Detection of Pneumocystis carinii, Mycobacterium tuberculosis, and cytomegalovirus in human immunodeficiency virus (HIV)-infected patients with hemophilia by polymerase chain reaction of induced sputum samples.

The purpose of this study was to diagnose the initial stage of acute pulmonary infections due to Pneumocystis carinii (P. carinii), Mycobacterium tuberculosis (M. tuberculosis), and cytomegalovirus (CMV) by polymerase chain reaction (PCR) combined with the induced sputum method in hemophilia patients infected with human immunodeficiency virus (HIV). Induced sputum and PCR were obtained at each outpatient visit or when any respiratory symptoms were present during a one-year period. All patients with a CD4+ count of less than 200 x 10(6)/l were given prophylactics against P. carinii pneumonia (PCP). PCR was conducted 111 times in 29 patients. M. tuberculosis DNA was detected in 1 patient and CMV DNA in 4 patients. P. carinii DNA was not detected. PCR on induced sputum samples is sensitive for the rapid detection of the initial stage of respiratory events. PCP prophylaxis changes the clinical manifestations of HIV infection.

Expression of tumor necrosis factor receptors in human lung cancer cells and normal lung tissues.

The purpose of this study was to investigate the expression of tumor necrosis factor (TNF) receptors for the control of the biologic action of TNF-alpha in lung cancer cells and normal lung tissues. Lung cancer specimens and normal lung tissues were freshly obtained in pairs from 15 patients who underwent surgery for lung cancer. Thirteen lung cancer specimens expressed the 55 kDa TNF receptor messenger RNA (mRNA), whereas only six lung cancer specimens expressed the 75 kDa TNF receptor mRNA by Northern blot analysis. The 55 kDa and 75 kDa TNF receptors mRNA were detected in all and 11 normal lung tissues, respectively. All four lung carcinoma cell lines examined expressed the 55 kDa TNF receptor mRNA, but only RERF-LC-MS (MS) expressed both the 55 kDa and 75 kDa TNF receptors mRNA. Immunohistochemical examination revealed that lung cancer cells expressed the 55 kDa TNF receptor, but not the 75 kDa TNF receptor at the protein level. In normal lung tissues, the 55 kDa TNF receptor was detected in alveolar macrophages, bronchioles, and some small vessels. The 75 kDa TNF receptor was detected in alveolar macrophages. All four lung carcinoma cell lines examined exhibited the only 55 kDa TNF receptor. TNF-mediated tumor cell lysis was observed in all lung carcinoma cell lines that exhibited the 55 kDa TNF receptor except A549, which is a TNF-insensitive cell line. In surface binding assays, specific surface binding of TNF-alpha to TNF-insensitive cell line A549 was observed to be about half that of TNF-sensitive cell lines. We demonstrated the expression of two distinct TNF receptors in human lung cancer and normal lung tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of round atelectasis related to spontaneous pneumothorax in a patient with neurilemmomatosis].

A 60-year-old man was admitted to our department for investigation of abnormal shadows on his chest X-ray. He had been diagnosed as having neurilemmomatosis in 1987. His chest X-ray showed nodular shadows in left S5 and S8 and localized spontaneous pneumothorax in left lung field. The nodular shadows, which were in contact with thickening of the pleura, showed curved shadows of bronchi and vessels (so-called comet tail sign). We suspected that they were round atelectasis, but to confirm the diagnosis and to treat the pneumothorax, limited resection of the lung and resection of the bulla were performed. The diagnosis of round atelectasis was confirmed by histological findings. Round atelectasis related to spontaneous pneumothorax is a very rare condition; however, we consider this to be an important case for understanding the pathogenesis of round atelectasis.

[A case of essential thrombocythemia with pulmonary hypertension and bilateral pleural effusions].

A 79-year-old woman was admitted with general fatigue. Chest roentgenogram showed diffuse reticular shadows and bilateral pleural effusion. Peripheral blood studies revealed an elevation of platelet count (203.3 X 104/mm3). The case was diagnosed as essential thrombocythemia and treated with ACNU. The platelet count decreased. Bilateral pleural effusions increased gradually and their characteristics changed from bloody exudate to transudate. Biopsy of her pleura and thoracoscopy were carried out without significant results. Later, systemic edema, which suggested right heart failure, developed. The diagnosis of pulmonary hypertension and right heart failure was made by echocardiogram and right cardiac catheterization. Because perfusion scan of the lung revealed some perfusion defects, complication of pulmonary embolism was suspected. Bilateral pleural effusion and pulmonary artery pressure decreased with treatment by nifedipine, furosemide and isosorbide dinitrate. This is the first case report of essential thrombocythemia, pulmonary hypertension, right heart failure and bilateral pleural effusion.

[A case of adult Still's disease with severe pulmonary complications].

We reported a case of adult Still's disease accompanied by pericarditis, pleuritis and extensive pneumonitis with respiratory failure. A 59-year-old woman was admitted to our hospital because of high grade fever and sore throat. She had a spiking fever between 38 degrees C and 40 degrees C. Surface lymph nodes were palpable in the neck and inguinal lesions and hepatosplenomegaly was recognized. Laboratory data showed a marked increase in peripheral leukocytes, erythrocyte sedimentation rate, liver dysfunction and anemia. Serologic tests were negative for various autoantibodies and rheumatoid factor. She received various antibiotics, but there was no improvement. Later, a rheumatoid rash which suggested adult Still's disease developed. The diagnosis of adult Still's disease was made by skin biopsy and clinical course. Although pericarditis, pleuritis and extensive pneumonitis were accompanied with severe respiratory failure, her symptoms improved with steroid pulse-therapy. A transbronchial lung biopsy revealed moderate fibrosis and cell infiltration in alveoli.