To elucidate the differences between the clinical aspects of Chlamydia pneumoniae (C. pn) pneumonia and those of two other atypical pneumonias, Chlamydia psittaci (C. ps) pneumonia and Mycoplasma pneumoniae (M. pn) pneumonia, we analyzed the symptoms and laboratory data on the cases of these three types of pneumonia: 46 cases of C. pn pneumonia, 39 cases of C. ps pneumonia, and 131 cases of M. pn pneumonia. C. pn pneumonia was significantly more frequent among the elderly (mean 70 +/- 16 years, p < 0.01) and patients were significantly more likely to be male (76%, p < 0.05). A white blood cell count of over 10,000 was seen in 46% of C. pn pneumonia cases, a higher proportion than those of C. ps pneumonia (15%, p = 0.03) or M. pn pneumonia (18%, p = 0.006) cases. The proportions of patients with these infections who had an elevated GOT or GPT were not significantly different. Maximum body temperature was higher in M. pn pneumonia than in C. pn pneumonia (p = 0.003). Purulent sputa were seen in 44% of C. pn pneumonia cases and 50% of M. pn pneumonia cases, and these rates were higher than that of 13% in C. ps pneumonia cases (p = 0.002, p = 0.004). Dyspnea and anorexia symptoms were the most frequent in C. pn pneumonia cases (24% and 29%, respectively, the highest of all three pneumonias). There were clinical differences between C. pn pneumonia and the other two atypical pneumonias. However, there was some difficulty in differentiating between C. pn pneumonia and typical bacterial pneumonia because mixed infections were common (24%) in C. pn pneumonia cases.
Quantitative imaging of neuromagnetic fields based on automated region of interest (ROI) setting was analyzed to determine the characteristics of cerebral neural activity in ischemic areas.Magnetoencephalography (MEG) was used to evaluate spontaneous neuromagnetic fields in the ischemic areas of 37 patients with unilateral internal carotid artery (ICA) occlusive disease. Voxel-based time-averaged intensity of slow waves was obtained in two frequency bands (0.3-4 Hz and 4-8 Hz) using standardized low-resolution brain electromagnetic tomography (sLORETA) modified for a quantifiable method (sLORETA-qm). ROIs were automatically applied to the anterior cerebral artery (ACA), anterior middle cerebral artery (MCAa), posterior middle cerebral artery (MCAp), and posterior cerebral artery (PCA) using statistical parametric mapping (SPM). Positron emission tomography with 15O-gas inhalation (15O-PET) was also performed to evaluate cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Statistical analyses were performed using laterality index of MEG and 15O-PET in each ROI with respect to distribution and intensity.MEG revealed statistically significant laterality in affected MCA regions, including 4-8 Hz waves in MCAa, and 0.3-4 Hz and 4-8 Hz waves in MCAp (95% confidence interval: 0.020-0.190, 0.030-0.207, and 0.034-0.213), respectively. We found that 0.3-4 Hz waves in MCAp were highly correlated with CBF in MCAa and MCAp (r = 0.74, r = 0.68, respectively), whereas 4-8 Hz waves were moderately correlated with CBF in both the MCAa and MCAp (r = 0.60, r = 0.63, respectively). We also found that 4-8 Hz waves in MCAp were statistically significant for misery perfusion identified on 15O-PET (p<0.05).Quantitatively imaged spontaneous neuromagnetic fields using the automated ROI setting enabled clear depiction of cerebral ischemic areas. Frequency analysis may reveal unique neural activity that is distributed in the impaired vascular metabolic territory, in which the cerebral infarction has not yet been completed.
