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Find video protocols related to scientific articles indexed in Pubmed.
IgG4-related pleuritis with chylothorax.
Intern. Med.
PUBLISHED: 07-15-2014
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Presently, 6 cases of IgG4-related pleuritis have been reported. We encountered a patient who developed chylothorax due to IgG4-related disease. To our knowledge, such patients have not been reported. This patient developed right-sided chylothorax and left-sided non-chylothorax lymphocyte-predominant pleuritis. Elevated serum and pleural IgG4 concentrations and histopathological analysis of pleural biopsy confirmed the diagnosis of IgG4-related pleuritis. Left-sided pleuritis improved with corticosteroid therapy, but right-sided chylothorax persists. IgG4-related disease can be one cause of chylothorax.
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Clinical characteristics of biopsy-proven allergic bronchopulmonary mycosis: variety in causative fungi and laboratory findings.
Intern. Med.
PUBLISHED: 06-15-2014
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The diagnosis of allergic bronchopulmonary mycosis (ABPM) has traditionally relied widely on Rosenberg's criteria, which emphasize immunologic responses while overlooking the investigation of mucous plugs as a primary criterion. Therefore, the characteristics of biopsy-proven ABPM require further elucidation. The aim of this study was to analyze the clinical characteristics of biopsy-proven ABPM and address whether full compliance with clinical criteria, such as the presence of asthma, and certain laboratory findings is necessary to establish a diagnosis of ABPM.
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Characteristics of tuberculosis in patients with rheumatoid arthritis: a retrospective single-center study.
Intern. Med.
PUBLISHED: 06-15-2014
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The objective of this study was to assess the characteristics of hospitalized patients suffering from tuberculosis with rheumatoid arthritis (RA), focusing specifically on those treated without anti-tumor necrosis factor (TNF) therapy.
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Development of multi-organ involvement including a left atrial myxoma-like lesion in a patient with granulomatosis with polyangiitis.
Intern. Med.
PUBLISHED: 06-01-2014
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A 76-year-old woman suffering from granulomatosis with polyangitis (GPA) developed organizing pneumonia with positive antineutrophil cytoplasmic antibodies and microscopic hematuria. Prednisolone improved the hematuria and radiological findings; however, after tapering the dose of prednisolone, a posterior left atrial wall mass was detected in association with a fever. Both regressed spontaneously, although secretory otitis media and sinusitis were noted; the resected sinusitis specimen exhibited vasculitis highly suggestive of GPA. The clinical picture of GPA with multi-organ involvement can vary. Recognizing the various manifestations of GPA is therefore necessary in order to provide an appropriate diagnosis and disease management.
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Deterioration of the immune response induced by sulfamethoxazole-trimethoprim in a rheumatoid arthritis patient with Pneumocystis jirovecii pneumonia.
Intern. Med.
PUBLISHED: 06-01-2014
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A 73-year-old woman with rheumatoid arthritis treated with methotrexate and prednisolone was admitted with dyspnea and ground-glass opacity on chest CT. We diagnosed her with Pneumocystis jirovecii pneumonia (PCP) based on a positive PCR analysis of Pneumocystis jirovecii and the presence of cysts in bronchoalveolar lavage fluid. The PaO2 was 74.7 Torr on room air, and treatment with sulfamethoxazole-trimethoprim only was initiated. The hypoxemia and ground-glass opacity increased on hospital day 3, and the administration of adjunctive steroid therapy resulted in an improvement in the patient's condition. Although patients with PCP with HIV infection and hypoxemia are often treated with adjunctive steroid therapy to prevent adverse immune reactions, the efficacy of additive steroid administration in case of non-HIV PCP has not been established.
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Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery.
Langenbecks Arch Surg
PUBLISHED: 05-27-2014
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Laparoscopic lymph node (LN) dissection around the middle colic vessels is technically demanding, thus raising controversy regarding the role of laparoscopic surgery for transverse colon cancer. We herein describe a cranial approach method to perform radical LN dissection around the middle colic vessels. The key characteristic of this approach is early division of middle colic vessels prior to mobilization of the colon.
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Diastereoselective additive trifluoromethylation/halogenation of isoxazole triflones: synthesis of all-carbon-functionalized trifluoromethyl isoxazoline triflones.
ChemistryOpen
PUBLISHED: 02-13-2014
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Highly functionalized 5-trifluoromethyl-2-isoxazoline derivatives featuring a triflyl (SO2CF3) group at the 4-position were successfully synthesized via diastereoselective trifluoromethylation and halogenation of isoxazole triflones using the Ruppert- Prakash reagent. The trifluoromethylation is quite general in terms of the substrates including 3,5-diaryl isoxazole triflones and 3-aryl-5-styrylisoxazole triflones to provide products in high yields with excellent diastereoselectivities. The highly functionalized 5-trifluoromethyl-2-isoxazoline derivatives are expected to be a new class of antiparasiticides. Thus the triflyl group both activates isoxazoles and the 4-postion of CF3 adducts, and has a potential biological function.
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A Patient who Survived Primary Seasonal Influenza Viral Pneumonia: Histologic Findings Obtained via Bronchoscopy.
Intern. Med.
PUBLISHED: 12-17-2013
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The histological findings and clinical course of primary seasonal influenza viral pneumonia have not been fully elucidated. We herein report the case of a 65-year-old man with primary seasonal influenza viral pneumonia. The patient presented with fever, myalgia, general fatigue and dyspnea of seven days duration. Chest computed tomography showed bilateral ground-glass opacity and consolidation. A rapid influenza virus antigen test was positive for influenza A virus. We diagnosed him as having community-acquired influenza pneumonia and started therapy with antibiotics plus oseltamivir; however, his symptoms, respiratory condition and radiological findings deteriorated. Polymerase chain reaction following bronchoscopy showed the bronchoalveolar lavage fluid to be positive for the influenza A virus. A right lower lobe transbronchial lung biopsy revealed type II pneumocyte metaplasia, acute and chronic interstitial infiltrates and alveolar organization without hyaline membranes or fibrin thrombi in the vascular lumen. Treatment with prednisolone at a dose of 60 mg/day (1 mg/kg) resulted in an improvement. The patient was discharged on hospital day 15. Two weeks after admission, the serum antibody titer for influenza A (H3N2) had increased significantly. No other pathogens were found either serologically or in the respiratory samples, and we diagnosed the patient to therefore have primary influenza viral pneumonia.
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A Favorable Response to Cisplatin, Pemetrexed and Bevacizumab in Two Cases of Invasive Mucinous Adenocarcinoma Formerly Known as Pneumonic-type Mucinous Bronchioloalveolar Carcinoma.
