Two hundred eighty one cases of the lung disease due to mycobacteria other than tubercle bacilli (atypical mycobacteria) were found at the seven National Chest Hospitals in Japan during the past ...several years. Eighteen of 281 cases were the disease due to M. kansasii, 3 due to M. scrofulaceuni, 247 due to M. intracellulare, 11 due to M. chelonei, and 2 due to M fortuitum. The first chest radiograms were observed, and the radiographic features of the disease due to various species of atypical mycobacteria were compared. The results were summerized as follows: (I) Minimal cases and cases without any previous pathological changes in the respiratory organs (primary infection cases) were found more f requently among persons of middle age and younger than among the older persons in the disease due to all the species of atypical mycobacteria. (II) There was no statistically significant difference in the ratio of cavitary cases to the total cases among the various species (83 to 100%). (III) The difference in the radiographic features among various species were as follows. i) In the case of the disease due to group IV organisms (M. chelonei and M. fortuitum), single solitary cavity was found in the lung field, and its shape was round, thin-walled and less than 40mm in diameter in almost all cases. In the case of the disease due to M. kansasii, round, thin-walled cavitary lesions were observed which were similar to that of the disease due to group IV organisms, however, the proportion of cases with multiple (3 and more) cavitations amounted to 16.6% of the total cases, and giant cavity (over 40mm in diameter) was found occasionally. ii) In the case of the disease due to M. intracellulare, subpleural cavitary lesions were found in many cases, while in the case of the disease due to M. kansasii, M. scrofulaceum and M. chelonei, cavitary lesions were found in the lung field in the majority of the cases. iii) In the cases with the lesions localized in one lobe, the lesions were found more frequently (2.7 times) in the right lung than in the left, and the number of cases with the lesions localized in the upper lobes amounted to approximately 90% of the total cases. The number of cases with the lesions localized in the middle lobe was only 2% in the case of M. intracellulare infections. iv) The majority of non-cavitary lesions were infiltrative. Only in the case of the disease due to M. intracellulare, various lesions (diffuse nodular lesions, bronchiectasis and pleural empyema, etc.) were observed. In the case of the disease due to group IV organisms, non-cavitary lesions were not found in most of cases (61.5%). v) The previous pathological changes in the respiratory organs were found in many cases of M. intracellulare infection, but they were found in a few cases of M. kansasii and group IV organisms infection. In the case of the disease due to M. scrofulaceum, pneumoconiosis was found in 2 of 3 cases. (IV) Even among the disease due to the same species of atypical mycobacteria (111. intrace llulare), the radiographic findings differed in different hospitals.
Sixty seven cases with pulmonary atypical mycobacteriosis (2 by M. kansasii, 62 by M. intracellulare, 2 by M. fortuitum and 1 by a possible new pathogen of group III mycobacteria) died in 9 Japanese ...national sanatoria up to October 1976. Of these 67 cases, 40 died of atypical mycobacterial disease, and the remaining 27 cases died of other diseases. Roentgenological aggravation was found in 44 cases (1 by M. kansasii, 1 by M. fortuitum and 42 by M. intracellulare). There were various types of roentgenological aggravation. Spread of non-cavitary foci, infiltrate and pneumonia were found most frequently (40/44, 90.9%). Enlargement of cavity was found in 12 cases (27.2%), appearance of pleural effusion in 5 cases (11.4%), and spontaneous pneumothorax in 3 cases. Infection of bulla was found in 11 out of 22 cases with bullae as the underlying disease. The first roentgenological aggravation was found in 20 (45.5%) out of 44 cases within 12 months; 13 cases (29.5%) between 13 to 24 months; and 11 cases (25%) over 2 years after the discovery of the disease. From the results mentioned above, in the fatal cases, progression of the disease was predicted by the appearance of the roentgenological aggravation within 2 years after the discovery of the disease. There were various courses of the progression of the lesions as shown in Figures 2a and 2b. One of the typical course of the progression was devided into the following 5 stages: The first stage: localized cavitary lesion. The second stage: spread of foci around cavity. The third stage: spread of foci in contralateral lung. The fourth stage: enlargement of cavity (appearance of giant cavity). The fifth stage: extensive pneumonia in the lower lung field. Another typical course of the progression was the repeated infections of bullae. Roentgenological aggravation found in patients with atypical mycobacterial disease was not rarely due to the mixed infection with various organisms (gram-negative bacilli, fungi and also human type tubercle bacilli). The majority of the patients with underlying pulmonary disease (extensive emphysema, chronic bronchitis and bronchiectasis) died of pulmonary insufficiency in the relatively early stage of atypical mycobacteriosis. The patients with the mixed infection have died, in spite of the negative conversion or the dicrease of the excretion of atypical mycobacteria. There were two cases (M. intracellulare infection) complicated with pulmonary tuberculosis.
