[Tension hemothorax associated with congenital pulmonary arteriovenous fistula].

We describe a case of intrapleural rupture of pulmonary arteriovenous fistula A 37-year-old woman was admitted to our hospital with a sudden onset of right chest pain. A computed tomography scan showed massive pleural effusion and tension hemothorax. Subsequently the patient went into shock. Partial resection of the lung was performed emergently. Pulmonary arteriovenous fistula is often associated with Rendu-Osler-Weber disease (ROW). Because of her brain arteriovenous malformation and family history, we could not exclude the possibility of ROW.

Genetic heterogeneity of the dnaK gene locus including transcription terminator region (TTR) in Campylobacter lari.

Nucleotide sequences of approximately 3.1 kbp consisting of the full-length open reading frame (ORF) for grpE, a non-coding (NC) region and a putative ORF for the full-length dnaK gene (1860 bp) were identified from a urease-positive thermophilic Campylobacter (UPTC) CF89-12 isolate. Then, following the construction of a new degenerate polymerase chain reaction (PCR) primer pair for amplification of the dnaK structural gene, including the transcription terminator region of C. lari isolates, the dnaK region was amplified successfully, TA-cloned and sequenced in nine C. lari isolates. The dnaK gene sequences commenced with an ATG and terminated with a TAA in all 10 isolates, including CF89-12. In addition, the putative ORFs for the dnaK gene locus from seven UPTC isolates consisted of 1860 bases, and the four urease-negative (UN) C. lari isolates included C. lari RM2100 reference strain 1866. Interestingly, different probable ribosome binding sites and hypothetically intrinsic p-independent terminator structures were identified between the seven UPTC and four UN C. lari isolates, respectively. Moreover, it is interesting to note that 20 out of a total of 28 polymorphic sites occurred among amino acid sequences of the dnaK ORF from 11 C. lari isolates, identified to be alternatively UPTC-specific or UN C. lari-specific. In the neighbour-joining tree based on the nucleotide sequence information of the dnaK gene, C. lari forms two major distinct clusters consisting of UPTC and UN C. lari isolates, respectively, with UN C. lari being more closely related to other thermophilic campylobacters than to UPTC.

Mosaicism of unstable CAG repeats in the brain of spinocerebellar ataxia type 2.

Spinocerebellar ataxia type 2 (SCA2) is caused by expansion of unstable CAG repeats within the coding region of the novel gene, ataxin-2, on chromosome 12q24.1. We analyzed CAG repeat size of the SCA2 allele in two deceased patients (father and daughter) to investigate the repeat mosaicism in CNS regions. The CAG repeat size was examined using lymphoblastoid cell lines, frozen brain tissues, and paraffin-embedded tissues. In each patient the major repeat size of the expanded allele varied within the brain or spinal cord (father, 39-42; daughter, 39-47 repeats), and was smaller by three to eight repeats in the cerebellum than in other CNS regions. Our results are in agreement with the findings in other polyglutamine disorders showing somatic mosaicism.

[Antimicrobial activities of roxithromycin against recently obtained clinical isolates].

The purpose of our investigation was to monitor current trends in the susceptibility patterns of clinical bacterial isolates to roxithromycin (RXM). We measured the MICs of macrolide antibiotics, such as RXM, erythromycin (EM), clarithromycin (CAM), rokitamycin (RKM) and midecamycin (MDM), and other classes of antibacterial compounds against various clinical isolates at seven institutions between October and December in 1994 and 1995. RXM had excellent antibacterial activities for S. pyogenes, S. agalactiae, M. (B.) catarrhalis and methicillin sensitive S. aureus. Against methicillin sensitive S. epidermidis, RXM activity was fairly good but about 20% of the strains had MIC > or = 128 micrograms/ml. The activity against S. pneumoniae was not so potent and similar to activities of EM, CAM, MDM, and clindamycin. The vast majority of methicillin resistant S. aureus and S. epidermidis were also resistant to macrolide antibiotics and other classes of compounds tested. In conclusion, RXM is an unique macrolide antibiotic by retaining potent activity against S. pyogenes, S. agalactiae, S. aureus except MRSA, M. (B.) catarrhalis and M. pneumoniae.

[Antimicrobial susceptibility patterns of the Proteeae in Japan, 1989].

