Satoshi Hamada

Gran absceso pulmonar con seudoaneurisma de la arteria pulmonar

Conservative therapy is the standard approach in lung abscesses. However, abscesses greater than 6 cm in diameter have little chance of healing with only conservative treatment. In this situation, surgical therapy, chest tube drainage or surgical resection should be considered.1 Pulmonary artery pseudoaneurysm (PAP) is a rare and life-threatening complication of lung abscesses.2 PAP can be successfully controlled with pulmonary artery embolization

Pembrolizumab-Induced Rhabdomyolysis With Myositis in a Patient With Lung Adenocarcinoma

We included 9 patients (8 women, 1 male; mean age 50 ± 17.11 years; post-bronchodilator FEV1 82 ± 15%). All patients were in step 5 of treatment.1 In order to prevent the AE related to BT, all patients received 50 mg/day prednisone (or equivalent) the 3 days before and the day after the procedure. BT treatment was completed in all patients (27 procedures). The mean number of activations per procedure was 76.52 ± 31.26 (71.66 ± 19.79 in RLL, 64.55 ± 14.99 in LLL and 93.37 ± 47.45 in UL) with a mean length of 65.81 ± 19.32 min (64.3 ± 18.58 in RLL, 59.2 ± 14.14 in LLL and 73.88 ± 23.28 in UL). During the procedure, 7 patients suffered mild AE (6 bleeding and 1 bronchoespasm). In the 24 h post-procedure we observed AE in 18 procedures. Most of them were mild (11/27) and moderate (5/27), consisting in cough and unspecific chest discomfort. Two patients had severe AE: one case of severe bronchospasm and acute respiratory insufficiency, and one case of collapse of the treated lobe with intense hypoxemia due to mucous plug. We did not find significant differences regarding adverse events when comparing our sample with those reported previously in clinical trials (Fig. 1(c)).10,11 No deaths were occurred, and all severe AE resolved. This little change in the procedure of BT allowed us to treat an extended bronchial area, as it is shown by the mean number of applications in our patients, which is higher than the average number of applications reported previously.12 The extended treated bronchial area did not increase adverse effects. Further research is needed to know long-term safety and whether this technical modification might increase the clinical benefits. This medical research was supported by a grant from the Sociedad Española de Neumología y Cirugía Torácica (SEPAR, 2012), a grant from Asociación Española de Endoscopia Respiratoria (AEER, 2013), and a prize from the Fundació Catalana de Pneumologia (FUCAP, 2014).

Effect of Long-Term Domiciliary High-Flow Nasal Cannula Use in a Child with Atypical Charge Syndrome

High-flow nasal cannula (HFNC) is a non-invasive respiratory support modality that provides heated and fully humidified gas mixtures to patients thorough a nasal cannula interface.1 In pediatrics, HFNC is primarily used in a hospital setting for patients with bronchiolitis, and data on its domiciliary use has been limited.2 CHARGE syndrome is a congenital syndrome characterized by coloboma, heart malformation, choanal atresia, retarded growth and development, genital hypoplasia, and ear anomalies/deafness with recurrent respiratory infections.3,4 We describe a patient with CHARGE syndrome in whom the frequency of hospitalization due to respiratory infections was successfully reduced by domiciliary HFNC. The patient was a male baby born at 37 weeks via cesarean section, which was performed because of a dichorionic diamniotic twin pregnancy, and his 1and 5-min Apgar scores were 4 and 8, respectively. His birth weight was 2738 g (−0.7 standard deviation [SD]), and height was 44.5 cm (−2.1 SD). He had cryptorchidism, micropenis, and an auricular malformation. He also had dysphagia and needed a nasogastric tube for feeding. Transthoracic echocardiography revealed a persistent patent ductus arteriosus and atrial septal defect. At the age of three months, auditory brainstem response test did not reveal wave V, and magnetic resonance imaging of the internal auditory canal showed hypoplasia of the semicircular canals and deficient

¿Es segura la pleurodesis con solución de glucosa al 50% en pacientes con neumotórax espontáneo? A propósito de una serie de casos

