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The urine bilirubin structural isomers may be used to estimate the serum (EZ)-cyclobilirubin levels and to evaluate the clinical effects of light sources.

It had been thought until the appearance of methicillin-resistant Staphylococcus aureus (MRSA) 10 years ago that all infections by pathogenic bacteria were curable by treatment with antimicrobial drugs. Even in cases in which MRSA is susceptive to vancomycin (VCM), treatment of MRSA infection with antimicrobial agents is diffi cult because MRSA has the biological property of forming a biofi lm. A biofi lm is composed of a bacterial lump surrounded by fi brin and provides an environment for the survival of bacteria. Combined treatment with urokinase and an antimicrobial agent has been shown to be effective for treating intractable catheter sepsis. However, there is still no effective treatment for intractable sepsis caused by a biofi lm adhering to an artifi cial blood vessel. In this report, the effectiveness of combined treatment with urokinase and VCM for a case of intractable sepsis that suggested the possibility of formation of an MRSA biofi lm is described. Case reportThe patient was an 8-month-old female infant who was diagnosed as having esophageal atresia (Gross C type), right renal aplasia, and tetralogy of Fallot. A chromosome test using the G-banding method showed no abnormalities. At 3 days after birth, the patient underwent radical treatment for the esophageal atresia. The patient was admitted to Kagawa University Hospital, Kagawa, Japan, at the age of 8 months due to a poor general condition caused by infl uenza virus infection. On administration, weight and height of the patient were only 4.3 kg and 55 cm, respectively. MRSA was not isolated from throat culture. The results of cardiac ultrasonography and a cardiac catheter examination revealed a reduction in blood fl ow in the pulmonary artery, and modifi ed Blalock -Taussig operation was performed. A polytetrafl uoroethylene (PTFE) graft (4 mm) was used for a shunt. The operation was completed without diffi culty. Overfl ow of the pulmonary artery due to the shunt did not occur after the operation. Cefazolin was given for prophylaxis after the operation, and cefazolin was changed to piperacillin and amikacin 1 week after the modifi ed BlalockTaussig operation, because the patient had fever and elevated levels of C-reactive protein (CRP; 24.4 mg/dL) and leukocytes (33 600/ L; Leukocytes included 27.5% rod-shaped leukocytes and 60.5% segmented leukocytes). Since MRSA was isolated from blood culture at that time, a diagnosis of MRSA sepsis was made. The susceptibility to drugs in blood culture is shown in Table 1 . The antimicrobial drugs were immediately changed to VCM. VCM was given by 24 h continuous infusion at the dose of 200 mg/day so as to maintain blood concentration in the range of 15 -20 g/mL. Chest X-ray examination revealed a round shadow in the upper region of the left chest. Thoracotomy was performed 29 days after the modifi ed Blalock -Taussig operation, and the round shadow was found to be a seroma. The seroma was resected, but a chest X-ray examination showed that there was still a small round shadow. Cardiac ultrasonography showed n...