We discussed the antimicrobial susceptibilities of Proteeae isolated in Japan, 1989. Eight hundred six clinical isolates were collected from 47 hospitals. These were comprised of 431 strains of Proteus mirabilis, 155 Proteus vulgaris, 154 Morganella morganii, 44 Providencia rettgeri and 22 Providencia stuartii. Antibiotics tested in this study were 2 penicillins, 5 cephems, 1 carbapenem and 2 aminoglycosides. The MIC's were determined using the standard method of the Japan Society of Chemotherapy. Susceptibilities of the above strains to these antibiotics are described below; 1. Latamoxef, ceftizoxime and imipenem had excellent activities with no evident differences among the species of Proteeae. 2. Ampicillin and cefazolin were less active against Indol-positive Proteeae. 3. Piperacillin and cefmetazole were also strongly active drugs against P. mirabilis, P. vulgaris and P. stuartii, and cefotiam against P. mirabilis and P. stuartii. 4. Gentamicin and netilmicin showed excellent activities against M. morganii.

[Carrier state and comparative study of methicillin-resistant Staphylococcus aureus from the staff and patients].

The nasal carriage of Staphylococcus aureus in 529 staff was screened. S. aureus from staff and patients whose minimum inhibitory concentration (MIC) of methicillin was larger than 12.5 micrograms/ml by agar dilution was defined as Methicillin-resistant S. aureus (MRSA). Coagulase typing was performed by DENKA SEIKEN kit. Hands of ward staff were screened before and after contact with the MRSA carriers and after hand washing. The nasal acquisition rate of S. aureus and MRSA for staff was 27.6% and 8.5%. The rate of ward staff for nasal carriers of MRSA was 91.1%. Coagulase type II strains from ward staff and inpatients were dominant. In some cases MRSA was detectable after hand washing: In MRSA infection ward staff played a dangerous role as a vector.

[Antimicrobial susceptibilities of clinical isolates of Morganella-proteus-providencia group of bacteria].

We examined in vitro susceptibilities of 3,109 isolates belonging to 5 species of Proteeae to 2 penicillins, 5 cephems and 2 aminoglycosides. The isolates were collected from 69 hospital laboratories throughout Japan between 1986 and 1988. Minimal inhibitory concentrations were determined using the agar dilution method with inoculation of 10(8) cells/ml of bacteria. Proteus mirabilis had marked susceptibilities to the penicillins and cephems tested. Proteus vulgaris and Morganella morganii were similar in their susceptibilities to ampicillin (ABPC), piperacillin (PIPC), cefazolin (CEZ), cefotiam (CTM), latamoxef, gentamicin (GM) and netilmicin (NTL), but M. morganii was slightly more resistant to cefmetazole and ceftizoxime (CZX) than P. vulgaris. Providencia rettgeri also had a susceptibility pattern similar to that of P. vulgaris, except that P. rettgeri showed higher resistances to CZX, GM and NTL. Providencia stuartii had a very similar susceptibility pattern to P. rettgeri, but P. stuartii was much more resistant to GM and NTL than the latter. Some major differences on susceptibilities were clearly evident among the 5 species of Proteeae tested. Notable species-specific differences included higher susceptibilities of P. mirabilis to ABPC, PIPC, CEZ and CTM than others and stronger resistances of P. rettgeri and P. stuartii to GM and NTL.

[Antibacterial activity of imipenem in combination with ampicillin against methicillin-resistant strains of Staphylococcus aureus].

