An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula.

OBJECTIVES: Some surgical cases of pleural empyema lead to death despite multidisciplinary treatment. The purpose of this study was to identify prognostic factors in cases treated surgically for pneumonia-associated pleural effusions and empyema caused by common bacteria. METHODS: We conducted a retrospective cohort study of 108 surgical patients of empyema who encountered at our hospital between 2011 and 2021. Patients were divided into surviving and non-surviving cases. Factors on admission (age, sex, body mass index, presence of fistula, performance status, pleural fluid culture results, HbA1c, albumin, leukocytes, hemoglobin, body temperature, heart rate, respiratory rate, systolic blood pressure, prognostic nutritional index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and RAPID score) were compared between the two groups. RESULTS: There were 87 cases of pleural empyema caused by pneumonia due to common bacteria. Variables that differed significantly in univariate analysis between the surviving and non-surviving cases in patients' characteristics on admission were fistula (p value < 0.001, odds ratio 20.000, 95% confidence interval 3.478-115.022), positive pleural fluid culture (0.016, 6.591, 1.190-36.502), body mass index < 18.5 (0.001, 16.857, 1.915-148.349), performance status 0-1 (0.007, 11.778, 1.349-102.858), and hemoglobin (0.024, 1.768, 1.077-2.904). Multivariate analysis showed significant differences in the presence of fistula (p = 0.036, CI 1.174-125.825). The odds ratio was 12.154. The mortality rate was 3.8% for non-fistulous empyema and 44.4% for fistulous empyema. In 6 of 9 cases of fistulous empyema, the fistula could be closed. CONCLUSION: Fistula was a significant independent prognostic factor for pneumonia-associated pleural effusions and empyema caused by common bacteria.

[Psoriasis and Psoriatic Arthritis Induced by Nivolumab in a Patient with Advanced Non-Small-Cell Lung Cancer].

BACKGROUND: Immune checkpoint-blocking antibodies may induce specific side effects known as immune-relatedad verse events. CASE PRESENTATION: A 66-year-oldman without any history of autoimmune disease was referredto our hospital for treatment of lung cancer in the right upper lobe. The tumor was diagnosed as Stage III A non-small-cell lung cancer by using bronchoscopic biopsy, computedtomography, andFDG -PET. After a single course of cisplatin andpemetrexed , the tumor size increasedremarkably andthe regimen was changedto nivolumab(3mg/kg every 2 weeks). Psoriasis andpsoriatic arthritis were observed after 4 courses of nivolumab. Nivolumab treatment continued, and the oral administration of predni- solone(20mg/day)couldimprove psoriasis andpsoriatic arthritis. However, the lung cancer showedprogressive disease after the 11th course of nivolumab. CONCLUSION: Psoriasis andpsoriatic arthritis were inducedby nivolumab in the patient without any history of autoimmune disease. It is unclear how prednisolone affected nivolumab for the treatment of lung cancer.

[Complete Remission after Weekly Intravenous Nanoparticle Albumin-Bound Paclitaxel in Elderly Patients with Non-Small-Cell Lung Cancer].

Case 1: An 86-year-old man was diagnosed with large cell or squamous cell lung cancer of clinical Stage II A.He was administered nanoparticle albumin-bound paclitaxel(nab-PTX)as fourth-line chemotherapy after monochemotherapy with docetaxel, vinorelbine, and S-1.The patient continues to show complete remission at the 15 courses of nab-PTX.Case 2: A 79-year-old man underwent partial resection of the right lower lung, and the pathological diagnosis was large cell lung cancer of pStage I A.However, recurrence in the right lung and multiple lymph node metastases were identified 3 years after the surgery.He was administered nab-PTX as second-line chemotherapy after vinorelbine monotherapy, and he has shown complete remission for a year.Weekly intravenous nab-PTX may be useful in elderly patients with non-small-cell lung cancer.

Skin rash by gefitinib is a sign of favorable outcomes for patients of advanced lung adenocarcinoma in Japanese patients.

Skin rash is one of the notorious adverse events of gefitinib as well as other epidermal growth factor receptor tyrosine kinase inhibitors. The differences of response rate and frequency of adverse events between ethnic groups are well known. Some reports demonstrated the correlation between development of rash and efficacy in Caucasian patients treated with erlotinib, gefitinib or cetuximab. We analyzed clinical course of Japanese patients of lung adenocarcinoma in order to assess the relation between adverse events and efficacy of gefitinib. Between January 2008 and June 2012, 24 Japanese patients administered gefitinib 250 mg daily. The adverse events were evaluated in accordance with Common Terminology Criteria For Adverse Events v4.0 (CTCAE). Objective response to gefitinib was evaluated with using computed tomography every 1-2 months. The relationship between each adverse event and objective response was examined by chi-square test. The Log-rank Test was used to assess the relationship between the presence of skin rash and overall survival. Twenty four patients with a median age of 67 years (range 55-89) entered were 16 female and 8 male patients; the pathological diagnosis of all patients was adenocarcinoma. Skin rash in CTCAE occurred in 10. The objective response and overall survival among the patients with skin rash was significantly superior to the patients without skin rash. Skin rash by gefitinib correlates with improved clinical outcomes among advanced lung adenocarcinoma patients.

