Postcardiac injury syndrome following vascular interventional radiofrequency ablation for paroxysmal atrial fibrillation.

Postcardiac injury syndrome (PCIS) occurs following a pericardial or myocardial injury. On the other hand, PCIS following cardiac catheter intervention is rare and can be difficult to diagnose because of its delayed onset. A 24-year-old man underwent radiofrequency ablation (RFA) for paroxysmal atrial fibrillation and suffered from general fatigue and left-sided pleural effusion three months after the procedure. His symptoms and effusion were effectively treated within a month by administrating nonsteroidal anti-inflammatory drugs. However, seven months later, he developed left-sided chest pain and low-grade fever. Computed tomography showed a thickening of the parietal pleura and reccurence of the pleural effusion. Pleural biopsy by video-assisted thoracoscopy demonstrated chronic pleuritis with a non-necrotizing granulomatous reaction. Given the previous RFA, and in the absence of infection or malignant disease, he was diagnosed with PCIS and treated with colchicine.

A case report of tuberculous abscess of the chest wall accompanied with pulmonary carcinoma.

With the decreasing incidence of tuberculosis (TB), tuberculous abscess of the chest wall (TACW) is becoming rare. Pulmonary carcinoma coexisting with pulmonary TB has been reported in the past, but reports of pulmonary TB accompanied with TACW are scarce. We present the first case of a 66-year-old male with TACW accompanied with pulmonary carcinoma.

[Positive sputum smear results after two consecutive negative smears during treatment of pulmonary tuberculosis].

OBJECTIVES: During treatment of pulmonary tuberculosis, sputum smear may turn positive after 2 consecutive negative results. In the present study, we analyzed the infectivity in such cases. SUBJECTS AND METHODS: The study involved 201 patients with sputum smear positive pulmonary tuberculosis who were admitted to our hospital between January 2004 and June 2009. Chart review was performed on the bacterial culture results and clinical course of patients in whom the sputum smear test turned to positive after 2 consecutive negative smears. RESULTS: There were 37 such cases (42 events). The event occurred after the treatment of 2 weeks or longer and less than 1 month in 6 cases (7 events). The culture examination of the smear-positive sputum was negative in only 1 of these cases. There were 9 cases who turned smear positive after the treatment period of 1 month or longer and less than 2 months, and 6 of these cases showed negative results in the bacterial culture of the smear positive sputum. In these cases, the grade of smear positivity was generally low and subsequent tests yielded negative results. There were 22 cases (26 events) in which this phenomenon was observed after treatment for 2 months or longer. Subsequent bacterial culture yielded negative results in all but 1 of these cases. DISCUSSION AND CONCLUSION: In patients whose sputum smears gave positive results after 2 consecutive negative smear tests, the bacterial load of the sputum decreased or disappeared after treatment for 1 month or longer, and bacterial discharge was almost completely absent after treatment for 2 months or longer. If the clinical condition is favorable in such cases, we may judge that they are no longer infectious.

[A study of adverse drug reactions in the treatment of pulmonary Mycobacterium avium complex disease].

OBJECTIVES: Adverse drug reactions interfere with the standard treatment of pulmonary Mycobacterium avium complex (MAC) disease; however, few studies have investigated this issue. We studied adverse drug reactions in the treatment of pulmonary MAC disease. SUBJECTS: We retrospectively examined 74 patients who underwent treatment for pulmonary MAC disease in our hospital between January 2001 and December 2009. These patients had received treatment with rifampicin, ethambutol (EB), and clarithromycin. We analyzed the adverse drug reactions seen in these patients. RESULTS: Twenty-two patients developed one or more adverse drug reactions that led to treatment discontinuation or change in medication, whereas 52 patients did not experience any adverse reactions. The incidence rate of adverse reactions was 29.7%. The adverse drug reactions included visual impairment in 9 patients, liver function disorder in 2, skin eruption in 5, and fever in 5. In most of the cases, the standard treatment could not be continued. DISCUSSION: Visual impairment associated with EB was the most common adverse drug reaction, and it led to the discontinuation of EB, and thus the standard treatment. Additionally, in case of other adverse drug reactions, it was difficult to find appropriate replacements for the causative drugs. Further investigations are required to establish a standard policy for the management of adverse drug reactions that can lead to the discontinuation of chemotherapy.

[Nontuberculous pulmonary mycobacteriosis complicated by pleuritis].

Pleuritis is a rare complication associated with nontuberculous mycobacteriosis of the lung and its etiology remains to be clarified. We investigated pleuritis associated with nontuberculous mycobacteriosis of the lung in 304 patients who visited our hospital. Of these, 9 patients (3%) had pleural effusion not attributable to any factor other than pleuritis; these cases were diagnosed as pleuritis. Massive pleural effusion requiring drainage was rare (1 patient, 0.3%) and pleuritis accompanied by pneumothorax was also rare (2 patients, 0.7%). The lung lesions in the patients with pleuritis were often extensive or contained a cavity. All these patients showed infection with Mycobacterium avium complex (MAC). Although it is difficult to diagnose MAC-induced pleuritis, patients with this condition often present with at least 1 of the following signs: the presence of nontuberculous mycobacterium in pleural effusion, a predominance of lymphocytes among the cells detected in pleural effusion, a high adenosine deaminase level, and the disappearance of pleural effusion following treatment. Recognizing these signs may aid the diagnosis of MAC-induced pleuritis.

[A case of quadruple cancer arising in the stomach, lung, liver and prostate].

A 75-year-old man was admitted to our hospital because of severe dyspnea and pollakiuria in October 2001. We diagnosed his illness as carcinomatous pericarditis caused by the recurrence of primary lung cancer and prostatic hypertrophy. He had undergone surgery for gastric cancer in 1986, and for lung cancer in 1996. Furthermore, he had been treated for hepatocellular carcinoma in 1997. He finally died in February 2002 of respiratory failure due to the carcinomatous lymphangitis that followed the lung cancer. After autopsy, a microscopic view of the prostate revealed that he had prostatic carcinoma. Such a case is rare.