-
[show abstract]
[hide abstract]
ABSTRACT: The pulmonary diseases caused by the Aspergillus species include invasive forms, for example, invasive pulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, and non-invasive pulmonary aspergillosis. Though these forms are defined pathologically by the presence of the Aspergillus species that invades the lung tissue, they are used as clinical entities. We report a case of non-invasive pulmonary aspergillosis which, from the clinical data, appeared likely to be misdiagnosed as the chronic invasive form. A 45 year-old man received chemoradiotherapy for lung cancer as well as undergoing an left upper lobectomy. Two weeks after the surgery the patient developed a cough, high fever and chest pain. Chest radiography and chest computed tomography showed a rapidly enlarging cavity with an internal mass and infiltration in the left lower lung field. A transbronchial biopsy specimen of the cavity wall showed fungal hyphae. Bronchial washing culture grew Aspergillus fumigatus. Itraconazole and amphotericin B were administered, but the patient's condition did not improve. A left lower lobectomy was performed. The histologic findings showed that the fungal hyphae were only on the surface of the cavity wall, and were surrounded by necrosis and widespread inflammatory cell infiltration. No fungal invasion of the viable lung tissue was seen. The area of infiltration revealed an organizing pneumonia without Aspergillus or other organisms. Our final diagnosis was non-invasive pulmonary aspergillosis. There has been no recurrence of the lung cancer or of the pulmonary aspergillosis in the three years since surgery. It is reported that non-invasive pulmonary aspergillosis passes through a period so active that it seems to be the invasive form for its entire clinical course. To avoid confusion in diagnosis, establishment of a comprehensive clinical classification of pulmonary aspergillosis will be needed.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 09/2001; 39(8):582-6.
-
[show abstract]
[hide abstract]
ABSTRACT: This is the first clinical report of a case of pneumonia caused by Nocardia nova in Japan. A 52 year-old woman who had received steroids and cyclophosphamide for six years because of polymyositis was admitted to our hospital for further examination. On admission she had a mild cough, and her chest radiography and computed tomography revealed bilateral multiple nodules, some of which were cavitated. She developed a cough productive of yellow sputum and fever up to 38 degrees C. Examination of the sputum revealed a gram-positive branched organism and sputum cultures repeatedly grew Nocardia species. The isolate was identified as Nocardia nova later. Clinical recovery was obtained readily upon treatment with imipenem and trimethoprim methoxazole, though the latter drug was discontinued because of nausea and anorexia. This drug was therefore replaced with oral minocycline, which proved to be ineffective clinically although susceptibility testing of the drug showed positive sensitivity. Minocycline was replaced with clarithromycin, after which chest radiography and computed tomography showed almost total resolution of the infiltrates. Clarithromycin may be an alternative oral agent to sulfonamides or minocycline when these agents are ineffective or not tolerated.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 08/2001; 39(7):492-7.
-
I Ito,
T Ishida,
T Hashimoto,
M Arita,
M Osawa,
H Tachibana, H Nishiyama,
S Takakura,
K Bando,
Y Nishizaka,
R Amitani,
H Onishi,
Y Kori
[show abstract]
[hide abstract]
ABSTRACT: To elucidate the differences between the clinical aspects of Chlamydia pneumoniae (C. pn) pneumonia and those of two other atypical pneumonias, Chlamydia psittaci (C. ps) pneumonia and Mycoplasma pneumoniae (M. pn) pneumonia, we analyzed the symptoms and laboratory data on the cases of these three types of pneumonia: 46 cases of C. pn pneumonia, 39 cases of C. ps pneumonia, and 131 cases of M. pn pneumonia. C. pn pneumonia was significantly more frequent among the elderly (mean 70 +/- 16 years, p < 0.01) and patients were significantly more likely to be male (76%, p < 0.05). A white blood cell count of over 10,000 was seen in 46% of C. pn pneumonia cases, a higher proportion than those of C. ps pneumonia (15%, p = 0.03) or M. pn pneumonia (18%, p = 0.006) cases. The proportions of patients with these infections who had an elevated GOT or GPT were not significantly different. Maximum body temperature was higher in M. pn pneumonia than in C. pn pneumonia (p = 0.003). Purulent sputa were seen in 44% of C. pn pneumonia cases and 50% of M. pn pneumonia cases, and these rates were higher than that of 13% in C. ps pneumonia cases (p = 0.002, p = 0.004). Dyspnea and anorexia symptoms were the most frequent in C. pn pneumonia cases (24% and 29%, respectively, the highest of all three pneumonias). There were clinical differences between C. pn pneumonia and the other two atypical pneumonias. However, there was some difficulty in differentiating between C. pn pneumonia and typical bacterial pneumonia because mixed infections were common (24%) in C. pn pneumonia cases.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society. 03/2001; 39(3):172-7.
