower limb.

Remote ischemic preconditioning reduces contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction: a randomized controlled trial.

BACKGROUND: Contrast medium-induced acute kidney injury (CI-AKI) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention. The aim of this randomized, sham-controlled trial was to evaluate the impact of remote ischemic preconditioning (RIPC) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention. METHODS AND RESULTS: Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a 1:1 ratio to receive percutaneous coronary intervention either with (n=63) or without (n=62) RIPC (intermittent arm ischemia through three cycles of 5min of inflation and 5min of deflation of a blood pressure cuff). A total of 47 RIPC patients and 47 control patients met all study criteria. The primary endpoint was the incidence of CI-AKI, which was defined as an increase in serum creatinine >0.5mg/dL or >25% over the baseline value 48-72h after administration of contrast medium. The incidence of CI-AKI was 10% (n=5) in the RIPC group and 36% (n=17) in the control group (p=0.003). The odds ratio of CI-AKI in patients who received RIPC was 0.18 (95% confidence interval: 0.05-0.64; p=0.008). CONCLUSIONS: In patients with ST-elevation myocardial infarction, RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI.

[Takotsubo cardiomyopathy manifesting as no reflow pattern in coronary flow by transthoracic Doppler echocardiography and prolonged recovery of regional left ventricular wall motion abnormality: a case report].

A 80-year-old woman was admitted to our hospital because of chest pain. Electrocardiography revealed ST segment elevation in the I, aVL, and V1-V5 leads. Echocardiography revealed left ventricular apical aneurysmal change with ejection fraction of 31%. Coronary angiography showed no abnormalities. Creatine kinase was not elevated in her clinical course. The diagnosis was takotsubo cardiomyopathy. Transthoracic Doppler echocardiography was performed on the 2nd hospital day. Coronary flow velocity pattern in the left anterior descending artery revealed shortened diastolic deceleration time (108 msec) and systolic retrograde flow. Asynergy of the left ventricle gradually improved, but still persisted slightly at 6 months after discharge. Most patients with takotsubo cardiomyopathy have normal coronary flow velocity pattern in the acute phase. In this case, no reflow pattern of coronary flow was observed during prolonged recovery from left ventricular regional wall motion abnormality.

A true aneurysm of axillary-subclavian artery with cystic medionecrosis: an unusual manifestation of Marfan syndrome.

We report a case of a 69-year-old female patient diagnosed with an axillary-subclavian artery(ASA) aneurysm, 7 cm long and 4 cm in diameter. The aneurysm had recently developed during follow-up for aortic sinus dilation associated with Marfan syndrome, which had been diagnosed in 1987. The patient underwent corrective surgery for the ASA aneurysm, and the aneurysm was histologically diagnosed as a true type with cystic medionecrosis.