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ABSTRACT: A 53-year-old Japanese woman was referred to our hospital for pure ground glass opacity (GGO) in the left upper lung on computed tomography. 18F-fluorodeoxyglucose positron emission tomography revealed no abnormal uptake in the lesion. After 4 months of follow-up, we strongly suspected the lesion to be a bronchioloalveolar carcinoma and decided to perform a surgery for diagnosis. Planning to perform lingual segmentectomy by video-assisted thoracic surgery (VATS) with mini thoracotomy, we finally performed the left upper lobectomy to guarantee the optimal margin by VATS, because the lesion was not identified by palpation. Final pathological diagnosis was a solitary pulmonary capillary hemangioma (SPCH). We herein report a resected case of SPCH showing pure GGO and review all reported SPCH cases.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 03/2013;
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ABSTRACT: A 33-year-old man complaining of cough admitted our hospital for examination of bilateral hilar and mediastinal lymphadenopathy. He diagnosed pulmonary sarcoidosis, because of elevation of serum angiotensin converting enzyme (ACE), epitheloid granuloma with noncaseating necrosis from transbronchial lung biopsy (TBLB) specimen, increasing of lymphocyte and elevation of the CD4/CD8 ratio in bronchoalveolar lavage fluid (BALF). Furthermore, eosinophil ratio in BALF was 3%, hyperplasia of goblet cell, eosinophilic invasion to bronchial epithelium, and thickened basal membrane were found in same biopsy specimen. He had mild reversible airway obstruction. He was diagnosed pulmonary sarcoidosis complicated with bronchial asthma. Sarcoidosis is characteristic of the T helper type 1 (Th1) mediated immune response, and bronchial asthma is characteristic of the Th2. This case histopathologically revealed that both Th1 mediated immune response and Th2 could be coexisted.
Arerugī = [Allergy] 12/2012; 61(12):1744-8.
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ABSTRACT: A 60-year-old man was diagnosed as multiple hepatic abscesses. Failure in the first empiric therapy led to extension into the pericardium, causing acute cardiac tamponade. Actinomyces species were not cultured from the pericardial effusion. The definitive diagnosis was acquired by ultrasound guided needle biopsy.
Internal Medicine 01/2012; 51(3):305-8. · 0.94 Impact Factor
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ABSTRACT: An 86-year-old woman who underwent placement of a prosthetic aortic valve for regurgitation 5 years previously was admitted because of spiking fever. The blood culture results were positive for gram-negative rods, which were identified as Achromobacter xylosoxidans. Approximately 4 months after being sent to the hospital, transthoracic echocardiography revealed vegetation at the prosthetic aortic valve. Ultimately, a diagnosis of A. xylosoxidans endocarditis of the prosthetic aortic valve was made. We report an extremely rare case of bacteremia associated by prosthetic valve endocarditis with A. xylosoxidans. In addition, we review 10 previously reported cases of endocarditis caused by A. xylosoxidans.
Internal Medicine 01/2012; 51(9):1133-8. · 0.94 Impact Factor
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ABSTRACT: A 69-year-old woman received radiation therapy of 50 Gy following surgery for left breast cancer. Eleven months later, chest computed tomography revealed infiltrative shadows with air bronchograms in both lower lung fields and a reversed halo sign in the right lower lobe. Transbronchial lung biopsy revealed polypoid granulation tissue in the terminal air spaces, which was consistent with organizing pneumonia (OP). Prednisolone therapy resolved the radiographic abnormalities. The reversed halo sign was believed to be specific to cryptogenic organizing pneumonia. We reported a case of OP with a reversed halo sign following postoperative irradiation for breast cancer.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 05/2011; 49(5):393-8.
