Hochuekkito can Prevent the Colonization of Methicillin-Resistant Staphylococcus aureus in Upper Respiratory Tract of Acute Stroke Patients.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization can lead to MRSA pneumonia or other infections in compromised hosts, and invasive MRSA infections lead to significant morbidity and mortality. The present observational study elucidated whether administration of hochuekkito (HET) can prevent MRSA colonization in the upper respiratory tract and support recovery in acute stroke patients. Methods: In this retrospective, observational study, 73 acute stroke patients admitted to Kenwakai Hospital between April 2007 and December 2019 who did not require emergency surgery during this period were enrolled. Conventional treatment was provided to all patients, depending on their condition, and 7.5 g/day of HET was administered to the patients who could take the medicine via nasogastric tube or orally in three divided doses for three months. Bacterial cultures from laryngeal swabs and sputum were evaluated every week. We evaluated the presence of MRSA infection or another infectious disease within 30 days of admission; modified Rankin Scale scores, which assesses the independent living skills after stroke at three months after admission; and blood biomarkers (white blood cell count, albumin levels, C-reactive protein levels, and hemoglobin levels). Results: In total, 73 patients (HET group, n = 41; non-HET group, n = 32) were enrolled in the study. MRSA detection was significantly less likely in the HET group than in the non-HET group (p = 0.0497). The incidence of infectious diseases was significantly lower in the HET group than in the non-HET group (p = 0.0096), and the modified Rankin Scale score at three months was also significantly lower in the HET group than in the non-HET group (p = 0.033). The white blood cell count, and serum C-reactive protein levels did not differ between those who were treated with HET and those who were not. However, serum albumin and hemoglobin levels improved slightly between month one and month three after admission only in those who were treated with HET. Conclusion: Our results indicate that the administration of HET may contribute to the prevention of MRSA colonization and promote rehabilitation in stroke patients.

[Prognosis after percutaneous endoscopic gastrostomy (PEG) in patients at home].

Percutaneous endoscopic gastrostomy(PEG)is a frequently performed operation. However, prognosis after PEG is sometimes poor. We investigated the survival rate after PEG and prognostic factors in patients at home. The subjects were 75 patients treated at home who had undergone PEG between January 2006 and December 2013. Forty-one of the 75 subjects were male and 45 were over 80 years old. The surgery was performed because of cerebral infarction in 37 patients, hemorrhagic stroke in 13, brain and cervical injuries in 4, encephalitis in 2, and other conditions in 19. The survival rate after PEG was 69.4% at 1 year, 34.3% at 3 years, and 10.3% at 5 years. These scores were lower than the reported survival rate of hospital patients. Poor prognostic factors were age ≥80, male sex, a serum albumin level≤2.5mg/dL, repeat occurrences of pneumonia, and disturbance of consciousness.

[A case of infant epidural hematoma treated by continuous drainage of cephalohematoma].

A female infant was born at 36 weeks with vacuum extraction. Her weight was 2.216 g and Apgar score was 9. She had a cephalohematoma at right parietal region. The cephalohematoma grew during 6 days after birth, then she came to our hospital. On arrival, her consciousness was alert and there were no neurological deficits. Her head circumference was 22.5 cm, and she had a pulsatile soft cephalohematoma, 7 cm in diameter, at right parietal region. Ultrasound examination showed a midline shift of the brain and CT scan revealed an epidural hematoma with bone fracture and cephalohematoma. We chose the puncture and continuous drainage of cephalohematoma as a primary therapy, because cephalohematoma was considered to be liquified and to be continuous to the epidural hematoma. The reason was that the pulsatile cephalohematoma became harder when she cried. The epidural hematoma was completely reduced on the next day's CT and then drainage was removed. She discharged on 15th post-operative day. We conclude that the puncture and continuous drainage of cephalohematoma may be one of the good therapeutic methods for the mild symptomatic neonate who has epidural hematoma with the cephalohematoma and bone fracture.

Successful surgical management of patients with infective endocarditis associated with acute neurologic deficits.

Subjects were 2 patients with neurologic deficits due to infective endocarditis. The first, a 30-year-old woman with acute ischemic stroke, was found to have vegetation from infective endocarditis as the embolic source. Two weeks after she experienced an acute ischemic stroke, we conducted elective cardiac surgery. The second, a 16-year-old girl with infective endocarditis, suffered a ruptured mycotic aneurysm in the left carotid system complicated by intracranial hemorrhage. We conducted a successful staged mitral valve replacement following craniotomy.

[Changes in peripheral lymphocytes count in unconscious patients treated at home with Japanese herbal medicines (Hozai)].

We investigated changes in peripheral white blood cells count, lymphocytes count, and serum albumin level in five unconscious patients administered Japanese herbal medicines (Hozai). The causes of unconsciousness were intracerebral hemorrhage in 3, cerebral infarction in 1, and craniopharyngioma in 1. The administered Hozai were Hotyu-ekki-to in 4 and Jyuzen-taiho-to in 1. To assess the effect of Hozai on the immune system of unconscious patients, we investigated these parameters before and after treatment. We observed normalization of WBC counts, increase of lymphocytes count, and unchanged levels of serum albumin after Hozai treatment. These findings suggest that Hozai may improve the immunological competence of unconscious patients. One of the problems affecting unconscious patients treated at home is infectious diseases, especially respiratory infections. It is considered that improvement of their immunological competence would contribute to prevent infections. These results suggest that Hozai treatment might be useful adjuvants to support the general condition of the patients treated at home.