Pulmonary tuberculosis with hypercalcemia

An 80-year-old man was referred to our hospital for further examination of fever, cough and left pleural effusion. The laboratory findings showed acute inflammation, and the elevation of albumin-corrected serum calcium and 1,25-dihydroxyvitamin D3. A chest CT revealed centrilobular particulate opacity in the bilateral lung fields and left pleural effusion, indicating acute hypercalcemia and hypervitaminosis D associated with pulmonary tuberculosis. By the confirmation of Mycobacterium tuberculosis on polymerase chain reaction and cultures of the sputum and pleural effusion, a diagnosis of pulmonary tuberculosis was made. The patient successfully completed a 9-month course of the anti-tuberculosis treatment, and bilateral infiltrative shadows and left pleural effusion in chest X-ray disappeared. Symptoms progressively improved and serum level of albumin-corrected calcium and 1,25-dihydroxyvitamin D3 eventually normalized. While pulmonary tuberculosis is an infrequent cause of hypercalcemia, it should be considered in patients with hypercalcemia and elevated serum level of 1,25-dihydroxyvitamin D3

Urban Streetscape Changes in Portland, Oregon: A Longitudinal Virtual Audit

Streetscape imagery has considerable potential for observing urban change. The literature lacks sufficient longitudinal studies, however, on urban change considering human perception and activities. We conducted a longitudinal virtual audit to observe the change in urban liveliness, human activities, and built environment by examining streetscape imagery taken in the late 2000s and the late 2010s in Portland, Oregon. Eleven untrained crowd workers were recruited to provide liveliness ratings of 24,242 streetscape images for both periods. Tabulation, mapping, and multilevel regression analyses were conducted to observe the distribution, changes in liveliness, and the factors affecting these changes. The results confirmed that the city had become livelier during the ten-year study period, which was spatially associated with the increase in pedestrians and cyclists and particular elements of the built environment, such as mid- and high-rise buildings and sidewalk signs. Although these results were somewhat expected, this study’s value lies in confirming the potential of virtual audits conducted using Google Street View Time Machine for retrospectively examining subjective and objective urban change. Caution should be exercised, though, while interpreting urban change as temporal conditions (e.g., season, weather, and irregular events) can potentially bias the results in longitudinal studies

A thymoma dramatically responded to PSL

A 76-year-old woman with a history of angina pectoris, hypertension and dyslipidemia was pointed out an abnormal opacity in the right hilar region on routine chest X-ray. Chest computed tomography showed masses in the anterior mediastinum with the invasion of the adjacent ascending aorta, right brachiocephalic vein and right pleura. Histologic examination led to a diagnosis of Masaoka stage IVa thymoma. Three courses of chemotherapy were given, but further tumor progression was seen. Thereafter, the patient was followed without aggressive treatments. One year after the initial diagnosis, she presented with dyspnea and right chest pain. Chest CT revealed right massive pleural effusion with pleural dissemination and much further progression of existing tumors. For the purpose of symptom palliation, a low dose (5 mg / day) of prednisolone was commenced, which unexpectedly led to marked alleviation of patient’s symptoms and dramatic decrease of pleural effusion. To the best of our knowledge, this is the first report of an invasive thymoma responded to low-dose corticosteroid. The present case suggests that corticosteroids, even at low doses, might be potentially effective for invasive thymoma after failure of surgery, chemotherapy and radiotherapy

Utility of FeNO for diagnosing cough

Cough is one of the most common symptoms seen in clinical practice, however the differential diagnosis is often difficult. The utility of fractional exhaled nitric oxide (FeNO) measurement in the differential diagnosis of the etiology of cough has been reported. NIOX VERO® (NOV) is a new hand-held device that will replace NIOX MINO®, but its diagnostic utility has not been fully elucidated in clinical practice. In this study, the performance of NOV for FeNO measurements was determined. We retrospectively analyzed 243 consecutive patients complaining cough. Among 243 patients, final diagnosis was cough variant asthma (CVA) in 74 (30.5%), bronchial asthma (BA) in 48 (19.8%), post-infectious cough (PIC) in 52 (21.4%), atopic chough (AC) in 24 (9.9%), gastroesophageal reflux disease (GERD) in 10 (4.1%), and Others in 35 (14.4%). FeNO values were significantly higher in CVA and BA as compared to PIC, AC, GERD, and Others. In the multivariate analysis, only FeNO value was identified as independent factors to discriminate CVA and non-CVA other than BA. These findings indicated that FeNO measured by using NOV could be used as a diagnostic marker of intractable cough, especially for the differential diagnosis of CVA from non-CVA

