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N Shinagawa

Publications and source records attributed to N Shinagawa.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Changes in erythrocyte structure and in platelets in elderly patients with disseminated intravascular coagulation].

We measured the platelet distribution width, the mean platelet volume, the volume percentage of platelets, and the platelet-to-large-cell ratio in 15 elderly patients with disseminated intravascular coagulation (DIC). Peripheral venous blood mixed with ehtylenediaminetetraacetic acid was analyzed with a Sysmex E-4000 analyzer. The underlying diseases were sepsis, pneumonia, pyelonephritis, and other inflammatory diseases. The mean duration of survival from the onset of DIC was 16.9 +/- 23.9 days. The distribution of red cell sizes before the onset of DIC did not differ significantly from that in patients without DIC, but fragmentation of erythrocytes on blood films was more common in the early stage of DIC (p < 0.01). Before the onset of DIC, the two groups did not differ significantly in the frequency of giant platelets on blood smears. At the onset of DIC, the platelet distribution width, the mean platelet volume, and the platelet-to-large-cell ratio were significantly higher than in patients without DIC. The concentration of glutamic-oxaloacetic transaminase and those of other serum enzymes did not change significantly, but the serum creatinine concentration and the blood urea nitrogen level increased as the platelet-to-large-cell ratio increased. No significant relation was evident between the levels of serum C-reactive protein and creatinine, between the platelet-to-large-cell ratio and the mean volume of red blood cells, or between the platelet-to-large-cell ratio and the distribution of red cell sizes. These data suggest that studies of platelets are more useful in the diagnosis of DIC at early stages of impaired organ function than are other indicators of inflammation such as the level of C-reactive protein.

Aged↗
PubMed1996

[Isolation rate of E. coli from surgical infections and their susceptibilities].

Escherichia coli isolated from surgical infections during the period from July 1983 to June 1995 were investigated in a multicenter study involving 19 hospitals in Japan, and the following results were obtained. 1. Although the isolation rate of E. coli was not high from postoperative infections, it was most frequently isolated from primary infections throughout the study period. E. coli, Klebsiella spp. and anaerobic bacteria were predominant from fresh infections. From the cases that had previous antibiotics treatment, Enterococcus spp. were the most predominant isolates followed by MRSA and Pseudomonas spp. in this order. 2. Against E. coli, cefozopran, carumonam and aztreonam had the strongest activity, followed by cefmenoxime, imipenem, latamoxef, gentamicin and ofloxacin. Recently, we have noticed that antibiotic resistant E. coli strains particularly against cefazolin are increasing year by year.

Anti-Bacterial Agents↗
PubMed1996

[Isolation rate of Pseudomonas aeruginosa from surgical infections and their susceptibilities].

Pseudomonas aeruginosa isolated from surgical infections during the period from July 1982 to June 1995 were investigated in a multicenter study involving 19 hospitals in Japan, and the following results were obtained. 1. Though the isolation rate of P. aeruginosa was not high from primary infections, it was more frequently isolated from postoperative infections throughout the study period. Enterococcus spp., P. aeruginosa and Staphylococcus aureus including MRSA were predominant among postoperative infections. From the postoperative cases that had previous antibiotic treatment, Enterococcus spp., MRSA and P. aeruginosa were more predominantly isolated than from those without previous treatments with antibiotics. 2. Cefozopran, ceftazidime, cefsulodin, aztreonam, carumonam, gentamicin, amikacin and ofloxacin had strong activities against P. aeruginosa. We recognize recently that antibiotic-resistant strains of P. aeruginosa against imipenem and ofloxacin have been increasing year by year.

Anti-Bacterial Agents↗
PubMed1996

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents. Special references to bacteria isolated between July 1994 and June 1995].

Isolated bacteria from infections in general surgery during the period from July 1994 to June 1995 were investigated by a multicenter study in Japan, and the following results were obtained. One hundred and fifty-three strains were isolated from primary infections, and 143 strains were isolated from postoperative infections. From primary infections, both anaerobic Gram-positive and-negative bacteria were predominant, and from postoperative infections, aerobic Gram-positive bacteria were predominant. Among aerobic Gram-positive bacteria, the isolation rate of Enterococcus faecalis was highest, followed by that of Staphylococcus aureus from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Streptococcus intermedius was highest from primary infections, but from postoperative infections anaerobic Gram-positive bacteria was uncommon. Among aerobic Gram-negative bacteria, Escherichia coli was most predominantly isolated from primary infections, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa in this order. From postoperative infections, P. aeruginosa was most predominantly isolated, followed by Serratia marcescens and E. coli. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. We have noticed that resistant strains against imipenem and ofloxacin were increasing among P. aeruginosa and resistant strains against cefazolin were increasing among E. coli. MICs of cefazolin against four out of 30 strains of E. coli were higher than 100 micrograms/ml, and MICs of imipenem was higher than 50 micrograms/ml against 5 out of 22 strains of P. aeruginosa.

