Predictors of exacerbation in Japanese patients with severe asthma: Analysis of the severe asthma research program (Okayama-SARP) cohort.

BACKGROUND: Because exacerbation of severe asthma decreases patients' quality of life, this study aimed to identify predictive factors for asthma exacerbation. METHODS: Japanese patients with severe asthma requiring treatment according to the Global Initiative for Asthma (GINA) guidelines ≥ Step 4 between January 2018 and August 2021 were prospectively enrolled and followed up for one year at facilities participating in the Okayama Respiratory Disease Study Group (Okayama Severe Asthma Research Program). RESULTS: A total of 85 patients (29 men and 56 women) were included. The median age was 64 (interquartile range [IQR], 51-72) years. Treatment according to GINA Steps 4 and 5 was required in 29 and 56 patients, respectively, and 44 patients (51.8%) were treated with biologics. The median peripheral-blood eosinophil count, fractional exhaled nitric oxide, IgE level, and percent predicted FEV1 (%FEV1) at enrollment were 204 (IQR, 49-436)/µL, 28 (IQR, 15-43) ppb, 172 (IQR, 56-473) IU/mL, and 80.0 (IQR, 61.1-96.1) %, respectively. Exacerbation during the previous year, asthma control test (ACT) score <20, %FEV1 <60%, and serum IL-10 level >6.7 pg/mL were associated with exacerbation during the observation period. CONCLUSIONS: Exacerbation during the previous year, low ACT score, and low %FEV1 were predictive factors of future exacerbation, even in a cohort with >50% of patients treated with biologics. Furthermore, high serum IL-10 levels might be a new predictive factor.

Pulmonary Hyalinizing Granuloma Mimicking Primary Lung Cancer.

We herein report a case of pulmonary hyalinizing granuloma (PHG), which is a rare pulmonary mass. A 69-year-old man with no symptoms presented to our hospital because of the appearance of an abnormal shadow on chest X-ray. Computed tomography revealed a right middle-lobe mass with spicula and infiltration into the upper lobe. Since a bronchofiberscopic examination showed no malignant cells in the specimen, the patient underwent thoracoscopic surgery, which revealed PHG. Spiculation and interlobar infiltration, which comprise the characteristic features of primary lung cancer, are uncommon presentations of this rare entity.

Septic pulmonary embolism induced by dental infection.

Dental infection can be an important source for septic pulmonary embolism (SPE), but only a few cases of SPE accompanying dental infection have been reported. The aim of this study was to characterize the clinical features of SPE induced by dental infection. Patients who fulfilled the diagnostic criteria described in the text were recruited in a retrospective fashion. All 9 patients were men, with a median age of 59 years (range:47 to 74 years). Eight patients had chest pain (88.9%), 5 had a preceding toothache (55.6%) and 3 had preceding gingival swelling (33.3%). Blood cultures obtained from 7 patients were negative. Periodontitis was found in all of the cases, periapical periodontitis in 5 cases, and gingival abscess in 3 cases. The median duration of hospitalization was 15 days, and symptoms were mild in some cases. In addition to antimicrobial therapy, tooth extraction was performed in 3 cases, tooth scaling in 6. SPE induced by dental infection has prominent clinical characteristics such as male preponderance, chest pain, preceding toothache, and mild clinical course.

A case of mediastinal lymph node carcinoma of unknown primary site treated with docetaxel and cisplatin with concurrent thoracic radiation therapy.

Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5 × 8.2 cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset.

Interstitial lung disease during trimethoprim/sulfamethoxazole administration.

We studied clinical and radiographic features of interstitial lung disease (ILD) during trimethoprim/sulfamethoxazole (TMP/SMX) administration. Ten patients who had received prednisolone treatment for underlying diffuse pulmonary disease showed various ILDs after introduction of TMP/SMX. The radiographic features of the ILDs were not consistent with infectious disease or exacerbation of the underlying disease, and these diagnoses were excluded radiographically and on clinical grounds during the differential diagnosis of the ILDs. These ILDs emerged relatively early after introduction of TMP/SMX, which is consistent with the former case report of drug-induced ILD (DI-ILD) caused by TMP/SMX. Therefore DI-ILDs caused by TMP/SMX were suspected in these cases. In most of these cases, the ILDs were clinically mild and disappeared immediately although administration of TMP/SMX was continued.

[Clinico-pathological prognostic factors in malignant pleural mesothelioma].

The prognosis of malignant pleural mesothelioma is poor, but selected patients might benefit from multimodality treatment. To establish the means that are available to predict the variable course of the disease in malignant pleural mesothelioma patients, we retrospectively investigated the correlation of clinico-pathological features of 54 patients with survival. Twenty-three patients received treatment, while 31 were referred to supportive care only. The median survival of the entire group was 8.6 months. The 1-year survival was 33.2%. Univariate analysis of subgroups showed that age over 70 years, non-epithelial histologic type, patients treated with supportive care only, and delayed diagnosis were individually associated with lower survival. The European Organization for Research and Treatment of Cancer (EORTC) score showed a significant correlation with survival (P = 0.0146). The median survival of patients with an EORTC score of over 1.27 was 3.5 months, compared to 10.5 months for patients with an EORTC score of 1.27 or less. Tumor necrosis (TN) was a poor prognostic factor on univariate analysis (P = 0.0077). Patients with TN had a median survival of 7.0 months vs 15.5 months in negative cases. On multivariate analysis, TN was determined as an independent prognostic factor (P = 0.0349). EORTC prognostic scoring systems successfully stratify survival for a general hospital population, and TN might play an important role in poor outcome in malignant pleural mesothelioma.

