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Impact of immune-related adverse events on survival outcomes in extensive-stage small cell lung cancer patients treated with immune checkpoint inhibitors. Cancer Med 2024; 13:e7188. [PMID: 38629295 PMCID: PMC11022147 DOI: 10.1002/cam4.7188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/27/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have recently become the standard of care in the first-line treatment of extensive-stage small cell lung cancer. Although immune-related adverse events have been reported to influence prognosis in non-small cell lung cancer patients, few studies have investigated the prognostic value of immune-related adverse events in small cell lung cancer patients. In this study, we evaluated the prognosis of patients who developed immune-related adverse events after first-line treatment with immune checkpoint inhibitor-based chemotherapy for extensive-stage small cell lung cancer. METHODS We enrolled 90 patients with extensive-stage small cell lung cancer who received immune checkpoint inhibitor-based chemotherapy as first-line treatment from September 2019 to December 2022 in six hospitals in Japan. The patients were categorized into groups with and without immune-related adverse events. RESULTS There were 23 patients with and 67 without immune-related adverse events. Seventeen patients had grade 1-2 immune-related adverse events, and nine (including overlapping cases) had grade ≥3. The most frequent immune-related adverse event was a skin rash. The median survival time was 22 months in patients with immune-related adverse events and 9.3 months in patients without immune-related adverse events. The hazard ratio was 0.40 (95% confidence interval: 0.19-0.83, p = 0.013). CONCLUSIONS The results of this study show that immune-related adverse events are associated with improved survival outcomes in patients with extensive-stage small cell lung cancer.
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Levofloxacin-induced Achilles Tendinitis in a Steroid User. Intern Med 2024; 63:889. [PMID: 37532546 PMCID: PMC11008989 DOI: 10.2169/internalmedicine.2256-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 08/04/2023] Open
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Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: A randomized controlled trial. Respirology 2024; 29:36-45. [PMID: 37648252 DOI: 10.1111/resp.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear. METHODS We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days. RESULTS Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148-0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events. CONCLUSION CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.
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Magnesium Oxide as an Unexpected Bronchial Foreign Body in an Elderly Patient. Intern Med 2023; 62:3511-3514. [PMID: 37062744 PMCID: PMC10749810 DOI: 10.2169/internalmedicine.1618-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/05/2023] [Indexed: 04/18/2023] Open
Abstract
As cases of magnesium oxide pill aspiration are rare, the associated airway proinflammatory properties and appropriate analytic strategies remain unclear. An 81-year-old woman presenting with dyspnea was diagnosed with magnesium oxide pill aspiration. Computed tomography, a "mixing test" with levodopa, and a magnesium content analysis revealed a similar density between the foreign body and her prescribed magnesium oxide pill. The patient recovered without airway complications after foreign body removal. Clinicians should be aware of magnesium oxide tablets as potential bronchial foreign bodies in elderly patients because they may not dissolve without exposure to gastric juices.
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First case of Cutibacterium avidum-infected pelvic lymphocele post-lymphadenectomy for endometrial cancer: A case report. Heliyon 2023; 9:e21396. [PMID: 37920529 PMCID: PMC10618815 DOI: 10.1016/j.heliyon.2023.e21396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
Background Pelvic lymphocele (lymphocyst) infection after lymphadenectomy is a rare complication that can cause the spread of inflammation to neighboring organs whose microbiology is not well known. Cutibacterium avidum causes various infections. However, no case reports of C. avidum pelvic lymphocele infection are available; therefore, its clinical characteristics in pelvic lymphocele infections remain unknown. Case presentation A 38-year-old woman with obesity (body mass index: 38.1 kg/m2) and a history of pelvic lymphadenectomy and chemotherapy for endometrial cancer presented with worsening left lower quadrant (LLQ) pain with fever. Physical examination revealed decreased abdominal bowel sounds and tenderness on LLQ palpation with no signs of peritonitis. Computed tomography (CT) revealed an infected left pelvic lymphocele with inflammation spreading to the adjacent sigmoid colon. Following blood culture, ampicillin/sulbactam (2 g/1 g every 6 h) was administered intravenously. Anaerobic culture bottles revealed gram-positive rods on day 4 of incubation at 37 °C. No other disseminated foci were observed in enhanced whole-body CT and upon transthoracic echocardiography. The isolates grew aerobically and anaerobically on blood agar plates with strong hemolysis. The bacterium was identified as C. avidum using a combination of characteristic peak analysis with matrix-assisted laser desorption ionization (MALDI) and 16S rRNA gene sequencing. The patient was diagnosed with C. avidum pelvic lymphocele infection. Based on penicillin susceptibility, the patient was successfully treated with intravenous ampicillin/sulbactam and de-escalated with intravenous ampicillin (2 g every 6 h) for 10 days, followed by oral amoxicillin (2000 mg/day) for an additional 11 days without drainage. Conclusions C. avidum should be considered a causative microorganism of pelvic lymphocele infection. Peak analysis using MALDI and distinctive growth on blood agar plates are suitable for identifying C. avidum. Mild pelvic lymphocele caused by C. avidum can be treated with a short course of appropriate antimicrobial treatment without surgical intervention.
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Group A Streptococcus dysgalactiae subspecies equisimilis vertebral osteomyelitis accompanied by progressive atlantoaxial subluxation: A case report and literature review. Medicine (Baltimore) 2023; 102:e34968. [PMID: 37653834 PMCID: PMC10470678 DOI: 10.1097/md.0000000000034968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Clinically, vertebral osteomyelitis commonly occurs in immunocompromised individuals, such as people with diabetes, immunosuppression, chronic liver disease, and malignancy. Microbiologically, vertebral osteomyelitis is commonly caused by Staphylococcus aureus; however, Streptococcus dysgalactiae subspecies equisimilis (SDSE) may also potentially cause vertebral osteomyelitis, albeit rarely. Since no case reports have documented the occurrence of SDSE cervical osteomyelitis accompanied by progressive atlantoaxial subluxation, its clinical characteristics remain uncertain. Herein, we report the first case of progressive atlantoaxial subluxation in addition to cervical osteomyelitis due to septic atlantoaxial arthritis caused by SDSE in an immunocompetent individual, and provide a review of the relevant literature. PATIENT CONCERNS A 63-year-old man with hypertension but no history of trauma or musculoskeletal disorders presented with worsening neck pain for 1 month without fever. Physical examination revealed neck pain due to neck retroflexion and tenderness with swelling of the upper cervical spine. No neurological deficit was observed. Magnetic resonance imaging revealed low-intensity areas on a T1-weighted image and high-intensity areas on a short tau inversion recovery image at the C2, C5, and C6 vertebral bodies with atlantoaxial subluxation. Two sets of blood culture tests (aerobic and anaerobic) were performed. DIAGNOSES The anaerobic blood culture bottle showed the presence of beta-hemolytic pyrrolidonyl arylamidase-negative SDSE expressing Lancefield group A antiserum. Hence, the patient was diagnosed with SDSE cervical osteomyelitis with atlantoaxial subluxation; intensive intravenous ampicillin (2 g every 6 hours) - which is effective against SDSE - was administered. INTERVENTIONS Posterior fusion (occipital bone, C4) was performed on day 33 because a follow-up magnetic resonance imaging on day 31 revealed progression of atlantoaxial subluxation with thickened atlantodental soft tissue. OUTCOMES The patient's neck pain was completely relieved after treatment with intravenous ampicillin for 6 weeks, followed by oral amoxicillin (1500 mg) daily for an additional 4 weeks. The patient did not experience recurrence or sequelae during the 2-year follow-up period. LESSONS SDSE expressing Lancefield group A antiserum can cause afebrile vertebral osteomyelitis and progressive atlantoaxial subluxation due to the occurrence of septic atlantoaxial arthritis in immunocompetent individuals. Spinal instrumentation for vertebral osteomyelitis may be acceptable after 6 weeks of antimicrobial therapy.
