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A 65-year-old-woman complained of lumbago from the end of March 2008. Three weeks later, she visited a local clinic because of high fever, and she was given a diagnosis of urinary tract infection. Although levofloxacin was given, her condition did not improve and she was referred to the urology department of our hospital. Two days after hospitalization, she rapidly developed respiratory failure. Chest CT revealed bilateral pleural effusion, interlobular septal thickening, diffuse ground-glass opacities and mediastinal lymphadenopathy. We suspected scrub typhus because we noticed a localized necrotic skin lesion on her left lower leg. When minocycline was administered, both her clinical condition and radiographic imaging promptly improved. Because lung involvement with scrub typhus is very rare in Japan, we report this case of scrub typhus with various lung findings.

A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.

A 77-year-old man who had fever and chest pain was admitted to a neighboring hospital on a diagnosis of pneumonia. Chest X-ray film finding deteriorated despite treatment with 2 g cefotaxime per day. Because of accompanying acute renal failure, he was transferred to our hospital. Hemodialysis with intravenous administration of erythromycin and meropenem resulted in recovery from acute renal failure, and his general condition improved. Because of liver dysfunction, erythromycin was changed to pazufloxacin. Although he was negative for Legionella urinary antigen determined with a rapid assay kit, Binax NOW, his serum titer for Legionella pneumophila serogroup 4 was elevated. Finally, a diagnosis of Legionnaires' disease caused by Legionella pneumophila serogroup 4 was established.

We evaluated 240 consecutive subjects (aged 20-91) without cardiopulmonary, endocrine or, neuromuscular disease consecutively regarding pulmonary function (TLC, VC, FEV1, RV) and static maximal inspiratory (PImax) and expiratory (PEmax) pressures. PImax and PEmax declined with advancing age. PImax correlated with grip strength, VC, FEV1, height, weight, and RV/TLC. PEmax also correlated with grip strength, TLC, VC, FEV1, height, and weight. Age, height, weight, and grip strength were entered stepwise into multiple linear regression models with PImax or PEmax as the dependent variable. Stepwise regression analysis revealed that grip strength was an independent predictor for both PImax and PEmax. However, age itself was not an independent predictor for PImax or PEmax. These results suggest that static maximal respiratory pressures decrease with aging, and that age-dependent changes in respiratory muscle function may depend on other factors, including lung volume, skeletal muscle status, and body composition.

A 44-year-old woman was admitted to our hospital complaining of dyspnea. A chest X-ray film obtained on admission showed bilaterally shrunken lungs, and peripheral bundle-like and linear shadows. A chest CT scan revealed marked thickening of bronchovascular bundles and low lung volumes. Mild dryness of the mouth, and the results of a Rose-Bengal test, Schirmer test, and sialography led to the diagnosis of primary Sjögren's syndrome. Corticosteroid pulse therapy was followed by slight improvement. To determine the pathological diagnosis and to plan further therapy, video-assisted thoracoscopic lung biopsy was done. Examination of the biopsy specimen revealed alveolitis and infiltration of lymphocytes, which suggested active interstitial pneumonia. Therapy with corticosteroids and the immunosuppressant azathioprine was followed by marked improvement.

We studied length of survival and related clinical findings in 715 inpatients with collagen-vascular diseases (1984 through 1994), the diagnostic Kaplan-Meier analysis showed that patients with polymyositis/dermatomyositis and those with systemic sclerosis did not survive as long as those with other types of collagen-vascular disease. Of the patients who died 37% died of respiratory failure due to interstitial lung disease. Patients with interstitial lung disease had better outcomes than did those with idiopathic interstitial pneumonia: they were younger, had higher initial vital capacities, and fewer episodes of acute exacerbation of lung disease than did those with idiopathic interstitial pneumonia. Among patients with interstitial lung disease, those who died of polymyositis/dermatomyositis did so within 1 year, but those who died of systemic sclerosis lived longer. Interstitial lung disease is an important prognostic factor in collagen-vascular disease, and needs further evaluation.

To determine the role of interstitial lung disease (ILD) in the outcome of polymyositis-dermatomyositis (PM/DM), we studied 41 patients who had radiographic evidence of ILD among 51 patients with PM/DM. The patients were divided into 3 groups according to therapy: progressive, no change, or improved. Those classified as progressive had significantly higher rates of skin and lung symptoms, milder muscle symptoms, and lower levels of muscle enzymes than the other 2 groups, and none was positive for the anti-Jo-1 autoantibody. Nine patients with DM died of respiratory failure; they had low serum creatine kinase levels, no anti-Jo-1 antibodies, and a rapidly progressive course before death. Autopsy findings were obtained in 7 patients, and all had diffuse alveolar damage as the main pulmonary histological finding. A subgroup of patients with PM/DM-ILD have a poor prognosis, and ILD in PM/DM is an important prognostic factor.