UNLABELLED: Imipenem (IPM) and beta-lactams have been reported to possess a synergistic relationship in their activities against methicillin (DMPPC)-resistant strains of Staphylococcus aureus (MRSA). The purpose of this study was to determine activities of IPM and ampicillin (ABPC) singly and in combination against MRSA. Activities of the 2 antibiotics against 19 strains of S. aureus resistant to DMPPC were investigated by means of the checkerboard method, the disk diffusion technique and the killing-curve method. MICs of DMPPC against these strains determined using the agar dilution method were greater than or equal to 100 micrograms/ml and MICs of IPM and ABPC ranged from 12.5 to 100 micrograms/ml and from 12.5 to 50 micrograms/ml, respectively, when used singly. The following results were obtained with the checkerboard method: Synergistic effects and additive effects were found against 13/19 and against 6/19 strains, respectively, and no antagonistic effect was found according to the FIC (fractionary inhibitory concentration) index. The disk diffusion technique indicated synergistic results. Killing-curves with the following drug concentration combinations were examined in Mueller-Hinton broth against 5 fosfomycin(FOM)-resistant and 5 FOM-susceptible stains: (1) IPM 12.5 micrograms/ml, (2) ABPC 25 micrograms/ml, (3) IPM 12.5 micrograms/ml + ABPC 25 micrograms/ml, (4) IPM 6.25 micrograms/ml + ABPC 25 micrograms/ml, (5) IPM 6.25 micrograms/ml + ABPC 12.5 micrograms/ml, (6) IPM 6.25 micrograms/ml + ABPC 12.5 micrograms/ml + FOM (fosfomycin) 25 micrograms/ml, (7) IPM 12.5 micrograms/ml + ABPC 25 micrograms/ml + FOM 50 micrograms/ml, (8) FOM 50 micrograms/ml. The following results were obtained with the killing-curve method; (1) Synergistic effects were found against 8/10 strains and no antagonistic effect was found with the combinations of IPM and ABPC. (2) Synergistic effects were found against 3/5 strains and no antagonistic effect was found with the combinations of IPM, ABPC and FOM against 5 FOM-susceptible strains. CONCLUSIONS: IPM in combination with ABPC produced synergistic effects against MRSA. This combination therapy should be evaluated in treating MRSA infections.

[Susceptibilities of uropathogenic bacteria to ampicillin, cefazolin, cefmetazole and gentamicin. Nine-year survey of changing patterns of susceptibilities].

We analyzed antibiotic susceptibilities of urinary isolates of Escherichia coli, Klebsiella spp., Proteus mirabilis, and Indole (+) Proteus group to ampicillin (ABPC), cefazolin (CEZ), cefmetazole (CMZ) and gentamicin (GM) in 69 laboratories in 1988 and also studied changing patterns of susceptibilities from 1980 to 1988. Minimal inhibitory concentrations were determined using the agar dilution method (MUELLER-HINTON agar, BBL) with inoculation of 10(6) cfu/ml of bacteria. Ninety to 99% of the strains of E. coli, Klebsiella spp. and P. mirabilis were inhibited at a concentration of 6.25 micrograms/ml of CEZ and CMZ and of 1.56 micrograms/ml of GM. Approximately 80% of the strains of Indole (+) Proteus group were inhibited at concentrations of 6.25 micrograms/ml of CMZ and of 1.56 micrograms/ml of GM. However, resistance to ABPC and CEZ was high, with 83% and 81% of the strains being not inhibited at a concentration of 50 micrograms/ml of ABPC and CEZ, respectively. No significant changes in susceptibilities of the 4 bacteria to the above 4 antibiotics were observed over the 9 year period. No increase was found in the incidence of the resistant strains of the 4 bacteria to CMZ and GM, nor of E. coli and Klebsiella spp. to CEZ.

[Comparative studies of serological test for Mycoplasma pneumoniae on 73 cases of lower respiratory infection disease].

The purpose of this report is to evaluate a test kit based on the High Density Composite Particle Agglutination Test Method (HDPA method, Newly developed by Tokuyama Soda Co., Ltd). Diagnosis of Mycoplasmosis has been done with clinical symptoms, breast x-ray examination, serum anti-M. pneumoniae antibody detection and bacteriological test result. Recently, we had the chance to use this HDPA method (IMMUNOTICLES MYCO) and compared the results with bacteriological test, complement fixation method (CF) and particle agglutination method (PA) using the cases of seventy-three (73) lower respiratory infected patients. The evaluation outcomes (positive rate, sensitivities and specificities) comparing with the conventional methods based on the clinical cultured results and clinical diagnostic results respectively are shown as follows. 1) The evaluation outcomes based on the cultured results. Forty-one (41) cases of 73 samples, we could isolate the M. pneumoniae (56.2%). a) The HDPA method is correlated with CF (r = 0.885, n = 73) and PA (r = 0.764, n = 73) respectively. b) The positive rate of HDPA, PA and CF are 45.2%, 31.5% and 20.5% respectively. 2) The evaluation outcomes based on the clinical diagnosis. a) The sensitivity of the HDPA method is 66.0% and this one is much higher than the one of CF and PA. b) The specificity of the HDPA method is 92.3%. c) The positive rate of the HDPA method is higher than the one of PA and CF even though the assay was done within seven-days. In conclusion, the HDPA method is a very sophisticated method for diagnosis of M. pneumoniae and able to be substituted to any other conventional methods.

