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For the purpose of a nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens in patients in Japan, the Japanese Society of Chemotherapy conducted their second year survey, during the period from January to August, 2007. A total of 1178 strains were collected from clinical specimens obtained from adult patients with well-diagnosed respiratory tract infections. Susceptibility testing was evaluable for 1108 strains (226 Staphylococcus aureus, 257 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 206 Haemophilus influenzae, 120 Moraxella catarrhalis, 122 Klebsiella pneumoniae, and 171 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 beta-lactams (four penicillins, three penicillins in combination with beta-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standards Institute (CLSI). The incidence of methicillinresistant Staphylococcus aureus (MRSA) was high, at 59.7%, and the incidences of penicillin-intermediateresistant and -resistant Streptococcus pneumoniae (PISP and PRSP) were 30.4% and 5.1%, respectively. Among Haemophilus influenzae strains, 19.9% of them were found to be beta-lactamase-non-producing ampicillin (ABPC)-intermediately-resistant (BLNAI), 29.1% to be beta-lactamasenon-producing ABPC-resistant (BLNAR), and 6.7% to be beta-lactamase-producing ABPC-resistant (BLPAR) strains. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae was not isolated. Two isolates (1.2%) of Pseudomonas aeruginosa were found to be metallo-beta-lactamase-producing strains, including one (0.6%) suspected multidrug-resistant strain showing resistance to imipenem, amikacin, and ciprofloxacin. These data will be a useful reference for future periodic surveillance studies and for investigations to control resistant infections as well. Continued surveillance is required to prevent the further spread of these antimicrobial resistances.

Structural damage induced by impulsive loading consist of local damage caused by local discontinuous behavior such as penetration, perforation, scabbing and spalling, and global damage caused by global structural responses. The global elasto-plastic structural response of concrete structures have been simulated by the Finite Element Method (FEM) or the Boundary Element Method (BEM). However, local damage has only been evaluated by a few empirical formulas based on experimental results. In 1971, the Distinct Element Method (DEM) was introduced. In this paper, the authors applied the DEM to simulate local damage of concrete structures. The numerical results were compared with empirical formulas and experimental results.

This paper describes the status and trends of the technical activities ongoing, as well as background circumstances, in protection and control systems in Japan to achieve ensuring stable power supply, improving efficiency, reducing cost, and protecting the natural environment at the same time. Several measures and systems accomplished to establish a reliable power supply network system are reported. Status on applying IT technologies to wide area communication and substation facilities are explained with several examples. Approaches to improve the reliability in the distribution substation are presented, followed by the anticipated effects of introducing distributed generation into the distribution networks.

To identify amplified oncogenes involved in hepatocellular carcinomas (HCC), we applied a genomic DNA microarray spotted with 57 oncogenes to 20 HCCs. Aberrations in DNA copy number also were analyzed by comparative genomic hybridization (CGH) using an aliquot of DNA samples. In 5 of 20 HCCs, only 6 oncogenes (CCND1, FGF3/FGF4, SAS/CDK4, TERC, MET, and MYC) were amplified, whereas in the remaining 15 tumors no oncogenes were amplified. A comparison of DNA microarray and conventional CGH analyses showed that, although 5 of 6 amplified oncogenes shown by microarray were located in chromosomal regions shown by CGH to have increased DNA copy numbers, not all genes located in such chromosomal regions were affected. One of the amplified oncogenes (SAS/CDK4) was found in a chromosomal region that was undetected by CGH. We, therefore, conclude that amplification of the oncogenes examined in this series is not directly implicated in hepatocellular carcinogenesis.

The clinical laboratory is important as a department which provides diagnostic and advisory services to clinicians and support surveillance for hospital infection control. Though the link between clinical laboratory and other departments including infection control team is paramount for infection control, there are the communication delays by the documented reports. The use of the hospital information system can streamline the work of infection control, because laboratory(including microbiology) data can be obtained quickly. In order to implement efficient infection control, it is necessary to construct the information network by utilizing the local area network in the hospital. Since the community-acquired infections due to resistant micro-organisms are increasing in 1990s, we should expand the information network in community and nation-wide in the 21st century.