In 715 patients with collagen vascular diseases, interstitial lung disease and pulmonary hypertension were found to be important causes of death (37.5% and 6%, respectively). The prognosis of interstitial lung disease associated with collagen vascular disease was better than that of idiopathic interstitial pneumonia; patients with the latter were more likely to experience exacerbations. A distinct subgroup of patients with dermatomyositis and interstitial lung disease with a rapidly progressive course was characterized by mild muscle symptoms, low levels of creatine phosphokinase and negative tests for anti-Jo-1 antibody. CT scores and analysis of bronchoalveolar lavage fluid proved to be of some value in predicting outcome. Measurement of IL-6 in bronchoalveolar lavage fluid and local immunostaining for this pro-inflammatory cytokine were helpful in evaluating responses to therapy.

A 26-year-old man was admitted to our hospital for evaluation of cavitary lesions on his chest X-ray film. Chest CT and conventional tomograms showed multiple cavities in both lung fields, as well as hilar and mediastinal lymphadenopathy. He had uveitis and the laboratory data showed a high level of angiotensin converting enzyme in the serum. Histological findings of the specimen obtained by transbronchial lung biopsy showed non-caseating epithelioid cell granuloma, consistent with sarcoidosis. Corticosteroid therapy (prednisolone 40 mg/day) resulted in reduction of the cavitary lesions and the lymphadenopathy. Negative bacteriological studies and the clinical course strongly suggested primary cavitation, a relatively rare form of pulmonary parenchymal involvement in sarcoidosis.

A 55-year-old woman with bronchorrhea and bronchial asthma was admitted to our hospital in June, 1992. On admission, she was producing a large volume of sputum (200 ml) each day. The volume decreased with oral administration of erythromycin and inhalation of beclomethasone. Next, inhalation of furosemide was added to the regimen, which lead to symptomatic improvement in mucus clearance, although the sputum increased in volume. The concentrations of albumin, fucose, sialic acid, and phosphatidylcholine in the sputum changed with these treatments, as did the lecithin/sphingomyelin ratio. These observations suggest that these drugs affect not only the quantity but also the quality of sputum.

There is increasing evidence that airway epithelial cells play an active role in allergic inflammation, including bronchial asthma. We showed that human airway epithelial cells in culture release GM-CSF, G-CSF, M-CSF, IL-6, and IL-8, using a serum-free culture system. These cytokines are known to modulate the bioactivities of inflammatory cells that accumulate at the site of inflammation. Among them, GM-CSF, IL-8, or both may be important because they influence the bioactivities of eosinophils, which are characteristic of allergic inflammation. Here we report on the effects of air pollutants such as suspended particulate matter and diesel exhaust particulates on release of cytokines from airway epithelial cells. All air pollutants we tested stimulated epithelial cells to release GM-CSF. These results suggest that one cause of the recent increase in the prevalence of allergic disorders is direct stimulation of airway epithelial cells by air-pollutants. Furthermore, anti-inflammatory agents such as steroids and anti-allergic drugs were found to suppress the release of GM-CSF from airway epithelial cells in vitro.

Three-dimensional CT images of six inflated lung specimens (4 lung cancer, 1 bronchiectasis, 1 hamartoma) were reconstructed from contiguous serial sections to study some probable problems in the clinical application of the technique. Optimal thickness and space of sections were evaluated, and contiguous 1.5-mm serial sections were found to provide a clear 3-D image with high fidelity. It was difficult to set a proper threshold to create clear images because a wide CT window is inconsistent with low noise. The images of tubular and linear structures such as from bronchi and vessels demonstrated higher resolution when reconstructed from scanning in the more perpendicular cross-sectional direction to their axis. Although 3-D images obtained here were not as clear as expected, technological advances such as helical CT or MRI may provide 3-D images with sufficient resolution to be applied clinically.