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Yoshihito Niki,
Hideaki Hanaki,
Tetsuya Matsumoto,
Morimasa Yagisawa,
Shigeru Kohno,
Nobuki Aoki,
Akira Watanabe,
Junko Sato,
Rikizo Hattori,
Naoto Koashi, [......],
Toshiyuki Ota,
Junichi Honda,
Junichi Kadota,
Kazufumi Hiramatsu,
Yosuke Aoki,
Zenzo Nagasawa,
Katsunori Yanagihara,
Jiro Fujita,
Masao Tateyama,
Kyoichi Totsuka
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ABSTRACT: For the purpose of nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens collected from patients in Japan, the Japanese Society of Chemotherapy conducted a third year of nationwide surveillance during the period from January to April 2008. A total of 1,097 strains were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections. Susceptibility testing was evaluable with 987 strains (189 Staphylococcus aureus, 211 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 187 Haemophilus influenzae, 106 Moraxella catarrhalis, 126 Klebsiella pneumoniae, and 162 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 β-lactams (four penicillins, three penicillins in combination with β-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including a ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standard Institute (CLSI). The incidence of methicillin-resistant S. aureus (MRSA) was as high as 59.8%, and those of penicillin-intermediate and penicillin-resistant S. pneumoniae (PISP and PRSP) were 35.5 and 11.8%, respectively. Among H. influenzae, 13.9% of them were found to be β-lactamase-non-producing ampicillin (ABPC)-intermediately resistant (BLNAI), 26.7% to be β-lactamase-non-producing ABPC-resistant (BLNAR), and 5.3% to be β-lactamase-producing ABPC-resistant (BLPAR) strains. A high frequency (76.5%) of β-lactamase-producing strains was suspected in Moraxella catarrhalis isolates. Four (3.2%) extended-spectrum β-lactamase-producing K. pneumoniae were found among 126 strains. Four isolates (2.5%) of P. aeruginosa were found to be metallo β-lactamase-producing strains, including three (1.9%) suspected multidrug-resistant strains showing resistance to imipenem, amikacin, and ciprofloxacin. Continual national surveillance of the antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.
Journal of Infection and Chemotherapy 03/2011; 17(4):510-23. · 1.80 Impact Factor
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ABSTRACT: A 67-year-old man was referred to our hospital for a detailed medical examination of a bronchial polyp that was detected during chest computed tomography. Bronchoscopic examination revealed a tumor that almost occluded the main left bronchus. Nd-YAG laser treatment and tumor removal with biopsy forceps were conducted. On the basis of the histopathological and immunohistochemical features, large cell neuroendocrine carcinoma (LCNEC), T2aN0M0, stage IB was diagnosed. After induction chemotherapy with a combination of cisplatin and etoposide, a sleeve resection of the left main bronchus with telescoping bronchial anastomosis was performed. LCNEC typically occurs in the peripheral lung field, but here, we report a rare case of LCNEC arising from the left main bronchus.
Internal Medicine 01/2011; 50(18):2003-6. · 0.94 Impact Factor
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ABSTRACT: Pleomorphic carcinoma (PC) is a rare malignancy of the lung. We present 3 cases that were resected. Case 1: The patient was a 75-year-old asymptomatic man whose chest roentgenogram showed a cavity at the right apex. A right upper lobectomy was performed, and the pathological stage was IB (pT2N0M0). After 3 courses of adjuvant chemotherapy, he is alive without relapse 56 months after the operation. Case 2: The patient was a 60-year-old man with left high back pain whose chest roentgenogram showed a mass shadow in the left upper lung field. A left upper lobectomy with partial resection of S6 was performed after induction chemotherapy. The pathological stage was IIIA (pT2N2M0). He died of infection 4 months after the operation during adjuvant chemotherapy. Case 3: A 78-year-old man with hemoptysis underwent aortic arch replacement after a diagnosis of impending rupture of an aortic aneurysm. During the operation, a tumor in the left upper lung lobe was detected. A left upper division segmentectomy was performed one month later. The pathological stage was IIB (pT3N0M0). Despite adjuvant radiotherapy, the patient died of cancer 9 months after the segmentectomy. The final pathological diagnoses for all 3 cases were PC. More cases of PC should be reported to establish optimal management.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2010; 16(4):264-9.
