Pemphigus vulgaris produces multiple and intractable erosions of the oral mucosa in the head and neck region. We describe a case of pemphigus vulgaris that showed erosions in the hypopharynx and stenosis of the esophageal orifice from an osteoporosis drug. A 73-year-old woman was admitted with oral intake difficulty and erosions in the hypopharynx. During the first admission, we could not make a definite diagnosis by biopsy or blood examination. The condition of the mucosa worsened subsequently; an esophagram showed marked stenosis of the esophageal orifice. As a possible factor exacerbating the stenosis, an osteoporosis drug was considered. The stenosis was improved by balloon expansion. One year after the first medical examination, we finally made a definite diagnosis of pemphigus vulgaris from the results of a blood examination in which anti-desmoglein 3 turned positive when the hypopharyngeal erosions and stenosis of the esophageal orifice became worse. Systemic treatment with a steroid was effective for the control of pemphigus vulgaris; restenosis of the esophageal orifice was recognized twice during a state of remission, and careful follow-up will be necessary in the future.

This study aimed to elucidate retrospectively the correlations between the genome and phenotype in clinical methicillin-resistant Staphylococcus aureus (MRSA) gentamicin (GEN), clindamycin (CLI), and minocycline (MIN) susceptibility using next-generation sequencing (NGS) technology. Ninety two MRSA strains were isolated from individual inpatients treated in Hiroshima University Hospital, Hiroshima, Japan, extracted for their genomic DNA, and sequenced using an Illumina® MiSeq sequencer to obtain their de novo whole-genome assembly. An in silico analysis using ResFinder was performed to obtain the genomic antimicrobial susceptibility profile which was analyzed together with GEN, CLI, and MIN minimum inhibitory concentration (MIC) levels. This study found aac(6')aph(2")⁺,spc⁺,ermA⁺,tetM⁺ MRSA strains were predominant (42/92) and were shown to exhibit >16 mg/L GEN (40/42), >4 mg/L CLI (26/42), and >8 mg/L MIN MIC levels (30/42). Associations between aac(6’)aph(2”) detections and GEN MIC levels (p <0.001), ermA detections and CLI MIC levels (p <0.001), and tetM detections and MIN MIC levels (p <0.001) were revealed in this study. Correlations between simultaneous detections of aac(6’)aph(2”)-spc-ermA-tetM and GEN MIC levels (φ_c= 0.398, p <0.001), CLI MIC levels (φ_c= 0.448, p <0.001), and MIN MIC levels (φ_c= 0.515, p <0.001) were revealed in this study. The genomic-phenotypic correlation analyses in this study provided an insight of a rapid antimicrobial detection in MRSA using in silico genomic antimicrobial susceptibility profiling.

Antimicrobial prophylaxis using cefaclor or trimethoprim-sulfamethoxazole (co-trimoxazole) is recommended for children with vesicoureteral reflex (VUR) to prevent recurrent urinary tract infection (UTI). This retrospective study was performed by reviewing the data of children ≤5 years of age treated for recurrent UTI in six hospitals from 2010 to 2015. The criteria for UTI diagnosis is fever (≥38°C) and positive results in urine culture (>10⁴ colony-forming units/ml in midstream or withdrawn urine specimens). In total, 41 children were reviewed, and 31 children had recurrent UTI without antimicrobial prophylaxis and 10 had breakthrough (BT)-UTI treated with prophylaxis using cefaclor or co-trimoxazole. In the cases of BT-UTI treated with prophylaxis, 5 children received cefaclor and 5 received co-trimoxazole. We collected data on pathogens, antimicrobial resistance, and antimicrobial agents chosen for the empirical treatment of recurrent UTI. We also evaluated the validity of empirical therapy for recurrent UTI in this study. Various pathogens were found in children who received prophylaxis with cefaclor. The rate of empirical antimicrobial agents that were inappropriate based on antimicrobial susceptibility tests was higher in children who received prophylaxis with cefaclor (60.0%) than in those who received no prophylaxis (25.9%) or prophylaxis with co-trimoxazole (20.0%). Prophylaxis with cefaclor was found to be a risk factor for inappropriate empirical treatment in BT-UTI cases. The results suggest that the choice of empirical antimicrobial agents in BT-UTI cases should be carefully considered before treatment with prophylaxis. To encourage the adequate use of antimicrobial agents, we recommend prophylaxis with co-trimoxazole to prevent recurrent UTI.

A 61-year-old man presented with an excruciating pain in the right lower extremity. The pain was aggravated by a short distance walk and lateral bending to the right. These symptoms implied right L4 radicular pain. Magnetic resonance images revealed foraminal disc herniation at the right L4-5 level. After failure of conservative treatment, the patient underwent surgery via the paraspinal transpars approach. Following exposure of the right lateral edge of the L4 lamina, we partially resected a part of the pars interarticularis in accordance with the preoperative simulation using a 3-dimensional printed bone model. Fragmented discs compressing the dorsal root ganglion of L4 nerve root were totally removed. Postoperative computed tomography showed complete preservation of the facet. The patient showed remarkable relief from the pain and returned to his job a week after the surgery. Foraminal disc herniations cause fierce leg pain and are often intractable to conservative treatment. Selection of the surgical approach is often a matter of debate. The paraspinal transpars approach was effective and a less invasive surgical method in that it can preserve the facet joint. A three-dimensional printed bone model was useful in determining the minimal resection range of the pars interarticularis.

Four cases of intestinal endometriosis seen at our hospital are presented. The patients ranged in age from 35 to 43 years and developed abdominal pain, vomiting, and dyschezia due to stenotic lesions of the intestine. The sites of the lesions were the ileum in 2 cases, and the sigmoid colon and rectum in 1 case each. All cases had no history of bowel disease or laparotomy, and were not diagnosed preoperatively. These results suggested that evaluations of symptoms and clinical examinations are inadequate for an accurate diagnosis of intestinal endometriosis. The patients’ postoperative courses were uneventful, and there have been no recurrences. In conclusion, intestinal endometriosis should be considered in women of childbearing age who present with bowel obstruction, especially in women without a history of laparotomy.