Intern. Med.
PUBLISHED: 12-17-2013
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The leading subtype of lung cancer, adenocarcinoma, received a new classification in 2011 when multifocal, pneumonic-type mucinous tumors, formerly called mucinous bronchioloalveolar carcinomas, were reclassified as "invasive mucinous adenocarcinomas." These tumors appear to be less sensitive to chemotherapy than other non-small cell lung cancers. We herein report two cases of invasive mucinous adenocarcinoma that showed a dramatic radiologic response to combination therapy with cisplatin, pemetrexed and bevacizumab. Recent data suggest that the use of paclitaxel-based chemotherapy is an acceptable therapeutic strategy in cases of invasive mucinous adenocarcinoma. The cases reported here and preclinical findings suggest the therapeutic efficacy of cisplatin, pemetrexed and bevacizumab in treating such tumors.
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CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study.
BMJ Open
PUBLISHED: 11-06-2013
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CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema.
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Clinical investigation of nontuberculous mycobacterial lung disease in Japanese patients with rheumatoid arthritis receiving biologic therapy.
J. Rheumatol.
PUBLISHED: 11-01-2013
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To review patients with rheumatoid arthritis (RA) receiving biologic therapy following a diagnosis of nontuberculous mycobacterial (NTM) lung disease and to evaluate disease deterioration according to clinical and radiological features and anti-NTM therapy.
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An autopsy case of pulmonary aspergillosis with fungus ball formation in an artificial aortic graft.
Intern. Med.
PUBLISHED: 09-18-2013
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A 38-year-old man with Marfan syndrome underwent an aortic replacement with an artificial aortic valve at 27 years of age and an aortic graft at 31 years of age. In 2011, he was diagnosed as having chronic necrotizing pulmonary aspergillosis (CNPA). He developed a fever and an increased sputum volume and was admitted to the hospital in 2012. Contrast-enhanced CT showed an irregularly shaped nonenhanced structure in the aortic graft. He died on hospital day 31. From the autopsy findings, we speculated that an infiltration by the CNPA lesion into a pulmonary vein was followed by the hematogenous formation of a fungus ball in the aortic graft.
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Prognostic factors and radiographic outcomes of nontuberculous mycobacterial lung disease in rheumatoid arthritis.
J. Rheumatol.
PUBLISHED: 04-15-2013
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The aims of our study were to retrospectively review patients with rheumatoid arthritis (RA) with nontuberculous mycobacterial (NTM) lung disease, to assess the prognostic factors, and to analyze the time to disease deterioration according to the antirheumatic drugs received during the NTM lung disease followup period.
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Prognostic factors in 194 patients with chronic necrotizing pulmonary aspergillosis.
Intern. Med.
PUBLISHED: 04-01-2013
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The prognostic factors of chronic necrotizing pulmonary aspergillosis remain unclear. We assessed the prognostic factors of all-cause mortality in patients with chronic necrotizing pulmonary aspergillosis, focusing especially on underlying pulmonary disease, first-line treatment and host predisposition.
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Etiology and factors contributing to the severity and mortality of community-acquired pneumonia.
Intern. Med.
PUBLISHED: 02-01-2013
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Community-acquired pneumonia (CAP) remains a major cause of death. No studies have reported the use of rapid influenza diagnostic tests (RIDT) for the etiological diagnosis, and the factors contributing to severity and mortality have not yet been fully investigated. The aim of this study was to review the etiologies of CAP using RIDT and to identify risk factors related to the severity and mortality of the disease.
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Regioselective 1,4-trifluoromethylation of ?,?-unsaturated ketones via a S-(trifluoromethyl)diphenylsulfonium salts/copper system.
Beilstein J Org Chem
PUBLISHED: 01-01-2013
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Regioselective conjugate 1,4-trifluoromethylation of ?,?-unsaturated ketones by the use of shelf-stable electrophilic trifluoromethylating reagents, S-(trifluoromethyl)diphenylsulfonium salts and copper under mild conditions is described. A wide range of acyclic aryl-aryl-enones and aryl-alkyl-enones were converted into ?-trifluoromethylated ketones in low to moderate yields.
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Changes in the airway lumen and surrounding parenchyma in chronic obstructive pulmonary disease.
Int J Chron Obstruct Pulmon Dis
PUBLISHED: 01-01-2013
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The purpose of this study was to examine changes in the airway lumen and parenchyma in relation to lung function in patients with chronic obstructive pulmonary disease (COPD) compared with controls.
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Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease.
Am. J. Respir. Crit. Care Med.
PUBLISHED: 12-28-2011
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The prognostic factors of Mycobacterium avium complex lung disease (MAC-LD) are not clearly defined.
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[Type A influenza pneumonia with diffuse alveolar damage diagnosed by increased antibody titers and immunohistochemical staining].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-23-2011
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A 58-year-old man presented to a local physician with cough, fever, myalgia and dyspnea. His chest X-ray film showed abnormal shadows and therefore he was admitted to our hospital. Chest computed tomography showed bilateral ground-glass opacities and bilateral consolidation. We suspected influenza pneumonia, but the results of both an influenza rapid antigen test and reverse transcriptase-polymerase chain reaction test for novel influenza (H1N1 2009) were negative. Transbronchial lung biopsy showed diffuse alveolar damage patterns. We diagnosed acute interstitial pneumonia and initiated corticosteroid therapy. Moreover, because influenza pneumonia could not be excluded according to his clinical picture, oseltamivir was administered. His condition improved and he was discharged. After discharge, the levels of antibody titers for influenza A virus significantly increased. We therefore re-evaluated his transbronchial lung biopsy specimen and found that immunohistochemical staining was positive for influenza A antigen in his bronchial and bronchiolar cells. We re-diagnosed his condition as influenza pneumonia. The possibility that influenza pneumonia may present in cases originally diagnosed as acute interstitial pneumonia must be considered.
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[A case of follicular bronchiolitis in which progressive bronchiectasis developed over 7 years].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-17-2011
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A 53-year-old man presented to our hospital with cough in August 2004. Chest computed tomography showed an anterior mediastinal tumor, centrilobular nodules and mild bronchiectasis. Centrilobular nodules were improved by the administration of clarithromycin, and we resected an anterior mediastinal tumor (thymoma). Partial lung resection was also performed, and a diagnosis of follicular bronchiolitis was established. The number of centrilobular nodules increased after cessation of the clarithromycin, and its administration was reinitiated; however, the patients bronchiectasis and airway obstruction worsened. Steroid administration was begun in January 2010; thereafter, pulmonary function, bronchial wall thickness, cough and shortness of breath improved. Since April 2004, the patient has experienced 12 episodes of airway infection. Careful attention should be paid to recurrent airway infection, progressive bronchiectasis and airway obstruction in patients with follicular bronchiectasis.
