Successful Treatment of Long-Term Severe Progressive Interstitial Pneumonia with Low-Dose Corticosteroid and Azathioprine in a Patient with Diffuse Systemic Sclerosis

For progressive interstitial pneumonia (progressive IP) that accompanies diffuse systemic sclerosis (diffuse SSc), no treatment guidelines have yet been established, and it is a complication with a poor prognosis. We herein report a case in which combination therapy of a low-dose corticosteroid and low-dose azathioprine was performed for progressive SSc-IP in a 64-year-old female whose respiratory function was severely damaged for a long period of time and for whom improvement was achieved. The beneficial effect has continued for 3 years with no side effects being observed during the course

Effect of shin'iseihaito on lung colonization of pneumococcus in murine model

Background: Streptococcus pneumoniae (pneumococcus) causes various serious diseases including sinusitis, pneumonia, and meningitis. One serious problem observed recently with pneumococcal therapy is attenuation of the antibiotic effect because of the emergence of antibiotic-resistant pneumococcus. Shin’iseihaito, a traditional Japanese medicine based on ancient Chinese medicine, has been used for treatment of otolaryngeal diseases in Japan. The objective of this study was to examine the anti-infectious effects of shin’iseihaito and its related mechanism.Materials and Methods: We evaluated the beneficial effect of shin’iseihaito extract (SSHT) against pneumococcus-infected murine model. The colonization of bacteria, blood and bronchoalveolar lavage (BAL) killing activity, the levels of inflammatory cytokine and IgA were investigated.Results: The pneumococcus from blood was not found in both SSHT-treated mice and untreated mice. However, the pneumococcal colonization of lung was significantly (p<0.05) lower after SSHT administration compared with untreated mice. Blood bactericidal assay showed that no significant difference (p=0.07) was observed in the anti-bacterial effect between SSHT-treated mice and untreated mice. However, BAL bactericidal assay showed that the survival rate of pneumococcus using the BAL from SSHT-treated mice was significantly (p<0.05) lower than that using the BAL from untreated mice. We also found increased levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IgA in pneumococcus-infected mice treated with SSHT.Conclusions: SSHT decreased the colonization rate after pneumococcal infection and up-regulated BAL bactericidal activity through modulation of inflammatory cytokines and IgA. Our data also suggest SSHT may be useful for the treatment of pneumococcal infection.Keywords: shin'iseihito, Streptococcus pneumoniae, murine model, inflammatory cytokine, Ig

MALIGNANT ONCOCYTOMA OF THE PARANASAL SINUS

A case of malignant oncocytoma developing in the paranasal sinus of a 37-year-old Japanese man with a habit of heavy smoking is described. The primary tumor was found in the right maxillary sinus with local invasion to the nose and right ethmoidal sinus ; it was composed of nests of large oncocytic cells, with finely granular and eosinophilic cytoplasm, nuclear pleomorphism and prominent nucleoli, surrounded by proliferation of spindle-shaped cells in some areas. Electron microscopically, the cytoplasm of oncocytic tumor cells was characterized by abundant mitochondria, and immunohistochemical investigation revealed positive binding for antibodies to S-100 protein and α₁-antitrypsin, but a negative reaction for both cytokeratin and vimentin. At autopsy, metastatic nodules of tumor in the lungs, liver and pancreas independently exhibited both oncocytic cell- and sarcomatous cell compartments. This phenomenon is rare, and to the authors' knowledge, this would be histologically an ususual report of malignant oncocytoma with sarcomatous metastatic nodules arising from the paranasal sinus to be described in the literature

EFFECT OF SHIN'ISEIHAITO ON LUNG COLONIZATION OF PNEUMOCOCCUS IN MURINE MODEL

Background: Streptococcus pneumoniae (pneumococcus) causes various serious diseases including sinusitis, pneumonia, and meningitis. One serious problem observed recently with pneumococcal therapy is attenuation of the antibiotic effect because of the emergence of antibiotic-resistant pneumococcus. Shin’iseihaito, a traditional Japanese medicine based on ancient Chinese medicine, has been used for treatment of otolaryngeal diseases in Japan. The objective of this study was to examine the anti-infectious effects of shin’iseihaito and its related mechanism. Materials and Methods: We evaluated the beneficial effect of shin’iseihaito extract (SSHT) against pneumococcus-infected murine model. The colonization of bacteria, blood and bronchoalveolar lavage (BAL) killing activity, the levels of inflammatory cytokine and IgA were investigated. Results: The pneumococcus from blood was not found in both SSHT-treated mice and untreated mice. However, the pneumococcal colonization of lung was significantly (

