Mycobacterium avium complex (MAC) infection needed differential diagnosis of the recurrence after surgery for double lung cancer; report of a case

A 62-year-old woman had undergone video-assisted thoracic surgery (VATS) -right upper lobectomy and right S8 segmentectomy for double lung cancers (papillary adenocarcinoma and bronchioloalveoler carcinoma, stage IA). Four years later, chest computed tomography (CT) showed abnormal shadow, 20 mm in size, along the staple-suture line. The 3 months later, new lesion, 15 mm in size, was observed in right lower lobe. CT-guided biopsy revealed no malignancy. The patient underwent partial resection of the right lower lobe and tumorectomy. The tumor was solid and cystic mass. Histopathologically, the tumor was granuloma infected by Mycobacterium avium. The patient was discharged on 17th postoperative day, and doing well without new lesion for 9 months postoperatively.     

Thoracoscopic resection for Mycobacterium avium complex

We report 2 cases of thoracoscopic resection for patients with Mycobacterium avium complex (MAC). A 25-year-old female was referred to our hospital because of abnormal shadows in the right lower lung field on chest X-ray. Her chest computed tomography (CT) showed that the lesion was localized in the right lower lobe. She was given a diagnosis of MAC by polymerase chain reaction (PCR) of sputum. Thoracoscopic lobectomy was performed after chemotherapy for 10 months. A 64-year-old female was referred to our hospital because of hemoptysis. Bronchiectasis had been diagnosed in her since the age of 35 years, and then she was given a diagnosis of secondary MAC. Her chest CT showed bronchiectasis, and consolidations were localized in the superior segment of the right lower lobe. Then superior segmentectomy of the right lower lobe under video-assisted thoracoscopic surgery (VATS) was performed. It was reported that surgical intervention is indicated in patients with MAC, when persistent hemoptysis is seen or chemotherapy is ineffective. If the lesion is localized, lung resection under VATS may be a good option in selected patients.     

Renal parencymal malacoplakia successfully treated with conservative therapy; a case report

Malacoplakia is a relatively rare form of chronic granulomatous inflammation. Which occurs most frequently in the genito-urinary system, but renal parenchymal involvement is rare. We present a case of malacoplakia of the renal parenchyma. A 69-year-old woman with left renal mass was referred to our department. Abdominal enhanced CT scan revealed heterogeneous mass in the left kidney (50 x 45 mm). CT-guided percutaneous left renal needle biopsy confirmed the diagnosis of renal malakoplakia. We successfully treated her with oral levofloxacin. The lesion resolved after the 4-months-therapy, and there has been no recurrence for 22 months since the treatment.     

Surgery for Mycobacterium avium complex lung disease in the clarithromycin era.

OBJECTIVE: Since the introduction of clarithromycin, it has been assumed that pulmonary Mycobacterium avium complex (MAC) disease can be treated with medication alone. This study examines whether surgery can still play an important role in the management of MAC lung disease in the current era. METHODS: Between April 1993 and January 2001, 21 patients (11 men and 10 women) underwent a pulmonary resection for MAC infection. The median age of the patients was 56 years (range: 27-67 years). None of the patients were immunocompromised. Regimens employing clarithromycin were initiated preoperatively in all patients. The indications for surgery were failure of drug therapy in 19 patients and discontinuation of chemotherapy because of drug toxicity in two patients. The pulmonary resections (19 right lung, 2 left lung) performed included lobectomy in 16 patients, pneumonectomy in three, bilobectomy in one, and lobectomy plus segmentectomy in one. RESULTS: All of the patients survived the surgery. Six major postoperative complications occurred in six patients (28.6%) and these included two bronchopleural fistulas after right pneumonectomy, two space problems, one prolonged air leak, and one case of interstitial pneumonia. All postoperative complications were manageable, and four of these were treated surgically. All patients had sputum-negative status after their operation. Relapse occurred in two patients (9.5%) at six months and two years postoperative, respectively. The first patient, who originally had a right upper lobectomy, underwent a left upper lobectomy during the follow-up period, attaining sputum conversion. The second patient underwent a right pneumonectomy and then died of respiratory failure four years postoperatively. This one late death was the only fatality. CONCLUSIONS: Although it is associated with relatively high morbidity, surgery provides a high sputum conversion rate for patients whose MAC disease responds poorly to drug therapy. Even in the present clarithromycin era, pulmonary resection remains the treatment of choice when MAC lung disease has not been successfully eradicated by drug treatment alone.     

Hyperparathyroidism after radioactive iodine therapy for Graves' disease: a case report

Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 X 23 X 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyperthyroidism has been treated with radioactive iodine should have their serum calcium levels examined at 5-year intervals.     