-
I Itoh,
T Ishida,
T Hashimoto,
M Arita,
M Osawa,
H Tachibana, H Nishiyama,
S Takakura,
K Bando,
Y Nishizawa,
R Amitani,
H Onishi,
Y Taguchi
[show abstract]
[hide abstract]
ABSTRACT: No report has been found comparing Chlamydia pneumoniae (C. pneumoniae) pneumonia radiographically with other atypical pneumonias, Chlamydia psittaci (C. psittaci) pneumonia and Mycoplasma pneumoniae (M. pneumoniae) pneumonia. We described the chest radiographs of three kinds of pneumonia cases: 46 cases of C. pneumoniae pneumonia, 39 cases of C. psittaci pneumonia, and 131 cases of M. pneumoniae pneumonia. Radiographic shadows were categorized into main shadows and sub-shadows. The main shadows are classified from the viewpoint of the characteristics; air space consolidation(AS), ground-glass opacity(GG), reticular shadow(RS), bronchopneumonia(BP), and small nodular shadows (SN). The size, the site, and the number of the main shadows were also analyzed. In comparison among the three pneumonias, BP was the most frequent in M. pneumoniae pneumonia (0.40/case). AS predominated in C. pneumoniae pneumonia (0.67/case), and GG in C. psittaci pneumonia (0.62/case). The number of main shadows was equal, about 1.4/case in three pneumonias. Large shadows were less frequent in M. pneumoniae pneumonia than C. pneumoniae pneumonia (p = 0.02) and C. psittaci pneumonia (p = 0.01). Main shadows were more frequent in the outer zone in M. pneumoniae pneumonia than C. psittaci pneumonia (p = 0.01), and in the middle zone in C. psittaci pneumonia than in M. pneumoniae pneumonia (p = 0.02). Cases with bilateral main shadows were less common in M. pneumoniae pneumonia (9%) than C. pneumoniae pneumonia(33%, p = 0.001) and C. psittaci pneumonia(30%, p = 0.005). Thickening of bronchovascular bundles as a sub-shadow was most frequently noted in M. pneumoniae pneumonia. Some differences among the three atypical pneumonias were seen in the chest radiograph. However, no specific findings of C. pneumoniae pneumonia were shown radiographically in this study.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 12/2000; 74(11):954-60.
-
[show abstract]
[hide abstract]
ABSTRACT: This multi-institutional phase II study was designed to assess the feasibility, efficacy, toxicity, and long-term survival of induction chemoradiotherapy followed by surgery in previously untreated patients with advanced stage III non-small cell lung cancer. Chemotherapy regimen included cisplatin 20 mg/m2 on days 1-5 and 29-33, and VP-16 40 mg/m2 on days 1-5 and 29-33. Radiotherapy (50 Gy in 25 fractions) began on day 1. Clinically downstaged patients underwent thoracotomy 3-5 weeks after the completion of radiotherapy. Forty-two eligible patients (ten stage IIIA and 32 IIIB) were followed for a median period of 64 months. The response rate was 81%, and 20 patients had a clinically good response. Twenty-one patients underwent thoracotomy. Nineteen patients had complete resections and there were seven pathologic complete responses. There were four treatment related deaths (all stage IIIBs). There were significant survival differences between stage IIIA versus IIIB patients (P = 0.028; median survivals, 24.9 vs. 11.1 months; 5-year survival rates, 20% vs. 8.3%), and patients that achieved pathologic complete response (CR) versus those that did not (P = 0.045; median survivals 30.1 vs. 11.1 months; 5-year survival rates, 28.6% vs. 8.3%). Although the induction chemoradiotherapy employed in this study was not appropriate for stage IIIB patients, it proved feasible in stage IIIA patients in whom it resulted in good 5-year survival rates. It also provided good survival rates in patients achieving pathologic CR.