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[Pulmonary tumor thrombotic microangiopathy responding to chemotherapy].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 11-12-2011
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A 65-year-old man without a history of cancer presented to our hospital because he was suspected of having acute pulmonary thromboembolism. Dyspnea that had developed 1 month before admission, had worsened 1-week before admission. Chest computed tomography showed faint ground-glass opacities in the lung fields without filling defects in the pulmonary arteries. He was transferred to the department of respiratory medicine for further investigation. Perfusion scintigraphy showed multiple, small perfusion defects throughout both lungs, and laboratory data showed increased lactic dehydrogenase value and thrombocytopenia. We suspected intravascular lymphoma, and a bone marrow aspiration smear detected malignant cells. We started chemotherapy on a diagnosis of intravascular lymphoma, which resulted in remarkable improvement of respiratory failure and pulmonary hypertension. After that, further evaluation of bone marrow specimen with immunostaining, the malignant cells were found not to be lymphoma cells but cancer cells. The primary site of the cells was not found by further investigation. Because of improvement of oxygenation and pulmonary hypertension, we performed transbronchial lung biopsy and diagnosed pulmonary tumor thrombotic microangiopathy. Here, we report this case and review previous reports.
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[Allergic bronchopulmonary mycosis due to Schizophyllum commune and Aspergillus fumigatus].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 09-08-2011
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A 53-year-old man who had been suffering from asthma presented to our hospital because of abnormal shadows detected on a chest X-ray film during a routine medical examination. A biopsy specimen of a mucus plug obtained by bronchoscopy showed fungal hyphae, eosinophils, and Charcot-Leyden crystals, with evidence of lung tissue eosinophilia. Schizophyllum commune and Aspergillus fumigatus were isolated from his sputum, bronchial washing specimens and the mucus plug. We detected specific immunoglobulin E anti-Aspergillus fumigatus responses and precipitating antibodies against Schizophyllum commune and Aspergillus fumigatus, which led to the diagnosis of allergic bronchopulmonary mycosis caused by both fungi. We gave him fluticasone/salmeterol and itraconazole; thereafter, his symptoms of cough and sputum production and his radiological findings all improved.
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Intestinal perforation due to concomitant cytomegalovirus infection during treatment for Pneumocystis jirovecii pneumonia in a patient with rheumatoid arthritis.
Intern. Med.
PUBLISHED: 09-01-2011
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A 78-year-old woman with rheumatoid arthritis treated with methotrexate and corticosteroid was admitted to our hospital for dry cough and dyspnea. She was diagnosed as having Pneumocystis pneumonia based on elevated beta-D-glucan and positive PCR analysis of bronchoalveolar lavage fluid for Pneumocystis jirovecii. We started trimethoprim-sulfamethoxazole and high-dose corticosteroid therapy. Her pulmonary lesions gradually improved; however, she developed perforation of the ileum and subsequently died from sepsis. Histology of the perforated site was compatible with cytomegalovirus enterocolitis.
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[Legionella pneumonia in a patient with positive culture results of Legionella pneumophila serotype 1 from bronchoalveolar lavage fluid but negative urinary antigen test results].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 07-09-2011
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A 39-year-old man presented to a local physician complaining of fever, headache without cough or sputum. Abnormal shadows were found on chest X-ray films. Pneumonia was diagnosed and he was referred to our hospital, where chest computed tomography showed bilateral, multifocal, and patchy ground-glass opacities. Neither the urinary antigen test for Streptococcus pneumoniae nor that for Legionella was positive. Because he had visited a public spa several days before developing the fever and headache, and because hypophosphatemia was identified, we then suspected Legionella pneumonia. Bronchoalveolar lavage fluid yielded positive culture of Legionella pneumophila serotype 1. The Legionella urinary antigen is known to detect Legionella pneumophila serotype 1 infection; however, sensitivity and specificity of the test are 60-95% and > 99%, but care should be taken when urinary antigen test results are negative in suspected cases of Legionella pneumophila serotype 1 pneumonia. In the present case, bronchoalveolar lavage fluid was a useful method for diagnosing Legionella pneumonia.
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[Comparison between pandemic H1N1 2009 influenza pneumonia and seasonal influenza pneumonia in adults].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 05-20-2011
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We compared 126 cases of seasonal influenza pneumonia (seasonal flu) reported between January, 1996 and March, 2009, with 10 cases of laboratory-confirmed pandemic influenza (H1N1) 2009 influenza virus pneumonia (novel flu), based on clinical condition, computed tomography (CT) findings, severity, treatment, and prognosis, to clarify the characteristics of this novel flu. The mean age of subjects was 52.4 years in the novel flu group and 64 years in the seasonal flu group, and novel flu patients were younger than seasonal flu patients. Seasonal flu patients had more underlying diseases than did novel flu patients. The median duration from illness onset to hospitalization was 4 days in both groups. Primary viral pneumonia was present in 70% of novel flu cases and 31% of seasonal flu cases. The proportion of primary virus pneumonia was higher in novel flu patients, and the disease severity of the seasonal flu group was more severe than that of the novel flu group. White blood cell and lymphocyte counts were lower in novel flu patients, and chest CT images showed bilateral shadows and pure ground-glass opacities more frequently in the novel flu cases. There were no differences in treatment, number of days required for the fever to subside, or mortality between the groups.
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[Eight cases of idiopathic pulmonary alveolar proteinosis followed up for more than 4 years].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 04-13-2011
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Few reports exist regarding the long-term clinical course of idiopathic pulmonary alveolar proteinosis.
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[A case of organizing pneumonia which recurred 51 months after radiotherapy following breast-conserving surgery].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 03-16-2011
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A 54-year-old woman who had undergone breast-conserving surgery followed by irradiation presented to a local physician after developing a cough and low-grade fever 9 months after radiation therapy. She was given a diagnosis of pneumonia and antibiotics were administered, but since she did not improve, she was transferred to our hospital. We performed lung biopsy via thoracoscopy and diagnosed organizing pneumonia based on pathological findings. Steroid administration based on her chest X-ray findings, improved her condition. After discharge, her steroid dose was tapered on an outpatient basis, but she suffered relapse of her organizing pneumonia three times. The prednisolone dose at relapse was 10 mg/day at 20 months, 7.5 mg/day at 36 months, and 7 mg/day at 51 months after radiation therapy, respectively. Organizing pneumonia that develops after irradiation following breast-conserving surgery has been known to occasionally relapse, and to the best of our knowledge the final relapse reported here, 51 months after radiation therapy is the longest relapse reported.
