Mycotic aneurysm of the bilateral tibioperoneal trunks associated with bacterial endocarditis: a case report.

Since antibiotics have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become extremely rare. We report the case of a 34-year-old man who had mycotic aneurysms in the tibioperoneal trunks of both legs six weeks after he had a mitral valve replacement due to Streptococcus viridans endocarditis. Color Doppler sonography was used to diagnose pseudoaneurysms in both legs. Surgical treatment included the closures of the orifices of both aneurysms in both legs and arterial reconstructions were not required. In the literature, however, the location of mycotic aneurysms in peripheral arteries related to endocarditis were usually reported to be in the upper extremities or femoral arteries. Thus, we present the extremely rare case of mycotic aneurysms because the aneurysms occurred in the infrapopliteal vessel and developed in both legs.

[Experience of reoperations followed by repairs of abdominal aortic aneurysms].

We experienced 8 cases who required reoperations, including 2 re-redo operations, after repairs of infrarenal abdominal aortic aneurysms. Of 8 patients, one patient developed a new aneurysm due to atherosclerosis in thoraco-abdominal aorta involving all visceral arteries and other 7 patients had aneurysmal formations at proximal anastomotic sites, including 3 suprarenal, 2 juxtarenal and 2 infrarenal aortic lesions. Etiology at initial operation in patients who subsequently developed anastomotic aneurysms included vasculo-Behçet disease in 4, atherosclerosis in 2 and dissecting aortic aneurysms type III due to Marfan syndrome in 1. At reoperation, all who had vasculo-Behçet disease had ruptures of anastomotic sites and 2 patients underwent repairs of dehiscent patch, 1 extra-anatomic bypass between ascending and abdominal aorta and 1 interposition of graft. One patient who had graft infection after repair of abdominal aortic aneurysm required axillo-femoral bypass with removal of infected graft. A patient who had dehiscence of proximal anastomosis after repair of aortoiliac occlusive disease required interposition of graft. Two patients, Marfan syndrome and aneurysm in thoraco-abdominal aorta, underwent graft replacement of thoraco-abdominal aorta concomitant with reconstruction of all visceral arteries. There were 8 patients who required reoperations for aneurysms at distal anastomotic sites after repairs of abdominal aortic aneurysms. Five patients underwent repairs of new aneurysms, including replacement of total arch in 3, descending aorta in 1 and iliac artery in 1. In all cases, no hospital death was noted, however, late deaths were occurred in vasculo-Behçet disease, Marfan syndrome and graft infection. Thus, late result depends on etiology of disease. Although patients who requires reoperation after repair of abdominal aortic aneurysms have higher operative risk factors, early and late results are satisfactory compared to initial operations.

[An outbreak of Pseudomonas folliculitis in children--the first report on Pseudomonas folliculitis in Japan].

An outbreak of Pseudomonas aeruginosa folliculitis in 6 children occurred within 5 days after playing in a tiny vinyl pool. The follicular macular or pustular eruptions were mainly distributed on the trunk. No associated symptoms were seen. The causative Pseudomonas aeruginosa strain isolated from pustules of one case belonged to serogroup E, corresponding to O-11 (Difco). The rash subsided promptly and spontaneously. Furthermore, we have encountered another case of Psedomonas folliculitis caused by P. aeruginosa serogroup G, corresponding to O-6 (Difco). The maculopustular rash was distributed on the trunk and disappeared spontaneously as the cases mentioned above. The folliculitis of this baby were probably associated with the repeated use of family bath without changing water. In U.S. and Europe Pseudomonas folliculitis have been reported very frequently, but our cases were reported for the first time in Japan.

[Histological study of cell attachment and proliferation of periodontal ligament cells on the tooth surface. Effect of the fibronectin application].

The purpose of this study was to examine the effect of fibronectin on cell attachment and the growth of cultured cells on the surface of the dentin. In the first experiment, dentin specimens were divided into following three groups: dentin surface polished with carborundum-point, carborundum-point and #150 sandpaper and carborundum-point, #150 sandpaper and #240 sandpaper. The roughness of the surface was measured with a profilometer (Surfcom e-st-sa) for the purpose of comparing differences among the three groups. The foregoing treated samples were added to cultures of periodontal ligament (PDL) cells and following fixation, the number of cells was counted under a light microscope and examination under a scanning electron microscope (SEM) was also performed. 1. Greater numbers of cells attached to the smooth surface (#240) than the rough surface. 2. SEM observations showed increased numbers of attached and proliferated cells on the smooth surface. In the second experiment, the dentin surfaces were polished with carborundum point, #150 and #240 sand paper. The dentin tube side was treated with fibronectin. MEM-treated samples not immersed in fibronectin were employed as controls. The foregoing treated root samples were cultured with PDL cells. Following fixation, the cells attached to the root surface were examined under the light microscope and using a SEM. 1. A significant increase in the number of the attached cells as observed after treatment with fibronectin. 2. SEM observation suggested PDL cells migrated more and proliferated more on the side treated with fibronectin. 3. Fibronectin application increased cell attachment and proliferation more on the smooth surface of dentin.

[The combination therapy of amikacin and beta-lactam antibiotic in the severe bacterial infections (author's transl)].

The combination therapy of beta-lactam and aminoglycoside antibiotics is now evaluated to be very effective in severe infections. Amikacin, one of aminoglycoside antibiotics, has antibacterial activity to gentamicin resistant bacteria. Then we tried to use the combination therapy of amikacin and beta-lactams in 20 cases with severe bacterial infections, including 2 cases of bacteremia etc. Fifteen cases out of them failed to cure by previous antibiotics treatment. With a few exception, amikacin was administered daily 200 mg in 2 divided intramuscular injections. beta-Lactams were administered twice a day by intravenous drip infusion, but dose and kind of beta-lactams were decided by attending doctors. Clinical efficacy of this combination therapy was classified in 4 degrees: excellent, good, fair and poor. Clinical efficacy rate (excellent and good results) in all cases was 75%. This is equally effective, compared with the newly sold antibiotics. Elevation of serum GOT and GPT levels was seen in 2 cases in whom large amount of PCs was given. As a conclusion, it was indicated that the combination therapy of amikacin and beta-lactam in the regular dose was sufficiently effective and useful for the therapy of severe bacterial infections.

Combination therapy using 9,3"-di-O-acetyl-midecamycin with beta-lactam antibiotics against Pseudomonas aeruginosa infection.

The combined effect of beta-lactam antibiotics and 9,3"-di-O-acetylmidecamycin were examined in 10 patients diagnosed as having chronic respiratory tract infections and complicated urinary tract infections. Patients were initially treated with 3 to 10 g/day of beta-lactams as intravenous infusions or by oral route for a certain period, after which period they were treated concurrently with 0.3 to 0.9 g/day of 9,3"-di-O-acetylmidecamycin by oral route. Through this combination therapy eradication of P. aeruginosa was obtained in 2 cases and remarkable decrease in another 2 cases out of the 10 cases. This combination therapy was judged to be effective in these 4 cases. Of the remaining cases, P. aeruginosa was eliminated before the start of the combination therapy in 3 cases, and no change in bacterial count was noted after the combination therapy in the other 3 cases.

Electrocardiographic findings in cholera El Tor patients.

One hundred and two electrocardiograms of 50 children and adults with El Tor cholera in the Philippines were analysed in relation to the course of the disease, plasma specific gravity and blood pressure. Pulmonary P waves, observed in 40% of the cases on admission, disappeared after rehydration. Hypokalaemic patterns were seen in 40% of the cases in the acute stage (during rehydration). This pattern became more marked after rehydration and disappeared gradually within 3-7 days.