23294000
Non-Hodgkin's pleural lymphoma in long-standing tuberculous pyothorax mimicking suppuration.
A 71-year-old Chinese man presented with hemoptysis, purulent sputum, dyspnea, and distending discomfort over the right chest. Symptoms had persisted for 1 week. He had late-onset asthma and chronic heart failure attributable to car pulmonale and ischemic heart disease. He was a nonsmoker, but his history included pulmonary tuberculosis, 40 years previously. Treatment with right artificial pneumothorax resulted in a chronic pyothorax. Surgery had not been attempted because of the patient’s compromised cardiopulmonary status. On admission, the patient was tachypneic and vital signs were temperature, 37.8”C; blood pressure, 140/70 mmHg; pulse, lOO/minute. Chest examination revealed signs of a large right pleural effusion, and the rest of the physical examination was unremarkable. The leukocyte count was 12.3 X 109/L with neutrophilia of 80%; hemoglobin was 11.8 g/dL; and erythrocyte sedimentation rate (ESR) was 50 mm/h. The blood biochemistry, including the serum lactic dehydrogenase, was unremarkable. Chest radiograph showed calcified granulomata in the left lung apex and further enlargement of the huge right calcified pyothorax compared with the radiograph taken 1 year previously New multiple air-fluid levels were noticed inside the CI? Intercostal tubal drainage was performed, releasing 1800 mL of blood-stained turbid fluid in the sub sequent few days. The pleural fluid repeatedly was negative on cultures for aerobic and anaerobic microorganisms,
43301231
Delayed sternotomy wound infection due to Paecilomyces variotii in a lung transplant recipient.
We report a case of sternotomy wound infection caused by Paecilomyces variotii in a previously bronchiectatic patient, occurring 10 months after bilateral sequential lung transplantation. The use of prophylactic antifungal therapy, the persistent colonization with Paecilomyces, and sternal instability after clamshell incision may have contributed to the development of delayed deep sternal wound infection. Besides antifungal therapy, vigorous surgical debridement is vital for treatment success. With the more liberal use of early post-transplant fungal prophylaxis, potentially drug-resistant fungi, such as the Paecilomyces species, may be emerging as important opportunistic pathogens after lung transplantation.
9308687
Multidrug-resistant tuberculosis in a lung transplant recipient.
Tuberculosis infection has been a relatively rare complication after lung transplantation. However, as more countries in which Mycobacterium tuberculosis infection remains endemic embark on lung transplant programs, the occurrence of multidrug-resistant tuberculosis after transplantation is a genuine threat. We report the first case of multidrug-resistant tuberculosis in a double-lung transplant recipient who probably acquired the disease from the donor. We discuss the problems in clinical management of post-transplant tuberculosis infection and of drug-resistance.
1652703
Ankylosing spondylitis in a patient with myelodysplastic syndrome: an association with HLA-B27 or coincidence?
The authors report an unusual case of myelodysplastic syndrome (MDS) associated with ankylosing spondylitis (AS). A 40-year-old-man with MDS presented with chronic low back pain for 6 years. Four years ago, MDS was diagnosed during routine blood analysis for the work-up of his articular complaints. His initial articular complaints were attributed to extramedullary manifestations of MDS. Persistent low back pain with increasing intensity finally led the patient to seek medical attention. Radiograph of the pelvis showed bilateral asymmetric sacroiliitis. A diagnosis of AS was established on the basis of modified New York criteria. Although various autoimmune phenomena associated with MDS have been described, this is the first report of AS in the setting of MDS. Causal relationship between these two disorders is currently unknown. Increased risk of hematological diseases as well as AS in individuals with a positive HLA-B27 provides a feasible explanation for this rare observation.
19885934
Identification and functional characterization of genes involved in the sexual reproduction of the ascomycete fungus Gibberella zeae.
We previously reported that G protein alpha subunit 1 (GPA1) is essential for sexual reproduction in the homothallic ascomycete fungus Gibberella zeae. In this study we performed microarray analyses on a GPA1 deletion mutant of G. zeae (Δgpa1) to identify genes involved in the sexual reproduction of this fungus. In the Δgpa1 strain, 645 genes were down-regulated and 550 genes were up-regulated during sexual reproduction when compared to the wild-type strain. One hundred of the down-regulated genes were selected for further investigation based on orthologous group clusters and differences in transcript levels. Quantitative real time-PCR was used to determine transcriptional profiles of these genes at various sexual and vegetative stages. We observed that transcript levels of 78 of these genes were dramatically increased in the wild-type strain during sexual reproduction compared to levels observed during vegetative growth, and were down-regulated in Δgpa1 compared to the wild-type strain. We deleted 57 of these genes and found that four of the deletion mutants lost self-fertility and five produced fewer perithecia compared to the wild-type strain. Two mutants produced wild-type numbers of perithecia, but maturation of perithecia and ascospores was delayed. In all we identified 11 genes that are involved in sexual reproduction of G. zeae and present evidence that some of these genes function at distinct stages during sexual reproduction in the fungus.