Lung Cancer 12/1998; 22(2):127-37. · 3.43 Impact Factor
-
T Kurasawa,
N Ikeda,
A Sato,
T Inoue,
T Ishida,
M Okazaki,
K Oida, H Nishiyama,
Y Suzuki,
R Amitani,
F Kuze
[show abstract]
[hide abstract]
ABSTRACT: During the 7 years from 1990, thirty-two patients (20 in male and 12 in female, mean age; 53 years old) were diagnosed as having pulmonary cryptococcosis. To clarify the essential points for early diagnosis of pulmonary cryptococcosis, we reviewed the clinical records and chest images. Three patients had a past history of pulmonary tuberculosis and eleven patients had underlying disorders such as malignancy, chronic pulmonary diseases and so on, but no HIV infection, which would affect this disease. Eighteen patients did not have any past history nor complications. The symptoms such as cough, sputum, chest pain and fever were generally of low-grade, 14 patients had no symptom at diagnosis. Except of some patients with severe infections and severe underlying disorders, laboratory findings such as inflamatory and nutritious markers were almost within near the normal range. On plain chest X-ray films the distribution of lesions was almost in proprtion to the volume of the lobes. The multifocal nudular and/or infitrative shadows wer observed in about 2/3 cases and single lesion in about 1/3. The width of lesions were minimal except of one case with interstitial pneumonia and two cases with multifocal segmental pneumonia. The cavity lesions were observed in 7 cases and hilar lymphadenopathy in 3 cases. On CT images, the lesions were almost located in the outer zone, the lesions which were adjacent to the pleura were observed in 15 cases. Cavitary lesions were almost smooth in edge and ubiquitous, the walls were also thick. The peripheral air-bronchogram in the nodular/infitrative shadows were observed in three cases. Pulmonary cryptococcosis is air-borne and almost a chronic infection except in AIDS patients, so careful planning for examination is essential with considerations of the characteristics of clinical and imaging features of this infection.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 05/1998; 72(4):352-7.
-
[show abstract]
[hide abstract]
ABSTRACT: We herein report a case of primary bronchopulmonary fibrosarcoma in a 70-year-old man. The patient was referred to our hospital for investigation of hemosputum and an abnormal shadow. On admission, chest radiograph and computed tomography scan showed a mass lesion in right S3 and an infiltrative shadow in the right upper lobe. Transbronchial biopsy specimens showed findings of malignancy, and adenocarcinoma was suspected. A right pneumonectomy was performed, and pathologic examination confirmed a diagnosis of fibrosarcoma. The patient had an uneventful recovery and no sign of recurrence has been found in the year since his operation, although strict follow-up is essential.
Surgery Today 02/1998; 28(12):1313-5. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Between July 1991 and October 1996, eight patients with Mycobacterium avium complex (MAC) underwent pulmonary resection in our department. There was equal distribution of men women. The length of the preoperative period averaged 8.1 months (range: 1 to 30 months). Surgical resection was complete, consisting of lobectomy in 4 patients, lobectomy with partial resection in 2, segmentectomy in 1, and segmentectomy with partial resection in 1. There were no major complications postoperatively. No patients had positive sputum culture with MAC just after operation; however, one patient had positive sputum culture 6 months after operation. Our results show the good outcome of resectional surgery for MAC in properly selected patients, who should be operated as early as possible.
The Thoracic and Cardiovascular Surgeon 01/1998; 45(6):311-3. · 0.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 64-year-old man who complained of the right chest pain was admitted in our hospital. A mass shadow which revealed the extrapleural sign was shown in the chest X-ray. This patient was performed thoracotomy and a tumor invading to the intercostal muscles was resected. Pathological diagnosis was benign fibrous mesothelioma. About 10 months after this operation, we suspected the local recurrence of the tumor on the chest X-ray. The re-operation was performed, and we resected the recurrent tumor and the 2nd and 3rd ribs. Pathologically the resected tumor was benign fibrous mesothelioma.
Kyobu geka. The Japanese journal of thoracic surgery 09/1995; 48(9):800-4.
-
[show abstract]
[hide abstract]
ABSTRACT: We studied the efficacy of intrapleural administration of bleomycin for the management of malignant pleural effusions of non-small cell lung cancer in 24 cases. Bleomycin 60 mg was administered into the pleural space after tube drainage. If the effusion continued, one additional dose was given. The efficacy was seen in 18 cases (75%). The main adverse drug reaction was transient fever among others. There was little toxicity and no cases of pulmonary fibrosis. Intrapleural administration of bleomycin is useful in management of malignant pleural effusions.
