Management and utility of transbronchial lung cryobiopsy in Japan

BackgroundTransbronchial lung cryobiopsy (TBLC), which is transbronchial lung biopsy performed using a cryoprobe, has emerged as a new method for obtaining lung tissue specimens for diagnosing pulmonary diseases. TBLC has been widely performed, and many reports have documented its safety and feasibility in diagnosing pulmonary diseases such as lung cancer and diffuse parenchymal lung disease. However, to date, no reports have yet been published from Japan. Therefore, the purpose of this study was to describe our experience with TBLC in daily practice in Japan and compare it with those reported in previous studies from other countries. We also evaluated the efficacy and feasibility of TBLC.MethodsWe retrospectively evaluated the clinical records of 50 consecutive patients who had undergone TBLC between November 2017 and May 2018 at the Japanese Red Cross Medical Center. Demographic data, procedure details, and the diagnostic yield were analyzed.ResultsWe analyzed the records of 50 patients who underwent diagnostic TBLC. Their median age was 71 years, and they included 34 men (68%). The median maximal diameter of the cryobiopsy specimens was 5.3 mm (range, 2.0–23.0 mm), and the median area of the cryobiopsy specimens was 15.5 mm² (range, 3.0–136.5 mm²). The rate of obtaining adequate specimens was 91%, and the pathological diagnostic yield was 76%. No complications were observed, except for one case of pneumonia.ConclusionsThis is the first report from Japan analyzing the efficacy and feasibility of TBLC in daily clinical practice. TBLC was considered efficacious, safe, and feasible for Japanese patients with various lung diseases.     

IMMUNOHISTOCHEMICAL STUDIES OF ULCERATIVE COLITIS With Special Reference to Localization of Immunoglobulins, Secretory Component, and Lysozyme in View of Suffering Periods

Surgically resected large bowels with ulcerative colitis (UC) and biopsied specimens from UC patients were studied immunohistochemically In terms of localization of immunoglobulins, secretory component (SG), complement (C3), and lysozyme in relation to suffering periods. In the long-standing group (suffering periods more than nine months) of UC, marked decrease of absence of IgA as well as IgM was frequently observed in the columnar epithelial cells despite residue of SC positivity. However, in the short-standing group (suffering periods from one month to four months) both SG and IgA were well preserved in the apical portion of the epithelial cells in the similar manner as observed in the control group. There was moderate to marked increase of IgA-producing cells and slight to moderate increase of IgM-producing cells In the majority of the UC cases regardless of suffering periods. Lysozyme was not demonstrable In the normal epithelial cells of the large intestine but occasionally observed in those of UC cases.     

CUSHING'S SYNDROME WITH BILATERAL MULTINODULAR ADRENAL HYPERPLASIA

An unusual case of Cushing's syndrome of a 59-year-old man with bilateral multinodular adrenal hyperplasia and microadenoma of the pituitary gland is presented. Failure to suppress plasma Cortisol with large doses of dexamethasone may suggest autonomous growth of hyperplastic nodules of the adrenals, which were at first induced by prolonged stimuli of ACTH from the microadenoma of the pituitary gland. ACTH could not be detected in the microadenoma cells on paraffin sections, while Crooke's cells were strongly positive for ACTH. The interrelation between bilateral multinodular adrenal hyperplasia and pituitary microadenoma is discussed.     

Catalase expression of Propionibacterium acnes may contribute to intracellular persistence of the bacterium in sinus macrophages of lymph nodes affected by sarcoidosis

Immunologic Research - Bacterial catalase is important for intracellular survival of the bacteria. This protein of Propionibacterium acnes, one of possible causes of sarcoidosis, induces...     

LDL apheresis in Japan

LDL apheresis has been developed as the treatment for refractory familial hypercholesterolemia (FH). Currently, plasma exchange, double membrane filtration, and selective LDL adsorption are available in Japan, and selective LDL adsorption is most common method. LDL apheresis can prevent atherosclerosis progression even in homozygous (HoFH). However, in our observational study, HoFH who started LDL apheresis from adulthood had poor prognosis compared with patients who started from childhood. Therefore, as far as possible, HoFH patients need to start LDL apheresis from childhood. Although indication of LDL apheresis in heterozygous FH (HeFH) has been decreasing with the advent of strong statin, our observational study showed that HeFH patients who were discontinued LDL apheresis therapy had poor prognosis compared with patients who were continued apheresis therapy. These results suggest that high risk HeFH need to be treated by LDL apheresis even if their LDLC is controlled by lipid-lowering agents. However, by launching new class of lipid lowering agents, that is, PCSK-9 antibody and MTP inhibitor, indication of LDL-apheresis in FH may be changed near the future. LDL-apheresis can provide symptom relief of peripheral artery disease (PAD). Therefore, PAD patients who have insufficient effect by other therapeutic approach including revascularization are also treated by LDL apheresis. Thus, LDL apheresis is still one of good therapeutic options for severe atherosclerotic diseases in Japan.     

Bioavailability of calcium from oyster shell electrolysate and DL-Calcium lactate in vitamin D-replete or vitamin D-deficient rats

Bioavailability of calcium (Ca) from oyster shell electrolysate (Active Absorbable Ca: AACa) and DL-Ca lactate in rats was investigated. Plasma Ca metabolism, bone mineral density and vitamin D-deficient rats were measured and compared each other. Vitamin D-deficient rats were fedad libitum a vitamin D-free diet containing 0.44 % Ca or 1.20 % Ca adjusted with either AACa or DL-Ca lactate with or without oral supplementation of physiological dose (10 IU/rat/day) of vitamin D₃ for 28 days. During and after feeding, concentrations of Ca, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D₃ (25-OH-D₃), 1α, 25-dihydroxyvitamin D₃ [1, 25(OH)₂D₃] and alkaline phosphatase (Alp) activity in plasma were measured. Furthermore, femoral Ca and phosphorus contents, mineral density and mechanical strength were also measured. Despite of the differences of contents and chemical forms of Ca in diets, all the groups showed prompt and complete recoveries in both Ca and vitamin D malnutritions under vitamin D-replete condition and there was no significant difference among all the groups in increases of body weight gains and plasma Ca levels, and in decreases of plasma PTH level and Alp activity. In contrast, the groups fed the same diets under vitamin D-deficient condition showed no significant recoveries in both plasma Ca metabolism and bone mineralization although Ca bioavailability of AACa appeared to be slightly better than that of DL-Ca lactate. These results suggest that bioavailability of Ca from AACa and DL-Ca lactate are substantially equal in increasing plasma Ca levels, bone mineral density and mechanical strength in both vitamin D-replete and vitamin D-deficient rats.     

Primary pulmonary Hodgkin lymphoma--two case reports and a review of the literature

Primary extranodal involvement of Hodgkin lymphoma (HL) is rare. We report two HL patients presenting with exclusive or predominant lung involvement. In both cases, the results of transbronchial and/or CT-guided lung needle biopsy were indicative of granulomatous disease. Eventually, lymph node biopsy specimens revealed HL with nodular sclerosis type and lymphocyte-rich type, respectively. There were no specific symptoms, laboratory and imaging findings for pulmonary HL. A histological examination was required to confirm the diagnosis. Lung biopsy techniques such as transbronchial or percutaneous biopsy may be insufficient to allow diagnosis of HL. Pulmonary HL should be included in the differential diagnosis of lung involvement, even when the pathological evaluation of nonspecific inflammation was made from the biopsied specimens.