The regulatory mechanisms of proliferation and differentiation of normal airway epithelial cells seem important for the better understanding of lung carcinogenesis. We isolated bovine and human bronchial epithelial cells by enzymatic digestion of bronchi, and cultured them in serum-free growth factor-supplemented medium. To determine the role of growth factors in the proliferation of bovine bronchial epithelial cells, the effect of each of these additives was evaluated. Of these, fetal calf serum (FCS), bovine pituitary extract (BPE), insulin and insulin-like growth factor-1 (IGF-1) showed a significant stimulatory effect on cell growth. These four additives induced transient increases in c-fos, c-jun and c-myc proto-oncogene mRNA levels. Transforming growth factor beta (TGF beta) inhibited growth factor-induced cell proliferation, and also showed selective inhibition of c-myc induction. We also studied the effect of interleukin 6 (IL-6) on human bronchial epithelial cell proliferation. IL-6 showed a significant inhibitory effect on cell growth. These cells were capable of expressing and releasing IL-6 and had specific receptors for IL-6, suggesting an autocrine mechanism. These results suggest that TGF beta and IL-6 may play roles in the regulation of airway epithelial cell growth as inhibitory growth factors.

It has been suggested that a variety of cytokines may play important roles in the regulation of immune and inflammatory responses in the lung. The purpose of this study was to determine whether interleukin 6 (IL-6) could affect the cell growth of human bronchial epithelial cells via a specific receptor for IL-6. Human recombinant IL-6 inhibited the cell proliferation in a dose-dependent manner. Binding assay with radiolabelled IL-6 demonstrated that human bronchial epithelial cells had specific receptors for IL-6. Moreover, Northern blot analysis using digoxigenin-labelled IL-6R mRNA expression in these cells. Interestingly, proinflammatory cytokines IL-1 alpha and IL-6 upregulated IL-6R mRNA levels. These results suggest that IL-6 may affect the functions of bronchial epithelial cells via a specific receptor, and that its activity on cells may be regulated at the level of receptor-cytokine binding.

Bronchoscopy was performed on a 68-year-old male patient with pulmonary tuberculosis, and revealed a yellow smooth polypoid tumor in the lumen of the left upper division bronchus. The histopathological diagnosis of the biopsy specimen was endobronchial lipoma. Since the patient did not have any symptoms due to the lipoma, we performed treatment for tuberculosis and continued careful observation of the tumor. During the subsequent 4 years, the patient developed no complications such as obstructive pneumonia, and the size of the tumor under bronchoscopic observation did not change. Endobronchial lipoma is a very rare benign tumor. Almost all reported cases have undergone operation or endoscopic surgery. This case is the first that was followed over 4 years without surgical procedure. The findings of follow-up bronchoscopic examination suggest that the growth rate of endobronchial lipoma is very slow. Furthermore, we reviewed 36 cases of endobronchial lipoma in the Japanese literature, including our case. Smoking seems to have a strong relation to the occurrence of the tumor. It is noteworthy that 6 cases had separate malignancies, but the direct relationship between endobronchial lipoma and such malignancies is unclear.

A 62-year-old woman presented with uveitis and abnormal chest X-ray (bilateral hilar adenopathy). Skin biopsy in 1983 had revealed non-caseating epithelioid cell granuloma consistent with sarcoidosis. Her serum biochemical investigations and exploratory laparoscopy suggested nodular liver cirrhosis, but biopsy was not performed. Both blood urea nitrogen (BUN) and serum creatinine values were within normal limits. She received prednisolone therapy of 15 mg daily initially, and later a maintenance dose of 5 mg daily. In 1985, she complained of skin itching and her laboratory data revealed severe renal insufficiency (BUN 97 mg/dl, serum creatinine 12.2 mg/dl) and hypercalcemia (corrected serum calcium level: 11.5 mg/dl). Prednisolone treatment (40 mg daily) resulted in a dramatic improvement of renal function as well as other clinical abnormalities due to sarcoidosis, without any significant changes in liver function. She died of cerebral infarction in 1989. Autopsy showed interstitial nephritis with tubular calcinosis and hyalinized glomeruli. It is postulated that hypercalcemia due to sarcoidosis contributed to the renal failure in this patient. This case suggests that renal damage due to sarcoidosis may be reversible with appropriate corticosteroid therapy.