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Primary bacterial intercostal pyomyositis diagnosis: A case report. Medicine (Baltimore) 2023; 102:e33723. [PMID: 37144984 PMCID: PMC10158914 DOI: 10.1097/md.0000000000033723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
RATIONALE Pyomyositis is a microbial infection of the muscles and contributes to local abscess formation. Staphylococcus aureus frequently causes pyomyositis; however, transient bacteremia hinders positive blood cultures and needle aspiration does not yield pus, especially at the early disease stage. Therefore, identifying the pathogen is challenging, even if bacterial pyomyositis is suspected. Herein, we report a case of primary pyomyositis in an immunocompetent individual, with the identification of S aureus by repeated blood cultures. PATIENT CONCERNS A 21-year-old healthy man presented with fever and pain from the left chest to the shoulder during motion. Physical examination revealed tenderness in the left chest wall that was focused on the subclavicular area. Ultrasonography showed soft tissue thickening around the intercostal muscles, and magnetic resonance imaging with short-tau inversion recovery showed hyperintensity at the same site. Oral nonsteroidal anti-inflammatory drugs for suspected virus-induced epidemic myalgia did not improve the patient's symptoms. Repeated blood cultures on days 0 and 8 were sterile. In contrast, inflammation of the soft tissue around the intercostal muscle was extended on ultrasonography. DIAGNOSES The blood culture on day 15 was positive, revealing methicillin-susceptible S aureus JARB-OU2579 isolates, and the patient was treated with intravenous cefazolin. INTERVENTIONS Computed tomography-guided needle aspiration from the soft tissue around the intercostal muscle without abscess formation was performed on day 17, and the culture revealed the same clone of S aureus. OUTCOMES The patient was diagnosed with S aureus-induced primary intercostal pyomyositis and was successfully treated with intravenous cefazolin for 2 weeks followed by oral cephalexin for 6 weeks. LESSONS The pyomyositis-causing pathogen can be identified by repeated blood cultures even when pyomyositis is non-purulent but suspected based on physical examination, ultrasonography, and magnetic resonance imaging findings.
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Vertebral osteomyelitis caused by Fusobacterium nucleatum with an associated asymptomatic liver abscess in an immunocompetent adult: a case report and literature review. IDCases 2023; 32:e01754. [PMID: 37096206 PMCID: PMC10121789 DOI: 10.1016/j.idcr.2023.e01754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Fusobacterium nucleatum rarely causes vertebral osteomyelitis or liver abscesses, and no reports exist of it concurrently causing vertebral osteomyelitis and pyogenic liver abscess. A 58-year-old woman with a history of periodontitis presented with worsening lumbago, left lower leg pain, numbness, and fever for a week. Physical examination indicated knocking pain at the L2-L3 levels with a psoas sign on the left side. A magnetic resonance image showed L2-S1 vertebral osteomyelitis and intervertebral discitis, with a left psoas major muscle abscess. Vertebral osteomyelitis caused by Staphylococcus aureus was suspected; blood cultures were obtained, and intravenous cefazolin was administered. Computed tomography, which was performed to detect disseminated foci, revealed a multilocular liver abscess. On day 4 of incubation, the anaerobic blood culture bottles were positive for characteristic filamentous gram-negative rods. The empiric antimicrobial therapy was changed to ampicillin/sulbactam. The isolate was identified as F. nucleatum based on 16S rRNA gene sequencing. The liver abscess was drained on day 12. Based on the antimicrobial susceptibility test results, the patient was treated with intravenous ampicillin/sulbactam for 4 weeks followed by oral amoxicillin/clavulanate for an additional 8 weeks and remained disease-free at the 1-year follow-up. Clinicians should consider F. nucleatum as the causative organism for vertebral osteomyelitis presenting with asymptomatic pyogenic liver abscess. The gold standard for identifying and diagnosing F. nucleatum infections is 16S rRNA gene sequencing, and gram staining helps determine appropriate antimicrobials.
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Vertebral osteomyelitis caused by the novel pathogen Cutibacterium modestum: a case report. BMC Infect Dis 2022; 22:305. [PMID: 35351040 PMCID: PMC8962030 DOI: 10.1186/s12879-022-07290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cutibacterium modestum is one of the five species of the genus Cutibacterium. While C. acnes has been reported as an important pathogen in bone and joint infections, the clinical characteristics of C. modestum infections remain unclear. Moreover, thus far, there has been no clinical case report regarding C. modestum infections. Case presentation An 82-year-old man with a history of repeated trigger point injections for lumbago at the L4 level presented with fever and an exacerbation of lumbago. Physical examination indicated knocking pain at the L4–L5 levels; magnetic resonance imaging showed irregular bone destruction of the L4 vertebral body, and low T1 and high T2 intensity lesions at the L4–L5 intervertebral disc. Two sets of blood cultures (two aerobic and two anaerobic) were performed. Intravenous cefazolin was administered, considering the common pathogens of vertebral osteomyelitis, such as Staphylococcus aureus. The patient’s condition did not improve; thereafter, anaerobic culture bottles revealed Gram-positive rods on day 11 of incubation. There was no evidence of infective endocarditis upon transthoracic echocardiography. Needle aspiration from the L4–L5 intervertebral disc was performed on day 13 that also showed the presence of Gram-positive rods. The patient was diagnosed with vertebral osteomyelitis caused by C. modestum using a combination of characteristic peak analysis with matrix-assisted laser desorption ionization (MALDI), microbial biochemistry examinations, and 16S rRNA gene sequencing from the blood and pus cultures. He was successfully treated with alternative intravenous ampicillin, followed by oral amoxicillin for 10 weeks, according to the tests for ampicillin susceptibility, with a minimum inhibitory concentration of 0.016 μg/mL using E-test® under aerobic conditions. Conclusions Cutibacterium modestum is a microorganism that is difficult to identify. A combination of characteristic peaks with MALDI, appropriate microbial biochemical examinations, and 16S rRNA gene sequencing may serve as an efficient guide for the identification of C. modestum.
