Biomedical subjects

Y Kobashi

Publications and source records attributed to Y Kobashi.

At least 109 records · Page 6Linked to original sources

PubMed1990

[Four cases of simultaneous discovery of familial tuberculous infection].

Index case is a 17-year-old boy who was admitted to our hospital with pleurisy and a minimal pulmonary lesion, and tubercle bacilli were recovered from pleural fluid. A diagnosis of primary tuberculosis was made based on the onset by pleurisy and the existence of hilar and mediastinal lymph node swelling. On the same day, a 76-year-old man, grandfather of the index case was admitted for precise examination of suspected extensive pneumonia. Tubercle bacilli were also isolated from the pus of infected bulla obtained by puncture. Neither of these two cases, however, seemed to be the source of the familial tuberculous infection because of such sudden onset of the disease as pleurisy and pneumonia. Two months later, a 46-year-old man, father of the index case was examined at our hospital. He was considered to be the source of the familial infection because he was diagnosed as tuberculosis with positive smear and a thick wall cavity (3.2 cm in diameter) on the left apex, and abnormal shadow was detected on his chest X-ray already two years ago. The fourth case was a mother of the index case, and wife of the third case, whose chest radiography revealed an infiltrative shadow on the right apex by a family contacts examination. Though tubercle bacilli were not isolated from her sputum, pulmonary lesions considered to be tuberculosis due to their typical location and nature, a positive PPD skin test, and the response to antituberculous drugs.

Adolescent↗

PubMed1990

[Three cases of malignant lymphoma developing from chronic empyema wall].

Three patients with non-Hodgkin's lymphoma (NHL) involving the lung or chest wall are reported. All patients had tuberculous pleuritis or received artificial pneumothorax for pulmonary tuberculosis 30 years or more previously. The NHL of these patients developed in or close to the thickened pleura. Histologic examination showed diffuse large cell type (LSG classification) in all cases. Lymphomas of all cases were considered to have originated from B-cell lineage because their neoplastic cells expressed B1 (CD20) antigens. In no case the tumors were resectable, and chemotherapy or radiotherapy were performed. Two died of local NHL at 5 and 6 months respectively after diagnosis. One patient is still alive at 8 months after the first treatment for NHL. Early diagnosis is essential to improve the prognosis of these NHLs although it is difficult because of the co-existent pyothorax. Following features seemed to be useful for diagnosis: 1) chest pain or shoulder pain, 2) elevation of LDH level, 3) mass shadow in computed tomography, and 4) abnormal uptake of gallium 67. As precise assessment of tumor size is difficult because of the co-existent pyothorax and necrosis, follow-up studies by gallium scan or magnetic resonance imaging might be useful for proper treatment.

Chronic Disease↗

PubMed1990

[Difference of clinical features between bacilli positive tuberculosis patients diagnosed at the outpatients dept. (OPD) and diagnosed after admission].

In order to determine the clinical features of patients whose tubercle bacilli were found after admission, the characteristics of 23 cases (17 males, 6 females) diagnosed after admission (Group I) were compared with 16 other cases (12 males, 4 females) diagnosed before admission (Group II). The patients in Group I were more elderly and had severer underlying diseases than those in Group II. In addition, the majority of the patients of Group I showed manifestations of respiratory infections similar to bacterial pneumonia. Therefore, 14 cases (61%) in Group I were diagnosed as bacterial pneumonia on admission. Radiological findings showed that less than half of Group I showed typical X-ray findings of tuberculosis such as location of lesions in the apex and upper lung field, cavity formation, and mixture of or new and old infiltrative lesions. Also on the PPD skin test, 7 cases (30%) of Group I were negative. Due to the above results, in many cases it took more than 10 days from admission to make a final diagnosis as tuberculosis. There were several differences in findings between two groups, but there was no definite signs to diagnose all patients at the OPD. It is therefore considered to be important to keep in mind the following to prevent admission of open tuberculosis patients into a general hospital: (1) Admission of patients suspected to have open tuberculosis at the OPD should be postponed until their smears are proven negative. (2) Sputum examinations for AFB always should be carried out in patients with respiratory symptoms.

Adult↗

PubMed1989

Clinical and pathological status of mesectodermal leiomyoma of the ciliary body. A case report and review of the literature.

