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Biomedical subjects

Y Kobashi

Publications and source records attributed to Y Kobashi.

At least 73 records · Page 4Linked to original sources
PubMed1996

[An adult case of pneumonia due to Mycoplasma pneumoniae and Chlamydia psittaci].

A 18-year-old male was admitted to another hospital complaining of his chest X-ray. After transfer to our hospital, increased serum antibody titers to simultaneous M. pneumoniae and C. psittaci were noted. These antibody titers decreased after about four months. Positive results for M. pneumoniae was obtained by Polymerase chain reaction in the right pleural effusion. Based on these findings, this case was diagnosed as M. pneumoniae and C. psittaci pneumonia. A transbronchial lung biopsy and a bronchial biopsy revealed rare histological findings, including histiocytic intra-alveolar pneumonia with palisaded granuloma and small foci of necrosis in the left upper lobe and eosinophilic bronchitis in the right middle bronchus. His chest X-ray and chest CT showed a nodular shadow, obstructive pneumonia and pleural effusion which are rare in M. pneumoniae and C., psittaci pneumonia.

Adolescent↗
PubMed1996

Salazosulfapyridine-induced angioimmunoblastic lymphadenopathy.

A 20-year-old man with ulcerative colitis was admitted because of fever, eruption and lymphadenopathy. He had started taking salazosulfapyridine one month previously. Lymph node biopsy revealed angioimmunoblastic lymphadenopathy. Autoantibody titers were all negative, and viral antibody titers were not increased retrospectively. Rearrangement of T-cell receptor beta and chromosomal aberration were not seen on the lymph node. This case is considered not to be a peripheral T-cell lymphoma but rather salazosulfapyridine-induced angioimmunoblastic lymphadenopathy (AIL), which is the second case in English language literature.

Adult↗
PubMed1996

[Chronic necrotizing pulmonary aspergillosis complicated by pneumothorax].

A 66-year-old man was admitted to the hospital due to a rapidly progressing interstitial shadow in both lower fields on a chest roentgenogram taken on November 30 1993. The diagnosis was idiopathic interstitial pneumonia. A corticosteroid and a neutrophil elastase inhibitor were administered and the interstitial shadow resolved. A new infiltration shadow appeared in the right upper lung field one and a half months after the start of steroid therapy. This shadow gradually grew and Aspergillus fumigatus was detected in sputum cultures. In spite of treatment with FCZ+5-FC and 5-FC+AMPH, the abnormal shadow increased in size and mixed with the cavity, and the patient died of respiratory failure, with a pneumothorax caused by ruptures of the cavity formed by CNPA. The clinical and radiological course were considered to the indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al. in 1982.

Aged↗
PubMed1996

[Pneumonia and mortality in patients requiring prolonged mechanical ventilation].

We examined patients who required prolonged (>60 days) mechanical ventilation. A total of 31 patients were studied, 23 with pulmonary disease, 4 with neurologic disease and 4 with other conditions. Many of these patients were elderly. The survival rates one year and two years after the start of mechanical ventilation were 40% and 33%, respectively. Respiratory tract infection was the most common and most serious complication, and ventilator-associated pneumonia was the main cause of death. It is difficult but quite important to prevent these complications, especially ventilator-associated pneumonia.

Adult↗
PubMed1996

[Four cases of pulmonary tuberculosis resembling pulmonary abscess with a so-called niveau-like shadow in a medical school hospital: discussion concerning the formation mechanism of niveau-like shadows].

Four cases of pulmonary tuberculosis resembling pulmonary abscess radiographically were reviewed from their clinical features, chest X-ray and chest CT, and the mechanism of formation of so-called niveau-like shadows was discussed. Only one case showed a newly formed tuberculous cavity with air fluid level on chest X-ray, however, even in this case, the possibility of the infection with tubercle bacilli of an emphysematous bulla of the lung could not be completely excluded as several bulla were found on chest CT. The remaining three cases showed a slightly different mechanism of the formation of niveau-like shadows. Namely, mycobacterium tuberculosis spread into an existed bulla and a tubercle bacilli infected bulla was formed. Regarding the clinical features, no remarkable findings were detected and we could find no differences with common tuberculosis. Based on these experiences, the presence of pulmonary tuberculosis resembling the shadow of pulmonary abscess should be emphasized.

