A 43-year-old woman was treated with piperacillin (PIPC) for spiking fever. Although she was afebrile, fever recurred on the 18th day of PIPC administration with progressive dyspnea and diffuse ground glass shadows on the chest X-ray. Bronchoalveolar lavage fluid (BALF) showed marked increase of total cell number and percentage of lymphocytes and a reduction of the ratio of CD4/CD8. Transbronchial lung biopsy (TBLB) specimen revealed interstitial infiltration of lymphocytes and histiocytes with granulomatous lesions. The drug lymphocyte stimulation test (DLST) was positive for PIPC. Based on these findings, the diagnosis of PIPC-induced pneumonitis was made. Recently, the incidence of drug-induced pneumonitis has increased, but to our knowledge this is a rare case report of PIPC-induced pneumonitis.
Abstract A randomized trial of chemotherapy in 105 patients with advanced and metastatic nonsmall‐cell lung cancer (NCSLC) was conducted in order to compare the effect of the additional drug mitomycin C (PVM) or ifosfamide (PVI), to the combination of cisplatin plus vindesine (PV). An objective response rate was observed in 42.8% of the patients treated with PVM, 42.4% with PVI and 28.6% with PV and these response rates were not statistically significant (P > 0.20). No patient achieved the complete response with either of the three regimens. Comparison of the median response durations among the three regimens showed an advantage of PVI over PVM (P < 0.02) and PV (P < 0.05). The median survival times (MST) were similar for all three regimens (PVM, 33.5; PVI, 40.0 and PV, 36.5 weeks); moreover, the difference in survival time between the three regimens of responders was not statistically significant. The univariate analysis showed that significant predictors of survival were performance status (PS) zero (P = 0.0002), limited disease (P = 0.004), no previous weight loss (P = 0.01) and normal serum albumin (P = 0.016), and in multivariate analysis by a stepwise Cox proportional hazard model, these were PS zero (a hazard ratio of 2.3, P = 0.0001) and limited disease (a hazard ratio of 1.9, P = 0.048). Toxicity did not differ among the three treatment regimens.
We investigated the relationship between tracheobronchial involvement in esophageal cancer and bronchoscopic findings in 27 patients. The bronchoscopic findings were classified into five types. Tracheobronchial involvement was confirmed in cases with endobronchial tumor, with protrusion and abnormal mucosa. In cases without protrusion, the absence of involvement was confirmed. Since a judgment of tracheobronchial involvement is difficult in cases with protrusion but an otherwise normal mucosa, use of CT and MRI, where an assessment of the thickness of the esophageal cancer may be made, is important for detecting involvement.
We experienced a case of progressive giant bulla which ruptured and disappeared on chest roentgenogram. The patient was a 60-year-old male who had been treated with home oxygen therapy for chronic pulmonary emphysema. One year after initiating home oxygen, emphysematous bulla occurred and expanded to become giant bulla which occupied 3/4 of the right hemithorax. Although we attempted to persuade him to undergo surgery for bullectomy, he refused. While being followed as an outpatient, sudden right anterior chest pain occurred, and dyspnea was markedly alleviated at the same time. Chest roentgenogram revealed right pneumothorax and pleural effusion, and the giant bulla subsequently receded. The patient has been stable for the approximately one year period since, without evidence of recurrence. It is rare for giant bullae to cause a pneumothorax. In addition, there are no previous reports in the literature with a clinical course such as that experienced by our patient.
The value of fiberoptic bronchoscopy in the diagnosis of solitary pulmonary nodules was studied. The subjects were 59 patients with chest-roentgenographic evidence of a solitary pulmonary nodule 2 cm or less in diameter. Definitive diagnoses were made in 34 patients (57.6%). Primary lung care was diagnosed 21 of 32 patients (65.6%), pulmonary tuberculosis in 7 of 12 (58.3%), metastatic lung cancer in 3 of 5 (60%), old lesions in 3 of 5 (60%), and pulmonary filariasis in 0 of 1 (0%). The diagnostic sensitivity of transbronchial biopsy was superior to that of curettage, and combining the two techniques further improved the diagnostic yield. Bronchial lavage was not effective for diagnosis of lung cancer, but was effective for diagnosis of pulmonary tuberculosis. Diagnostic yield was less for nodules in upper lobes than for those in other lobes, and most malignant tumors that were not diagnosed from the results of fiberoptic bronchoscopy were in upper lobes. We conclude that combining various fiberoptic bronchoscopic procedures can improve the diagnostic yield in patients with small pulmonary nodules. CT-guided needle biopsy and video-assisted thoracoscopic biopsy are two such procedures. Early diagnosis of small pulmonary nodules requires a skilled bronchoscopist who can choose the most appropriate method for biopsy.
A retrospective analysis was done of 88 patients with hemoptysis cared for between 1991 and 1997 at our institution. There were 56 male and 32 female patients, with a mean age of 52 years (range: 15 to 91 years). On chest X-ray, there were 31 patients (35.2%) with findings related to hemoptysis, and 57 patients (64.8%) with normal or no related findings. The part of lung from which the intrabronchial hemorrhage originated could be localized in 45 patients (51.1%) by bronchofiberscope. The upper right lobe was involved more often than the others. The most common underlying cause of hemoptysis was bronchiectasis, which accounted for 46.6% of our patients. Bronchial arteriography was performed in massive hemoptysis patients. Angiographic findings for the bronchial arteries consisted of dilatation, hypervascularity, bronchopulmonary shunts, and extravasation. Successful control of bleeding by conservative therapies was achieved for 64 patients (72.7%). There were 16 patients who underwent bronchial-artery embolization or operation, and 8 patients who had endobronchial treatment.