The protection relay should be designed so as to securely function against faults that may occur to various objects of protection (e.g. transmission lines, transformers, and generators). However, due to the wide variety of objects of protection and circumstances of faults, conditions which the protection relay should guarantee correct operation are just too many, thus it is not easy to secure high quality. Moreover, trip conditions and the number of operation display outputs may vary depending on each substation, therefore sufficient verification is required also on the mass-production stage for securing the required high quality. We have successfully realized an advanced production environment by applying the latest computer technology by taking into account the requirements for securing the required protection relay quality. As a major characteristic of this new production environment, a spiral model was introduced. We call this new production environment MELPRO-SAVE. In this paper, we explain the method for achieving the spiral model design environment.

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and analyzed some characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In these 17 institutions around the entire Japan, 512 strains of presumably etiological bacteria were isolated mainly from the sputa of 440 patients with lower respiratory tract infections during the period from October in 1997 to September in 1998. MICs of various antibacterial agents and antibiotics were determined against 100 strains of Staphylococcus aureus, 81 strains of Streptococcus pneumoniae, 85 strains of Haemophilus influenzae. 71 strains of Pseudomonas aeruginosa (non-mucoid strains), 27 strains of Pseudomonas aeruginosa (mucoid strains), 33 strains of Moraxella subgenus Branhamella catarrhalis, 17 strains of Klebsiella pneumoniae etc., and the susceptibilities of these strains were assessed except for those strains that died during transportation. S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus: MRSA) accounted for 55.0%. The frequency of the drug resistant bacteria decreased comparing to the previous year's 67.3%. Arbekacin (ABK) and vancomycin (VCM) showed the most potent activities against MRSA. Imipenem (IPM) and panipenem (PAPM) of carbapenems showed the most potent activities with MIC80S of 0.063 microgram/ml against S. pneumoniae. The frequency of penicillin (PC)-intermediate S. pneumoniae (PISP)+PC-resistant S. pneumoniae (PRSP) had decreased gradually, that is, in 1995 the frequency of it was 40.3%, but that was 30.9% in 1997. Against H. influenzae and M.(B.) catarrhalis, all the drugs showed good activities. But the sensitive strains of them against ceftazidime (CAZ) had decreased in 1997, compared those in 1995 and 1996. Meropenem (MEPM), IPM and tobramycin (TOB) showed the most potent activity against P. aeruginosa (mucoid strains). And TOB and ciprofloxacin (CPFX) showed the most potent activities against P. aeruginosa (non-mucoid strains). All drugs except ampicillin (ABPC) were more active against K. pneumoniae in 1997 than that in 1996. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. The examination of age distribution indicated that the proportion of patients with ages over 70 years was 45.5% of all the patients showing a slight increase year by year. About the proportion of diagnosed diseases, not so particular changes were recognized as follows: Bacterial pneumonia and chronic bronchitis were the most frequent with 33.6% and 29.1%, respectively. Number of strains isolated from patients before administration of antibiotics were more than those after administration of them in chronic bronchitis, but these had reversed in bacterial pneumonia. The tendency in bacterial pneumonia had been acknowledged since 1995. The increase of S. aureus and P. aeruginosa (both mucoid and non-mucoid strains) isolated after administration of antibiotics, has suggested the decrease of the susceptibility of these strains against antibiotics. Administration of antibiotics has changed the results of the frequency of isolation of bacterial species. Bacterial isolations before administration of antibiotics were as follows: S. pneumoniae 24.5%, H. influenzae 21.4%, S. aureus 18.4% and P. aeruginosa 12.2%. The frequencies of S. aureus decreased after antibiotics administration over 15 days, but the frequencies of P. aeruginosa was not affected. The frequencies of P. aeruginosa was 47.8% after administration over 15 days. From patients administered antibiotics of penicillins and cephems. S. aureus was mainly detected with 31.7-58.3%, and from patients administere

We used a rabbit model to test the postoperative mechanical strengths of two new tendon suture techniques. These were compared with the conventional modified Kessler and double looped suture techniques. For each technique, maximum load until 3 mm gap, load at 1 mm gap and ultimate load were measured at the time of operation and at weeks 1 and 3 after operation.Maximum load until 3 mm gap and load at 1 mm gap were significantly higher in the new techniques than in the conventional techniques at the time of operation and at 1 week; there was no statistical difference between the four techniques at 3 weeks. No technique resulted in a decrease in maximum load until 3 mm gap, load at 1 mm gap and ultimate load at 1 week.The new techniques reported here have the potential to withstand early active flexion exercises.

