Utility of a shortened Hasegawa Dementia Scale Revised questionnaire to rapidly screen and diagnose Alzheimer's disease.

AIMS: The aim of this study was to analyze the sensitivity and specificity of a shortened Hasegawa Dementia Scale Revised (shortened HDS-R) questionnaire and explore its utility for the rapid screening and diagnosis of Alzheimer's disease (AD). METHODS: We included 113 patients over the age of 60 years who visited our hospital from June 2018 to January 2021 including 70 subjects with AD and 43 healthy subjects. AD was diagnosed in accordance with the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and the standard HDS-R questionnaire was used as a neuropsychological examination. The shortened HDS-R questionnaire was composed of the first seven subdomains (1 to 7) of the HDS-R questionnaire and excluded subdomains 8 and 9. Magnetic resonance imaging (MRI) was performed to calculate the degree of atrophy of the whole brain, hippocampus, and parahippocampal gyrus. RESULTS: The cumulative contribution ratio of subdomains 1 to 7 of the HDS-R questionnaire was as high as 94%, indicating that the construct validity of the shortened HDS-R was very good. The correlation coefficient of the total scores of the shortened HDS-R and the HDS-R was 0.96, indicating that the criterion-related validity was also very good. Furthermore, the shortened HDS-R was significantly negatively correlated with the degree of atrophy in the whole brain, hippocampus, and parahippocampal gyrus, indicating that its concurrent validity was very good in relation to imaging parameters. Cronbach's α coefficient of the shortened HDS-R was 0.76, and the correlation coefficient of the item-total correlation analysis was between 0.68 and 0.76, indicating that this questionnaire has high internal consistency and reliability. The total shortened HDS-R score of the normal group (17.0 ± 1.9) was significantly higher than that of the AD group (8.6 ± 3.8), demonstrating that the total shortened HDS-R score can be used to identify healthy individuals and patients with AD. When the cutoff score was 14 of 15, the sensitivity was 92.9% and the specificity was 88.4%. The diagnostic ability of the shortened HDS-R was 91.2%, which indicates that it is similar to the full HDS-R questionnaire as an AD screening tool. CONCLUSION: As a neuropsychological examination questionnaire for the screening and diagnosis of AD, the shortened HDS-R had very high validity and reliability. Its sensitivity, specificity, and diagnostic ability were similar to those of the gold standard HDS-R; therefore, it can be considered a concise and useful questionnaire for AD screening and diagnosis in the older population.

[A case of hypersensitivity pneumonitis caused by zinc fume].

A 55-year-old man with a 3-year occupational history of welding was admitted for repeated episodes of fever, cough and dyspnea after inhalation of smoke while welding galvanized steel. A computed tomography (CT) showed diffuse centrilobular nodules, panlobular ground-glass opacity and interlobular septal thickening in both lung fields, and he suffered from hypoxemia (PaO2 = 55.3Torr) while breathing room air. Percentage of lymphocytes in bronchoalveolar lavage fluid increased, and lung biopsy specimens at thoracoscopy revealed lymphocytic alveolitis and organization in air spaces. His symptoms and signs disappeared spontaneously only when he ceased welding. Panlobular ground-glass opacity and interlobular septal thickening improved immediately with oral corticosteroids. Patch tests using metal series gave positive reactions to zinc. We diagnosed this case as hypersensitivity pneumonitis caused by zinc fumes.

[Placement of an ultraflex nitinol stent for severe tracheobronchial obstruction in a case of relapsing polychondritis].

A 59-year-old man, who had been treated for bronchial asthma since 2000, was hospitalized with high fever and productive cough in November 2003. Chest radiography on admission showed consolidations in both lower lung fields, and computed tomography demonstrated anteroposterior narrowing of both main bronchi. A physical examination revealed deformity of auricular cartilage and saddle nose, and we diagnosed him relapsing polychondritis (RP). When he was readmitted 4 months later because of severe tracheobronchial stenosis and respiratory failure he required mechanical ventilation, but it was difficult to wean him from the ventilator. Self-expandable metallic stents were placed in the left main bronchus and the trachea. After the procedure, he was successfully weared from mechanical ventilation. Since airway complications of RP can be fatal, stent implantation should be considered in the management of RP with airway manifestations.

Nonspecific interstitial pneumonia in collagen vascular diseases: comparison of the clinical characteristics and prognostic significance with usual interstitial pneumonia.

BACKGROUND: Nonspecific interstitial pneumonia (NSIP) has recently been described as a distinct clinicopathological entity among idiopathic interstitial pneumonias (IIP), having more favorable prognosis than usual interstitial pneumonia (UIP). Although NSIP was initially reported to also occur in patients with interstitial pneumonia associated with collagen vascular diseases (IP-CVD), the prevalence of NSIP and its prognostic significance in IP-CVD remains to be determined. Thus, we attempted to clarify clinical characteristics and prognostic significance of NSIP in IP-CVD. METHODS: We histologically examined surgical lung biopsies from 43 patients with IP-CVD based on a current classification of interstitial pneumonias, and compared the clinical characteristics and prognostic significance of NSIP with UIP in IP-CVD. We also studied 98 patients with biopsy-proven NSIP and UIP in IIP, and compared the prognostic significance of histopathologic subclassification in IIP with that in IP-CVD. RESULTS: In IP-CVD, twenty-six patients (60%) were classified as NSIP, 17 (40%) as UIP. In contrast, 76 (77%) were categorized into UIP and 22 (23%) into NSIP of the patients with IIP. No significant difference in survival rates was observed between UIP and NSIP in IP-CVD (p = 0.3863), while, in IIP, NSIP has a significant better survival than UIP (p = 0.022). CONCLUSIONS: These results suggest that NSIP is more common histologic pattern than UIP in IP-CVD and, unlike in IIP, the prognosis of NSIP patients may not be different from that of UIP patients in IP-CVD.

Rapid occurrence of pulmonary aspergillosis after pulmonary wedge resection.

A 61-year-old man with diabetes mellitus undertook wedge resection of pulmonary tuberculoma in the left upper lobe. He was discharged uneventfully. However, he became febrile with productive cough five weeks after the discharge, and was readmitted. Imaging studies showed a cavitary lesion at the formerly resected site and multiple infiltrates in the other lobes. A diagnosis was rapidly deteriorating pulmonary aspergillosis. While medical treatments helped his general condition to improve, pulmonary shadows remained unchanged. Finally, we successfully treated him firstly, by performing left upper lobectomy and secondly, by treating multiple infiltrates with postoperative medical treatments. Multiple infiltrates improved gradually and diminished one month after surgery. He remains well without relapse for ten years after surgery.