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Chronic Bacterial Laryngitis: A Diagnostic Pitfall for Clinicians. Intern Med 2022; 61:597-598. [PMID: 34544943 PMCID: PMC8907767 DOI: 10.2169/internalmedicine.7796-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Primary melanoma in the bronchus. Clin Case Rep 2021; 9:e05192. [PMID: 34938558 PMCID: PMC8659558 DOI: 10.1002/ccr3.5192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 11/06/2022] Open
Abstract
Primary malignant melanoma of the lung (PMML) is an extremely rare tumor with a dismal prognosis. Distinguishing PMML from metastatic melanoma of the lung can be difficult without an established treatment protocol for advanced PMML. We present a case of immunotherapy-treated PMML wherein the patient died 3 months after treatment.
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Candida parapsilosis graft infection presenting as cutaneous leukocytoclastic vasculitis. IDCases 2021; 26:e01336. [PMID: 34840953 PMCID: PMC8605414 DOI: 10.1016/j.idcr.2021.e01336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
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Lactobacillus paragasseri as a novel causative pathogen of cavernosal abscess. IDCases 2021; 26:e01320. [PMID: 34777993 PMCID: PMC8577437 DOI: 10.1016/j.idcr.2021.e01320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
L. paragasseri causes oligosymptomatic febrile spontaneous cavernosal abscesses. Molecular identification methods alone can misidentify L. paragasseri as L. gasseri. Molecular and microbial biochemistry methods can identify L. paragasseri. Penicillins are optimal antimicrobials for treatment of L. paragasseri infections. L. paragasseri cavernosal abscesses need drainage with appropriate antimicrobials.
Most cases of cavernosal abscesses result from the progression of sexually transmitted diseases (STDs) commonly caused by Neisseria gonorrhoeae; however, cavernosal abscesses without STDs are rare events. Herein, we describe the first case report of a Lactobacillus paragasseri cavernosal abscess. A 63-year-old man with diabetes and a history of foreign object insertion into the urethra one year prior presented with high-grade fever and slight local pain. The patient was diagnosed with L. paragasseri cavernosal abscess based on computed tomography and microbial biochemical examinations in addition to matrix-assisted laser desorption ionization (MALDI) and 16S rRNA sequencing from blood and pus cultures. The patient was successfully treated with a surgical procedure and appropriate antimicrobials. Hence, L. paragasseri, a commensal bacterium of the gastrointestinal or genitourinary tract, can cause cavernosal abscesses. Notably, L. paragasseri is difficult to distinguish from L. gasseri using MALDI or 16S rRNA sequencing without microbial biochemical examinations owing to morphological similarities. Therefore, special attention should be paid, clinically and microbiologically, to the potential of L. paragasseri cavernosal abscess in clinical settings.
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Dry pleural dissemination of malignancy diagnosed by aggressive thoracoscopy. Clin Case Rep 2021; 9:e05102. [PMID: 34824853 PMCID: PMC8603416 DOI: 10.1002/ccr3.5102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 12/05/2022] Open
Abstract
Determination of pleural dissemination of lung cancer helps define the treatment strategy. Positron emission tomography-computed tomography imaging could be false-negative for dry pleural dissemination of lung cancer. Clinicians should consider preoperative thoracoscopy in affected patients showing limited pleural effusion, interlobar fine granular shadows, and no metastasis on high-resolution computed tomography.
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An unusual case of hemoptysis: Pulmonary artery pseudoaneurysm secondary to a lung abscess. Respir Med Case Rep 2021; 34:101508. [PMID: 34540580 PMCID: PMC8437821 DOI: 10.1016/j.rmcr.2021.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/24/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Massive hemoptysis may originate from injured pulmonary arteries, such as from pulmonary artery pseudoaneurysms (PAPs). A 93-year-old man, diagnosed with pneumonia, was hospitalized; he later developed a lung abscess (controlled with intravenous antibiotics). On post-hospitalization day 29, he suddenly developed hemoptysis. Multi-detector computed tomography angiography (MDCTA) showed an enhanced nodule, diagnosed as a PAP, inside the lung abscess. The hemoptysis resolved, without recurrence, following transcatheter arterial embolization (TAE) of the PAP and its feeding arteries. PAPs should be considered in patients with lung abscesses and delayed massive hemoptysis. In these patients, MDCTA and TAE are effective diagnostic and treatment modalities. Massive hemoptysis can originate from pulmonary artery pseudoaneurysms (PAPs). PAPs should be considered in patients with delayed hemoptysis and lung abscesses. Multi-detector computed tomography angiography can identify origin of hemoptysis. It is useful for diagnosing and treating PAPs secondary to lung abscesses. Transcatheter arterial embolization can treat PAPs secondary to lung abscesses.
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Asymptomatic endobronchial tuberculosis represented as a solitary airway stenosis without tree-in-bud appearance on computed tomography. Clin Case Rep 2021; 9:e04742. [PMID: 34594550 PMCID: PMC8462059 DOI: 10.1002/ccr3.4742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022] Open
Abstract
Bronchoscopy is a crucial tool for diagnosing endobronchial tuberculosis in patients with airway stenosis. Early diagnosis and treatment may reduce airway sequelae and prevent the spread of infection.
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Non-bacterial thrombotic endocarditis with cryptogenic stroke. Clin Case Rep 2021; 9:e04833. [PMID: 34552744 PMCID: PMC8443433 DOI: 10.1002/ccr3.4833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/06/2021] [Accepted: 08/29/2021] [Indexed: 01/09/2023] Open
Abstract
Negative blood culture and pathological findings are helpful to diagnose non-bacterial thrombotic endocarditis. The treatment strategy, including lifelong anticoagulation or surgery, should be individualized based on patients' underlying diseases.
