Haruhi Takagi

Factors influencing weaning from mechanical ventilation in elderly patients with severe pneumonia.

Aims:  The purpose of this study was to determine the factors that adversely affect the weaning of elderly patients with community‐acquired pneumonia from mechanical ventilation.

Improvement in skin color achieved by smoking cessation.

It has been well known that habitual smoking accelerates premature skin ageing recognized as ‘smokers face’. However, the effect of smoking cessation on the appearance of skin has not been elucidated. The aim of this study was to evaluate objectively the effect of smoking cessation on the skins appearance. The stratum corneum carbonyl protein level and skin colour of the cheek and the hand were measured. The change before and during the smoking cessation treatment (0, 2, 4, 8 and 12 weeks), and the success or failure in smoking cessation, was compared and examined. Eighty‐four cases who had smoking cessation treatment were examined. The level of the stratum corneum carbonyl protein did not show any difference comparing before and after treatment for the smoking cessation success group and the failure group. The lightness of skin colour showed an upward tendency 4–12 weeks after starting the treatment in the success group and increased significantly compared with the failure group. The redness showed a significant decrease in comparison with before the treatment, and it also showed a significant decrease compared with the failure group. The yellowness did not show any clear tendency. Also, the haemoglobin showed a decreased tendency. Furthermore, multivariate statistical analysis showed a possibility that the lightness and haemoglobin could be changed by smoking cessation treatment. In conclusion, our study showed that an upward tendency of skin lightness was seen to correspond with a haemoglobin decrease accompanied by smoking cessation. If we can easily measure skin improvement as an effect of smoking cessation, it is thought to be a useful aid for smoking cessation support.

Safety of Bronchoscopy for Patients Undergoing Hemodialysis

Yuuki Sandhu, Katsutoshi Ando, Hidenori Takekawa, Haruhi Takagi, Michihiro Hirama, Kenji Kido, Kazuhisa Takahashi Department of Respiratory Internal Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan Department of Internal Medicine, Division of Respiratory Medicine, Juntendo University Graduate School of Medicine, 21-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan

Efficacy of Antibiotic Prophylaxis after Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Preliminary Prospective Study

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing mediastinal and hilar lymphadenopathy. While bacteremia and serious infectious complications after EBUS-TBNA have been reported, the efficacy of antibiotic prophylaxis is unclear. This preliminary prospective study aimed to evaluate the efficacy of antibiotic prophylaxis after EBUS-TBNA. Methods: Patients were randomly assigned to the antibiotic group (n = 43) or control group (n = 47). Ampicillin/ sulbactam was intravenously administered before the puncture, followed by oral amoxicillin/clavulanate. The primary outcome was body temperature (BT) within 5 days after EBUS-TBNA. The secondary outcomes were the change in the white blood cell count (WBC) and C-reactive protein (CRP) value before and after the examination, and the frequency of infectious complications that required antibiotics. We also assessed the clinical characteristics of patients with fever. Results: BT after EBUS-TBNA did not significantly differ between the groups. Antibiotic prophylaxis had no effect on the changes in the WBC and CRP value. Neither group had infectious complications associated with EBUS-TBNA. The smoking pack-year was higher in the group with fever than without fever, although the WBC and CRP value at baseline were similar between the groups. The number of punctures, presence of low-density areas in the lymph nodes, and antibiotic treatment were unrelated to the development of fever following EBUS-TBNA. Conclusion: Results of this study and the low frequency of infectious complications, which has been demonstrated in previous reports, suggest that antibiotic prophylaxis is not recommended for EBUS-TBNA (UMIN: 000008813).