Pneumothorax is a common pleural disease. It is defined as the presence of air in the pleural cavity and results in parenchymal collapse.1 The management of pneumothorax includes observation, simple aspiration, intercostal drainage, intercostal drainage with pleurodesis, or surgical intervention with or without chemical pleurodesis. The form of management is selected depending on the size of pneumothorax, the severity of symptoms, whether there is a persistent air leakage, and comorbidities.2 Pleurodesis is performed in order to achieve symphysis between the 2 pleural layers. Clinically, a variety of sclerosants have been used, including tetracyclin and its derivatives (doxycycline or minocycline), talc, bleomycin, and OK-432.2,3 Currently, talc and OK-432 are most commonly used for pleurodesis in Western countries and Japan, respectively.2 Recently, some studies have

Cases of Pulmonary Mycobacterium szulgai Infection Leading to Pneumothorax and Spontaneous Remission

Nontuberculous mycobacteria (NTM) are environmental organisms residing in soil and water. A greater number of isolates of NTM species has led to a higher prevalence of pulmonary infections caused by NTM.1 Over 150 different species of NTM have been described. NTM-induced pulmonary infections are usually caused by Mycobacterium avium-intracellulare, M. kansasii, and M. abscessus.1 NTM are traditionally divided into slowly-growing and rapidly-growing organisms.2 M. szulgai is a slow-growing organism that was first reported by Marks et al. in 1972.3 It is isolated from environmental sources, including snails, aquarium water, swimming pool water, and tropical fish. However, this organism is rarely isolated from humans, and accounts for just <0.5% of all human isolates of NTM.4 Pulmonary infection is the most common manifestation of M. szulgai, and clinically and radiologically it resembles the manifestation of M. tuberculosis and M. kansasii.2 Here we describe two cases of pulmonary M. szulgai infection: 1 with pneumothorax and the other with spontaneous remission. A 86-year-old man (Case 1), an ex-smoker, presented with dyspnea and fever. He had no history of pulmonary tuberculosis. He did not respond to oral levofloxacin, and was referred to Hikone Municipal Hospital for further investigation. His white blood cell count was 16,290/ l and C-reactive protein level was 16.22 mg/dL. Chest X-ray and computed tomography (CT) showed pulmonary infiltration with an air bronchogram and bronchiectasis in the right upper lobe and right pneumothorax with pleural effusion (Fig. 1A,

Diffuse Pulmonary Uptake of Gallium-67 Induced by Pulmonary Mycobacterium mucogenicum and Mycobacterium phocaicum Infection

