Kansai Medical University Research Articles

Differences in antimicrobial susceptibility breakpoints for Pseudomonas aeruginosa, isolated from blood cultures, set by the Clinical and Laboratory Standards Institute (CLSI) and the Japanese Society of Chemotherapy

A study was made of the antimicrobial susceptibility to and efficacy of various kinds of antimicrobial agents against 179 strains of Pseudomonas aeruginosa that were isolated from blood cultures at Kansai Medical University Hospital from 1990 through 2004. The annual detection rate was highest in 1994, at 22 strains (6.5%). There were 9 multidrug resistant strains of Pseudomonas aeruginosa (5.0%). Among 14 antimicrobial agents tested for measurements, ciprofloxacin (CPFX) showed the best minimum inhibitory concentration (MIC) 50 value, of 0.25 microg/ml, followed by pazufloxacin (PZFX) and biapenem (BIPM), each at 0.5 microg/ml. When the period of 15 years was divided into three stages, the MIC50 value for each antimicrobial agent was highest in the middle stage (1995 to 1999). Assuming that the percentage of sensitive strains according to the breakpoints set by the Clinical and Laboratory Standards Institute (CLSI) represents the antimicrobial susceptibility rate, amikacin (AMK) showed the best value, of 85.5%. According to the sepsis breakpoint set by the Japanese Society of Chemotherapy (JSC), the efficacy of CPFX showed the highest rate (77.1%) of all the antimicrobial agents tested. Among beta-lactams, BIPM showed the highest efficacy rate, of 67.0%. When the efficacy rates were compared with each other, the difference in efficacy rate between the breakpoint set by the CLSI and the sepsis breakpoint set by the JSC was large for beta-lactams. Comparisons made based on the CLSI criteria showed no difference in cross-resistance rates between CPFX, meropenem (MEPM), and BIPM. However, when comparisons were made using the JSC sepsis breakpoint, MEPM showed a cross-resistance rate of 87.8%, while the rate for BIPM was lower, at 56.1%, with the chi2 test showing a significant difference, at P = 0.0014. In accordance with the pharmacokinetics/pharmacodynamics theory that has been advocated, breakpoints which are more suitable for the clinical setting in Japan should be set so that more effective and more appropriate treatment can be carried out.

Truview Video Laryngoscope in Patients with Difficult Airways

To the Editor: The video laryngoscope is a major technological advancement in anesthesia practice (1–3) because it captures and magnifies the image of the glottis near the tip of the laryngoscope blade. Compared with conventional laryngoscopes, a video laryngoscope may provide a better view of the glottis. Several varieties of video laryngoscopes are available, but most are expensive. In contrast, the Truview laryngoscope (Truphatek, Natanya, Israel), a Macintosh-type blade with an optical lenses attached (Fig. 1), costs about the same as conventional blades. We report successfully using the Truview laryngoscope in two patients with difficult airways in whom endotracheal intubation with a Macintosh laryngoscope had failed.Figure 1.: The Truview laryngoscope blade (Truphatek, Natanya, Israel) (above) and a Macintosh blade (below). The Truview blade can be attached to a conventional laryngoscope handle.Case 1. A 49-yr-old woman with a history of temporomandibular arthritis was scheduled for mastectomy. She had Mallampati class 2 airway, with a 2.5 finger-width gap between her upper and lower incisors. After anesthetic induction and neuromuscular blockade, we encountered difficulty opening her mouth. Laryngoscopy with a Macintosh blade could not reveal the glottis. In contrast, with the Truview laryngoscope, we could see the posterior part of the glottis, and successfully intubated the trachea with the aid of a gum elastic bougie. Case 2. A 72-yr-old man, 172 cm, 56 kg, with an unremarkable airway was scheduled for gastrectomy. After anesthetic induction and neuromuscular blockade, we tried and failed at several attempts at endotracheal intubation with a Macintosh blade. The primary problem was a large, floppy epiglottis. We inserted a Truview laryngoscope, viewed the posterior part of the glottis, and inserted a tracheal tube into the trachea with the aid of a gum elastic bougie. We have experienced several other cases in which a Macintosh blade failed to expose the glottis, but the Truview laryngoscope did. We believe that the Truview laryngoscope is a simple and inexpensive device that may be useful in patients with difficult airways. Sanae Matsumoto, MD Takashi Asai, MD, PhD Koh Shingu, MD Kansai Medical University Otokoyama Hospital Yawata City, Kyoto, Japan Kansai Medical University Moriguchi City, Osaka, Japan [email protected]