Screening for atypical mycobacteria (mycobacteria other than tubercle bacilli) were carried out in thirteen participating hospitals by using the p-nitrobenzoic acid-Ogawa egg medium. The subjects ...were the patients who were under hospitalization in June, September and December, 1975 and March, 1976. The isolation of mycobacteria was carried out using Ogawa egg medium which was inoculated with a sputum specimen after treatment with equal volume of a 4% (2%) NaOH solution for 15 minutes. 1. The ratio of atypical mycobacteria (including Gordona) among all mycobacteria was 7.8% in average and the ratio in senso stricto (excluding Gordona) was 7.5% in average (Table 1). The ratio was high in the hospitals located in South coast of Honshu and Shikoku islands facing Pacific Ocean (Fig. 1). 2. The kinds of species of atypical mycobacteria are shown in Table 2. The results agreed well with the results obtained by previous two studies (National Chest Hospital Group: Kekkaku, 48: 203-211, 1973; 51: 99-107, 1976). 3. The number of patients with lung disease due to atypical mycobacteria who were hospitalized in the period April, 1975 to March, 1976 was 128. Out of these, ca. 94% of the patients belonged to the disease due to M. avium-intracellulare omplex, and only 3% to that due to M. kansasii. Two cases showed the disease due to M fortuitum (Table 3). The frequency of occurrence of disease, so far observed using a ratio, the number of patients with disease due to atypical mycobacteria per the number of patients with lung disease (including tuberculosis) under hospitalization per day, as an index, was high in the hospitals located in the South coast of Honshu and Shikoku islands facing Pacific Ocean (Table 4 and Fig. 2). 4. The kinds of species isolated from sputa of patients with cavitary lung disease (mostly tuberculosis) and/or bronchiectasis were almost the same in three studies (Table 5). However, decrease in the ratio of M. nonchromogenicum was observed (1968 7.5%, 1971 4.4%, 1974 2.3%, t975 0.4%). 5. The kinds of species that caused lung disease were almost similar in our three studies (Table 6). Disease due to M. aviwn-intracellulare complex showed 94 to 96% of all atypical mycobacterioses, and disease due to M. kansasii 2 to 4% (Table 6). So far observed from the index used, the ratio of patients with lung disease due to atypical mycobacteria is increasing (Table 6). This increase has been suggested to be due to accumulation of such patients, as our another study (Kekkaku, 51: 447-451, 1976) showed that the prevalence rate of the disease among newly hospitalized patients was almost the same in recent five years (1971 to 1975).
The devastating effects of the recent global pandemic (termed COVID-19 for “coronavirus disease 2019”) caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) are paramount with ...new cases and deaths growing at an exponential rate. In order to provide a better understanding of SARS CoV-2, this article will review the proteins found in the SARS CoV-2 that caused this global pandemic.
We describe a case of gastric cancer with multiple liver metastasis that clearly decreased in size after administration of 5'-DFUR. The patient (a 63-year-old male) was inoperable because of multiple ...liver metastasis. 5'-DFUR 600 mg/day reduced the size of the multiple liver tumors (reduction rate 90%, partial response for four months), but the gastric tumor was unaltered. A rapid decrease in alkali-phosphatase indicated reduction of the liver tumors only one week after the initiation of 5'-DFUR.
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct ...comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones.
Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure.
Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation.
Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment. (Gut Liver 2023;17:647-658)
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