The case of a 28-year-old woman with a well-vascularized, yellowish neoplasm in her right eye is reported. The findings upon slit-lamp examination and fluorescein iridography strongly suggested a malignant lesion. The tumor and the adjacent portion of the iris, angle structures, ciliary body, cornea, and sclera were removed en bloc under the half-thickness corneoscleral flap. On the basis of light-microscopic studies, the tumor was suspected to be a neurogenic or glial tumor but further studies confirmed it to be a mesectodermal leiomyoma of the ciliary body. Electron-microscopic studies revealed the smooth muscle nature of the tumor. Because of the high percentage of benign lesions in this site, we believe that even though examinations may suggest malignancy, excision of the tumor should be preferred to enucleation of the globe in cases of ciliary tumor.

Adult↗

PubMed1989

Malignant lymphoma of the testis: histological and immunohistological study of 28 cases.

Histological and immunohistological studies were made in 28 patients with testicular lymphoma who presented with a right (15), left (11) or bilateral (2) scrotal swelling. Patient age at hospitalization ranged from 39 to 87 years, with a median age of 64 years. The disease was stage 1 in 12 patients, stage 2 in 11 and stage 3 in 5. Histologically, most of the neoplasms were of the diffuse large cell type, with an immunoblastic type being the most common. Immunohistochemistry revealed that all but 2 cases were of the B cell type. None of the tumors reacted with monoclonal antibody for T cell. These findings suggested that testicular lymphoma exclusively consisted of the B cell type, identical to previous reports of extranodal lymphomas other than those in the skin. The pertinent literature is reviewed and the histogenesis of testicular lymphoma is discussed.

Adult↗

PubMed1989

Erythroderma with generalized lymphadenopathy induced by phenytoin.

A 40-year-old man developed a generalized erythematous rash, fever, and systemic lymphadenopathy after treatment for two months with anticonvulsants including phenytoin. Laboratory examinations revealed increased white blood cell counts with eosinophilia, abnormal liver function, and increased gammaglobulin levels. A lymphocyte stimulation test showed a significant stimulation index for phenytoin. Skin biopsy findings were nonspecific cellular infiltrates in the upper dermis whereas in lymph nodes the normal architecture was replaced by massive cellular infiltrates consisting largely of lymphocytes, immunoblasts, and eosinophils suggesting a pattern of phenytoin lymphadenopathy. No malignant changes were noted. Phenytoin was discontinued and after a two-month treatment with oral corticosteroids, all manifestations had nearly subsided. However, the patient should be carefully followed up since phenytoin occasionally induces lymphoproliferative states including malignant lymphoma even after cessation of the medication.

Adult↗

PubMed1989

Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases.

Our previous study suggested a close relation between a preceding chronic tuberculous pyothorax and the development of non-Hodgkin's lymphoma (NHL) in the pleural cavity. To confirm this further, 37 cases were collected from Japanese hospitals, and their clinical and pathological findings summarized. The age at first admission for lymphoma of patients ranged from 46 to 81 (mean 63) years, the male to female ratio being 5.2:1. All patients were admitted after a 22-55 (mean 33) year history of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis (29 cases) or tuberculous pleuritis (seven cases). The most common presenting symptom was chest pain. The main tumor mass, detected by chest roentgenogram and computed tomographic scans, was situated in the pleura (28 patients), the lung near the pleura (five patients) and the pleura and lung (four patients). The diagnosis of pleural NHL was made by biopsy for 31 of the patients and at autopsy for the other six. Histologically 30 (81%) of the 37 cases were of the diffuse large cell type, and of these the immunoblastic type was the most common (22 cases). Immunological and immunohistologic studies revealed a B-cell nature of the proliferating cells in all but one tumor. Thirty-two patients received chemotherapy and/or radiotherapy. Twenty-seven patients died between one and 144 (median eight) months of diagnosis. Autopsies carried out in 23 cases revealed the disease to have been localized to the thorax in 11 patients. These findings indicated that malignant B-cell lymphoma arose as a monoclonal growth from a pool of proliferating polyclonal B lymphocytes in tissues affected by the chronic tuberculous pyothorax.

Aged↗

PubMed1988