Comparison of the clinical features of invasive pneumococcal disease with those of pneumococcal pneumonia in adults / Journal of Rural Medicine

Background: Invasive pneumococcal disease (IPD) is an infectious disease where Streptococcus pneumoniae can be detected in the cerebrospinal fluid or blood.Methods: Eight patients presented to our hospital with adult IPD. We compared with 69 cases of pneumococcal pneumonia treated in our department between 2012 and 2014. None of the patients had a history of pneumococcal vaccine administration.Results: Hematological examination showed the platelet count was significantly lower and the serum C-reactive protein level was significantly higher in the IPD group. There was a significant difference in the use of a respirator and mortality in the IPD group. About antibiotics, Carbapenem and quinolone were used for the treatment of many patients in the IPD group. In the fatal three cases of IPD, the age of all members were 65 years or younger. Two of three had no underlying disease.Conclusion: IPD develops without elderly people and in those without underlying disease. Also, the patients who took a sudden course may result in death. In line with previous studies that have reported the effectiveness of the pneumococcal vaccine, our study findings emphasize the need of administering vaccination for prevention of IPD in person who was younger than 65 years old.

A Case of Severe Respiratory Failure in a Patient with Sepsis From a Pressure Ulcer in Which Cooperation Among Many Professions Was Useful for Discharge From the Intensive Care Unit / 日本農村医学会雑誌

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.

Nontraumatic Hemopneumothorax Treated by Transcatheter Arterial Embolization / 日本農村医学会雑誌

From April 2009 to April 2017, we experienced on average 40 cases of spontaneous pneumothorax per year at our hospital, but we encountered only 2 cases of nontraumatic hemopneumothorax over the entire 8-year period. In one of these cases, we performed transcatheter artery embolization. Extravasation of contrast media was observed on CT near the apex of the lung, and angiography revealed the culprit vessel. We performed embolization and were able to achieve hemostasis and symptomatic improvement. However, hemopneumothorax recurred as a result of adhesion tear due to re-collapse of the lung and required surgical treatment. In this report, we describe our experience of this relatively rare condition and discuss the case with reference to the literature.

A Case of Papillary Lung Adenocarcinoma that was Difficult to Distinguish from Chronic Eosinophilic Pneumonia / 日本農村医学会雑誌

An 82 year-old-woman was referred to our hospital because of infiltrative shadow of the lingula in 201X. She was asymptomatic, so we followed up with imaging observation. After 1 year, the infiltrative shadow had progressed, so we performed bronchoscopy. Glandular epithelium with the mild aberrant type was detected, but did not lead to a definitive diagnosis. There was increased eosinophilic compartmentalization of immune response in the bronchoalveolar lavage, so we started treatment with corticosteroids for chronic eosinophilic pneumonia. However, there was no improvement of the shadow. Subsequent computed tomography-guided lung biopsy revealed evidence of papillary adenocarcinoma.

A Case of Mediastinal Abscess Requiring Surgical Management / 日本農村医学会雑誌

We report on an apparently healthy woman in her 50s who noticed pain in the left side of her neck anteriorly and was prescribed an antimicrobial agent at a nearby clinic. However, she developed hypotension and hypoxemia and was brought to our hospital. Laboratory investigations revealed evidence of inflammation, and imaging findings showed low-density areas corresponding to the left lobe of the thyroid gland. The low-density areas extended to the superior mediastinum, raising suspicion of a thyroid gland mediastinal abscess. We performed inferior mediastinal drainage with video-assisted thoracoscopic surgery and resection of the left lobe of the thyroid gland. Culture of mediastinal aspirate yielded Streptococcus viridans. Based on these findings, the final diagnosis was descent-related mediastinitis secondary to acute suppurative thyroiditis.

