Clinical efficacy of kanamycin for Mycobacterium avium complex disease

No previous reports have compared clarithromycin (CAM), rifampicin (RFP) and ethambutol (EB) containing regimens with and without an aminoglycoside antibiotic kanamycin (KM) for the treatment of pulmonary Mycobacterium avium complex (MAC) disease. We conducted a retrospective study to investigate the clinical efficacy of KM using data from 40 patients who received combined chemotherapy for MAC disease with or without KM in the National Hospital Organization Tokyo Hospital from July, 1999 to December, 2005. All patients were administered CAM, RFP and EB for 6 to 12 months, and 20 of the 40 simultaneously received combined chemotherapy with KM. The difference in the backgrounds of the groups was not statistically significant. The improvement rates of clinical symptoms and radiological findings were significantly higher in the KM-treated group than in the KM-untreated group (75% versus 35% and 80% versus 25%). Moreover, the sputum relapse rate was significantly lower in the KM-treated group (18% versus 75%). However, there were no significant differences in the sputum conversion rate (55% with KM versus 40% without KM). As for adverse reactions, there were no significant differences between the groups. Furthermore, we examined time-kill kinetics of KM and streptomycin (SM) against a clinical isolate of M. avium. Most M. avium was killed by KM and SM at concentrations higher than MIC (8 microg/ml), and concentration- and time-dependent killing by KM and SM were almost identical. These observations indicate that KM is effective for treatment of patients with MAC disease.     

Improvement of predicted hematocrit values after the initiation of cardiopulmonary bypass in cardiovascular surgery

Journal of Artificial Organs - Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an...     

Metastatic colon cancer mimicking Crohn's disease

A 66-year-old Japanese woman presented with intestinal obstruction and right-sided hydronephrosis. Although upper gastrointestinal endoscopy demonstrated signet-ring cell gastric carcinoma, colonoscopy and barium enema study yielded findings mimicking Crohn's disease in the colon, that is, skipping longitudinal ulcer scarlike strictures, cobblestone appearance, segmental stricture, and pseudosacculations. After total gastrectomy and right-sided hemicolectomy, the final diagnosis of gastric cancer extensively involving the colon, and not of Crohn's disease complicating gastric cancer, was established. Pathologic examination showed that anaplastic cancer with exuberant desmoplastic reaction and infiltration along the mesenteric border principally accounted for the morphological similarities noted between Crohn's disease and metastatic colon cancer in this case. The findings in the present case, together with a review of the literature, suggest that metastatic colon cancer should be considered when Crohn-like colonic findings are encountered, not only in individuals with concurrent cancer in other sites but also in those with distant history of cancer.     

Reduced-intensity stem cell transplantation (RIST) for lymphoproliferative diseases

For lymphoproliferative disease, RIST is a curative treatment option. Here, we review the patients with follicular lymphoma(FL), diffuse large B cell lymphoma(DLBCL) and mantle cell lymphoma(MCL), who were mainly transplanted at Toranomon Hospital and National Cancer Center Hospital. In our series, 1-year disease-free survival rate were 100%, 56% and 63%, respectively. Main cause of death was treatment related mortality associated with graft-versus-host disease(GVHD) rather than disease progression in both DLBCL and MCL. These data suggest that intensified GVHD prophylaxis would improve the survival rates. We are now undergoing multi-center phase I/II study for RIST using fludarabine and busulfan. In designing our future study, we held nationwide survey to retrospectively evaluate the efficacy of RIST for various types of malignant lymphoma diseases. We also review the literature about RIST for acute lymphoblastic leukemia.     

Life course genetic epidemiologic study based on longitudinal twin-family data: a new perspective

Family-based life course epidemiology is the approach to clarify long-term effects of accumulations and chains of biological and social risk exposures in one's life trajectory, namely, before and during conception, infancy, childhood, young adulthood and later adult life. Both genetic and environmental factors are considered. One of the theoretical rationales is the 'developmental origin of health and disease (DOHaD)' hypothesis. According to this theory, the causes of adult diseases are attributed to predictive adaptive responses and biological programming or epigenetic changes during a critical period of early life. If the environment later in life after birth is different from what is predicted, a mismatch has happened, leading to the development of a disease. This theory is supported by many epidemiologic studies, animal experiments, and evolution theory of biology. Longitudinal twin-family data are very powerful and useful information in the family-based life course genetic epidemiologic study.     

Fatal child maltreatment associated with multiple births in Japan: nationwide data between July 2003 and March 2011

Objectives

The purpose of the present study is to clarify the impact of multiple births in fatal child maltreatment (child death due to maltreatment).

Methods

The national annual reports on fatal child maltreatment, which contain all cases from July 2003 to March 2011, published by the Ministry of Health, Labor and Welfare of Japan, were used as the initial sources of information. Parent–child murder–suicide cases were excluded from the analyses. Multiple births, teenage pregnancy and low-birthweight were regarded as the exposed groups. The relative risks (RRs) and their 95 % confidence intervals (CIs) were estimated using the data from the above reports and vital statistics. These analyses were performed both including and excluding missing values.