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In 16 institutions around the entire Japan, 557 strains of presumably etiological bacteria were isolated mainly from the sputa of 449 patients with lower respiratory tract infections during the period from October 1996 to September 1997. MICs of various antibacterial agents and antibiotics were determined against 98 strains of Staphylococcus aureus, 93 strains of Streptococcus pneumoniae, 84 strains of Haemophilus influenzae, 84 strains of Pseudomonas aeruginosa (non-mucoid strains), 17 strains of Pseudomonas aeruginosa (mucoid strains), 31 strains of Moraxella subgenus Branhamella catarrhalis, 21 strains of Klebsiella pneumoniae etc., and the drug susceptibilities of these strains were assessed except for those strains that died during transportation. 1) S. aureus S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus) accounted for 67.3%. The frequency of the drug resistant bacteria increased comparing to the previous year's 52.7%. Arbekacin (ABK) and vancomycin (VCM) showed the highest activities against both S. aureus and MRSA with MIC80s of 1 microgram/ml. 2) S. pneumoniae Imipenem (IPM) and panipenem (PAPM) of carbapenems showed the most potent activities with MIC80s of 0.063 microgram/ml. Faropenem (FRPM) showed the next potent activity with MIC80 of 0.125 microgram/ml. The other drugs except erythromycin (EM), clindamycin (CLDM) and tetracycline (TC) were active against S. pneumoniae tested with MIC80s of 8 micrograms/ml or below. 3) H. influenzae The activities of all drugs were potent against H. influenzae tested with MIC80s of 4 micrograms/ml or below. Cefotiam (CTM), cefmenoxime (CMX), cefditoren (CDTR) and ofloxacin (OFLX) showed the most potent activities with MIC80s of 0.063 microgram/ml. 4) P. aeruginosa (mucoid strains) Tobramycin (TOB) showed the most potent activity against P. aeruginosa (mucoid strains) with MIC80 of 1 microgram/ml. Ceftazidime (CAZ), cefsulodin (CFS), IPM, gentamicin (GM), ABK and ciprofloxacin (CPFX) showed the next potent activities, with MIC80s of 2 micrograms/ml. The MIC80s of the other drugs ranged from 4 micrograms/ml to 16 micrograms/ml. 5) P. aeruginosa (non-mucoid strains) TOB and CPFX showed the most potent activities against P. aeruginosa (non-mucoid strains) with MIC80s of 1 microgram/ml. The MIC80s of piperacillin (PIPC) and cefoperazone (CPZ) were 16 micrograms/ml in 1995, and they were 64 micrograms/ml in 1996. 6) K. pneumoniae All drugs except ampicillin (ABPC) were active against K. pneumoniae. CMX, cefpirome (CPR), cefozopran (CZOP) and carumonam (CRMN) showed the most potent activities against K. pneumoniae with MIC80s of 0.125 microgram/ml. The MIC80s of the other drugs ranged from 0.25 microgram/ml to 2 micrograms/ml. 7) M.(B) catarrhalis Against M.(B.) catarrhalis, all drugs showed good activities with MICs of 4 micrograms/ml or below. IPM and minocycline (MINO) showed the most potent activities with MICs of 0.063 microgram/ml. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. Patients' backgrounds were examined for 557 isolates from 449 cases. The examination of age distribution indicated that the proportion of patients with ages over 60 years was 71.0% of all the patients showing a slight increase over that in 1994. Proportions of diagnosed diseases were as follows: Bacterial pneumonia and chronic bronchitis were the most frequent with 35.9% and 30.3% respectively. They were followed by bronchiectasis with a proportion of 10.