Aged↗
PubMed1996

[Dermatomyositis complicated by sarcoidosis].

We encountered a patient with dermatomyositis complicated by sarcoidosis. A 57-year-old woman was admitted to our hospital because of fever dry cough, and myalgias. There were reticular shadows on her chest X-ray film. Although the typical skin rash and myositis suggested the diagnosis of dermatomyositis biopsy specimens from a salivary gland, muscle, and lung revealed noncaseating granulomas as well. Uveitis was also noted. These findings suggested the coexistence of sarcoidosis with dermatomyositis. Examination of the lung-biopsy specimens showed interstitial pneumonia compatible with dermatomyositis, except for the granuloma. The typical rash of dermatomyositis and pathological findings of the lung specimen were inconsistent with sarcoidosis. Therefore we concluded that this patient had both dermatomyositis and sarcoidosis. This case sheds new light on the importance of pathological examinations.

Dermatomyositis↗
PubMed1995

Papillary serous carcinoma of the peritoneum in women. A clinicopathologic and immunohistochemical study.

BACKGROUND: Papillary serous carcinoma of the peritoneum (PSCP) is a primary peritoneal tumor in women that histologically resembles papillary serous carcinoma of the ovary (PSCO). Recognition of PSCP as an entity is controversial, as is the histogenesis, histopathologic differential diagnosis, and treatment. METHODS: Ten cases of PSCP retrieved from the pathology files of 4 hospitals in Kyoto and Nara, Japan, were studied clinicopathologically and immunohistochemically. RESULTS: Patient ages at presentation ranged from 40 to 74 years (median, 56 years). All patients were Asian (Japanese). None of the patients had a history of asbestos exposure. Most of the patients had abdominal swelling, ascites with positive cytology, and elevated serum CA125. At surgery, omental tumors with dissemination to the abdominal and pelvic peritoneum were found in all patients. The histology was similar to that of Grade 2 to 3 PSCO. Immunohistochemical studies using a panel of monoclonal antibodies against carbohydrates showed that Lewis Y is a good marker, in addition to S-100, placental alkaline phosphatase, CA125, and CD15 for separating PSCP from malignant mesothelioma (MM). With cytoreductive surgery and cisplatin-based combination chemotherapy and in some cases adoptive immunotherapy and radiation, a median survival of 27 months and a 5-year survival rate of 27% were attained. One patient with Grade 3 tumor has survived for more than 6 years after surgery. CONCLUSIONS: (1) Papillary serous carcinoma of the peritoneum is a definite clinicopathologic entity; (2) immunohistochemistry is a useful tool for distinguishing PSCP from MM; (3) cytoreductive surgery and cisplatin-based combination chemotherapy with other adjunct therapies such as immunotherapy and radiation may improve patient survival in PSCP.

Adult↗
PubMed1995

Serial changes of cystic air spaces in fibrosing alveolitis: a CT-pathological study.

In patients with cryptogenic fibrosing alveolitis (CFA), subpleural large cysts are sometimes seen within honeycombing on computed tomography (CT). These cysts may be interpreted as bullae and the coexistence of emphysema with CFA might be assumed. We evaluated whether cystic spaces in honeycombing become larger in patients with CFA on serial CT scans. CT scans were obtained in 16 patients with CFA, who had undergone two CT examinations (6 to 43 months, mean 25.1 months apart), were reviewed focusing on the changes in size of the cystic spaces in honeycombing. The mechanism of enlargement of cystic spaces was investigated using microscopic serial sections of autopsied specimens. In 15 of 16 patients, the cystic spaces in honeycombing were larger on the second examination. Histologically, stenosis of bronchioles and slit-like structures between cysts and bronchioles were detected in addition to alveolar septal dissolution and bronchiolectasis. Both the bronchiolar stenosis and the slit-like gaps have the potential to work as check-valves and increase the volume of cystic spaces. Therefore, in the evaluation of CFA, large cysts should be interpreted with caution to avoid misinterpretation of the cysts as bullae associated with emphysema. From the results of this correlative study, we suggest that a check-valve effect is an important mechanism in the formation of large cysts in honeycomb lung.

