Pulmonary actinomycosis diagnosed through transbronchial lung biopsy (TBLB)]

Pulmonary actinomycosis is a rather rare chronic pulmonary infection. Its diagnosis may be difficult without biopsy, because its culture from sputum or bronchial secretion is rarely successful. We report a case of pulmonary actinomycosis diagnosed by means of TBLB. A 57-year-old man was admitted to our hospital because of hemosputum. The chest radiograph at the first visit revealed a nodular lesion in the right middle lobe. The biopsy examination showed sulfur granules of which PAS-positive mycelium was arranged in a radiating pattern. On the basis of these findings, we diagnosed pulmonary actinomycosis. So far, there have been only 4 reported cases of pulmonary actinomycosis diagnosed by TBLB in Japan. TBLB is worth trying in the diagnosis of pulmonary actinomycosis, because it can avoid surgical procedures, if successful.     

Saprophytic mycosis appearing as a necrotic bronchial tumor and masking lung cancer]

We describe four cases of saprophytic mycosis superficially covering lung cancer to form a bronchial necrotic tumor. Although the first biopsy in each case disclosed mycosis with necrosis, repeated transbronchial biopsy revealed malignant cells. In two of the four cases, we started treatments for lung cancer based on the clinical diagnosis preceding histological diagnosis. Although no treatment to eliminate fungi was performed, all cases showed an uneventful clinical course. It is important not to misdiagnose cancer as a fungal disease on the basis only of a transbronchial biopsy, and to bear in mind this type of saprophytic mycosis.     

A significant reduction in serum alanine aminotransferase levels after 3-month iron reduction therapy for chronic hepatitis C: a multicenter, prospective, randomized, controlled trial in Japan

Background Increasing evidence indicates that iron cytotoxicity plays an important role in the pathogenesis of chronic hepatitis C (CHC). However, the biochemical effects of iron reduction therapy on CHC remain to be confirmed in a controlled study. This study aimed to test whether iron removal by repeated phlebotomy improves serum alanine aminotransferase (ALT) levels in patients with CHC.Methods Patients were randomly assigned to an iron reduction therapy or control group. The patients in the treatment group received 3-month iron reduction therapy by biweekly phlebotomy, while the patients in the control group were followed up for 3 months with regular blood tests alone.Results Thirty-three patients completed the 3-month treatment, while 29 patients received the complete follow-up. The serum ALT levels were reduced from 118 ± 79 to 73 ± 39IU/L in the treatment group, but did not change in the control group (106 ± 45 versus 107 ± 48IU/L). Posttreatment enzyme activity was decreased significantly from the baseline. Furthermore, it was significantly lower than the 3-month control level. Although 5 patients withdrew from the study, none was affected by any side effects of repeated phlebotomy that required them to discontinue the treatment.Conclusions This short-term controlled trial demonstrated the biochemical efficacy and safety of iron reduction therapy for patients with CHC.     

Clinical presentation in relation to diversity within the Helicobacter pylori cag pathogenicity island

OBJECTIVE: This study investigated the genetic diversity of the cag pathogenicity island (PAI) in Helicobacter pylori (H. pylori) in relation to clinical outcome and interleukin (IL)-8 production. METHODS: Seven genes in the cag PAI (cagA, cagE, cagG, cagM, cagT, open reading frame 13 and 10) were examined by polymerase chain reaction and Southern blot hybridization using H. pylori from 120 patients with different presentations (duodenal ulcer, gastric cancer, gastritis alone). IL-8 production from AGS cells (gastric cancer cell line) cocultured with H. pylori was measured by ELISA. RESULTS: An intact cag PAI was present in 104 (87%) isolates, and five (4%) had deletions within the cag PAI; 11 (9%) lacked the entire cag PAI. Clinical isolates containing the complete cag PAI induced a greater secretion of IL-8 as compared with those without the cag PAI (3048 +/- 263 vs 480 +/- 28 pg/ml, p < 0.001). Deletion of only cagG reduced IL-8 secretion by two thirds. Deletions of more than one locus reduced IL-8 secretion to background. A similar proportion of H. pylori from patients with gastritis, duodenal ulcer, or gastric cancer had intact cag PAI (88%, 88%, and 85%, respectively). Although the presence of cagG was a better predictor of the presence of an intact cag PAI than cagA or cagE, the presence or absence of any of these genes had no association with clinical presentation. CONCLUSION: Although the cag PAI plays an important role in IL-8 production, clinical presentation cannot be predicted by the presence of an intact cag PAI or any of these seven cag PAI genes.     

