Papers - Asakura, Takanori

Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients.

Masako Ueyama, Takanori Asakura, Kozo Morimoto, Ho Namkoong, Shuichi Matsuda, Takeshi Osawa, Makoto Ishii, Naoki Hasegawa, Atsuyuki Kurashima, Hajime Goto

Medicine 95 ( 29 ) e4246 2016.07

Accepted,  ISSN  0025-7974

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The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative prognostic factor for pneumothorax associated with NTMPD in multivariate analysis (HR 0.79, 95% CI 0.64-0.96; P = 0.018)Patients with pneumothorax associated with NTMPD have advanced disease, a high rate of pneumothorax recurrence, and poor prognosis, regardless of the pneumothorax treatment used. Further improvements in early diagnosis of NTMPD and appropriate management in both NTMPD and NTMPD-associated pneumothorax are needed.

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Streptococcus pneumoniae-induced purpura fulminans.

T Asakura, A Higuchi, N Mori

QJM : monthly journal of the Association of Physicians 109 ( 7 ) 499 - 500 2016.07

Accepted

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Asakura T, Higuchi A, Mori N, QJM : monthly journal of the Association of Physicians, 2016

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Finger Fractures as an Early Manifestation of Primary Hyperparathyroidism Among Young Patients: A Case Report of a 30-Year-Old Male With Recurrent Osteoporotic Fractures.

Akihiko Ozaki, Tetsuya Tanimoto, Eiki Yamagishi, Shunsuke Sato, Manabu Tsukada, Toyoaki Sawano, Claire Leppold, Kenji Tsuda, Takanori Asakura, Masaharu Tsubokura, Shigeaki Kato, Masahiro Kami, Hiromichi Ohira

Medicine 95 ( 20 ) e3683 2016.05

Accepted,  ISSN  0025-7974

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Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism. However, little information is available regarding early skeletal manifestations of primary hyperparathyroidism.A 30-year-old Japanese male presented with pain in his left wrist, and was diagnosed with a distal radius fracture. During surgery, we noticed decreased bone strength of the fracture site. Further investigation found osteoporosis and primary hyperparathyroidism owing to a solitary parathyroid adenoma, which was resected without significant complications. History revealed that the patient suffered a metacarpal bone fracture of his right fifth bone 6 months earlier. Although serial x-rays at that time had shown rapidly developed cortical bone erosion around the fractured finger, the possibility of primary hyperparathyroidism was overlooked because of poor awareness of the condition, leading to a 6-month delay in the diagnosis of primary hyperparathyroidism.Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.

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Multiple nodular lesions following Pneumocystis pneumonia in a non-HIV immunocompromised patient.

Takanori Asakura, Naofumi Kameyama, Makoto Ishii, Ichiro Kawada, Sadatomo Tasaka, Kenzo Soejima, Tomoko Betsuyaku

Clinical case reports 4 ( 5 ) 528 - 30 2016.05

Accepted

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Cytomegalovirus superinfection is associated with a poor prognosis in non-HIV Pneumocystis pneumonia (PCP) and can cause deterioration of PCP not only simultaneously but also after initiating PCP treatment. Cytomegalovirus pneumonia should be considered in cases with deterioration after initiating PCP treatment; multiple nodular lesions are useful findings for the diagnosis.

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Pneumococcal Infection Aggravates Elastase-Induced Emphysema via Matrix Metalloproteinase 12 Overexpression.

Saeko Takahashi, Makoto Ishii, Ho Namkoong, Ahmed E Hegab, Takahiro Asami, Kazuma Yagi, Mamoru Sasaki, Mizuha Haraguchi, Minako Sato, Naofumi Kameyama, Takanori Asakura, Shoji Suzuki, Sadatomo Tasaka, Satoshi Iwata, Naoki Hasegawa, Tomoko Betsuyaku

The Journal of infectious diseases 213 ( 6 ) 1018 - 30 2016.03

Accepted,  ISSN  0022-1899

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Disseminated Mycobacterium marinum Infection With a Destructive Nasal Lesion Mimicking Extranodal NK/T Cell Lymphoma: A Case Report.