Aged↗
PubMed1995

[A case report of invasive pulmonary aspergillosis which could not be saved in spite of making an early diagnosis].

A seventy-one year old male with pemphigus vulgaris and treated with steroid therapy for long periods of 7 months was suffered from invasive pulmonary aspergillosis. He complained of a productive cough and the chest X-p indicated a mild infiltration shadow in his both lungfields. He was treated by intravenous antibiotics and no clinical improvement was observed. Two days after the onset of the clinical respiratory symptoms, he was transferred to the division of respiratory diseases and the diagnosis of aspergillosis was confirmed by serological and histopathological studies on the same day. Intravenous amphotericin B and oral itraconazole administrations were started immediately after the diagnosis was made. However, the progression of the disease was so rapid and his immune condition was too weak to respond to the treatment. The overall clinical course of the case was extremely short only 5 days.

Aged↗
PubMed1995

[Eight cases of infection caused by the Streptococcus milleri group--significance of serum antibody titer and a comparative investigation of the backgrounds and factors of infections caused by Streptococcus milleri and Streptococcus pneumoniae].

Eight cases of infection caused by Streptococcus milleri were studied clinically, and a comparative study was made of the backgrounds and factors influencing the development of infectious diseases caused by Streptococcus milleri and Streptococcus pneumoniae. The patients (six males and two females) with infectious diseases caused by Streptococcus milleri ranged in age from 21 to 81 years old with an average age of 62.0 years. The infectious diseases encountered among the patients were pyothorax in three patients, and in one patient each pyothorax and lung abscess, pleurisy, a secondary infection of pulmonary emphysema, skin infection related to a tracheostomy, a subdural abscess and a brain abscess, respectively. Six out of the eight cases had infections which formed pus. An underlying disease existed in seven cases, and, in five of these seven cases, it influenced the general condition of these patients. Six serum antibody titers for the S. milleri groups were examined in the First Department of Internal Medicine, University of the Ryukyus. Three cases for S. anginosus, two cases for S. intermedius, and one case for S. constellatus showed high titers of X1024 or X2048. Therefore, the examination of the serum antibody titer seems useful for the diagnosis of infections caused by the S. milleri group. We also carried out a comparative investigation of the backgrounds and factors of infectious diseases caused by S. milleri and S. pneumoniae. There are more underlying diseases in infections caused by S. milleri than in those caused by S. pneumoniae. There were more smokers among the patients with infections caused by S. milleri than among those with S. pneumonia infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[A case of lung cancer with choroidal metastasis].

A 72-year-old woman was admitted to our hospital because of a mass shadow in the left upper lobe on chest roentgenograms. She had noticed floaters in both visual fields 2 months before admission. Percutaneous aspiration of the lung lesion was done, and revealed poorly differentiated squamous cell carcinoma. Metastatic tumors were noted in the choroid of both eyes and in both kidneys. These lesions responded partially to systemic chemotherapy and the floaters disappeared. There have been few reports of metastatic choroidal tumors, but most cite the lung and the breast as the primary sites. We should pay attention to ophthalmologic findings because lung cancer may metastasize to the choroid.

Aged↗
PubMed1995

[Comparison of the clinical features of smear-positive and culture-positive tuberculous patients with smear-negative and culture-positive patients in an education hospital].

