Malignant lymphoma mimics miliary tuberculosis by diffuse micronodular radiographic findings.

This case reports rare findings on computed tomography of a manifestation of malignant lymphoma, in which diffuse lung shadows appeared as miliary nodules distributed throughout the lungs bilaterally. The patient had a history of surgical treatment of rectal cancer and had received chemotherapy for suspicious liver metastasis. At her current presentation for evaluation suspected miliary tuberculosis on chest radiography, subsequent liver biopsy revealed a mass infiltration of atypical lymphocytes, which was diagnosed as follicular lymphoma. The miliary tuberculosis was suspected more than neoplastic lesions, such as metastatic rectal cancer or malignant lymphoma. Despite repeated bacteriologic tests of various samples, including sputum, urine, bronchial secretion, peripheral blood, bone marrow aspiration, and gastric lavage, all results were negative for mycobacterium tuberculosis. Finally, multiple, small, mass lesions of lymphocytes were demonstrated in the lung obtained from video-assisted thoracic surgery, and a diagnosis of follicular lymphoma was given. The final interpretations of liver mass and military lung lesions were tumor involvement by the follicular lymphoma. This radiologic findings of multiple miliary opacities throughout the whole lungs confused definite diagnosis because these images were remarkably similar with miliary tuberculous. This case reminds us to consider a wide variety of differential diagnoses even we assumed to be familiar with radiographic imaging at first glance.

Elevated serum ß-d-glucan levels in cavitary pulmonary nocardiosis.

An 86-year-old woman with Borrmann type III colorectal cancer (Union for International Cancer Control pT4aN2bM1c, pStage IVc) had received dexamethasone for the last 6 months as palliative care. She presented with a low-grade fever, chest pain and cough. Chest radiography on admission showed cavities and consolidations bilaterally in the upper lobes. A blood examination on admission revealed highly elevated serum ß-d-glucan levels. The diagnosis by bronchoscopy was pulmonary nocardiosis. With trimethoprim/sulfamethoxazole and imipenem/cilastatin, the ß-d-glucan levels were decreased, and chest X-ray showed improvement after 1 month. ß-d-glucan is known to be a biomarker of fungal infection. It is possible that ß-d-glucan levels also indicate a pulmonary infection by Nocardia.

[Examining attitudes toward mutual support in daily life and their associated factors within a community-based integrated care system: Findings of the "Survey to Enrich the Lives of Miyamae Ward Residents"].

Objectives　This study aimed to examine current relationships with neighbors among city dwellers and determine the factors associated with providing and accepting support in daily life.Methods　The "Survey to Enrich the Lives of Miyamae Ward Residents" was conducted with 1,000 people aged ≥30 years residing in Miyamae Ward, Kawasaki City. The survey items included baseline characteristics (e.g., sex, age, and residential status), relationships with neighbors, inclination to share personal information, and inclination to provide/accept support for the instrumental activities of daily living (IADL). To identify the factors associated with providing and accepting support for IADL, logistic regression analyses were performed with the following independent variables: baseline characteristics, neighborly relationships, inclination to share personal information, and inclination to provide support for the IADL.Results　We analyzed 407 respondents with complete responses. Among the different levels of neighborly relationships, 11.8% of the respondents were "cooperative with neighbors in daily life," 33.3% would "only stand and talk," 46.0% would "only exchange greetings," and 9.0% had "no relationships with neighbors." Among those willing to provide support, the highest proportions of responses were for "Calling on/watching over others" (60.1%) and "Helping to throw out garbage" (51.7%). In contrast, less than 30% of respondents were willing to seek support from neighbors and volunteers for these two activities. The factors significantly associated with a willingness to provide support were women and relationships with neighbors at the "stand and talk" level or higher. A disinclination to share personal information was inhibitory to providing support. The factors significantly associated with a willingness to accept support were women and the inclination to provide support according to IADL. Home ownership was inhibitory to accepting support.Conclusion　Fixed residential status and longer residence durations did not necessarily contribute to closer relationships with neighbors in urban areas. Although the respondents generally only exchanged greetings with neighbors, closer relationships are needed to facilitate a willingness to provide support to others. While many respondents were willing to provide simple assistance in daily life, rather fewer would seek help for the same activities. However, the acceptance of support was associated with the inclination to provide support, indicating a correlation between these two attitudes. In order to further encourage mutual support in daily life in urban areas, it is necessary to not only improve the level of relationships with neighbors, but also to implement initiatives that increase opportunities for people to gain experience providing support.

latrogenic Mediastinal Emphysema and Subcutaneous Emphysema Induced by Bronchoscopic Examination.

A 79-year-old man presented with fever of unknown origin with interstitial shadows in the bilateral lung fields. A bronchoscopic examination did not indicate any malignancy or specific interstitial disease. After the bronchoscopic examination, the patient gradually developed subcutaneous and mediastinal emphysema. As the subcutaneous emphysema and mediastinal emphysema were mild, the patient was not administered any specific treatment. However, he eventually developed severe subcutaneous emphysema and mediastinal emphysema, and did not show any transient improvement. The patient underwent another bronchoscopic examination at another centre and a lacerated wound was detected. Thereafter, emergent operation was performed.