ABSTRACT
Churg-Strauss syndrome is characterized by asthma, eosinophilia and systemic necrotizing vasculitis; cardiac involvement (ie, eosinophilic heart disease) is the major cause of morbidity and mortality, although there are no reports of an association between left ventricular dysfunction because of eosinophilic heart disease and myocardial blood flow or myocardial fatty acid metabolism. A patient presented with Churg-Strauss syndrome associated with eosinophilic heart disease that had progressed to dilated cardiomyopathy. Coronary angiography, thallium-201 ((201)Tl) and iodine-123 beta-methyl-iodophenyl pentadecanoic acid ((123)I BMIPP) myocardial single photon emission computed tomography (SPECT) were performed to evaluate left ventricular dysfunction. Although coronary angiography was normal and (201)Tl SPECT showed no apparent image defect, (123)I BMIPP SPECT showed diffuse decreased accumulation, excepting the apex. The left ventricular dysfunction in patients with eosinophilic heart disease is associated with impaired myocardial fatty acid metabolism rather than with impaired myocardial blood flow.
Subject(s)
Churg-Strauss Syndrome/metabolism , Coronary Circulation , Eosinophilia , Fatty Acids/metabolism , Heart Diseases , Aged , Cardiomyopathy, Dilated , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/physiopathology , Disease Progression , Echocardiography , Electrocardiography , Heart Diseases/blood , Heart Diseases/metabolism , Heart Diseases/pathology , Humans , Male , Time Factors , Tomography, Emission-Computed, Single-PhotonABSTRACT
A 64-year-old woman with periodontal disease was admitted because of fever, right chest pain, and bloody sputum. Her chest radiograph revealed a nodular shadow in the right middle lung fields. From the results of a needle aspiration biopsy, she was diagnosed with a lung abscess due to Actinomyces odontolyticus (A. odontolyticus) and Streptococcus spp. The patient improved quickly with antibiotics. To our knowledge, only nine cases of pulmonary infection due to A. odontolyticus have been reported, and we report the first case in Japan. Although respiratory disease caused by A. odontolyticus is rare, the association of this organism should be considered even in healthy individuals.
Subject(s)
Actinomyces/isolation & purification , Actinomycosis/diagnosis , Actinomycosis/microbiology , Lung Abscess/diagnosis , Lung Abscess/microbiology , Actinomycosis/complications , Actinomycosis/drug therapy , Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Biopsy, Needle , Female , Humans , Lung Abscess/drug therapy , Middle Aged , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Sulbactam/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Eight sickbeds for the support of patients at home were established in Chiba Municipal Hospital in response to a request from the Chiba City Medical Association in 1997. These sickbeds were run by physicians and nurses in the hospital and nurses from Chiba City Public Health Center to promote a tight relation among the medical care, the health care and the public welfare systems. The role of the public health nurses is to receive and manage the documents of the patients from regional medical practitioners and to communicate with the related organizations. These sickbeds were set up to offer medical care, educational teaching to the family, and the social environment to support the patients at home. The patients, who were consulted by regional medical practitioners, were pre-registered by them. The length of stay at the hospital was limited to 2 weeks. The number of patients who were registered and hospitalized increased every year: thus 374 patients receiving treatment from 44 medical practitioners have already been registered. The average age of the patients was 81.1 and almost all of the patients were sick in bed for the whole day at home. Sixty-three patients were hospitalized making use of those sickbeds this year. Further promotion of the relation among the organizations involved in medical care, health care, and welfare is very important to support the patients to be able to stay at home.
