CMV pneumonia and Nocarsia asiatica pneumonia presented as Cavitary lung lesions

Cytomegalovirus Pneumonia in a Patient with Interstitial Pneumonia and Nocardia asiatica Presenting as Cavitary Lung Lesions

Internal Medicine Vol. 52 (2013) No. 5 p. 593-597


Takeshi Saraya1), Kosuke Ohkuma1), Ken Kikuchi2), Masaki Tamura1), Kojiro Honda1), Atsuko Yamada1), Koji Araki3), Haruyuki Ishii1), Hiroshi Makino3), Hidefumi Takei4), Shin Karita4), Masachika Fujiwara5), Hajime Takizawa1), Hajime Goto1)

1) Department of Respiratory Medicine, Kyorin University School of Medicine, Japan 2) Department of Infection Control Science, Faculty of Medicine, Juntendo University, Japan 3) Department of Laboratory Medicine, Kyorin University School of Medicine, Japan 4) Department of General Surgery, Kyorin University School of Medicine, Japan 5) Department of Pathology, Kyorin University School of Medicine, Japan

Drug-Induced Pulmonary Toxicity with special reference to Gemcitabine

High-Resolution Computed Tomography Findings for Patients With Drug-Induced Pulmonary Toxicity, With Special Reference to Hypersensitivity Pneumonitis-Like Patterns in Gemcitabine-Induced Cases

Masaki Tamuraa, Takeshi Saraya, Masachika Fujiwara, Sayuki Hiraoka, Takuma Yokoyama, Kinuko Yano, Haruyuki Ishii, Junji Furuse, Tomoyuki Goya, Hajie Takizawa and Hajime Goto


Oncologist. 2013 Feb 12. [Epub ahead of print]

Abstract

Abstract Background. Gemcitabine (GEM) is widely used as a chemotherapeutic agent. However, pulmonary toxicity has been rarely observed with GEM use. This article aims to determine the incidence and causes of drug-induced pulmonary toxicity, and to classify the high-resolution computed tomography (HRCT) findings for antitumor therapy-associated pulmonary toxicity based on characteristic patterns and pathological considerations, with a special focus on GEM-associated pulmonary toxicity (GAPT).

Methods. Medical records of all patients with drug-induced pulmonary toxicity seen at Kyorin University hospital between April 2006 and December 2011 were retrospectively reviewed. The study examined correlations between HRCT and the assessed pathological or clinical findings, with a specific focus on antitumor drugs.

Results. We identified 66 patients with drug-induced pulmonary toxicity. Among the antitumor drugs, GEM was the primary offending agent (n = 8) for pulmonary toxicity followed by docetaxel and gefitinib. HRCT patterns for the eight GAPT patients included the non-specific interstitial pneumonia (NSIP; n = 5) and the hypersensitivity pneumonitis (HP)-like pattern (n = 3). In contrast, four patients in the study were found to have the HP-like pattern, with three cases associated with GEM and one case associated with imatinib mesylate. The transbronchial lung biopsy or video-assisted thoracic surgery specimens for these patients showed granuloma or organizing tissue with a random distribution that was independent of the respiratory bronchiole. These results appeared to correspond to the HRCT-determined centrilobular nodules.

Conclusion. GEM was the leading cause of drug-induced pulmonary toxicity in the patients examined in this study. This toxicity appears as NSIP or an HP-like pattern during HRCT examinations. This HP-like pattern may be useful for diagnosing GEM-induced pulmonary toxicity, as well as demonstrating granuloma or organizing tissue during lung pathology examinations.

High-resolution CT findings of patients with pulmonary nocardiosis

High-resolution CT findings of patients with pulmonary nocardiosis


http://www.jthoracdis.com/article/view/637

Naoki Tsujimoto, Takeshi Saraya, Ken Kikuchi, Saori Takata, Yasuyuki Kurihara, Sayuki Hiraoka, Hiroshi Makino, Shota Yonetani,
Koji Araki, Haruyuki Ishii, Hajime Takizawa, Hajime Goto

