[A case of drug-induced pulmonary injury showing organizing pneumonia pattern due to S-1].

Reported here is the case of a 76-year-old male with gastric cancer. Distal gastrectomy was performed after his admission to our hospital. Histopathologically, the cancer was determined to be in the advanced stage. Combination chemotherapy with CDDP and S-1 was administered for 6 courses, after which S-1 was used alone. Chest X-ray and CT showed multiple dispersed lesions in the lung. Further examination by bronchoscope was performed. Histopathological examination of a biopsy specimen revealed the lesion to be organizing pneumonia. A drug-induced lymphocyte stimulation test (DLST) for S-1 proved to be positive. Discontinuation of S-1 administration led to natural improvement of the pneumonia. These results suggest that S-1 had induced the organizing pneumonia.

[Two cases of Guillain-Barré syndrome in late pregnancy].

We describe two patients who developed progressive ascending paralysis associated with Guillain-Barré syndrome (GBS) during late pregnancy. A 25-year-old woman in the 30th week of gestation (GW) developed diarrhea followed by GBS and weakness of the bilateral facial muscles. Serum IgM antibody titers against cytomegalovirus (CMV) were high. Respiratory insufficiency developed at GW 31 requiring cesarean section and artificial ventilation. The facial palsy and limb paralysis persisted thereafter. Serum anti-GM2 IgM and anti-GalNAc-GD1a IgM antibodies were positive so immunoadsorption therapy (IAT) was applied. These antibody titers decreased with clinical improvement after IAT. The baby was healthy and did not have CMV. The other patient was a 24-year-old woman at GW 28 in whom GBS developed after a common cold. Right facial muscles were also weak and serum anti-GM2 IgM antibody was positive. Cesarean section was performed because of uterine bleeding. The clinical findings improved thereafter and the baby was healthy. The findings show that the course of GBS that develops after CMV infection can be severe and accompanied by respiratory insufficiency.

[Comparison between predicted equations obtained by standard Japanese values and present predicted equations for vital capacity and forced expiratory volume in one second].

Until recently, predicted values of vital capacity (VC) and forced expiratory volume in one second (FEV1) have been calculated with Baldwin's equation (VC-B) and Berglund's equation (FEV1-B) respectively, in Japan. Due to several problems using these equations, new prediction equations of VC (VC-J) and FEV1 (FEV1-J), which were created using data from healthy Japanese, were provided by the Japanese Respiratory Society in 2001. In the present study, we studied the validity of these prediction equations. Also, we compared the outcomes of patients who match respiratory handicap "indexes" with VC-B and VC-J. The subjects were all adult patients whose respiratory function was tested in Asahikawa Medical College Hospital between 1998 and 2006. Cases which were diagnosed as contractive respiratory disorder increased approximately 2-fold when %VC was calculated with VC-J compared with VC-B. Grade 4 or higher respiratory handicap scores increased 20% if the index was calculated with VC-J compared with VC-B. There was no significant difference in mortality between the respiratory handicap grade 3 scores calculated with VC-J and VC-B. Also, there was no significant difference in mortality between grade 4 respiratory handicap scores calculated with VC-J and VC-B. These findings suggest that the prediction equations using Japanese data increase the number of predicted respiratory disorders, and those additional cases have the same prognoses as those cases diagnosed with the former criteria.

[A case of peritonitis carcinomatosa of pulmonary adenocarcinoma in which gefitinib was effective].

We report a case in which gefitinib was effective in reducing the amount of ascites. A 61-year-old man with peritonitis carcinomatosa due to metastasis from pulmonary adenocarcinoma was admitted to our hospital. Various chemotherapies were not effective for controlling his ascites. Therefore, we orally delivered gefitinib at a dose of 250 mg/day. Three days after administration, a reduction in the amount of ascites was noticed. Subjective symptoms including general fatigue and difficulty breathing were dramatically improved as was QOL. We conclude that this case was a good candidate for treatment using gefitinib.

Evaluation of baker's yeast strains exhibiting significant growth on Japanese beet molasses and compound analysis of the molasses types.

Cane molasses, most of which is imported, is used as a raw material for production of baker's yeast (Saccharomyces cerevisiae) in Japan. On the other hand, beet molasses is scarcely used for this purpose, but it can be of great advantage to cane molasses because it is domestically produced in relatively high amounts as a by-product of beet sugar processing. However, the yield of baker's yeast is sometimes low with Japanese beet molasses compared to imported cane molasses. For the production of baker's yeast with Japanese beet molasses, we evaluated S. cerevisiae strains, including industrial and laboratory strains, to group them according to the growth profile on beet and cane molasses. To discuss the factors affecting growth, we further analyzed the major compounds in both types of molasses. Beet molasses seems to contain compounds that promote the growth of beet molasses-favoring strains rather than inhibit the growth of cane molasses-favoring strains. It was assumed that α-amino acid was one of the growth promotion factors for beet molasses-favoring strains.

