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Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates. ispartof: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE vol:202 issue:3 pages:E36-E69 ispartof: location:United States status: published

Pulmonary alveolar proteinosis (PAP) is a rare disease of unknown aetiology. Although resolution occurs in about 30% of autoimmune PAP (APAP) cases, its pathogenesis is not yet sufficiently understood. Two APAP cases at our institute showed remission following infectious episodes. Case 1: a 40-year-old female APAP patient suffered from herpes encephalitis and was treated with an antiviral drug. Her symptoms and radiological results resolved within two months of her recovery from the encephalitis. Case 2: A 53-year-old male current-smoker APAP patient was admitted for pneumonia. After treatment with antibiotics, his radiological results and symptoms improved. He experienced a similar resolution of APAP after another infectious episode two years later. Remission of APAP may occur following viral or bacterial infection. We hypothesise that remission of APAP is triggered by the induction of granulocyte-macrophage colony-stimulating factor (GM-CSF) following viral or bacterial infection. Further studies of APAP remission, and especially of the effects of GM-CSF induction, are needed. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 85-90)

Currently, five types of interstitial pneumonia of unknown etiology or IIP have been described; DAD, UIP, BOOP, DIP and LIP. A summary of the features of clinical course, prognosis and therapeutic effects to steroid hormone treatment of the five types of interstitial pneumonia of unknown etiology or IIP is given in Table 15. Among the previous mentioned [table] 52 open lung biopsy cases of interstitial pneumonia of unknown etiology or IIP, for which an open lung biopsy was necessary for diagnosis, the majority of those cases (81%) was IPF (UIP) while idiopathic BOOP occurred as the second in frequency (13%). These data will help in understanding the clinical outcome and the therapeutic response to steroid hormone treatment in cases of interstitial pneumonia of unknown etiology or IIP, because idopathic UIP is slowly progressive and usually not responsive to steroid while idiopathic BOOP is usually responsive to steroid hormone treatment and may regress even spontaneously. Cases of IPF (UIP) should have revolutional modalities for therapy.

A new pathologic data base management system was introduced in the Section of Pathology, Clinical Laboratory, of this hospital for an efficient sorting and searching past data and for the rapid epidemiological study of them. By the use of this system, the incidence and the age and sex distribution of various diseases were studied in a total of 1,264 patients received pathological examination for surgically operated specimens or biopsied materials at the Chest Disease Research Institute Hospital, Kyoto University, from January, 1986 to December, 1988. A gradual increase in the number of frozen section samples of surgically removed organs and of open lung biopsies was noted during this period. Adenocarcinoma, squamous cell carcinoma, small cell carcinoma and large cell carcinoma amounted to 42.5%, 32.9%, 12.2%, and 7.5% of primary lung cancers, respectively. The male-to-female ratio of patients with primary lung cancers was 2.9 : 1 but there was no significant difference in the age distribution among four types of the primary cancers in both sexes. Two hundred and ninety nine (32.6%) patients were diagnosed as non-neoplastic lung diseases : 121 infectious (13.2%), 69 granulomatous (7.5%), 62 pulmonary fibrotic (6.8%) and 47 miscellaneous non-neoplastic (5.1%) diseases.

Mediastinal germ cell tumor is so rare that only about 60 patients have been reported in Japan. Recently, we have observed one patient with mediastinal germ cell tumor (Seminoma type). This was remitted by treatment with radiation and chemotherapy, but recurred after 12years. The patient was operated upon after the second radiation. He is now alive 14years and 4months after the initial tumor developed. We also examined the patient for the purpose of clinical and embryological study., この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。

Clinical significance of a skin test with 5μg of purified phytohemagglutinin (PHA) was studied by testing 95 subjects, including 45 cases of lung cancer, 27 cases of pulmonary tuberculosis, 14 cases of leprosy, and 9 healthy controls. Forty three of the lung cancer patients were tested simultaneously with 0.05μg of PPD in order to examine the correlation between the PPD test and the PHA test. The PHA skin reaction was determined 24hr after intradermal injection of PHA and was judged as positive when the diameter of erythema was 30mm or more. The mean diameter of erythema was 38.1±8.1mm (negative rate 0%) in healthy controls, 31.2±8.1mm (59.3%) in pulmonary tuberculosis, 28.8±8.1mm (55.6%) in lung cancer, and 13.8±7.2mm (100%) in leprosy. Lung cancer patients with stage III, IV or undifferentiated small cell carcinoma showed reduced PHA skin reactivity. In leprosy, the PHA skin reactivity of the lepromatous type was more markedly imparied than the reactivity of the borderline type. A positive correlation between the PPD skin reaction and the PHA skin reaction was observed in 27 (62.8%) of the 43 lung cancer patients tested. It is concluded that the PHA skin test is significant for the evaluation of cellular immunity in patients with various diseases., この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。

症例は70歳, 女性。64歳時, 胸部X線で腫瘤陰影を発見され, 67歳で摘出術を施行。その結果, 第6肋骨発生の孤立性形質細胞腫と診断され, 術後2年未満で再発, 3年後にさらに4ケ所の骨に播腫を認めた。しかし, 骨髄穿刺所見は正常であった。病理学的には, 頭蓋骨および頸椎の病変は肋骨腫瘤病変と同様に, 形質細胞の増殖を認め, 腫瘍細胞のモノクローナリティはIgM・λタイプであることが, PAP法により証明されたことから, 骨に多発した形質細胞腫と診断された。孤立性形質細胞腫から多発性骨髄腫へと進行する症例は数多く報告されているが, 本例は骨に多発する形質細胞腫へと移行した稀な例であり, 診断に対する考察を加えて報告した。, We recently experienced one case of multiple plasmacytomas of the bone (IgM-λtype), a 70 year-old female who had five foci of bony destruction for a three-year follow-up period after surgery of solitary plasmacytoma of the rib. A diagnosis for plasma cell tumor was discussed in detail.