Integrin-Mediated Transforming Growth Factor-β Activation Regulates Homeostasis of the Pulmonary Epithelial-Mesenchymal Trophic Unit

Trophic interactions between pulmonary epithelial and mesenchymal cell types, known as the epithelial-mesenchymal trophic unit (EMTU), are crucial in lung development and lung disease. Transforming growth factor (TGF)-beta is a key factor in mediating these interactions, but it is expressed in a latent form that requires activation to be functional. Using intact fetal tracheal tissue and primary cultures of fetal tracheal epithelial cells and fibroblasts, we demonstrate that a subset of integrins, alpha(v)beta(6) and alpha(v)beta(8), are responsible for almost all of the TGF-beta activation in the EMTU. Both alpha(v)beta(8) and alpha(v)beta(6) contribute to fetal tracheal epithelial activation of TGF-beta, whereas only alpha(v)beta(8) contributes to fetal tracheal fibroblast activation of TGF-beta. Interestingly, fetal tracheal epithelial alpha(v)beta(8)-mediated TGF-beta activation can be enhanced by phorbol esters, likely because of the increased activity of MT1-MMP, an essential co-factor in alpha(v)beta(8)-mediated activation of TGF-beta. Autocrine alpha(v)beta(8)-mediated TGF-beta activation by fetal tracheal fibroblasts results in suppression of both transcription and secretion of hepatocyte growth factor, which is sufficient to affect phosphorylation of the airway epithelial hepatocyte growth factor receptor, c-Met, as well as airway epithelial proliferation in a co-culture model of the EMTU. These findings elucidate the function and complex regulation of integrin-mediated activation of TGF-beta within the EMTU.

Education, in addition to a thin material, encourages anaesthetists to wear gloves

Acta Anaesthesiologica ScandinavicaVolume 50, Issue 2 p. 260-261 Education, in addition to a thin material, encourages anaesthetists to wear gloves T. Asai, T. AsaiSearch for more papers by this authorM. Masuzawa, M. MasuzawaSearch for more papers by this authorK. Shingu, Corresponding Author K. ShinguT. Asai Kansai Medical University Moriguchi City Osaka 570-8507 Japan e-mail: asait@takii.kmu.ac.jpSearch for more papers by this author T. Asai, T. AsaiSearch for more papers by this authorM. Masuzawa, M. MasuzawaSearch for more papers by this authorK. Shingu, Corresponding Author K. ShinguT. Asai Kansai Medical University Moriguchi City Osaka 570-8507 Japan e-mail: asait@takii.kmu.ac.jpSearch for more papers by this author First published: 18 January 2006 https://doi.org/10.1111/j.1399-6576.2006.00906.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume50, Issue2February 2006Pages 260-261 RelatedInformation

電子ブック 電子ブックの導入‐ＳＴＡＴ！Ｒｅｆをはじめとして

The Library of Kansai Medical University has introduced eBook “STAT!Ref”, which is superior to hard copy for full-text searches and for referring to different resources at the same time. In addition, it has the advantage of enabling users at branch libraries to peruse it simultaneously. However, a statistical analysis performed after its introduction showed that it had not yet become popular among users, so we distributed questionnaires to students and teachers regarding their knowledge and usage of eBook. The questionnaires showed that a few students knew of eBook and that most of the teachers were aware of it, but that only half of the teachers who answered the questionnaire had actually used eBook. Increasing the Japanese content and relating eBook to university classes will be important for its dissemination.