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Acute generalized exanthematous pustulosis in a postpartum woman. Clin Case Rep 2021; 9:e04462. [PMID: 34306687 PMCID: PMC8294142 DOI: 10.1002/ccr3.4462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/19/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
The distribution of pustular erythema, characteristic clinical course, and pathological findings can help diagnose acute generalized exanthematous pustulosis. Clinical management should include discontinuation of the suspected drug, hydrocortisone administration, and careful follow-up examination.
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Successfully treated infected aneurysm caused by Listeria monocytogenes. IDCases 2021; 25:e01206. [PMID: 34258224 PMCID: PMC8255223 DOI: 10.1016/j.idcr.2021.e01206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
L. monocytogenes causes seriously infected aneurysms in immunocompromised hosts. Cephalosporins are used as an empirical therapy for infected aneurysms. L. monocytogenes has intrinsic resistance to cephalosporins. Rapid diagnostic testing is helpful in patients with life-threatening listeriosis. A short course of preoperative therapy with appropriate antibiotic is beneficial.
Infected aneurysms caused by Listeria monocytogenes are extremely rare. Therefore, there is no standard procedure for their diagnosis and treatment. A 76-year-old Japanese man with diabetes and hypertension was diagnosed with a left common iliac aneurysm caused by L. monocytogenes, using multidetector computed tomographic angiography and rapid diagnostic testing of the positive blood culture. He was successfully treated with a combination of ampicillin administration, timely surgical debridement, and in-situ Y-graft placement with revascularization and omental implantation. Vancomycin and third-generation cephalosporins, to which L. monocytogenes is resistant, are used as an empirical regimen for infected aneurysms. Therefore, the use of a rapid diagnostic testing is important as it identifies L. monocytogenes within 24 h from obtaining the blood cultures, and guides the administration of the appropriate antibiotics. In-situ Y-graft placement restores nearly normal blood flow, following the confirmation of negative conversion of blood culture in response to the intensive intravenous ampicillin therapy. Appropriate and timely microbiological examinations, in addition to radiographic examinations, can be the key for selecting the optimal therapeutic procedures for each patient and achieving the best possible outcomes.
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The First Case Report of Mediastinal Abscess Caused by Gemella bergeri. Intern Med 2021; 60:1631-1635. [PMID: 33390483 PMCID: PMC8188013 DOI: 10.2169/internalmedicine.5043-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Most cases of mediastinal abscess occur as a postoperative complication of a thoracic surgical procedure or following trauma. The most common causative microorganism is Staphylococcus aureus, but it can be rarely caused by unusual microorganisms, such as Gemella species. These are relatively difficult-to-identify commensal microorganisms of the upper respiratory and gastrointestinal tracts and may cause several infections. A 66-year-old man was diagnosed with Gemella bergeri mediastinal abscess by the molecular detection of bacterial genes. He was successfully treated with penicillin antibiotic for eight weeks. To our knowledge, this is the first case report of mediastinal abscess caused by G. bergeri.
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Salmonella enterica var. Enteritidis osteomyelitis with pulmonary involvement in an immunocompetent young woman. IDCases 2021; 24:e01127. [PMID: 33981579 PMCID: PMC8085699 DOI: 10.1016/j.idcr.2021.e01127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/28/2022] Open
Abstract
Primary bacteremia due to non-typhoid Salmonella often occurs in immunocompromised individuals, but may also occur in immunocompetent individuals. Contrastingly, vertebral osteomyelitis with respiratory involvement caused by non-typhoid Salmonella in immunocompetent individuals is extremely rare. A 21-year-old healthy woman with histories of eating ready-to-eat roasted beef and a recent vertebral compression fracture developed high-grade fever and was diagnosed with bacteremia, complicated by vertebral osteomyelitis with pulmonary involvement characterized as an extra-intestinal infection. The pathogen was identified as Salmonella enterica var. Enteritidis using molecular and serotyping techniques. The appropriate antibiotic therapy and focal detection were based on antimicrobial susceptibility testing (including fluoroquinolone resistance), medical histories (eating ready-to-eat roasted beef and vertebral compression fracture), and diagnostic imaging. This case highlights the potential of vertebral osteomyelitis and pulmonary involvement caused by S. enterica var. Enteritidis in an immunocompetent individual, and misinterpretation of fluoroquinolone susceptibility with conventional methods.
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Salmonella stanley ovarian abscess with endometrioma in a pregnant woman in the third trimester. IDCases 2021; 24:e01068. [PMID: 33763329 PMCID: PMC7973292 DOI: 10.1016/j.idcr.2021.e01068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/09/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Salmonella stanley can be identified according to the Kauffman-White scheme. Ovarian abscesses without tubal involvement can occur as metastatic infections. Th2 cytokine dominance in pregnant women increases susceptibility to Salmonella.
Ovarian abscesses infected with Salmonella species are a rare clinical occurrence. A 26-year-old woman at 36 weeks gestation presented with high fever, left lower abdominal pain, and diarrhea; she was referred to our hospital 5 days after a vaginal delivery. She was diagnosed with a left ovarian abscess and underwent abscess enucleation. According to the stool findings, we speculated that the abscess was infected with Salmonella species; appropriate antibiotics were administered after the positive identification of Salmonella stanley. This case highlights the importance of treating infections in pelvic abscesses appropriately to limit the effects on fertility.
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Evaluation of a chest rehabilitation project in Nepal using the St. George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test. J Phys Ther Sci 2020; 32:795-799. [PMID: 33362348 PMCID: PMC7758612 DOI: 10.1589/jpts.32.795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
[Purpose] The incidence of chronic obstructive pulmonary disease is rapidly increasing
worldwide. In Nepal, it has the highest mortality rate among all noninfectious diseases.
Since 2015, we have been involved in a project that aims to facilitate chest
rehabilitation for patients with chronic obstructive pulmonary disease in Nepal. We
compared the Nepali version of the St. George’s Respiratory Questionnaire with the Chronic
Obstructive Pulmonary Disease Assessment Test, the latter of which was translated into
Nepali for this project. We also evaluated the extent to which patient quality of life
improved after the rehabilitation program. [Participants and Methods] The Nepali St.
George’s Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment
Test were used to assess the health status of patients both before the intervention’s
initiation and one year after it. Between May and September of 2016, 122 patients with
chronic obstructive pulmonary disease participated in this program. [Results] We collected
valid responses from 57 patients both before and after the intervention. The scores of
both screening tools were significantly lower after the intervention than before and
showed a significant correlation with one another. [Conclusion] These results suggest that
the Nepali version of the Chronic Obstructive Pulmonary Disease Assessment Test is a
reliable tool for the evaluation of chronic obstructive pulmonary disease and that the
intervention used in the project might be effective for patients afflicted with the
disease. However, there are limitations to the research design, such as the limited number
of participants used in the study.
