[A case of eosinophilic pneumonia with elevated levels of carcino-embryonic antigen (CEA)].

A 70-year-old woman was admitted for productive cough and infiltrative shadows in the right lower lung field on chest X-ray film. Eosinophilia (17%) in blood, an abnormally high percentage of eosinophiles (7%) in bronchoalveolar lavage fluid and eosinophilic infiltration with proliferated goblet cells in transbronchial lung biopsy specimens led to the diagnosis of eosinophilic pneumonia. Laboratory data on admission also revealed a high level of CEA (17.1 ng/ml) in serum. After administration of prednisolone (30 mg/day), the symptoms ameliorated and the CEA levels were normalized. The proliferated goblet cells were immunohistochemically positive for CEA, which suggests that the high levels of CEA were caused by excessive CEA secretion from the goblet cells associated with eosinophilic pneumonia. These studies showed that serum CEA also may be a marker for disease activity in eosinophilic pneumonia.

[A case of paragonimiasis westermani diagnosed on the observation of parasitic ova in bronchial washing fluid and successfully treated with praziquantel].

A 41-year-old male visited our clinic complaining of cough and dirty hemosputum. Roentgenogram and CT scan of the chest revealed a cavitary nodule in the S1+2 of the left lung. After administration of antibiotics (CFIX, ASPC, FMOX, CLDM), the cavities were disappeared but the size of the nodule remained unchanged. Because the possibility of lung cancer could not be excluded, we underwent transbronchial brushing and bronchial lavage. Then, parasitic ova of Paragonimus westermani was detected in BALF, and an Ouchterlony's double diffusion test showed strong reaction against Paragonimus westermani antigen. The patient was successfully treated with praziquantel. Efficacy of the treatment was confirmed by a remarkable decrease of antibody titer measured by microplate-EIA.

[A case of pulmonary adenocarcinoma in a young man with multiple metastasis to the nasopharynx and paranasal sinuses].

A 36-year-old man who complained of bloody sputum showed a mass-like shadow in the right upper lung field on chest X-ray, which was diagnosed as adenocarcinoma by sputum cytology in August, 1990. Since his clinical stage was too advanced for curative operation, chemotherapy was started on October 1, 1990. On October 26, he brought up a polyp-like mass, and was found to have polypoid tumors on the bilateral tonsils and nasopharynx, which were biopsied and diagnosed as poorly-differentiated adenocarcinoma. On November 21, CT of the face showed soft tissue density tumors in the bilateral paranasal sinuses. According to the clinical course, all tumors were thought to be metastatic lesions. Since he had suffered from epistaxis and nasal obstruction due to the enlargement of metastatic tumors, nebulization chemotherapy and palliative resection were performed. In February 1991, he developed severe headache due to brain metastasis. Despite irradiation therapy, he died from cerebral intra-tumorous hemorrhage on February 22. We reported a rare incurable case of lung cancer with metastasis to the nasopharynx and paranasal sinuses.

[A case of loxoprofen-induced pulmonary eosinophilia].

A 65-year-old female suffering from lumbago, headache, and hypertension had been treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and antihypertensive drugs. On June 13, 1990, 2 weeks after the commencement of loxoprofen administration, she developed cough and low grade fever. She was treated with antibiotics and NSAIDs without improvement. Laboratory data showed marked eosinophilia (2200/mm3), elevation of IgE (3090 IU/ml), and liver dysfunction. Her chest X-ray revealed no active lesion, but the percentage of eosinophils in BALF was elevated (38%). Because drug-induced eosinophilic pneumonia was suspected, all drugs were discontinued. Her symptoms improved and the abnormalities of laboratory data normalized. The lymphocyte stimulation test was weakly positive with three NSAIDs (loxoprofen, pranoprofen, and alminoprofen). The challenge test by loxoprofen reproduced eosinophilia and liver dysfunction, suggesting that she had loxoprofen-induced eosinophilic pneumonia. To our knowledge, this is the first reported case of loxoprofen-induced lung injury.

[A case of bronchiolitis obliterans organizing pneumonia, which recurred during prednisolone maintenance therapy].