The effect and problem of chemoradiation for advanced uterine cervical cancer in Kansai Medical University Hospital

The effect and problem of chemoradiation for advanced uterine cervical cancer in Kansai Medical University Hospital

Japanese Residents Have Been Judged to Be Workers

To the Editor .— On June 3, 2005, the Supreme Court of Japan determined that Kansai Medical University must pay a wage compatible with Minimal Wage Law to the family of a resident who died by “karoshi” …

A Case of Struma Uteri

Case Report A 35-year-old woman was admitted to Kansai Medical University Hospital because of a uterine mass with pelvic pain. She had had five pregnancies and three full-term deliveries (one normal and two cesarean deliveries). At the first cesarean delivery 8 years previously, a mass was found attached to the uterus. On gynecologic examination, a large pelvic mass was found. A sonogram showed a complex mass in the postuterine region. CA125, CA130, SLX (Sialyl Lex-i antigen), and SCC (squamous cell carcinoma-related antigen) were within normal ranges. A thyroid function test was not performed before the procedure. After the procedure, the stock serum obtained preoperatively was measured, and the result of thyroid function was normal. MRI revealed a complex mass with small areas of T1 and T2 shortening and central areas of T1 and T2 prolongation in the postuterine region (Figs. 1A–1C). The ovaries were separate from the mass. We thought the lesion was a mass with hemorrhagic necrosis because of small areas of T1 and T2 shortening. Although the origin of the mass was not certain based on the images, we considered it to be a leiomyoma because a nondegenerated area within the lesion was hypointense, similar to the pelvic muscles on T2-weighted images. Also, hemorrhagic necrotic areas were occasionally seen in the leiomyoma, and subserosal leiomyoma often involved the parauterine region. Various sarcomas, including leiomyosarcoma, are also often seen as a mass with hemorrhagic necrosis in the postuterine region. In the current case, we thought they were inconsistent with the slow growth of the mass. During surgery, an 11-cm mass attached to the uterine cervix and vaginal wall was completely removed. The adnexa were normal. On section, the tumor consisted of a large central cystic part and a solid part with peripheral cystic hemorrhagic necrotic areas. No fat tissue was in the lesion. Microscopically, the mass consisted of a thyroid tissue composed of multiple follicles and stroma (Fig. 1D). The final histologic diagnosis was pure struma of the uterus. No evidence of malignant change was present in the struma uteri.

Effect of beta-blockers on the mortality of Japanese patients with myocardial infarction

Background After a myocardial infarction, a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population. Beta-blockers may exacerbate coronary vasospasm. However, beta-blockers are given to Japanese patients after an acute myocardial infarction, though the mortality benefit is unknown. Thus, we investigated the mortality benefit of beta-blockers given to Japanese patients after an acute myocardial infarction. Methods We prospectively studied consecutive patients with a first myocardial infarction admitted to the coronary care unit of Kansai Medical University Hospital, Osaka, Japan from May 1994 through the end of 2001. Patients who died during hospitalization or who were referred for coronary artery bypass graft surgery were excluded. The association of beta-blocker use with mortality after discharge was assessed by a proportional hazards regression analysis. Results There were 546 patients and 400 (73.3%) patients were treated with beta-blockers at the time of discharge from hospital. During a mean follow-up of 2 years, 46 (8.4%) patients died. Beta-blocker therapy was associated with a reduced mortality after adjustment for age, gender, Q wave myocardial infarction, reperfusion therapy during acute phase, Killip functional class, serum creatinine level, cardiovascular risk factors, and medications (hazard ratio = 0.51, 95% confidence interval = 0.27 to 0.95). Conclusions Contrary to the concern that beta-blocker therapy might induce coronary vasospasm and reduce survival, beta-blocker therapy improved survival after discharge in Japanese patients with a first myocardial infarction.

