Clinical significance of posterior expansion of the utricular endolymphatic space.

BACKGROUND: Posterior expansion of the utricular endolymphatic space (ES) is a finding occasionally observed, and often occurs in bilateral ears. The clinical significance of posterior expansion of the utricular ES is not clear. OBJECTIVES: To investigate the clinical significance of posterior expansion of the utricular ES detected on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Among 957 patients who underwent contrast-enhanced MRI to investigate the presence of endolymphatic hydrops (EH), clinical findings in cases with posterior expansion of the utricular ES were evaluated and the significance of their existence is considered. RESULTS: Posterior expansion of the utricular ES was detected in 30 ears from 20 cases (7 males, 13 females; mean age 48.7 years). The ears with posterior expansion had a significantly lower incidence of vestibular EH than those without, and this tendency was more prominent in cases in bilateral ears. Some cases with posterior expansion had vestibular symptoms and were diagnosed with Ménière's disease, although EH was not detected in their vestibules. CONCLUSION AND SIGNIFICANCE: Posterior expansion of the utricular ES was associated with Ménière's disease without vestibular EH. Posterior expansion of the utricular ES might not be associated with the formation of EH but may occur independently.

Peritonsillar abscess caused by Mycoplasma hominis and Fusobacterium necrophorum following oral sex.

Mycoplasma hominis is a bacterium that colonizes the genital tract of some females and males, as well as their respiratory tracts. Although only two cases of deep neck infection have been reported, the associations between the onset and sexual intercourse have not been reported. A healthy 19-year-old female was diagnosed with a left peritonsillar abscess. The patient had sexual intercourse with a new partner, including oral sex, two days prior to symptom onset. It was not known whether the male partner had urethritis symptoms. M. hominis and Fusobacterium necrophorum were isolated from the abscess culture. The patient's condition improved after drainage, and sulbactam ampicillin was switched to oral clindamycin.

A case of welder's pneumoconiosis treated with corticosteroid followed by nintedanib.

A 32-year-old man who had worked as a welder for 13 years was hospitalized for a fever and hemosputum with dyspnea. He was diagnosed with welding fume-associated lung disease with alveolar hemorrhaging and acute respiratory failure. Despite surviving the acute phase with corticosteroid therapy, hypoxemia persisted after a month and a half, requiring home oxygen therapy. As a result of the introduction of nintedanib, his clinical findings gradually improved, and the patient was weaned from oxygen therapy after six months. Inhalation of a large amount of welding fumes in a short period can cause alveolar hemorrhaging and prolonged pulmonary dysfunction.

Macrolide antibiotics induce apoptosis of human peripheral lymphocytes in vitro.

We previously reported that long-term administration of macrolides (MCL) reduced the number of lymphocytes in bronchoalveolar lavage fluid (BALF) of patients with chronic lower respiratory tract disease. To investigate the anti-inflammatory activity of macrolides, we evaluated their effect on apoptosis of lymphocytes isolated from human peripheral blood. Lymphocytes treated with clarithromycin, azithromycin and josamycin at a final concentration of 200 microg/ml showed positive staining for Annexin V, Fas and Fas ligand using flow cytometry with time at 12-72 h, while other antibiotics did not. Our results suggest that macrolides induce apoptosis of lymphocytes through Fas-Fas ligand pathway and could potentially reduce the number of lymphocytes in the lungs of patients with chronic lower respiratory tract disease.

Soluble form of Fas and Fas ligand in serum and bronchoalveolar lavage fluid of individuals infected with human T-lymphotropic virus type 1.

Human T-lymphotropic virus type 1 (HTLV-1) carriers are known to develop pulmonary complications characterized by T-lymphocytic alveolitis. The aim of this study was to determine the profile and role of soluble Fas (sFas) and sFas ligand (sFasL) in the lung of asymptomatic HTLV-1 carriers. We measured sFas and sFasL levels in serum and bronchoalveolar lavage fluid (BALF) of 16 seropositive asymptomatic HTLV-1 carriers and 32 healthy subjects. The serum levels of both sFas and sFasL were significantly higher in HTLV-1 carriers than in the control. In BALF, the percentage of lymphocytes and CD4 positive T-cells, and the levels of sFasL were also significantly higher in asymptomatic carriers than the control, but there were no significant differences in sFas levels between the two groups. There was a significant correlation between BALF sFasL levels and serum sFasL levels and percentage of CD4 positive T-cells in BALF. Our results suggest that the increased levels of sFasL in the lung of asymptomatic HTLV-1 carriers are associated with accumulation of CD4 positive T-cells, and that resistance to apoptosis in HTLV-1 infected T-cells and overproduction of sFasL could contribute to T-lymphocytic alveolitis by down-regulating Fas-FasL mediated apoptosis.

[A case of pulmonary sarcoidosis with cavitation].

