Surgical treatment for non-tuberculous mycobacterial pulmonary disease: analysis of prognostic factors.

BACKGROUND: The surgical treatment for non-tuberculous mycobacterial pulmonary disease (NTM-PD) has an important adjunctive role and reported outcomes have been generally good; however, the prognostic factors remain unclear.METHODS: Sixty-one patients with NTM-PD who underwent surgical resection for a therapeutic purpose from January 2000 to March 2017 at five affiliated institutions were enrolled. We explored the factors that influence complications and prognosis by retrospectively referring to the medical records.RESULTS: The mean age of the present cohort was 61.8 ± 11.4 years. The pathogen was Mycobacterium avium complex in 49 patients, M. abscessus in 5. The most common indications were refractory to medication in 39. The surgical techniques employed were lobectomy or further resection in 49, sublobar resection in 8, with video-assisted thoracoscopic surgery in 21. Sputum culture conversion rate was 95.1%. Univariate analysis of factors associated with deterioration revealed significant differences related to age (P = 0.025), pre-operative albumin level (P = 0.001) and development of postoperative complications (P = 0.037), while pre-operative albumin level alone was a significant factor in multivariate analysis (P = 0.009).CONCLUSION: Outcomes after resection were generally good in the present cases. Nutritional status, as indicated by albumin level, may affect prognosis after surgical treatment.

Polypoid type of laryngeal sarcoidosis--case report and review of the literature.

A 45-year-old mentally retarded woman was discovered to produce a stridor upon inhalation. Fiberoptic laryngoscopic study revealed a smooth-surfaced, wide, and pedunculated tumor on the right arytenoid and the right aryepiglottic fold. Histopathological study revealed that the tumor was characterized by granulomatous inflammation. The condition was diagnosed as laryngeal sarcoidosis. The tumor was resected surgically. Surgical resection of the tumor and injection of corticosteroid should be performed for polypoid-type laryngeal sarcoidosis. The case is discussed in detail, along with a review of the literature pertaining to sarcoidosis of the larynx.

Diagnosis and physiopathology of laryngeal deposits in autoimmune disease.

We report the clinical features and pathology of a previously unreported form of vocal fold disease seen in 4 patients, 3 of whom were diagnosed as autoimmune disease. The characteristic features of these lesions were found as bilateral transverse lesions in the mid portion of the vocal folds. The patients had dysphonia and diplophonia. Stroboscopic examinations showed 180-degree phase shifts between the anterior and posterior portion of the vocal folds. Case 1 had systemic lupus erythematosus, case 2 had Hashimoto's thyroiditis, and case 3 had progressive systemic sclerosis. Prior to the onset of hoarseness, autoimmune antibody titers were increased. These cases need differential diagnosis from vocal fold nodules and cysts. Two cases were recurrent after endoscopic surgery, 1 recurring 3 times. Glucocorticoid was effective in preventing the recurrence in the early phase. Recurrence may have occurred because the surgical strategy was the same as that used for vocal fold nodules or cysts.

Auditory brainstem responses in leptomeningeal metastatic spread. Presentation of 2 cases.

Auditory brainstem responses (ABRs) were recorded in 2 patients with hearing loss caused by leptomeningeal metastatic spread. These recordings showed similar characteristic findings. The absolute latencies of wave V and interwave latencies I-V were exceedingly increased. Definite effects on the wave morphology and latency of wave V were observed with the use of high repetition rates. It is surmised that the hearing loss caused by leptomeningeal metastatic spread is mainly an effect on the auditory nerve and/or the cochlear nucleus. ABR examination is of clinical value in detecting functional abnormalities resulting from leptomeningeal metastatic spread.

[Surgical approach to the nasal valve stenosis].

Nasal valve, originally defined by Mink (1903), has changed its concept and is now regarded as slit-like opening between the caudal end of the upper lateral cartilage and the septum. Contrary to Caucasians whose smallest area of the nose lies at the nasal valve, the narrowest part of Japanese nose situates at the area between the anterior portion of the inferior turbinate and the septum. Thus, we have fewer chance to experience patients with stenotic nasal valve. Six patients complaining nasal obstruction resulted from nasal valve stenosis, mainly due to dislocated or collapsed upper lateral cartilage, underwent surgery during the last 2 years and a half. Cases of septal deformity, even it it produced valve stenosis, were excluded in this study. Surgical intervention was directed toward reconstruction of normal anatomic relationships, usually by widening the nasal valve angle and preventing collapsibility. Three underwent open rhinoplasty with gull-wing columellar skin incision, whereas 3 others were operated on via transnostril approach. History of midfacial trauma caused us to choose open rhinoplasty for restoring the function and structure. Immediate postoperative result was excellent in the aspect of appearance and subjective data regardless of surgical approach. Open rhinoplasty provided a splendid long-term result without remarkable complications. On the other hand, 2 cases operated via transnostril approach complained recurrence of stuffy nose.