Anti-Bacterial Agents↗
PubMed1996

[The pathophysiology and treatment of severe intra-abdominal abscess].

Formation of an abscess within the peritoneal cavity is a dynamic process, representing the body's success at localizing the contamination but its ultimate failure to completely destroy the bacteria and neutralize their toxic products. In most instances, the origin of the microbial insult is from bacteria which colonize the intestinal lumen. The therapeutic means are prompt surgical drainage and appropriately administered antimicrobial agents. Surgical drainage of abscess are accompanied by either (1) an extraperitoneal approach, (2) an intra-abdominal exploration, or (3) ultrasound-guided needle aspiration of the abscess. Choice of antimicrobial agents is frequently based upon prediction of pathogens from normal flora of bowel contents contaminating a normally sterile area, or from knowledge of pathogens expected in certain conditions, rather than on results of cultures and susceptibility tests. This selection frequently calls for the choice of agents effective against multiple organisms. Patients with prolonged septic courses die from a combination of the infection itself and the malnutrition resulting from the associated hypercatabolism and starvation. Nutritional therapy also of clinical importance in halting the progression toward a fatal outcome.

Abdominal Abscess↗
PubMed1995

Perforated acute appendicitis in a patient with AIDS/HIV infection: report of a case.

We report herein the case of a 40-year-old man with AIDS who was admitted to hospital with severe abdominal pain, fever, and chills. He underwent an emergency laparotomy which revealed a perforated appendix with suppurative peritonitis. An appendectomy with peritoneal drainage was carried out, but the postoperative course was complicated by fever without leukocytosis; however, he gradually improved following treatment with intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF) and immunoglobulins, and made a complete recovery. His postoperative course demonstrates the effectiveness of this treatment regimen for patients with AIDS complicated by infection without an increase in the white blood cell count (WBC).

AIDS-Related Opportunistic Infections↗
PubMed1995

[Bacteriological and clinical evaluation tazobactam/piperacillin in infectious diseases in surgical field].

We carried out bacteriological and clinical studies on tazobactam/piperacillin (TAZ/PIPC), a combination drug of piperacillin with the new beta-lactamase inhibitor tazobactam, in various infectious diseases in surgical field such as intra-abdominal infections (peritonitis and intra-abdominal abscess), hepatobiliary infections (cholecystitis, cholangitis and hepatic abscess) and secondary infections in wound, etc. The total number of cases treated with the combination drug was 164. Of these cases, 141 cases were assessable for clinical responses including 60 cases with intra-abdominal infections, 38 cases with hepatobiliary infections, and 43 cases with secondary infections. Clinical efficacy rates of the drug were 83.3% in cases with intra-abdominal infections, 86.8% in cases with hepatobiliary infections, and 95.3% in those with secondary infections, hence the overall efficacy rate was 87.9%. In the cases from which beta-lactamase producing strains were isolated, clinical efficacy rates were 84.8% in cases with intra-abdominal infections, 84.6% in those with hepatobiliary infections, and 96.2% in those with secondary infections, hence the overall efficacy rate was 88.9%. Bacteriological efficacy rates were 92.9% in cases with Gram-positive bacterial infections, 64.3% in those with Gram-negative bacterial infections, and 100% in those with anaerobic bacterial infections. Bacteriological efficacy rates were 84.2% in cases with single bacterial infections and 56.5% in those with multi-bacterial infections, and the overall bacteriological efficacy rate was 69.0%. In the cases of infections with beta-lactamase producing strains, bacteriological efficacy rates were 80.0% in cases with Gram-positive bacterial infections, 75.0% in those with Gram-negative bacterial infections, and 100% in those with anaerobic bacterial infections. They were 82.6% in cases with single bacterial infections and 57.9% in those with multi-bacterial infections; the overall bacteriological efficacy rate was 67.2%. The bacterial eradication rate was 79.9% against all the isolates, and it was 79.2% against beta-lactamase producing isolates. In addition, we compared the sensitivity distribution of the isolates to TAZ/PIPC with those to control drugs piperacillin (PIPC), cefotiam (CTM), ceftazidime (CAZ), sulbactam/cefoperazone (SBT/CPZ). The MIC50 and MIC90 values of TAZ/PIPC against all strains were 3.13 micrograms/ml and 50 micrograms/ml, respectively. MIC50 values show that TAZ/PIPC was two times less effective than CAZ and SBT/CPZ but four times more effective than CTM; furthermore, from the MIC90 values, TAZ/PIPC was four times more effective than PIPC, CTM and CAZ. The MIC50 and MIC90 values of TAZ/PIPC against beta-lactamase producing strains were 3.13 micrograms/ml and 50 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Abscess↗
PubMed1994