Abstract
Background: Opportunistic pulmonary infection with Nocardia species is rare in humans, and only a few studies have radiologically analyzed patients with pulmonary nocardiosis using high-resolution computed tomography (HRCT).
Methods: We retrospectively reviewed the medical records of patients with pulmonary nocardiosis at our hospital between April 2006 and December 2011 to assess HRCT and clinical findings.
We also searched the medical literature for pulmonary nocardiosis reported in Japan between 2002 and 2011 for comparison.
Results: We identified seven patients at our institution and 33 reported infections in Japan. Four of our patients were immunocompetent, whereas the other three had impaired cellular immunity due to type 2 diabetes mellitus or having been inappropriately treated with steroid. Thoracic HRCT revealed no zonal predominance, but tropism for distribution from the middle to the peripheral area, and radiological findings of nodules, cavitation, mass, consolidations, bronchial wall thickening, septal line thickening and ground glass opacity (GGO) were evident. The main HRCT finding in our study comprised nodules (n=5, 71.4%) <30 mm and four patients had multiple nodules as described in other reports. Furthermore, we discovered a crazy paving appearance (CPA) around nodules, cavities, masses or consolidations in five patients (71.4%).
Conclusions: Multiple nodules distributed from the middle to the peripheral area on HRCT might reflect pulmonary nocardiosis, and CPA seemed to be a worth paying attention to the diagnosis.

Guillain-Barré syndrome

Guillain-Barré syndrome in two patients with respiratory failure and a review of the Japanese literature

http://www.jthoracdis.com/article/view/640

Erei Sohara, Takeshi Saraya, Kojiro Honda, Atsuko Yamada, Toshiya Inui, Yukari Ogawa, Mitsuru Sada,
Naoki Tsujimoto, Masuo Nakamura, Akiko Tsuchiya, Masaki Saito, Chizuko Oishi, Atsuro Chiba,
Hajime Takizawa, Hajime Goto

Abstract
We described two patients with Guillain-Barré syndrome and respiratory failure with or without mechanical ventilation. Case 1 was a 44-year-old man who treated as pneumonia under mechanical ventilation for a month and transferred to our hospital with unsuccessful weaning trials because of phrenic nerve palsy. Case 2 was a 74-year-old man who presented with aspiration pneumonia because of bulbar palsy. The present two cases with review of the Japanese literature showed that antecedent infection with initial symptoms within the most recent 5 to 46 days is a clinical clue to the diagnosis even in patients with Guillain-Barré syndrome accompanied by respiratory failure.

Malignant peritoneal mesothelioma

http://www.jthoracdis.com/article/view/489

A case of malignant peritoneal mesothelioma revealed with limitation of PET-CT in the diagnosis of thoracic metastasis

Author Takeshi Saraya, Takuma Yokoyama, Haruyuki Ishii, Yasutaka Tanaka, Naoki Tsujimoto, Yukari Ogawa, Erei Sohara,
Akira Nakajima, Toshiya Inui, Hiraoka Sayuki, Masachika Fujiwara, Teruaki Oka, Riken Kawachi, Tomoyuki Goya, Hajime Takizawa, Hajime Goto


Abstract
A 47-year-old man was referred to our hospital because of a 2-month history of dry cough, 2-kg weight loss, and a feeling of abdominal fullness. The PET-CT scan depicts the intense standard uptake values (SUVs) of the anterior and subphrenic lymphnodes, and intraperitoneal cavity, especially in the omentum, while, no uptake was found in the pleural cavity. Based on the pathological findings of the open lung biopsy specimens, he was diagnosed with malignant peritoneal mesothelioma of epithelioid type with thoracic metastasis. The present case demonstrated the some of the limitations of PET-CT in the diagnosis of malignant mesothelioma, which failed to detect pleural involvement despite aggressive invasion by this tumor.

MP Extract Induces an IL-17-Associated Inflammatory Reaction in Murine Lung: Implication for MP

http://www.ncbi.nlm.nih.gov/pubmed/23001692

Inflammation. 2012 Sep 22. [Epub ahead of print]
Mycoplasma pneumoniae Extract Induces an IL-17-Associated Inflammatory Reaction in Murine Lung: Implication for Mycoplasmal Pneumonia.

Kurai D, Nakagaki K, Wada H, Saraya T, Kamiya S, Fujioka Y, Nakata K, Takizawa H, Goto H.

Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.

Abstract
Mycoplasma pneumoniae (Mp) may cause immune cell reactions as pivotal aspects of this clinically common respiratory pathogen. Our aim is to determine if Mp extract induces a cellular immune response associated with interleukin (IL)-17, leading to lung inflammation and lung injury. BALB/c mice were immunized with Mp extract intraperitoneally followed by its intratracheal administration, to mimic repeated Mp infection found in humans (repeated inoculation, RI group). Those with a single inoculation were compared as single inoculation group (SI group). Analysis of bronchoalveolar lavage fluid (BALF) demonstrated that keratinocyte-derived cytokine, tumor necrosis factor-α, and IL-6 were produced and peaked on days 0.5 or 1, followed by IL-17 on day 2. Levels of these mediators in BALF were higher in RI group than SI group (P < 0.05). Further, significantly more neutrophils were recruited to the lungs of the RI group (P < 0.05). These observations suggest that IL-17 is involved in the prolonged induction of neutrophils in mice treated with Mp extract.