A 37-year-old woman, who had first been given a diagnosis of sarcoidosis at 23 years of age, was admitted to our hospital after her condition deteriorated. Chest radiographs and CT scan films showed multiple cavitary lesions with thick walls, diffuse granular shadows and bilateral hilar and mediastinal lymphadenopathy. Skin lesions were also observed. In the bronchoalveolar lavage fluid, no pyogenic bacteria, fungi, acid-fast bacilli or malignant cells were detected. A CT-guided transcutaneus lung biopsy specimen revealed a sarcoid granuloma, and we concluded that the cavitary lesions were due to sarcoidosis. After treatment with prednisolone (30 mg/day), the multiple cavitary lesions, diffuse granular shadows and skin lesions showed obvious improvement.

Increased expression of collagen-binding heat shock protein 47 in murine bleomycin-induced pneumopathy.

The 47-kDa heat shock protein 47 (HSP47) is a collagen-specific molecular chaperone that has been shown to play a major role during the processing and/or secretion of procollagen. Expression of HSP47 has been reported to increase in parallel with expression of collagens during the progression of various fibrosis models. The aim of the present study was to investigate the association between HSP47 expression and collagen accumulation in bleomycin (BLM)-induced murine fibrosis. We investigated the expression of HSP47 protein and mRNA using immunohistochemical analysis and semi-quantitative RT-PCR in murine BLM-induced pulmonary fibrosis. Immunohistochemical analysis showed that higher expression of HSP47 protein was present in BLM-induced pulmonary fibrosis compared with controls. HSP47 was localized predominantly in alpha-smooth muscle actin-positive myofibroblasts, F4/80 negative, surfactant protein-A-positive type II pneumocytes, and F4/80-positive macrophages. RT-PCR also demonstrated an increase of HSP47 mRNA expression in BLM-treated lungs. Moreover, the relative amounts of HSP47 mRNA correlated significantly with the lung hydroxyproline content as an indicator of pulmonary fibrosis in BLM-treated lungs (r = 0.406, P <0.05). Our results suggest that these cells may play a role in the fibrotic process of BLM-treated lungs through upregulation of HSP47.

[Two cases of Legionella pneumophila pneumonia improved by parenteral ciprofloxacin administration].

We report here two cases of Legionella pneumophila pneumonia that were markedly improved by parenteral ciprofloxacin administration. A 69-year-old man who had previously visited a hot spring was admitted to our hospital with severe pneumonia and a 48-year-old man with dilated cardiomyopathy as an underlying disease was also hospitalized because of heart failure and pneumonia. In both cases a urinary antigen test for L. pneumophila was negative at the incipient stage, and the initial treatment with a beta-lactam agent was ineffective. However, the high titer of L. pneumophila serogroup 6 antigen in the serum at the convalescent stage revealed that these two pneumonia cases were caused by L. pneumophila, and the following intravenous administration of ciprofloxacin was highly effective. We concluded that intravenous treatment with ciprofloxacin could be effective against L. pneumophila pneumonia, which is sometimes hard to diagnose in the acute phase.

Giant cell interstitial pneumonia in a 15-year-old boy.

Giant cell interstitial pneumonia (GIP) is a very uncommon respiratory disease. We report a juvenile patient with GIP aged 15 years. Although he has a negative past history of direct exposure to hard metals, we could not exclude possible exposure in very small amounts through his parents. Microscopic examination of lung biopsy specimen obtained by video-assisted thoracoscopy revealed marked cellular interstitial infiltrates and prominent intraalveolar macrophages as well as giant cells showing cellular cannibalism. Analysis of the biopsied lung tissue for cobalt and tungsten was negative. Clinical symptoms, laboratory, and radiological findings improved markedly after treatment with corticosteroids. To our knowledge, only eleven cases of GIP have been reported in Japan. Although possible exposure to hard metals was identified in 9 of the 11 reported cases, there is no clear dose-dependent relationship with onset and prognosis. The average age at onset was 46.2+/-15.0 years. Our patient is the youngest case of GIP reported in the world.

[Comparison of bronchoalveolar lavage fluids from nonspecific interstitial pneumonia and from ordinary interstitial pneumonia].

We studied cell findings in the bronchoalveolar lavage fluid (BALF) of 13 patients with nonspecific interstitial pneumonia (NSIP) and 20 with ordinary interstitial pneumonia (UIP). NSIP and UIP were difficult to distinguish by high-resolution CT. Surgical lung biopsies were performed in all patients. We divided the patients with NSIP and UIP into 4 groups, a group of idiopathic NSIP (idiopathic NSIP), a group of NSIP patients associated with collagen vascular disease (CVD NSIP), a group of idiopathic UIP patients (idiopathic UIP) and a group of UIP patients associated with collagen vascular disease (CVD UIP). We then examined the differences in BALF cell findings between these groups. The percentage of lymphocytes in BALF was higher in idiopathic NSIP and CVD NSIP than in the healthy control. The percentage of alveolar macrophages was lower and the percentage of lymphocytes was higher in CVD NSIP than in idiopathic UIP. The CD4/CD8 ratio in BALF of idiopathic NSIP was lower than with idiopathic UIP. It is important that NSIP be distinguished from UIP clinically, and our results suggest that BALF cell findings may be useful for making this distinction.

