A case of Sjögren's syndrome in which diffuse cystic lung lesions led to an accurate diagnosis.

Key Clinical Message: Even in the absence of other symptoms or other pulmonary manifestations suggesting Sjögren's syndrome (SS), it is necessary to include SS in the differential diagnosis of diffuse cystic lung disease (CLD). Abstract: A case of SS that presented initially with diffuse CLD is reported. This case is considered rare because diffuse pulmonary cysts were observed in the early stage with few symptoms, only cysts were observed without other lung lesions on imaging, cyst formation was histologically considered to be alveolar loss, and airway lesions not observed on imaging were suspected based on lung function testing. The details of this case provide extremely important information to consider for the diagnosis and management of CLD and SS.

Peribronchiolar Metaplasia of the Lung Incidentally Detected During a Surgery for Pneumothorax: A Case Report.

BACKGROUND: Peribronchiolar metaplasia (PBM) is a lesion characterized by an abnormal connection between the terminal bronchiole and parabronchiole via the Lambert's canals. We report a rare case of PBM incidentally detected during a surgery for pneumothorax. CASE PRESENTATION: At 38-year-old man was admitted to our hospital with chest pain. He was diagnosed with pneumothorax and treated using a thoracic drain 12 years ago. Chest computed tomography revealed a cyst in the right upper lobe and ground glass lesion with a solid component in the right lower lobe of the lung. Hence, we performed a surgery for pneumothorax management, which revealed a cyst in the right upper lobe and induration with angiogenesis in the right lower lobe. We performed partial resection of the right upper and lower lobes. Pathological examination of the lower lobe nodule revealed small airways with lymphocytic inflammation and bronchiolar metaplasia. Pathological diagnosis of the nodule was PBM. CONCLUSION: Although PBM is considered a lesion with good prognosis, there have been cases associated with early-stage lung cancer. Hence, care should be taken to distinguish PBM from other neoplasms. However, preoperative diagnosis is difficult in most cases so complete surgical resection is recommended, if feasible.

Bronchial Foreign Body Aspiration Due to Polycarbophil Calcium.

Polycarbophil calcium (Polyful®; Mylan, Tokyo, Japan) is a stool stabilizer that absorbs liquid and swells to form a soft, bulky mass. A 75-year-old woman experienced sore throat and difficulty breathing immediately after taking the drug. Chest computed tomography showed a foreign body in the right intermediate bronchus. Bronchoscopy showed a white mass blocking the right intermediate bronchus. Since the mass was very fragile, we performed suctioning while breaking up the mass with a suction tube. The mass consisted of polycarbophil calcium. Since aspirated polycarbophil calcium swells and can obstruct bronchi, complete removal is crucial.

Why parents and children consent to become involved in medical student teaching.

AIM: Clinical experience in paediatrics is essential for medical undergraduates. This is the first study, of which we are aware, to examine why children of different ages admitted acutely to hospital and their parents agree to become involved in medical student teaching. We wanted to establish whether they considered that they needed to give consent before seeing medical students, whether this was routinely sought and what influenced their decisions. METHODS: Data were collected using questionnaires and semi-structured interviews of parents and children. RESULTS: Questionnaires were completed by 105 parents of children less than 6 years old, and 34 children between 10 years and 15 years old and their parents. Interviews were conducted with 32 children between the ages of 6 and 10 years and their parents. Most parents and children consider that they have a responsibility to teaching but must always be asked for consent. They were motivated by altruism, but fear of emotional distress or pain can lead them to refuse. Younger children may not be able to give reasons for not wanting to see a medical student but sometimes have firm views, which must be respected. Having seen a medical student previously did influence children's or parents' opinions. Most children who have seen a medical student were prepared to see students again. CONCLUSION: Medical students can be reassured that parents and children admitted acutely to a children's hospital have a positive attitude to student involvement and are prepared to help them learn clinical skills, but consent must always be obtained and the child's perspective must always be considered.