To elucidate the preventive effect of 23-valent pneumococcal polysaccharide vaccine (PV) on drug-resistant Streptococcus pneumoniae.
Participants (outpatients, over 60 years of age, and with chronic ...lung disease) were interviewed and divided into two groups: the PV-vaccinated group (n=722) and the non-vaccinated group (n=872). The antimicrobial susceptibility and the genotype of antibiotic-resistant genes among the isolated pneumococcal strains from sputum before and after vaccination were studied.
The number of the isolated strains was as follows: prior to the vaccination, 24 isolates in the vaccinated group, 18 isolates in the non-vaccinated group; after vaccination (within 5 years), 53 isolates in the vaccinated group, 46 isolated in the non-vaccinated group. The PV decreased the frequency of Penicillin G-resistant strains successfully (from 16.7 to 7.5%) in the vaccinated group while the frequency increased (from 5.5 to 15.2%) in the non-vaccinated group during the same period. In genetic analysis, the rates of strains with altered pbpla, pbp2x and pbp2b were decreased in the vaccinated group than the non-vaccinated group (28.6% versus 53.3%).
The 23-valent pneumococcal polysaccharide vaccine may have a preventive effect against drug-resistant Streptococcus pneumoniae.
Angiosarcoma of the scalp is a very rare disease. Secondary pneumothorax is known as a characteristic complication in this disease due to lung metastasis. In this study, 17 patients of angiosarcoma ...of the scalp, diagnosed at our hospital between 1996 and 2006, were analyzed. Secondary pneumothorax was observed in 10 of these patients, among which bilateral pneumothorax occurred in 5 relapse of pneumothorax occurred in 6 and pneumothorax with bloody pleural fluid occurred in 7 patients. Characteristic findings on chest CT were multiple thin-wall cavities and ground-glass attenuation around the cavity, located in bilateral subpleural lung fields. It is suggested that the subpleural thin-wall cavities cause pneumothorax. Although pleurosclerosis were performed in 5 patients and one of them had a subsequent partial resection of the lung, pneumothorax reocurred within a short period of time in all patients. The average survival time from the first pneumothorax episode was only 4.1 months. Secondary pneumothorax caused by this disease was intractable, resulting in an unfavorable outcome. It is necessary to develop a proper treatment strategy for secondary pneumothorax to create a favorable prognosis in this disease.
We encountered a rare case of lymphocytic interstitial pneumonia (LIP) complicated with primary Sjögren's syndrome (SjS), followed by chest CT scanning for a long period of time. A 54-year-old man ...with hemoptysis was admitted to our hospital in December, 2001. A diagnosis of SjS was made based on elevation of anti-SS-B/La antibody titer in serum in combination with diagnosis of keratoconjunctivitis sicca and xerostomia on a Schirmer test and a lip biopsy, respectively. Subsequent histopathological diagnosis by open lung biopsy showed LIP. Chest CT in September, 1995 at previous hospital revealed ground-glassed opacity (GGO), small nodules, thickened bronchovascular bundles and cyst formation in lungs. Chest CT was performed every year until 2008, when remarkable progression from thickened bronchovascular bundles accompanied by nodular opacities to an air-space consolidation in the right lower lobe was observed. Also, appearance of cyst formation in the right middle lobe, nodular lesions and GGO in the left lower lobe were noticed. Although the nodular opacities and GGO improved after an administration of corticosteroid (PSL 0.5 mg/kg/day), little improvement in the consolidations and cyst formation was demonstrated. In conclusion, it was suggested that differences among CT findings of LIP may be important for evaluating of efficacy of treatment by steroid agents for LIP associated with SjS.
A well-controlled comparative study was undertaken to assess the clinical efficacy and safety of BRL28500 (BRL), a formulation comprising one part of clavulanic acid (CVA) and 15 parts of ticarcillin ...(TIPC), using TIPC as a reference drug in patients with respiratory tract infections (RTI). Patients with apparent clinical signs and symptoms of chronic RTI (chronic bronchitis, diffuse panbronchiolitis, infected bronchiectasis, infected pulmonary emphysema, infected pulmonary fibrosis and infected bronchial asthma), acute exacerbation of chronic RTI, bacterial pneumonia and lung abscess were administered 1.6g of BRL (1.5g of TIPC plus 0.1g of CVA) or 1.5g of TIPC twice daily by intravenous drip infusion for 14 days in principle. BRL-treated group and TIPC-treated group were compared in terms of clinical efficacy, improvement of clinical symptoms and signs, bacteriological response, incidence of side effects, abnormal changes in laboratory findings and utility. The following results were obtained: 1. BRL and TIPC were administered to a total of 312 patients (BRL to 161 and TIPC to 151). Clinical efficacy was judged in 272 patients (138 on BRL and 134 on TIPC) excluding 40 patients from total patients by the committee. Incidence of side effects was evaluated in 289 patients (148 on BRL and 141 on TIPC) and abnormal changes in laboratory findings were assessed in 278 patients (141 on BRL and 137 on TIPC). 2. The respective clinical efficacy rate for the BRL and the TIPC group was 78.8%, 75.0% in total patients and 74.6%, 79.1% in chronic RTI. No significant difference was observed between both treatment groups. However, the statistical analysis of patients with pneumonia or lung abscess showed that efficacy rate was 82.1% for the BRL group and 70.8% for the TIPC group respectively. BRL tended to be more effective than TIPC (p<0.10). 