Hideyo Watanabe

Treatment of Empyema by Transposition of Contralateral Lower Trapezius Flap

We report the successful treatment of bronchopleural fistula and empyema using transposition of a contralateral lower trapezius musclocutaneous flap, which provided immediate obliteration of the middle-back empyema cavity. This technique is easy to perform without any intraoperative change of position and with little postoperative impairment of the back and shoulder movement.

Transfer of Cefaclor and Ceftibuten into Lung Tissue and Dosing Schedules for Patients with Respiratory Tract Infections

Cefaclor (CCL) and ceftibuten (CETB) are cephem antibiotics synthesized in Japan for oral use. CCL has a broad antibacterial spectrum and CETB is specific for gram-negative bacteria. In our studies, serum and lung tissue CCL and CETB levels were determined from samples obtained at the time of lung surgery after administration of a single fasting dose of 500 mg of CCL or 200 mg of CETB. This study was undertaken to investigate the transfer of the drugs into lung tissue and to determine the appropriate dosing schedules of these drugs for patients with respiratory tract infections. The mean peak serum CCL level was 4.04 μg/mL at 1.5 hours after administration, and the mean alveolar tissue CCL level was 0.30 μg/g tissue 5 hours after administration. The mean peak serum CETB level was 8.47 μg/mL 2 hours after administration, and the mean alveolar, subsegmental bronchial, and bronchiolar tissue CETB levels were 2.65,1.64 and 1.75 μg/g tissue, respectively, at 5 hours after administration, while the CETB level in cancerous lung tissue was 1.41 μg/g 5 hours after administration. From our results, both CCL and CETB showed favorable uptake into lung tissue, suggesting that both compounds may be useful for respiratory tract infections. CCL should be selected for patients with respiratory tract infections in which the pathogens are unknown, with a dose of 500 mg administered every 8 hours. When the pathogen has been identified as a gram-negative organism in patients with pulmonary or bronchiolar infections, 200 mg of CETB should be administered every 12 hours.