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[A single-center prospective study of viral infection in community-acquired pneumonia in adults].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 03-10-2011
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From July, 2008 to March, 2009, 125 adults with community-acquired pneumonia (CAP) who were admitted to our hospital were retrospectively investigated to elucidate the characteristics of viral infection in adult CAP in Japan. Nasopharyngeal swabs for real-time polymerase chain reaction for 7 types of influenza virus, rhinovirus, respiratory synctial virus, human metapneumovirus, parainfluenza virus, coronavirus, and enterovirus were obtained. Diagnoses of viral infections were established according to positive results in real-time polymerase chain reaction and influenza rapid diagnostic testing, and based on a fourfold increase in antibody titer of influenza virus antibody in paired sera. Overall, a pathogen was identified in 74 patients (59.8%). Of these pathogens, 47 (37.6%) were bacterial, 17 (13.6%) were viral, and 10 (8.0%) were mixed virus and bacterial infection. Influenza virus (n = 12; 9.6%), rhinovirus (n = 8; 6.4%), respiratory syncytial virus (n = 8; 6.4%), and parainfluenza virus (n = 6; 4.8%) were detected. Adenovirus, coronavirus or enterovirus was not detected. Sore throat was more frequently found in patients with viral pneumonia than in those with non-viral pneumonia. Higher age and pneumococcal pneumonia were factors which contributed to severity in the present cases. It is difficult to distinguish viral pneumonia from non-viral pneumonia by clinical findings, and there were few clinically meaningful differences in presentation and severity, and no differences in severity or outcomes according to either the presence or absence of viral infection. Further studies are needed to clarify the possible significance of viral infection in CAP.
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[Clinical study of pneumocystis pneumonia in patients with rheumatoid arthritis].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 03-10-2011
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We reviewed case of pneumocystis pneumonia (PCP) with rheumatoid arthritis. We administered the antirheumatic drug methotrexate (MTX) at the time of to 13 patients, corticosteroids to 11 patients and a tumor necrosis factor (TNF) inhibitor to 3 patients. Treatment for PCP was started on admission in all cases. We administered adrenocorticosteroids to all 13 patients with a PaO2 level < 70 Torr. Three patients were under respiratory management, and 4 patients died. By univariate analysis, prognostic indicators of death were: presence of acute respiratory distress syndrome (ARDS), peripheral blood neutrophil/lymphocyte ratio, serum albumin value, serum beta-D-glucan value, and AaDO2 and PaO2/FiO2 ratios. Readministration of a TNF inhibitor in 2 patients and MTX in 3 patients was possible after PCP remission. Even though we began treatment for PCP on the day of admission, 25% of patients died. PCP may occur in patients who are given MTX or a TNF inhibitor or both, and the clinician should endeavor to detect its onset as early as possible. Elucidation of the prognostic indicators of recovery may require multivariate analysis of many cases.
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Comparison of high-dose salmeterol/fluticasone and moderate-dose salmeterol/fluticasone plus low-dose mometasone in patients with severe persistent asthma.
Respirology
PUBLISHED: 03-09-2011
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The effects of adding a second inhaled corticosteroid with a different particle size, compared with using an increased dose of a single inhaled corticosteroid, were assessed in patients with persistent asthma.
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[Case of bird-related hypersensitivity pneumonitis in a farmer].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-20-2010
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A 48-year-old female farmer presented to our hospital with shortness of breath and cough. Her partial pressure of arterial oxygen (PaO2) level on room air was 58.4Torr, and chest computed tomography (CT) showed centrilobular ground-glass micronodules. She was admitted for further evaluation. After admission, symptoms, PaO2, and radiological findings improved without any treatment; however, her symptoms recurred when she returned to work. Exposure to her house did not elicit any symptomatic response. We initially suspected farmers lung, but inhalation provocation tests with hay showed no significant change in symptoms, laboratory data or radiological findings. Antibody tests for Thermoactinomyces vulgaris or Saccharopolyspora rectivirgula were negative. Because many pigeons were found roosting on her farm, we suspected bird-related hypersensitivity pneumonitis. Precipitating antibodies testing against pigeon serum and IgG and IgA antibodies testing against pigeon dropping extracts were all positive, and bird-related hypersensitivity pneumonitis was diagnosed. Because typically, many birds roost on farms, not only farmers lung, but also bird-related hypersensitivity pneumonitis, should be included in a differential diagnosis when a farmer clinically suspected to have hypersensitivity pneumonitis is encountered.
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[Case of novel influenza A (H1N1) pneumonia with shrinkage of a pulmonary lesion].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-20-2010
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Fever developed in a 56-year-old man with sarcoidosis and bronchial asthma, and influenza was diagnosed. He was given zanamivir on the day of diagnosis, but he suffered a bronchial asthma attack 4 days after the diagnosis of influenza, and pneumonia developed 7 days subsequently. He was then admitted to our hospital. A rapid antigen test was positive for influenza type A, and reverse-transcriptase polymerase chain reaction results were also positive for novel influenza A (H1N1). Chest computed tomography showed homogeneous ground-glass opacities in bilateral lung fields, and novel influenza A (H1N1) pneumonia was diagnosed. The patient was treated with oseltamivir and steroid therapy for the bronchial asthma attack; however, ground-glass opacities enlarged and became consolidated. The lower lobes of both lungs showed shrinkage and persistent volume loss. Improvement in the consolidation was accompanied by improvement in his respiratory condition. We report a case with an interesting radiological course.
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[Two patients with novel influenza A virus (H1N1) pneumonia treated with steroid therapy after an incorrect diagnosis of rapid progressive interstitial pneumonia due to the negative results of a rapid-antigen test].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 10-20-2010
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We encountered 2 patients with novel influenza A (H1N1) pneumonia initially treated with steroid therapy after an incorrect diagnosis of cryptogenic organizing pneumonia and acute interstitial pneumonia, made because of atypical radiological findings and negative rapid antigen test results. After the patients were discharged, we performed reverse-transcriptase polymerase chain reaction tests for the presence of novel influenza A (H1N1); the results were positive, and we established the correct diagnosis of infection by novel influenza A (H1N1) virus pneumonia. Diagnostic clues included radiological findings similar to those of previously reported cases of novel influenza A (H1N1) virus pneumonia and an increase in similar cases due to the novel influenza A (H1N1) pandemic, suggesting that these 2 patients were also suffering from it. Similar cases of inappropriate treatment resulting from an initially incorrect diagnosis of cryptogenic organizing pneumonia or acute interstitial pneumonia may occur, and greater attention should be paid to accurate diagnosis.
