Reduced pulmonary function is associated with enhanced inflammation and tissue inhibitor of metalloproteinase 1 concentration in the bronchoalveolar lavage fluid of patients with lung parenchymal sarcoidosis.

Lung parenchymal disease is associated with reduced pulmonary function in patients with sarcoidosis, however, the underlying pathophysiology of the condition is unclear. The present study was conducted to characterize the association between pulmonary function and bronchoalveolar lavage (BAL) findings in patients with sarcoidosis. Twenty-three patients with lung parenchymal disease (stage 2) and twenty-five patients without lung parenchymal disease (stage 1) underwent pulmonary function tests, including blood gas analysis, spirometry and diffusing capacity for carbon monoxide (DLco) and BAL, to determine the number of inflammatory cells, matrix metalloproteinase (MMP) 9 activity and tissue inhibitor of metalloproteinase (TIMP) 1 concentration in the lower airway. Vital capacity (VC) to its reference value (%VC) and %DLco were significantly reduced in patients with stage 2 disease in comparison with those with stage 1 disease. BAL fluid analysis revealed that the numbers of total inflammatory and CD8 cells, and TIMP-1 concentration were significantly higher in patients with stage 2 disease in comparison with those in patients with stage 1 disease. There were significant correlations between %VC and the numbers of inflammatory cells and TIMP-1 in the BAL fluid. These results suggest that inflammation and enhanced TIMP-1 concentration in the lower airway play critical roles in the impaired pulmonary function in patients with lung parenchymal sarcoidosis.

Prevalence of previously undiagnosed airflow limitation in patients who underwent preoperative pulmonary function test.

Although being a rapidly expanding socioeconomical burden worldwide, chronic obstructive pulmonary disease (COPD) is often overlooked because of its insidious progression. Since spirometry is the primary tool for the diagnosis of COPD, physicians should be aware of the disease in any situation where interpreting spirometry. This study was to estimate the prevalence of undiagnosed COPD among patients who underwent spirometry as a preoperative evaluation for elective surgeries. Patients aged 40 years or older who completed routine spirometry as a preoperative evaluation for elective surgeries between January to December, 2000. Medical records were reviewed for medical history, clinical findings, smoking status, and discharge diagnoses for patients who demonstrated airflow limitation (AL), defined as FEV(1)/FVC<70% on spirometry. Of the 1031 patients who qualified for the study, 263 (26%) presented AL. Sixty-nine of these patients with AL (26%) had underlying conditions that could account for AL, such as asthma and previously diagnosed COPD. The remaining 194 patients with AL (74%) were suspected to have undiagnosed COPD, 90% of which was mild in severity. Only 30 (15%) of these patients appeared to be diagnosed have received a diagnosed as COPD by physician on this occasion. This study testifies that COPD is often unnoticed, and demonstrates that every spirometry, such as in preoperative evaluation, gives a clue to identify affected individuals, for which awareness of the disease is essential.

Pulmonary metastasis of endometrial stromal sarcoma.

Multiple round opacities suggestive of metastatic lung tumors were incidentally found on a chest x-ray film in a 43-year-old woman. The patient underwent hysterectomy for "myoma uteri" three years previously. Extensive examinations could not specify the primary neoplastic lesions. Morphological characteristics of the thracoscopically resected lung tumors suggested low-grade endometrial stromal sarcoma (ESS), and immunostaining revealed that the tumor cells were positive for progesterone and estrogen receptors, CD10 and vimentin, confirming a diagnosis of ESS. ESS is an uncommon uterine neoplasm, however, may be mistaken as benign tumors such as epithelioid leiomyoma, and occasionally metastasizes to remote organs such as lungs even after long disease-free period, posing diagnostic challenge.

A young adult patient with septic pulmonary emboli of undetermined origin.

A 25-year-old male who had no significant medical history presented abrupt onset of high-grade fever and chills without noticeable trigger. The patient sought for medical attention for subsequently developed dyspnea and chest pain. Radiological examinations revealed bilateral lung peripheral multiple opacities, some of which were cavitating, suggesting of septic pulmonary emboli (SPE). Isolation of Staphylococcus aureus in blood and sputum culture confirmed the diagnosis. Extensive examinations disclosed neither underlying immunocompromising conditions nor infectious foci, which are usually notable in patients with SPE. The present patient illustrates that there are patients with SPE in whom underlying conditions or infectious foci are difficult to determine, and that suspicion of the disease based on characteristic radiological findings is critical for appropriate management in those patients.

[Successful treatment with micafungin in a case of candidemia associated with pneumonia].

A 63-year-old woman was admitted to our hospital with fever and cough. Candidemia was diagnosed by blood culture and culture of IVH catheter. Although, the patient was treated with fluconazole, clinical symptoms and chest radiographic findings worsened. After micafungin was replaced with fluconazole, her symptoms, chest radiographic findings improved and stabilized. It is suggested that micafungin is useful for the treatment of candidemia associated with Candida parapsilosis.