Effectiveness of azithromycin in aspiration pneumonia: a prospective observational study.

BACKGROUND: Aspiration pneumonia is an urgent health concern with high mortality and long hospitalization in industrialized and aging countries. However, there is no information about the effectiveness of azithromycin (AZM) for the treatment of aspiration pneumonia. This study investigated if AZM is effective for the treatment of aspiration pneumonia. METHODS: Patients with aspiration pneumonia with no risk of multidrug-resistant pathogens were included in this prospective study at Kishiwada City Hospital from December 2011 to June 2013. Patients were divided into the ampicillin/sulbactam (ABPC/SBT) and AZM (intravenous injection) groups. The success rates of 1(st)-line antibiotic therapy, mortality, length of hospital stay, and total antibiotic costs were compared. RESULTS: There were 81 and 36 patients in the ABPC/SBT and AZM groups, respectively. There was no significant difference in the success rate of 1(st)-line antibiotics between the groups (74.1% vs. 75.0%, respectively, P = 1.000). Mortality and hospitalization periods did not differ between the 2 groups (11.1% vs. 8.3%, P = 0.753, and 22.3 ± 7.3 days vs. 20.5 ± 8.1 days, P = 0.654, respectively). However, the total antibiotic costs were significantly lower in the AZM group than the ABPC/SBT group (2.19 ± 1.65 × 10,000 yen vs. 2.94 ± 1.67 × 10,000 yen, respectively, P = 0.034). The febrile period of the ABPC/SBT group was significantly shorter than that of the AZM group (P = 0.025). CONCLUSIONS: In this small prospective non-randomized observational study, we found no statistically significant differences in mortality or antibiotic failure in patients receiving AZM compared to ABPC/SBT for the treatment of patients with aspiration pneumonia who require hospital admission and have no risk of drug-resistant pathogens. Therefore, AZM may be another first choice of antibiotic treatment for patients with aspiration pneumonia when they have no risk of multidrug-resistant pathogens.

Acute cerebral arterial embolism following pemetrexed and carboplatin treatment in non-small-cell lung cancer: A case report.

Thromboembolism is a known vascular toxicity associated with tumor chemotherapy. The combination of pemetrexed and carboplatin has exhibited significant antitumor activity, with mild manageable toxicity in patients with advanced non-small-cell lung cancer (NSCLC), whereas cerebral arterial embolism has not been recognized as a side effect associated with this regimen. This is the case report of an unusual case of NSCLC, in which the patient suffered a left middle cerebral arterial embolism following chemotherapy. A 62-year-old non-smoking woman, diagnosed with stage IV lung adenocarcinoma, was administered pemetrexed and carboplatin as second-line therapy. On the day of the completion of the first regime cycle, the patient was readmitted to the emergency department with complaints of sudden-onset right hemiplegia and agitation. Brain magnetic resonance imaging and magnetic resonance angiography revealed an occlusion of the left middle cerebral artery (MCA) and no further chemotherapy was administered due to the deterioration in the performance status of the patient associated with right hemiplegia. Pemetrexed plus carboplatin is routinely used for the treatment of advanced NSCLC. The present case highlights the potential risk for development of embolism following pemetrexed-based chemotherapy. Further investigations are required to elucidate the mechanism through which these drugs may eventually cause neurovascular adverse events. Clinicians should be aware of the potential risk for development of cerebral arterial embolism following pemetrexed-based chemotherapy.

[A case of IgG4-related inflammatory pseudotumor of the lung].

The chest X-ray film and computed tomography of a 62-year-old asymptomatic man showed bilateral multiple nodules. Since bronchoalveolar lavage and transbronchial lung biopsy revealed no diagnostic findings, video-assisted thoracic surgery (VATS) was performed. The VATS specimens showed marked infiltration of inflammatory cells, intraluminal organization and fibrosis in the alveolar wall. Plasma cells were predominant components of infiltrating inflammatory cells. Since immunohistochemical staining of the specimens revealed much IgG4-positive plasma cell infiltration, we diagnosed IgG4-related inflammatory pseudotumor. One month after VATS, multiple nodules disappeared without any treatment or medication. No definite change or recurrence occurred after that. IgG4-positive plasma cells may be involved in the pathogenesis of inflammatory pseudotumor of the lung.