During the 7 years from 1990, thirty-two patients (20 in male and 12 in female, mean age; 53 years old) were diagnosed as having pulmonary cryptococcosis. To clarify the essential points for early diagnosis of pulmonary cryptococcosis, we reviewed the clinical records and chest images. Three patients had a past history of pulmonary tuberculosis and eleven patients had underlying disorders such as malignancy, chronic pulmonary diseases and so on, but no HIV infection, which would affect this disease. Eighteen patients did not have any past history nor complications.The symptoms such as cough, sputum, chest pain and fever were generally of low-grade, 14 patients had no symptom at diagnosis. Except of some patients with severe infections and severe underlying disorders, laboratory findings such as inflamatory and nutritious markers were almost within near the normal range. On plain chest X-ray films the distribution of lesions was almost in proprtion to the volume of the lobes. The multifocal nodular and/or infitrative shadows wer observed in about 2/3 cases and single lesion in about 1/3. The width of lesions were minimal except of one case with interstitial pneumonia and two cases with multifocal segmental pneumonia. The cavity lesions were observed in 7 cases and hilar lymphadenopathy in 3 cases.On CT images, the lesions were almost located in the outer zone, the lesions which wereadjacent to the pleura were observed in 15 cases. Cavitary lesions were almost smooth in edge and ubiquitous, the walls were also thick. The peripheral air-bronchogram in the nodular/infitrative shadows were observed in three cases.Pulmonary cryptococcosis is air-borne and almost a chronic infection except in AIDS patients, so careful planning for examination is essential with considerations of the characteristics of clinical and imaging features of this infection.
A double blind comparative study was conducted to objectively evaluate the clinical efficacy and safety of Cefuzonam (CZON) in the treatment of chronic respiratory infections. Cefmenoxime (CMX) was used as a control drug. Each drug was administered by intravenous drip infusion 1g at a time, twice daily, for 14 days as a rule.The results were as follows:1. Treated in this study were 167 cases in total, 88 of CZON group and 79 of CMX group, but subjected for clinical evaluation by the evaluation committee were 147 cases, 77 of CZON group and 70 of CMX group, with 20 cases (11 of CZON group and 9 of CMX group) excluded from the committee's evaluation.2. Clinical effectiveness assessed by the committee showed the efficacy rates of 81.8%(63 cases our of 77) for CZON group and 80.0%(56 cases out of 70) for CMX group, with no significant difference observed between the two drug groups. Also, there was no significant difference between the two groups in clinical efficacy evaluation by physicians in charge.3. Classified by causal bacteria, clinical efficacy rates were 85.2% for CZON group and 78.6% for CMX group, and in single infection cases of gram-positive bacteria the effectiveness rates were 100% for CZON group and 75.0% for CMX group. In these two evaluations, CZON group showed higher efficacy percentages but no statistically significant difference was observed between the two drug groups. As for bacterial eradication rate, CZON group showed higher percentage but no significant difference was noted.4. The incidence rate of abnormality in laboratory tests was lower for CZON than for CMX, but no significant difference was observed. Side effects incidence rates showed no significant difference between the two groups.5. Usefulness rates by the evaluation of the committee were 77.9%(60 cases out of 77) for CZON group and 77.1%(54 cases out of 70) for CMX group, whereas evaluation by physicians in charge were 71.1%(54 cases out of 76) for CZON group and 82.6%(57 cases out of 69) for CMX group. In either evaluation, there was no significant difference observed between the two drug groups.These results show that CZON is a useful drug in the treatment of chronic respiratory infections.
A 71-year-old man was noted to habitually snore loudly at night and have a predisposition to somnolence during the daytime. While dozing during the day, he developed cardiac arrest at the time when snoring stopped, and was resuscitated. By means of a respiration monitor, he was diagnosed as having sleep apnea syndrome (SAS) with a combination of obstructive, central, and mixed type. However, neither respiratory insufficiency nor cardiac insufficiency was observed, and there were no abnormal findings on laboratory tests and bronchoscopy. SAS complicated by cardiac arrest is usually seen in cases with concomitant symptoms such as excessive obesity, hypertension, arrhythmia, right heart insufficiency, secondary polycythemia, or mental disorder. The present case abruptly developed cardiac arrest in the absence of such symptoms. This case therefore suggests the importance of screening tests using a respiration monitor during sleep in subjects who have a loud snore or a predisposition to somnolence during the daytime. Although treatment with UPPP alone had no noticeable effect, UPPP treatment combined with sleeping in the lateral position was effective in the present case. The efficacy rate of UPPP has been reported to be 50 to 60%. The early establishment of a method for precise evaluation of the site of obstruction as well as criteria for appropriate application of UPPP are urgently required.