Takanori Asakura, Makoto Ishii, Taku Kikuchi, Kaori Kameyama, Ho Namkoong, Noboru Nakata, Kayoko Sugita, Sadatomo Tasaka, Takayuki Shimizu, Yoshihiko Hoshino, Shinichiro Okamoto, Tomoko Betsuyaku, Naoki Hasegawa

Medicine 95 ( 11 ) e3131 2016.03

Accepted,  ISSN  0025-7974

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Mycobacterium marinum is a ubiquitous waterborne organism that mainly causes skin infection in immunocompetent patients, and its disseminated infection is rare. Extranodal NK/T cell lymphoma, nasal type (ENKL) usually localizes at the nasal and/or paranasal area, but occasionally disseminates into the skin/soft tissue and gastrointestinal tract. Compromised immunity is a risk factor for developing nontuberculous mycobacterial (NTM) infection and malignant lymphoma, and the 2 diseases may share similar clinical presentation; however, only a few reports have described NTM infection mimicking malignant lymphoma.A 43-year-old Japanese man presented to our hospital complaining of multiple progressive skin nodules and purulent nasal discharge for 3 weeks. He was diagnosed with Crohn disease with refractory enteropathic arthritis and has been treated with anti-tumor necrosis factor alpha agents for 25 years. Fiberoptic nasal examination revealed septal perforation with hemorrhagic mucus and purulent rhinorrhea. Histological examination of the nasal septum revealed the infiltration of atypical medium-to-large-sized cells with erosion. The cells were positive for cytoplasmic CD3, granzyme B, and Epstein-Barr virus-encoded small RNA. Histological examination of the skin nodules and auricle also showed infiltration of atypical lymphocytes. The patient was tentatively diagnosed with ENKL, and chemotherapy was considered. However, the skin lesions decreased in size after discontinuation of immunosuppressive agents and minocycline administration. Two weeks later, nasal septum and lavage fluid and left leg skin cultures were positive for M marinum, and minocycline was discontinued. The skin and the nasal lesions improved after 2 months. To the best of our knowledge, this is the first case of disseminated M marinum infection with a destructive nasal lesion mimicking ENKL. The differentiation between M marinum infection and ENKL is clinically important because misdirected treatment leads to a poor prognosis. NTM infections including M marinum should be considered in differential diagnosis of ENKL. Bacterial cultures, pathological analysis, and close monitoring are required for the differentiation of ENKL and disseminated M marinum infection; both are serious diseases and early diagnostic distinction between them and immediate appropriate treatment will improve the patient's prognosis.

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Blue-Black Trachea as a Result of Minocycline-induced Hyperpigmentation.

Takanori Asakura, Shigenari Nukaga, Ho Namkoong, Kazuma Yagi, Shoji Suzuki, Makoto Ishii, Sadatomo Tasaka, Tomoko Betsuyaku, Naoki Hasegawa

American journal of respiratory and critical care medicine 193 ( 3 ) e5-6 - e6 2016.02

Accepted,  ISSN  1073-449X

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Intimal Sarcoma of the Pulmonary Artery Treated with Pazopanib.

Yohei Funatsu, Miwa Hirayama, Junichi Shiraishi, Takanori Asakura, Misa Wakaki, Erina Yamada, Kazuyuki Fujimoto, Ryosuke Satomi, Shunsuke Inaki, Yuya Murata, Yoshitaka Oyamada

Internal medicine (Tokyo, Japan) 55 ( 16 ) 2197 - 202 2016

Accepted,  ISSN  0918-2918

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Intimal sarcoma is a rare disease with a poor prognosis. We herein report the case of a 71-year-old man with intimal sarcoma of the pulmonary artery treated with pazopanib. The tumor showed regression after 1 month of treatment. Hand-foot syndrome led to cessation of pazopanib, which triggered a disease flare. Pazopanib should be considered in patients with intimal sarcoma of the pulmonary artery that is unresectable or recurrent after surgery or cytotoxic chemotherapy. We must be careful about drug cessation, as it can lead to a disease flare.

