Ayako Kumabe

Physicians' opinions regarding the criteria for resuming oral intake after aspiration pneumonia: A questionnaire survey and cluster analysis of hospitals across Japan.

To investigate the items that are considered by physicians when making decisions regarding the resumption of oral intake among patients with aspiration pneumonia who have undergone short‐term fasting.

Pseudo-renal failure: bladder rupture with urinary ascites

We report a case of pseudo-renal failure caused by urinary ascites due to spontaneous bladder rupture following transurethral resection of a bladder tumour (TUR-BT). A 63-year-old man presented with 2 months of abdominal distension due to ascites. Laboratory findings showed elevated serum creatinine and hyperkalaemia. Peritoneal fluid urea, creatinine and potassium levels were greater than those in serum levels. CT scan showed partial wall thinning in the bladder wall, and cystography indicated fragility in the dome where the latest TUR-BT was performed. Pseudo-renal failure (laboratory abnormalities of acute kidney injury in the setting of normal kidney function) from urinary ascites and reverse intraperitoneal dialysis was diagnosed. Symptoms and laboratory abnormalities improved promptly with insertion of a urinary catheter. This report aims to increase recognition of urinary ascites when a patient with genitourinary surgical procedures or radiation therapy, or blunt abdominal trauma, presents with ascites and elevated creatinine simultaneously.

Factors involved in the discontinuation of oral intake in elderly patients with recurrent aspiration pneumonia: a multicenter study

Purpose To assess the factors involved in oral intake discontinuation in elderly patients with recurrent aspiration pneumonia. Patients and methods This study included patients with pneumonia who were treated at Jichi Medical University Hospital between 2007 and 2013, at Toyooka Public Hospital between 2011 and 2013 and at Yuzawa Community Medical Center between 2010 and 2012. We consecutively enrolled patients with aspiration pneumonia. The primary study point was oral intake discontinuation after the initiation of oral intake during hospitalization in cases of recurrent aspiration. Various parameters were recorded at admission, at the initiation of intake, and during hospitalization; these parameters were statistically evaluated. Results A total of 390 patients were assigned to either a “no reaspiration of intake” group (n=310) or a “reaspiration of intake” group (n=80), depending on whether intake was discontinued owing to aspiration during hospitalization. At admission, the following items significantly differed between the groups: level of consciousness, respiratory rate, oxygen saturation, CURB-65 score, extent of infiltration/opacity on chest radiography, albumin levels, blood urea nitrogen levels, and application of swallowing function assessment. At the initiation of intake, level of consciousness, pulse rate, and albumin levels significantly differed between the groups. The following items did not significantly differ between groups: systolic blood pressure, pulse rate, C-reactive protein, bacteremia, use of ventilator at admission, oxygen administration, respiratory rate, and systolic blood pressure at initiation of intake. Multivariate analysis revealed that application of swallowing function assessment, level of consciousness at the initiation of intake, and extent of infiltration/opacity on chest radiography were significant predictive variables for discontinuation of intake. Conclusion A low level of consciousness at the initiation of intake and a greater extent of infiltration/opacity on chest radiography and the application of a swallowing function are important factors. These factors may be helpful to determine a suitable timing for resumption of oral intake.

String test of hypervirulent Klebsiella pneumonia.

A 63-year-old woman with a history of type 1 diabetes mellitus and IgA nephropathy, on maintenance dialysis for 10 years, presented with exertional dyspnea of 1 week’s duration and bloody sputum since the previous day. On the day of admission, the patient had awoken with clouding of consciousness; she was brought to the emergency outpatient department by ambulance. …

Hyperammonemia in a patient with obstructive urinary tract infection due to Corynebacterium urealyticum

A 93-year-old woman with neurogenic bladder was admitted to our hospital because of impaired consciousness. Her urine culture revealed urease-test-positive Corynebacterium urealyticum. She was diagnosed with hyperammonemia due to an obstructive urinary tract infection that was caused by urease-producing bacteria. The patient showed rapid improvement of impaired consciousness and hyperammonemia after urine analysis. It is necessary to consider obstructive urinary tract infection as a differential diagnosis of hyperammonemia, which commonly occurs in urinary tract infections owing to the presence of urease-producing bacteria. Relief from obstruction is the most important treatment for hyperammonemia caused by this mechanism.

