Takahiro Santo

Postoperative Enteritis Caused by Methicillin-Resistant Staphylococcus aureus

We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistantStaphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average. In severe cases organ insufficiency was involved. Coagulase-positive staphylococci were the predominant organisms isolated from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome toxin-1 (TSST-1) withenterotoxin A, C, andtst genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-α and IL-2 production was enhanced by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins A, C and TSST-1 with enterotoxin A, C were cultured for 24h. Both glucocorticoid hormone and gama globulin suppressed TNF-α and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.

Mucin-producing pancreatic tumors: A study of nuclear DNA content by flow cytometry

Nuclear DNA content in eight surgically resected mucin-producing pancreatic tumors (MPPT) consisting of two mucinous intraductal adenocarcinomas (MIDAC), two mucinous intraductal adenomas (MIDA), one mucinous cystadenocarcinoma (MCAC), and three mucinous cystadenomas (MCA) were measured by flow cytometry using paraffin-embedded tissue samples. The technique of Shutte was used for the preparation of paraffin-embedded tissue into single dissociated nuclei, while the method of Vindelov was used for staining the isolated nuclei with propidium iodine. Clinicopathologically, the four patients with MIDAC or MIDA were all male and had cystic lesions with a dilated pancreatic duct at the head of the pancreas, while the four patients with MCAC or MCA were all females and had cystic tumors at either the body or tail of the pancreas. All eight patients with MPPT had no metastasis to the regional lymph nodes and were all still alive without recurrence. In an analysis of nuclear DNA content, seven of eight patients had DNA diploid tumors while one patient with a MIDAC perforating the duodenum and choledochus had a DNA aneuploid tumor. Thus, these findings suggest that DNA diploid patterns in MPPT might be associated with a favorable prognosis in MPPT although some patients whose MPPT invaded the surrounding organs might have DNA aneuploid tumors.

Severity and predicted outcome of postoperative Pseudomonas aeruginosa infections

The severity and predicted outcome of postoperative Pseudomonas aeruginosa (P. aeruginosa) infections (PPAI) was evaluated using a severity scoring system based on a simplification and modification of the APACHE II system. A total of 86 patients in whom P. aeruginosa was isolated from various sources were examined. PPAI developed in 50 patients, resulting in an overall mortality rate of 24%. An increased severity score (SS) correlated with an increased risk of developing PPAI. Thus, PPAI developed in 33% of the patients with an SS of 0–1, in 66.7% of those with an SS of 2–3, and in 100% of those with an SS of 6 or higher. Moreover, the mortality rate of the patients with an initial score of 6 or higher was 50%. The mean (±SD) initial severity score was 5.4±2.9 for survivors and 2.9±2.6 for nonsurvivors (P<0.01). In the patients who subsequently died, the SS remained high throughout the clinical course despite therapy, whereas in the survivors the SS decreased progressively, reflecting a favorable clinical course. These results suggest that our severity scoring system was useful for predicting outcome and monitoring the response of PPAI to therapy.

Significance of Peripheral Polymorphonuclear Leukocyte Counts in the Early Period after Gastrointestinal Surgery : With Reference to Serum Cytokine Levels and Organ Dysfunction

食道癌, 胃癌, 消化管穿孔性腹膜炎症例各10例を対象として, 術後早期の末梢血好中球数 (PMN) と血中サイトカイン値 (granulocyte colony-stimulating factor (G-CSF), interleukin 8 (IL-8)) ・臓器障害の関連について検討を行った.術後4時間後のPMNが7,000/mm3未満の群 (L群) は, 7,000/mm3以上の群 (H群) に比べ, 有意に (p<0.01) 高率に臓器障害が認められ, 有意に (p<0.01) 術後早期の血中サイトカイン値の高値が認められた.術後4時間後のPMNと臓器障害度および血中サイトカイン最高値との間には有意な (p<0.05) 相関が認められた.以上より, 術後早期にPMNが低値を推移する症例は, 高サイトカイン血症により過剰な刺激を受けたPMNが組織に遊出することにより臓器隔害が発生することが推測され, 術後早期の末梢血好中球数は術後の臓器障害を予測する指標となることが示唆された.

Clinicopathological Studies of Polypoid Lesions of the Gallbladder.

最近5年間に当科で経験した胆嚢隆起性病変21例 (腺癌6例, 腺腫3例, コレステロールポリープ5例, 過形成性ポリープ4例, 炎症性ポリープ2例, 異所性胃粘膜1例) の臨床病理学的検討を施行した.術前診断では, 超音波検査にて腺癌と他疾患の鑑別は困難で, コレステロールポリープのみ質的診断が可能であった.腺癌症例は, 高齢者の最大径10mm以上の隆起性病変に多く, 有茎性の腺腫内腺癌と広基性の進行癌に大別され, 後者はその最大径がより小さい時期に進行癌となる傾向を認めた.なお, 腺癌症例は, 全例, 無再発生存中で, DNA ploidy patternがdiploidであり, 予後良好な一因と考えられた.以上より, 胆嚢隆起性病変においては, 有茎性の症例は最大径10mm以上を, 広基性の症例は最大径5mm以上を手術適応とし, 手術術式としては, 全層胆嚢摘出術の後, 主病変, リンパ節の術中迅速病理診断の結果により, リンパ節郭清, 胆管切除, 肝切除を施行するのが妥当と考える.