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Theory and strategy for Pneumococcal vaccines in the elderly.

Ho Namkoong, Makoto Ishii, Yohei Funatsu, Yoshifumi Kimizuka, Kazuma Yagi, Takahiro Asami, Takanori Asakura, Shoji Suzuki, Testuro Kamo, Hiroshi Fujiwara, Sadatomo Tasaka, Tomoko Betsuyaku, Naoki Hasegawa

Human vaccines & immunotherapeutics 12 ( 2 ) 336 - 43 2016

Accepted,  ISSN  2164-5515

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Health-related quality of life is inversely correlated with C-reactive protein and age in Mycobacterium avium complex lung disease: a cross-sectional analysis of 235 patients.

Takanori Asakura, Yohei Funatsu, Makoto Ishii, Ho Namkoong, Kazuma Yagi, Shoji Suzuki, Takahiro Asami, Tetsuro Kamo, Hiroshi Fujiwara, Yoshifumi Uwamino, Tomoyasu Nishimura, Sadatomo Tasaka, Tomoko Betsuyaku, Naoki Hasegawa

Respiratory research 16 ( 1 ) 145 - 145 2015.12

Accepted,  ISSN  1465-9921

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BACKGROUND: Mycobacterium avium complex (MAC) lung diseases generally cause chronic disease in immunocompetent hosts. Although a few studies have examined health-related quality of life (HRQL) in patients with MAC lung disease, there have been no large studies. This study aimed to evaluate HRQL and its correlation with clinical outcomes in MAC lung disease. METHODS: A cross-sectional study was conducted at Keio University Hospital to investigate the factors associated with HRQL in pulmonary nontuberculous mycobacterial diseases. MAC lung diseases were diagnosed according to the 2007 ATS/IDSA guidelines for nontuberculous mycobacterial diseases. The 36-item short form health survey (SF-36) was administered to assess clinical outcomes. Clinical variables included treatment status, latest haematological data, and bacterial smear and culture results. RESULTS: The SF-36 scores for the 235 patients (median age, 69 years; 45 men and 190 women) with MAC lung disease, except for the bodily pain and mental health subscale scores, were significantly lower than the Japanese population norms. In the multivariable analyses, current treatment for MAC and a positive sputum smear or culture within the past year were significantly associated with lower SF-36 scores. C-reactive protein (CRP) and age showed stronger inverse correlations with SF-36 scores. CONCLUSIONS: HRQL, especially the physical component, was impaired in patients with MAC lung diseases; this appears to be related with current treatment status, positive sputum smear or culture within the previous year, and particularly CRP and age. Further studies including qualitative assessments are needed to investigate the efficacy of CRP as a marker for progression or treatment response in MAC lung disease. TRIAL REGISTRATION: Clinical trial registered with UMIN ( UMIN000007964 ).

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Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.

Takanori Asakura, Makoto Ishii, Mizuha Haraguchi, Ikuo Kamiyama, Mitsutomo Kohno, Hiroyuki Sakamaki, Katsura Emoto, Yuichiro Hayashi, Hiroaki Sugiura, Ichiro Kawada, Kenzo Soejima, Ho Namkoong, Sadatomo Tasaka, Naoki Hasegawa, Tomoko Betsuyaku

Journal of medical case reports 9 ( 1 ) 238 - 238 2015.10

Accepted

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Immune reconstitution inflammatory syndrome due to Mycobacterium avium complex successfully followed up using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography in a patient with human immunodeficiency virus infection: A case report.

Ho Namkoong, Hiroshi Fujiwara, Makoto Ishii, Kazuma Yagi, Mizuha Haraguchi, Masako Matsusaka, Shoji Suzuki, Takanori Asakura, Takahiro Asami, Fumitake Saito, Koichi Fukunaga, Sadatomo Tasaka, Tomoko Betsuyaku, Naoki Hasegawa

BMC medical imaging 15 ( 1 ) 24 - 24 2015.07

Accepted

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A massive cavitary lesion invading the chest wall.

