[Successful Early Surgical Treatment for Infected Traumatic Pulmonary Pseudocyst].

Almost all traumatic pulmonary pseudocysts (TPP), such as cavitary pulmonary lesions after blunt chest trauma, resolve spontaneously. On the contrary, secondary infection of a TPP should be considered in the presence of purulent sputum or hemosputum and a persistent cavity. We report a case of an infected TPP that was successfully treated by early surgical treatment. A 25-year-old man was transferred to our hospital with a TPP, shown by computed tomography (CT) as having a thick-walled large cavity, after the acute phase of blunt chest trauma. Purulent hemosputum suggested infection of the cavity. Serial CT scans of the chest revealed a persistent cavity. The thick-walled large cavity was diagnosed as a secondary infection of the TPP, that is, a potential lung abscess. We resected the cavity before a systemic inflammatory reaction occurred.

[CLINICAL INVESTIGATION OF 6 CASES OF TUBERCULOUS SPONDYLITIS].

[Objective] A delay in the diagnosis of tubercu- lous spondylitis can result in worsening of the condition. We investigated previously reported cases of tuberculous spondylitis, as well as cases experienced in our hospital, to identify factors that are useful in the diagnosis. [Materials and Methods] We retrospectively evaluated six cases of tuberculous spondylitis diagnosed in our hospital between October 2007 and September 2012, and an additional 23 cases that had been reported in Japan between 1994 and 2014. [Results] The median age of our six patients was 78.5 years and five were women. In all cases, the focal lesion was seen in 2-3 adjacent vertebrae; four patients had miliary tuberculosis and five had lower back pain. All patients received oral treatment for 10-12 months. Among the 23 patients previously reported, 57% were women, and a focal lesion was found in 2-3 adjacent vertebrae in 86%. In addition, 57% had miliary tuberculosis and 65% had lower back pain. A personal and family history of tuberculosis was found in 20% and 26%. [Discussion] Radiographic assessment and microbiological testing of areas other than the chest and spine are useful in the diagnosis of tuberculous spondylitis. Furthermore, lower back pain, lower extremity symptoms, and personal and family history of tuberculosis are important factors. [Conclusion] When tuberculous spondylitis is suspected, diagnosis may be possible by investigating focal lesions in areas other than the spine.

Cytokine profiles, signalling pathways and effects of fluticasone propionate in respiratory syncytial virus-infected human foetal lung fibroblasts.

To examine cytokine production in response to RSV infection, we assessed the levels of 29 cytokines released from RSV-infected human foetal lung fibroblasts. We also examined the relationships between the effects of fluticasone propionate and various signalling pathways in the cells. Twenty-four hours after infection (1MOI), RSV-infected cells released cytokines, for example proinflammatory cytokines (IL-1ß, IL-6 and TNF-α), anti-inflammatory (IL-1ra), Th1 (IFN-γ, IFN-λ1a, IL-2 and IL-12), Th2 (IL-4, IL-5, IL-10 and IL-13), granulopoiesis-inducing (G-CSF and GM-CSF), eosinophil recruitment-inducing (eotaxin and RANTES) and neutrophil recruitment-inducing cytokines (IL-8, IP-10, MCP-1 and MIP-1α). Aberrant release of most was significantly suppressed by fluticasone propionate. Twelve hours after RSV infection, increased phosphorylation of Akt, p38 MAPK, ERK1/2 and IκB-α was noted. Fluticasone propionate suppressed the phosphorylation of Akt, p38 MAPK, and ERK1/2, but not IκB-α, in virus-infected cells. TLR-4 expression was unchanged in control and RSV-infected cells, and TLR-3 and RIG-I expression was not detected. The results indicate that RSV infection induces aberrant production and release of certain cytokines through these signalling pathways in human lung fibroblasts. Overproduction and imbalance of these cytokines may be associated with the pathophysiology of RSV-induced excessive and allergic inflammation.

Diffusion-weighted magnetic resonance imaging in differentiating the invasiveness of small lung adenocarcinoma.

BACKGROUND: Magnetic resonance imaging (MRI) with several sequences may provide a valuable additional modality for evaluating the grade of invasiveness lesions. Diffusion-weighted magnetic resonance imaging (DWI) represents the biological characteristics of tissues. PURPOSE: To retrospectively evaluate the usefulness of DWI for evaluating the invasiveness of small lung adenocarcinomas. MATERIAL AND METHODS: From May 2005 to June 2008, 46 patients with lung adenocarcinomas measuring 2 cm or less across the greatest dimension underwent a preoperative MRI study followed by surgery at the Gunma Prefectural Cancer Center. Fourteen of the tumors were bronchioloalveolar carcinomas (so-called Noguchi's type A+B group), 26 were adenocarcinomas with mixed subtypes (type C group) and six were other histological subtypes of adenocarcinomas (type D+E+F group). The mean signal intensities of a lesion (DWI) and the spinal cord (SC) were analyzed in the region of interests (ROIs), and the mean DWI/SC ratio was then calculated with the value of DWI divided by the value of SC. RESULTS: The calculated mean DWI/SC ratio for the lesions were as follows: 0.448±0.261 (mean±standard deviation [SD]) for type A+B group, 0.963±0.465 for type C group, and 0.816±0.291 for type D+E+F group. The mean DWI/SC ratio of type A+B group was significantly lower than that for the type C (P = 0.0005) or type D+E+F groups (P = 0.0117). CONCLUSION: DWI may thus provide useful supplementary information before determining the surgical strategy, including a limited resection.