Present Situation of Pneumonia in Elderly Inpatients of Our Respiratory Medicine Department / 日本農村医学会雑誌

To understand the present situation of elderly patients with pneumonia, all 3,784 inpatients of our Department of Respiratory Medicine from April 2010 to March 2015 were analyzed. In total, 718 patients (pts) were diagnosed with pneumonia (median age, 78 years) and they were classified into two groups: those aged>65 years (elderly group, EG: 600 pts and those ≤d65 years (younger group, YG; 118 pts). Annual change in the ratio of EG/YG, mortality rate, respiratory assist mode, and number of hospital days were analyzed. The ratio of EG/YG was 0.11 in 2011 but was higher at 0.20 in 2014.The mortality rate was significantly higher in EG than in YG (147/600 vs 15/118; p<0.05). In the group of deaths, among patients who were intubated, 6 of 15 were in YG and 5 of 147 were in EG, respectively. The median number of hospital days was not significantly different between the groups for patients who died (EG 13, YG 14) or were discharged (EG 15, YG 12). In EG, the proportion of patients who changed hospitals for recuperation was up to 10% and the median hospital stay was 48 days, compared to 28 days in YG. With regard to pneumonia, because the guidelines are well established and because elderly individuals, in particular, often do not require additional treatment, it is possible to provide treatment at general hospitals or at home by strengthening the cooperation between clinic and hospital as well as hospital and hospital in the community through the incorporation of information technology.

mFOLFOX6 therapy could control ascites caused by peritonitis carcinomatosis in a patient with recurrent colorectal cancer. A case report

We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial.Palliat Care Res 2008; 3(2): 316-320

Review of Early Lung Cancer Cases Treated by Our Hospital in Eastern Hokkaido / 日本農村医学会雑誌

We treated 472 patients with lung cancer from 1983 though 1993. Of the total number of the cases, early lung cancer accounted for 31 caces (6.6%), 6 of the hilar and 25 of the peripheral type. Of the 6 hilar type early lung cancer cases, 3 cases were detected by mass screening (2 cases were detected by sputum cytology). On the other hand, of the 25 cases of the peripheral type early lung cancer, 10 cases were detected by mass screening. All the 10 peripheral type early lung cancer cases detected by mass screening were detected by chest roentogenography. The 5-year survival rates for the hilar and peripheral type early lung cancer were 100% and 94.4%, respectively. For the improvement of prognosis of lung cancer, every effort should be made to detect lung cancer at an early stage. Careful lung cancer screening such as sputum cytology and bronchoscopy in a highrisk group and modern techniques such as helical X-ray CT are recommended for the increase in the detection of early lung cancer.

Review of Home Oxygen Therapy Provided by Our Hospital / 日本農村医学会雑誌

Prognostic facfors were examined in 71 patients receiving home oxygen therapy under the direction of our hospital between 1984 and 1994. In 25 patients who had undergone right catheterization, relationships between pulmonary hemodynamics and prognosis were also discussed. Mean pulmonary arterial pressure (P<SUB>PA</SUB>) were correlated negatively with PaO<SUB>2</SUB>. This indicated that hypoxic pulmonary vasoconstriction was the major cause of pulmonary hypertention in these patients. Pulmonary hypertention was revealed in 80% of the patients with P<SUB>PA</SUB> ≥20 Torr and in 52% of the patients with P<SUB>PA</SUB> ≥25 Torr. Acute hemodynamic effects of low-flow oxygen administration were investigated in 17 patients. P<I>PA</I> decreased significantly from 25.5 Torr to 23.5 Torr after oxygen administration and pulmonary arteriolar resistance (PAR) decreased from 243 dynes ·ses ·cm<SUP>-5</SUP> to 225 dynes&middot;sec·cm<SUP>-5</SUP>, but this change was not significant.<BR>In patients with pulmonary fibrosis and sequelae of tuberculosis, the survival rates were lower than that of the patients with pulmonary emphysema. The median survival time (MST) for patients with cor pulmonale was significantly lower than that for those without cor pulmonale. When background factors were compared between the group with % home stay≥90% and % home stay<90%, there were no significant differences in observation periods, arterial blood gases and spirometry. The factors influencing % home stay were considered to be an important subject in addition to improving the survival rate.