Effect of Shin’iseihaito (Xinyiqingfeitang) on Acute Streptococcus pneumoniae

Streptococcus pneumoniae (S. pneumoniae) causes sinusitis. The general treatment of S. pneumonia sinusitis is by using antibiotics; however, one of their serious problems is the attenuation of their effect. Shin’iseihaito (Xinyiqingfeitang), a formula of Japanese traditional Kampo medicine, has been used for the treatment of sinusitis in Japan. In this study, we investigated the efficacy of Shin’iseihaito against S. pneumoniae-caused sinusitis in mice. Oral administration of Shin’iseihaito extract (SSHT) decreased the nasal colonization of S. pneumoniae in both prophylactic and therapeutic treatments, respectively, and the former was more effective than the latter. Histopathological analysis revealed that the epithelial tissue from S. pneumoniae-infected nose under SSHT treatment recovered the tissue destruction in comparison to infected nose. We also confirmed this result by scanning electron microscopic analysis. Murine peritoneal macrophages from SSHT-treated mice had significant phagocytic activity in comparison to those from untreated group. We also found that tumor necrosis factor-α, interleukin-1β, interleukin-6, and monocyte chemotactic protein-1 levels and the migration of macrophages from S. pneumoniae-infected mice with the treatment with SSHT were increased compared to those from untreated group. Our data suggest that Shin’iseihaito may be useful for the treatment of S. pneumoniae-induced sinusitis

Repair activity of base and nucleotide excision repair enzymes for guanine lesions induced by nitrosative stress

Nitric oxide (NO) induces deamination of guanine, yielding xanthine and oxanine (Oxa). Furthermore, Oxa reacts with polyamines and DNA binding proteins to form cross-link adducts. Thus, it is of interest how these lesions are processed by DNA repair enzymes in view of the genotoxic mechanism of NO. In the present study, we have examined the repair capacity for Oxa and Oxa–spermine cross-link adducts (Oxa–Sp) of enzymes involved in base excision repair (BER) and nucleotide excision repair (NER) to delineate the repair mechanism of nitrosative damage to guanine. Oligonucleotide substrates containing Oxa and Oxa–Sp were incubated with purified BER and NER enzymes or cell-free extracts (CFEs), and the damage-excising or DNA-incising activity was compared with that for control (physiological) substrates. The Oxa-excising activities of Escherichia coli and human DNA glycosylases and HeLa CFEs were 0.2–9% relative to control substrates, implying poor processing of Oxa by BER. In contrast, DNA containing Oxa–Sp was incised efficiently by UvrABC nuclease and SOS-induced E.coli CFEs, suggesting a role of NER in ameliorating genotoxic effects associated with nitrosative stress. Analyses of the activity of CFEs from NER-proficient and NER-deficient human cells on Oxa–Sp DNA confirmed further the involvement of NER in the repair of nitrosative DNA damage

Repeated Enterocutaneous Fistula in a Munchausen Syndrome Patient

Munchausen syndrome is a rare type of mental disorder in which the patient fakes illness to gain attention and sympathy. Patients may lie about symptoms, make themselves appear sick, or make themselves purposely unwell. We describe a case of repeated enterocutaneous fistula in Munchausen syndrome. A 53-year-old Japanese male was admitted to our hospital for the treatment of a high-flow enterocutaneous fistula. Surgery was performed two times, but the fistula recurred each time. Chopsticks with blood on them were coincidentally detected in the trash in the patient’s room. It was revealed that the enterocutaneous fistula was caused by self-mutilation. A psychiatrist was consulted, and the patient was diagnosed with Munchausen syndrome. The psychiatrist initiated treatment and the patient admitted the self-harm. His prolonged wound site was closed and he was able to be discharged. There has been no recurrence of the self-harm as of this writing, 3 years later. The treatment of Munchausen syndrome is difficult and early detection is important

Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus

Type 1 diabetes is a disease characterized by destruction of pancreatic β-cells, which leads to absolute deficiency of insulin secretion. Depending on the manner of onset and progression, it is classified as fulminant, acute-onset or slowly progressive type 1 diabetes. Here, we propose the diagnostic criteria for acute-onset type 1 diabetes mellitus. Among the patients who develop ketosis or diabetic ketoacidosis within 3 months after the onset of hyperglycemic symptoms and require insulin treatment continuously after the diagnosis of diabetes, those with anti-islet autoantibodies are diagnosed with \u27acute-onset type 1 diabetes mellitus (autoimmune)\u27. In contrast, those whose endogenous insulin secretion is exhausted (fasting serum C-peptide immunoreactivity <0.6 ng/mL) without verifiable anti-islet autoantibodies are diagnosed simply with \u27acute-onset type 1 diabetes mellitus\u27. Patients should be reevaluated after certain periods in case their statuses of anti-islet autoantibodies and/or endogenous insulin secretory capacity are unknown