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The space around the staple line after lung surgery is at high risk of nontuberculosis Mycobacterium pulmonary disease (NTM-PD). Solitary nodules of NTM-PD around the staple line are difficult to distinguish from lung cancer. There is no clear identification from laboratory data and radiologic findings without histological examination. In the present case, we misdiagnosed the pulmonary granulomas with Mycobacterium avium complex pulmonary disease (MAC-PD) as a recurrence of lung cancer. We conducted radiation therapy. The pulmonary granulomas with MAC-PD were exacerbated by irradiation. The effects of radiation therapy for MAC-PD are unknown. When radiation therapy is performed for the patient coexistence with MAC-PD, we should pay attention to exacerbation of MAC-PD.

Objectives: Since large cell neuroendocrine carcinoma (LCNEC) is a relatively rare histologic type of primary lung cancer, little is known about the immunological status of patients with LCNEC. We aimed to clarify the expression and prognostic impact of programmed cell death ligand 1 (PD-L1), CD8, CD4, and Forkhead box protein P3 (Foxp3) in LCNEC. Methods: We retrospectively analyzed PD-L1, CD8, CD4, and Foxp3 expressions in 95 surgically resected LCNEC. PD-L1 positive staining was determined in tumors with more than 1% of tumor cells stained to any intensity, and CD8, CD4, and Foxp3 positivity was determined in tumors with more than 5% of lymphocytes stained. Results: Positive expression of PD-L1, CD8, CD4, and Foxp3 was observed in 70 (74%), 52 (55%), 76 (80%), and 43 (45%) tumors, respectively. The expression of PD-L1 was significantly correlated with positive lymphatic permeation. Positive correlations were mutually observed among tumor infiltrating immune cells. Univariate and multivariate analyses showed that positive pleural invasion and Foxp3 negative expression were independent unfavorable prognostic factors for overall survival (OS). Advanced pathological stage, positive pleural invasion, CD4 negative expression in cancer stroma, and Foxp3 negative expression were identified as independent unfavorable prognostic factors for recurrence free survival (RFS). Conclusions: Foxp3 positive tumor infiltrating lymphocytes (TILs) were an independent favorable prognostic factor for both OS and RFS, whereas CD4 positive TILs were an independent significant unfavorable prognostic factor for RFS. The high frequency of PD-L1 expression could support the use of anti-programmed cell death 1 antibody in the treatment of LCNEC.

前立腺肥大症患者50例に対してchlormadinone acetate(CMA)50mg/日の1年間長期投与を行った。1)CMA投与後に自・他覚症状の改善を認めた。投与4ヵ月後と12ヵ月後の比較から, 概して4ヵ月以降の継続投与により一層の改善がもたらされた。また, 総合判定における「有効」以上, 「やや有効」以上の有効率はおのおの92.0%, 100%であった。2)副作用として2例にimpotenceを認めたが, その発現時期はいずれも投与後4ヵ月以内であった。一方, 臨床検査においては臨床上問題となる所見はみられなかった。3)総合判定における「有用」以上, 「やや有用」以上の有用率はおのおの92.0%, 100%であった, Fifty patients with benign prostatic hypertrophy were treated with chlormadinone acetate (CMA) at the dose of 50 mg/day for 12 months. Subjective symptoms and objective findings were evaluated before, and after 4 and 12 months of treatment. Better improvement was observed in all of the subjective symptoms and in almost all the parameters of objective findings, in proportion to the period of CMA treatment. Generally speaking, 12 months of treatment was more effective than 4 months of treatment. Two patients had impotence (4.0%). Both of them complained of side effects within 4 months after treatment, but they were not severe. In conclusion, long-term treatment of benign prostatic hypertrophy with CMA was useful.

In some patients with cleft palate (CP), velopharyngeal insufficiency persists after palatoplasty. In order to determine whether such insufficiency is due to the pathological changes of the levator veli palatini (LVP) muscle, we examined histologically the LVP muscles of 35 patients with CP and of six control patients with congenital microtia. Electromyographic records were obtained of the LVP muscles of 12 patients with CP after palatoplasty.The muscle structures were well preserved in seven of 35 patients with CP. Among the other 28 patients, perimysial fibrosis was observed in 13, variations in fiber caliber in seven and internal nuclei in one, but these findings were also observed in the control group. The incidence of each finding was not significantly different between the two groups. Electromyography revealed the mean action potential during phonation of the sound “ah” to be 825 μV. Effective elevation of the soft palate was correlated with neither the histology nor the action potential of the LVP muscle.Therefore velopharyngeal insufficiency persisting after palatoplasty is considered not to be due to pathological changes in the LVP muscle.

A rare case of bilateral pneumothorax in a 54-year-old woman with advanced breast cancer associated with lung and pleural metastases is presented. The patient was admitted to our hospital complaining of unexpected severe dyspnea. A chest X-ray showed bilateral pneumothorax associated with multiple lung metastases and pleural effusions, followed by immediate pleural drainage. Although air leak and effusions of the right lung were well controlled by the conservative management, massive air leaks of the left lung had continued for 40 days. Because of patient's poor general status a surgical closure of the leaking site was selected using video-assisted thoracoscopic surgery techniques. Thoracoscopy revealed a ruptured bulla in the lower lobe (S6), thus, followed by a successful bullectomy with a stapling device. We speculate that multiple pleural metastasis may disturb the normal repair mechanism of the lung tissue and cause prolonged persistent air leaks.

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