We studied the micro-agglutination method (MAT) for the diagnosis of legionellosis. Serum samples were collected from 44 clinically legionellosis suspected patients (17 positive with indirect immunofluorescent antibody technique [IFA] and 27 IFA negatives) and 20 healthy adults (25-30 years old). MAT showed negative results with sera collected from healthy adults and IFA negative patients, 8 out of 17 cass of IFA positive patients showed positive results in MAT. The remaining 9 cases out of 17 were negative in MAT judging from our criteria (1:256 in single serum or fourfold rise to 1:128 in pair sera). MAT had good proportion to IFA in samples collected within three weeks after onset of each disease. All sera that became positive in MAT were sampled within four weeks after onset of each illness. It was noted that MAT was mainly related to IgM-class antibodies. These relationships must be decided by investigating more cases of legionellosis. According to the result of this study, the MAT method was thought to be useful for rapid diagnosis of legionellosis.

Bacteria isolated from lower respiratory tract infections were collected in cooperation with institutions located throughout Japan, since 1981. IKEMOTO et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In 23 institutions around the entire Japan, 492 strains of presumably etiological bacteria were isolated mainly from the sputum of 421 patients with lower respiratory tract infections from October 1994 to September 1995. MICs of various antibacterial agents and antibiotics were determined against 70 strains of Staphylococcus aureus, 101 strains of Streptococcus pneumoniae, 92 strains of Haemophilus influenzae, 61 strains of Pseudomonas aeruginosa (non-mucoid strains), 25 strains of Pseudomonas aeruginosa (mucoid strains), 48 strains of Moraxella subgenus Branhamella catarrhalis, 14 strains of Klebsiella pneumoniae etc., and the drug susceptibilities of these strains were assessed except for those strains that died during transportation. 1. S. aureus. S. aureus strains for which MICs of oxacillin were higher than 4 micrograms/ml (methicillin-resistant S. aureus) accounted for 51.4%, but the frequency of the drug resistant bacteria decreased comparing to the previous year's 56.0%. Vancomycin showed the highest activity against S. aureus with MIC80 of 0.5 microgram/ml. 2. S. pneumoniae. Most of the drugs tested showed potent activities against S. pneumoniae. Imipenem of carbapenems showed the most potent activity with MIC80 was 0.063 microgram/ml. Erythromycin and clindamycin showed low activities with MIC80sor = 256 micrograms/ml. Among these strains, however, 46.5% and 68.3% of strains, were quite sensitive toward these agents, respectively, with MICs of 0.063 microgram/ml. 3. H. influenzae. The activities of all drugs were potent against H. influenzae tested. Cefmenoxime a cephem, showed the most potent activity, the MICs of this drug against all of the 92 strains were 0.063 microgram/ml. Ofloxacin also showed a potent activity, and inhibited about 96% of strains with MIC of 0.063 microgram/ml. 4. P. aeruginosa (mucoid strains). Tobramycin showed the most potent activity against P. aeruginosa (mucoid strains) with MIC80 of 0.5 microgram/ml. Gentamicin, arbekacin and ciprofloxacin showed next potent activities, and their MIC80s were 2 micrograms/ml. 5. P. aeruginosa (non-mucoid strains). Tobramycin showed the most potent activity against P. aeruginosa (non-mucoid strains) with MIC80 of 2 micrograms/ml. Comparing to the activities against P. aeruginosa (mucoid strains), the activities of all the drugs tested were lower against P. aeruginosa (non-mucoid strains). 6. K. pneumoniae. Carumonam showed the most potent activity against K. pneumoniae with MIC80 of 0.063 microgram/ml. Cefozopran showed the next most potent activity with MIC80 of 0.125 microgram/ml. Ampicillin and cephems except cefpodoxime, cefozopran and cefditoren showed low activities and their MIC80s wereor = 16 micrograms/ml, and their MICs were all higher thanor = 4 micrograms/ml. 7. M. (B.) catarrhalis. Imipenem and ofloxacin showed the most potent activities against M. (B.) catarrhalis, their MIC80s were 0.063 microgram/ml. Erythromycin and minocycline showed the next highest activities with their MIC80s at 0.25 microgram/ml. Also, we investigated year to year changes in the background of patients, the respiratory infectious diseases, and the etiology of bacteria. Patients characteristics, in this period of investigation showed varieties of infectious diseases found in patients in a high age bracket, and the patients over age 60 accounted for 62.0% of all the cases. Different lower respiratory tract infectious were distributed as follows: chronic bronchitis and bacterial pneumonia accounted for the greatest number of cases with 35.6%, 27.1%, respectively, followed by