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ABSTRACT: In December 2007, a 78-year-old woman was admitted to our hospital complaining of cough and low-grade fever for 1 month. We performed various medical tests and diagnosed acute hypersensitivity pneumonitis. We suspected that the cause of illness was the prolonged use (10 years) of a feather duvet. She was treated with corticosteroids and was advised to avoid using feather duvets. This treatment improved her symptoms. However, she relapsed after 1 year. She had never used a feather duvet since the last admission, but her housemate used a feather duvet in the same room during winter. Bronchoalveolar lavage revealed lymphocytosis. Specific antibodies against pigeon and budgerigar-dropping extracts were present in her serum. On the basis of these findings, we diagnosed acute bird-related hypersensitivity pneumonitis. This condition is rarely caused by indirect exposure. Therefore, we reiterate the significance of obtaining of a detailed medical history to identify relevant antigens.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 04/2010; 48(4):328-32.
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ABSTRACT: We report an extremely rare case of minute localized malignant pleural mesothelioma (LMPM) coexisting with multiple lung adenocarcinomas in a 64-year-old woman without a history of smoking or asbestos exposure. A computed tomography scan of the chest displayed total five ground-glass opacities in the lung. Transbronchial lung biopsy from a ground-glass opacity in the posterior segment revealed a bronchioloalveolar carcinoma. With a diagnosis of primary lung cancer, right upper lobectomy and wedge resection of the right lower lobe with systematic lymph node dissection was performed using video-assisted thoracoscopic surgery. Incidentally, a minute gray-white nodule measuring 6 mm was detected on the visceral pleural surface of the right upper lobe. The postoperative histological diagnosis was minute LMPM coexisting with multiple adenocarcinomas.
General Thoracic and Cardiovascular Surgery 02/2010; 58(2):91-4.
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Internal Medicine 01/2010; 49(15):1677-8. · 0.94 Impact Factor
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Akira Yamasaki,
Keichi Hanaki,
Katsuyuki Tomita,
Masanari Watanabe,
Yasuyuki Hasagawa,
Ryota Okazaki,
Miki Yamamura,
Kouji Fukutani,
Yuji Sugimoto,
Kazuhiro Kato,
Masahiro Kodani,
Toshikazu Ikeda,
Tatsuya Konishi,
Yuji Kawasaki, Hirokazu Tokuyasu,
Hiroki Yajima,
Hitoshi Sejima,
Takeshi Isobe,
Eiji Shimizu
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ABSTRACT: Cough is one of the most common reasons for visiting a clinic. The causes of cough differ according to the duration of cough. Infectious disease is commonly observed in acute cough while noninfectious disease is commonly observed in chronic cough. On the other hand, cough is frequently observed in patients with asthma/cough variant asthma (CVA).
In this study, we investigated the causes of cough in a rural region in Japan and the clinical examination and treatment for the patients diagnosed as asthma/CVA.
We analyzed 124 patients who complained of cough.
The most common reason for acute cough was respiratory tract infection while asthma/CVA is the most common reason for subacute and chronic cough. The diagnostic procedure for asthma/CVA depends on clinical symptoms in asthmatic patients with acute cough. While in asthmatic patients with subacute and chronic cough, diagnosis of asthma depends on clinical examinations including chest radiogram, immunoglobulin E, white blood cells counts, sputum examination or spirometry as well as symptoms. For the treatment of asthma, the use of long-acting beta(2)-stimulant was dominant in asthmatic patients with acute cough while the use of leukotriene receptor and inhaled corticosteroid were dominant in asthmatic patients with subacute or chronic cough.
Diagnosis and treatment for asthma differs according to the duration of cough. Simple guidelines for asthma/CVA according to the duration of cough might be necessary for diagnosis and treatment of asthma/CVA for general physicians especially in rural areas.