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Pulmonary nocardiosis caused by Nocardia blacklokiae in an immunocompetent patient. Respir Med Case Rep 2020; 29:101005. [PMID: 32025483 PMCID: PMC6997618 DOI: 10.1016/j.rmcr.2020.101005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/24/2020] [Indexed: 11/26/2022] Open
Abstract
A subset of Nocardia isolates, previously belonging to N. transvalensis, has recently been given the new species designation N. blacklokiae. Here we report a case of pulmonary nocardiosis caused by N. blacklokiae in a 52-year-old immunocompetent woman presenting with low-grade fever and fatigue. The isolated Nocardia strain was resistant to sulfamethoxazole-trimethoprim and amikacin, but susceptible to amoxicillin-clavunate, ceftriaxone, clarithromycin and linezolid. With amoxicillin-clavunate treatment, the patient recovered and her condition remained stable, although recurrence occurred after cessation of the initial treatment. While infection by Nocardia is rare, clinicians should be aware of its resistance to antimicrobials including amikacin and sulfamethoxazole-trimethoprim.
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P2.01-59 PD-L1 Very High Expression Associated with Clinical Outcome of Pembrolizumab Monotherapy of Advanced NSCLC with PD-L1 TPS of 50% or Greater. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Interstitial pneumonitis associated with dasatinib: two case reports and literature review. Respir Investig 2019; 57:506-509. [PMID: 31311724 DOI: 10.1016/j.resinv.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 12/01/2022]
Abstract
Dasatinib has increasingly been used to treat chronic myeloid leukemia (CML), although interstitial pneumonitis has been found as a complication in large clinical trials. In the present study, 23 patients received dasatinib for CML between 2012 and 2017 at our institution, of whom 2 developed symptomatic interstitial pneumonitis. Notably, the first patient developed interstitial pneumonitis five years after initiating dasatinib. Interstitial pneumonitis should be considered as a complication in patients receiving dasatinib for CML, which may even occur after a long period of uncomplicated administration.
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Abstract
Chronic pulmonary aspergillosis, which features nodular lesions known as Aspergillus nodules, is a relatively uncommon disorder. We herein report a case of slowly progressing chronic multiple nodular pulmonary aspergillosis in a 59-year-old man with rheumatoid arthritis, dyspnea, and fatigue. One nodule was surgically resected. The surgical specimen featured central necrosis and was located adjacent to a respiratory bronchiole and pulmonary artery, without parenchymal invasion. Branching septate hyphae, compatible with Aspergillus, were seen inside this necrotic nodule. Chronic pulmonary aspergillosis should therefore be considered in the differential diagnosis of patients who present with slowly progressing pulmonary multiple nodules.
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Abstract
We herein report a 37-year-old woman with lung adenocarcinoma with brain metastases and an asymptomatic ovarian tumor. Immunohistochemistry and a fluorescent in situ hybridization analysis of the biopsied lung tumor revealed anaplastic lymphoma kinase (ALK) gene rearrangement. Although the origin of the ovarian tumor remained unclear, alectinib administration was initiated, and radiological responses were observed in all lesions, which confirmed that the ovarian tumor was a metastasis from lung cancer. Although differentiating the origin of an ovarian tumor is difficult in lung cancer patients due to the rarity of ovarian metastases, alectinib therapy can replace an invasive biopsy, especially in ALK-rearranged lung cancer patients.
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Abstract
SummaryThe plasma level of interleukin-1β (IL-1β) was determined in normal individuals, patients with disseminated intravascular coagulation (DIC), patients in the pre-DIC period (within 7 days before the onset of DIC), and non-DIC patients to examine the relationship between DIC and the plasma ILlp level. The plasma IL-1β level was 0-0.085 ng/ml in normal individuals, with little difference being seen according to related age. It was significantly higher in the DIC group (0.19 ± 0.19 ng/ml) than in the pre-DIC group (0.05 ± 0.08 ng/ml) or the non-DIC group (0.09 ± 0.01 ng/ml). The plasma IL-1β level was not markedly elevated in leukemia patients, even in the DIC group, but it was significantly increased in the DIC group of solid cancer patients and was generally elevated in patients with sepsis. It was markedly elevated to 0.39 ± 0.26 ng/ml in patients with organ failure. When mononuclear cells were incubated with lipopolysaccharide, it was found that IL-1β, tumor necrosis factor, and tissue factor (TF) were released into the medium, and there was an increase of TF release from endothelial cells incubated with this medium. These results suggest that the increase in IL-Iβ reflected the activation of monocytes and may be an important factor in DIC and its associated organ failure.
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SurePath ® LBC improves the diagnostic accuracy of intrahepatic and hilar cholangiocarcinoma. Cytopathology 2018; 29:349-354. [PMID: 29723910 DOI: 10.1111/cyt.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The current study aimed to compare cytology using SurePath® (SP)-LBC and biliary tissue histology (BTH) for the diagnosis of biliary disease. METHODS Between January 2014 and December 2016, 57 patients underwent endoscopic retrograde cholangiopancreatography for the diagnosis of biliary disease. Biliary cytological samples were processed using SP-LBC and subsequently BTH was performed. A final diagnosis was confirmed by surgery (23 malignant cases) and clinical follow-up (34 benign and malignant cases): 18 extrahepatic cholangiocarcinoma; 17 intrahepatic/hilar cholangiocarcinoma (intra/H-CC); eight other malignant disease; and 14 benign biliary disease. The diagnoses made using SP-LBC and BTH were classified into four categories: (1) benign; (2) indeterminate; (3) suspicious for malignancy/malignant; and (4) inadequate. In addition, diagnostic accuracy was compared between SP-LBC and BTH. RESULTS Although 23% (13/57) of BTH samples were classified as inadequate, all SP-LBC cases were classified as adequate. Among 43 malignant cases, 11 normal, four indeterminate and 28 suspicious for malignancy/malignant were found using SP-LBC (26%, 9% and 65%, respectively), in contrast to 10 inadequate, nine normal, 10 indeterminate and 14 suspicious for malignancy/malignant observed using BTH (23%, 21%, 23%, and 33%, respectively). The identification of malignant cells was strikingly different between SP-LBC and BTH. Furthermore, limited to intra/H-CC, accuracy was significantly higher using SP-LBC than using BTH (P < .001). CONCLUSIONS SP-LBC of the biliary tract is a useful and reliable method for diagnosing biliary malignant disease and has an advantage over BTH for detecting malignant cells and accurately diagnosing intra/H-CC.