It is generally considered that we have already been through with problems caused by various kinds of parasites which had once raged throughout the country. On the contrary to our common concept, we occasionally encounter some kinds of parasites in a laboratory as well as in clinical fields, which have become unfamiliar to us in these days. Parasitic diseases are in the first place, proper and limited to certain local regions, but the present situation has been greatly changed. Nowadays, specific parasites are no longer limited to polluted areas, but also they can be detected in any part of the world owing to facilitated transportations and a promoted international exchange of people. A recent gourmet boom is also one of the causes of infection as seen in anisakiasis. This study was conducted on the investigation of parasites detected from clinical specimens in our laboratory during the period from 1989 to 1993. 1) The following parasites were detected : (1) Strongyloides stercoralis, (2) Giardia lamblia, (3) Diphyllobothrium latum, (4) Schistosoma mansoni, (5) Entamoeba histolytica, (6) Necator americanus, (7) Isospora belli. 2) Strongyloides stercoralis was detected at the highest frequency. This result gives an account of high prevalence of the parasite among the inhabitants in Okinawa. In addition, the agar plate medium method which has been newly adopted has definitely led to far-advanced results for detection of this parasite. 3) Schistosoma mansoni and Necator americanus were found from foreigners one of whom was a Tanzanian and the other was a Dominican. 4) Isospora belli was found from those compromised cases such as ATL and AIDS.

Multiple Pseudomonas aeruginosa strains with different characteristics are occasionally isolated from a clinical specimen. Therefore, more than five isolated colonies of P. aeruginosa obtained at random from each clinical specimen (47 sputa, 18 urine, 10 pus and 8 others). These were investigated for serotype, drug susceptibility to eight antimicrobial agents and productivity of enzymes, such as protease and elastase. The specimens with multiple serotype colonies were shown in 17% of the sputa, 11% of the urine and 10% of the pus. 45.7% of the specimens with single serotype colonies exhibited more than two different patterns of enzyme productivity and so did 47.1% different patterns of drug susceptibility. Single serotype strains of P. aeruginosa with different characteristics of these tests were demonstrated in 81.3% of the urine, 73.6% of the sputum, 50.0% of the pus and 66.7% of others. We conclude that it is important to recognize the possible existence of multiple P. aeruginosa strains with different patterns of the enzyme productivity and drug susceptibility, regardless of single serotype, in clinical specimens.

The pathogenicity of Streptococcus constellatus in pulmonary infections was investigated in mice in correlation with the phagocytic killing of the microorganisms by human polymorphonuclear neutrophils (PMNs). The histological inflammation score of the lungs in mice inoculated intratracheally with 10(8) cfu/mouse of the virulent strain S. constellatus RZYK001 obtained from bronchoalveolar fluid of a patient with pneumonia, was significantly higher than in mice inoculated with the avirulent strains S. constellatus RT4303 and RT6002 obtained from saliva of healthy adults (p0.001). The bactericidal activity of human PMNs against Staphylococcus aureus ATCC 25923 was not inhibited at all by the culture filtrate of the virulent strain, but the killing index against RZYK001 was 36.4% after 90-min incubation whereas that against RT4303 and RT6002 was 94.7% and 99.4%, respectively (p0.001). Therefore, these results suggest a possible pathogenic mechanism of S. constellatus apparently mediated by a structural component of the organisms so that a virulent strain is less likely to be killed than an avirulent one, predisposing it to survive in the infection sites.

We had examined antibody titers against Legionella spp. of patients' sera which were mainly sent from other hospitals, performed with the indirect fluorescent antibody (IFA) method. The clinical status of the cases diagnosed as Legionella pneumonia serologically, were also studied. Out of 105 cases with clinically suspected Legionella pneumonia, 15 cases (14.3%) were seropositive. In 9 out of the 15 cases (60.0%) were caused by Legionella pneumophila serogroup 1. Clinical outline of these 15 cases did not contradict those reported in the literature, and erythromycin was effective in many cases. Significant rises (more than four times) of the titer were observed 3 to 4 weeks after onset in most of cases. We would like to emphasize that this should be performed serodiagnosis of Legionella pneumonia.

