Blood-stream infections (BSIs) are prevalent in critical care settings and are associated with a high attributable morbidity and mortality. Blood culture is one of the most important tests to detect and identify the pathogens causing BSI. In this study, we performed a retrospective case series analysis of 644 laboratory-confirmed episodes of bacteraemia at Shinshu University Hospital between 1 July 2001 and 31 December 2005. Although bacterial culture examinations decreased in number during these 5 years, blood cultures gradually increased. Positive rates went up from 8.1% to 12.6%. The most commonly isolated microorganisms were coagulase-negative staphylococci (CNS) (23.1%), Staphylococcus aureus (14.7%), Klebsiella species (9.3%) and Escherichia coli (9.1%). Staphylococcus species accounted for 37.8% of all microorganisms detected. The proportion of the microorganisms did not change remarkably during the study period. The microorganisms commonly cultured were different among the departments because infected sites were specific for each department. Blood culture is a valuable examination to identify causable microorganisms in any bacterial infection.

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A 60-year-old woman who underwent mitral valve replacement experienced melena on the thirteenth postoperative day. We performed gastrofiberscopy and total colonoscopy, but the hemorrhage point was not clear. Abdominal computed tomography showed a tumor 4.0cm in diameter in the small intestine. Abdominal angiography revealed a tumor in the ileocolic artery.
We diagnosed it as an ileal tumor and performed an operation. The patient had a medical history of laparoscopic cholecystectomy, but we decided to perform partial excision of the ileum under laparoscopic assistance because of the diagnosis of a tumor. A tumor 5.0cm in diameter was present in the terminal ileum, and we performed partial ileal resection. The pathological result was GIST. This presents with melena, and we diagnosed it as an ileal tumor by CT and angiography ; we report it as an example of ileal GIST which we removed surgically under laparoscopic assistance.

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We reported a case of a mucinous cystadenoma of the appendix. A 74-year-old man was admitted to our hospital because a mass approximately 5cm in diameter was detected in the right lower quadrant of the abdomen. In the blood chemistry, the serum level of carcinoembryonic antigen (CEA) was slightly elevated (4.0ng/ml). Barium enema study revealed a tumor in the cecum, 40mm in diameter with a smooth surface. Colonoscopy revealed it as a submucosal tumor. Abdominal computed tomography revealed the cystic mass, 40×40×100mm in diameter, localized on the dorsal side of the cecum, which might be identified as the appendix. From these findings a mucinous cyst of the appendix was suspected, and an ileo-cecectomy with regional node dissection was performed. In the histopathological study, the tumor was diagnosed as mucinous cystadenoma of the appendix. No malignant findings were revealed, but the CEA and CA19-9 levels of the mucilaginous solution in the cystadenoma were remarkably elevated : CEA 8125ng/ml, CA19-9 4315U/ml. The postoperative course was uneventful.

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[in Japanese]

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