[Efficacy and safety of moxifloxacin in patients with nursing and healthcare-associated pneumonia].

Moxifloxacin (MFLX) is a respiratory quinolone, and is effective against not only Gram-positive and negative bacteria but also anaerobes. There has been no prospective studies evaluating the efficacy and safety of MFLX in patients with nursing and healthcare-associated pneumonia (NHCAP). Therefore, we assessed the efficacy and safety of MFLX in patients with NHCAP. NHCAP patients with mild and moderate severity assessed by the A-DROP system in community-acquired pneumonia guideline proposed by Japan Respiratory Society visited our hospitals from April 2011 to March 2012. Clinical symptoms, chest X-ray films and/or computed tomography, peripheral white and red blood cell and platelet counts, serum CRP, AST, ALT, BUN, creatinine were evaluated. Forty patients were eventually evaluated, and average age was 74.1 years old, male/female were 21/19, 92.5% (37/40) of them had one or more comorbidities. Median duration of MFLX administration was 7.1 days (4-15 days). The efficacy of MFLX in all patients was 87.5% (35/40). The efficacies in each age group were 87.9% (aged over 65 years old), 85.7% (aged under 64 years old), and in each pneumonia severity group by the A-DROP system were 91.7% (mild), 85.7% (moderate). Diarrhea and swelling of the breast were observed in one patient (2.5%) after starting MFLX administration. Mild elevated transaminases were observed in three patients (7.5%), and mild renal dysfunction was observed in two patients (5.0%). All abnormally increased levels of transaminases and serum creatinine were recovered after a cessation of MFLX. MFLX is effective and safe in patients with NHCAP.

[Efficacy and safety of sitafloxacin for lower respiratory tract infections].

We investigated the efficacy and safety of sitafloxacin (STFX) in patients with mild to moderate community-acquired pneumonia or secondary infections of chronic respiratory tract diseases. The results showed that the efficacy rate was 96.5% (111/115) in patients analyzed for efficacy. The efficacy rate by STFX administration method was 93.9% (46/49) at 50mg b.i.d., 100% (37/37) at 100 mg q.d. and 96.6% (28/29) at 100mg b.i.d. In chest X-rays, the image improvement rate in 102 patients with shadows before treatment was 94.1% (96/102). The image improvement rate by STFX administration method was 90.5% (38/42) at 50 mg b.i.d., 97.1% (33/34) at 100mg q.d. and 96.2% (25/26) at 100mg b.i.d. Side effects occurred in five out of 115 patients (4.3%). Abnormalities in hepatic function test values appeared in two patients and abnormalities in renal function test values appeared in three patients. In four cases, the abnormalities were very mild and STFX administration was continued without any treatment. In the other patient, the abnormal value rapidly returned to normal after STFX administration was discontinued. These findings indicated that STFX can be used safety in routine practice by adjusting the administration within the approved dose based on patient characteristics. Good therapeutic effects can be expected in patients with respiratory tract infections.

[Retrospective analysis of the safety of four hours administration of liposomal amphotericin B in patients with chronic necrotizing pulmonary aspergillosis].

We have retrospectively analyzed the safety of 4 hours administration of liposomal amphotericin B (L-AMB) compared to less than or equal to 3 hours administration in patients with chronic necrotizing pulmonary aspergillosis (CNPA). The elevation of serum creatinine in the group with 4 hours administration of L-AMB in patients with CNPA was equal to the group with shorter administration time (less than or equal to three hours). During the administration of L-AMB, the group with 4 hours administration of LAMB had significantly a safer profile in relation to hypokalemia during L-AMB treatment than the group with shorter administration time. Additionally, white cell counts, platelet counts, serum creatinine, AST, ALT were not significantly different between L-AMB 4 hours administration group and less than or equal to 3 hours administration group. As the group with 4 hours administration of L-AMB had significantly a safer profile in relation to hypokalemia during L-AMB treatment, this modality can be one of the safer ways in the treatment of CNPA. As L-AMB is one of the fungicidal agents, 4 hours administration of L-AMB can be an optimal way of treating CNPA.

Pathology and mechanism of lung toxicity following inhalation of hair spray in rats.

In order to elucidate the pathology and mechanism of lung toxicity induced by chronic hair spray inhalation, male Wister rats 9 wk of age were exposed to a uniform concentration of hair spray for up to 12 wk using a jet nebulizer. The aerosol concentration to which the rats were exposed was about 7 g/m(3). Differential cell counts in bronchoalveolar lavage fluid (BALF), the expression of several cytokines from alveolar macrophage using the reverse-transcription polymerase chain reaction (RT-PCR) method, and histopathologic evaluation using a computer-aided graphic analyzer (IBAS) were conducted 1, 4, 8, and 12 wk after exposure. Over the passage of time, neutrophils and macrophages increased in BALF, and neutrophils infiltrated in the lung interstitium from the peribronchial interstitium to the alveolar septum. Alveolar macrophages showed increased expression of both the mRNA of tumor necrosis factor (TNF)-alpha and the mRNA of the chemokines macrophage inflammatory protein 2 (MIP2) and cytokine-induced neutrophil attractant (CINC). From these findings, chronic inhalation of hair spray is considered to induce at first intra-alveolar accumulation and activation of alveolar macrophages, followed by recruitment of neutrophils in the lung through the expression of proinflammatory cytokine, CINC, and MIP2, which cause predominantly neutrophilic inflammation in the lung.