3. As to clinical improvement of clinical symptoms and signs, improvement of ESR in the BRL group was better (p<0.10) than that in the TIPC group on 14th day after administration in patients with pneumonia or lung abscess. On the contrary, improvement of WBC and ESR in the BRL group was inferior (p<0.10) to those in the TIPC group on 3rd and 14th day after administration respectively in patients with chronic RTI. 4. Bacteriological response was evaluated in 136 patients (68 each on BRL and TIPC) and eradication of causative organisms was 75.0% for the BRL group and 67.6% for the TIPC group, giving no statistical difference between both groups. However, there was a significant difference (p<0.05) in preference for BRL to TIPC in terms of eradication of H. influenzae (100% in BRL and 88.9% in TIPC) and all strains of Gram-negative bacilli (78.6% in BRL and 60.0% in TIPC). 5. In 289 patients assessed incidence of side effects, five patients treated with BRL and seven patients treated with TIPC complained of side effects and there was no significant difference between both groups. 6. Abnormal changes in laboratory findings were evaluated in 278 patients. Numbers of patients with the abnormal changes were 45 (31.9%) out of 141 patients treated with BRL and 32 (23.4%) out of 137 patients treated with TIPC respectively and the statistical difference was not significant between both groups. 7. As to clinical utility judged by the committee taking into account of clinical efficacy and safety, the useful rate including “very useful” plus “useful” was 76.3% for the BRL group, 72.4% for the TIPC group in overall patients, 70.0% for the BRL group and 77.6 for the TIPC group in patients with chronic RTI, giving no siginificant difference between both groups. However, in patients with pneumonia or lung abscess the utility rate was 81.0% in the BRL group and 67.2% in the TIPC group respectively. BRL was more useful (p<0.10) than TIPC in these diseases.
A well-controlled comparative study was undertaken to assess the clinical efficacy and safety of BRL28500 (BRL), a formulation comprising one part of clavulanic acid and 15 parts of ticarcillin, ...using piperacillin (PIPC) as a reference drug in patients with respiratory tract infections (RTI). Patients with apparent clinical signs and symptoms of chronic RTI (chronic bronchitis, diffuse panbronchiolitis, infected bronchiectasis, infected pulmonary emphysema, infected pulmonary fibrosis and infected bronchial asthma), acute exacerbation of chronic RTI, bacterial pneumonia and lung abscess were administered 1.6 g of BRL (1.5 g of ticarcillin plus 0.1 g of clavulanic acid) or 2.0 g of PIPC twice daily by intravenous drip infusion for 14 days in principle. BRL-treated group and PIPC-treated group were compared in terms of clinical efficacy, improvement of clinical symptoms and signs, bacteriological response, incidence of side effects, abnormal changes in laboratory findings and utility. The following results were obtained: 1. BRL and TIPC were administered to a total of 314 patients (BRL to 161 and PIPC to 153). Clinical efficacy was judged in 269 patients (138 on BRL and 131 on PIPC) excluding 45 patients from total patients by the committee. Incidence of side effects was evaluated in 293 patients (148 on BRL and 145 on PIPC) and abnormal changes in laboratory findings were asessed in 286 patients (141 on BRL and 145 on PIPC). 2. Clinical efficacy rate for the BRL group and PIPC group was 78.8% and 79.4% in total cases, 82.1% (79 patients) and 79.5% (73 patients) in pneumonia and lung abscess and 74.6% (59 patients) and 79.3% (58 patients) in chronic RTI respectively. There was no statistically significant difference between the two groups. 3. As to improvement of clinical symptoms and signs, improvement of ESR in the BRL group was better than that in the PIPC group on 14th day after administration in patients with pneumonia or lung abscess. On the contrary, improvement of rale, WBC and CRP in the BRL group was inferior to those in the PIPC group on 3rd day after administration in patients with chronic RTI. Significant differences were shown in these items between both groups. 4. Bacteriological response was evaluated in 125 patients (68 on BRL and 57 on PIPC) and eradication of causative organisms was 75.0% for the BRL group and 71.9% for the PIPC group, giving no statistical difference between both groups. However, there was a significant difference in preference for BRL to PIPC in terms of eradication of Klebsiella spp. (87.5% for BRL and 16.7% for PIPC). When causative organisms were classified into two groups according to susceptibility to PIPC, eradication effect of PIPC (94.7%) was superior (p<0.10) to that of BRL (69.6%) in PIPC-sensitive organisms having 50μg/ml of MIC. On the other hand, in PICP-resistant organisms having 50μg/ml of MIC BRL exerted better eradication effect (66.7%) than PIPC (12.5%) and a significant difference was shown between the two groups. 5. In 293 patients assessed incidence of side effects, five patients treated with BRL and eleven patients treated with PIPC complained of side effects and there was no significant difference between both groups. 6. Abnormal changes in laboratory findings were evaluated in 286 patients. Numbers of patients with the abnormal changes were 45 (31.9%) out of 141 patients treated with BRL and 28 (19.3%) out of 145 patients treated with PIPC respectively and the difference was significant (p<0.05) between both groups. Itemized analysis showed that abnormal changes in GPT were found in 26 (18.6%) out to 140 patients treated with BRL and 14 (10.0%) out of 140 patients treated with PIPC and indicated that elevation of BUN were shown only in the PIPC group (4/127, 3.1%), giving tendency of significant difference (p<0.10) on the above items between the two groups.
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