A 69-year-old man was admitted with general fatigue, dyspnea, cough, fever and right pulmonary infiltrations on a chest X-ray films. He had suffered from myocardial infarction 8 years before. Since September 1987, he had been given Aprindine in addition to previous drugs. In early November 1987, he developed dyspnea. Antibiotics were not effective. He was hospitalized on Nov. 13, '87 when crepitations were audible on his right chest. Methylprednisolone pulse therapy was effective, however right pneumothorax developed. He underwent right thoracotomy and lung biopsy. Lung biopsy specimens showed pathological features of bronchiolitis obliterans organizing pneumonia (BOOP). Corticosteroid therapy yielded a remarkable clinical, physiological and roentgenographic recovery. However, approximately two years later during prednisolone maintenance therapy, BOOP recurred. He responded again to corticosteroid treatment, however he died of hepatic failure on Dec. 17, '89. "Idiopathic" rather than "drug induced" was suggested for the cause of BOOP in this case.

[The usefulness of pleural biopsy in benign or malignant pleurisy].

Retrospective studies of pleural biopsy, cytology and ADA in pleural effusion were performed in 116 patients with pleural effusion between 1980 and 1988. Pleural malignant disease was diagnosed in 25 patients (75.8%) by cytology, in 19 patients (57.6%) by pleural biopsy. Thus, cytology should be performed first in patients with pleurisy. Both of cytologic study and CEA in pleural effusion were negative in 3 cases of squamous cell carcinoma. Tuberculous pleuritis was diagnosed in 24 patients (50.0%) by pleural biopsy, in 5 patients (10.4%) by isolation of Mycobacterium tuberculosis. Both pleural biopsy and adenosine deaminase activity (ADA) were examined in 19 cases of tuberculous pleuritis and ADA was elevated in 16 patients (84.2%). These data suggested that pleural biopsy was useful for diagnosis of pleuritis and the combination of cytology, tumor markers and ADA with biopsy improved diagnostic rates of pleuritis.

[Isolation of methicillin-resistant Staphylococcus aureus (MRSA) at the Hokusho Central Hospital--observation during the recent 4 years].

Clinical and bacteriological studies were carried out to investigate the isolation of MRSA from clinical materials, during the 4 years from 1985 to 1988 at the Hokusho Central Hospital. The isolation frequency of MRSA from Staphylococcus aureus increased from 5.6% (3 strains) in 1985 to 50.0% (90 strains) in 1988. MRSA from sputum and pressure sore increased significantly. However MRSA from outpatient and inpatient in the ward for common people were constant, about 20%. Inpatients in the ward for aged person were increased significantly from 13.6% (3 strains) to 67.0% (67 strains). Most of the patients with positive MRSA isolation had background diseases (88.3%) and were bedridden (78.4%). Patients with cerebrovascular disease were 55.9% of all of the cases. But most of the MRSA strains were resistant to CZX, FOM, DMPPC, CMX, CEZ, CZON, CZX, most of the MRSA strains were sensitive to RFP, VCM, MINO, IPM/CS.

[Adverse reactions of antituberculous agents, especially about its onset and duration].

We examined the adverse reactions of the antituberculous agents in 225 hospitalized patients (150: male, 75: female, average age: 45.4 years old) and the results were summarized as follows: 1) The side effects were seen in 53 patients (23.6%), and the abnormal laboratory findings were observed in 94 patients (41.8%). 2) The incidence of adverse reactions in patients treated with three drugs (INH, RFP, EB) and four drugs (plus SM) were 45.9% and 82.4%, respectively. 3) Adverse reaction appeared within one month after starting treatment in 67.9% of eligible patients, and it disappeared within one month from its onset in 76.8% of patients. There results suggested the importance of careful clinical observation especially soon after starting antituberculous therapy.

[Isolation of methicillin-resistant Staphylococcus aureus (MRSA) from sputum and clinical features of bronchopulmonary infection due to MRSA during 4 years (1985-1988)].

Clinical and bacteriological studies were carried out to investigate the isolation of MRSA from sputa and 13 cases with bronchopulmonary infections due to MRSA, during 4 years from 1985 to 1988 at the Hokusyo Central Hospital. The isolation rate of MRSA in Staphylococcus aureus from sputum increased from 0% in 1985 to 51.4% in 1988, and especially from patients in wards for aged people. Most of the MRSA strains were isolated from patients with underlying diseases, or bed sores. The roentgenographic appearances in bronchopulmonary infection patients due to MRSA, showed infiltration and cavitation. Seven out of 13 cases of bronchopulmonary infection due to MRSA died, in spite of therapy with current antibiotics, suggesting poor prognosis of this infection.