[Assessing the efficacy of antimicrobial agents based on the Japanese Respiratory Society Guidelines for a community-acquired pneumonia].

We evaluated the efficacy of antimicrobial agents used for patients with community-acquired pneumonia (CAP) based on the guidelines of Japanese Respiratory Society. A total of ninety-nine hospitalized patients who were suspected to have bacterial pneumonia at the time of admission between January, 1998 and December, 2000 were assessed. Our conclusions were as follows. 1) The rate which was considered as effective by the guidelines were 83.3% (5 of 6 cases), 98.7% (74 of 75 cases), 85.7% (12 of 14 cases), and 100% (4 of 4 cases) for penicillin, cephem, carbapenem and tetracycline, respectively. 2) These guidelines were useful and practical for identifying the etiological organisms, determining the severity of pneumonia and evaluating the efficacy of chemotherapeutic agents in CAP. 3) Gram-positive organisms were isolated more frequently among the "mild" group. The number of isolated gram-negative was increased significantly as the severity of pneumonia progressed from "mild" to "severe" group. 4) Factors such as body temperature and white cells count were not always applicable for evaluating the clinical effect in elderly cases. 5) Risk factors such as underlying diseases, or complications, age (over eighty years old) and specific etiological organisms might influence the ineffectiveness of antimicrobial agents among the cases that had no clinical response. 6) The choice of antibiotic agents for the treatment of CAP should be made with consideration to the local-specific profiles of each medical facility as described in the guidelines.

High concentrations of soluble Fas ligand in bronchoalveolar lavage fluid of patients with pulmonary sarcoidosis.

BACKGROUND AND OBJECTIVES: Sarcoidosis is a systematic granulomatous disorder of unknown origin characterized by accumulation of T lymphocytes and macrophages in multiple organs. We postulated that apoptosis through the Fas/Fas ligand (L) system may be associated with regulation of immune reactions characterized by the formation of noncaseous necrotizing granulomas. Soluble (s) FasL is not equivalent to membrane-associated FasL since conversion of membrane-bound FasL to the soluble form is associated with downregulation of cytotoxicity. To examine the involvement of sFasL in lung inflammation, we compared the levels of sFasL in bronchoalveolar lavage (BAL) fluid and serum of patients with pulmonary sarcoidosis to those of healthy subjects. METHODS: sFasL was measured in BAL fluid and in serum of 15 patients with active pulmonary sarcoidosis by sandwich ELISA. RESULTS: High concentrations of sFasL were detected in BAL fluid and serum of patients with sarcoidosis but not in normal subjects. There was a significant correlation between the percentage of lymphocytes and sFasL concentrations in BAL fluid (r = 0.585, p < 0.05). CONCLUSIONS: Our results suggest that sFasL may be upregulated locally in the lung during the inflammatory process of active pulmonary sarcoidosis.

[Desquamative interstitial pneumonia--case report and review of literature].

A 50-year-old man was admitted to our hospital because diffuse reticulonodular shadows in the bilateral lung fields had deteriorated on chest radiographs during a regular checkup. The bronchoalveolar lavage (BAL) fluid revealed an increase in the total number of cells, including slightly elevated levels of eosinophils and neutrophils. The thoracoscopic lung biopsy specimens showed findings compatible with desquamative interstitial pneumonia (DIP). Corticosteroid therapy was done, and improvement of chest CT findings and pulmonary function were seen. We reviewed the clinical features in seventeen patients with biopsy-proven DIP reported in Japan. All patients have good prognoses and a high frequency of steroid responsiveness. Moreover, many patients were positive for antinuclear antibodies in serological tests, and there was a tendency toward increasing eosinophils in BAL fluids.

[A case of endobronchial sarcoidosis presenting as a polypoid lesion].

A 51-year-old woman was admitted to our hospital because of deterioration of abnormal chest shadows. Though the shadows had been pointed out at another hospital about two years before, no evaluation had been made at that time. A chest CT scan showed multiple small nodular shadows and thickening of the bronchovascular bundles bilaterally, and marked swollen lymph nodes in the axilla, mediastinum, and bilateral the hili of both lungs. Bronchoscopic evaluation revealed bronchial mucosal hypervascularity and a polypoid lesion at the orifice of the right B8b. The transbronchial biopsy specimen of the polypoid lesion showed non-caseating epithelioid cell granulomas in the bronchial mucosa. The bronchoalveolar lavage revealed a increase in the total number of cells including high levels of lymphocytes. Therefore, a diagnosis of sarcoidosis was made. This is a very rare case of endobronchial sarcoidosis. However, biopsy specimens of normal mucosa in sarcoidosis often show a microscopic sarcoid process, so a diagnosis of endobronchial sarcoidosis in this case should be given prudently.