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Background/aim: The aim of this study was to investigate the risk factors of surgical site infection (SSI) in patients who underwent liver resection for colorectal liver metastases (CRLM)., Patients and Methods: A total of 151 patients who underwent liver resection for CRLM were included in this study. We investigated the relationship between the patient characteristics and perioperative factors and the incidence of SSI., Results: Nineteen (13%) of these patients developed SSI. Multivariate analysis revealed that modified Glasgow Prognostic Score (mGPS) (1 or 2, odds ratio 3.86, p=0.03) and presence of an enterostomy (yes, odds ratio 3.93, p=0.04) were significant and independent risk factors for SSI., Conclusion: A higher mGPS and an enterostomy were risk factors for SSI in patients who underwent a liver resection for CRLM., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

We report a case of severe leptospirosis infection (Weil's disease) in Tokyo. A 54-year-old man admitted on September 14, 2006, for a 5-day inability to walk due to severe progressive bilateral leg pain, shoulder pain, and fever exhibited jaundice, conjunctival suffusion, hypoxia, and grasping pain in the bilateral leg muscles. Laboratory findings showed severe liver damage, renal failure, leukocytosis, anemia, thrombocytopenia, elevated CRP, hyponatremia, and hypokalemia. Chest X-ray imaging showed interstitial infiltrates in the bilateral lung fields. After cefepime was initiated, he developed chills, fever, and hypotension due to Jarisch-Herxheimer reaction, necessitating respiratory support. Pulmonary hemorrhaging was also found. On hospital day 2, a urine polymerase chain reaction test for leptospira proved positive for the same base sequence as part of the leptospira gene. A microscopic agglutination test showed elevated antibody titers against Leptospira interrogans. Based on a diagnosis of leptospirosis, the man was treated with 2g per day of ceftriaxione for 2 weeks and recovered fully. The leptospira strain was isolated from rodents captured at his home, and we identified the same base sequence as from his urine sample. Reports shows, leptospirosis in Japan have decreased recently, but, as this case can still be seen even in Tokyo, and diagnosticians should maintain an awareness of possible significance in patients with typical findings for this disease.

There were 71 patients with candidemia in our hospital from November 1, 1993 to October 31, 1999. We investigated the 59 patients from isolated species, route of infection, underlying disorders, risk factors, complications, treatment and prognosis. Candida albicans was the most commonly isolated species (52%), followed by Candida tropicalis (11%). Eighty eight percent of the patients developed candidemia from central venous catheter related infections. The risk factors to candidemia included keeping the catheter in place for more than 5 days, gastrointestinal tract malignancies, postoperative state of gastrointestinal tract surgery, administration of broad-spectrum or combination antibiotics for more than 5 days, and under corticosteroid therapy. About half of the patients (47%) had complications, including endophthalmitis (19 patients, 32%), septic shock (12 patients, 20%). Mortality rate associated with candidemia was 46%. Mortality rate was lower in 20 patients who were treated with amphotericin B (40%) than in 34 patients treated with only fluconazole (50%), but it was not statistically significant. In order to make an early diagnosis of candidemia, taking blood cultures and ophthalmologic examinations are essential, especially for patients who have those risk factors to candidemia mentioned above. If the patient was suspected of having catheter related infection, the catheter should be removed quickly and the catheter tip should be cultured. Once candidemia is found, ophthalmologic examination and systemic antifungal therapy are needed. Antifungal therapy with Amphotericin B should be used for patients with severe candidemia or with candidemia of non-albicans Candida species.