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Birt-Hogg-Dubé syndrome with multiple cysts and recurrent pneumothorax: pathological findings.
Intern. Med.
PUBLISHED: 10-01-2010
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A 39-year-old woman presented with right-sided pneumothorax. Partial lung resection was done via thoracoscopy. Five years later, left-sided pneumothorax occurred, and she underwent thoracoscopy again. However, air leakage continued, and pleurodesis was performed. Although she had no skin eruptions or renal tumors, Birt-Hogg-Dubé (BHD) syndrome was suggested by radiographic findings. BHD gene analysis was performed, which revealed the BHD gene mutation. Reevaluation of pathological findings showed elastic fibers in the alveolar walls with fine granular changes and accumulation of macrophages. BHD syndrome should be considered in patients presenting with multiple pulmonary cysts with or without skin eruption, or kidney tumor.
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Isolation of Candida species is an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.
Intern. Med.
PUBLISHED: 09-15-2010
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Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood.
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[A case of pulmonary alveolar proteinosis which initially deteriorated rapidly with exacerbation of pulmonary nocardiosis, responded promptly to treatment of the pulmonary nocardiosis].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 09-01-2010
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A 37-year-old man was admitted with complaints of continuous cough and sputum production for 1 month. Computed tomography (CT) of the chest revealed a solitary mass with a cavity in the apex of the left lung and bilateral ground-glass opacities (GGO). Thereafter, the patient complained of fever, and an increase in the mass shadow size and expansion of the ground-glass opacities were observed on serial CT. The patient was given diagnoses of pulmonary nocardiosis and pulmonary alveolar proteinosis by bronchoscopic examination. Serum anti-GM-CSF antibody tests were positive. On the basis of these findings, we diagnosed autoimmune pulmonary alveolar proteinosis. After beginning antituberculosis drugs and antibiotics, the tumor shadow and GGO reduced. The pulmonary alveolar proteinosis rapidly worsened on exacerbation of the pulmonary nocardiosis, but prompt overall improvement was obtained after treating the latter. We believe this to be a valuable case for examining the time progression of autoimmune pulmonary alveolar protein syndrome, because of the clinical course of the exacerbation, and the improvement in the pulmonary alveolar proteinosis after treatment of pulmonary nocardiosis.
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The effect of emphysema on lung function and survival in patients with idiopathic pulmonary fibrosis.
Respirology
PUBLISHED: 06-04-2010
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In this study the prevalence, lung function and prognosis of IPF combined with emphysema were evaluated.
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[Antisynthetase (anti PL-7 antibody) syndrome presenting as a skin rash and exacerbation of interstitial pneumonia during treatment for rheumatoid arthritis].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 04-15-2010
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A 52-year-old man was admitted to our hospital for progressive dyspnea of 3 months duration and a skin rash of 4 months duration. Previously, he had been given a diagnosis of rheumatoid arthritis at age 40, then a diagnosis of interstitial pneumonia at age 46. Tacrolimus and prednisolone were begun at age 50, and 50 mg/week of etanercept was added 17 months before admission to our hospital. Due to renal dysfunction, tacrolimus was discontinued 9 months before admission. A skin rash developed 4 months before admission, and progressive dyspnea developed over the 3 months before admission. Tacrolimus was restarted at 1 mg/day and prednisolone was increased from 5 mg/day to 15 mg/day; however, neither the skin rash nor the dyspnea improved. After visiting a local physician, the patient was then referred to our institution. On presentation, skin changes such as erythema of the superior palpebrae and fingers were noted. His serum creatine phosphokinase level was elevated, but muscle strength was normal and no abnormal electromyographic and muscle biopsy findings were found. Anti-Jo-1 antibody was negative but anti PL-7 antibody was positive. The patient did not meet the diagnostic criteria of dermatomyositis/ polymyositis, so antisynthetase syndrome was diagnosed. Etanercept was discontinued and the prednisolone increased, which resulted in improvement of the interstitial pneumonia and skin rash. Antisynthetase syndrome should be considered as a differential diagnosis when skin rash and exacerbation of interstitial pneumonia are found during treatment for rheumatoid arthritis.
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[Two cases of Mycobacterium avium complex pleuritis].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 02-27-2010
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We encountered 2 cases of Mycobacterium avium complex pleuritis. One case was a 68-year-old woman suffering from rheumatoid arthritis, treated with steroids. She presented to our hospital with dyspnea, which improved after a chest tube insertion and the administration of rifampicin, ethambutol, clarithromycin, and streptomycin. In the other case, a 71-year-old man suffering from nephritic syndrome and who had been treated with steroids presented to our hospital with low-grade fever and dyspnea. He improved after therapeutic thoracentesis and clarithromycin administration. Only 6 cases of Mycobacterium avium complex pleuritis have been reported; because it is rare, the characteristics and prognosis of the disease remain unknown. We report 2 cases and review 6 previous reports of Mycobacterium avium complex pleuritis.
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Etiology and outcome of community-acquired lung abscess.
Respiration
PUBLISHED: 02-09-2010
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Anaerobes are the first and Streptococcus species the second most common cause of community-acquired lung abscess (CALA) in the West. The etiologic pathogens of this disease have changed in Taiwan, with Klebsiella pneumoniae being reported as the most common cause of CALA.
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[A case of scleritis as the initial clinical manifestation of limited Wegeners granulomatosis].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-10-2009
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A 63-year-old man who was transferred to our hospital had noticed ocular hyperemia, and 2 months later headache, dry cough, nose bleeds and fever. Chest X-ray film showed bilateral infiltrating shadows. He was given a diagnosis of pneumonia at the previous hospital, where antibiotics were administrated with no effect. High-resolution chest computed tomography (HRCT) on admission revealed consolidations distributed predominantly in the bilateral lower lobes and multiple nodules. Consolidations were also mainly distributed around bronchovascular bundles and at subpleural areas. We suspected Wegeners granulomatosis because of his eye lesion and HRCT findings. Ophthalmologic examination after admission revealed bilateral scleritis. The proteinase 3-antineutrophil cytoplasmic antibody level was 51.4 IU/ml. Thoracoscopic lung biopsy (left S8) showed eccentric granulomatous necrotizing vasculitis, which was consistent with Wegeners granulomatosis. We finally diagnosed this case as limited type Wegeners granulomatosis without renal involvement. We administrated both 60 mg/day prednisolone and 100mg/day cyclophosphamide for initial treatment. After this treatment, he remarkably improved. Scleritis was the initial clinical presentation in this case of Wegeners granulomatosis.