Takanori Asakura, Yohei Funatsu, Takahiko Oyama, Katsutaka Mineura, Arafumi Maeshima, Takashi Okabe, Hironori Ueno, Takahiro Yano, Yoshitaka Oyamada, Ryoichi Kato

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 34   117 - 8 2015.05

Accepted,  ISSN  1201-9712

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Roving eye movements in a patient with hypoglycemic coma.

Takanori Asakura, Nobuaki Mori

Clinical case reports 3 ( 5 ) 335 - 6 2015.05

Accepted

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Roving eye movements are the sign of cortical dysfunction not involving the brainstem. This finding is useful in the differential diagnosis of impaired consciousness and indicates cerebral damage in patients with hypoglycemic coma.

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Levels of Soluble Receptor for Advanced Glycation End Products in Bronchoalveolar Lavage Fluid in Patients with Various Inflammatory Lung Diseases.

Tetsuro Kamo, Sadatomo Tasaka, Yuriko Tokuda, Shoji Suzuki, Takanori Asakura, Kazuma Yagi, Ho Namkoong, Makoto Ishii, Naoki Hasegawa, Tomoko Betsuyaku

Clinical medicine insights. Circulatory, respiratory and pulmonary medicine (Libertas Academica Ltd.)  9 ( Suppl 1 ) 147 - 54 2015

Accepted,  ISSN  1179-5484

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Small Cell Lung Cancer Expressing Glutamate Decarboxylase with Latent Autoimmune Diabetes in Adults.

Takanori Asakura, Shuichi Yoshida, Arafumi Maeshima, Kazuyuki Fujimoto, Rie Jo, Kyoko Iwase, Yoshitaka Oyamada

Internal medicine (Tokyo, Japan) 54 ( 23 ) 3035 - 7 2015

Accepted,  ISSN  0918-2918

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Small cell lung cancer (SCLC) causes paraneoplastic syndromes, such as diabetes mellitus, by eliciting the expression of various antibodies including anti-glutamate decarboxylase (GAD) antibody. A 62-year-old woman presented to our hospital with a 1-week history of progressive dyspnea and difficulty in walking. Computed tomography showed a tumor obstructing the left bronchus and obstructive lung abscesses with pleural effusions. A biopsy during bronchoscopy revealed SCLC, and the clinical stage was ultimately determined to be IIIB. SCLC was complicated by diabetes mellitus with high titers of serum anti-GAD antibody. An immunohistochemical analysis showed GAD expression in the cancer cells, which is a novel finding.

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Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression.

Takanori Asakura, Nobutake Ito, Takahiro Sohma, Nobuaki Mori

Internal medicine (Tokyo, Japan) 54 ( 13 ) 1619 - 22 2015

Accepted,  ISSN  0918-2918

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Pulmonary nocardiosis caused by Nocardia cyriacigeorgica in patients with Mycobacterium avium complex lung disease: two case reports.

Kazuma Yagi, Makoto Ishii, Ho Namkoong, Takahiro Asami, Hiroshi Fujiwara, Tomoyasu Nishimura, Fumitake Saito, Yoshifumi Kimizuka, Takanori Asakura, Shoji Suzuki, Tetsuro Kamo, Sadatomo Tasaka, Tohru Gonoi, Katsuhiko Kamei, Tomoko Betsuyaku, Naoki Hasegawa

BMC infectious diseases 14 ( 1 ) 684 - 684 2014.12

Accepted

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Efficacy of empirical therapy with non-carbapenems for urinary tract infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae.

Takanori Asakura, Masayuki Ikeda, Akira Nakamura, Satoshi Kodera

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 29   91 - 5 2014.12

Accepted,  ISSN  1201-9712

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Thiamine-responsive pulmonary hypertension.

Takanori Asakura, Satoshi Kodera, Junji Kanda, Masayuki Ikeda

BMJ case reports 2013 2013.01

Accepted

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