Mycobacterium intracellulare lung disease that was detected by follow-up after pulmonary resection for lung cancer; report of a case

The patient was a 61-year-old woman diagnosed with lung cancer who underwent lower right lobectomy in March 2003. Brochopleural fistula developed in the 3rd postoperative month and subsequent chest drainage stopped the air leak. Chest X-ray on follow-up in August 2006, revealed nodular shadows in the lower right field and computed tomography of the thorax showed clusters of small nodules in the right S2. The bronchial washing specimen showed acid-fast bacilli, which was identified as Mycobacterium intracellulare by DNA-DNA hybridization. The patient showed radiological improvement following combination therapy with rifampicin, ethambutol, clarithromycin, and streptomycin.     

Pulmonary metastasis fifteen years after hysterectomy for uterine leiomyosarcoma; report of a case

A 75-year-old woman who had undergone a hysterectomy for uterine leiomyosarcoma 15 years before was noted to have a lung tumor on chest radiography. Chest computed tomography (CT) showed a tumor mass, 3.5 cm in size, in her left lung (S10). CT-needle aspiration biopsy revealed sarcoma We performed a left lower lobectomy, as there was no distant metastasis. The histopathological diagnosis was a metastasis of uterine leiomyosarcoma. The disease-free interval for this case was 15 years, which was. to our knowledge, the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma.     

Cardiac mass many years after heart transplantation—a case report

The bi-atrial surgical technique of heart transplantation is associated with postoperative atrial dysfunction, sinus node dysfunction, valvular dysfunction, and bi-atrial enlargement predisposing to atrial arrhythmia with thrombus formation. This report deals with a very late thrombus formation in the neo-atrium of a heart transplanted using the bi-atrial technique. The absence of arrhythmia and absence of any history of intake of prothrombotic medications make it noteworthy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12055-022-01362-x.     

The ochronosis disease picture and conservative and operative therapy. Presented in relation to a case report

Ochronosis leads very early, already in the fourth decade, to osteoarthritic alterations, mainly of the large joints. As the treatment has to be symptomatic, joint prosthesis is often inevitable. We report about a case history of a patient with coxarthrosis and basic alterations by ochronosis. In spite of a bone structure similar those of osteomalacia, we were able to implant a cementless total hip prosthesis in the left hip joint.     

Recurrent spontaneous bladder rupture cured by conservative therapy: a case report

The patient was a 44-year-old woman, who had undergone radical hysterectomy and postoperative radiation therapy for cervical cancer at the age of 34 years old. In 1998, she was admitted to our hospital with chief complaints of acute abdominal pain and high fever. We made a diagnosis of spontaneous bladder rupture associated with neurogenic bladder dysfunction and radiation cystitis, based on findings of cystoscopy and cystography. She was cured by conservative therapy, including catheter drainage and antibacterial chemotherapy. Thereafter, she was managed with intermittent self-catheterization. In 2000, spontaneous bladder rupture recurred, but conservative therapy was effective again. A review of 12 cases of recurrent spontaneous bladder rupture in Japan, including the present case, suggests that proper management of urination for neurogenic bladder dysfunction may be necessary for prevention of recurrent rupture, when the impaired bladder is left after either successful conservative or surgical treatment of bladder rupture. Urinary diversion and augmentation cystoplasty should be considered for repeated rupture of the bladder.     

Renal autotransplantation for complex renal arterial disease: a case report

A renal artery aneurysm in a stenotic renal artery is a rare clinical entity with an incidence of 0.015% to 1% in patients with renovascular hypertension. Interventional stent placement is the first line of treatment for simple aneurysms of the proximal renal artery. However, renal autotransplantation has been used as an alternative treatment for complex lesions and for lesions originating from the distal renal artery. We present a patient with a renal artery aneurysm, renal artery stenosis of the segmental branches of the left kidney, and occlusion of the right renal artery. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the 2 renal artery branches, and renal heterotopic autotransplantation. We conclude that renal autotransplantation is a safe and effective surgical procedure for patients with complex renal arterial disease.     

Pulmonary metastasis of uterine leiomyosarcoma 8 years after hysterectomy; report of a case

A 57-year-old woman, who had undergone hysterectomy for uterine leiomyosarcoma 8 years ago, was admitted to our hospital for pulmonary tumors on chest X-ray. Two tumors were recognized on each side at left and right lung field by computed tomography (CT). Two-staged tumor resection was performed by left thoracotomy and by video-assisted thoracoscopic surgery (VATS) in the right. The histologic findings showed that those tumors were metastases of uterine leiomyosarcoma. This case suggests that the long term follow-up is necessary in the case of uterine leiomyosarcoma after operation.     

Three-vessel coronary artery disease, aortic stenosis, and constrictive pericarditis 27 years after chest radiation therapy: a case report

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.     

Mycobacterium chelonae infection after total knee arthroplasty: a case report

We present a case of Mycobacterium chelonae infection after total knee arthroplasty in a 70-year-old woman. The patient underwent implant removal, drainage, debridement, and insertion of a gentamycin-load cement spacer. After 4 months, the second-stage surgery was performed. Intravenous amikacin (6 weeks) and oral clarithromycin (12 weeks) were given. At the 12-month follow-up, the patient achieved 90 degrees of flexion and could walk with a stick for up to 15 minutes. She was not taking any analgesics.