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[A surgical case of extramedullary plasmacytoma in the left main bronchus].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 12-10-2009
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A 69-year-old woman complaining of cough and wheezing of 2-months duration was admitted for diagnosis and treatment. She had been treated for bronchial asthma. Chest computed tomography showed an endobronchial tumor in the left main bronchus. Bronchoscopic biopsy yielded a diagnosis of plasmacytoma. We confirmed the absence of M-protein in the serum and urine, bone lesions in bone scintigraphy, and other organ dysfunction. In addition bone marrow biopsy and revealed normal findings. We diagnosed extramedullary plasmacytoma in the left main bronchus. We performed a sleeve resection of the left main bronchus including the tumor and reconstructed the bronchus with primary end-to-end anastomoses. We achieved complete excision and were able to maintain lung function. One year after the operation, the patient remains well, with no evidence of recurrence, or conversion to multiple myeloma. When a patient complains of wheezing, a bronchial tumor should always be considered.
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[A case of empyema due to Capnocytophaga sp. and Actinomyces israelii].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 11-04-2009
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A 54-year-old man was admitted to our hospital for investigation of cough, sputum production, and fever of 1 months duration. His diabetes mellitus was poorly controlled, and his hemoglobin HbA1c value was elevated at 10.9%. Chest X-ray film and computed tomography scan showed bilateral but predominantly right-sided pleural effusion. Aspiration of the pleural fluid from the right-side showed frank pus, and empyema was diagnosed. Capnocytophaga sp. and Actinomyces israelii were isolated in the pleural effusion and were regarded as the pathogens causing the empyema. Klebsiella pneumoniae was isolated in his sputum, and it may also have been a possible pathogen. The patient improved with administration of antibiotics (6 g/day ampicillin/sulbactam, 3 g/day ceftazidime hydrate and 1200 mg/day clindamycin) and chest tube drainage. He was discharged and regularly followed on an outpatient basis. We report this rare case of Capnocytophaga sp. and Actinomyces israelii as the pathogenic causes of empyema.
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[Hypersensitivity pneumonitis induced by Hypsizigus marumoreus].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 11-04-2009
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We present the case of a 53-year-old woman who was employed at a mushroom (Pleurotus eryngii and Hypsizigus marumoreus) cultivation factory for 15 years. She was admitted to our hospital because of fever and dry cough. Chest radiography and CT scanning revealed diffuse ground glass opacity and centrilobular nodules in both lung fields. Serum KL-6 was elevated. In the bronchoalveolar lavage fluid, the CD4/CD8 ratio was reduced, and the lymphocyte fraction was very high. Transbronchial lung biopsy specimens showed lymphocyte alveolitis. After admission, the patients symptoms improved rapidly without medication. Although these findings are compatible with hypersensitivity pneumonitis, it was difficult to identify a causative antigen. Serum antibody against Trichosporon was positive. A lymphocyte stimulation test of the peripheral blood was positive against extracts of P. eryngii and H. marumoreus. Furthermore, precipitins against the extracts of H. marumoreus were detected by a double immunodiffusion test. Therefore, we decided to conduct a challenge test using H. marumoreus. As an inhalation provocation test with H. marumoreus conducted in a sickroom caused the same clinical symptoms and signs as experienced in the workplace, we diagnosed hypersensitivity pneumonitis caused by H. marumoreus. A provocation test, in which antigen exposure is limited using a closed space, such as a sickroom, was simple, safe and effective for determining the antigen causing hypersensitivity pneumonitis.
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[Pathological study of the natural history of pulmonary infarction mainly seen in lung tumors--pulmonary infarction begins with alveolar wall bleeding].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 11-04-2009
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This study investigated the histological features of pulmonary infarction (PI). We examined lung tissue samples from 25 patients with PI treated in our hospital. The mean patient age was 59 years, 21 were men, and 4 were women. In 22 cases, the PI was located at the periphery of lung cancers. The mean number of slides examined was 2.7 including ordinary and immunohistochemical examinations. There were 3.6 PI per case. Eight cases of alveolar wall bleeding suspected of being at the beginning stage of infarction were characterized by partial alveolar epithelial and capillary endothelial disruption from the alveolar wall and separation of epithelial and endothelial basement membranes (BM). Eleven cases showed acute PI characterized by marked dilatation of the alveolar wall and separation of epithelial and endothelial BM in necrosis. Fourteen were organizing PI. Seven were organized PI with fibrotic encapsulation and partial organization of the infarction. The beginning stage of pulmonary infarction shows separation between epithelial and endothelial BMs and bleeding into the alveolar wall. The organized stage of PI shows gradual organization of infarction.
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[Bilateral primary racemose hemangioma of the bronchial artery detected by nodular stenosis of the bronchial lumen in a patient with chronic cough and a review of the Japanese literature].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 10-16-2009
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A 55-year-old man was admitted to our hospital with chronic cough. Although his chest X-ray was normal, chest computed tomography revealed a nodular lesion that was causing beaded stenosis of the lumen of the upper lobe bronchus. Nodules approximately 10 mm in size were seen in the mediastinum. We could not deny the possibility of vascular disease, and enhanced chest computed tomography was performed, which showed these abnormalities to be caused by a dilated and convoluted bronchial artery. Because no pulmonary diseases that would lead to secondary vascular dilatation were evident, a diagnosis of primary racemose hemangioma of the bronchial artery was made. We performed bronchial artery embolization to prevent potential fatal bleeding from vascular rupture. The patient has been followed regularly as an outpatient, and recanalization has not been detected. Primary racemose hemangioma of the bronchial artery is a rare entity; it is also rare for this entity to be detected by findings of a nodular protrusion in the bronchial wall or in a patient presenting with a cough. Here, we report this case and review previous reports.
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Adult-onset Stills Disease With Pulmonary Involvement.
J Bronchology Interv Pulmonol
PUBLISHED: 10-01-2009
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Only a few earlier pathologic reports exist describing adult-onset Stills disease (AOSD) with pulmonary involvement. We report a case of AOSD with pulmonary involvement producing an organizing pneumonia pattern as seen on transbronchial lung biopsy (TBLB).