Gan to kagaku ryoho. Cancer & chemotherapy 09/1995; 22(9):1203-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Forty-two patients with stage IIIA (bronchoscopically T3 and/or bulky N2) and stage IIIB NSCLC were treated with concurrent chemoradiotherapy (CRT). Treatment consisted of CDDP, 20 mg/m2 and etoposide, 40 mg/m2 by continuous infusion (day 1-5) of weeks 1 and 5 simultaneously with chest radiotherapy (RT), 50 Gy, 2 Gy/Fx, 5 Fx/week. Surgery was attempted 3-5 weeks after RT in pts clinically downstaged. Between 10/90 and 12/92, 43 previously untreated pts were enrolled and 42 were eligible. Pts characteristics were: male/female = 37/5; mean age, 61 yrs (range, 31-74 yrs); stage IIIA/IIIB = 10/32; 15 adenocarcinoma, 24 squamous cell, 2 large cell, 1 unclassified; PS 0/1/2 = 11/24/7. Excluding 1 ineligible pts, 42 pts were evaluated for CRT response. The response rate was 81% (1 CR, 33 PR, 5 NC, 1 PD, 2 NE). Clinical downstaging was achieved in 20 pts (48%). Twenty-one pts (50%) received surgery and 19 of them were completely resected. In 7 resection specimens, no tumor was observed. Toxicity of CRT was well tolerable (Grade 4 leukopenia, 15%; Grade 2-3 esophagitis, 15%). We conclude that this intensive combined modality therapy is acceptable and appears to increase the response rate as well as resectability. Prospective randomized studies should be conducted for further evaluation of this treatment modality.
Gan to kagaku ryoho. Cancer & chemotherapy 04/1995; 22(4):531-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Clinical and serological studies of chlamydial pneumonia were done in six patients (three men and three women). The other three patients had no avian contact and showed almost the same clinical symptom. Acute infection with Chlamydia psittaci and Chlamydia pneumoniae were diagnosed in two patients and in one patient, respectively, by MFA. Because in some cases Chlamydia psittaci pneumonia and Chlamydia pneumoniae pneumonia are difficult to differentiate, it is necessary to use a test that allows different chlamydia species to be distinguished.
Nihon Kyōbu Shikkan Gakkai zasshi 12/1994; 32(11):1056-60.
-
[show abstract]
[hide abstract]
ABSTRACT: The efficacy of continuous five-day intravenous infusion of cisplatin (CDDP) and etoposide with concurrent chest radiation therapy was evaluated in patients with limited stage small cell lung cancer. The first group of patients registered from February 1989 to September 1990 received three courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 40 mg/m2/day x 5 days) and concurrent chest radiation therapy on the third course with dose reduction of etoposide. The second group of patients registered after February 1991 received four courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 50 mg/m2/day x 5 days) and concurrent chest radiation therapy on the first and second courses with dose reduction of etoposide. The response rates were 91.7% and 93.3%, respectively. The median duration of survival was 32.0 months and 20.1 months, respectively. Major toxicity was leukocytopenia and 64% and 80% of patients encountered leukocytopenia of Grade 3 or 4. In conclusion, these regimens show remarkable efficacy with acceptable toxicity.
Gan to kagaku ryoho. Cancer & chemotherapy 11/1994; 21(14):2479-83.
-
[show abstract]
[hide abstract]
ABSTRACT: A 60-year-old man with cough and fever was admitted to our hospital. Chest radiography revealed multiple bullae and fungus balls in both lungs. He was treated with MCZ and FCZ for about 2 months, but the chest radiograph shadows did not improve and the fever continued. A two-stage operation was performed. The bullae were incised and the fungus balls were removed, then a muscle flap plombage was made with a pectoralis major muscle, a latissimus dorsi muscle and an intercostal muscle. The postoperative course was uneventful and respiratory function was preserved.
Nihon Kyōbu Shikkan Gakkai zasshi 10/1994; 32(9):899-901.