Gefitinib frequently induces liver damage in patients with lung adenocarcinoma previously treated by chemotherapy.

BACKGROUND: Gefitinib is known as one of the agents for treating patients with both advanced lung cancer and an epidermal growth-factor receptor mutation. In the epidermal growth-factor receptor-mutant advanced non-small-cell lung cancer population, gefitinib therapy has been associated with increased response rate, longer progression-free survival, and better quality of life compared to other anticancer drugs. However, gefitinib has to be discontinued for patients in whom adverse events occur, even if it is still effective. Here, we retrospectively assessed the clinical course of patients receiving gefitinib therapy, with a particular focus on liver damage. PATIENTS AND METHODS: Of 24 Asian patients treated with 250 mg gefitinib daily at Kanagawa National Hospital, Japan, between January 2008 and June 2012, grade 3 liver damage (Common Terminology Criteria for Adverse Events, version 4.0) occurred in nine and were eligible for our assessment. The regimen was subsequently changed to alternate-day administration. The relationships between liver damage and each clinical factor were retrospectively examined using Fisher's exact test. RESULTS: Of the nine patients with liver damage, seven had previous exposure to another anticancer drug. There was a significant relationship between the incidence of liver damage and previous chemotherapy (P = 0.009). The objective response rates of patients treated with daily gefitinib 250 mg and alternate-day gefitinib following liver damage were 66.7% and 46.7%, respectively; these were not significantly different (P = 0.597). CONCLUSION: Gefitinib for advanced adenocarcinoma patients who have previously undergone chemotherapy should be used cautiously and liver function monitored closely, because it frequently induces significant liver damage. The alternate-day administration of gefitinib may be a suitable option for patients in whom daily gefitinib therapy induces liver damage.

[Epidemiological study on factors affecting the hospitalization period of patients with active tuberculosis].

OBJECTIVE: We compared the time needed for sputum negative conversion of tubercle bacilli among patients with active tuberculosis to clarify factors affecting the hospitalization period. SUBJECTS AND METHODS: We retrospectively reviewed 1260 patients definitely diagnosed as active tuberculosis between Jan. 1996 and Dec. 2003. Smears were examined by fluorescent staining procedure, and cultures were tested by egg-based Ogawa and Kudo-PD solid media. Sputum smears and cultures were examined at least once a month. All patients received standard chemotherapy including isoniazid (INH), rifampicin (RFP), ethambutol hydrochloride (EB) [or streptomycin sulfate (SM)], and pyrazinamide (PZA). Time needed for sputum conversion was defined as the period from the initiation of chemotherapy to the first documented negative smear and culture. Multivariate analysis was performed to document factors that were independently associated with hospitalization period. RESULTS: Factors correlated with longer conversion time were high amount of bacilli discharge, severe radiographic findings, and drug sensitivity at the initiation of treatment. Patients with bacilli discharge Gaffky 9-10 required 3 months (median) [3.9 months (mean)], and those with culture 3+ required 2 months (median) [2.8 months (mean)] for conversion. Patients with large and widespread cavities, classified as I or II 3 according to the Classification by the Japanese Society for Tuberculosis, required conversion time of 3 months (median) [2.8 months (mean)]. Cases with initial drug resistance to any of the drugs required 2 months (median) [2.2 months (mean)] for conversion. Factors associated with prolongation of hospitalization were the amount of bacilli in sputum at the initiation of chemotherapy, past history of tuberculosis, presence of cavities and size of lesion observed on chest X-ray, drug resistance, and presence of extra-pulmonary lesions. Gender, complication with chronic renal failure, and alcoholism did not affect the hospitalization period. CONCLUSION: Patients with huge amount of bacilli discharge, extensive cavitary lesion, or initial drug resistance required more than 2 months for sputum negative conversion. In these cases, hospitalization period shorter than 2 months is inadequate, even if chemotherapy is initiated. For complete eradication of tuberculosis, we must ensure adequate chemotherapy and hospitalization period to eliminate further sources of infection. Our study shows that hospitalization period should be cautiously determined based on the disappearance of bacilli in sputum.