[Video-assisted thoracic surgery for pulmonary metastasis of colorectal cancer].

The effect of surgical procedures for survival of cases with pulmonary metastasis from colorectal cancer was examined retrospectively. In the literature, some factors such as timing of surgery, numbers of metastases, site of laterality, lesion in lymph nodes, extra-pulmonary metastases and serum CEA level have been considered to exert influence on surgical treatment for pulmonary metastasis of colorectal cancer. On the other hand, no significant differences have been in the literature and our hospital found between open thoracotomy and thoracoscopic surgery, lobectomy and limited resection, and with and without lymph node dissection. Therefore, less invasive and limited resection using thoracoscopy should be attempted in surgical treatment of pulmonary metastasis of colorectal cancer.

Magnetic resonance imaging in peripheral lung adenocarcinoma: correlation with histopathologic features.

OBJECTIVE: Magnetic resonance imaging (MRI) with various technologic advancements has generally been used to elevate the accuracy of diagnosis for several malignant tumors. This study retrospectively evaluated the efficacy of newer MRI techniques for differentiating among the different types of invasiveness in lung adenocarcinoma by comparing the MRI findings with the pathologic findings. MATERIALS AND METHODS: From May 2005 to April 2007, 46 patients with lung adenocarcinoma measuring 3 cm or less across the greatest dimension underwent a surgical operation including preoperative MRI study in this hospital. The MR imaging protocol included 3 pulse sequences: (1) respiratory-triggered T2-weighted short TI inversion recovery; (2) respiratory-triggered high b-value diffusion-weighted imaging (DWI); (3) gadolinium-enhanced dynamic MRI studies. RESULTS: Of all the tumors, 13 were bronchioloalveolar carcinoma (BAC), 24 were adenocarcinomas with mixed subtypes (advanced BAC), and 9 were other histologic subtypes (non-BAC). Both the moderate and strong signal intensity on DWI was significantly greater in the advanced BAC (79.2%) and the non-BAC (88.9%) than in the BAC (38.5%). In the dynamic study, a strong enhancement on the time-intensity curve was significantly greater in the advanced BAC (95.2%) and the non-BAC (87.5%) than in the BAC (25%). When the lesions demonstrated a strong enhancement in dynamic study or showed strong signal intensity on DWI, they were judged to be positive. Sensitivity, specificity, and accuracy were 97%, 76.9%, and 91.3%, respectively. CONCLUSIONS: DWI could therefore be a useful diagnostic modality for differentiating the subtypes of lung adenocarcinomas, and the MRI finding may thus provide useful supplementary information before surgery comprising limited resections.

Differential diagnosis of primary versus metastatic pulmonary adenocarcinomas using gene mutation analyses: a case report.

A 61-year-old Japanese woman underwent a partial mastectomy for cancer of the right breast (pT1cN0M0, stage I). Eight months later, chest computed tomography revealed two small nodules in the left lower lobe (Segmentum basale laterale and Segmentum basale posterius; S9 and S10). She thereafter underwent partial pulmonary resections for both diagnostic and treatment purposes. The nodule of S10 was pathologically diagnosed to be primary lung cancer. The nodule of S9 was pathologically diagnosed to be poorly differentiated adenocarcinoma. The same pattern of the distribution of the p53 mutation was observed in the DNA samples of the S9 nodule and the treated breast cancer. We therefore finally diagnosed the S9 nodule to be metastatic pulmonary carcinoma. A mutation analysis of the p53 gene is thus considered to be a good modality for differentiating metastases from primary carcinomas of the lung.

Mucinous adenocarcinoma of the thymus: a case report.

A mucinous adenocarcinoma of the thymus is rare, and there is presently limited information on the clinical aspects of this uncommon type of tumor. Only six cases have been reported in the literature. A 49-year-old Japanese male presented with an anterior mediastinal mass, and underwent a tumor resection. Histologically the tumor consisted of a mucinous adenocarcinoma with pleural dissemination. Postoperative radiotherapy and chemotherapy were performed. The patient is still alive with pleural dissemination 11 months after surgery.