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Objective: The incidence and mortality rates of pneumonia are far higher in the elderly, especially. There are few report which investigate pneumonia only in the oldest old., Method: We performed a retrospective study of 34 patients over age 80 who were admitted to our hospital with a diagnosis of community-acquired pneumonia over a period of 24 months., Results: The patients' mean age was 87.1 years. Of these, 19 were men (55.9%) and 15 were women (44.1%). Upon admission, the most common symptom was anorexia (87.5%). In the elderly patients, nervous system diseases, such as cerebrovascular disease and dementia, were the most common underlying diseases. The crude mortality rate was 14.7%, and the mean duration of hospitalization 33.7 days. In laboratory findings, serum creatinine and urea nitrogen levels were high, and percutaneous oxygen saturation level was low. Methicillin-resistant Staphylococcus aureus was the most common causative pathogen. The patients were treated equally with carbapenems (44.1%) and penicillins (44.1%)., Conclusion: Pneumonia may be associated with reduced respiratory symptom, raising the possibility that its diagnosis may be delayed, resulting in a severe condition in the oldest old patients. We must select the most appropriate treatment according to age because pneumonia in extremely elderly patients have many aspects different from young cases.

A 79-year-old woman was admitted to the Department of Orthopedics Surgery for treatment of osteoarthritis in her knee. Multiple pulmonary nodular lesions were found on preoperative chest x-ray film screening. Metastatic lung tumor was suspected, but no tumorous lesions were detected in other organs. CT guided lung biopsy was performed. Histopathological examination revealed amyloid consisting of homogenous eosinophilic materials. No amyloid deposits were detected in other organs, so we diagnosed localized nodular pulmonary amyloidosis. She was subsequently given a diagnosis of primary Sjögren syndrome. We believe that such a case of multiple nodular pulmonary amyloidosis with Sjögren syndrome is rare, and the case showed interesting radiological findings, such as mimicking metastatic lung tumor.

Nocardia is typically regarded as an opportunistic infection, with pulmonary nocardiosis frequently disseminated to organs hematogenous by, and nearly half of these cases resulting in complicated nocardia brain abscess. Disseminated nocardia has a dismal prognosis with high mortality, and should be checked for multiple organs including the brain when nocardiosis is diagnosed. We describe the successful treatment of nocardia brain abscesses in an immunocompetent older people with pneumoconiosis by combining trimethoprim-sulfamethoxazole and ciprofloxacin. Patients had no history of fever, headache, or respiratory symptoms such as cough, or sputum until the acute hemiplegia episode. Nocardia infection is not as rare as generally assumed and should be considered as a possibility in the elderly due to its high mortality.

A 65-year-old woman, treated with prednisolone (5 mg daily) for rheumatoid arthritis, visited our hospital because of right chest pain. Chest CT showed small nodular shadows in the right lung accompanied with right pleural effusion. A pulmonary Mycobacterium gordonae infection was diagnosed, since M. gordonae was identified twice from her sputum. She was treated with rifampicin, ethambutol and streptomycin for two months, and then streptomycin was replaced with clarithromycin. Three months after the initial treatment, M. gordonae was eradicated from her sputum. Pleural puncture revealed bloody, exudative, lymphocytotic pleural effusion, but no malignant cells were identified. Although pathological diagnosis by thoracoscopic pleural biopsy could not be performed, it is likely that the pleural effusion was associated with the pulmonary M. gordonae infection in the present case.

A multicenter cooperative study of docetaxel (60 mg/m2) combined with cisplatin (60 mg/m2) was performed in stage III and IV patients with inoperable non-small cell lung cancer from March 1998 to September 1999. Of 37 patients enrolled, 36 patients were eligible. One patient obtained a complete response (CR) and nine patients had a partial response (PR). The overall response rate in 36 patients was 28.6%. The median survival time was 360 days. The response rates of stage III and stage IV patients were 36.8% and 18.7%, respectively. The median survival times of stage III and stage IV patients were 502 days and 286 days, respectively. The major toxicities were grade 3 leukopenia (16.2%), grade 3 neutropenia (32.4%), and grade 4 neutropenia (10.8%).

A chest CT of an 82-year-old woman suffering from general fatigue revealed ground-glass opacities in both lower lung fields. Antibiotics were administered, but the ground-glass opacities developed into air-space consolidation with air-bronchogram. Hematuria was observed and abdominal CT showed multiple retroperitoneal masses, suggesting malignant lymphoma. The case was diagnosed histopathologically as malignant lymphoma (non-Hodgkins) of the diffuse, medium-sized B cell type on the basis of a right inguinal lymph node biopsy. Autopsy results suggested that the malignant lymphoma may have developed from the left adrenal gland. In the lungs, lymphoma cells infiltrated mainly into the interstitial spaces, but also into some alveolar spaces. The ground-glass opacities found in this case may have reflected the infiltration of lymphoma cells into the pulmonary interstitial spaces.