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[A case of pulmonary Mycobacterium scrofulaceum infection and review of the tendency towards recent acid-fast bacilli infection].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 09-22-2009
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A 47-year-old man presented to a local physician with a chief complaint of sputum and cough for 3 months. Chest X-ray showed bilateral consolidation in the upper lung fields, and the patient was suspected to have pulmonary tuberculosis: he was then referred to our hospital. Smear and culture of both sputum and gastric juice showed acid-fast bacilli, and we started administration of rifampicin, isoniazid, ethambutol, and pyrazinamide. Results of the culture and identification test showed the causative bacillus to be Mycobacterium scrofulaceum (M. scrofulaceum). We stopped pyrazinamide and added clarithromycin to the treatment regimen, which resulted in symptomatic relief and radiological improvement. The frequency of pulmonary nontuberculous mycobacteriosis is increasing: in contrast, pulmonary infection by M. scrofulaceum has been decreasing. Nevertheless, M. scrofulaceum infection should be considered in the differential diagnosis from tuberculosis when the results of radiological findings and sputum culture suggest pulmonary tuberculosis.
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[A case of Ehlers-Danlos syndrome suspected from pulmonary hematoma due to disruption of the lung].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 09-22-2009
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A 20-year-old man was referred to our hospital due to hemoptysis. Chest CT showed a ground-glass opacity, suggesting pulmonary bleeding; however, a diagnosis was not obtained. At a follow-up examination after 2 months, Chest CT showed improvement of the ground-glass opacity, however a cavitary nodule had newly appeared. Four months later, another new nodule was found on chest X-ray film. Video-assisted thoracoscopic lung biopsy was performed for pathological diagnosis; disruption of the pleural, lung and blood vessels, and pulmonary hematoma were found. We thought of the fragility of the pleuro-pulmonary connective tissue and also thought of the probability of Ehlers-Danlos syndrome (EDS). A biochemical analysis of cultured dermal fibroblasts and molecular biological examination revealed decreased production of type III collagen in fibroblasts and COL3A1 mutation. We diagnosed this case as vascular EDS. EDS is one of the differential diagnoses in patients presenting hemoptysis and pulmonary hematoma due to disruption of the lung.
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Pulmonary microvascular cytology can detect tumor cells of intravascular lymphoma.
Intern. Med.
PUBLISHED: 08-17-2009
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A 68-year-old man was admitted to our hospital for indistinct consciousness, progressive dyspnea, night sweats and fever of 2 weeks duration. Hypoxemia, thrombocytopenia, and elevated serum lactate dehydrogenase were found. Computed tomography was negative except for a small bilateral pleural effusion. Chest perfusion scintigraphy showed inhomogeneous perfusion thought unlikely to be pulmonary artery thromboembolism. Intravascular large B-cell lymphoma was suspected, and a pulmonary microvascular cytology specimen was obtained that contained numerous large lymphoma cells. Because the patients condition was rapidly deteriorating, we started chemotherapy on the basis of the pulmonary microvascular cytology findings, and he improved. Later, atypical lymphocytes similar to those in the pulmonary microvascular cytology specimen were found in a bone marrow specimen. He was diagnosed as having diffuse large B-cell lymphoma. Because lymphoma cells were found in the pulmonary microvasculature, intravascular lymphoma was also diagnosed. Pulmonary microvascular cytology was helpful to detect lymphoma cells in the pulmonary microvasculature.
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[Severe complications and their outcomes in 65 patients with Legionella pneumonia].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 07-30-2009
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The aim of the current study was to investigate the lethal complications of Legionella pneumonia. Severe complications and their outcomes in 65 patients with Legionella pneumonia were studied. All patients who eventually had a fatal outcome or who had severe complications received antimicrobial agents active against Legionella on the admission day. Many patients in the severe complication category had multiple severe complications. Six deaths occurred (mortality rate 9.2%), 4 of which were due to septic shock/multiple organ dysfunction syndrome (MODS) (2 patients) or interstitial pneumonia/pulmonary fibrosis after Legionella pneumonia (2 patients), whereas the other 2 deaths were due to causes unrelated to Legionella pneumonia. Mortality rates for each severe complication were as follows: acute respiratory distress syndrome 27.3% (3 of 11); renal failure 33.3% (2 of 6); disseminated intravascular coagulation 33.3% (2 of 6); severe sepsis 0% (0 of 1); septic shock/MODS 66.7% (2 of 3); interstitial pneumonia/pulmonary fibrosis 50% (2 of 4). Despite prompt diagnosis and appropriate treatment with antimicrobial agents active against Legionella, the lethal complications of Legionella pneumonia are septic shock/MODS and interstitial pneumonia/pulmonary fibrosis.
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[Mucoid impaction of the bronchi caused by Schizophyllum commune which developed after discontinuation of itraconazole administration].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 05-22-2009
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We report the case of a 75-year-old woman with mucoid impaction of the bronchi (MIB) due to Schizophyllum commune who improved with itraconazole (ITCZ) administration and relapsed after discontinuation of the drug. She improved again after readministration of ITCZ, and MIB has not recurred. This patient was not suffering from asthma and has been well without steroid administration. Reports of respiratory disorders due to S. commune have been increasing, and cases of allergic bronchopulmonary mycosis (ABPM), fungus ball, lung abscess, and pneumonia have been reported. Including this report, 12 cases of ABPM and MIB due to S. commune have been reported by Japanese authors. Treatment in these 12 cases included anti-fungal agent in 6, single steroid therapy in 3, combination therapy in 2, and bronchial toilet in 1 case. S. commune is not well recognized; however, one should suspect this fungus to be the causative pathogen when Aspergillus species are not detected or anti-Aspergillus antibody is negative.
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Ehlers-Danlos syndrome with recurrent spontaneous pneumothoraces and cavitary lesion on chest X-ray as the initial complications.
Intern. Med.
PUBLISHED: 05-01-2009
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A 17-year-old-man developed left-sided pneumothorax in 1995. Chest computed tomography (CT) showed a thick-walled cavity in the left lower lobe. Video-assisted thoracic surgery was performed, and pathologic findings of the resected lung showed a cavity, organizing hematoma, and a fibrous nodule. Fragility of connective tissue was suspected, and biochemical and molecular analysis showed reduction of type III collagen production and point mutation of the COL3A1 gene. The patient was diagnosed as having vascular-type Ehlers-Danlos syndrome (EDS). From 2002, the patient developed hemoptysis and bloody sputum once a year. Chest CT detected several nodules and cavities, which were regarded as hematomas with or without excretion. Several vascular changes including aneurysmal formations have been found since 2002, and an aneurysm of the left ulnar artery was resected. The patient continues to be followed regularly on an outpatient basis. We report a rare case of vascular-type EDS who developed pulmonary symptoms as an initial complication.
