A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent.

Given the results of the present study, anaerobes may play an important role in the pathogenesis of bronchiectasis in patients with NTM.

We evaluated the incidence and outcome of lung involvement in 35 patients with autoimmune pancreatitis (AIP). Our results indicate that lung involvement is commonly observed in AIP (40%). In addition, corticosteroid treatment improved the lung lesions and appeared to reduce the probability of relapse compared with pancreatic lesions (0% vs 36%). This is the first report to assess the long-term outcome of lung involvement in AIP (52 ± 33 months).Key words: autoimmune pancreatitis, immunoglobulin G4, immunoglobulin G4-related disease, immunoglobulin G4-related lung disease, type 1 autoimmune pancreatitis.Abbreviations: AIP, autoimmune pancreatitis; CT, computed tomography; IgG4-RD, immunoglobulin G4-related disease; L-AIP, autoimmune pancreatitis with lung involvement; NL-AIP, autoimmune pancreatitis without lung involvement.Immunoglobulin G4-related disease (IgG4-RD) is a recently described systemic fibroinflammatory condition associated with an elevated serum IgG4 level and abundant IgG4-positive plasma cell infiltration involving multiple organs.1,2 Type 1 autoimmune pancreatitis (AIP) is the prototypical form of systemic IgG4-RD, and various clinical findings have been documented for this disease. Early intervention using corticosteroids has been shown to improve IgG4-related organ dysfunction, although relapse of the disease is common. In addition, various types of lung involvement in IgG4-RD, including interstitial pneumonia, inflammatory pseudotumours and lymphadenopathy, have been described. [3][4][5][6][7] In contrast, the clinical characteristics of lung involvement in IgG4-RD, in particular the response to treatment and prognosis, remain unclear. In this study, we retrospectively evaluated the incidence and outcomes of lung involvement in 35 patients with AIP.Between December 1996 and March 2011, a total of 35 patients with type 1 AIP diagnosed at our university hospital according to the consensus diagnostic criteria 8,9 were consecutively enrolled in this study (24 males and 11 females, average age: 67 ± 9), with a median follow-up time of 52 ± 33 months (range: 5-160 months). All patients were examined using chest and abdominal computed tomography (CT) at the time of diagnosis and relapse, and underwent chest X-ray examinations at least every 6 months, regardless of the presence or absence of respiratory symptoms. In addition, all patients regularly received medical examinations by a physician using abdominal ultrasound and assessments of biochemical parameters, including serum IgG4 levels. Lung involvement in AIP was diagnosed based on findings of chest CT abnormalities accompanied by compatible X-ray findings associated with IgG4-related lung disease, with or without a favourable response to corticosteroid therapy. Definitive diagnosis for a relapse of AIP and lung involvement was according to the CT findings since re-elevation of the serological levels alone without any abnormal CT findings is not considered to indicate a relapse. [10][11][12][13] We retrospectively reviewed the following data: (i)...

Aim To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A‐DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I‐ROAD) scoring systems, and risk factor evaluation of potentially drug‐resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing‐ and healthcare‐associated pneumonia patients. Methods We included 289 hospitalized nursing‐ and healthcare‐associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A‐DROP, I‐ROAD and qSOFA to predict pneumonia‐related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia‐related mortality. Results The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia‐related mortality predicted using PSI, A‐DROP, I‐ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59–0.80), 0.63 (95% CI 0.51–0.76), 0.61 (95% CI 0.52–0.70) and 0.701 (95% CI 0.59–0.81), respectively. In addition, higher areas under the curve were observed for pneumonia‐related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64–0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62–0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia‐related mortality. Conclusions qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia‐related mortality in nursing‐ and healthcare‐associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177–183.

Paraneoplastic neurological syndromes (PNS), such as sensory polyneuropathy, are rare, and serum neuronal antibodies that are used for diagnosing this syndrome are occasionally positive. Similarly, neurological immune-related adverse events due to immune checkpoint inhibitors (ICIs) are also rare. However, their etiologies and the relationship between them remain unclear. We herein report a patient with suspected small cell lung cancer who showed sensory polyneuropathy after treatment with atezolizumab in combination with cytotoxic agents (carboplatin and etoposide) and was doubly positive for serum anti-Hu and anti-SOX-1 antibodies. Treatment with ICI and cytotoxic agents may sometimes lead to the development of PNS.