23590250
Successful cyclophosphamide therapy with complete resolution of pulmonary artery aneurysm in Hughes–Stovin syndrome patient
Hughes–Stovin syndrome is an exceedingly rare disorder of unknown etiology, and it is characterized by multiple pulmonary artery aneurysms and peripheral venous thrombosis. We report a case of Hughes–Stovin syndrome with complete resolution of pulmonary artery aneurysm after treatment with cyclophosphamide. A 48-year-old man presented with massive hemoptysis, fever, and weight loss of 4-month duration. Computed tomography angiography revealed multiple pulmonary arterial aneurysms of variable sizes in both lung fields. Inferior vena caval thrombosis was also noted. Despite multiple surgical procedures including embolectomy and lobectomy combined with steroid therapy, new aneurysms continued to appear with persistent hemoptysis. Thorough history and physical examination did not suggest any evidence of Behcet’s disease. Hughes–Stovin syndrome was subsequently diagnosed. High-dose prednisolone combined with oral cyclophosphamide therapy was initiated. Chest radiography follow-up in 3 months revealed complete resolution of pulmonary aneurysm. No new aneurysm was detected at 15 months of follow-up.
40463310
A rapid screening method for the detection of viable spores in powder using bioluminescence.
A rapid diagnosis of a biological threat in a powder sample is important for fi rst responders who have to make decisions on-site. The present culture-based method does not provide timely results, which is a critical barrier for a quick response when a suspicious powder sample is found. The ATP bioluminescence method, combined with a heat shock, was investigated to determine the presence of spores in powder. The results show that only spore-containing powder samples provided a dramatic increase in the bioluminescence signal after the heat shock, which induces germination of the spores. Various conditions were tested to fi nd the most effective and rapid germination procedure. Elevated temperatures (37 degrees C and 50 degrees C) were more effective in germination than room temperature. At 50 degrees C, a double-strength germinant was more effective in germination than the regular strength. The 37 degrees C/15 min procedure induced the germination of spores most effectively, while a 50 degrees C/2 min procedure provided reasonably high signals, so it could make the entire procedure even faster (< 5 min). The detection limit of the bioluminescence method is < 100 spores.
36669058
Underexpression of TIM-3 and Blunted Galectin-9-Induced Apoptosis of CD4+ T Cells in Rheumatoid Arthritis
The aim of this study is to compare the expression of TIM-3 from CD4+ T cells from rheumatoid arthritis (RA) patients and healthy controls and to evaluate the effect of galectin-9 (Gal-9) on apoptosis of CD4+ T cells in these patients. CD4+ T cells from RA patients and healthy controls were isolated from peripheral blood mononuclear cells and were activated. The expression of TIM-3 mRNA in CD4+ T cells was measured using real-time polymerase chain reaction. CD4+ T cells were activated in the presence of graded doses of Gal-9 or control, and Gal-9-induced cytotoxicity and apoptotic activity of CD4+ T cells were analyzed using MTT assays and annexin-V staining, respectively. TIM-3 mRNA expression was significantly lower in CD4+ T cells from RA patients compared with those in healthy controls (p = 0.028). CD4+ T cell survival as measured by MTT assay when incubated with Gal-9 (15 nM) was significantly higher in RA patients than in healthy controls (p = 0.002). Apoptotic activity of CD4+ T cells from healthy controls as measured by annexin staining increased with graded doses of Gal-9 (0 nM vs. 30 nM, 0 nM vs. 90 nM, p = 0.016 each). However, apoptotic activity of CD4+ T cells from RA patients did not change despite the stimulation with Gal-9. Gal-9-mediated apoptosis of CD4+ T cells is dysfunctional in RA patients. Blunted Gal-9-mediated apoptosis may be exerted through underexpression of TIM-3 that negatively regulates Th1 response. Our data suggest that TIM-3 and its interaction with Gal-9 may play an important role in the pathogenesis of RA and may represent a potential therapeutic target.