A case of myasthenia gravis in which the interval to repeated exacerbation was prolonged by L-carnitine

We report the case of a 62-year-old woman diagnosed with myasthenia gravis. She felt dyspnea and weakness of bilateral upper limbs, followed by left blepharoptosis. Pyridostigmine markedly improved her symptoms. But later, blepharoptosis and head drop worsened and predonisolone was ineffective. Yet, after intravenous immunoglobulin therapy her symptoms markedly improved. However, her head drop worsened at intervals of 25.79 days on average. She was administered L-carnitine, and the interval until exacerbation became longer (40.67 days on average). This case is interesting because L-carnitine therapy has never been reported as therapy for myasthenia gravis

Clinical effect of 3g/day administration of meropenem on severe pneumonia

We examined the clinical effect of Meropenem (MEPM) on severe pneumonia. We administered 3g of Meropenem daily to 20 patients with severe pneumonia: 8 communityacquired pneumonia patients, 9 nursing and healthcare-associated pneumonia patients, and 3 hospital-acquired pneumonia patients. It was effective in 15 of the 20 patients (75%): 8 of 8 community-acquired pneumonia patients (100%), 6 of 9 nursing and healthcare-associated pneumonia patients (66.6%), and 1 of 3 hospital-acquired pneumonia patients (33.3%). Bacteriologically, 9 of a total of 10 strains (90%) were eradicated: 4 of 4 Streptococcus pneumoniae strains, 2 of 2 methicillin-sensitive Staphlococcus aureus strains, 1 of 2 Enterococcus faecalis strains, 1 of 1 Klebsiella pneumoniae strain, and 1 of 1 Escherichia coli strain. Hepatic dysfunction was observed as a side effect in 8 patients (40%). Based on the above, administration of MEPM daily 3 g is extremely effective for community-acquired pneumonia, while it appears ineffective in many cases of nursing and healthcare-associated pneumonia or hospital-acquired pneumonia, and results in hepatic dysfunction at a high frequency

Q fever in acute upper respiratory tract infection

We examined whether or not acute upper respiratory tract infection is associated with Q fever (Coxiella burnetii infection). The subjects consisted of 124 patients with acute upper respiratory tract infection. At initial medical consultation, the presence or absence of serum C. burnetii was examined by nested PCR method. Of the 124 patients, no patients (0 percent) were positive for C. burnetii in serum. These results suggested that the involvement of Q fever in acute upper respiratory tract infection is extremely low

Association between ImmunoCard Mycoplasma test and particle agglutination (PA) method in Mycoplasma pneumonia diagnosis

We examined the association between ImmunoCard Mycoplasma test and particle agglutination (PA) method in Mycoplasma pneumonia diagnosis. Subjects were 105 pneumonia patients who were positive for ImmunoCard Mycoplasma test at initial consultation and followed up by PA method using paired sera. The coincidence rates of positive cases of ImmunoCard Mycoplasma test and positive cases of PA method were examined by generation. The results showed that the coincidence rate was 87.5% in aged less than 19 years, 48.8% in aged 20-39 years, 36.4% in aged 40-59 years, 21.1% in aged 60-79 years, and 25.0% in aged 80 or greater, for a total of 44.8% (47 of 105 patients). The results suggested that a positive result for ImmunoCard Mycoplasma test may be due to acute infection in patients aged 19 years or less; however, 50% or more of patients aged 20 years or greater were false positive, which may reflect the presence of past infection

Clinical effect of sulbactam/ampicillin on community-acquired pneumonia with positive Streptococcus pneumoniae urinary antigen test

We investigated the efficacy of intravenous penicillin (sulbactam/ampicillin: SBT/ABPC) in adult patients with positive Streptococcus pneumoniae urinary antigen test requiring hospitalization. We administered 3g of SBT/ABPC intravenously in the morning and evening for 7-14 days to 32 adult community-acquired pneumonia patients with positive Binax NOW(R) S. pneumoniae urinary antigen. Clinical efficacy, bacteriological efficacy, and side effects of these patients were prospectively examined. We observed clinical efficacy in a total of 28 of 32 patients (87.5%); 24 of 26 moderate patients (92.3%), and four of six severe patients (66.7%). Side effects were drug eruption, increased GOT, increased AMY, and decreased WBC, observed in one patient each; however, all were mild. SBT/ABPC is extremely useful in patients with positive S. pneumoniae urinary antigen test requiring hospitalizatio

