Search

Herein, we report an autopsy case of idiopathic pulmonary fibrosis (IPF) in which remarkable honeycomb cyst expansion appeared in the clinical course. Radiological findings initially showed subpleural predominant reticulation that had progressed to usual interstitial pneumonia with honeycomb cysts, along with a restrictive pattern in the pulmonary function tests. The diameter of honeycomb cysts had gradually increased, and some cysts had abruptly expanded at the end stage. Based on pathological findings of autopsy specimens, bronchiectasis, alveolar collapse due to inflammation, and check-valve mechanism caused by a slit-like orifice of the cysts could have contributed to honeycomb cyst expansion. [ABSTRACT FROM AUTHOR]

Abstract: Background: Antenatal magnetic resonance imaging (MRI) is useful for the diagnosis of abdominal wall defects. Its predictive value concerning the possibility of primary closure of the abdominal wall, however, has so far not been reported. Methods: Between August 2001 and November 2004, antenatal MRI was performed on 9 patients with abdominal wall defects in whom surgical repair was performed immediately after birth. Areas of the abdominal cavity and exteriorized viscera were manually traced from both sagittal and axial MR images, and the data were further transmitted to a Workstation for MRI Volumetry (Advantage Windows 4.1, General Electric Medical Systems, Milwaukee, Wis). We examined the exteriorized ratio (ER), which is calculated by dividing the absolute volume of the abdominal cavity by that of the exteriorized viscera, and evaluated the predictive value by a retrospective comparison with surgical procedure. Results: In the primary closure group (n = 5), mean values of ER were 0.33 ± 0.31 from axial and 0.45 ± 0.31 from sagittal MR images. In contrast, in the staged closure group (n = 4), mean values of ER were 1.39 ± 0.40 from axial and 1.34 ± 0.42 from sagittal MR images. There was a significant difference (P < .05) between the 2 groups for both sets of images. The ER obtained from antenatal MRI correlated well with surgical procedure. Conclusions: The ER might be useful for antenatal counseling, planning for delivery, and prediction of the most likely surgical procedure. [Copyright &y& Elsevier]

The preoperative diagnosis of pulmonary sclerosing pneumocytoma (PSP) is complicated since PSP has several histological structural patterns in the same neoplasm; hence, it is sometimes pathologically misdiagnosed as adenocarcinoma or carcinoid. In recent years, with the prevalence of transbronchial cryobiopsy (TBLC), we are able to obtain larger specimens than previously. However, to date, there have been no reports describing PSP diagnosed using TBLC. A 43-year-old man was referred to our hospital for an abnormal lesion in the left lung discovered on routine health examination. A computed tomography scan of the chest revealed a 14-mm heterogeneous round nodule with surrounding ground-glass opacity in the left lower lobe. The tumor size increased to 18 mm in three weeks, and he developed bloody sputum. TBLC was performed using radial endobronchial ultrasonography and fluoroscopy. An occlusion balloon and prophylactic epinephrine were used to prevent severe bleeding. Histologically, epithelioid cells with solid proliferation, various papillary lesions, and hemosiderin-laden histiocytes were observed. Immunohistochemical staining revealed the histiocytes positive for thyroid transcription factor-1 and vimentin, and the type II pneumocyte-like-cells positive for cytokeratin 7. The tumor was preoperatively diagnosed as a PSP; the patient underwent left basal segmentectomy and consequently, a final diagnosed of PSP was formulated. We report the first case of PSP preoperatively diagnosed using TBLC. Therefore, cryobiopsy could be beneficial in the preoperative diagnosis of PSP. [ABSTRACT FROM AUTHOR]

In 2014, an autochthonous dengue fever outbreak occurred around the Yoyogi Park in Japan for the first time in 70 years. Despite no local cases reported since then, the risk of another outbreak remains high. This study reviews the autochthonous dengue fever cases of the outbreak, investigates its causes, and delineates preventive measures against autochthonous dengue epidemics. We conducted a case series study of 15 patients who visited our institution during the 2014 outbreak. We collected and evaluated data on the surveillance of vector mosquitoes, weather, pest control, travelers' origins and destinations, and imported dengue fever cases using reports made by public institutions. All patients recovered with supportive treatments and none met the diagnostic criteria for severe dengue infection. Twelve patients with positive real-time polymerase chain reactions were confirmed as having dengue virus-1 infections. We found no obvious associations between the number of mosquitoes and the weather, or between the number of imported dengue fever cases and that of travelers. Insect growth regulator (IGR) against vector mosquitoes has been used since 2014 for pest control, but the number of larvae has not declined in the Yoyogi Park, although that of imagoes has been relatively suppressed. The 2014 outbreak emerged without particularly favorable climate conditions for vector mosquitoes. We found no obvious associations between the number of travelers or the imported dengue fever cases and the outbreak, but the increasing number of travelers may contribute to another outbreak. Pest control, including IGR, remains essential for infection control. • We studied 15 patients with autochthonous dengue fever during a local outbreak. • This outbreak emerged without favorable climate conditions for mosquitoes. • There were no increased number of travelers or imported dengue cases. • Pest control using insect growth regulator can be effective for infection control. [ABSTRACT FROM AUTHOR]