トクシマ ダイガク ビョウイン ガイライ カガク リョウホウシツ ニオケル チーム イリョウ ト カンゴシ ノ ヤクワリ

Recently, cancer chemotherapy in outpatient chemotherapy unit has been progressively promoted, which is affected by improvement of supportive therapy, shortening of hospital stay, induction of comprehensive medicine, and political necessity. Whereas chemotherapy in outpatient chemotherapy unit has expected benefit to advance the quality of life, cancer patients sometimes feel some anxiety about their daily life and adverse events induced by anticancer agents. Moreover, in the setting of out patient clinic, the delay of adequate response against adverse events might be a serious problem. For the safety administration of anticancer agents and the enhancement of patient satisfaction in outpatient chemotherapy unit, multidisciplinary team approach should be essential. In this chapter, we outline the role of multidisciplinary team including nursing staffs in the outpatient chemotherapy unit in Tokushima University Hospital

Diagnostic utility of FeNO for CTVA

A 50-year-old woman was referred to our hospital for further examination of severe constricting pain at the right-side dominant anterior chest. She had medical history of outgrown childhood asthma and allergies to several animals. Chest auscultation revealed no wheezes, rhonchi and other crackles. Laboratory findings showed an eosinophilia and an elevation of total immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled nitric oxide value remarkably elevated, but the abnormalities in pulmonary function test were modest. Her chest pain was ameliorated after inhaling procaterol. Based on these findings, a diagnosis of chest tightness variant asthma was formulated, and we started treatment with inhaled corticosteroid / long acting β2 agonist. At two-weeks after treatment, her symptom markedly improved and a fractional exhaled nitric oxide value decreased, which led to a definitive diagnosis of chest tightness variant asthma. A fractional exhaled nitric oxide value further decreased to the normal range in consistent with symptom disappearance at 10-months after treatment, indicating the usefulness of fractional exhaled nitric oxide as a promising marker for the diagnosis and clinical improvement of chest tightness variant asthma

Production of interleukin-10 by alveolar macrophages from lung cancer patients

AbstractInterleukin (IL)-10 is known to be an autoregulatory factor of functions of monocyte macrophages. The purpose of this study was to determine whether IL-10 production by alveolar macrophages (AMs) is altered in patients with lung cancer. AMs were obtained by bronchoalveolar lavage from 25 patients with lung cancer and 14 control patients. The production of IL-10 by AMs was quantitated by enzyme immunoassay with or without stimulation with lipopolysaccharide (LPS). No significant difference in spontaneous and LPS-stimulated IL-10 production by AMs was observed between lung cancer patients and control patients (mean ± sem; 288·0 ± 56·7 vs. 249·6 ± 58·4 pg ml−1). IL-10 production of LPS-stimulated AMs was not impaired even in lung cancer patients with systemic metastasis. IL-4 failed to suppress LPS-induced production of IL-10 by AMs both in control patients and in lung cancer patients. In eight patients with lung cancer, IL-10 production by AMs was estimated before and after systemic chemotherapy and IL-10 production by LPS-stimulated AMs tended to increase after systemic chemotherapy from 152·3 ± 51·9 to 278·0 ± 112·8 pg ml−1. As IL-10 is a potent inhibitor of tumour angiogenesis, an important process of tumour progression, these results suggest that, even in advanced cancer patients, macrophages can produce potent angiogenesis inhibitor and systemic chemotherapy may augment this inhibitory activity in the lung

Neighborhood food environment and body mass index among Japanese older adults: results from the Aichi Gerontological Evaluation Study (AGES)

<p>Abstract</p> <p>Background</p> <p>The majority of studies of the local food environment in relation to obesity risk have been conducted in the US, UK, and Australia. The evidence remains limited to western societies. The aim of this paper is to examine the association of local food environment to body mass index (BMI) in a study of older Japanese individuals.</p> <p>Methods</p> <p>The analysis was based on 12,595 respondents from cross-sectional data of the Aichi Gerontological Evaluation Study (AGES), conducted in 2006 and 2007. Using Geographic Information Systems (GIS), we mapped respondents' access to supermarkets, convenience stores, and fast food outlets, based on a street network (both the distance to the nearest stores and the number of stores within 500 m of the respondents' home). Multiple linear regression and logistic regression analyses were performed to examine the association between food environment and BMI.</p> <p>Results</p> <p>In contrast to previous reports, we found that better access to supermarkets was related to higher BMI. Better access to fast food outlets or convenience stores was also associated with higher BMI, but only among those living alone. The logistic regression analysis, using categorized BMI, showed that the access to supermarkets was only related to being overweight or obese, but not related to being underweight.</p> <p>Conclusions</p> <p>Our findings provide mixed support for the types of food environment measures previously used in western settings. Importantly, our results suggest the need to develop culture-specific approaches to characterizing neighborhood contexts when hypotheses are extrapolated across national borders.</p