It is believed in Japan that only psychiatrists are capable of providing reliable psychiatric diagnosis. However, more awareness of mental health issues related to perinatal care means that midwives are now required to have psychiatric diagnostic skills. The purpose of the present paper was to examine how well Japanese midwives agreed with a psychiatrist on diagnoses of different psychiatric disorders. Vignettes of 29 cases including DSM-IV mood disorders (major depressive disorder and bipolar disorder) and anxiety disorders (generalized anxiety disorder, panic disorder, phobic disorders, and obsessive-compulsive disorder) were distributed to 12 Japanese midwives. They decided the DSM-IV diagnoses independently and compared them with those made by an expert. The kappa coefficients of the diagnoses with a base rate of 0.1 or more were moderate to almost perfect (0.64-0.83). The accuracy of symptom assessment was also satisfactory. Appropriately trained Japanese midwives can use the diagnostic criteria for psychiatric disorders reliably. It is therefore feasible to dispatch midwives who are trained in psychiatric diagnosis to antenatal clinics.

An 51-year-old man had undergone surgery for Rathke's cleft cyst by transsphenoidal approach on October 2015. After the surgery, cerebrospinal fluid (CSF) rhinorrhea arose. Surgical treatment of CSF rhinorrhea was performed by the same approach. Ten days after reoperation, he suffered from severe headache, high fever, and nuchal rigidity. CSF findings indicated bacterial meningitis. CSF culture showed methicillin-resistant Staphylococcus lugdunensis. He received vancomycin intravenously for 19 days and recovered from the bacterial meningitis with no serious complication.

No abstract

Amphotericin B is recommended for the treatment of pyelonephritis caused by Candida glabrata. However, as its nephrotoxicity is well known, liposomal amphotericin B (L-AMB) was developed to reduce the adverse effects. There have been few reports of L-AMB as a treatment for urinary tract infection. One reason is its low excretion rate in urine. We report the first case of pyelonephritis caused by C. glabrata successfully treated with L-AMB. In 2011, a 52-year-old diabetic woman developed pyelonephritis and renal abscess caused by C. glabrata after transurethral ureterolithotripsy, which was treated with oral fluconazole administration for 12 days. Residual fragments of renal pelvic calculus then gradually increased and caused intermittent asymptomatic candiduria with C. glabrata. In 2015, a week after right ureteral stenting for a ureteral stone, the patient was hospitalized for management of a fever and left lumbar pain. A left ureteral stone had caused hydronephrosis and pyelonephritis, and left ureteral stenting was thus performed. Fluconazole was administered intravenously for pyelonephritis with C. glabrata for 3 days, but failed to control the high-grade fever, and was thus discontinued. L-AMB administration for 11 days treated the pyelonephritis successfully. Although slight increases in serum creatinine and blood urea nitrogen levels and a serum potassium decrease were observed, no treatments were necessary. L-AMB is highly concentrated in renal tissue and plasma, which may account for its efficacy in treating pyelonephritis, which is an infection of the renal parenchyma.