Internal medicine
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This is a report of a patient with occupational hypersensitivity pneumonitis (HP) caused by Konjak flour and powdered Hijikia fusiforme. A 56-year-old man had worked as a Konnyaku manufacturer for 38 years, and suffered from dyspnea on exertion. ⋯ The diagnosis of HP was confirmed immunologically by the detection of serum precipitins to powdered Hijikia fusiforme, and by the positive result of in vitro lymphocytic proliferative response for Konjak flour using peripheral blood lymphocytes. To our knowledge, this is the first case report of Konnyaku manufacturer's lung.
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Although cigarette smoking is a recognized cause of acute eosinophilic pneumonia (AEP), and an increase in eosinophils in the lung is a common occurrence in AEP, early-phase neutrophilia in AEP is not well understood. We describe three cases of cigarette smoke (menthol type)-induced AEP with neutrophilia in the lungs or blood. Increased in-vitro production of the neutrophil chemoattractant interleukin (IL)-8 by human bronchial epithelial cells (HBECs) was correlated with neutrophilia. We suggest that IL-8 released from HBECs is involved in neutrophilia in the lung in AEP, and is newly recognized as an important factor in the early phase of AEP development.
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Editorial Comment
Treatment of pulmonary disease caused by Mycobacterium avium complex.
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We report 7 cases of adrenal tumors with concurrent increases in cortisol and aldosterone secretion, which we have examined over the last 2 years. We also present the pathology of excised specimens based on immunohistochemical staining, as well as endocrinological findings. Four patients were male and 3 female; 6 were first diagnosed as suffering from primary aldosteronism (PA) and one as adrenal preclinical Cushing's syndrome (PCS). ⋯ No increase in renin activity was seen in the renin-producing irritable test in any of the patients. Immunohistochemical staining showed not only the presence of aldosteronoma, but also the expression of P-450c17, which is involved in the biosynthesis of cortisol, indicating that both cortisol and aldosterone were concurrently synthesized. With regard to the function of adrenal tumors, we suggest that concurrent secretion of cortisol and aldosterone are not rare and that immunohistochemical examination of the surgically-extirpated specimen is important for diagnosis.
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High-dose trimethoprim-sulfamethoxazole (TMP-SMX) is known to cause hyperkalemia by blocking amiloride-sensitive sodium (Na) channels in distal nephrons. The purpose of this study was to establish whether the standard dose of TMP-SMX could cause electrolyte disorders. ⋯ Electrolyte disorders, particularly hyperkalemia and hyponatremia can be detected in patients given TMP-SMX. These disorders are more frequent in patients given high doses, but can also be detected after low-dose administration. Renal dysfunction accelerates the incidence of electrolyte disorders induced by TMP-SMX.