[In vitro susceptibility of Escherichia coli and Klebsiella sp. to antibiotics].

A nationwide susceptibility survey of clinical isolates of Escherichia coli and Klebsiella pneumoniae initiated in 1980 was continued for the 8th consecutive year. A total of 4,421 strains of E. coli and 2,825 strains of K. pneumoniae isolated mainly from urine, sputum and pus, were obtained from 69 hospitals throughout Japan during the 2 years (1986-1987). MICs were determined using the agar plate dilution method (Mueller-Hinton agar, BBL) with inoculation of 10(8)CFU/ml bacteria. Antibiotics tested in this survey were 2 penicillins, 7 cephems and 2 aminoglycosides. Most of the strains of the two species of bacteria were susceptible to ceftizoxime (CZX), cefotetan (CTT), latamoxef (LMOX), cefotiam (CTM) and cefmetazole (CMZ) and also gentamicin (GM) and netilmicin (NTL) were active against both species of bacteria. About 90% of the E. coli strains were inhibited at a concentration of 0.20 micrograms/ml of CZX, 0.39 micrograms/ml of LMOX, 0.78 micrograms/ml of CTT, 1.56 micrograms/ml of CTM or NTL, or 3.13 micrograms/ml of CMZ or GM. Most of the strains were resistant to ampicillin (ABPC) and piperacillin. For the strains of K. pneumoniae, similar results were obtained. Yearly changes in susceptibility of E. coli and K. pneumoniae were not obvious with ABPC, cefazolin, CMZ or GM. No significant differences were observed during 1986-1987 in susceptibilities of the isolates of both species of bacteria due to different clinical specimens. These results suggest that the 2nd and the 3rd generation cephems and aminoglycosides, alone or in combination, may be efficacious in treating infections due to E. coli and K. pneumoniae.

[Hospital and district differences in susceptibilities to antibiotics of main clinical isolates].

A nationwide survey of susceptibilities of Staphylococcus aureus, Escherichia coli, Klebsiella sp. and Proteus mirabilis initiated in 1980 was continued in 1986. This report documents differences in susceptibilities of clinical isolates of the above microorganisms to ampicillin (ABPC), cefazolin (CEZ), cefmetazole (CMZ) and gentamicin (GM) among general hospitals throughout Japan. Clinical isolates of each species of microorganisms which were collected in 24 hospitals made up each study group and were collected at the Kosei General Hospital, Tokyo, from April 1980 to March 1986. We compared the variability in the resistant rates (MIC greater than or equal to 25 micrograms/ml) and MICs of each antibiotic for 50% and 80% of the isolates among the hospitals. MICs were determined by the serial 2 fold agar plate dilution method, standardized by the Japan Society of Chemotherapy, with an inoculum of approximately 10(6) CFU/ml or 10(8) CFU/ml. Susceptibility patterns of S. aureus to ABPC, CEZ and GM, of E. coli to ABPC, of Klebsiella sp. to CEZ and GM and of P. mirabilis to ABPC, CEZ and GM varied from hospital to hospital. On the other hand, the differences in the susceptibility patterns among the 6 districts of Japan were not obvious, because the differences were affected by different susceptibility patterns of each hospital located in each district.

[A nationwide study of the antimicrobial susceptibility of clinical isolates of Staphylococcus aureus in Japan].

We described antimicrobial susceptibilities of clinical isolates of Staphylococcus aureus in 1985 and also a 6-year survey of changing patterns of their susceptibilities to ampicillin (ABPC), cefazolin (CEZ), cefmetazole (CMZ) and gentamicin (GM) from 1980 to 1985 in 103 hospitals. The MICs were determined by the standard method of the Japan Society of Chemotherapy. Among 2,891 isolates in 1985, ratios of resistant strains to ABPC and GM were 24% and 29%, respectively, and those to CEZ and CMZ were 8% and 3%, respectively. Gradual increases in numbers of resistant strains to ABPC, CEZ and CMZ were observed until 1984 but a trend for decreases in numbers of resistant strains to the above 3 antibiotics was observed in 1985. A continuous rise in numbers of resistant strains to GM until 1985 was noted. Isolates from clinical materials such as pus, bile, and urine showed higher incidences of resistance to ABPC and GM than those from sputum, secreta and throat swab. Rates of resistant strains to CEZ were the highest in isolates from bile, pus, sputum and urine. Rates of resistant strains to CMZ were the highest in isolates from bile, and decreased in isolates from sputum, urine and pus in this order. Rates of resistant isolates from inpatients to the 4 antibiotics tested were greater than those from outpatients.