The bacteriology of empyema fluid and the clinical background of 23 cases from July 1987 through July 1992 were studied. Nineteen cases were male and 4 female, with a mean age of 59.6 years (range; 33 to 84 y.o.). There were 15 cases of community-acquired infection and 8 of nosocomial infection. Acute pneumonia and/or lung abscess developed into empyema in 19 cases. Sixteen cases had associated predisposing conditions, such as diabetes, chronic bronchitis, disorders with dysphagia, and excess alcohol intake. Forty-one strains were isolated from empyema in 22 cases. The predominant organisms, in order of prevalence, were "Streptococcus milleri" group (11 strains), Peptostreptococcus spp. (6), Prevotella spp. (6), Fusobacterium spp. (5) and other viridans streptococci (3). The majority of streptococcal infections, which were primarily caused by "S. milleri" group, were mixed with anaerobes and/or aerobes/facultatives. These results demonstrate that oral streptococci, especially "S. milleri" group, and anaerobes play a significant role as pathogens in empyema.

Forty patients with chronic respiratory infections were randomly assigned to 2 groups to compare the effect of once daily administration of 300 mg each and 3 times daily administration of 600 mg each of ofloxacin (OFLX). Twenty patients were administered with 300 mg OFLX a day and 18 cases received 600 mg. The number of underlying diseases in the 300 mg group was greater than that in the 600 mg group. The ratios of general amelioration of clinical symptoms were 80.0% in the 300 mg group and 88.9% in the 600 mg group. For bacteriological effects, the eradication rate was 80.0% in the 300 mg group and it was 84.6% in the 600 mg. The incidence of side effects in the 300 mg group was 0% and that of the 600 mg group was 5.6% (1 patient) but the symptom was mild. The incidence of abnormal laboratory test results was 15.0% in the 300 mg group and it was 11.2% in the 600 mg group, but all of these abnormalities were slight and transient. The safety rates in the 300 mg and the 600 mg groups were 95.0% and 94.4%, respectively. Efficacy rates in the 300 mg and the 600 mg groups were 80.0% and 88.9%, respectively. There was no statistically significant difference in all the results between the 2 treatment groups, and the both treatments were highly effective. From the above results, we consider that once daily administration of 300 mg is a useful therapy in respiratory tract infections.

We have tried to characterize the blastogenic responses of murine spleen lymphoid cells from BALB/c mice immunized with Legionella pneumophila serogroup (SG) 1 (Philadelphia 1 strain) and non-treated mice. Lymphoid cells from immunized mice showed stronger blastogenic responses following stimulation with concanavalin A or formalin-treated L. pneumophila SG1 whole cell antigen than those showed by lymphoid cells from non-treated mice. These cells from immunized mice also responded strongly when stimulated in vitro with other SGs of L. pneumophila, while these responded weakly when stimulated with other species of Legionella. Serum antibody titers of immunized mice against each SG of L. pneumophila were examined and the cross reactions were also recognized. However, the relatedness of serum antibody titers and the blastogenic responses against each serogroup of L. pneumophila was small. The epitopes recognized by the cellular immunity might be different in part from those recognized by serum antibodies, and investigations should be made on what the cellular immunity recognizes and how it works.