[A case of aprindine-induced pneumonitis].

A 73-year-old man had been treated with Aprindine because of paroxysmal atrial fibrillation. On July 13, 1987, five months after the commencement of aprindine administration, he developed dyspnea and low grade fever. His chest X-ray revealed multiple infiltrative shadows in both lung fields. He was treated by various antibiotics, but the infiltrative shadows increased. BALF showed increased percentage of lymphocytes and a decrease in the OKT4/T8 ratio, and the histological findings of TBLB carried out on August 6, 1987, showed alveolitis with Masson bodies. The lymphocyte stimulation test by drugs was positive only for aprindine. After cessation of Aprindine administration, his complaints and laboratory data improved, but his abnormal shadow on chest X-ray did not diminish completely. Open lung biopsy was performed for differential diagnosis of BOOP, on Sep. 14, 1987. The histopathology of specimens of the lung was compatible with drug-induced pneumonitis. The administration of 30 mg of prednisolone was started on Oct. 14, 1987, and the dosage was decreased gradually. The abnormal shadow on chest X-ray improved. To our knowledge, there has been no reported case of Aprindine-induced pneumonitis, and this could be the first report.

[Rapid diagnostic methods for fungal infections--using chromogenic limulus tests and enzymatic measurement of D-arabinitol].

Conventional chromogenic limulus test (toxicolor test) reacts with glucan of bakers yeast as well as endotoxin, because toxicolor test contains factor G which is sensitive to glucan and polysaccharide of fungus. A new endotoxin specific limulus test (endospecy test) was developed to improve reaction which responded only to endotoxin. The toxicolor test showed the positive reaction to the culture media of candida albicans 7N strain in RPMI 1640 medium, but the endospecy test did not. D-arabinitol, measured by fluometric enzymatic method, also was positive to culture media. These results suggested that a combination of the toxicolor and the endospecy test and enzymatic measurement of D-arabinitol could be applied to rapid diagnostic methods of fungal infection.

[Detection of Pseudomonas aeruginosa antigens in sputum, broncho-alveolar lavage and concentrated urine by enzyme-linked immunosorbent assay].

A sandwich enzyme-linked immunosorbent assay (ELISA) for detection of a 11 serotypes of P. aeruginosa has been developed by using polyclonal rabbit anti P. aeruginosa (NC-5 strain) antiserum. The following results were obtained: 1. Cultured broth of P. aeruginosa was detected most sensitively by this assay followed by sonicated soluble antigen, washed bacterial fluid and heated soluble antigen of P. aeruginosa. The lower limit of detection was approximately 2.3 X 10(4) cfu/ml of P. aeruginosa (NC-5 strain) (containing 22.2 ng/ml of protein) in cultured broth. 2. By this assay, all serotypes of P. aeruginosa and some strains of Family Pseudomonadaceae (RNA group I) were detected, but no cross reaction was noticed to other species of bacteria (24 species, 268 strains). 3. The serum antigen in the experimental sepsis of P. aeruginosa or murine experimental pneumonia was detected when at least approximately 10(3) cfu/ml of P. aeruginosa was present in serum or BALF. But the antigen was detected from concentrated urine even under the concentration of 10(2) cfu/ml in sepsis. 4. P. aeruginosa antigens in sputum of patients with chronic respiratory tract infection was also detected. There was a significant difference between absorbance value of sputum in non-infected patients (group 1) and one in infected patients by P. aeruginosa (group 3) (p less than 0.01). And there was a strong correlation between absorbance value of sputum in Group 3 and number of P. aeruginosa. In 22 of 33 sputa (66.7%) with P. aeruginosa infection as verified by conventional culture methods, the antigen was detected in sputum. In a patient of P. aeruginosa pneumonia with acute leukemia, the antigen was detectable from sputum and one of the series of concentrated urine. It is concluded that the detection of P. aeruginosa antigen in sputum and urine by ELISA is a helpful aid to diagnose P. aeruginosa infection.