Skin rash from dengue fever

A 47-year-old Japanese man presented with a history of having been bitten by mosquitoes, several years earlier in the Philippines, this resulted in a fever and a rash which dissipated spontaneously. He had stayed in the Philippines for 3 weeks, 1 month prior to hospitalisation, and was bitten by several mosquitoes. He had a fever for 6 days and a systemic rash for 3 days before consultation at our hospital. At …

A comparison of pneumonia care quality between general physicians and pulmonologists

We compared the quality of care for nursing‐ and healthcare‐associated pneumonia (NHCAP) and aspiration pneumonia provided by general physicians and pulmonologists.

Effect of starting oral intake on weekends on the clinical course of patients with aspiration pneumonia

Purpose The aim of this study was to investigate whether the day of starting oral intake affects the clinical course of patients with aspiration pneumonia. Results We conducted a retrospective cohort study of 392 patients who were hospitalized for aspiration pneumonia but tolerated oral intake. Patients were divided into two groups according to the day of starting oral intake: Monday to Friday (midweek group) and Saturday or Sunday (weekend group). Underlying diseases, severity of pneumonia, time to oral intake, hospital duration, discontinuation of oral intake, and death during hospitalization were compared between the groups. Multivariate analysis was performed using hospital duration and discontinuation of oral intake due to aspiration as the dependent variables. Results The cohort comprised 244 men and 148 women with a mean age of 79.3 ± 13.1 years. The weekend (n = 98) and midweek (n = 294) groups exhibited similar age, sex, and underlying diseases. There were no significant differences in pneumonia-related factors, such as CURB-65 score, A-DROP score, extent of shadow on chest radiograph, incidence of bacteremia, and ventilator use. The weekend group exhibited a significantly shorter time to oral intake and hospital duration, as well as a significantly lower incidence of discontinuation of oral intake than the midweek group. Multivariate analysis revealed that starting oral intake on the weekend was independently associated with a lower incidence of discontinuation of oral intake due to aspiration. Conclusion The weekend group exhibited a shorter total hospital duration and a lower incidence of discontinuation of oral intake due to aspiration.

Acute Calcific Prevertebral Tendinitis

A 47-year-old Japanese man had been suffering from acute posterior neck pain for the previous 2 days. He visited our outpatient department because he had limited neck mobility and was unable to sleep well due to this pain. The posterior neck pain became exacerbated when swallowing, and he also had dysphagia. Computed tomography scans showed light calcification on the anterior surface of the axis below the atlas (Picture A, arrows), with edematous changes in the retropharyngeal space (Picture B, arrows inside the box). We diagnosed his condition as acute calcific prevertebral tendinitis, and we administered a non-steroidal anti-inflammatory drug. His symptoms thereafter disappeared 1 week later. Acute calcific prevertebral tendinitis is caused by an inflammatory reaction of the longus colli muscle due to the absorption process of hydroxyapatite which is deposited in the tendons of this muscle (1). Acute calcific prevertebral tendinitis is characterized by calcifications on the anterior surface of the odontoid process, as observed on either a simple radiograph or computed tomography scan (2).

Thigh pyomyositis caused by group A streptococcus in an immunocompetent adult without any cause

BackgroundPyomyositis is typically caused by Staphylococcus aureus, and is rare in temperate climates, although its prevalence has been recently increasing. This infection often involves the thigh, and is associated with immunodeficiency.Case presentationWe report the case of a healthy 20-year-old Japanese woman who experienced a fever and continuous pain for several days. She was admitted to our hospital and was diagnosed with pyomyositis after we discovered an abscess between the muscles of her dorsal distal left thigh using computed tomography. This is a rare case of thigh pyomyositis, as it was caused by group A streptococcus and occurred in an immunocompetent adult from a temperate climate.ConclusionsOur review of the literature revealed that group A streptococcus pyomyositis typically occurs in temperate climates, among young adults without any underlying disease, and is associated with a poorer prognosis, compared to general pyomyositis. We suggest that pyomyositis should be considered when immunocompetent adults present with apparently idiopathic inflammatory muscle lesions.