-
[show abstract]
[hide abstract]
ABSTRACT: Chronic cough may be the sole presenting manifestation of bronchial asthma (reference 3; Corrao et al, 1979), and "cough variant asthma (CVA)" has been used to categorize such patients. In order to clarify the clinical picture of CVA, we evaluated the clinical history, laboratory data, sputum cytology and pulmonary function in 14 subjects (5 males and 9 females, aged 14 to 65 years) compatible with the following diagnostic criteria: (1) chronic cough persistent for more than 8 weeks, (2) no wheeze nor dyspnea, (3) no rales, (4) no past history of asthma, (5) bronchial hyperreactivity to methacholine proven by Takishima's method (reference 13), (6) effectiveness of bronchodilators against cough, (7) normal chest X-ray film, (8) afebrile and negative CRP, (9) absence of sinusitis and postnasal drip, or if present, they are proved not to be responsible for the cough, and (10) no other causes of cough such as heart disease, prescription of ACE inhibitors, current smoking. The results were as follows. 1) Many of the subjects were atopic, with positive skin tests to one or more common allergens in 10 subjects, elevated serum IgE in 4 subjects, and past history and family history of atopy in 4 and 7 subjects, respectively. 2) Respiratory infection preceded the onset of CVA in 3 subjects. 3) Cough was generally nocturnal, but 2 subjects coughed only in the daytime. 4) FEV1.0% was decreased (less than 70%) in only 2 subjects, whereas V25 was decreased (less than 80% of predicted value) in 11 out of 12 evaluable subjects, which suggested peripheral airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Nihon Kyōbu Shikkan Gakkai zasshi 07/1992; 30(6):1077-84.
-
[show abstract]
[hide abstract]
ABSTRACT: A 71-year-old man was noted to habitually snore loudly at night and have a predisposition to somnolence during the daytime. While dozing during the day, he developed cardiac arrest at the time when snoring stopped, and was resuscitated. By means of a respiration monitor, he was diagnosed as having sleep apnea syndrome (SAS) with a combination of obstructive, central, and mixed type. However, neither respiratory insufficiency nor cardiac insufficiency was observed, and there were no abnormal findings on laboratory tests and bronchoscopy. SAS complicated by cardiac arrest is usually seen in cases with concomitant symptoms such as excessive obesity, hypertension, arrhythmia, right heart insufficiency, secondary polycythemia, or mental disorder. The present case abruptly developed cardiac arrest in the absence of such symptoms. This case therefore suggests the importance of screening tests using a respiration monitor during sleep in subjects who have a loud snore or a predisposition to somnolence during the daytime. Although treatment with UPPP alone had no noticeable effect, UPPP treatment combined with sleeping in the lateral position was effective in the present case. The efficacy rate of UPPP has been reported to be 50 to 60%. The early establishment of a method for precise evaluation of the site of obstruction as well as criteria for appropriate application of UPPP are urgently required.
Nihon Kyōbu Shikkan Gakkai zasshi 03/1992; 30(2):333-7.
-
[show abstract]
[hide abstract]
ABSTRACT: On the basis of the studies of autopsy cases and experimental animals, the pulmonary pathological findings of fat embolism syndrome (FES) have been reported to be (1) fat globules in the alveolar capillaries and the alveoli, (2) intra-alveolar hemorrhage, (3) alveolar edema and (4) foci of secondary infection. However, reports on lung biopsy in FES are rare, and no report has mentioned bronchoalveolar lavage (BAL) in FES. We experienced a case of FES, in which BAL was diagnostic. A 23 year-old man traffic accident victim was brought to our hospital by ambulance. His consciousness was clear and skeletal X-ray films revealed multiple fractures of the right femur, left tibia and left fibula. Direct traction of bilateral lower extremities was done. He remained stable subjectively, but anemia and thrombocytopenia progressed gradually in spite of blood transfusion. On the 4th hospital day severe hypoxemia, diffuse pulmonary infiltrates and petechiae in bilateral axillary lesions appeared, and FES was strongly suspected. O2 inhalation by face mask and high dose methylprednisolone administration was started. The hypoxemia improved, but pulmonary infiltrates worsened. For differential diagnosis, bronchoscopy and BAL was done on the 7th hospital day. Bronchoscopy revealed much fresh blood in the left main, upper lobe and lower lobe bronchus but no bleeding point was found. BAL fluid was bloody. The Sudan III stain and Berlin blue stain revealed several fat globules and numerous hemosiderin-laden macrophages. The presence of intra-alveolar fat globules and intra-alveolar hemorrhage was proved and definite diagnosis of FES was established.
Nihon Kyōbu Shikkan Gakkai zasshi 03/1990; 28(2):362-7.
-
Bulletin of the Chest Disease Research Institute, Kyoto University 04/1988; 21(1-2):1-7.
-
Kekkaku: [Tuberculosis] 09/1985; 60(8):421-8.
-
Bulletin of the Chest Disease Research Institute, Kyoto University 04/1985; 18(1-2):60-72.
