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Publications (13)2.92 Total impact

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    ABSTRACT: A rare case of chronic obstructive pulmonary disease (COPD) with severe pulmonary hypertension (PH) was found in a 68-year-old man. COPD was diagnosed in his 50s, from which time he received home oxygen therapy. In January 2007, he was admitted due to progression of dyspnea. On admission to our hospital, arterial blood gas analysis showed severe hypoxemia. Moreover, echocardiographic findings demonstrated severe deviation of the interventricular septum toward the left ventricle, with right ventricular dilatation. Cardiac catheterization data demonstrated pulmonary arterial hypertension with a low cardiac output. Because severe PH is uncommon in patients with COPD and there was no apparent etiology of PH other than COPD, we thought this case was predominantly a pulmonary vascular disease such as idiopathic pulmonary arterial hypertension. Though we first treated this patient with bosentan, it was not effective. Therefore, he was treated with continuous infusion of epoprostenol. Epoprostenol administration along with bosentan resulted in decrease of BNP and right ventricular function improvement. We report a case of severe PH due to severe COPD treated with continuous administration of epoprostenol.
    09/2008; 46(8):660-6.
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    ABSTRACT: We reported a case in which multi-drug resistant tuberculosis was recognized after two courses of anti-tuberculosis treatment. A 41-year-old woman who had received two courses of anti-tuberculosis treatment for pulmonary tuberculosis was admitted to our hospital due to productive cough, high fever and positive sputum smear showing acid fast bacillus. In the past treatment, drug susceptibility was unknown because of culture-negative TB. Chest radiograph showed atelectasis of the right upper lobe. The pathological examination of surgically resected lung specimen revealed that atelectasis was formed by a granulation tissue with caseous necrosis progressed to the bronchus wall. We examined cultures three times using both solid and liquid media. Liquid culture of the first time specimen was positive for Mycobacterium tuberculosis after six weeks and multi-drug resistant tuberculosis was recognized on drug susceptibility test. Thereafter she was treated with KM, LVFX, PZA and PAS, and maintained sputum smear negative for 7 months after treatment. Physicians must consider possibility of MDR-TB despite findings showing smear-positive and culture-negative TB.
    Kekkaku: [Tuberculosis] 08/2008; 83(7):513-7.
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    ABSTRACT: To investigate the infection rate of tuberculosis among nurses with a history of working in our hospital's tuberculosis ward (TW). We measured interferon gamma levels in 50 nurses who had worked in our TW, and evaluated the infection rate among these nurses before (I) and after (II) the use of our hospital's tuberculosis infection control manual. The infection rate including probable infection was 6/50 (12.0%) in all TW nurses. The infection rate in the group I was 17.6%, but that in group II was 0%. Our hospital's tuberculosis infection control manual was effective for decreasing the infection rate, despite a high rate of infection in group I.
    Kekkaku: [Tuberculosis] 05/2008; 83(4):359-63.
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    ABSTRACT: A 71-year-old man was initially given a diagnosis of pulmonary nontuberculous mycobacterial infection due to Mycobacterium intracellulare (M. intracellulare). The patient was admitted because chest roentgenogram and CT scanning showed a progression of infiltrating shadows in the bilateral upper lung fields. Aspergillus fumigatus was identified by bronchial lavage. The patient was found to have chronic necrotizing pulmonary aspergillosis with M. intracellulare and treated with voriconazole (VRCZ). After fifteen days of treatment, he complained of dyspnea and cough. A chest CT showed new diffuse ground glass opacity in the left lower lobe. Arterial blood gas analysis demonstrated severe hypoxemia. Due to concerns about drug-induced lung injury, voriconazole was discontinued and corticosteroid therapy was started. VRCZ was replaced by micafungin. Thereafter, symptoms and left lower shadows resolved. Although the lymphocyte stimulation test for voriconazole was negative, we considered that this pulmonary lesion may have been an adverse reaction to voriconazole.
    05/2008; 46(4):319-24.
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    ABSTRACT: Pleural effusion without occurrence of active pulmonary lesion due to nontuberculous mycobacteria is extremely rare. We report a case of Mycobacterium intracellulare pleurisy in an 84-year-old woman. The patient was admitted to a nearby hospital because of dyspnea. Massive right pleural effusion was observed on chest roentgenogram. Bacteriological examinations, smear and culture of the sputum or pleural effusion were negative. First we thought pleurisy was caused by M. tuberculosis as pleural effusion showed predominant lymphocyte count and high adenosine deaminase level. However, M. intracellulare was identified by the polymerase chain reaction method from pleural effusion. Based on clinical findings and laboratory data, we suspected pleurisy was due to M. intracellulare infection. Clarithromycin, kanamycin, rifampicin and ethambutol were administered. After four months of treatment pleural effusion disappeared without accompanying the active pulmonary lesion. Therefore, we diagnosed this case as pleurisy without pulmonary lesion due to M. intracellulare.
    Kekkaku: [Tuberculosis] 02/2008; 83(1):27-31.
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    ABSTRACT: We encountered a case of suspected bronchocentric granulomatosis (BCG) occurring in a COPD patient. Chest CT on admission showed a nodular shadow with indentation and a notch-like opacity in right S(3)a. Based on these findings, lung cancer was suspected. As we could not establish a definitive diagnosis, video-assisted thoracic surgery was performed. The histological findings of the resected specimen demonstrated BCG with clustering of fungal hyphae in the bronchioles. As the lesion was resected completely, we did not give additional treatment with an antifungal agent. It is difficult to differentiate BCG from lung cancer preoperatively. However, considering the homogeniecity of the nodule, it may be able to differentiate this type of lesion from lung cancer based on the feature. We report a rare case of a solitary nodule caused by BCG with Aspergillosis.
