廣島 健三

症例は16歳, 女性.主訴は胸部異常陰影.1996年5月, 学校健診の胸部X線写真にて左中肺野に縦隔に接する腫瘤影を指摘され, 紹介受診, 精査加療目的にて入院.術前行った肺動脈造影, 大動脈造影では異常動脈は確認されなかったが, 肺分画症, 縦隔腫瘍などを疑い8月15日に手術を施行した.腫瘤は左上葉S3と前縦隔の間に存在し, 有茎性に肺門部と連続していた.茎部には左肺動脈主幹から流入する動脈と左上肺静脈への還流静脈が確認された.内部は嚢胞が大部分を占め, 正常気管支との交通はなく, 肺葉外肺分画症の診断にて摘出術を施行した.<BR>同部位に発生する肺葉外肺分画症は比較的稀で術前診断の面からも興味ある症例であり報告した.

Infections by Cunninghamella bertholletiae have been on the increase in recent years. However, little is known about this fungus and its infection. To clarify the pathogenicity of C. bertholletiae, we made a murine model, and to our knowledge, the first infectious model of this fungus. ICR mice pretreated with cortisone acetate and cyclophosphamide were inoculated intratracheally with 5 x 10(5) spores of C. bertholletiae. About half of the mice died by day 4 and 90% died by day 9. C. bertholletiae was cultured from the lungs, and the pathological analysis disclosed diffuse hyphal growth in the lungs, resulting in necrosis in the later stage. Angioinvasion with alveolar hemorrhage was extremely pronounced from the early stage, and this was the most characteristic feature of this infection. Treatment with amphotericin B showed only minimal improvement of survival, comparable to the poor result of this treatment in actual human cases. In fact, our model has many similarities to the actual human infection by C. bertholletiae, and will be useful for further investigations of this infection.

A 53-year-old male was admitted with cough and chest pain. A chest X-ray film showed left pleural effusion and a chest CT revealed irregular thickening of the pleura. Pleural fluid cytology and percutaneous needle biopsy were negative for malignancy. Thoracoscopic findings revealed fibrin network with pleural effusions and yellow-white pleural thickening, but neither nodules nor masses were found. The thoracoscopic biopsy specimen from the pleural thickening resulted in the diagnosis of malignant pleural mesothelioma. Left pleuropneumonectomy with mediastinal lymph node dissection was performed. Since detailed inspection of the pleural cavity and taking large biopsy samples under thoracoscopic examination are possible, we consider thoracoscopic biopsy to be a useful method for obtaining diagnosis of malignant pleural mesothelioma. Pleuropneumonectomy and systematic lymph node dissection of the pulmonary hilum and mediastinum were believed to be necessary for the surgical treatments.

In an open, prospective, multicenter trial the clinical efficacy of imipenem/cilastatin sodium (IPM/CS) for the treatment of 14 cases with aspiration pneumonia was investigated. The mean age was 75.4 years old. Diseases of central nervous system were present in 11 cases, cardiovascular diseases, pulmonary diseases and diabetes mellitus in 2 cases each respectively. Seven cases were community-acquired and another seven were hospital-acquired. Six cases were moderate and 8 cases were severe. Causative organisms were determined in 9 cases (64.3%),multiple causative organisms were isolated in 3 cases. Isolated organisms were Staphylococcus aureus (4),Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Escherichia coli (1), Acinetobacter calcoaceticus (1). Detection of anaerobes was not attempted. Clinical effects of IPM/CS were excellent in 3, good in 8, fair in 2, poor in 1, the efficacy rate was thus 78.6%. P. aeruginosa was isolated from 2 out of 3 cases in which therapy with IPM/CS failed. Monotherapy with IPM/CS appears to be highly effective for cases of aspiration pneumonia, but the disease due to IPM-resistant P. aeruginosa is an exception. © 1990, Japan Antibiotics Research Association. All rights reserved.

In an open, prospective, multicenter trial we investigated the clinical efficacy of Imipenem/cilastatin sodium (IPM/CS) for the treatment of pulmonary infection. Out of 129 cases collected, 103 could be evaluated for utility of IPM/CS: 83 with pneumonia (49 moderate and 34 severe cases), 6 with lung abscess, 5 with empyema, 9 with chronic bronchial infection caused by Pseudomonas aeruginosa. In 83 cases of pneumonia, the mean age was 67.6 years old, significant underlying diseases were present in 87.9%, and 21 cases (25.3%) were hospital-acquired. Causative organisms were determined in 36 cases (43.4%), and multiple causative organisms were isolated in 5 cases. The principal pathogens were Streptococcus pneumoniae (8), Staphylococcus aureus (8), P. aeruginosa (8), Haemophilus influenzae (6), Klebsiella pneumonia (6). The efficacy rate of the cases of pneumonia in monotherapy with IPM/CS was 84.6%: moderate 87.2%, severe 80.6%, community-acquired 91.7%, and hospital-acquired 61.1%. Monotherapy with IPM/CS was highly effective in cases of aspiration pneumonia. The efficacy rate in cases in which the causative organism was P. aeruginosa was low (50.0%). The efficacy rate of the cases of lung abscess was 100% and of empyema was 50.0%. Of 9 cases of chronic bronchial infection due to P. aeruginosa, in 5 cases treated with IPM/CS combined with tobramycin and I case treated combined with amikacin, the efficacy rate was 66.6% and the eradication rate 33.3%. We consider monotherapy with IPM/CS to be highly effective in cases of moderate and severe pneumonia, with the exception of disease due to imipenem-resistant P. aeruginosa. © 1990, Japanese Society of Chemotherapy. All rights reserved.