International Journal of General Medicine 01/2010; 3:101-7.
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ABSTRACT: In July 2009, a 69-year-old man was admitted to our hospital because an abnormal chest shadow had been noted on medical examination. Chest radiography and computed tomography showed mediastinal and bilateral hilar lymphadenopathy. Bronchoalveolar lavage fluid (BALF) from the right B(5) revealed an increased CD4/CD8 ratio. Histological examination of the biopsy specimens obtained from the tumor in the left upper bronchus revealed small cell lung cancer, whereas examination of the specimens obtained from the left B(3) revealed noncaseating epithelioid cell granulomas containing giant cells, confirming the diagnosis of sarcoidosis. The patient underwent chemotherapy with carboplatin and etoposide without any steroids. After 4 courses of chemotherapy, bronchoscopic examination revealed that the tumor had shrunk, and the BALF CD4/CD8 ratio had decreased; further, no histological evidence of sarcoidosis was seen in specimens obtained from the left B(3). Concomitant small cell lung cancer and sarcoidosis is rare. Interestingly, cancer chemotherapy might improve pulmonary sarcoidosis.
Internal Medicine 01/2010; 49(18):1997-2001. · 0.94 Impact Factor
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ABSTRACT: A 69-year-old woman with a history of cervical cancer was admitted to our hospital for further investigation of abnormal shadows on her chest roentgenogram. Histologic examination of transbronchial lung biopsy specimens revealed epithelioid cell granuloma, and Mycobacterium intracellulare was detected in the bronchial lavage fluid. The plasma level of (1→3)-beta-d-glucan was very high, and this elevated level was attributed to administration of sizofiran for treatment of cervical cancer 18 years previously. Therefore, in patients with cervical cancer, it is important to confirm whether or not sizofiran has been administered before measuring (1→3)-beta-d-glucan levels.
International Journal of General Medicine 01/2010; 3:273-7.
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ABSTRACT: This report presents a case of bilateral multiple sclerosing hemangiomas of the lung in a 73-year-old woman. A computed tomography (CT) scan of the chest showed a total of three well-defined small nodules in the right and left lower lobes of the lung. Because malignant metastatic lung tumors were highly suspected, a wedge resection of the left lower lobe was performed to obtain a definitive diagnosis. Histopathologically, two tumors of the left lower lobe were composed of epithelial-like cuboidal cells covering the surface of papillary protrusions and sheets of round to polygonal cells underneath the epithelial-like cells. The final diagnosis was that both tumors were sclerosing hemangiomas. After surgery the residual lesion of the right lower lobe was carefully followed by chest CT. The size of the right lung nodule did not change over the course of 9 years, and no new lesion has emerged.
General Thoracic and Cardiovascular Surgery 12/2009; 57(12):667-70.
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ABSTRACT: This report presents a case of primary malignant melanoma of the lung with rapid progression in a 68-year-old man. During a regular checkup, a chest roentgenogram revealed an abnormal shadow in the left lower lung field. Computed tomography (CT) of the chest revealed an ill-defined tumor shadow measuring 4 x 3 cm in the left upper lobe. A CT-guided lung biopsy suggested a large-cell carcinoma, and left upper lobectomy was performed. Histopathologically, the tumor was comprised of malignant epithelial tumor cells with large amounts of acidophilic cytoplasm and prominent nuclei. A dark brown pigment was observed in the tumor cells. Immunohistochemical staining was positive for S-100 protein and HMB45; staining for cytokeratin, CAM5.2, and chromogranin was negative. The final diagnosis was malignant melanoma of the lung. Two months later, multiple brain metastases developed, and he died of the disease 6 months after the surgery.
General Thoracic and Cardiovascular Surgery 12/2009; 57(12):671-4.