脊髄梗塞の1例

症例は66歳男性で,30本/日の喫煙歴がある.両肩にピリピリしたしびれ感が出現し,その後両上肢と左下肢の動きにくさが出現しその後急激に四肢の筋力が低下し歩行できなくなり,自力で呼吸もできなくなったため緊急入院.気管切開を施行し,人工呼吸器の使用を開始した.頸髄MRIにてC3-6レベルに異常信号域を認め,脊髄梗塞が疑われた.四肢麻痺(左上下肢は不全麻痺,右上下肢は完全麻痺)を認めた.腱反射は左上下肢および右上肢で消失しており,病的反射はみられなかった.両上肢および臍部以下の温痛覚低下を認めたが,触覚や深部感覚は正常であった.頸髄MRIではC3-6レベルにT2強調画像で高信号域を認めた.急性の発症であることや頸髄MRI所見から脊髄梗塞と診断し,オザグレルナトリウム,エダラボン投与とリハビリテーションを開始し,呼吸状態は改善し人工呼吸器から離脱した.左上下肢および右下肢の筋力はやや改善を認めたが,自立歩行できない状態が残存した.右上肢は手指の動きが出てきたが,挙上はできない状態が残存した.脊髄梗塞は稀な疾患であり,その原因としては動脈硬化が多く,その他として大動脈解離,血管奇形,腫瘍塞栓,血管炎,手術や血管造影による医原性,椎間板ヘルニアなどがある.本例では明らかな大動脈解離がなく,血液検査で炎症所見が見られず,頸動脈超音波検査で両総頸動脈のIMT(内膜中膜複合体厚)肥厚を認め,頭部MRIで左椎骨動脈より右椎骨動脈の血管径が細く,頭部MRAの原画像で右椎骨動脈の血流信号が欠如していたことから,原因としては喫煙による動脈硬化が考えられた.急激に発症した四肢麻痺を見た場合には,脊髄梗塞の可能性があることも念頭に置き脊髄MRIを施行すべきと考える.We report the case of a 66-year-old man, a heavy smoker (30 cig/day), diagnosed with spinal cord infarction. He had first noted an abnormal sensation in both shoulders. After that, he complained of acute onset of paralysis of all four limbs and trouble breathing. He was admitted to our hospital for emergency tracheostomy and endotracheal intubation. On neurological examination, he had left hemiparesis, right hemiparalysis, areflexia in both arms and left leg, disturbance of pain and temperature sensation in both arms and hypogastric region. His touch and deep sensation were normal. Spinal cord MRI revealed a high signal lesion at C3-6 level on the T2-weighted image. He was diagnosed spinal cord infarction because of the acute onset of symptoms and MRI findings. He was started on sodium ozagrel and edaravone, as well as rehabilitation. As his respiratory disturbance improved, he was weaned from respiratory support. Muscle strength of left arm and both legs improved slightly, but he could not walk. Muscle strength of right fingers improved slightly, but he could not raise his arm. Spinal cord infarction is a rare disease. Causes of spinal cord infarction are atherosclerosis, aortic dissection, vascular malformation, tumor thrombus, vasculitis, a herniated disk and iatrogenic causes such as surgery and angiography. Our patient did not have aortic dissection on chest and abdominal CT. Blood examination did not reveal findings of inflammation. Carotid artery ultrasonography revealed thickening of intima-media thickness of bilateral common carotid artery. Brain MRI revealed blood vessel diameter of right vertebral artery more narrow than left vertebral artery. Brain MRA revealed lack of blood flow signal of right vertebral artery. Consequently, we speculated that the cause of spinal cord infarction in this patient was atherosclerosis due to smoking. Thus, in patients with acute quadriplegia the possibility of spinal cord infarction should be considered, and spinal cord MRI should be performed