[Blow-out fractures of the orbit--imaging modalities and therapeutic results].

Thirty-four cases of blow-out fracture were evaluated by high-resolution CT, Hess test for red and green color and synoptophore. The results of these tests were compared with the final outcome of the fractures. The fractures were classified on the basis of the location (floor, medial wall or roof), extent (total, partial or linear) and type of fragments (punched-out or trapdoor). The medial wall type included many cases (33%) with no complaint of double vision, and many cases with a combination of disturbances in ocular mobility in both the horizontal and vertical directions. The floor type showed a low incidence of disturbances in ocular movement in the horizontal directions. Regarding the extent of the fracture, all cases with the total type showed disappearance of double vision within three months. Many of the partial and linear types had a poor outcome. With regard to the type of fragments, all of the trapdoor type cases showed a favorable result with disappearance of double vision within three months. Some of the punched-out type cases, however, showed a poor outcome.

[Practical value of LDH-X determination for the detection of sperm traces]. / Zur praktischen Anwendbarkeit der LDH-X-Bestimmung zum Nachweis von Spermaspuren.

The examination of 38 stains collected in sexual offences provided spermatozoa-positive, LDH-X-negative results in 4 samples and spermatozoa-negative, LDH-X-positive results in 6 samples. The results suggest that besides the microscopic detection of spermatozoa the demonstration of LDH-X should be performed in medicolegal identification of seminal stains.

[B-modes ultrasonic diagnosis of the maxillary sinus].

As a routine preoperative evaluation for chronic sinusitis and postoperative maxillary cyst (mucocele and pyocele), CT scans and B-mode ultrasonic diagnosis including three methods, linear, sector, and convex scans, were performed. By chronic sinusitis, 112 sides by linear scans, 43 sides by sector scans, and 29 sides by convex scans were included in the study. By the postoperative cyst, 43 sides by linear scans, 24 sides by sector scans, and 12 sides by convex scans were included. The positive diagnostic finding by ultrasonography is defined as the depicted echo of the posterior wall. In chronic sinusitis, positive diagnostic rates were as follows: linear scans, 73.2%, sector scans, 88.2%, and convex scans, 77.8%. As for the scan planes, horizontal plane yielded more positive than sagittal one. In postoperative cyst similarly, linear, 86.0%, sector, 95.8%, and convex, 83.3%. Horizontal more positive than sagittal also. The negative findings were caused, in chronic sinusitis, by attenuation by the air in the sinus, thick anterior wall, and artifacts. In postoperative cysts, the negative findings were caused by specific location of the cysts (lateral or posterior). Our results recommend the use of sector scan because of its easy manipulation and higher positive diagnostic rates due to the radial beam conforming to the curvature of the posterior wall. Especially, the sector scan was higher diagnostic rate than linear scan, because the sector scan transmitted radial beam, and received its reflective wave easily from a curved posterior wall of the maxillary sinus. The sector scan, its manipulation is easy, and its diagnostic rate is higher than any other scans.

[Types and treatments of blow-out fractures].

A total of ten cases of blow-out fractures of the orbit was investigated as to the signs and symptoms, image findings of conventional views of Caldwell and Waters' and of coronal CT. According to the locations of fractures, medial, floor and medial-floor types were classified. Fractured bone tips were classified to depressive and trapdoor types. Fractures often occur posterior to the eyeball, the inferior rectus muscle showed dislocation and cylinder-like hypertrophy. Contrary to the reports in the past, the inferior rectus muscle did not show entrapment in the herniated portion. Caldwell view is superior to Waters' view in demonstrating fractures at the medial orbital wall. As to the choice of treatment in the majority of cases, conservative methods are indicated. Images by CT are used in determining surgical methods, the depressive type without clinical improvement after two weeks is the indication for the surgical treatments.

[C7 typing of blood stains using isoelectric focusing and immunoblotting]. / C7-Typisierung an Blutspuren mittels Isoelektrofokussierung und Immunoblotting.

By means of isoelectric focusing and immunoblotting C7 types were clearly demonstrated from bloodstains which had been stored at 37 degrees C for up to three weeks, at room temperature for up to six weeks and at 4 degrees C for over ten weeks. The C7 typing is practically useful in medicolegal individualization of unknown bloodstains.

Age-related occurrence of simple renal cysts studied by ultrasonography.

Three hundred forty-eight outpatients without evidence of renal disease were examined by ultrasound. Their ages ranged from 18 to 83 years. Unexpected renal cysts of more than 1 cm were found in 47 patients (13.5%). No cysts were demonstrated in patients less than 23 years old; thereafter the number of patients with cysts increased significantly with age. The cyst diameter also tended to increase with age, but the correlation with age was not significant. There was no statistical difference of cyst occurrence between the right and left kidney, or between males and females. The upper portion of the kidney was most often affected in the equally divided three portions along the long axis. These results confirm that the development of simple renal cysts is age-related.