Pulmonary actinomycosis diagnosed by VATS with a growing fungus ball within a small cavity

Pulmonary actinomycosis diagnosed by video-assisted thoracic surgery with a growing fungus ball within a small cavity

http://journal.kyorin.co.jp/journal/ajrs/detail.php?-DB=jrs&-recid=16658&-action=browse

Ichiro Hirukawa, Takeshi Saraya, Ryota Tanaka, Masachika Fujiwara,
Haruyuki Ishii and Hajime Goto

Department of Respiratory Medicine, Kyorin University School of Medicine
Department of Surgery, Kyorin University School of Medicine
Department of Pathology, Kyorin University School of Medicine

The saw-tooth sign as a clinical clue for intrathoracic central airway obstruction.

BMC Res Notes. 2012 Jul 29;5(1):388. [Epub ahead of print]

The saw-tooth sign as a clinical clue for intrathoracic central airway obstruction.

Nakajima A, Saraya T, Takata S, Ishii H, Nakazato Y, Takei H, Takizawa H, Goto H.



ABSTRACT:

BACKGROUND:
The saw-tooth sign was first described by Sanders et al in patients with obstructive sleep apnea syndrome as one cause of extrathoracic central airway obstruction. The mechanism of the saw-tooth sign has not been conclusively clarified. The sign has also been described in various extrathoracic central airway diseases, such as in burn victims with thermal injury to the upper airways, Parkinson's disease, tracheobronchomalacia, laryngeal dyskinesia, and pedunculated tumors of the upper airway.

CASE PRESENTATION:
A 61-year-old man was referred to our hospital with a two-month history of persistent dry cough and dyspnea. He was diagnosed with lung cancer located in an intrathoracic central airway, which was accompanied by the saw-tooth sign on flow-volume loops. This peculiar sign repeatedly improved and deteriorated, in accordance with the waxing and waning of central airway stenosis by anti-cancer treatments.

CONCLUSION:
This report suggests that the so-called saw-tooth sign may be found even in intrathoracic central airway obstruction due to lung cancer.
PMID: 22838841

Bronchial artery varices

Clin Radiol. 2012 Jun 28. [Epub ahead of print]

Two cases of bilateral bronchial artery varices: One with and one without bilateral coronary-to-pulmonary artery fistulas.
Review and characterization of the clinical features of bronchial artery varices reported in Japan.

Nagatomo T, Saraya T, Masuda Y, Yokoyama K, Hiraoka S, Nakamura M, Nakajima A, Takata S, Yokoyama T, Ishii H, Inami T, Satoh T, Kubota H, Takizawa H, Goto H.
Source

Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.
PMID: 22748673 [PubMed - as supplied by publisher]

気管支蔓状血管腫と言えば、この論文！というものになるでしょう！
日本の４７症例のすべてのreview!

Rheumatoid nodule evaluated by PET/CT

Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature.

Saraya T, Tanaka R, Fujiwara M, Koji H, Oda M, Ogawa Y, Nagatomo T, Watanabe M, Yokoyama T, Ishii H, Takei H, Goya T, Takizawa H, Goto H.

Mod Rheumatol. 2012 Jun 6. [Epub ahead of print]

PMID: 22669597

http://www.springerlink.com/content/e31pl4kn082141x3/?MUD=MP

ブログ更新がままなりませんが、こそぞめ太郎、次郎のかわりに、三郎が登場です。
しばらく更新していないにもかかわらず、沢山のご訪問感謝いたします。

感度と特異度からひもとく感染症診療のDecision Making

感度と特異度からひもとく感染症診療のDecision Making　が出ました。
亀田の細川先生らによる本です。
あんずの呼吸の先生も一部書いております。
一家に一冊、どうでしょうか？

http://www.bunkodo.co.jp/book/detail_1054.html

攻める問診

「救急室では緊急性のある疾患だけ除外すれば十分、あとは明日の外来で診断してもらえばいいと考える研修医がいるが、私は賛同できない。攻める問診と的を絞った身体所見から、できるだけ診断を絞り込んで欲しい。このトレーニングを試行錯誤繰り返すことで臨床能力は向上すると信じている。」（山中克郎先生の言葉ですが、、）

研修医だけ、でなく上級医にも耳が痛い話だったりします。当院も救急室があるので、mornong conferenceを利用して、お互いにフィードバックしていかないといけません。そして怒涛の反復。。。
（ネタは尽きない、はKampo-master先生の口癖）

Massive Tension Pneumomediastinum

Massive Tension Pneumomediastinum [Intern Med 51: 677, 2012]

抗CADM140抗体陽性のDMのケースです。

写真：morning conferenceの一風景