Primary pulmonary hypertension treated with short-term epoprostenol infusion.

We describe the use of short-term epoprostenol in a 61-year-old man with primary pulmonary hypertension. The patient was on a ventilator because of respiratory distress. Continuous infusion of epoprostenol was started and it initially reduced the pulmonary artery pressure by 32%. Epoprostenol was tapered, and even after discontinuation, the pulmonary artery pressure was controlled. The ventilator was removed, and the patient remained well on home oxygen therapy 3 months after discharge.

[Bowel perforation due to metastatic lung cancer: a case report].

We report a case of small bowel perforation secondary to metastasis from a lung squamous cell carcinoma that occurred in a 72-year-old man. He was admitted to the hospital because of remittant hemoptysis after undergoing a right upper lobectomy. Fiberoptic bronchoscopy revealed bleeding from the right upper lobe bronchial stump that was due to recurrence of the tumor. He developed abdominal pain, nausea and vomiting four months after resection of the primary tumor. An abdominal radiograph demonstrated free air in the abdominal cavity. He was diagnosed as having intestinal perforation and was operated on. The operative findings indicated adherence and perforation of the jejunum and ileum. The pathological diagnosis of the removed tumor was poorly differentiated squamous cell carcinoma. The patient died 32 days after the second operation. Although abdominal metastasis from lung cancer is not an unusual postmortem finding, it is rare in clinical situations. If a patient with lung cancer complains of abdominal pain, it is important to consider the possibility of abdominal metastasis.

[A case of benign asbestos pleural effusion suspected on thoracoscopic examination under local anesthesia].

We report the case of a 92-year-old man with a 13-year history of occupational asbestos exposure who presented with a complaint of dyspnea. In September 2001, bilateral pleural effusions were revealed on chest radiography, and continued to progress despite treatment for heart failure. Chest CT revealed calcification of the pleura but no abnormal findings in the lung fields. Both pleural effusions were exudative and lymphocytes were the predominant cells contained in them. Antituberculous chemotherapy had no effect on the exudates. In March 2002, thoracoscopy was performed under local anesthesia (medical thoracoscopy). Plaque was recognized on the parietal pleura; however, the serosal surfaces of the parietal and visceral pleura were smooth, and no evidence of malignancy, especially malignant mesothelioma, was noted. The patient's condition was diagnosed as benign asbestos pleural effusions. Prednisolone was administered, and these effusions gradually decreased. Cases of benign asbestos pleural effusion occurring simultaneously with massive bilateral effusions are rare. Thoracoscopy aided in the differential diagnosis of this case.

Pulmonary sequestration associated by Mycobacterium intracellulare infection.

A case of a 29-year-old woman with intralobar pulmonary sequestration infected with Mycobacterium intracellulare is presented. A chest CT scan revealed a density in the posterior segment of the left lower lobe, and an acid-fast bacillus sputum culture yielded Mycobacterium intracellulare. After 3 months of treatment with clarithromycin, streptomycin, rifampicin and ethambutol, the patient underwent partial resection of the left lower lobe. At the 6-month follow-up the patient's clinical status is excellent. A review of the literature revealed only three case reports of pulmonary sequestration associated with Mycobacterium avium-intracellulare complex infection.

Septic pulmonary embolism associated with periodontal disease: reports of two cases and review of the literature.

We report two cases of septic pulmonary embolism associated with periodontitis. Chest CT revealed multiple nodular shadows with features characteristic of septic pulmonary embolism in both patients. Both patients had toothache, fever, and chest pain, and showed findings of periodontitis at initial presentation. Antimicrobial agents combined with dental surgery were successful in treatment. While septic pulmonary embolism from the lesions of periodontitis appears to be rare, periodontitis remains important in the differential diagnosis of septic pulmonary embolism.

Intracellular IL-5 and T-lymphocyte subsets in atopic and nonatopic bronchial asthma.

BACKGROUND: Allergen-stimulated IL-5 production by CD4+ T cells is the key issue in atopic asthma. On the other hand, virus-specific CD8+ T cells produce IL-5 and might play an important role in the pathogenesis of nonatopic asthma. OBJECTIVES: We sought to compare the IL-5-producing T-lymphocyte subsets in the peripheral blood of atopic and nonatopic asthmatic subjects, especially the contribution of IL-5-producing CD8(+) T cells in nonatopic asthma. METHODS: Heparinized blood samples were obtained from subjects with atopic asthma (n = 10), subjects with nonatopic asthma (n = 10), and healthy subjects (n = 10) and stimulated with ionomycin and phorbol myristate acetate in the presence of brefeldin A. Two-color flow cytometric analysis with mAbs to cell-surface antigens and intracellular IL-5 was used to detect the IL-5-producing T-cell subsets. RESULTS: A higher percentage of IL-5-producing CD3(+) T cells was detected in subjects with atopic and nonatopic asthma than that seen in the healthy subjects. The percentage of IL-5-producing CD4(+) T cells was significantly higher in subjects with atopic asthma than in the healthy subjects. The percentage of IL-5-producing CD8(+) T cells was significantly higher in subjects with nonatopic asthma than in the healthy subjects. The percentage of IL-5-producing CD8(+) T cells was higher in subjects with nonatopic asthma than in those with atopic asthma, but the difference was not statistically significant. CONCLUSIONS: CD4(+) T cells are the major source of IL-5 among CD3(+) lymphocytes in subjects with atopic asthma. On the other hand, increased IL-5 production by CD8(+) T cells, as well as by CD4(+) T cells, is a characteristic feature of nonatopic asthma.