Sumako Yoshioka

Expression of HSP47 in Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia

BackgroundHeat shock protein (HSP) 47, a collagen-specific molecular chaperone, is involved in the processing and/or secretion of procollagens, and its expression is increased in various fibrotic diseases. The aim of this study was to determine whether quantitative immunohistochemical evaluation of the expression levels of HSP47, type I procollagen and α-smooth muscle actin (SMA) allows the differentiation of idiopathic usual interstitial pneumonia (UIP) from UIP associated with collagen vascular disease (CVD) and idiopathic nonspecific interstitial pneumonia (NSIP).MethodsWe reviewed surgical lung biopsy specimens of 19 patients with idiopathic UIP, 7 with CVD-associated UIP and 16 with idiopathic NSIP and assigned a score for the expression of HSP47, type I procollagen and α-SMA in type II pneumocytes and/or lung fibroblasts (score 0 = no; 1 = weak; 2 = moderate; 3 = strong staining).ResultsThe expression level of HSP47 in type II pneumocytes of idiopathic UIP was significantly higher than in CVD-associated UIP and idiopathic NSIP. The expression of HSP47 in fibroblasts was significantly higher in idiopathic UIP and idiopathic NSIP than in CVD-associated UIP. The expression of type I procollagen in type II pneumocytes was significantly higher in idiopathic UIP than in idiopathic NSIP. The expression of type I procollagen in fibroblasts was not different in the three groups, while the expression of α-SMA in fibroblasts was significantly higher in idiopathic UIP than in idiopathic NSIP.ConclusionOur results suggest the existence of different fibrotic pathways among these groups involved in the expression of HSP47 and type I procollagen.

Development of hepatocellular carcinoma in a patient with chronic hepatitis C after 6 years of a sustained and complete response to IFN-alpha.

The authors report a rare case of hepatocellular carcinoma (HCC) that developed 6 years after a sustained and complete response to interferon (IFN) therapy for chronic hepatitis C. A 61-year-old Japanese man presented with a mass in the liver that was diagnosed as HCC. Six years earlier he was treated with IFN-alpha and responded successfully to therapy, with sustained normalization of serum aminotransferases and eradication of serum hepatitis C virus (HCV)-ribonucleic acid (RNA). HCV-RNA was also not detected in the resected tumorous and nontumorous liver tissues. The findings suggest that all patients with chronic HCV infection should be followed closely for as long as possible for the potential development of HCC even after a complete and sustained response to IFN treatment.

Effects of smoking cessation on gastric emptying in smokers.

Background Smoking cessation can lead to changes in appetite and weight gain in some patients; thus, smoking cessation may alter gastrointestinal motility. Effects of smoking cessation on gastric emptying in smokers have not been established. Aim This study sought to determine how smoking cessation affects gastric emptying in smokers. Methods Participant group comprised 53 habitual smokers and 12 healthy nonsmokers. Habitual smokers were treated for 2 months with transdermal nicotine patches. Gastric emptying was studied using 13C acetate breath tests at the beginning of the study, and at 1 week and 9 weeks after cessation of patch use. Maximal 13CO2 excretion time (Tmax), 13CO2 excretion half-life (T1/2), and parameters β and κ, representing initial and subsequent gastric-emptying phases, respectively, were determined using conventional formulae. Results Before smoking cessation, Tmax was reached significantly later in smokers (0.94±0.3 h, P=0.014) than in controls (0.89±0.1 h). At 1 week after the end of treatment, Tmax was significantly decreased (from 1.05±0.32 h to 0.72±0.64 h, P=0.003). T1/2 also tended to decrease, but not significantly. Although β was decreased significantly (from 2.46±0.40 to 2.17±0.58, P=0.022), κ was unchanged. However, by 9 weeks after the end of treatment, Tmax (1.28±0.69 h) had increased to levels seen before treatment. Conclusions Smoking cessation temporarily accelerates gastric emptying, and decreases in β suggest that initial-phase gastric emptying accelerates after smoking cessation. The temporary acceleration of gastric emptying after smoking cessation may be involved in the temporary increase in appetite and weight gain seen after smoking cessation.