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ABSTRACT: We report a case of desmoid tumor of the chest wall in a 79-year-old woman. The patient was referred to our hospital for management of a chest wall mass. Four months previously, the patient noted a small lump in the right lateral chest wall that had rapidly increased in size. Magnetic resonance imaging of the chest revealed a soft tissue tumor in the right lateral chest wall with unclear margins that extended into the intercostal muscles. Positron emission tomography with (18)F-fluorodeoxyglucose (FDG) showed slight FDG accumulation at the lesion. Because open biopsy suggested a desmoid tumor, full-thickness chest wall resection with reconstruction was performed. The final diagnosis was desmoid tumor of the chest wall. Wide surgical resection during the initial operation is an essential element in the treatment of this tumor.
General Thoracic and Cardiovascular Surgery 10/2009; 57(10):554-7.
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ABSTRACT: Micropapillary adenocarcinoma is becoming increasingly recognized as a prognostically important histological subtype of carcinoma in various organs. This report presents the clinicopathological findings of lung adenocarcinomas with micropapillary components.
A total of 15 patients with micropapillary components were selected between April 2005 and December 2008. The results of their clinical presentation, metastasis to lymph nodes, pleural invasion, pathological stage, and clinical outcomes were evaluated.
In all, 12 patients underwent a lobectomy or bilobectomy with a regional lymph node dissection; 8 showed metastases to the regional lymph nodes at the time of the operation. Altogether, 14 of 15 cases showed lymphovascular invasion; 10 cases were up-staged after the operation because of lymph node metastases or pleural invasion. The duration of follow-up ranged from 1 to 42 months (median 16 months). Seven patients are alive without disease, whereas seven are alive with disease and one patient died of disease.
These results suggest that the micropapillary components are a manifestation of aggressive behavior, as shown by the frequent lymph node metastases and pleural invasion. Surgeons should search more carefully for metastases and conduct a closer follow-up on these patients when this feature is present with lung adenocarcinoma.
General Thoracic and Cardiovascular Surgery 10/2009; 57(10):534-9.
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ABSTRACT: A pulmonary resection of metastatic colorectal carcinoma is an accepted method of treatment. The purpose of this study was to confirm the role of resections for pulmonary metastases from colorectal carcinoma, and to determine the clinical course, outcome, and prognostic factors after surgery. A retrospective analysis was conducted of the records of all patients with pulmonary metastases from colorectal carcinoma who underwent a surgical resection between 1995 and 2008, at a single surgical center. The overall 5-year survival rate was 74%. Multivariate Cox analysis demonstrated that the number of pulmonary metastases (HR: 9.40, 95% confidence interval (CI): 1.08-82.2, P=0.0428) and prethoracotomy carcinoembryonic antigen (CEA) level (HR: 9.79, 95% CI: 1.11-86.8, P=0.0404) were statistically significant predictors of survival after the first pulmonary metastasectomy. In addition, a second resection for recurrent metastases was performed in eight patients, and a third resection was done in one patient. There were no major postoperative complications among the patients who underwent second or third resections. Pulmonary resections are considered to be a safe and effective treatment in selective patients.
Interactive cardiovascular and thoracic surgery 08/2009; 9(4):640-4.
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ABSTRACT: In November 2007, a 30-year-old obese woman was admitted to our hospital with a complaint of persistent dry cough. Her chest-X-ray and computed tomography revealed multiple infiltrative shadows with air bronchograms in all lung fields. The bronchoalveolar lavage fluid revealed small bodies of Cryptococcus species. Cryptococcal serum antigen was also positive. To examine the cause of her snoring, polysomnography was done and revealed obstructive sleep apnea syndrome. The patient was given a diagnosis of primary pulmonary cryptococcosis with obstructive sleep apnea syndrome. After 12 months of treatment with fluconazole, the infiltrative shadows disappeared. Pulmonary cryptococcosis should be considered in the differential diagnosis of pulmonary multiple infiltrated shadows in patients without immunological abnormalities.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 07/2009; 47(6):548-52.