Absence of a gamma-melanocyte-stimulating hormone sequence in proopiomelanocortin mRNA of chum salmon Oncorhynchus keta.

1. Complete nucleotide sequence of one of the salmon proopiomelanocortin mRNAs (POMC mRNAs) was determined. 2. The region corresponding to gamma-melanocyte-stimulating hormone (gamma-MSH) was lacking in salmon POMC mRNA, although overall organization of the multi-hormone structure was exactly the same as that of mammalian POMC mRNAs. 3. The possible evolutional history of POMC mRNA in mammalian species may be revealed from the finding of this characteristic that salmon POMC mRNA lacks the region corresponding to gamma-MSH.

Primary structure of two mRNAs encoding putative salmon alpha-subunits of pituitary glycoprotein hormone.

1. By random sequence analyses, we isolated from the cDNA library of salmon pituitary glands two clones, the deduced amino acid sequences corresponding to the C-terminal region of which are almost the same as those of the alpha subunits of mammalian glycoprotein hormones. 2. Comparison of the nucleotide sequences and deduced amino acid sequences from these two clones with those of mammalian species revealed that the two newly-isolated cDNAs corresponded to mRNAs encoding the putative salmon pre-alpha subunit of glycoprotein hormones. 3. Homology in the nucleotide sequences of these two clones suggested that corresponding mRNAs may be encoded by separate genes which probably evolved from a common ancestral gene.

Improvement of cytotoxicity of tumor necrosis factor (TNF) by increase in basicity of its N-terminal region.

Two new recombinant TNFs (named rTNF-Scw1 and -Scw2) with higher basicity than conventional recombinant human TNF-alpha (rTNF-alpha) in the N-terminal region were constructed. Their sequences were constructed based on those of partially purified cytotoxic factors from the culture supernatant of acute monocytic leukemia cells THP-1, which unlike rTNF-alpha are cytotoxic to T24 bladder carcinoma cells in vitro. These new rTNF-Ss showed a broader cytotoxicity to tumor cells than rTNF-alpha. This increase in the basicity of the N-terminal region over that of conventional TNF significantly increased the cytotoxicity on tumor cells in vivo as well as in vitro.

Detection of a countertranscript in promyelocytic leukemia cells HL60 during early differentiation by TPA.

We have isolated several cDNA clones corresponding to the mRNAs expressed during early phase of differentiation of promyelocytic leukemia cells HL60 by TPA. Two interrelated clones were examined, one pHH81 and the other pHH58 possessing inserts of 180 and 730 base pairs, respectively. Northern blot analyses of poly(A) RNAs from induced cells revealed that the clone pHH81 hybridized with 4.3kb RNA, while the clone pHH58 hybridized with 4.3kb and, in addition 0.7kb RNA. Sequence determination of those cDNA clones and extensive Northern blot analyses revealed that the inserts of these clones were derived from 4.3kb mRNAs. 0.7kb RNA was hybridized with only 5' upstream region of the clone pHH58, especially with the strand designed to detect anti-sense RNA. Thus we concluded that 0.7kb RNA is a countertranscript of 4.3kb RNA expressed during early differentiation of HL60 cells.

Nucleotide sequence of a cloned cDNA for proopiomelanocortin precursor of chum salmon, Onchorynchus keta.

We have isolated a cDNA clone encoding salmon proopiomelanocortin precursor. Polyadenylated RNA was isolated from pituitary neurointermediate lobes and used to construct a cDNA library. The library was screened with 17 mer of oligodeoxyribonucleotides specific for the hexapeptide sequence in salmon beta-endorphin I, Phe-Met-Lys-Pro-Tyr-Thr at positions 4-9 excluding the third nucleotide. One positive clone, pSSM17 containing an insert of 1303 base pairs (bp) was characterized. Sequence determination revealed that it possessed sequences covering the entire regions encoding ACTH and beta-lipotropin and that the mRNA had the same overall organization as those of other mammalian species, i.e., the following peptide hormones were arranged in order from 5' upstream, ACTH including alpha-melanotropin and corticotropin-like intermediate lobe peptide, beta-lipotropin including gamma-lipotropin, beta-melanotropin and beta-endorphin. Amino acid sequences for putative salmon ACTH, beta-, and gamma-lipotropin were predicted. Comparison of the salmon mRNA sequence with those of mammals showed that the regions of alpha- and beta-MSH are relatively homologous, but other regions are much less so, especially in the 3' nontranslated region where it is much longer and completely heterologous.