Chemotherapy targeting regional lymph nodes by gastric submucosal injection of liposomal adriamycin in patients with gastric carcinoma.

We investigated the delivery of adriamycin (ADR) to the regional lymph nodes of the stomach following the gastric submucosal injection of liposomal adriamycin (Lipo-ADR) in 34 gastric carcinoma patients, as well as following intravenous administration of free ADR (F-ADR) in another 18 patients. Prior to radical gastrectomy, Lipo-ADR was endoscopically injected into the gastric submucosa adjacent to the primary tumor via a needle-tipped catheter. After Lipo-ADR injection, the ADR concentration in the primary and secondary drainage lymph nodes was higher than in the other regional lymph nodes. Thus, the regional nodes more susceptible to metastasis showed higher levels of ADR. In contrast, the intravenous administration of F-ADR produced a similar and far lower ADR concentration in all the nodes. Delivery of ADR to the primary drainage lymph nodes following injection of 5 ml of Lipo-ADR was compared with delivery to the left gastric artery lymph nodes after intravenous administration of an equal dose of F-ADR. The ADR levels (micrograms/g) after gastric submucosal injection were 15.1 +/- 8.30 on day 1 (n = 4); and 11.9 +/- 4.80 on day 4 (n = 6). Those after intravenous administration were 0.29 +/- 0.10 on day 1 (n = 4); and 0.36 +/- 0.0 on day 4 (n = 2). The differences between the two groups were significant (P < 0.05). The ADR levels after the gastric submucosal injection were far higher than those after intravenous administration. These findings indicate that the gastric submucosal injection of Lipo-ADR can specifically deliver ADR to the regional lymph nodes at high concentrations. Such preoperative adjuvant chemotherapy targeting the regional lymph nodes may be useful for preventing the lymph node recurrence of gastric carcinoma.

Adult↗
PubMed1994

[Bacteria isolated from intraabdominal infection and their susceptibilities to antimicrobial agents].

Bacteria isolated from intraabdominal infections during the period from July 1982 to June 1993 were investigated with regard to their classifications according to a joint research by 9 university hospitals in Japan. The following results were obtained. 1. A total of 971 strains were isolated from 684 out of 597 patients with peritonitis, and 287 strains out of 971 were isolated from postoperative peritonitis. 2. The most predominant organism isolated from patients with acute peritonitis was Escherichia coli (28%), followed by Bacteroides fragilis group (17%), Gram-positive anaerobic cocci (16%), Enterococcus spp. (9%) and Klebsiella spp. (8%). 3. Against E. coli, cefmenoxime, cefuzonam, cefozopran, aztreonam and carumonam showed MIC50 less than 0.05 micrograms/ml. Against B. fragilis group, erthromycin, clindamycin, imipenem, lincomycin and latamoxef showed MIC50 less than 0.78 micrograms/ml. 4. The most predominant organism isolated from patients with postoperative peritonitis was Enterococcus spp. (20%) and followed by Pseudomonas spp. (14%), and Staphylococcus spp. (13%), E. coli (9%), Enterobacter spp. (8%) and Klebsiella spp. (8%). We suggest that cefazolin, cefmetazole, flomoxef, cefmenoxime, cefuzonam, and latamoxef are the first choice agents in empiric therapy for the treatment of acute peritonitis.

Aged↗
PubMed1994

[Year to year changes in isolation frequencies of different bacteria from postoperative infections].