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Lung abscess caused by Streptococcus pneumoniae serotype 6B. Respir Med Case Rep 2018; 23:71-73. [PMID: 29487787 PMCID: PMC5805848 DOI: 10.1016/j.rmcr.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022] Open
Abstract
Lung abscess has been considered to be a rare complication of pneumococcal infection, and most cases are reported to be Streptococcus pneumoniae serotype 3. A 67-year-old man presented with fever and was diagnosed to have lung abscess caused by S. pneumoniae serotype 6B. The minimal inhibitory concentration (MIC) of penicillin for the isolate was 1 μg/mL. He was treated with high-dose intravenous sulbactam/ampicillin as definitive therapy based on susceptibility testing for S. pneumoniae and recovered successfully without surgical intervention. S. pneumoniae serotype 6B can cause lung abscess.
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P3.01-064 Detection of EGFR Mutations in Circulating Tumor DNA Using Plasma Samples: Clinical Validation of Cobas EGFR Mutation Test V2. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sequential Therapy with Crizotinib and Alectinib in ALK -Rearranged Non–Small Cell Lung Cancer—A Multicenter Retrospective Study. J Thorac Oncol 2017; 12:390-396. [DOI: 10.1016/j.jtho.2016.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/01/2022]
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Abstract
We investigated diurnal variation and age-related changes in bone turnover markers in female Göttingen minipigs. Ten females, 6–9 months of age, were used for confirmation of diurnal variation. Blood was collected at 3 h intervals for 24 h, and bone-specific alkaline phosphatase and intact osteocalcin (OC) levels were determined by enzyme immunoassay and radioimmunoassay, respectively. Urine was collected at 3 h intervals for 24 h using a tray attached to the bottom of the cage. The levels of N-terminal telopeptide of type I collagen (NTX) were determined by enzyme immunoassay. Pyridinoline and deoxypyridinoline were measured by high performance liquid chromatography. OC and NTX exhibited diurnal variation (Kruskal–Wallis test, P < 0.05), with the highest and lowest levels at 18:00 h (76.7 ± 26.2 ng/ml) and 06:00 h (44.3 ± 10.3 ng/ml), and at 03:00–05:59 h (550.4 ± 82.4 nmol/μmol Cr) and 12:00–14:59 h (297.8 ± 152.5 nmol/μmol Cr), respectively. In the study of age-related changes, blood and urine samples from 66 females (age range, 3–76 months) were examined to determine the bone turnover markers. All markers showed high correlations with age (0.569 < R2 < 0.818). High levels of bone turnover markers were observed in young animals, decreasing with age (Kruskal–Wallis test, P < 0.01). The diurnal variation and age-related changes revealed in the present study will be useful in studies of bone diseases using female Göttingen minipigs.
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457P Background of patients (pts) with ALK rearranged (ALK+) non-small-cell lung cancer (NSCLC), and efficacy and safety of ALK inhibitors (ALK-Is) in actual clinical practice: Multicenter retrospective study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv532.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Primary tracheobronchial amyloidosis. Ann Thorac Surg 2013; 96:1878. [PMID: 24182484 DOI: 10.1016/j.athoracsur.2013.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 01/21/2013] [Accepted: 03/04/2013] [Indexed: 11/29/2022]
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[Primary small intestinal Burkitt lymphoma treated with rituximab-combined CODOX-M/IVAC therapy without surgical resection]. Gan To Kagaku Ryoho 2013; 40:1229-1232. [PMID: 24047786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 38-year-old man complaining of abdominal pain was admitted to our hospital and diagnosed with small bowel obstruction. Whole body computed tomography(CT)scan showed moderate right pleural effusion with pleural and anterior chest wall thickening, with a mass approximately 100 mm in diameter at the terminal ileum. Histopathological and immunohistorical analysis of the endoscopic biopsy from the terminal ileum mass revealed diffuse infiltration of medium-sized, monotonous, atypical B lymphocytes with scanty basophilic cytoplasms carrying the so-called "starry sky" appearance, and primary small intestinal Burkitt lymphoma(BL)was diagnosed. Because of his advanced clinical stage(stage IV with Ann Arbor staging system)and the need for immediate treatment, he was promptly treated with cyclophosphamide and doxorubicin without surgical resection. Fortunately this initial therapy was received without the occurrence of bowel perforation. After initiating additional rituximab combined high-dose chemotherapy consisting of alternating courses of rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate(R-CODOX-M)and rituximab, ifosfamide, etoposide, and cytarabine(R-IVAC), he achieved complete remission and remains without signs of disease now more than seven years after his last treatment. While further investigation will of course be needed, if possible, immediate chemotherapy without surgical resection is a treatment worth considering for improving the prognosis of those with small intestinal BL.
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P160 A humanized anti-IL-6 receptor antibody for the treatment of chronic inflammatory diseases. Cytokine 2012. [DOI: 10.1016/j.cyto.2012.06.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Genome-wide analysis of DNA copy number alterations and gene expression in gastric cancer. J Pathol 2008; 216:471-82. [PMID: 18798223 DOI: 10.1002/path.2424] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Genomic copy number aberrations (CNAs) are believed to play a major role in the development and progression of human cancers. Although many CNAs have been reported in gastric cancer, their genome-wide transcriptional consequences are poorly understood. In this study, to reveal the impact of CNAs on genome-wide expression in gastric cancer, we analysed 30 cases of gastric cancers for their CNAs by array comparative genomic hybridization (array CGH) and 24 of these 30 cases for their expression profiles by oligonucleotide-expression microarray. We found that with the application of laser microdissection, most CNAs were detected at higher frequency than in previous studies. Notably, gain at 20q13 was detected in almost all cases (97%), suggesting that this may play an important role in the pathogenesis of gastric cancer. By comparing the array CGH data with expression profiles of the same samples, we showed that both genomic amplification and deletion strongly influence the expression of genes in altered genomic regions. Furthermore, we identified 125 candidate genes, consisting of 114 up-regulated genes located in recurrent regions (>10%) of amplification and 11 down-regulated genes located in recurrent regions of deletion. Up-regulation of several candidate genes, such as CDC6, SEC61G, ANP32E, BYSL and FDFT1, was confirmed by immunohistochemistry. Interestingly, some candidate genes were localized at genomic loci adjacent to well-known genes such as EGFR, ERBB2 and SMAD4, and concordantly deregulated by genomic alterations. Based on these results, we propose that our list of candidate genes may contain novel genes involved in the pathogenesis of advanced gastric cancer.