    12/2007; 45(11):856-60.
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    ABSTRACT: A 63-year-old man was admitted to our hospital for the evaluation of an abnormal nodule in lung. Chest CT demonstrated a smooth nodular shadow in the left S6 and enlarged left hilar and mediastinal lymph nodes. Local uptake in these nodes was demonstrated on 18FDG-PET. Although bronchoscopic study was performed, definitive diagnosis had not yet been determined. After one year, the nodular shadow increased in its size. To confirm the diagnosis, VATS was performed. The histological findings showed a caseating epithelioid-cell granuloma and culture of the specimen was positive for Mycobacterium tuberculosis. This case suggested the difficulty in distinguishing lung cancer from solitary tuberculous nodules by using 18FDG.
    Kekkaku: [Tuberculosis] 10/2007; 82(9):715-9.
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    ABSTRACT: To investigate the infection rate of tuberculosis in high-risk employees at our hospital. We measured interferon gamma levels in 40 employees and evaluated the infection rate in doctors working in the Tuberculosis Ward (D group), nurses in the Tuberculosis Ward (N group), and other high-risk employees (O group). The overall infection rate including probable infection was 6/40 (15.0%). The infection rate in the N group was 0%, while those in the D and O groups were 27.3% and 20.0% respectively. No new infection of tuberculosis was observed after the introduction of tuberculosis infection measure manual of our hospital. Our hospital's tuberculosis infection measure manual was effective in decreasing the new tuberculosis infection despite a high infection rate in high-risk employees at our hospital.
    Kekkaku: [Tuberculosis] 08/2007; 82(7):557-61.
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    ABSTRACT: Transient worsening of tuberculosis (TB) symptomatology and lesions in response to anti-TB therapy has previously been reported as paradoxical worsening. Recently, paradoxical worsening of TB following antiretroviral therapy in AIDS patients was reported. However, paradoxical worsening of nontuberculous mycobacterium, including Mycobacterium abscessus (M. abscessus), has not been reported previously. We reported the first case of paradoxical worsening of pulmonary M. abscessus. (c) 2006 Elsevier Ltd. All rights reserved.
    Respiratory Medicine 05/2007; 101(4):868-70. DOI:10.1016/j.rmed.2006.06.026 · 2.92 Impact Factor
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    ABSTRACT: A 79-year-old woman was admitted to our hospital because of general fatigue. Chest radiograph and computed tomograph showed bronchiectasis and centrilobular nodules in the right middle lobe and lingula, which had not changed from previous examination. Intrahepatic nodular lesions and swelling of the left cervical lymph nodes, supraclavicular lymph node, abdominal paraaortic lymph nodes and inguinal lymph nodes was observed. Biopsy specimen of the liver lesion demonstrated epithelioid cell granulomas. Biopsy of the right inguinal lymph node demonstrated epithelioid cell granulomas with caseous necrosis and culture of the specimen showed Mycobacterium tuberculosis. The patient was diagnosed as having liver tuberculosis and multiple tuberculous lymphadenitis. Antituberculous treatment with isoniazid, rifampicin, ethambutol and pyrazinamide were started and continued for 6 months. All lesions improved after treatment. This was a rare case of liver tuberculosis that was difficult to distinguish from liver metastasis of cancer.
    Kekkaku: [Tuberculosis] 04/2007; 82(3):185-8.
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    ABSTRACT: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis with a characteristic long bone lesion. Although about half of the patients have extraosseous organs, pulmonary involvement is very rare. We report a 55-year-old man with ECD who complained of severe dyspnea despite home oxygen therapy with noninvasive positive pressure ventilation. Continuous PGI2 administration was not very effective, but administration of cyclophosphamide and prednisolone induced rapid improvement of respiratory failure and the effect for six months on arterial blood gas analysis and stability of the disease state persisted.
    02/2007; 45(1):43-8.
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    ABSTRACT: Bronchioloaveolar cell carcinoma (BAC) was defined by the WHO in 1999 to be a subtype of adenocarcinoma with a pure bronchioloalveolar growth pattern showing no evidence of stromal, vascular, or pleural invasion [Travis WD, Colby TV, Conin B, et al. Bronchioloalveolar carcinoma. In: Sobin LH, editor. WHO international histological classification of tumors, 3rd ed. Copenhagen, Denmark: Springer; 1999. p. 34–8]. Although there were some reports that BAC was presented together with squamous cell carcinoma, this is the first report that it might be transformed from surrounding pure nonmucinous BAC. Physicians should be aware that pure BAC could transform to squamous cell carcinoma, and that such cases might not respond to gefitinib.
    Respiratory Medicine Extra 01/2007; 3(4):175-177. DOI:10.1016/j.rmedx.2007.09.010
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    ABSTRACT: Though pulmonary lymphangioleiomyomatosis (LAM) is a rare disease that affects women in the reproductive years, there have been some reports in postmenopausal women, and even a few reports of pulmonary LAM in postmenopausal women without exogenous estrogen. This is the first report describing progression of pulmonary LAM after menopause. Physicians should be aware that pulmonary LAM could progress after menopause, although the course might run slower than that of LAM in the younger patients.
    Respiratory Medicine Extra 01/2007; 3(2):71-73. DOI:10.1016/j.rmedx.2007.02.002