Prognostic significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in various staging systems for hepatocellular carcinoma : Akiko Saitoh, Tokyo Women's Medical College, Tokyo Japan; Kazuki ito, Shizuoka General Hospital, Shizuoka Japan; Takashi Kumada, Ogaki Municipal Hospital, Ogaki Japan; Hiroko Oka, Osaka City General Hospital, Osaka Japan; Hiroshi Kasugai, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Japan; Toshihito Seki, Kansai

Prognostic significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in various staging systems for hepatocellular carcinoma : Akiko Saitoh, Tokyo Women's Medical College, Tokyo Japan; Kazuki ito, Shizuoka General Hospital, Shizuoka Japan; Takashi Kumada, Ogaki Municipal Hospital, Ogaki Japan; Hiroko Oka, Osaka City General Hospital, Osaka Japan; Hiroshi Kasugai, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Japan; Toshihito Seki, Kansai

Smad 2 activated by autocrine TGF-B signal, merges with MAPK dependent Smad 3 and Smad 4 complex in the nuclei of rat myofibroblasts during chronic liver injury: Koichi Matsuzaki, Fukiko Furukawa, Shigeo Mori, Yoshiya Tahashi, Katsunori Yoshida, Hideo Yamagata, Yasushi Sugano, Masanori Matsushita, Kyoichi Inoue, Kansai Medical University, Osaka Japan

Smad 2 activated by autocrine TGF-B signal, merges with MAPK dependent Smad 3 and Smad 4 complex in the nuclei of rat myofibroblasts during chronic liver injury: Koichi Matsuzaki, Fukiko Furukawa, Shigeo Mori, Yoshiya Tahashi, Katsunori Yoshida, Hideo Yamagata, Yasushi Sugano, Masanori Matsushita, Kyoichi Inoue, Kansai Medical University, Osaka Japan

めまい患者におけるＳｔａｔｅ‐Ｔｒａｉｔ Ａｎｘｉｅｔｙ Ｉｎｖｅｎｔｏｒｙ（ＳＴＡＩ）の検討

The State-Trait Anxiety Inventory (STAI) test is a self survey method used to study a patient's anxiety status. In this study, we investigated the role of dizzy patients' anxiety psychology by analyzing the STAI. Subjects were 377 patients (141 male and 236 female) who complained of dizziness and visited the Department of Otorhinolaryngology at Kansai Medical University from August 2002 to July 2003.1, In the dizzy patients, State Anxiety (A-State) and Trait Anxiety (A-Trait) score showed significantly higher than in the controls. STAI score in female patients was significantly higher than that in male patients.2, In the same patients, A-State scores were decreased after patients showed improvement in their symptoms, however A-Trait score were not changed.3, The patients whose A-State and A-Trait scores in the first medical examination were very high(V) showed high A-State score even after absence of vertigo and dizziness.Based on these results, we concluded that STAI test was simple to use and might provide some helpful information for therapy of anxiety in dizzy patients.

Abstracts

Abstracts

耳下腺ワルチン腫ようの手術法

Warthin's tumor is benign and exclusively involves the parotid gland but may, however, often show multifocal and/or bilateral growth. The aim of this study was to evaluate the surgical procedure for removal of this tumor. Sixty patients with Warthin's tumor in the parotid gland who presented at the Kansai Medical University Hospital from 1990 to 1999 were the subjects of the present study. The surgical procedures were as follows. We performed enucleation for tumors in the deep lobe. Tumors in the superficial lobe were resected with partial parotidectomy, and an enucleative procedure was also performed at the bottom of the tumor where the tumor capsule directly touched the facial nerve. No recurrence was observed in all sixty cases including cases of rupture of the capsule before or during surgery. Therefore, we recommend that enucleation is a useful choice as a surgical procedure for the removal of Warthin's tumor after accurate detection of the tumors using MRI. The overall incidences of temporary and permanent facial nerve palsy were 19.7% and 0%, respectively. The incidence of palsy increased after surgery for multiple tumors or deep lobe tumors. These findings indicate that more careful consideration for preservation of the facial nerve should be given in such cases and that simultaneous surgery for such tumors in the bilateral parotid glands should be avoided to prevent bilateral facial nerve palsy.