Nontuberculous mycobacteria (NTM) are classified by their growth rate, either slowly growing or rapidly growing. Rapidly growing mycobacteria (RGM) produce mature colonies on agar plates within 7 days.1 They have a special ability to create a biofilm, which enhances a catheter-related bloodstream infection.2 Furthermore, RGM induce skin and soft tissue infections, osteomyelitis, and pulmonary infections.2 The most commonly encountered RGM are Mycobacterium abscessus complex, M. chelonae, and M. fortuitum complex.3 M. mucogenicum group, which comprises M. mucogenicum, M. aubagnense, and M. phocaicum, is another set of RGM.3 A 16S rRNA gene sequence analysis helps in discriminating between M. mucogenicum and M. aubagnense.4 Furthermore, M. phocaicum and M. mucogenicum can be discriminated by rpoB gene and heat-shock protein (hsp)-65 gene sequence analysis.4 In this report, we describe the case of a patient with pulmonary M. mucogenicum and M. phocaicum infection, whose gallium-67 (67Ga) scintigraphy reveals diffuse pulmonary uptake without any abnormal findings on chest computed tomography (CT) scan. We report the case of an 88-year-old non-smoking male patient who was diagnosed with hypertension. He was referred to Hikone Municipal Hospital because of malaise lasting for approximately 1 week. While he did not present with a fever or any respiratory symptoms, he complained of spontaneous pain in the right scapula. He had neither used any humidifiers nor hot tubs. His white blood cell (WBC) count was 12 610/ l and C-reactive protein level (CRP) was 17.49 mg/dL. While chest X-ray and chest CT scan revealed no remarkable changes, 67Ga scintigraphy demonstrated diffuse pulmonary uptake (Fig. 1A). Although the induced sputum culture tested negative for bacteria, it gave positive results for mycobacteria. Bone marrow aspiration analysis and biopsy revealed a slightly hypocellular-to-normocellular bone marrow, and the bone marrow culture tested negative for bacteria and acidfast bacillus. Because we initially suspected miliary tuberculosis, the antituberculosis drug isoniazid (300 mg/day) and rifampicin (450 mg/day) were administered. We conducted the bronchoscopic examination and prescribed levofloxacin (500 mg/day) 1 week after the administration of antituberculosis drugs because the patient had taken aspirin (an antiplatelet drug). Transbronchial lung biopsy did not detect any malignant tumors and granulomas. While the bronchial lavage culture tested negative for bacteria, it was positive for mycobacteria. Reportedly, the WBC count and CRP level decreased to 6710/ l and 3.09 mg/dL, respectively, 2 weeks after the antituberculosis regimen. After 3 months of the antituberculosis regimen, mycobacteria cultured from the induced sputum using a DNA–DNA hybridization method did not identify any particular species. However, M. mucogenicum and M. phocaicum were identified using 16S rRNA gene, rpoB gene, and hsp-65 gene sequence analyses. Therefore, we changed the treatment

Es la hiperplasia histiocítica nodular una causa del derrame pleural asociado con el dasatinib

Dasatinib (Sprycel; Bristol-Myers Squibb, New York, USA) is a second generation, broad-spectrum tyrosine kinases inhibitor, and a potent effective drug for the treatment of chronic myeloid leukemia (CML).1 Use of this drug is, however, complicated by the occurrence of the specific adverse effect of pleural effusion.2 The incidence of pleural effusion associated with dasatinib differs according to the phase of the disease, the presence of comorbidities, and the dose or dose interval.2 Cortes et al. reported an overall incidence of pleural effusion occurring in 29% of CML patients receiving 100-mg dasatinibonce daily.1 Pleural effusion can also result in a need for supplemental oxygen or induce lifethreatening conditions as a result of inducing hemodynamic or respiratory instabilityin approximately five percent of patients treated with dasatinib.1,2 Several mechanisms underlying the development of dasatinib-related pleural effusion, including the non-specific inhibition of platelet-derived growth factor receptoror other molecules implicated in immune related pathways, have been proposed, but the exact mechanism remains unknown.3 We described a case of dasatinib-related pleural effusion that histologically resembled pleural nodular histiocytic hyperplasia (NHH).

Bronquiolitis celular: : una complicación pulmonar no infecciosa de inicio tardío tras un trasplante alogénico de médula ósea

Bone marrow transplantation (BMT) provides long-term survival. However, the incidence of late-onset non-infectious pulmonary complications is 10%–26%, and can be fatal due to progressive respiratory failure.1 We describe a case of cellular bronchiolitis diagnosed 27 years after allogenic BMT. We report the case of a 65-year-old woman, non-smoker, who was diagnosed with acute lymphocytic leukemia at the age of 33 years. After preoperative treatment consisting of busulfan and cyclophosphamide, she received an allogenic BMT from a related donor (her brother), followed by complete remission. At the age of 59 years, she was referred to Aizawa Hospital due to cough and hemoptysis. Thin-section computed tomography (CT) revealed dilated, thick-walled bronchi and tree-in-bud appearance (Fig. 1A). The forced volume capacity (FVC) (%predicted) was 65.3%, and the forced expiratory volume in 1 s/FVC was 65.9%. Serologic studies for autoimmune disease (rheumatoid factor, anti-nuclear antibody, SS-A/Ro antibody, and SS-B/La antibody) were all negative. A sputum culture detected Pseudomonas aeruginosa, but no species of mycobacteria. She was treated with 200 mg clarithromycin once