The clinical efficacy and safety of T-2588 were compered with those of cefaclor (CCL) in patients with chronic respiratory tract infection by a double-blind study. Administration was performed by oral for a fixed period of 14 days and the daily dosage was fixed at 600 mg for T-2588or 750 mg for CCL.The following results were obtained.1) Clinical efficacy rate by committee judgement was 83.6% for T-2588 and 56.3% for CCL, respectively. The statistical analysis of these results revealed that T-2588 was significantly moreeffective than CCL.2) The results of the clinical efficacy judged by the doctors in charge was similar to efficacy judged by the committee.3) The bacteriological eradication rate of causative organisms by committee judgement was 77.6% for T-2588 and 52.4% for CCL, respectively. Furthermore, eradication rate of T-2588 in H. influenzae was significantly superior to that of CCL.4) With respect to the rate of improvement of clinical signs, symptoms and laboratory findings the T-2588 was superior to the CCL in the improvement for cough, sputum volume, sputum property, rale and ESR.5) The incidence rate of side effect was 4.5% for T-2588 and 6.5% for CCL, respectively, and these were no significant difference between the two drug group. Abnormal laboratory findings were observed at the rate of 15.5% for T-2588 and 5.8% for CCL, respectively. Incidence rate ofabnormal laboratory findings was significantly higher in T-2588 and the most frequent finding was eosinophilia.6) Usefulness rate judged by committee members for T-2588 and CCL were 80.2% and 55.7%, respectively, and these were significantly different statistically.7) The results of clinical usefulness judged by the doctors in charge were similar to the usefulness judged by committee. These results indicated that T-2588 is useful drug for the treatment of chronic respiratory tract infections.
The clinical efficacy and safety of MK-0787/MK-0791 were compared with piperacillin (PIPC) in respiratory tract infections by a well controlled study. Drugs were administered by intravenous drip infusion twice a day for 14 days, at a daily of 1 g/1 g of MK-0787/MK-0791 or 4 g of PIPC.The following results were obtained.1. Out of 367 patients (183 administered MK-0787/MK-0791, 184 PIPC) included in this trial, the clinical efficacy of 301 patients (155 received MK-0787/MK-0791, 146 PIPC) was evaluated by the committee members.2. The clinical efficacy rates in all cases evaluated by the committee members were 80.0% in MK-0787/MK-0791 and 71.7% in PIPC, respectively, and no significant difference was observed between the two drugs. Wheras, the clinical efficacy rates evaluated by the attending physicians were 82.0% in MK-07871/MK-0791 and 72.0% in PIPC, and significant difference was observed between the two drugs.3. No significant difference was observed between the clinical efficacy of the two drugs evaluated by the committee members in patients with pneumonia or pulmonary suppuration. But in patients with chronic respiratory tract infections, the clinical efficacy rates were 83.5% in MK-0787/MK-0791 and 63.0% in PIPC, respectively, therefore MK-0787/MK-0791 was significantly superior to PIPC. The clinical efficacy evaluated by both the attending physicians and the committee members in those patients were observed to be similar.4. The clinical and bacteriological efficacy against causative organisms in all cases were observed to have no significant difference between the two drugs, but MK-0787/MK-0791 was significantly superior to PIPC in single infections by P. aeruginosa.5. No significant difference was observed between the two drugs in regard to side effects or abnormality in laboratory findings.6. The usefulness of MK-0787/MK-0791 was superior to PIPC in all cases and in patients with chronic respiratory tract infections judged by committee members, and in patients with chronic respiratory tract infections judged by attending physicians.From these results it was concluded that MK-0787/MK-0791 is an extremely useful drug in the treatment of respiratory tract infections.