[A case of MPO-ANCA positive vasculitis associated with diffuse alveolar hemorrhage and various cardiac conducting system abnormalities following propylthiouracil treatment].

A 50-year-old woman had been treated with propylthiouracil (PTU) for hyperthyroidism. She was admitted to our hospital because of hemosputum, and severe hypoxemia developed. The CT scan showed diffuse infiltration in both lung fields, bronchoalveolar lavage fluid revealed diffuse alveolar hemorrhage, and the level of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was high; and therefore diffuse alveolar hemorrhage associated with MPO-ANCA positive vasculitis induced by PTU was diagnosed. Following corticosteroid therapy initiated after the termination of PTU, the pulmonary infiltration rapidly improved and the patient's MPO-ANCA level returned to normal. Recrudescence of diffuse alveolar hemorrhage occurred following a reduction in steroids, but no recurrence was found after cyclophosphamide therapy was combined with steroid therapy. During the course of therapy, various cardiac conducting system abnormalities which correlate with the course of steroid therapy were found, indicating that cardiac conducting system abnormalities may be associated with MPO-ANCA-positive vasculitis.

[A new medical education using a lung sound auscultation simulator called "Mr. Lung"].

We developed a lung sound auscultation simulator "Mr. Lung" in 2001. To improve the auscultation skills of lung sounds, we utilized this new device in our educational training facility. From June 2001 to March 2002, we used "Mr. Lung" for our small group training in which one hundred of the fifth year medical students were divided into small groups from which one group was taught every other week. The class consisted of ninety-minute training periods for auscultation of lung sounds. At first, we explained the classification of lung sounds, and then auscultation tests were performed. Namely, students listened to three cases of abnormal or adventitious lung sounds on "Mr. Lung" through their stethoscopes. Next they answered questions corresponding to the portion and quality of the sounds. Then, we explained the correct answers and how to differentiate lung sounds on "Mr. Lung". Additionally, at the beginning and the end of the lecture, five degrees of self-assessment for the auscultation of the lung sounds were performed. The ratio of correct answers for lung sounds were 36.9% for differences between bilateral lung sounds, 52.5% for coarse crackles, 34.1% for fine crackles, 69.2% for wheezes, 62.1% for rhonchi and 22.2% for stridor. Self-assessment scores were significantly higher after the class than before. The ratio of correct lung sound answers was surprisingly low among medical students. We believe repetitive auscultation of the simulator to be extremely helpful for medical education.

[Pulmonary eosinophilic granuloma in a woman of 72].

We report a case of pulmonary eosinophilic granuloma with the latest onset ever reported in Japan. A 72-year-old woman, a current smoker, developed dyspnea and dry cough in late January 2001. Chest radiography and CT examinations revealed numerous small nodular lesions and multiple cysts in both upper lung fields. A thoracoscopic lung biopsy revealed a granulomatous lesion composed of eosinophils and large histiocytic cells with pale eosinophilic cytoplasms and large cleaved nuclei. These cells gave a positive reaction for S-100 protein. These findings led to a diagnosis of pulmonary eosinophilic granuloma. This disease is generally reported in much younger subjects, and few cases are known in those over 60-years old. No Japanese report of histologically confirmed pulmonary eosinophilic granuloma in an older patient has previously appeared, but it may now be prudent to take this disease into consideration when diagnosing pulmonary disease in older subjects.

[Measurement of anti-type II collagen antibody diagnosis and follow-up useful in a case of relapsing polychondritis].

A 68-year-old man had been suffering from swelling and deformation of both auricles, hoarseness, hearing loss, and a productive cough since November, 1999. Elevation of the inflammatory reaction was noted, together with swelling of the glottis and inflammation of the bronchial mucosa on bronchoscopy. Relapsing polychondritis was diagnosed when an auricle biopsy specimen demonstrated auricle chondritis. The laboratory findings revealed high titers of anti-type II collagen antibody. After steroid treatment, the symptoms improved and the titer of anti-type II collagen antibody decreased. The measurement of this antibody was useful for the diagnosis and follow-up of this disease. To prevent the impairment of organs and sudden death, early diagnosis involving the use of anti-type II collagen antibody and the commencement of therapy are important in this disease.

[Two cases of Swyer-James syndrome].

Two cases of Swyer-James syndrome are reported. Case 1; A 25-year-old man was admitted to our hospital to be treated for Mycobacterium avium infection. Chest X-ray film revealed hyperlucency in the right lower lung. High-resolution CT showed a low attenuation area and bronchiectasis in the right lower lobe. He had had two episodes of pneumonia in his childhood. 3D CT scan showed a narrowing of right lower pulmonary arteries. Case 2; A 65-year-old woman was admitted to our hospital with dyspnea on effort. Chest X-ray film revealed hyperlucency in the right lung. Chest CT scan on inspiration and expiration detected air-trapping, which is characteristic of this syndrome. In both cases, the volume of the hyper lucent lung was normal. From these clinical findings, we diagnosed these two cases as Swyer-James syndrome and in this paper described the clinical features and treatment.