[Role of gastro-esophageal reflux (GER) and swallowing latency in aspiration pulmonary diseases].

We evaluated the role of gastro-esophageal reflux (GER) in aspiration pulmonary disease. To explore swallowing function, we measured the latent time (LT) on the swallowing provocation test in patient with non-aspiration pneumonia (PN, n=5), aspiration pneumonia (AP, n=8), post-gastrectomy aspiration pneumonia (PGAP, n=8), gastro-esophageal reflux disease (GERD, n=12) and normal group (NR, n=7). LT was prolonged in the AP (2.83 +/- 1.66 sec p < 0.01), PGAP (2.58 +/- 1.40 sec p < 0.05) and GERD (2.40 +/- 1.70 sec p < 0.05) groups compared with NR (1.04 +/- 0.56 sec) group, but not prolonged in PN (1.46 +/- 0.75 sec) group. LT was also prolonged when swallowing was provoked during inspiration both in AP (3.61 +/- 2.60 sec vs. 2.73 +/- 2.19 sec, p < 0.05) and NR (2.13 -/+ 1.12 sec vs. 1.49 +/- 1.30 sec, p < 0.01). Protected specimen brushing (PSB) was employed to detect pathogenic organisms in the PN (n=70), AP (AP, n=27) and PGAP (n=15) groups. Gram-negative rods were most frequently detected in the PGAP (p=0.008) group. We conclude that GER plays an important role in aspiration pulmonary disease not only as a source of aspirating agent but also as a disturbing factor of swallowing function.

[Drug susceptibility of Trichosporon beigelii isolated from urine and clinical features of their hosts].

We investigated of Trichosporon beigelii by a surveillance study for two years in the Tokyo Metropolitan Police Hospital. T. beigelii was frequently found in the urine in aged patients with indwelled urethral catheter and in serious stage patients associated with malignancy. T. beigelii was in all cases isolated from the samples of patients in a hospital stay over 5 days. Minimum inhibitory concentrations (MICs) of anti-fungal agents against T. beigelii were determined by agar-dilution method. Fluconazole resistant strains of T. beigelii were found by this method. Microscopic examination revealed phagocyted T. beigelii in multinucleated neutrophils in some cases. In conclusion, T. beigelii might be suggested a causative organism of opportunistic infection in urinary diseases.

[A case of invasive Clostridium perfringens infection complicated intravascular hemolysis].

We experience a case of a 83-year-old male who was admitted complaining of chills, cramp, high fever and respiratory distress. His blood revealed marked hemolysis. Gram positive Rods was observed in the hemoliesed blood taken on admission. About 2 hours after admission, he suddenly fell into a critical condition. He died about 6 hours after admission in spite of resuscitation. Clostridium perfringens was detected from the blood and liver obtained by autopsy. We suspected that he died of acute intravascular hemolysis caused by alpha-toxin produced by C. perfringens. In conclusion, for a patient who has a high fever with strong hemolysis such as our case, C. perfringens infection should be considered.