The clinical features of 27 smear-positive and culture-positive tuberculous patients (Group 1) were compared with those of 39 smear-negative and culture-positive patients (Group 2) experienced in our hospital. The proportion of the patients who have underlying diseases was lower in Group 1 than Group 2. Ninety-five % of the patients in Group 1 showed positive PPD skin reaction in comparison with 73% of the patients in Group 2. In most of the patients in Group 1, the chest X-ray findings were typical ones for pulmonary tuberculosis, but 36% of the patients in Group 2 showed atypical X-ray findings. Final diagnosis was more difficult for the patients in Group 2 than Group 1. Almost all patients in Group 1 could be diagnosed within a few days and were referred to a tuberculosis hospital for the treatment of tuberculosis. On the contrary, by the patients in Group 2, the final diagnosis was delayed more than one month until the results of culture was available. Also, many patients in this group had underlying disease and only 8 patients could be transferred to a tuberculosis hospital.

Adolescent↗
PubMed1995

[Expression of bc1-2 protein in collagen vascular diseases with pulmonary interstitial involvement].

Expression of bc1-2 protein was studied immunohistochemically in 25 patients with collagen vascular diseases and in 10 patients with idiopathic interstitial pneumonia. The collagen vascular diseases included rheumatoid arthritis (n = 9), progressive systemic sclerosis (n = 9), polymyositis/dermatomyositis (n = 4), Sjögren's syndrome (n = 2), and systemic lupus erythematosus (n = 1). All 35 patients underwent open lung biopsy; cellular infiltration, fibrosis, and lymphoid aggregation were scored according to Cherniack's classification. T lymphocytes (CD43: DFT-1) and B lymphocytes (CD20:L-26) were also evaluated. Expression of bc1-2 protein was dominant in T lymphocytes infiltrating the alveolar interstitium and in B lymphocytes in the mantle zone of lymphoid follicles. In collagen vascular diseases, the degree of expression of bc1-2 protein in those T lymphocytes was closely related to the alveolar lymphocyte infiltration score. However, these findings were not marked in the patients with idiopathic interstitial pneumonia, and were not related to the underlying disease in the patients with collagen vascular diseases. The expression of bc1-2 protein in T lymphocytes was not related to fibrosis or to lymphoid aggregation. Expression of bc1-2 protein in B lymphocytes did not correlate with pathological scores or with underlying disease. Bc1-2 protein has been recognized as an oncogene that suppresses apoptosis. Marked expression of bc1-2 protein in T lymphocytes from patients with collagen vascular diseases indicates that oversuppression of apoptosis may be related to the pathogenesis of pulmonary interstitial involvement in these conditions. Further clinicopathological studies focusing on apoptosis in collagen vascular diseases and in idiopathic interstitial pneumonia are needed.

Apoptosis↗
PubMed1994

[Comparison of the prevalence of symptoms, elevated serum antibody, antibody types and complications between two outbreaks of influenza in a ward].

We experienced two outbreaks of influenza in the respiratory ward of our hospital in Feb. 1990 and Feb. 1993. Influenza-like symptoms were recognized in 42 of 67 cases (63%) in 1990, and in 22 of 56 cases (39%) in 1993. In the former outbreak, the prevalence of the serum CF titer for anti-influenza antibody was elevated in 25 of 42 cases (60%) (only the A2 antibody titer in 2 cases, B antibody titer in 4 cases in the latter one). Among asymptomatic inpatients, the serum titer was elevated in 3 of 25 cases (12%) in the former outbreak, but in 1 of 8 cases which the serum CF titer for anti-influenza antibody was measured in the latter one. A respiratory complications secondary to influenza were observed in 6 (2 cases pneumonia, 3 cases lower respiratory tract infection, 1 case asthma attack) of 67 cases during the former period, but only 1 of 56 cases during the latter period. In the two outbreaks of influenza in the respiratory ward we found the same results concerning the occurrence of influenza-like symptoms, an elevation of the serum antibody titer, but a significant difference was noted with regard to the phenotype of the prevalent influenza and the occurrence of complications.

Aged↗