[Gallbladder metastasis of large cell lung cancer].

A man, who received right upper lobectomy of the lung due to stage IIB large cell carcinoma 7 and half years ago, visited our hospital complaining of right upper abdominal pain. Computed tomography (CT) revealed gallbladder tumor and extended resection of the gallbladder was performed. Pathological diagnosis was adenosquamous cell carcinoma After 1 year and 4 months later, left adrenal gland tumor was found by CT scan, and the surgery was conducted. Pathologically, it was diagnosed as metastasis from lung cancer. By reevaluation of pathology of the gallbladder, the tumor was found to have similar component of resected lung cancer, suggesting the possibility of the tumor to be metastatic.

Cytokines in pleural liquid for diagnosis of tuberculous pleurisy.

An elevated level of adenosine deaminase (ADA) in pleural liquid has been considered as a supplemental diagnostic marker for tuberculous pleurisy. However, this is complicated by false-positives and -negatives. Recently, it has been revealed that various cytokines are intimately involved in the pathognomonic physiology of tuberculosis. In this study, interleukin-8 (IL-8), tumour necrosis factor alpha (TNFalpha) and interferon gamma (IFNgamma) were compared with ADA in pleural liquid of patients with inflammatory (21 cases), malignant (28 cases) and tuberculous (21 cases) disease. The pleural ADA, IL-8, TNFalpha and IFNgamma levels in the tuberculous group were higher than in the other three groups. Analysis of receiver operating characteristic (ROC) curves, to evaluate the utility of the various parameters, demonstrates values for the area under the curve (AUC) of 0.770, 0.875, 0.892 and 0.987, respectively for IL-8, TNFalpha, ADA and IFNgamma. No false-positives were encountered with IFNgamma and only one case with a small volume of pleural liquid was a false-negative. This indicates that IFNgamma is a very reliable marker of tuberculous pleurisy.

[Study of bacterial flora in the oral cavity and stomach of elderly patients receiving nasogastric tube feeding].

To investigate the significance of oropharyngeal flora and gastric flora in elderly patients receiving nasogastric tube feeding, throat secretions and gastric aspirates were cultured and the pH of the latter was measured. Of 116 bacterial isolates from throat secretions of 27 elderly patients, 30 were beta-streptococci and 28 were Pseudomonas aeruginosa. Bacteria isolated from gastric aspirates numbered 86 and 24 (27.9%) of them were the same species as those found in the throat secretions. Patients with gastric pH were below 3.5 had significantly lower concentrations of gram-negative bacili in gastric aspirates. We also studied oropharyngeal flora in 33 elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital. The major bacterial isolates from throat swabs of bedridden patients were gram-negative bacilli and beta-streptococci, especially group B streptococci (GBS). We measured the level of antibody to GBS in these patients. Those from whom GBS were isolated had high titers. These results suggest that in elderly patients receiving enteral nasogastric) tube feeding, large numbers of bacteria colonize the oral cavity and stomach. The measurement of type-specific antibody to GBS may be useful in managing such patients.

Amino-acid change on the antigenic region B1 of H3 haemagglutinin may be a trigger for the emergence of drift strain of influenza A virus.

Sera from 27 children and eight older persons, which had been collected in 1998 and 1999 and showed haemagglutination-inhibition (HI) activity against influenza A/Sydney/5/97 (H3N2) strain, were characterized with a binding assay using chimeric haemagglutinin (HA) proteins between A/Aichi/2/68 (A/AI/68) and A/Sydney/5/97 (A/SD/97) strains. Sera from the young children had a tendency to recognize only the antigenic site B1 of the HA1 region. On the other hand, sera of the older individuals were fully reactive to all antigenic sites of HA1 except antigenic site D. Recent epidemic strains, A/Panama/2007/99 (A/PM/99)-like viruses have differences in amino acids in antigenic sites A, C, and B2 but not B1. However, human antisera obtained even from young children had HI activity to Panama-like viruses. The limited epidemic of A/PM/99-like viruses may have been due to the existence of antibody against B1, which had been produced in response to infection by the A/SD/97-like viruses.