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Genome-wide microRNA expression profiling in renal cell carcinoma: significant down-regulation of miR-141 and miR-200c. J Pathol 2008; 216:418-27. [PMID: 18925646 DOI: 10.1002/path.2437] [Citation(s) in RCA: 228] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated expression profiles of microRNA (miRNA) in renal cell carcinoma [clear cell carcinomas (CCC) and chromophobe renal cell carcinomas (ChCC)] and in normal kidneys by using a miRNA microarray platform which covers a total of 470 human miRNAs (Sanger miRBase release 9.1). Unsupervised hierarchical cluster analysis revealed that CCC and ChCC were separable and that no subgroups were identified in CCCs. We found that 43 miRNAs were differentially expressed between CCC and normal kidney, of which 37 were significantly down-regulated in CCC and the other 6 were up-regulated. We also found that 57 miRNAs were differentially expressed between ChCC and normal kidney, of which 51 were significantly down-regulated in ChCC and the other 6 were up-regulated. Together, these observations indicate that expression of miRNAs tends to be down-regulated in both CCC and ChCC compared with normal kidney. We observed that miR-141 and miR-200c were the most significantly down-regulated miRNAs in CCCs. Indeed, in all cases of CCC analysed, both miR-141 and miR-200c were down-regulated in comparison with normal kidney. Microarray data and quantitative RT-PCR showed that these two miRNAs were expressed concordantly. TargetScan algorithm revealed that ZFHX1B mRNA is a hypothetical target of both miR-141 and -200c. We established by quantitative RT-PCR that, in CCCs in which miR-141 and miR-200c were down-regulated, ZFHX1B, a transcriptional repressor for CDH1/E-cadherin, tended to be up-regulated. Furthermore, we found that overexpression of miR-141 and miR-200c caused down-regulation of ZFHX1B and up-regulation of E-cadherin in two renal carcinoma cell lines, ACHN and 786-O. On the basis of these findings, we suggest that down-regulation of miR-141 and miR-200c in CCCs might be involved in suppression of CDH1/E-cadherin transcription via up-regulation of ZFHX1B.
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High-resolution analysis of DNA copy number alterations and gene expression in renal clear cell carcinoma. J Pathol 2008; 213:392-401. [PMID: 17922474 DOI: 10.1002/path.2239] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We analysed chromosomal copy number aberrations (CNAs) in renal cell carcinomas by array-based comparative genomic hybridization, using a genome-wide scanning array with 2304 BAC and PAC clones covering the whole human genome at a resolution of roughly 1.3 Mb. A total of 30 samples of renal cell carcinoma were analysed, including 26 cases of clear cell carcinoma (CCC) and four cases of chromophobe renal cell carcinoma (ChCC). In CCCs, gains of chromosomes 5q33.1-qter (58%), 7q11.22-q35 (35%) and 16p12.3-p13.12 (19%), and losses of chromosomes 3p25.1-p25.3 (77%), 3p21.31-p22.3 (81%), 3p14.1-p14.2 (77%), 8p23.3 (31%), 9q21.13-qter (19%) and 14q32.32-qter (38%) were detected. On the other hand, the patterns of CNAs differed markedly between CCCs and ChCCs. Next, we examined the correlation of CNAs with expression profiles in the same tumour samples in 22/26 cases of CCC, using oligonucleotide microarray. We extracted genes that were differentially expressed between cases with and without CNAs, and found that significantly more up-regulated genes were localized on chromosomes 5 and 7, where recurrent genomic gains have been detected. Conversely, significantly more down-regulated genes were localized on chromosomes 14 and 3, where recurrent genomic losses have been detected. These results revealed that CNAs were correlated with deregulation of gene expression in CCCs. Furthermore, we compared the patterns of genomic imbalance with histopathological features, and found that loss of 14q appeared to be a specific and additional genetic abnormality in high-grade CCC. When we compared the expression profiles of low-grade CCCs with those of high-grade CCCs, differentially down-regulated genes tended to be localized on chromosomes 14 and 9. Thus, it is suggested that copy number loss at 14q in high-grade CCC may be involved in the down-regulation of genes located in this region.
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[Splenic marginal zone lymphoma associated with autoimmune hemolytic anemia treated with splenectomy and rituximab]. [RINSHO KETSUEKI] THE JAPANESE JOURNAL OF CLINICAL HEMATOLOGY 2007; 48:1489-1491. [PMID: 18080507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 51-year-old woman, who presented with dyspnea on effort and was diagnosed with autoimmune hemolytic anemia in July 2004, was suspected of having splenic marginal zone lymphoma (SMZL) because of clonality of B cell on bone marrow and splenomegaly. She underwent splenectomy, and histopathological examination of the resected specimen confirmed the diagnosis of SMZL. The patient was treated with rituximab, and complete remission was achieved. Up to the present, three years after diagnosis, the patient has shown no evidence of progression.
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[Marked hypoalbuminemia caused by Capillaria philippinensis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2007; 96:2282-2283. [PMID: 18044166 DOI: 10.2169/naika.96.2282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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[A case of CD56 positive T-cell lymphoma originating from mediastinal lymph nodes]. NIHON KOKYUKI GAKKAI ZASSHI = THE JOURNAL OF THE JAPANESE RESPIRATORY SOCIETY 2006; 44:944-50. [PMID: 17233392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The patient, a 63-year-old man was admitted to our hospital with complaints of high-grade fever and left chest pain. The chest X-ray film taken on admission showed the presence of pleural effusion. The chest CT scan revealed left mediastinal enlargement. Examination of the pleural effusion showed a high concentration of adenosine deaminase (ADA) and the cytological examination showed no malignancy. We diagnosed pleuritis tuberculosa. His general condition worsened in spite of anti-tuberculosis therapy and soluble interleukin-2 receptor (sIL-2R) was elevated. The video-assisted thoracoscopic biopsy was negative. Soon after that the lymph nodes from the left supraclavicular region to the mediastinum became swollen. The diagnosis of peripheral T-cell lymphoma, unspecified (WHO classification) with CD56 expression, was established based on the results of lymph node biopsy and pleural effusion cytology. He was treated with cyclophosphamide/doxorubicin/vincristine/prednisolone (CHOP) chemotherapy. Since two courses of chemotherapy were not effective we changed to carboplatin/ifosfamide/ etoposide/dexamethasone (DeVIC) chemotherapy. His condition improved and a complete response was obtained. In conclusion, the presence of a high level of ADA in the pleural effusion and resistance to anti-tuberculosis therapy should suggest a malignant lymphoma.