Molecular epidemiologic study of tuberculosis--a study on isolates of M. tuberculosis in southern half of Osaka Prefecture

Restriction fragment length polymorphism, RFLP or DNA fingerprinting technique provides a very useful tool for the study of epidemiology of tuberculosis transmission in human. We performed RFLP analysis with the IS6110 insertion sequence of the organisms isolated from culture-positive patients who visited our Hospital during the period from January to December 2001. Our Hospital covers patients living in southern half of Osaka Prefecture including a part of Osaka City, which is the highest TB prevalence area in Japan. The number of copies of IS6110 per isolate ranged from 1 to 21. Most isolates (67%) carried 10 to 15 copies. Of 410 available isolates during the year of 2001, 131 (32%) belonged to a cluster and 279 (68%) did not. The clusters comprised one matching isolate in minimum to 13 isolates in maximum and had a total of 49 distinct RFLP patterns. The average age of the clustered cases was 52.1 years and 64% cases belonged to patients with ages younger than 60 years. Above findings suggest that many cases of tuberculosis in southern part of Osaka Prefecture result from recent transmission. It remains to be elucidated, however, how and where these recent infections occurred in these clustered cases.     

Screening and diagnosis of acute and chronic bird-related hypersensitivity pneumonitis by serum IgG and IgA antibodies to bird antigens with ImmunoCAP®

BackgroundBird antigens are some of the most relevant antigens in hypersensitivity pneumonitis (HP). Possible sources of bird antigens are bird breeding, feather products and fertilizer with fowl droppings. For the screening and diagnosis of HP, the measurement of bird-specific antibodies should be standardized. The aim of this study was to clarify the utility of serum IgG (sIgG) and IgA (sIgA) antibodies to bird antigens in screening and diagnosing acute/chronic bird-related HP with ImmunoCAP® in multi-centre clinical research.MethodsWe executed a clinical performance test by conducting a multi-institutional study to measure the levels of sIgG/sIgA against pigeon, parrot and budgerigar antigens by the ImmunoCAP® system in 29 acute and 46 chronic bird-related HP patients.ResultsThe levels of sIgG/sIgA against the bird antigens of the three species were significantly higher in subjects with acute bird-related HP and chronic bird-related HP with acute episodes (recurrent type) than in the control subjects. For sIgG, the optimal cutoff values by receiver operating characteristic (ROC) analysis were 24.6 mgA/L for pigeon, 14.0 mgA/L for parrot, and 8.7 mgA/L for budgerigar. By measuring multiple bird antigens and combining sIgG values of two species, the sensitivity and specificity for acute and recurrent-type chronic bird-related HP patients were 85–91% and 73–80%, respectively. For recurrent and insidious types of chronic bird-related HP, the sensitivity and specificity were 48–61% and 73–80%, respectively.ConclusionsMeasurement of the levels of sIgG/sIgA against pigeon, budgerigar and parrot antigens by ImmunoCAP® was useful for screening and diagnosis in bird-related HP.     

Metastasis of hepatocellular carcinoma to the supramaxillary gingiva and right ventricle

We describe a rare double metastasis of hepatocellular carcinoma to the supramaxillary gingiva and papillary muscle of the right ventricle. The patient was a 72-year-old woman who underwent three sessions of transcatheter arterial embolization for the primary lesions. Control of bleeding from the supramaxillary gingival metastasis was difficult by conservative treatment such as compression with gauze soaked in epinephrine. Therefore, radiotherapy was performed, but it failed to control the bleeding. The patient subsequently died due to hepatic failure. Autopsy revealed metastases of hepatocellular carcinoma to the papillary muscle of the right ventricle and paraaortic lymph node in the abdomen in addition to the supramaxillary gingival metastasis. Histopathological examination showed moderately differentiated hepatocellular carcinoma of both the primary site and metastatic sites to the gingiva and the heart and poorly differentiated in the paraaortic lymph node.     

Major hepatic resection reduces the probability of intrahepatic recurrences following resection of colorectal carcinoma liver metastases

BACKGROUND/AIMS: The use of major versus limited hepatic resection for colorectal carcinoma liver metastases remains controversial. We evaluated the role of major hepatic resection in managing patients with colorectal carcinoma liver metastases. METHODOLOGY: We performed a retrospective analysis of 102 patients undergoing either major (n = 61) or limited (n = 41) hepatic resection for colorectal carcinoma metastases. Major hepatic resection was defined as segmentectomy or more extensive hepatic resection; limited hepatic resection was defined as non-anatomic removal of the liver tumor plus a rim of normal parenchyma. The median follow-up period was 94 months. RESULTS: Patients undergoing major hepatic resection had larger hepatic tumors than those undergoing limited hepatic resection (p < 0.001, Fisher's exact test). The cumulative probability of intrahepatic recurrences after major hepatic resection was significantly lower than that after limited hepatic resection (p = 0.010, log-rank test). Major hepatic resection independently reduced the probability of intrahepatic recurrences (p = 0.043, Cox's proportional hazards model). Limited hepatic resection frequently resulted in recurrences within the same segment or the same lobe of the remnant liver. CONCLUSIONS: Major hepatic resection is more effective in reducing the risk of intrahepatic recurrences than limited hepatic resection in patients with resectable colorectal carcinoma liver metastases.