[A case of pulmonary Mycobacterium scrofulaceum infection presented as pleurisy].

A 68-year-old man was referred to our hospital for further examination of pleurisy. Before this admissions, he was diagnosed as having tuberculous pleurisy initially and later as having pleurisy due to SLE in another hospital. He was administered anti-tuberculous medicine including INH, RFP and EB empirically, and later prednisolone and azathioprine. Despite of these medications, there was no improvement. After admission to our hospital, positive results for acid fast bacilli were obtained from both sputum and pleural fluid, and they were identified as Mycobacterium scrofulaceum. He was treated successfully with the combination of INH, RFP, EB plus SM and CAM. The expectoration of M. scrofulaceum was ceased after 4 months of treatment. The common lesion of non-tuberculous mycobacterium is found in the lung. A non-tuberculous mycobacterium infection might accompany with pleural involvement or pleurisy. Thus in case of pleural diseases, non-tuberculous mycobacterium should also be included among differential diagnosis.

Platelet activation in patients with alcoholic liver disease.

OBJECTIVE: To elucidate the mechanisms of thrombocytopenia in alcoholic liver diseases, we investigated activation status of platelets in patients with alcoholic fatty liver (Al-FL), alcoholic liver cirrhosis (Al-LC) or hepatitis-C liver cirrhosis C (C-LC). METHODS: Platelet activation was evaluated by flow cytometry using monoclonal antibodies against P-selectin (CD62P) and the fibrinogen receptor (PAC-1), both specific for platelet activation, and anti-CD61 antibody for the presence of microparticles (PMP) in seven patients with Al-FL, thirteen patients with Al-LC and, as a non-alcoholic liver disease control, nine patients with C-LC. As a normal control, seventeen healthy subjects without liver dysfunction were also evaluated. RESULTS: Compared with the healthy controls, the platelet count was significantly decreased in patients with alcoholic liver diseases or C-LC. Ten days after discontinuation of alcohol intake, the platelet count was significantly higher in both the Al-FL and Al-LC groups than that measured on admission. There was an inverse correlation between the platelet count and PMP, a marker of platelet activation. The Al-FL, Al-LC and C-LC groups showed significantly higher percentages of platelets positive for CD62P than the healthy controls. The PAC-1 positivity was increased only in the C-LC group. PMP were significantly increased in the Al-FL, Al-LC and C-LC groups compared to that in the healthy group. In the Al-LC group, PMP were significantly decreased 10 days after discontinuation of alcohol intake from that measured on admission. CONCLUSION: Patients with alcoholic liver diseases have increased platelet activation, which may contribute to the occurrence of thrombocytopenia. The formation of PMP might be one of the important factors of thrombocytopenia in alcoholic liver diseases.

Outbreak of tuberculosis in a 2000-year-old Chinese population.

The molecular identification of Mycobacterium tuberculosis DNA in ancient human remains has been achieved mainly in mummies with macroscopic changes but not in the skeletons without bone tuberculosis. Using polymerase chain reaction studies, we identified mycobacterial DNA in 2000-year-old human skeletons without pathological changes. Our findings suggest that these people suffered from an outbreak of tuberculosis. Molecular examinations for mycobacterial DNA in the bone marrow of skeletons may contribute to the clarification of ancient diseases in old human populations.

Platelet activation in patients with chronic hepatitis C.

OBJECTIVE: To elucidate the mechanisms of thrombocytopenia in chronic hepatitis C (CHC), we investigated platelet activation in patients with chronic viral liver diseases. METHODS: Platelet activation was evaluated with flow cytometry in twenty-five patients with chronic viral hepatitis and 11 patients with liver cirrhosis of viral etiology. Liver biopsies were carried out in all patients. RESULTS: The platelet counts decreased significantly in patients with CHC and in patients with liver cirrhosis compared to controls, but not in patients with chronic hepatitis B (CHB). Patients with CHC had a significantly higher percentage of platelets positive for activation-dependent monoclonal antibodies (MoAbs), and also had a higher percentage of platelet microparticles (PMP), a marker of platelet activation, than patients with CHB. There was a significant correlation between the percentage of PMP and the levels of liver fibrosis markers, such as serum hyaluronate and N-terminal propeptide of type III procollagen (P-III-P), in CHC, suggesting the relationship between platelet activation and liver fibrosis. Platelet activation was markedly enhanced in CHC patients with high histological scores of liver fibrosis. CONCLUSION: Patients with CHC have increased platelet activation, which may contribute to the occurrence of thrombocytopenia in CHC. Liver fibrosis may play a role in activation of platelets in CHC.