Fifty-two patients with moderate or severe infections associated with internal medicine were treated with imipenem/cilastatin sodium (IPM/CS) and the efficacy and the safety of this drug were evaluated. There were 20 patients with pneumonia, 10 with acute exacerbation of chronic respiratory tract infections, 9 with sepsis, 2 with pyothorax, 3 with intraabdominal infection, 2 with urinary tract infection, 1 with pulmonary abscess, 1 with infective endocarditis, 4 with fever of unknown origin. Forty-four patients were evaluable for the efficacy. Clinical efficacies were excellent in 12 patients, good in 26, fair in 3 and poor in 3. The overall clinical efficacy was 86.4%. The efficacy rate was 63.6% in patients previously treated and 93.9% in patients previously untreated with other antibiotics. Bacteriologically, Staphylococcus aureus (8 strains), Streptococcus pneumoniae (5), Streptococcus pyogenes (1), other Gram-positive coccus (1), Klebsiella pneumoniae (8), Haemophilus influenzae (4), Pseudomonas aeruginosa (3), Serratia marcescens (3), Escherichia coli (3), Branhamella catarrhalis (1), Citrobacter freundii (1), Klebsiella oxytoca (1), Enterobacter sp. (1), and Peptostreptococcus sp. (1) were eradicated. P. aeruginosa (3) and Acinetobacter sp. (1) decreased. S. aureus (1), S. epidermidis (1), P. aeruginosa (5), and S. marcescens (1) persisted or appeared. The eradication rate was 83.7%. Six patients showed adverse reactions including general fatigue 1, epigastralgia 1, eruption 1, eosinophilia 1 and elevation of S-GOT 2. But all of the adverse reactions were mild or slight, and transient. These findings indicate that IPM/CS is a useful and safe drug against bacterial infections in internal medicine.

Methicillin-resistant Staphylococcus aureus (MRSA) isolated in our hospital between 1986 and 1989 were mainly examined for their susceptibility to various antibiotics and coagulase types. The isolation frequency of MRSA among S. aureus isolated from clinical specimens has been steadily increasing; 37.8% in 1986, 49.8% in 1987, 60.6% in 1988 and 63.2% in 1989. This trend was particularly noticeable in the specimens associated with the respiratory tracts. The isolation rate of MRSA in the surgery and pediatrics wards was higher than that in the internal medicine ward. More than 80% of MRSA were coagulase type II, which were multi-resistant to penicillins, cephems, aminoglycosides and macrolides, and sensitive to MINO, new quinolones and VCM. These epidemic strains were also isolated from the nose of medical staff and from air samples in the wards. These findings suggest that the hospital environment including the patients and hospital personnel is extensively contaminated with multi-resistant MRSA of coagulase type II. Measures should be taken for prevention and control of nosocomial infection with MRSA in the whole hospital.

We have examined background factors in MRSA infection in cases in which S. aureus had been isolated from sputa. The incidence of isolation of S. aureus was high and still increasing in expectorated sputa, and causative organisms in the cases of pneumonia and autopsied lungs. A significant correlation was observed between high incidence of isolation of S. aureus and abuse of third-generation cephems. MRSA isolation rates of inpatients was higher than that of outpatients. Among the inpatients such cases with severe underlying diseases and prolonged admission showed the highest incidence of isolation of MRSA. There seemed to be a correlation between distribution of patients with S. aureus and that of rooms with S. aureus in the air. This suggests nosocomial infection. Although MRSA was frequently isolated from sputa, most cases showed no signs of infection, and this suggested that they had been transient colonization. Such antimicrobial agents as rifampicin, teicoplanin, vancomycin reveal excellent antibacterial activity against MRSA and minocycline, ofloxacin were moderately effective. The physician must be informed of the significance of MRSA, because their understanding of MRSA still remains insufficient.

Tuberculin purified protein derivative (PPD) is a relatively crude antigen prepared from Mycobacterium tuberculosis and has species nonspecificity in immunological reaction. It is, however, more readily available than more highly purified materials. Therefore, the detection of IgG antibody to PPD was done by enzymed-linked immunosorbent assay (ELISA) and its diagnostic useful was evaluated in this study. The patients with active tuberculosis had significantly high titer of IgG antibody to PPD compared with healthy persons and the patients without tuberculosis (P less than 0.001). An upper limit of normal set (=cut-off titer) at 2 standard deviations above mean of logarithmic titers in 220 healthy adult subjects would result in positive test reactions on the sera from 78 of 100 patients with active tuberculosis. Although 8 of 39 with atypical mycobacteriosis would be positive, 6 of 7 were distinguished almost with tuberculosis by detecting antibodies to PPD from M. intracellulare and M. kansasii concurrently. The antibody titer increased after chemotherapy would be gradually reduced under the cut-off titer when culture of mycobacteria turned to negative and markers of inflammation became negative. In false-negative cases, 4 were patients with hypo-gammaglobulinemia, 6 were with fresh tuberculosis before chemotherapy, 2 were with negative CRP in all clinical course and 4 were with bacilli needed over 7 weeks culture. From these results, this assay is helpful in the diagnosis of tuberculosis and a useful marker for judgment of clinical improvement, although detection of antibody has its limitations.

