Mitral stenosis reversed by medical treatment for heart failure.

It is reported that functional mitral stenosis frequently develops after ring annuloplasty for ischemic mitral regurgitation. The mechanism is a combination of annular size reduction by surgery and diastolic mitral valve tethering, restricting the anterior leaflet opening due to posteriorly displaced papillary muscles with left ventricular dilatation. We report the case of a 57-year-old man who had a history of successful mitral valve plasty for degenerative mitral regurgitation. Four years later he developed heart failure, severe hypertension, mild mitral regurgitation, and significant mitral stenosis, which were reversed by aggressive medical treatment for heart failure.

[How to reduce unnecessary orders of laboratory tests].

The medical insurance system in Japan has been focusing on how to reduce the annual increases in medical expenses. In this context, the circumstances in the laboratory department in large hospitals have been growing more strict. Therefore, medical staff working in large hospitals need to know how to reduce the expenditure consumed in laboratory tests. In this paper we report economical loss resulted from physicians' excessive test-orders and suggest how to manage the problem.

[A bacteriological study of multiple-drug-resistant Pseudomonas aeruginosa isolates derived from 2 patients].

We investigated the isolation circumstances of multiple-drug-resistant Pseudomonas aeruginosa (MDRP) in the UOEH hospital and the bacterial analysis of isolated MDRP. From January to October 2003, MDRP was isolated from 2 patients. During this period, the isolation frequency of MDRP was 0.57% (2/350). Case 1 had 2 MDRP isolates from catheter urine, and case 2 had 5 MDRP isolates from pus. Regarding serotype, 2 isolates from case 1 were B type and the other 16 isolates from case 2 were E type. Pyomelanin was produced by 9 isolates of 16 E type isolates. The same PFGE patterns were observed in 2 isolates from case 1; that is, 9 pyomelanin producers from case 2 and the other 7 isolates from case 2, respectively. Metallo-beta-lactamase was produced by 2 isolates from case 1. bla(IMP) was detected from the 2 isolates by PCR, and the clones from case 1 were quite different from the clones from case 2. Regarding the pyomelanin producing isolates from case 2, although the clones were the same genetically, the MICs of imipenem and meropenem increased from 8 to > 32 microg/ml with the progress of time. In the UOEH hospital, 6 patients with MDRP isolates have been isolated so far, but these 6 patients are not correlated with each other. It is important that we detect and report MDRP as early as possible to prevent nosocomial infection.