The performance evaluation of endotoxin retentive filters in haemodialysis.

BACKGROUND: Hemodialysis is a method for removing uremic toxins and water directly from the blood into a dialysis fluid through an artificial semipermeable membrane called a dialyzer. The ability of the dialyzer to remove uremic toxins has steadily improved, but the likelihood has also increased that bioactive substances, such as bacterial endotoxin (ET) fragments, can be transferred from the dialysis fluid into the patient's blood through the phenomena of back-diffusion and back-filtration in the dialyzer. Therefore, further efforts to improve the quality of water are required. In 2008, the Committee of Scientific Academy of the Japanese Society for Dialysis Therapy presented its new recommendations for the quality standards of dialysis fluid, but achieving and maintaining these standard values would seem difficult without installing an ET-retentive filter (ETRF). In the present study, we evaluated whether the standards for ultrapure dialysis fluid of the Japanese Society for Dialysis Therapy can be achieved and maintained by installing 3 types of ETRF for a period of 12 months. METHODS: To evaluate the quality of dialysis fluid, ET values were measured with nephelometry, and viable cell counts were determined with the membrane filter method. Changes in the basic performance of the ETRFs were evaluated by measuring their water permeability, ET-retentive capacity, and hollow-fiber membrane intensity. Moreover, the hollow-fiber membrane surfaces of the ETRFs were observed with scanning electron microscopy, and the elements of the adherent substances were identified by means of energy dispersive X-ray spectrometry. RESULTS: The ET concentrations were less than the limit of detection during the evaluation period for samples obtained at post-ETRF sites. The viable cell counts for pre-ETRF sites were approximately 10 colony-forming units/mL. However, colonies had not formed in samples obtained from the post-ETRF sites. The substances adhering to hollow fibers included the silicon from the dialysate powder, the iron from the fluid path, and the elements derived from stainless steel. Scanning electron microscopy of the ETRF hollow fibers showed no substances except the hollow fibers and the elements derived from the dialysis fluid. CONCLUSION: Installation of an ETRF is useful for achieving and maintaining the quality standards for ultrapure dialysis fluid and for preventing the entry into the blood of ETs, viable cells, and such substances as silicon and metals.

Use of ultrasonic cleansing in managing the couplers of dialyzer systems.

Dialysis-related complications have become a major concern as the number of patients receiving long-term maintenance dialysis increases. One cause of complications is contamination of the dialysis fluid. When dialysis fluid contaminated by bacteria or endotoxin (ET) or both has been used for a long time, cytokine production in vivo is enhanced and can lead to such complications as dialysis amyloidosis. The rate of dialysis-related complications might be reduced with a hemopurification method that uses a large amount of dialysis fluid as a substitution fluid (on-line hemodiafiltration) or an efficient dialyzer with enhanced internal filtration in which the dialysis fluid returns to the body as a replacement fluid; however, at the same time, there is an increased risk of ET entering the body because the dialysis fluid might be contaminated. Therefore, the dialysis fluid must be made aseptic, and the dialysis fluid line must be properly managed to prevent contamination of the dialysis fluid. A half-opened line is at great risk of contamination by living microbes, which can grow in dead spaces and where the flow of dialysis fluid is interrupted. The management of couplers is an important measure for maintaining cleanliness at the end of the dialysis fluid flow. We attempted to separate and regularly clean the main body of the coupler with ultrasonic equipment as a method of managing the conventional coupler. Using improved types of coupler, the water quality of the postcoupler flow was maintained at a level as high as that of the precoupler flow for the duration of the evaluation period without separate cleansing being done. Although separate once-a-week cleansing of the conventional coupler was able to keep ET values less than the detection limit, viable cell counts were unstable. On the other hand, twice-a-week ultrasonic cleansing eliminated almost all viable cells. No definite difference in ET values or viable cell counts was found between the cleansing groups, and ultrasonic cleansing was able, by itself, to provide a sufficient cleansing effect. We conclude that ultrasonic cleansing of conventional couplers is a useful method for maintaining the water quality of the postcoupler flow because the cleansing of the coupler twice or more a week is sufficient to keep the water quality of the postcoupler flow as high as that of the precoupler flow.

Renal abscess with Morganella morganii complicating leukemoid reaction.

We report a case of leukemoid reaction (LR) complicating renal abscess caused by Morganella morganii infection in an 80-year-old man. On administration, laboratory tests revealed white blood cell count of 76160 /microL and C reactive protein 3.09 mg/dL. Although chronic myeloid leukemia was suspected, bcr/abl fusion transcript was not observed. Contrast enhanced computer tomography imaging of the abdomen showed abscess in the right kidney. M. morganii was detected repeatedly in material of liquid from the abscess and arterial blood culture. To our knowledge, this is the first case of M. morganii infection complicating LR.