Bacterial species isolated from postoperative infections during the period from July 1982 to June 1993 were studied regarding isolation frequencies of different species in different years in a joint research project involving nine (9) university hospitals in Japan. The obtained results are summarized as follows. (1) Altogether, 1,453 strains were isolated with 153 strains obtained during the most recent one year from July of 1992 through June of 1993. The most numerous source of isolation was postoperative intra-abdominal sepsis. (2) Gram-positive cocci were the most often isolated, among them methicillin-resistant Staphylococcus aureus was isolated in increasing frequencies until June, 1992. (3) In the last one year, Enterococcus spp. was isolated the most from postoperative infections followed by Staphylococcus spp. and Pseudomonas spp. Rates of isolation of anaerobic bacteria were relatively low with annual isolation frequencies ranging 8 to 15 per cent.

Digestive System Diseases↗
PubMed1994

[Efficacy of arbekacin, a new aminoglycoside antibiotic, in surgical patients with MRSA infections].

The clinical efficacy of a new aminoglycoside antibiotic, arbekacin (ABK), was studied in surgical patients who had been infected with methicillin-resistant Staphylococcus aureus (MRSA). Six cases of pneumonia, 2 of wound infections and 2 of intra-abdominal infections were treated by ABK alone or ABK together with beta-lactam antibiotics such as imipenem/cilastatin or cefotiam. The overall clinical efficacies against these MRSA infections were excellent in one case, good in 6 and poor in 3. In six cases treated by ABK alone, good clinical responses were obtained in 4 cases. Among 4 cases that received combination therapy with ABK, good responses were obtained in 3 cases. No adverse reactions were found in ABK monotherapy or in combined therapy. These data suggested that ABK is an effective antibiotic on surgical infections caused by MRSA.

Aged↗
PubMed1994

[Infection in patient with malignant disease].

The rate of infection in patients with malignant disease was significantly high than that of patients with benign disease. Enterococcus spp. was the most predominant organism isolated from patients with malignant disease, followed by Staphylococcus spp., Pseudomonas spp., Enterobacter spp. and Klebsiella spp. in order. From patients with benign disease, E. coli was the most predominant organism, followed by Gram negative anaerobes, and Klebsiella spp.. The rate of postoperative infection in the patients with malignant biliary disease was significantly high than that without a risk factor. The rates of bacterial isolation from intraoperative bile culture and wound swab were significantly higher in patient with malignant disease. These findings suggest that the utmost care should be exercised in patients with malignant disease in order to prevent intraoperative contamination with prophylactic antibiotic therapy covering the bacteria isolated from the bile.

Aged↗
PubMed1992

Bacterial adherence to human gallbladder epithelium.

The adherence of Escherichia coli and Pseudomonas aeruginosa to the epithelium of the gallbladders obtained from 32 patients with negative bile culture was quantified by a scanning electron microscope. Of the gallbladders, 5 were histologically normal (group A), 21 had chronic calculus cholecystitis (group B), and 6 had acute calculus cholecystitis (group C). The data were expressed as the mean +/- S.D. of the numbers of adherent bacteria to 1,000 microns2 of the gallbladder epithelium. The number of adherent E. coli were 0.1 +/- 0.2 in group A, 4.2 +/- 2.8 in group B, and 9.2 +/- 3.3 in group C. A similar result was also observed with P. aeruginosa. The number of adherent bacteria, both of E. coli and P. aeruginosa were significantly higher in group C than in groups A and B, and were also significantly higher in group B compared to group A. The amount of bacterial adherence paralleled that of the degree of epithelial damage, and the normal epithelium proved to have an inhibiting ability. Thus, a secondary bacterial infection is more likely to happen in patients with contaminated bile, and therefore, the treatment for acute cholecystitis should be based either on the results of a bile culture or according to predictive factors for bactibilia.

Acute Disease↗
PubMed1992

The operative risk factors of cholelithiasis in the elderly.