A case of severe head injury associated with fulminant pulmonary edema considered as neurogenic which developed within short time after the injury was presented. A five-year-old boy who had no previous history of cardiopulmonary disease was struck on his right frontal region by car accident at 15.30 PM on July 5 of 1979. Immediately after the impact he lost his consciousness and subsequently transferred to a local hospital where bilateral dilated pupil and flaccid paralysis of the limbs were noted. On transmission of the patient to Omuta City Hospital 30 minutes after the injury, massive foamy fluid was discharged from the tracheal tube. On admission, he was comatous, with bilateral dilated and fixed pupils and flaccid paralysis of the limbs. There was no retinal bleeding. He showed ataxic respiration with severe stridor and massive discharge of foamy fluid pinkish in colour from the trachea characteristic in pulmonary edema was significant. Chest x-ray film demonstrated perihilar densities suggesting pulmonary edema. CT scan showed extremely small ventricle on both sides without manifestations of intracranial hematomas or cerebral contusion. With an intensive medical treatments including corticosteroids, alkalizing agents and alpha-blocker were administered under controlled respiration, the discharge of edema fluid was gradually decreased and the findings on blood gases were also improved. However neurological signs were aggravated and he died 8 hours after the injury. Central venous pressure was maintained at the level between 8 to 10 cm. From these clinical findings the pulmonary edema was concluded as neurogenic. Direct or indirect injury to the hypothalamic efferent pathway at the level of lower brain stem seemed to be important as the cause of neurogenic pulmonary edema in this case. The possible pathophysiology of neurogenic pulmonary edema associated with brain stem injury and intracranial hypertension was discussed with other related literature.

Histopathological observations were made on the spontaneous age-related kidney lesion in relation to some biochemical measurements for renal function using male SD rats from 82 to 560 days of age. Although all the rats examined were appearently healthy and had no gross lesions in the kidneys, several renal changes were detected histopathologically in the kidneys. The lesions occurred initially in renal tubules and then in glomerulus and in interstitial tissues successively increasing in severity with age. There was a correlation between the degree of the histopatholigical changes and the excreted amount of protein and sodium in the urine. The urinary protein was first detected at 34 days of age increasing with age. For rats of over 395 days of age, the urinary protein was greatly variable in amount among individuals. The negative correlation between urinary protein levels and those of serum albumin and urinary potassium was significant.

A rare case of duplication of the middle cerebral artery with a ruptured aneurysm on its origin during pregnancy was reported. A 29-year-old woman, primipara, was admitted to our clinic at 17 weeks' gestation on June 26, 1979 with a history of sudden onset of severe headache and vomiting, followed by unconsciousness fit for 30 minutes. The patient displayed typical features of subarachnoid hemorrhage. Lumbar puncture revealed bloody CSF. Right carotid angiogram 20 days after admission demonstrated duplication of the middle cerebral artery arising from the terminal internal carotid artery and a small aneurysm at its origin. There was evidence of associated spasm in the internal carotid artery, M1 and A1 portion without hematoma. The patient was treated conservatively for 2 months and then aneurysm surgery was performed. At operation, under the hypotensive anesthesia, on August 21, 1979, the presence of duplication of the middle cerebral artery on the right side and ruptured aneurysm on its origin were confirmed. The neck of aneurysm was completely clipped. Fetal heart rates were monitored by Doptone monitor during the operation. Postoperative course was excellent. Three months postoperatively, the patient went into spontaneous labor, at 40 week's gestation, and delivered a healthy infant. Clinical management of subarachnoid hemorrhage in pregnancy and the relationship between anomaly of the middle cerebral artery and aneurysm were discussed with the literature.