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Abstract
Fourteen adult patients with haematological malignancies (eight non-Hodgkin's lymphoma, one multiple myeloma, one chronic lymphocytic leukaemia, two acute lymphoblastic leukaemia and two acute myeloid leukaemia) developed acute interstitial pneumonitis (IP) during the course of chemotherapy. All patients manifested high fever over 38 degrees C, bilateral diffuse pulmonary interstitial infiltrates in the chest radiograph and severe hypoxia without hypercapnia in the arterial blood gas analysis. Pathogenic microorganisms were not detected in repeated examinations in any patient. Chemotherapy given included various anti-neoplastic drugs. Five patients had received granulocyte colony-stimulating factor (G-CSF) for chemotherapy-induced leucopenia. The onset was associated with an increase of leucocytes in 10 patients. All patients were treated with high dose steroid hormone and broad spectrum antibiotics with or without anti-fungal agents, and three required mechanical ventilation. Eleven patients quickly recovered from these situations, whereas three died. Autopsies were done in two patients and disclosed pneumocystis carinii (PC) pneumonitis in one and non-specific pulmonary congestive oedema and fibrosis in the other. In conclusion, IP of unknown cause could develop in patients with various haematological malignancies especially at the recovery phase of chemotherapy-induced leucopenia irrespective of the previous G-CSF administration. High dose steroid hormone should be used as therapy for such patients as soon as possible after exclusion of an infective aetiology.
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[A case of tuberculous peritonitis]. KEKKAKU : [TUBERCULOSIS] 2005; 80:695-9. [PMID: 16363674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We report a case of a 73-year-old man with tuberculous peritonitis. He had sought treatment at a clinic near his house for his fever and abdominal distension. Massive ascites were found and he was referred to our hospital. The endoscopy and abdominal CT scan performed on admission revealed no abnormal findings except the massive ascites. Mycobacterium tuberculosis (MT) DNA was detected in the ascitic fluid by polymerase chain reaction (PCR) and ascitic adenosine deaminase (ADA) activity was 127.6 U/l. He was diagnosed as tuberculous peritonitis and transferred to the Department of Respiratory Medicine. A chest CT scan showed predominant right pleural effusion with no other abnormal findings in bilateral lung fields. His sputum were all positive by smear acid-fast staining, MT DNA and culture on MT. His final diagnosis was tuberculous peritonitis, pulmonary tuberculosis, and tuberculous pleuritis. Treatment was started by anti-tuberculosis drugs with combined use of isoniazid, rifampicin, ethambutol, and pyrazinamide. The therapy was continued for 6 months. The culture for MT (Mycobacteria Growth Indicator Tube) converted to negative after 2 weeks of treatment and the C-reactive protein level became normal after a month. The pleural effusion and ascites disappeared after 2 and 3 months, respectively. Tuberculous peritonitis is a relatively rare disease, however when we encounter unexplained ascites, MT PCR and the measurement of ADA should be done considering a rapid diagnosis of tuberculous peritonitis, before invasive diagnostic laparoscopy.
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Functional Assessment of Microencapsulated Porcine Islets With Agarose Polystyrene Sulfonic Acid In Vitro and in Xenotransplantation. Transplant Proc 2005; 37:3512-3. [PMID: 16298645 DOI: 10.1016/j.transproceed.2005.09.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the functional efficacy of microencapsulated porcine islet xenografts transplanted into nonobese diabetic (NOD) mice. Islets were isolated from the pancreata of CSK miniature swine by manual collagenase digestion and Ficoll purification. Purified porcine islets were immediately encapsulated into microbeads of agarose polystyrene sulfonic acid (Ag-PSSa). They remained morphologically intact by dithizone staining after 7 days in culture. Insulin secretion from encapsulated islets was determined in response to glucose challenge during perifusion. When encapsulated islets were exposed to 200 mg/dL glucose, within 5 minutes, insulin release became 5-fold greater than that at 80 mg/dL. However, a second phase insulin secretion appeared in response to 250 mg/dL glucose challenge. In xenotransplantation, microencapsulated porcine islets (1000 to 1800 MC islets) were transplanted into the peritoneal cavity of diabetic NOD mice (n = 4) without immunosuppression. The survival times after the onset of diabetes were observed after both MC islets transplanted NOD mice and nontransplanted NOD mice (n = 4). MC islets transplant recipients had significantly (P < .05) longer survival (47.5 +/- 18.6; mean +/- SD) than nontransplanted NOD mice (21.0 +/- 9.31), although random blood glucose levels were not normalized.
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[A case of Kartagener's syndrome]. NIHON KOKYUKI GAKKAI ZASSHI = THE JOURNAL OF THE JAPANESE RESPIRATORY SOCIETY 2005; 43:155-9. [PMID: 15801284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This case describes a 57-year-old woman in whom situs inversus had been noted at her birth. She had bronchial asthma and bilateral sinusitis during her childhood. She married and experienced childbirth. In December 2003, she was admitted to our Division complaining of wheezing, expectoration and dyspnea on effort. Bronciectasis was visualized on chest X-ray and CT. Electron microscopic examination of the nasal cavity epithelium and bronchial epithelial cilia revealed a deficit of bilateral dynein arms. These findings, helped establish a diagnosis of Kartagener's syndrome, which is characterized by primary ciliary dyskinesia. The restrictive and obstructive pulmonary dysfunction with increase of residual volume in the lung function tests and diffuse centrilobular small nodules with hyperinflation on chest CT were consistent with the findings of diffuse panbronchilitis (DPB) and suggested extended obliterative peripheral airway disease. Clarithromycin which is highly effective for DPB failed to prevent the aggravation of airway infection, arousing the concern about the progression into chronic respiratory failure.
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Elevated levels of soluble interleukin-2 receptor in serum of patients with hematological or non-hematological malignancies. ACTA ACUST UNITED AC 2005; 29:256-9. [PMID: 15899555 DOI: 10.1016/j.cdp.2005.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 03/25/2005] [Indexed: 11/24/2022]
Abstract
We measured the levels of soluble interleukin-2 receptor (sIL-2R) in the serum of 53 patients with hematological malignancies (14 with acute leukemia, 10 myeloproliferative disorders, 21 non-Hodgkin's lymphoma and 8 multiple myeloma), 40 with non-hematological solid malignancies (24 with lung cancer, 11 digestive system cancer and 5 other cancers) and 95 healthy subjects as a control using an enzyme-linked immunosorbent assay. Both hematological and non-hematological neoplasms showed significantly higher sIL-2R levels than normal subjects (p<0.01). However, compared to solid malignancies, hematological neoplasms displayed a wide range of sIL-2R levels and extremely elevated values of sIL-2R were seen in certain cases. These results seem to suggest that sIL-2R levels may serve as one of non-invasive markers of differential diagnosis for patients with bulky mass lesions between hematological and solid malignancy.
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