[Nationwide study of the antimicrobial susceptibility of clinical isolates of Proteus group in Japan].

We discussed the antimicrobial susceptibilities of Proteus group isolated in 1983 and 1984 and also the annual changes of the susceptibilities from 1980 to 1984. The tested strains were isolated in 103 hospitals in Japan. Antibiotics tested for this study were ampicillin (ABPC), cefazolin (CEZ), cefmetazole (CMZ), and gentamicin (GM). The MIC's were determined by the standard method of the Japan Society of Chemotherapy. Susceptibilities of the bacterial strains to the 4 antibiotics were described below: 1. Proteus mirabilis had good susceptibilities to all the antibiotics tested. 2. Susceptibilities of Proteus vulgaris were low to ABPC and CEZ, but high to CMZ and GM. 3. Proteus morganii showed low susceptibilities to ABPC and CEZ, and moderate to CMZ and GM. 4. Susceptibilities of Proteus rettgeri were low to ABPC and CEZ, and 25-40% of the strains were resistant to CMZ and GM. 5. Proteus inconstance had low susceptibilities to ABPC and CEZ, but fairly good to CMZ. About 55% of the strains showed resistance to GM. 6. There were no significant annual changes in susceptibilities of P. mirabilis, P. vulgaris and P. morganii to ABPC, CEZ and CMZ during the period from 1980 to 1984, but decreased susceptibilities to GM were noted in 1982. 7. There was no evidence of changes in susceptibilities of strains of P. rettgeri to ABPC and CMZ, but a tendency of decreasing susceptibilities to CEZ was shown from 1981. 8. P. inconstance showed no major changes in susceptibilities to ABPC, CMZ and GM. 9. Frequencies of resistant strains with MIC of 25 micrograms per ml or more in P. mirabilis, P. morganii and P. rettgeri were higher in 1982 and/or 1983 than the other years.

[A nationwide study of the antimicrobial susceptibility of clinical isolates of Escherichia coli in Japan].

We studied the antimicrobial susceptibility of E. coli isolated in 1983 and 1984 and also the yearly changes of the susceptibility of E. coli from 1980 to 1984 isolated in 103 hospitals in Japan. Antibiotics used for MIC determination were ampicillin (ABPC) as a penicillin, cefazolin (CEZ) as a cephalosporin, cefmetazole (CMZ) as a cephamycin and gentamicin (GM) as an aminoglycoside. Numbers of isolates tested were 2,321 strains in 1983 and 1,965 strains in 1984. CMZ was the most effective agent among the 4 antibiotics tested, followed by GM and CEZ in this order. A large number of the isolates were inhibited by 1.56 micrograms/ml on CMZ and GM and by 6.25 micrograms/ml of CEZ. About two-thirds of the isolates were inhibited at a concentration of 12.5 micrograms/ml or less of ABPC. The susceptibility of E. coli against the 4 antibiotics changed little year by year and the tendency of the appearance of resistant strains did not increase in the last 5 years.

[A nationwide study of the antimicrobial susceptibility of clinical isolates of Klebsiella sp. in Japan].

We have reported the antimicrobial susceptibility of clinical isolates of Escherichia coli in 1983 and 1984 to 4 antibiotics, ampicillin (ABPC), cefazolin (CEZ), cefmetazole (CMZ) and gentamicin (GM), in the previous report. In this paper, we described the antimicrobial susceptibility of Klebsiella sp. to the same antibiotics during the same period reported for E. coli before. Numbers of isolates tested were 1,671 strains in 1983 and 1,374 strains in 1984. We determined MICs of the 4 antibiotics against isolates by the standard method of the Japan Society of Chemotherapy. The most effective agent was GM among the 4 antibiotics. CMZ had a similar antimicrobial activity to GM. Resistance rates were low for both agents. CEZ had a fairly good antimicrobial activity, but it was less active than GM and CMZ. ABPC was not effective. There was neither significant annual change of antimicrobial activity of each agent against isolates nor an increasing tendency of resistant strains in the last 5 years. Depending on isolates from clinical materials, differences in the susceptibility were noted and there was a high ratio of resistant organisms among isolates from urine.