Chronic eosinophilic pneumonia (CEP) is an eosinophilic inflammatory disease of unknown etiology, and oral corticosteroid (OCS) is commonly used for its treatment. Approximately half of CEP cases relapse secondary to reduction or termination of OCS. A 43-year-old woman visited our hospital because of a chronic cough and abnormal chest X-ray findings. She was diagnosed with CEP because of marked eosinophilia, as well as eosinophilic infiltrates in cryobiopsy samples. After initiation of OCS treatment, her symptoms disappeared with a decrease in peripheral blood eosinophil counts and the amelioration of abnormal infiltrative shadows on chest X-ray. However, symptoms reappeared after OCS termination, including a recurrence of eosinophilia and appearance of fresh abnormal shadows on chest X-ray. Because she refused readministration of OCS because of side effects such as appetite enhancement and moon face in last treatment course, we administered her a single dose of benralizumab. Her symptoms and peripheral eosinophil counts were markedly ameliorated 1 week after benralizumab administration. The marked amelioration in abnormal shadows on chest X-ray were maintained 2 weeks after benralizumab administration. She had no relapse of CEP for almost 6 months after benralizumab administration. Our experience with this case suggests that a single dose of benralizumab may be a treatment option for relapsed CEP cases or those with side effects of long-term OCS therapy. [ABSTRACT FROM AUTHOR]

Thoracoscopic pleural biopsy is an efficient procedure in patients with undiagnosed exudative pleurisy. Rigid or flexible forceps have been widely used for this procedure. Recently, the use of cryo-techniques was reported in pleural biopsy during semi-rigid thoracoscopy; however, the feasibility and safety of pleural cryobiopsy in elderly patients have not yet been fully elucidated. We describe two elderly patients who safely underwent semi-rigid thoracoscopic cryobiopsy and were diagnosed with tuberculous pleurisy. Both were >85 years of age, and chest auscultation revealed reduced breath sounds in the right lower zones. Laboratory investigations revealed an elevated level of C-reactive protein without leukocytosis in both patients. Computed tomography scan of the chest revealed right pleural effusion in both patients. Pleural fluid biochemical analysis results were indicative of an exudate. Sputum cultures demonstrated no bacterial growth and smears were negative for the presence of acid-fast bacilli. For definitive diagnosis, pleural biopsy was performed via thoracoscopic cryobiopsy. Specimens obtained from the cryoprobe demonstrated 200-300-μm caseating and non-caseating epitheloid cell granulomas with Langerhans type giant cells. Based on the above results, both patients were diagnosed with TB pleurisy. Anti-tuberculosis treatment resulted in good clinical outcome in both patients. Cryobiopsy is easier and more efficient than biopsy with conventional forceps. Our findings in these patients suggest that semi-rigid thoracoscopic cryobiopsy might be a useful alternative diagnostic method for undiagnosed pleural effusion in elderly patients. [ABSTRACT FROM AUTHOR]

• Gordonia bronchialis is an emerging pathogen causing various infectious diseases. • This is the first report of pneumonia caused by G. bronchialis with a foreign body. • Conventional cultures cannot be used to identify G. Bronchialis accurately. • 16S ribosomal RNA gene sequencing provides definitive identification of Gordonia species. [ABSTRACT FROM AUTHOR]

Summary: A 55-year-old man with severe chest pain was hospitalized for acute coronary syndrome. Coronary angiography revealed total occlusion of his left anterior descending coronary artery, which was successfully recanalized by percutaneous coronary intervention (PCI). However, the patient subsequently experienced subacute stent thrombosis, restenosis in the stent, and frequent thrombosis in PCI toward restenosis. Primary antiphospholipid syndrome should be considered as a possible cause of repeated stent thrombosis, and, if salvage by PCI is impossible, salvage by coronary artery bypass graft should be considered. [ABSTRACT FROM AUTHOR]