[An autopsied case of mucinous bronchioloalveolar carcinoma associated with multiple thin-walled cavities].

A 82-year-old man was found to have mucinous bronchioloalveolar carcinoma associated with a cavity 10-cm in size in the right lower lobe, and he underwent a surgical lobectomy in April 2005 (pT2N0M0). Seven months after the surgery, chest images showed multiple metastases with thick-walled cavities in bilateral lung fields. The serial HRCT showed that thick-walled cavity lesions transformed into thin-walled cystic cavities associated with decreasing serum CEA levels. The patient's condition was good with best supportive care for 24 months from the time of recurrence. Subsequent progression of the thick-walled cavities into thin-walled cavities, was acompanied by re-elevation of serum CEA levels, and he died of respiratory failure 5 months after re-exacerbation. Macroscopic findings at autopsy showed multiple cavities in both lungs. Microscopic findings of the right lung showed desquamative mucinous bronchioloalveolar carcinoma cells lining the thick-walled cavity surface, and a single layer of tumor cells proliferating in the thin-walled cavity surface. Tumor cells with excessive mucus and necrosis were observed in the thick-walled cavities. It is suggested that thick-walled cavities were formed as a result of avascular necrosis and destruction of the pulmonary alveoli by excessive mucus, and thin-walled cavities were formed as a result of a check-valve mechanism.

Successful treatment with pneumonectomy for pulmonary Mycobacterium abscessus infection.

We report a case of pulmonary Mycobacterium abscessus (M. abscessus) infection with destructive growth in the entire right lung. The patient was 56-year-old woman who had had pulmonary tuberculosis at the age of 40 and had been diagnosed as having pulmonary Mycobacterium abscessus infection 4 years prior to admission at our hospital. Although various antibiotics were administered, persistent fever, hemoptysis and weight loss developed. After undergoing a right pneumonectomy, her clinical symptoms improved dramatically and sputum excretions of M. abscessus ceased. No relapse of the disease has been observed in the 2 years since surgery. Pneumonectomy was very effective for refractory M. abscessus infection that destroyed the right lung.

[Human parvovirus B19 infection in 15 adults--two-year Toho University Hospital study].

Human parvovirus B19 infection in adults features clinical symptoms and laboratory abnormal findings unlike those in children commonly associated with cheek rash. We diagnosed 15 adult cases based on the positive increase in anti-parvovirus B19 IgM antibody (8.89 +/- 7.86 mean +/- SD, enzyme immunoassay (EIA)). Antibody titer was measured in 78 patients clinically showing fever, edema, exanthema, arthralgia, and myalgia among 11,040 outpatients first visiting the hospital from January 2005 to December 2007. Based on clinical and laboratory findings for these 15 cases, we recommended that physicians taking anti-parvovirus B19 antibody blood samples note whether (1) the level of C reactive protein is negative or low and without leucocytosis; (2) a miliary rash is observed in short duration (rarely facial); (3) arthralgia and/or myalgia is present in the extremities (sometimes asymmetrical); (4) edema is present in the extremities, especially finger, ankle, or sole of the foot; (5) contact has been made with ill children; (6) flu-like symptoms occur such as fatigue, headache, or fever;and (7) normo- or hypocomplementemia and/or antinuclear antibody is positive. Patients who fulfill requirement (1) plus at least three of requirements (2) through (7) should have a blood sample taken. We retrospectively studied 78 cases using these requirements, finding their sensitivity to be 100% (15/15), specificity to be 88.9% (56/63), positive predictive value to be 68.1% (15/22) and negative predictive value to be 100% (56/56). These requirements are thus useful in selecting patients for measuring antibody titer and definitively diagnosing severe or persistent parvovirus B19 infection occationally observed in adults.

[A case of pulmonary alveolar hemorrhage caused by methylergometrine].

A 35-year-old woman underwent endometrial curettage for suspicion of miscarriage. A few minutes after intravenous injection of methylergometrin (0.2 mg) for inducing uterine contraction, blood gas analysis revealed severe hypoxemia. Chest CT showed diffuse ground-glass opacities in both lung fields and consolidation in the right lower lobe. Bronchoscopy revealed blood coagulation in the right bronchus intermedius. Bronchoalveolar lavage fluid showed fresh blood-like fluid containing hemosiderin-laden macrophages. We diagnosed pulmonary alveolar hemorrhage associated with pulmonary edema. Although we analyzed the possible causes of alveolar hemorrhage such as pulmonary thromboembolism, collagen disease, ANCA-related angitis and malignant disease, there were no underlying systemic diseases. It seems likely that contraction of the blood vessels caused by methylergometrin caused the increased pulmonary arterial and wedge pressure which led to pulmonary edema and alveolar hemorrhage. We believe this is the first reported case of pulmonary alveolar hemorrhage caused by methylergometrin, confirmed by bronchoscopy.

High prevalence of gastroesophageal reflux symptoms in patients with both acute and nonacute cough.

Although there have been many studies that showed a close association between gastroesophageal reflux disease (GERD) symptoms and chronic cough, it has been unknown whether acute cough is also associated with GERD. The aim of this study was to evaluate the relationship between GERD and respiratory symptoms in general practice. 1725 consecutive patients who first attended our hospital were enrolled in the present study. They were asked to respond the F-scale questionnaire regardless of their chief complaints. Over all, 656 (38%) patients were diagnosed as GERD and 226 (13%) had respiratory symptoms. Patients with respiratory symptoms had GERD symptoms more frequently than patients without respiratory symptoms (p < 0.05). Forty-three (37%) of 115 patients with acute cough and 48 (43%) of 111 with nonacute cough had GERD symptoms, suggesting that development of GERD is not associated with the period of respiratory symptoms. Patients with respiratory symptoms are at a significantly increased risk of developing GERD. Whether or not treatment for GERD or respiratory diseases is useful for the prevention of respiratory symptoms and GERD, respectively, should not be driving management decisions in primary care.