Successful use of linezolid for refractory Mycobacterium abcessus infection: A case report.

A 51-year-old male patient was receiving treatment for Mycobacterium abscessus infection for approximately 10 years. However, as his condition gradually progressed to type II respiratory insufficiency, he was referred to our hospital, which was near his home. Computed tomography on his first visit revealed an abscess in the right lower lobe. Because respiratory insufficiency was evident, he was admitted the same day. We began treatment with meropenem, amikacin, and clarithromycin, but his symptoms did not improve. In accordance with the 2007 American Thoracic Society/Infectious Diseases Society of America statement, we administered linezolid, which resulted in gradual improvement in his physical status and imaging findings.

Efficacy of long-term omalizumab therapy in patients with severe asthma.

BACKGROUND: The efficacy of omalizumab, an anti-immunoglobulin E (IgE) antibody, has been studied in patients with severe bronchial asthma. We conducted a study to evaluate, on the basis of both objective and subjective measures, the efficacy of omalizumab as a long-term therapy in patients with severe and persistent asthma. METHODS: Omalizumab was administered subcutaneously every two or four weeks. The results of pulmonary function tests, Asthma Control Test (ACT) and Asthma Health Questionnaire (AHQ)-33 scores, the dosage of methylprednisolone during the 12-month treatment period, and the number of emergency visits prior to the start of treatment with omalizumab were compared in patients pre- and post-treatment with omalizumab. RESULTS: Fourteen patients were enrolled in the study between June 2010 and February 2012. Ten patients completed the study. With omalizumab treatment, there was no improvement in lung function; however, the number of emergency visits (19.3 before treatment vs. 1.2 after treatment, p=0.020) and the dosage of methylprednisolone (871.5mg before treatment vs. 119.0mg after treatment, p=0.046) decreased significantly. ACT and AHQ-33 scores at 16 weeks after treatment were significantly better than baseline scores. Four patients continued treatment with omalizumab for four years, and a reduction in their corticosteroid usage was noted. CONCLUSIONS: Long-term omalizumab therapy in our patients was found to significantly reduce corticosteroid usage and the number of emergency visits. Long-term omalizumab therapy was effective and might have potential to reduce the frequency of asthma exacerbations. The trial has not been registered because it is not an intervention study.

Vibration response imaging in healthy Japanese subjects.

BACKGROUND: Vibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults. METHODS: VRI images of 106 healthy subjects (33.7±9.6 years, 52 male and 54 female), including 67 nonsmokers and 39 asymptomatic smokers, were recorded. The regional intensity of vibrations was assessed using quantitative lung data (QLD), and VRI dynamic images by rater assessment, left and right lung asynchrony (gap index), and regional lung asynchrony (asynchrony score). RESULTS: A dominance of total left lung QLD was observed in all subjects, and this phenomenon was more prominent in female subjects. However, there was no significant difference between the total left and total right lung QLD in smokers. Rater assessments showed that 81.1% of all subjects had a normal final assessment. Male subjects had a significantly higher percentage of good or normal assessments for all image scores, except dynamic image scoring. The asynchrony score was significantly higher in female subjects. There were no significant differences in these qualitative assessments between non-smokers and smokers. CONCLUSIONS: Although our QLD results were similar to those of a previous report, there were discrepancies between sexes for the qualitative assessments. A significantly higher number of female subjects had abnormal images as assessed by the raters. Furthermore, significantly higher asynchrony scores were observed in female subjects. The VRI variability in sex may be considered normal among the Japanese population. This study is registered with UMIN-CTR under registration number UMIN000002355.

[Efficacy of omalizumab in patients with severe asthma using the asthma health questionnaire and asthma control test].

BACKGROUND: The efficacy of anti-IgE antibody, omalizumab, was studied in patients with severe bronchial asthma. There have been reports stating that although omalizumab could not improve objective results, it has shown improvements in subjective symptoms of patients. The aim of this study is to evaluate the efficacy of omalizumab in severe bronchial asthma. METHODS: Thirteen patients were enrolled. Omalizumab was administered subcutaneously every 2 or 4 weeks based on serum IgE level and body weight of each patient. Pulmonary function tests, Asthma Control Test (ACT), Asthma Health Questionnaire-JAPAN (AHQ-JAPAN), number of emergency visits and dosage of methylprednisolone during a 16-week period were compared to the previous year. We examined the correlations between respiratory function, and ACT and AHQ-JAPAN. RESULTS: Treatment with omalizumab did not improve lung function. AHQ and ACT over the 16-week period significantly improved compared to baseline (p<0.01). The number of emergency visit and doses of methylprednisolone were significantly reduced compared to the previous year (p<0.01). CONCLUSION: Although treatment with omalizumab could not improve lung function, AHQ and ACT during the 16-week study period had significantly improved compared to baseline. Omalizumab significantly reduced the number of emergency visits and dosages of methylprednisolone.

Comparison of 21-gauge and 22-gauge Needles for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes.

BACKGROUND: : Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a 22-gauge needle has emerged as an accurate, minimally invasive, and safe technique for accessing undiagnosed mediastinal adenopathy, particularly in patients with lung cancer, the small sample size obtained by a conventional needle may limit the accuracy of the result. OBJECTIVES: : We evaluated the safety and efficacy of obtaining specimens using 21-gauge needles, comparing diagnostic yield with conventional 22-gauge needles. METHODS: : Participants consisted of 56 consecutive patients with mediastinal lesions referred to our institution for diagnostic EBUS-TBNA. The 21-gauge needle group (21 G) included 24 patients with 6 nonmalignancies and the 22-gauge needle group (22 G) included 32 patients with 9 nonmalignancies. Final diagnosis was based on cytology, histology, surgical results, appropriate clinical pictures on examination, and/or clinical follow-up. RESULTS: : Comparing 21 G and 22 G, inadequate material rates were 0% versus 3.1% in cytology, and 4.2% versus 18.8% in histology, respectively. Accuracy in cytology, histology, and combined cytology and/or histology were 91.7% versus 65.6% (P=0.02), 95.8% versus 81.3% (P=0.11), and 100% versus 84.4% (P=0.04), respectively. After limiting cases to suspected malignancies, sensitivity in cytology, histology, and combined cytology and/or histology were 88.9% versus 52.2% (P=0.01), 100% versus 82.6% (P=0.09), and 100% versus 87.0% (P=0.17), respectively. CONCLUSIONS: : Increasing sample volume using a 21-gauge needle rather than a 22-gauge needle might improve diagnostic yield in EBUS-TBNA. This study revealed the benefits of using a 21-gauge needle for cytological and histologic diagnostic yields.