Results

Among 437 fatal child maltreatment cases, 14 multiple births from 13 families were identified. The RRs of multiple births per individual were 1.8 (95 % CI 1.0–3.0) when including missing values and 2.7 (95 % CI 1.5–4.8) when excluding missing values. The RRs of multiple births per family were 3.6 (95 % CI 2.1–6.2) when including missing values and 4.9 (95 % CI 2.7–9.0) when excluding missing values. The RR tended to be much lower than the RR of teenage pregnancy (RR 12.9 or 22.2), but slightly higher than the RR of low-birthweight (RR 1.4 or 2.9).

Conclusions

Families with multiple births had elevated risk for fatal child maltreatment both per individual and per family unit. Health providers should be aware that multiple pregnancies/births may place significant stress on families and should provide appropriate support and intervention.     

Laparoscopic percutaneous extraperitoneal closure for inguinal hernia: learning curve for attending surgeons and residents

Background/purpose

Laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia is a simple technique in which a purse-string suture made of nonabsorbable material is placed extraperitoneally around the hernia orifice by a special suture needle (Lapaherclosure?). Concerns have been raised about the extensive learning curve for both attending surgeons and residents to master this technique. This study assesses the difference in learning curves for the safe performance of LPEC by attending surgeons and residents.

Methods

A retrospective analysis was performed on the surgical charts of 409 consecutive patients (175 girls, 234 boys) who had undergone LPEC for inguinal hernia repair from December 2005 to December 2011 at Jikei University Hospital. The number of operation needed by attending surgeons and residents to reach the appropriate operation time was analyzed by the Mann–Whitney U test.

Results

LPEC was performed by three attending surgeons and four residents who had not previously performed LPEC. The standard operation time for LPEC by attending surgeons who have performed more than 100 LPEC cases safely is 30 min. In our study, the attending surgeons needed a mean of 12 operations (range, 10–16) to reach 30 min for LPEC. Three residents needed a mean of 31 operations (range, 27–33) to reach 30 min for LPEC. The fourth resident could not perform LPEC in 30 min or less. The difference between the number of operations needed by the attending surgeons and the residents to perform LPEC safely was statistically significant (P < 0.05). The overall incidence of contralateral patent processus vaginalis was 47.9 %.

Conclusions

Our learning curve analysis showed that whereas attending surgeons needed a mean of 12 operations to perform LPEC repairs safely in 30 min or less, residents needed more than 30 operations to safely perform LPEC repairs without supervision.     

Antiviral effects of Psidium guajava Linn. (guava) tea on the growth of clinical isolated H1N1 viruses: its role in viral hemagglutination and neuraminidase inhibition

Rapid evolution of influenza RNA virus has resulted in limitation of vaccine effectiveness, increased emergence of drug-resistant viruses and occurrence of pandemics. A new effective antiviral is therefore needed for control of the highly mutative influenza virus. Teas prepared by the infusion method were tested for their anti-influenza activity against clinical influenza A (H1N1) isolates by a 19-h influenza growth inhibition assay with ST6Gal I-expressing MDCK cells (AX4 cells) using fluorogenic quantification and chromogenic visualization. Guava tea markedly inhibited the growth of A/Narita/1/2009 (amantadine-resistant pandemic 2009 strain) at an IC(50) of 0.05% and the growth of A/Yamaguchi/20/06 (sensitive strain) and A/Kitakyushu/10/06 (oseltamivir-resistant strain) at similar IC(50) values ranging from 0.24% to 0.42% in AX4 cells, being 3.4- to 5.4-fold more potent than green tea (IC(50) values: 0.27% for the 2009 pandemic strain and 0.91% to 1.44% for the seasonal strains). In contrast to both teas, oseltamivir carboxylate (OC) demonstrated high potency against the growth of A/Narita/1/09 (IC(50) of 3.83nM) and A/Yamaguchi/20/06 (IC(50) of 11.57nM) but not against that of A/Kitakyushu/10/06 bearing a His274-to-Tyr substitution (IC(50) of 15.97μM). Immunofluorescence analysis under a confocal microscope indicated that both teas inhibited the most susceptible A/Narita/1/2009 virus at the initial stage of virus infection. This is consistent with results of direct inhibition assays showing that both teas inhibited viral hemagglutination at concentrations comparable to their growth inhibition concentrations but inhibited sialidase activity at about 8-times higher concentrations. Guava tea shows promise to be efficacious for control of epidemic and pandemic influenza viruses including oseltamivir-resistant strains, and its broad target blockage makes it less likely to lead to emergence of viral resistance.     

A case of multicentric Castleman's disease with membranoproliferative glomerulonephritis type 3-like lesion

Renal involvement is a significant complication of multicentric Castleman's disease (MCD) and various glomerular involvements have been reported. A 45-year-old Japanese man presented with persistent proteinuria, with lymphadenopathy and hypergammaglobulinemia. He had been diagnosed 4 years previously with MCD. As his renal impairment had progressed to renal failure, he underwent a renal biopsy. Histology revealed diffuse and global membranous lesions with large and heterogeneous epimembranous deposits. In addition, mesangial cell proliferation and focal extracapillary lesions were found. Under immunofluorescence, granular staining for anti-IgG, IgG1, IgG2 and IgA was strongly positive in the capillary loop, and weakly positive in the mesangium. As such, there was a diversity of histological features. Our perspective with regard to pathogenesis is that the formation of the immune-complex contributed to the membranoproliferative glomerulonephritis type 3-like lesion. This histological multiform with MCD is valuable for increasing our understanding of the mechanism for onset of immune-complex glomerular deposition and cellular proliferation of glomerulonephritis.