[A Case of central venous catheter-related infection with Malassezia sympodialis].

We report a 63-year-old male with central venous catheter-related infection caused by Malassezia sympodialis after total gastrectomy for a gastric cancer. He had fever and his leukocyte counts and C-reactive protein were elevated 14 days after his operation. After his central venous hyperalimentation catheter was removed, the inflammatory signs immediately disappeared, suggesting an intravenous catheter-related infection. A yeast-like fungus was cultured in brain-heart infection semi-solid agar ten days later, and was diagnosed morphologically as Malassezia sp. This strain was identified as M. sympodialis by Tween assimilation test and was confirmed by whole-sequence of internal transcribed spacer 1 regions (ITS1). This is the first report of catheter-related infection caused by M. sympodialis. This strain grew and was subcultured on CHROMagar Candida, potato dextrose agar and Sabouraud agar. There have been no reports of such a lipid-independent Malassezia sp. except for M. pachydermatis. The mechanism of lipid independence of this strain is undetermined and future work is needed. Malassezia sp. is receiving increased attention as an etiologic pathogen of catheter-related fungemia in clinical microbiology laboratories and infectious disease sections.

[Home parenteral nutrition (HPN) for cancer patients].

We have treated thirty-five cancer patients with HPN since 1987. This paper describes its efficacy and problems. Their average age was 62 years old. The duration of HPN varied from 31 to 573 days (mean: 167 days). The catheter was removed in three cases because of catheter fever or obstruction. Metabolic complications arose in three cases, but they were easily treated. Twenty-three cases underwent pain control. Twelve cases were given cancer chemotherapy. We concluded that HPN for recurrent cancer patients is a relatively safe and effective means to improve the quality of life. We consider the following important in order to carry out HPN more smoothly. 1) Improvement of drug delivery system. 2) Establishment of home care system with other hospitals, clinics, and home care companies. 3) The easing of health-insurance restrictions on making out prescriptions to outpatients.

[Attempt to create a HPN database].

We experienced fifty cases of HPN (home parenteral nutrition) from January 1987 to May 1994. Using effectively these important data, we attempted to make a database for these fifty cases of HPN. We constructed a database based on Windows 3.1-J and Access 2.0-J produced by Microsoft company. At this time, we introduce a part of the database, which must be completed in terms of input items and simplicity.

[Study of medical economy in home parenteral nutrition].

UNLABELLED: The authors studied the relation between home parenteral nutrition (HPN) and medical economy. The items of study are 1) cost benefit of HPN compared with TPN, 2) hospital intention to promote HPN, 3) economical demerits for outpatients receiving HPN. RESULTS: 1) HPN had the advantage of cost benefit compared with TPN in reimbursement; however, hospitals did not have such an intention. 2) It is necessary for advanced home care to improve reimbursement in the health insurance system; and in the existing situation, hospitals do not profit from HPN. 3) Home care companies are unprofitable because of nursing visits and reimbursement issues which do not ease legal restrictions. 4) HPN in the present situation depends on the ability of patients to pay and the ability of care givers to provide care.

[Study of PyNPase activity in patients with gastric cancer--the association with preoperative IAP values].

5'-DFUR manifests its antitumor activity after being converted to 5-FU by pyrimidine nucleoside phosphorylase (PyNPase), an enzyme having high activity in tumor tissue. We surgically removed tissue samples weighing at least 1 g from 28 patients with gastric cancer and measured the PyNPase activity. The tissue samples were taken from gastric carcinomas, normal gastric tissue, metastasis-positive lymph nodes, metastasis-negative lymph nodes, small intestine, spleen, and other organs. The PyNPase activity was higher in gastric carcinomas than in normal gastric tissue. Similarly, metastasis-positive lymph nodes showed higher PyNPase activity than in metastasis-negative lymph nodes. PyNPase activity in the spleen was approximately equivalent to that in gastric carcinomas. Correlations were assessed between the PyNPase activity of gastric carcinomas and their tissue type. Stage and nutritional status, but there was no correlation with PyNPase activity for any of the variables assessed. The relationship between the PyNPase activity of gastric carcinomas and serum IAP concentration measured within one week before operation was similarly assessed. Mean PyNPase activity in the group of 14 patients with low serum IAP concentrations (< 550 micrograms/ml) was 102.8, while that in 11 patients with high serum IAP concentrations (> or = 550 micrograms/ml) was 145.7. Although this difference was not significant, there tended to be a positive correlation between PyNPase activity and serum IAP concentration (r = 0.74). PyNPase activity in splenic tissue was significantly higher in group of 10 patients with low IAP activity (104.7) (p = 0.020). These results indicated that patients with high serum IAP concentrations, generally associated with a poor prognosis, showed a high PyNPase activity in tumor tissue and splenic tissue. PyNPase activity, including its involvement in the immune response, was thus suggested to be somehow related to prognosis.

[Home therapy approach in cancer patients-nutrition therapy (case 1-1)--a case of recurrent gastric cancer with home parenteral nutrition].