A 47-year-old male was referred to our hospital with persistent high fever. He had received antibiotics (ASPC) for the diagnosis of acute infectious disease, which failed to respond, and subsequently developed marked lymphocytopenia and thrombocytopenia. During his hospitalization, hypoxic respiratory failure rapidly developed. A bone marrow aspiration revealed marked hemophagocytosis, leading to the tentative diagnosis of opportunistic respiratory infection associated with malignant histiocytosis. Treatment for suspected malignancy and Pneumocystis carinii pneumonia was commenced. However, because of the initial lack of response to ASPC, generalized skin rashes without an ordinary stick wound which had diminished before the hospitalization, and a history of working outdoors in a nearby mountain area, the possibility of new type tsutsugamushi disease was strongly suggested. Intravenous administration of minocycline promptly improved his symptoms and laboratory data. The diagnosis was confirmed by a significant increase in the titer of antibody to Rickettsia tsutsugamushi. The thrombocytopenia was considered to have been caused by co-existent hemophagocytic syndrome.

FCR (Fuji Computed Radiography) was added to plain chest radiography in order to evaluate its image characteristics and to determine the best image characteristics and to determine the best image processing program by comparing the visibility of shadows on conventional X-rays and on six FCR hard copy images processed by six mutually different image processing program. FCR showed excellent ability to visualize abnormal lung shadows as well as normal chest structures when processed by a moderate spatial frequency enhancement (spatial frequency 0.11 cycle/mm, level of enhancement). FCR also proved superior to the conventional film-screen system in the visualization of hilar and mediastinal structure as well as lung shadows. The effects of the image processing program on the visibility of shadow, granular and linear shadows were clearly demonstrated when a more intense spatial frequency enhancement (spatial frequency 0.18 cycle/mm, level of enhancement) was performed. The same results were obtained in terms of reticular and linear shadows and calcified lesions. On the contrary, low density shadows with poorly defined margins the lung field and infiltrates from mycoplasma pneumonia were well depicted by a program with a slightly steeper gradation (gamma; 1.0) and minimal frequency enhancement. Accordingly, FCR was found to be useful for the screening of abnormal chest X-ray shadows whereas it was also likely to demonstrate the best image when processed by the most appropriate image processing programs, depending on the characteristics of the shadows.

As the first step to investigate a possibility that viral infection is involved in the pathogenesis of idiopathic interstitial pneumonia (IIP), serum antibody titers against various viruses were studied in 98 IIP patients. The patients were positive for herpes simplex virus, cytomegalovirus, rubella virus, parainfluenza virus 3, EBV-VCA IgG and adeno virus 1, which were also assessed in 45 normal subjects. As results, IIP patients showed higher titers of EBV-VCA IgG (p less than 0.01). When the frequency of positive populations for each of the 6 viral antibodies was calculated, the values of the frequency in all the 6 viruses were found to be very high in both patients and normal subjects, and there was no significant difference between IIP patients and normal controls. In conclusion, a specific relationship between IIP and a certain viral infection was not observed by studying serum antibody titers against various viruses in IIP patients. It might be worthwhile studying why EBV-VCA IgG titers were shown to be significantly higher in IIP patients than in normals.

A 49-year-old woman was admitted in February 1987, with a six-month history of joint pain, maculopapular and erythematous rash, proximal muscle weakness and a two-month history of skin ulceration and dyspnea on exertion. Physical examination showed Gottron's papules on her fingers and a faint heliotrope rash. Biopsy of erythematous skin lesions on the shoulder and the back of the hand revealed perivascular inflammatory cell infiltration and tiny ulcerative lesions of the cutaneous tissue. Biopsy of the right quadriceps muscle showed type II fiber atrophy and slight perivascular lymphocytic infiltrate, whereas serum CPK level was within normal range. Chest X-ray film showed granular infiltrates in both lower lung fields. Based on the current findings the case was diagnosed as dermatomyositis associated with interstitial pneumonia. The administration of prednisolone, 30 mg/day resulted in the improvement of the skin lesions and muscle weakness, while the intensity of lung infiltrates was little affected. Three months after steroid therapy, the patient was readmitted because of increasing dyspnea on exertion and multiple skin ulcers. Chest X-ray revealed a small amount of gas in the mediastinum, in addition to slight deterioration of interstitial lung disease. In spite of various treatments for pneumomediastinum, including bed rest, administration of analgesics and oxygen inhalation, it developed rapidly, complicated severe subcutaneous emphysema and right-sided pneumothorax. Although high-dose prednisolone therapy and mediastinal drainage were performed, the pneumomediastinum was not resolved and she died from respiratory failure. At autopsy, predominant histological features of the lungs were acute interstitial pneumonia with hyaline membrane and edematous granulation formation in the alveoli.(ABSTRACT TRUNCATED AT 250 WORDS)