Association of HLA and Autoantibodies Against the Exocrine Pancreas in Type 1 Diabetes

Department of Internal Medicine, Ohtsu Red Cross Hospital, Shiga, Japan Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan Department of Internal Medicine, Ohtsu Red Cross Hospital, Shiga, Japan

Occipital extra- and intracranial lipoencephalocele associated with tectocerebellar dysraphia: case for discussion

Y. Yamanouchi ()) Department of Neurosurgery, Kansai Medical University, 10–15 Fuimizono-cho, 570–8507 Moriguchi-city, Osaka, Japan e-mail: yamauchy@takii.kmu.ac.jp Tel.: +81-6-69921001 Fax: +81-6-69916207 The author presented a rare and interesting case in which embryological consideration and pathogenesis of tectocerebellar dysraphia with lipoma was discussed. I felt a strong similarity between this case and lipomyelomeningoceles in the spine after a first reading. I agreed with almost everything the authors wrote. However, it does not seem to me that the co-existence of the lipoencephalocele and tectocerebellar dysraphia suggests multiple sites of neural closure. Intracranial lipomas can occur in various locations: in the corpus callosum, quadrigeminal area, brainstem, and cerebellum, mainly in the midline. Many of them occur without skull defect and other cerebral malformations. Regarding lipomas, we should consider ordinary lipoencephaloceles or lipomeningoceles totally separately from lipomas, such as those located in the corpus callosum or spinal lipomas without dysraphism. Truwit and Barkovich, cited by the author, stated that intracranial lipomas are congenital malformations that result from abnormal persistence and maldifferentiation of meninx primitiva during the development of the subarachnoid cisterns [3]. But in this case, it is possible that abnormal development occurred earlier than the stage of development of the subarachnoid cisterns. In the dysraphic state, I don’t think there is the same pathogenesis in skin-covered lesions and lesions with the neural tissue exposed. Tarara et al. [2] induced central nervous system malformations in primates by using triamcinolone acetonide. They suggested encephaloceles may result from a combination of mesenchymal and neural tube abnormalities. In this case, considering the coexistence of lipomatous tissue, we may apply the theory of embryogenesis of spinal lipomyelomeningoceles resulting from premature dysjunction, which is that lipomas arise when the cutaneous ectoderm prematurely separates from the neuroepithelium prior to neural fold fusion. Under these circumstances, the surrounding mesenchyme ingresses between the neural tube and overlying cutaneous ectoderm [1].

Diagnosis, therapy of climacteric disturbance patient by Kansai Medical University

Diagnosis, therapy of climacteric disturbance patient by Kansai Medical University

関西医科大学附属図書館

関西医科大学附属図書館

Application of the JJ1017 code to master-table of RIS database

We are developing an open-type Radiology Information System (RIS) under the project name KPECK. Part of the RIS has already been employed in Kouri Hospital of Kansai Medical University. The RIS is based on a database of the history of clinical study and exposure. We tried using the JJ1017 (ver1.0) code for the master-table of the database. The JJ1017 code, which is standardized by JIRA and JAHIS, is used in communicating information between the RIS and medical modalities. Through construction of the database, we found a technique by which the JJ1017 code could be applied to its master-table. In coordinating the JJ1017 code with the master-table of the database, we extended various study codes and systematically coordinated them with the architecture of the database.

Journal-related Activities at the 2003 American Society of Anesthesiologists Annual Meeting

Journal-related Activities at the 2003 American Society of Anesthesiologists Annual Meeting