Interstitial Lung Disease during Trimethoprim/Sulfamethoxazole Administration

We studied clinical and radiographic features of interstitial lung disease (ILD) during trimethoprim/sulfamethoxazole (TMP/SMX) administration. Ten patients who had received prednisolone treatment for underlying diffuse pulmonary disease showed various ILDs after introduction of TMP/SMX. The radiographic features of the ILDs were not consistent with infectious disease or exacerbation of the underlying disease, and these diagnoses were excluded radiographically and on clinical grounds during the differential diagnosis of the ILDs. These ILDs emerged relatively early after introduction of TMP/SMX, which is consistent with the former case report of drug-induced ILD (DI-ILD) caused by TMP/SMX. Therefore DI-ILDs caused by TMP/SMX were suspected in these cases. In most of these cases, the ILDs were clinically mild and disappeared immediately although administration of TMP/SMX was continued

A Case of Mediastinal Lymph Node Carcinoma of Unknown Primary Site Treated with Docetaxel and Cisplatin with Concurrent Thoracic Radiation Therapy

Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5×8.2cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset

Three cases of endoscopic treatment for bronchial obstruction using a balloon catheter.

背景．バルーンカテーテルの使用により，容易に摘出ができた気道閉塞の３例を経験したので報告する。症例１．80歳女性。呼吸困難で受診，胸部computed tomography（CT）で左主気管支内の高濃度領域と左無気肺を認めた。気管支鏡検査で左主気管支内に粘液栓を認め，バルーンカテーテルを用いて摘出した。病理所見でアスペルギルス菌糸を認めアレルギー性気管支肺アスペルギルス症と診断した。症例２．89歳女性。食事中の呼吸困難で受診，胸部CT で左主気管支内の異物，左無気肺を認めた。気管支鏡検査で鶏肉の咀嚼物と考えられる異物を認め，バルーンカテーテルを用いて摘出した。症例３．77歳男性。呼吸困難で受診，胸部CT で左主気管支内に異物，左無気肺を認めた。気管支鏡検査でティッシュペーパーと考えられる異物を認め，バルーンカテーテルで摘出した。結論。気管支閉塞物の内視鏡的治療を行う際は，形態や性状に応じて適切なデバイスを選択する必要がある。本３症例の内視鏡治療においては，バルーンカテーテルが特に有用であった。Background. We herein report three cases of bronchial obstruction that was easily removed using a balloon catheter. Case 1. An 80-year-old woman visited the hospital because of dyspnea. Chest computed tomography （CT） showed a high-density area in the left main bronchus and left atelectasis. Bronchoscopy revealed a mucous plug obstructing the left main bronchus and was removed using a balloon catheter. Pathological findings revealed aspergillus hyphae, and the patient was diagnosed with allergic bronchopulmonary aspergillosis. Case 2. An 89-year-old woman visited the hospital because of dyspnea during meals. Chest CT showed a foreign body in the left main bronchus and left atelectasis. Bronchoscopy revealed a foreign body, identified as chicken residue, and was removed using a balloon catheter. Case 3. A 77-year-old man visited the hospital because of dyspnea. Chest CT showed a foreign body in the left main bronchus and left atelectasis. Bronchoscopy revealed a foreign body, identified as tissue paper, and was removed using a balloon catheter. Conclusion. During bronchoscopy, an appropriate device should be selected according to the shape and properties of the bronchial obstruction. Balloon catheters were particularly useful in the bronchial endoscopic treatment of the three above mentioned cases

Septic Pulmonary Embolism Induced by Dental Infection

Dental infection can be an important source for septic pulmonary embolism (SPE), but only a few cases of SPE accompanying dental infection have been reported. The aim of this study was to characterize the clinical features of SPE induced by dental infection. Patients who fulfilled the diagnostic criteria described in the text were recruited in a retrospective fashion. All 9 patients were men, with a median age of 59 years (range:47 to 74 years). Eight patients had chest pain (88.9%), 5 had a preceding toothache (55.6%) and 3 had preceding gingival swelling (33.3%). Blood cultures obtained from 7 patients were negative. Periodontitis was found in all of the cases, periapical periodontitis in 5 cases, and gingival abscess in 3 cases. The median duration of hospitalization was 15 days, and symptoms were mild in some cases. In addition to antimicrobial therapy, tooth extraction was performed in 3 cases, tooth scaling in 6. SPE induced by dental infection has prominent clinical characteristics such as male preponderance, chest pain, preceding toothache, and mild clinical course