Autoimmune pulmonary alveolar proteinosis co-existing with breast cancer: a case report

IntroductionPulmonary alveolar proteinosis is a rare pulmonary disease characterized by excessive alveolar accumulation of surfactant due to defective alveolar clearance by macrophages. There are only a few published case reports of pulmonary alveolar proteinosis occurring in association with solid cancers. To the best of our knowledge, there are no previously reported cases of pulmonary alveolar proteinosis associated with breast cancer.Case presentationA 48-year-old Asian woman, a nonsmoker, presented to our institution with a right breast mass. Biopsy examination of the lesion revealed scirrhous carcinoma. A chest computed tomography scan for metastases showed abnormal shadows in both upper lung fields. As a result of flexible fiberscopic bronchoscopy, this patient was diagnosed as having pulmonary alveolar proteinosis. This case was categorized as autoimmune pulmonary alveolar proteinosis due to the positive anti-granulocyte-macrophage colony-stimulating factor antibody. Pulmonary alveolar proteinosis decreased gradually after mastectomy.ConclusionsThe present case involved the coincident occurrence of autoimmune pulmonary alveolar proteinosis with breast cancer; breast cancer may be a factor during pulmonary alveolar proteinosis development.

A case of community-acquired pneumonia due to influenza A virus and Nocardia farcinica co-infection

Nocardia spp. has not been reported previously as a cause of post-influenza pneumonia. Here we present a first case of post-influenza bacterial pneumonia due to Nocardia farcinica. Initial reason for hospitalization of the 90 year old female patient was a pneumonia with the symptoms of fever and productive cough. A rapid test for influenza antigen was positive for influenza A virus. Treatment with Zanamivir and piperacillin was initiated. However, after 1 week of treatment, the infiltration shadows on chest X-ray had worsened. Because the expectorated sputum collected on admission for culture was found to be positive for Nocardia spp., piperacillin was replaced with trimethoprim/sulfamethoxazole, and a chest X-ray showed some improvement. Although pulmonary nocardiosis with co-infection with influenza A is extremely rare, clinicians should be alert to the possibility.

A rare case of dilatation of pulmonary veins and pulmonary emphysema in both lower lobes.

Abstract:  A 34‐year‐old man was admitted to hospital because of persistent shortness of breath and diffuse vascular dilation at both lower fields of his CXR. Bronchiectasis had been suspected during childhood because of abnormal chest shadows. However, a chest CT scan obtained on admission failed to show bronchiectasis, but rather there was a dilation of blood vessels and low attenuation areas in both lower lobes. A pulmonary angiogram showed normal pulmonary arteries in the arterial phase and diffuse dilated veins in the venous phase. Although the patient also had liver cirrhosis type B with portal hypertension, no association could be found between his liver cirrhosis and the lung lesions. This is a rare case of possible congenital or idiopathic diffuse dilatation of the pulmonary veins.

A 44-Year-Old Japanese Female with Recurrent Pleuritis

Laboratory tests showed a slightly increased white blood cell count (8,800/mm 3 ) and increased C-reactive protein (11.13 mg/dl). Other blood tests including liver enzymes and renal function were within normal ranges. The urine was negative for Legionella pneumophila and Streptococcus pneumoniae antigen tests. Further laboratory investigation, including immunoglobulin levels, rheumatoid factor, antinuclear antibodies and antineutrophilic cytoplasmic antibodies were within normal ranges. Chest radiography showed a left pleural effusion ( fig. 1 ). A CT scan of the chest revealed a small left pleural effusion and passive atelectasis of the left lower lobe ( fig. 2 ). The left pleural effusion was not large enough to perform a diagnostic thoracentesis. What is your diagnosis? Clinical Presentation – Case Report

Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report

BackgroundTuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases.Case presentationAn 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss. Chest computed tomography (CT) showed diffuse micronodules in random patterns in both lung fields. Liver, skin and bone marrow biopsies showed epithelioid cell granuloma. Polymerase chain reaction of gastric aspirate was positive for Mycobacterium tuberculosis. According to these findings, miliary tuberculosis was suspected and antimycobacterial therapy was initiated. After a 6-month treatment course, chest radiograph showed new multiple nodules in the right middle lung field. Chest CT showed that a right S6 small nodule was increased and new multiple nodules appeared in the right lower lobe. Flexible fiberoptic bronchoscopy was subsequently perfomed. Cytology of the bronchial lavage showed a small number of Periodic acid-Schiff-positive bodies, suggesting Cryptococcus species. Moreover, serum cryptococcal antigen testing was positive. According to these findings, pulmonary cryptococcosis was diagnosed, although the culture was negative. Oral fluconazole therapy was subsequently initiated. After a 6-month treatment course, chest radiograph showed gradual improvement.ConclusionAlthough tuberculosis and cryptococcosis co-infection is relatively rare in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, clinicians should be aware that these infections can co-exist even in non-HIV patients without underlying diseases.

Intraabdominal abscess caused by Stenotrophomonas maltophilia: A case report

Highlights • Surgical site infections (SSI) after colon or urogenital operations are most often caused by enteribacteriaceae and anaerobes.• Skin or soft tissue infection due to Stenotrophomonas maltophilia is relative rare.• We report a rare case of SSI that presented as an intraabdominal abscess caused by .