A total 725 patients with cholelithiasis were divided into three groups according to age, and the risk factors and morbidity rates compared. Group 1 consisted of those aged younger than 49 years, group 2 of those aged between 50 to 69 years, and group 3 of those aged over 70 years. In group 3, the incidence of calculi in the common bile duct was significantly higher than in the other two groups (p less than 0.05), and therefore, choledochotomy accompanying cholecystectomy was performed more often in this group (p less than 0.01). The rate of complications related to calculi and the presence of underlying disease were also higher in this group than in the two younger groups (p less than 0.05), as were preoperative abnormal liver or renal function tests, anemia and hypoproteinemia (p less than 0.05). The rate of positive bile cultures in group 3 was 75.6 per cent which was again significantly higher than in groups 1 and 2 (p less than 0.01). Postoperative complications appeared in 14.3 per cent of the group 3 patients, which was not statistically higher than in group 2 (9.7 per cent), but the percentages of both groups 2 and 3 were high compared to the 4.3 per cent of group 1 (p less than 0.01). The rates of complications directly attributable to the surgical procedures were 2.0 per cent in group 1, 4.8 per cent in group 2, and 5.1 per cent in group 3 with no significant differences between the three groups. There was no increase in the technical problems associated with the surgical procedures performed on the elderly patients and thus, if the operative risks are precisely evaluated and treated cautiously elderly patients should tolerate surgery for cholelithiasis well.

Aged↗
PubMed1992

Composition and turnover of phospholipids and neutral lipids in human breast cancer and reference tissues.

The phospholipid (PL) content was 4-fold higher while the triacylglycerol (TG) content tended to be 65% lower in human breast cancer tissues as compared with non-cancerous reference parts from excised breast tissues. The variation in TG content among breast tissues was very large while that of PL was relatively small. The fatty acid compositions of PL were significantly different between the cancer and reference tissues; the proportions of octadecenoate (18:1), docosahexaenoate (22:6n-3), the total n-3 fatty acids and the n-3/n-6 ratio, but not the proportion of arachidonate (20:4n-6), were significantly higher in the major PL of cancer tissues as compared with those of the reference tissues. No significant differences were observed in the proportion of the major fatty acids of TG in these tissues. The turnover of lipids was faster in the cancer tissues than in the reference tissues. The turnover of TG was faster than that of PL in the cancer tissues, whereas the opposite was true in the reference tissues, indicating significant differences in lipid metabolism between these tissues. A striking difference in the n-3 and n-6 fatty acids of the reference tissues noted for Japanese and Finnish women is discussed in relation to the roles of eicosanoids and eicosanoid precursors in mammary carcinogenesis.

Adult↗
PubMed1992

[Postoperative infection control in patients with hepatic, biliary tract, and pancreatic cancers].

Postoperative infection occurs more frequently in patients with malignant disease than in patients with benign disease. Postoperative infection control in patients with hepatic cancer, biliary tract cancer and pancreatic cancer is studied. Although in patients with jaundice due to malignancy the rate of positive bacterial culture of the bile collected at the time of PTCD was low, the rate of positive bile culture increased after 10 to 14 days of PTCD. The predominant strain was Enterococcus spp., followed by Klebsiella spp., Enterobacter spp. and E. coli in that order. These bacteria isolated from the bile were considered to be causative organisms of postoperative infection. Prophylactic antibiotics after the operation for jaundice due to malignancy should be chosen based on the results of bile culture. In patients undergoing hepatectomy, which is considered to be an aseptic operation, gram positive cocci such as S. aureus was the most frequently encountered organism. On the other hand, in patients undergoing hepatectomy and intestinal anastomosis, enteric bacteria were frequently isolated from the infectious foci. In this study there were 6 cases of methicillin-resistant S. aureus (MRSA) postoperative infection, 3 cases after pancreatoduodenectomy, and 3 cases after hepatectomy. Even after an aseptic operation, postoperative MRSA infection is likely to occur in patients undergoing a more invasive operation, so hospital infection control should be again emphasized.

Bacteria↗
PubMed1992

[Early diagnosis and management against perioperative fungus infection].

Candida spp. is frequently detected from perioperative patients, especially from those requiring central venous catheter (CVC) management. CAND-TEC could detect the blood fungus infection easily and quickly. We analyzed 438 specimens from 57 patients requiring perioperative CVC management for more than three weeks, and investigated usefulness of CAND-TEC comparing with other serological methods. The dilution rate of CAND-TEC showed a positive correlation with amount of beta-D-glucan which was measured by Toxicolor test and Endotoxin-specific assay. It also showed a positive correlation with amount of D-arabinitol. When blood samples diluted more than four times were positive with CAND-TEC, the patients were considered to be infected, and accumulative infection rate was up to 84.2% three weeks after introduction of CVC management. CAND-TEC would be useful in detecting Candida infection compared with conventional methods, and the fungus infection was much more frequent incidence than ever expected. It is important to detect fungus infection early and respond immediately to avoid nosocomial infection.

Candidiasis↗