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[Primary ciliary dyskinesia. A case report and comparison with 4 previous cases].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 04-08-2009
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We encountered a 59-year-old man, whose chief complaints were sputum and dyspnea on effort. He had suffered from sinusitis since childhood, and chest computed tomography showed bronchiectasis. Electron microscopic examination of bronchial mucosa biopsied by bronchoscopy showed defect of the inner dynein arm in most of his cilia. We diagnosed primary ciliary dyskinesia. Seminal analysis showed no abnormalities, and the etiology of infertility remains unclear. The present case is the fifth case treated at our hospital. In this paper, we compared this case with 4 cases (2 cases of Kartageners syndrome and 2 cases of primary ciliary dyskinesia without situs invertus) of our hospital, and findings of previous reports. Primary ciliary dyskinesia should be included in the differential diagnosis even in cases of mild bronchiectasis or normal mobility of sperm. Primary ciliary dyskinesia has more variety in radiological and clinical findings than has been recognized.
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[Nemaline myopathy detected with respiratory failure and right ventricular heart failure].
Nihon Kokyuki Gakkai Zasshi
PUBLISHED: 03-06-2009
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We describe the case of a 40-year-old woman who was admitted for dyspnea and pitting edema of the lower extremities. Severe type II respiratory failure and right ventricular heart failure were present. Non-invasive positive pressure ventilation (NIPPV) improved the symptoms and blood gas values. Since the results of respiratory function tests and computed tomography indicated neuromuscular disease, muscle biopsy was performed and nemaline myopathy was diagnosed. NIPPV was necessary due to severe hypoxia and hypercapnia caused by severe hypoventilation during sleep; however, daytime NIPPV was stopped within a few days, and the patient was discharged with instructions to continue NIPPV at night only. Since discharge, she has been followed-up on an outpatient basis for 8 years. Adult-onset nemaline myopathy with respiratory failure and right ventricular heart failure as presenting features is rare, and NIPPV can be useful in such cases.
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Changes in lung function and health status in patients with COPD treated with tiotropium or salmeterol plus fluticasone.
Respirology
PUBLISHED: 02-13-2009
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The effects of tiotropium, a long-acting anticholinergic drug, were compared with those of the combination of salmeterol, a long-acting beta(2)-agonist, and fluticasone, an inhaled corticosteroid, in patients with COPD.
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Allergic bronchopulmonary aspergillosis with repeated isolation of nontuberculous mycobacteria.
Intern. Med.
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A 68-year-old woman without asthma presented with a cough and abnormal shadows on a chest X-ray. Computed tomography showed right middle lobe atelectasis and centrilobular nodules with a tree-in-bud appearance in the other lobes. The patients sputum repeatedly yielded positive cultures of nontuberculous mycobacteria (NTM); however, no fungi were detected. A transbronchial biopsy showed allergic mucin with eosinophils, although the findings were not diagnostic. We suspected that the patient had pulmonary mycobacteriosis; however, treatment for this condition failed. We then performed thoracoscopy for further evaluation and treatment of the NTM infection. The resected specimen obtained from the right middle lobe exhibited the characteristic findings of allergic bronchopulmonary mycosis without evidence of mycobacterial infection. The administration of corticosteroids and itraconazole resulted in improvement of the patients condition. The NTM appeared to be simply a coincidental colonization of the resected middle lobe bronchus. The absence of asthma, the inability to isolate fungi and the repeated isolation of NTM made it difficult to differentiate allergic bronchopulmonary aspergillosis from NTM infection.
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[Clinical analysis of mycobacteriosis patients with pneumothorax].
Kekkaku
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Secondary pneumothorax caused by mycobacteriosis is rare. The frequency of incidence of pneumothorax in tuberculosis patients is reported to be only 1.5%, and that in nontuberculous mycobacteriosis patients may be very low. It is important to detect mycobacteriosis at an earlier stage in patients hospitalized for pneumothorax, in general wards so that nosocomial infections such as tuberculosis can be prevented.
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Desquamative interstitial pneumonia may progress to lung fibrosis as characterized radiologically.
Respirology
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In some patients, desquamative interstitial pneumonia may progress to lung fibrosis. The aim of this study was to assess the long-term radiological follow-up results in patients with desquamative interstitial pneumonia.
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Magnetic resonance imaging can detect thoracic inflammation due to familial Mediterranean fever.
Mod Rheumatol
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A 32-year-old man presented to our hospital complaining of periodic fever and unilateral chest pain. We suspected that he had familial Mediterranean fever because of his symptoms. Magnetic resonance imaging (MRI) showed an increased intensity within the anterior chest wall, which was consistent with the site of his pain. Genomic analysis showed the patient to be heterozygous for the E148Q/M694I mutation in the MEFV gene, and we diagnosed familial Mediterranean fever. The ability of MRI to detect inflammatory changes could provide useful additional information for evaluating thoracic symptoms in FMF patients, and the detection of inflammatory changes using MRI may aid in early diagnosis, thus contributing to early and adequate treatment.
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Pulmonary capillaritis in Wegeners granulomatosis detected via transbronchial lung biopsy.
Intern. Med.
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A 73-year-old woman presented to our hospital with scleritis, cough, and hemoptysis. Chest computed tomography showed a mass lesion, multiple ground-glass opacities, and nodules. Bronchoscopy showed a skip lesion of mucosal erosion with white necrotic substance; however, a biopsy specimen of the erosion yielded no characteristic findings. Transbronchial lung biopsy showed alveolar hemorrhage and capillaritis. Proteinase-3 antineutrophil cytoplasmic antibody was elevated to 62.5 U/mL, and she was diagnosed as having Wegeners granulomatosis. Steroid therapy combined with cyclophosphamide was started; however, hemoptysis was not resolved until plasmapheresis therapy was added. Her general condition initially improved, but respiratory insufficiency worsened with fever on the 30th hospital day. The patient subsequently died on the 41st hospital day, and cytomegalovirus infection was suggested as a possible cause of death.
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Partially saturated fluorinated heterocycles: diastereo- and enantioselective synthesis of ?-trifluoromethyl-pyrroline carboxylates.
Chem. Commun. (Camb.)
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The first asymmetric synthesis of ?-trifluoromethylated pyrroline carboxylates has been achieved by organocatalytic conjugated addition of adamantyl glycine imine to ?-trifluoromethylated enones, followed by a deprotection/cyclization/dehydration sequence.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.