An 81-year-old man was referred to our hospital with bilateral multiple patchy opacities on chest radiography. His chief complaints were a few months’ history of intermittent mild cough and slightly yellow sputum. Chest computed tomography (CT) showed non-segmental air-space consolidations with ground-glass opacities. Amyloid deposition with organizing pneumonia (OP) was seen in transbronchial lung biopsy (TBLB) specimens from the left S8. Three months later, the infiltration originally seen in the left lower lobe was remarkably diminished, and new infiltrations in the lingual and right lower lobes were detected on chest CT. Amyloid deposition with OP was seen in TBLB specimens from the left S4. Transthyretin was detected following immunohistochemical examination. The presence of wild-type transthyretin (ATTRwt) was proven using genetic analysis. The present report describes a rare case of ATTRwt amyloidosis associated with OP.

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic

Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.