This paper describes a case of recurrent gastric cancer with home parenteral nutrition (HPN). A 48-year-old man underwent nutrition support with HPN for the last 6 months. We treated the patient with adjuvant chemotherapy and provided pain management along with HPN treatment. The patient was able to achieve a meaningful and satisfactory quality of life. We concluded that HPN for recurrent cancer patients is a relatively safe and effective means of improving and maintaining the nutritional status. We think the following is important in order to establish home infusion therapy. 1) Organization of a home care team (physician, nurse, pharmacist, dietitian, and caseworker) and a practice-team approach. 2) Establishment of a home infusion system in home care. 3) Preparation of patient manuals by the medical staff. 4) Establishment of sterility preparation and delivery system in home infusion therapy. 5) Establishment of a patient-information-communication system by connection with other hospitals, clinics, and home care companies.

[Home therapy approach in cancer patients-nutrition therapy (case 1-3)].

When nutrition therapy is necessary in a long time in care of cancer patient, we take Home parenteral nutrition (HPN) as one selection rami. We enforced it than 1987, but the home care center was established in 1993 to carry out it more smoothly. Now the center becomes the leading role, and pattern of home therapy which was suited for a patient of each in cooperation with each part in hospital place and support group of external is made, and it is enforced. Staff of the center consists of it than doctor, nurse, dietitian, apothecary, medical social worker care office workers. When HPN of each patient is enforced, the staff of field of specialty will each solve the problems that there is. When all is not possible in the center, a private being at home care support company, affiliated hospital is connected with. We detain catheter during admission to thing of approximately 1 week, and education necessary for HPN is enforced to a patient and family. An exclusive manual is used for education.

[Intraarterial infusion combination therapy with LV and 5-FU in hepatic metastases from colorectal cancer].

Intraarterial infusion combination therapy with LV and 5-FU was performed on 8 patients with hepatic metastases from colorectal cancer. Briefly, immediately after administration of LV 30 mg/body, 5-FU was administrated in doses of 750 to 1,250 mg/body over about 2 hours. The therapy was repeated at every weekly visit to the clinic. The number of courses per patient averaged 22. The response rate was 50% (4 PR). Clinical responses were obtained 6 months on average. The 50% survival period was 300 days. Five patients died, 3 due to metastases to other sites. This therapy on an out-patient basis could be continued in all but one patient who was withdrawn from the treatment because of leucopenia. The results of this study suggest that this combination therapy is effective for hepatic metastasis from colorectal cancer.

Efficacy and safety of a quick drying rubbing type povidone-iodine alcoholic disinfectant solution.

The efficacy and safety of a quick drying rubbing type disinfectant (HAD Hand Wash) composed of a povidone-iodine (PVP-I) and ethanol were evaluated in the disinfection of transient skin flora on fingers of 30 medical staff of our department. Three millilitres of HAD solution was rubbed onto the hands for three minutes several times a day over a four week period. Bacteriological effects were evaluated twice, on the first day and after four weeks, by the palm stamp method. The rate of colonies sterilized (bacterial reduction rate) after the use of HAD Hand Wash was 86.9 +/- 21.2% (mean +/- SD) on the first measurement, and 91.5% +/- 12.8% at four weeks. Staphylococcus epidermidis was isolated most frequently and this was eradicated in 83.3% of subjects, the bacterial reduction rate 99.7%. Staphylococcus aureus was originally isolated in 14 subjects and was eradicated in 13; the bacterial colony reduction rate was 99.9% showing high antiseptic efficacy. Although the bacterial reduction rate for Bacillus sp. was a rather low, 75.8-100%, this result was not considered problematic from the clinical standpoint. There were no side effects like chapping in spite of an average 104 applications of HAD Hand Wash during the 4-week test period. From these results, HAD Hand Wash was considered highly effective and safe.

[Evaluation of loco-regional cancer chemotherapy with assistance of home parenteral nutrition].

Out of 79 cases dealt with reservoir, a response was obtained in 31% of 51 assessable cases. When assessed by cumulative survival with Kaplan-Meier method, the 50% survival was 8 months for total cases and prolonged to 21 months for responsive cases. However, eventually re-hospitalization was required for almost all cases. Although oral nutrition was impossible because of poor general condition, there were many patients who refused re-hospitalization and wished to continue treatment at home. In the present study, in 5 such cases the usefulness of home parenteral nutrition (HPN) combined with chemotherapy was determined. All the five patients in this study had gastric cancer with metastases and recurrent lesions in the liver or lymph node, or localized or with peritoneal spread. The site of the reservoir was within the artery in 4 cases and in the abdominal cavity in 1 case. The chemotherapy was multidrug-combination therapy consisting of 5-FU, MMC, CDDP and EPIR. In 4 cases local hyperthermia was added. In 3 out of the 5 cases (3 out of 7 lesions), a partial response (PR) was obtained. The mean dwelling period of the reservoir was 349.2 days for all cases, but longer than 400 days for 3 cases in which PR was obtained. For HPN, a catheter was inserted through the internal cervical vein, and 750-1,500 kcal/day was administered intermittently during night or constantly for 24 hours. In cases in which PR was obtained with chemotherapy and in those in which the reservoir for HPN was been in place before the terminal stage, the reservoir could be used for administration for a prolonged period. The mean dwelling period of the reservoir was 179.8 days and the duration of home stay was 121.2 days. All of the patients were classified as PS2 or higher and pronounced improvement in PS was obtained after HPN in only 1 case. Four out of the 5 patients were satisfied with receiving treatment at home. However, since HPN is associated with many problems such as sudden worsening in general condition, cancer pain and great burden to families, the solution to these problems remains.