[A case of pseudomembranous colitis concomitant with toxic megacolon and paralytic ileus].

A 60-year-old man was diagnosed as pseudomembranous colitis with chief complaint of fever and abdominal distension after a cerebral operation. It was ineffective although vancomycin hydrochloride (VCM) was given orally. Complications occurred. The patient had toxic megacolon and paralytic ileus. VCM was administrated via an ileus tube. In addition, the bowel was lavaged and VCM was sprayed by colonoscopy. This therapy was very effective. Generally, a patient with pseudomembranous colitis concomitant with toxic megacolon or/and paralytic ileus is considered to have a poor prognosis, however, he completely recovered by a combination of medical treatment.

[Current trend and importance of prevention on pertussis].

There has been talk about the rise in adult pertussis in Japan. This paper mentions three important points: (1) Why has there been a rise in the number of patients having pertussis ? (2) The difficulty in diagnosing pertussis. (3) Do all the DPT vaccines have the same contents? The pain when receiving DPT vaccine is various among three types of DPT vaccines. Adult pertussis vaccination has been carried out in the United States, but not in Japan. DPT vaccination in adults has been reducing the incidence of pertussis in the United States. In Japan, it has been investigated, but not started. The number of pertussis patients is expected to increase in the future in Japan. Therefore, it's important to address this to the public and create awareness. This will help in decreasing pertussis with early diagnosis and adequate therapy. If we see patients with prolonged cough, we should suspect that the patient may have pertussis. Five types of DPT vaccine are available in Japan. We examined the pain when children vaccinated among three types of DPT vaccines. As the result of our study, the difference of the pain is demonstrated three types of DPT vaccine. Further study is necessary for the reason why the pain was different among three types of DPT vaccine. We had better consider these results when we choose the DPT vaccine.

[Clinical study of 28 children with bacterial meningitis].

A retrospective study was conducted on 28 patients with bacterial meningitis who were admitted to our department between April 1988 and March 2002. The most commonly detected pathogen was group B Streptococcus in those under 1 month of age and Haemophilus influenzae (72.2%) among those over 1 month. The most commonly administered antibiotic combination (67.9%) at the initial treatment was that of cefotaxime (CTX) and ampicillin (ABPC). We encountered one case that was resistant to both CTX and ABPC. Through this experience, it became apparent that for the initial treatment of bacterial meningitis in infants, it is necessary to apply a combination of two antibiotics, instead of a single agent, and new antibiotics should be considered for such combinations rather than persisting on conventional CTX and ABPC. The aforementioned 28 patients were divided into 2 groups--7 patients (25.0%) with sequelae and 21 (75.0%) without--and various factors noted during the diagnosis were evaluated retrospectively. It was found that the number of days leading to admission at the hospital and the development of convulsions were unrelated to the prognosis. Those who succumbed or suffered sequelae were all infants under 1 year of age. All cases were caused by genus Haemophilus.