Captopril, an angiotensin-converting enzyme inhibitor, induced pulmonary infiltration with eosinophilia.

In this study, we investigated the association between the drug-induced pulmonary infiltration with eosinophilia (PIE) syndrome in a patient with hypertension and the angiotensin-converting enzyme inhibitor (ACE-I) captopril. Although the patient developed diffuse lung field infiltrates accompanied by productive cough and striking peripheral eosinophilia, these symptoms disappeared after termination of the administration of captopril, pronase and cephalexine. Furthermore, the results of the peripheral lymphocyte stimulation test, skin patch test and provocation test under informed consent showed a positive reaction only for captopril. Therefore, this patient was diagnosed as captopril-induced PIE syndrome.

[Clinical analysis of foreign patients with tuberculosis found in Chugoku-Shikoku area].

In this study, we investigated 45 foreign patients who had been diagnosed as having tuberculosis in Chugoku-Shikoku area during the past 12 years. Regarding regional characteristics, in Hiroshima prefecture an epidemic of tuberculosis was experienced among patients coming from South America, but antituberculous therapy was performed for 87% of the patients because of the high coverage of the health insurance scheme. But in Okayama prefecture, most of the patients were female and came from Asian countries, such as, the Philippines. Antituberculous therapy was not performed for nine patients because of no coverage of the health insurance scheme. In the other prefectures, only a few cases of tuberculosis were experienced, but in Yamaguchi prefecture two of three foreign patients were multidrug-resistant tuberculosis.

[Assessment of myocardial viability by thallium-201 reinjection imaging with sublingual nitroglycerin].

Although thallium-201 (201Tl) reinjection imaging improves the detection of myocardial viability compared to standard 3-4-hr redistribution (RD) imaging, it still underestimates the extent of viable myocardium. We examined whether 201Tl reinjection SPECT with sublingual nitroglycerin (NTG) had a higher sensitivity for viability detection than reinjection alone. Eighty patients with coronary artery disease were studied, 38 of them with an old myocardial infarction. At the peak of exercise, 111 MBq 201Tl was injected and the initial and the delayed SPECT images were obtained. Then, all patients were divided randomly into two groups, and in each group, SPECT data were obtained again after the injection of 37 MBq 201Tl with (NTG(+) group) or without 0.6 mg of sublingual NTG (NTG(-) group). Among 50 segments showing fixed defects on the delayed image in the NTG(+) group, 21 (42%) were found to be reversible on the reinjection image, as compared to 16 of 51 (31%) in the NTG(-) group. Twenty-two of 44 (50%) segments showing incomplete RD were found to be reversible in the NTG(+) group, while 17 of 42 (41%) segments in the NTG(-) group. Moreover, the ratio of reversible segments seen in the reinjection images was significantly higher in the collateralized regions of the NTG(+) group than in those of the NTG(-) group (20/26 vs. 14/28, p < 0.05). Thus, 201Tl reinjection SPECT with sublingual NTG improves the detection of ischemic but viable myocardium as compared to SPECT with reinjection alone.

[A case of bronchial leiomyoma with obstructive pneumonia].

A 44-year-old man, who had suffered repeated episodes of pneumonia since 1984, was admitted with complaints of cough, low grade fever and sputum. Chest X-ray showed a mass shadow in the left lower lobe. Bronchofiberscopy revealed a tumor with a smooth surface which obstructed the B9 bronchus. Left lower lobectomy was performed despite the lack of evidence of malignancy because of the recurrent pneumonia. The resected specimen contained a smooth-surfaced tumor, 18 mm in size, protruding into a bronchial lumen. The pathological diagnosis was leiomyoma of the lower bronchus and the specimen showed organized pneumonia with necrosis in the left S8-S10 region. Primary benign tumors of the lung are rare and leiomyoma of the lung is particularly rare. Only 65 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the lower bronchus.

[A case of peripheral adenoid cystic carcinoma].

A case of peripheral adenoid cystic carcinoma in a 70-year-old woman is presented. She had a coin lesion in the left upper lung field on chest X-ray film. Before one month on admission to our hospital, she noticed a tumor in the left thigh and underwent simple resection. Histological diagnosis was liposarcoma. Lung metastasis of the liposarcoma or primary lung cancer were suspected. Lung wedge resection was performed and adenoid cystic carcinoma was diagnosed. Generally adenoid cystic carcinoma originates from bronchial gland, arising in the trachea or main bronchus. In this case, the tumor originated from the peripheral lung field.

Evaluation of serum KL-6 levels in patients with pulmonary tuberculosis.

SETTING: KL-6, a human MUC-1 mucin preferentially expressed on type II pneumocytes, is a sensitive serum marker for evaluating alveolar damage of interstitial pneumonia and pulmonary fibrosis. Some patients with pulmonary tuberculosis develop severe respiratory dysfunction caused by extensive pulmonary fibrosis, compensatory emphysema and fibrous pleural thickening. OBJECTIVE: To evaluate the clinico-pathological significance of KL-6 in pulmonary tuberculosis. DESIGN: Serum KL-6 levels were measured in sera from 57 patients with active pulmonary tuberculosis and 38 healthy controls by a sandwich-type enzyme-linked immunosorbent assay. Immunohistochemistry was performed by an avidin-biotin-peroxidase complex method. RESULTS: KL-6 levels were significantly higher in the patients than in the healthy controls (518 +/- 693 [SD] vs 227 +/- 91 U/ml, P < 0.001) and increased significantly according to the extent of pulmonary lesions evaluated by chest X-ray (P < 0.001). There was a significant negative correlation between serum KL-6 levels and % vital capacity (VC) (r = 0.642, P < 0.05). KL-6 was strongly expressed on proliferated type II pneumocytes and cuboidal epithelial cells adjacent to thickened intralobular septa and pleura. CONCLUSIONS: In pulmonary tuberculosis, serum KL-6 originates from proliferated type II pneumocytes and cuboidal epithelial cells, and is a useful marker presenting the degree and extent of pulmonary fibroproductive lesions.