It has been shown that the in situ hybridization (ISH) method for the detection of phagocyted bacteria in polymorphonuclear neutrophils is more sensitive than conventional blood culture in patients with sepsis. The present study was designed to further evaluate the clinical utility of the ISH method, using a commercially available kit (Hybrizep®), for detecting pathogens in patients with severe respiratory infections. Peripheral blood was taken from patients with severe respiratory infections for both routine blood culture and the ISH method, respectively. In addition, focal samples including sputum, bronchoalveolar lavage, central and thoracic catheter, etc. were simultaneously examined for bacterial culture. A total number of 22 specimens was examined. The positive cases by ISH were 50.0% in the respiratory infections, which were significantly higher than those in blood cultures (9.1%). However, identical pathogens in the ISH method were not isolated from blood and/or other sources in respiratory sites.
These findings suggest a possibility of high frequency of bacteremia or multifactorious pathogens in severe respiratory infections. The ISH method may provide additional information on serious respiratory infections for the detection of bacteremia. However, the clinical utility by the ISH method for patients with severe respiratory infection remains undetermined.

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To elucidate the prevalence of influenza A (H1N1) pdm infection in the Hokushin area in Nagano Prefecture, Japan, we determined the patient number and studied the clinical features of children hospitalized because of influenza A (H1N1) pdm infection. Between August 2009 and March 2010, 169 children with influenza A (H1N1) pdm infection were hospitalized in this area. The rate of hospitalization was 185 per 100,000 children aged 0-14 years. At the time of admission, 82 patients (49%) were diagnosed with pneumonia or bronchitis, and 31 patients (18%) with bronchial asthma. Oxygen saturation (SpO₂) was measured in 160 patients by using a pulse oximeter ; 29 patients (18%) were found to have severe hypoxemia, defined by SpO₂ <90%, and 8 of them were immediately transferred to the pediatric intensive care unit of Nagano Children’s Hospital. Oxygen was supplied and steroids were administered to treat hypoxemia in the case of 81 (48%) and 63 patients (37%), respectively. Five patients (3%) required mechanical ventilation support, but no patients died. All patients except 4 (98%) were treated with either oseltamivir or zanamivir. Early detection of severe hypoxemia is important in treating patients with influenza A (H1N1) pdm infection.

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Background and objective : This study was conducted to investigate whether or not FeNO correlates with lung function tests, the Asthma Control Test (ACT) for assessing asthma control or the Asthma Health Questionnaire (AHQ-33) for evaluating the health status in asthmatics.
Methods : FeNO was compared with the results of spirometry, ACT and AHQ-33 in 57 non-smoking patients with asthma and 17 healthy individuals without pulmonary diseases who had never smoked. Sixteen of 57 asthmatics treated with inhaled corticosteroid (ICS) underwent step-down therapy if they showed good/total control or step-up therapy if they showed poor control, and were evaluated by spirometry, ACT and AHQ-33 prior to and more than one month after starting step-down or step-up therapy.
Results : FeNO in asthmatics was significantly higher than that in the control group. There were no significant correlations between FeNO and FEV₁, ACT score or AHQ-33 scores. However, there were significant correlations between the changes in FeNO and changes in FEV₁, ACT score or AHQ-33 scores following stepdown or step-up therapy.
Conclusion : FeNO is a useful marker not only for the diagnosis of asthma but also for asthma control and determining the health status in an individual patient, although it is variable without any correlation with symptoms and lung function among asthmatics.

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We explored the relationship between transient portal vein clamping (TPVC)-induced adhesion molecule expression in the liver and liver metastasis. TPVC was achieved by clamping the portal vein of male F344/DU rats for 15min. For the investigation of liver metastasis, the portal vein was clamped in experimental rats and simple laparotomy was performed in control rats at the first operation. All rats were injected 6 and 18h post-first surgery with 4.0x10⁶ ACL-15 colon carcinoma cells intrasplenically. The number of tumor nodules on the liver surface was determined 14 days later. For the investigation of gene and protein expression in the liver, E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) were determined 6 or 18h after the first operation by quantitative RT-PCR for m-RNAs and immunohistochemical staining for proteins. Portal vein-clamped rats had significantly more liver metastatic foci than did unclamped controls. TPVC enhanced mRNA and protein expression of E-selectin, VCAM-1, and ICAM-1 on the liver in experimental rats, except for m-RNA ICAM-1 expression at 18h post surgery. It is supposed that factors produced by TPVC can upregulate the mRNA and protein expression of E-selectin, VCAM-1, and ICAM-1 on the liver, which may facilitate liver metastasis.

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A 63-year-old man was diagnosed with hypertrophic obstructive cardiomyopathy. Echocardiography revealed asymmetrical left ventricular hypertrophy, systolic anterior movement (SAM) of mitral leaflets causing an outflow tract pressure gradient of 52mmHg, and moderate mitral regurgitation (MR) directed posteriorly in the left atrium. Four years later, when the patient was admitted for mild congestive heart failure, SAM and left ventricular outflow obstruction were absent, and prolapse of the posterior mitral leaflet was causing anteriorly-directed severe MR. Rupture of the chordae tendineae was responsible for the mitral prolapse and for the abolition of the outflow obstruction.

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A 78-year-old man who had malnutrition and Parkinson’s disease vomited. Abdominal X-ray showed a distended stomach, small intestine and colon. Abdominal computed tomography (CT) indicated ascites, hepatic portal venous gas (HPVG), thickened intestinal wall and pneumatosis cystoides intestinalis (PCI) in the wall of the small intestine. Because there was no sign of peritoneal irritation, we decided to use conservative therapy. Neither HPVG nor PCI was observed on the abdominal CT scan taken 14 days after the onset of failure. Oral intake was started and the patient took a 1400-kilocalorie diet daily. The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were increased on the 40th day after the onset of failure. On the 46th day, respiratory and cardiac arrest occurred. His blood sugar level was below 20mg/dl. Intravenous hyperalimentation was started. Hypoglycemia was not present from the next day. The cause of the hypoglycemia was supposed to be malabsorption and liver insufficiency, which might have been caused by HPVG and PCI. It is supposed that patients with HPVG and PCI with malnutrition need careful observation for a long period after recovery from HPVG and PCI.

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