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Yamanaka S, So C, Nishimura N, Nakamura T, Kabemura S, Kumagai R, Okafuji K, Kitamura A, Kojima F, Tomishima Y, Jinta T, Bando T. Successful thoracoscopic operative approach for refractory pneumothorax in interstitial lung disease under local anaesthesia. Respirol Case Rep 2024; 12:e01331. [PMID: 38528945 PMCID: PMC10963132 DOI: 10.1002/rcr2.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024] Open
Abstract
Refractory pneumothorax associated with interstitial lung disease (ILD) remains a challenging condition due to the patient's tolerability and lung compliance that restrict the feasibility of aggressive interventions. Additionally, many cases recur after improvement with treatment, and reports of successful management for this complicated condition are limited. Herein, we report the case of a 60-year-old man with ILD, utilizing home oxygen therapy, who experienced a successful recovery from a surgical intervention under local anaesthesia for pneumothorax. This case highlights the potential for operative intervention under local anaesthesia as a viable option for patients who do not respond to internal approaches.
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Affiliation(s)
- Shinya Yamanaka
- Department of Internal MedicineSt. Luke's International HospitalTokyoJapan
| | - Clara So
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Shinsaku Kabemura
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Ryosuke Kumagai
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kohei Okafuji
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Toru Bando
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
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Fujita K, Arai R, Shoji S, Saito R, Nomura M, Hotta T, Asahina H, Kawakami M, Nakachi I, Hasegawa Y, Okafuji K, Suzuki A, Miyanaga A, Sunaga N, Nagashima H, Ikeda N, Watanabe S, Nagai Y, Furuta M, Kage H, Arai D, Fukuhara T, Nakayama M, Morita S, Kobayashi K, Hagiwara K. Detection of multiple druggable mutations of lung cancer from cytology specimens by MINtS: An advanced medicine A trial. Cancer Sci 2023; 114:3342-3351. [PMID: 37139543 PMCID: PMC10394136 DOI: 10.1111/cas.15831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
Most multigene mutation tests require tissue specimens. However, cytological specimens are easily obtained in the clinical practice and provide high-quality DNA and RNA. We aimed to establish a test that utilizes cytological specimens and performed a multi-institutional study to investigate the performance of MINtS, a test based on next-generation sequencing. A standard procedure for specimen isolation was defined. The specimens were considered suitable for the test if >100 ng DNA and >50 ng RNA could be extracted from them. In total, 500 specimens from 19 institutions were investigated. MINtS detected druggable mutations in 63% (136 of 222) of adenocarcinomas. Discordant results between MINtS and the companion diagnostics were observed in 14 of 310 specimens for the EGFR gene, and 6 of 339 specimens for the ALK fusion genes. Confirmation by other companion diagnostics for the EGFR mutations or the clinical response to an ALK inhibitor all supported the results obtained by MINtS. MINtS along with the isolation procedure presented in the current study will be a platform to establish multigene mutation tests that utilize cytological specimens. UMIN000040415.
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Affiliation(s)
- Kazutaka Fujita
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
| | - Ryo Arai
- Department of Pulmonary and Clinical ImmunologyDokkyo Medical University School of Medicine, Shimotsuga‐gun Mibu‐machiTochigiJapan
| | - Satoshi Shoji
- Department of Respiratory Medicine and Infectious DiseasesNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Ryota Saito
- Department of Respiratory MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Motoko Nomura
- Division of Pulmonary Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Takamasa Hotta
- Department of Internal Medicine. Division of Medical Oncology and Respiratory MedicineShimane UniversityIzumoJapan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Masanori Kawakami
- Department of Respiratory MedicineThe University of Tokyo HospitalTokyoJapan
| | - Ichiro Nakachi
- Pulmonary Division, Department of Internal MedicineSaiseikai Utsunomiya HospitalTochigiJapan
| | - Yukihiro Hasegawa
- Department of Respiratory MedicineAomori Prefectural Central HospitalAomoriJapan
| | - Kohei Okafuji
- Department of Pulmonary MedicineSt. Luke's International HospitalTokyoJapan
| | - Aya Suzuki
- Miyagi Cancer CenterDepartment of Respiratory MedicineNatoriJapan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and OncologyGraduate School of Medicine, Nippon Medical SchoolTokyoJapan
| | - Noriaki Sunaga
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Hiromi Nagashima
- Division of Pulmonary Medicine, Department of Internal MedicineIwate Medical UniversityIwateJapan
| | - Naoya Ikeda
- Department of Pulmonary and Clinical ImmunologyDokkyo Medical University School of Medicine, Shimotsuga‐gun Mibu‐machiTochigiJapan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious DiseasesNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yoshiaki Nagai
- Division of Pulmonary Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Megumi Furuta
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Hidenori Kage
- Department of Respiratory MedicineThe University of Tokyo HospitalTokyoJapan
| | - Daisuke Arai
- Pulmonary Division, Department of Internal MedicineSaiseikai Utsunomiya HospitalTochigiJapan
| | - Tatsuro Fukuhara
- Miyagi Cancer CenterDepartment of Respiratory MedicineNatoriJapan
| | - Masayuki Nakayama
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
| | - Satoshi Morita
- Department of Biomedical Statistics and BioinformaticsKyoto University Graduate School of MedicineKyotoJapan
| | - Kunihiko Kobayashi
- Department of Respiratory MedicineSaitama Medical University, International Medical CenterSaitamaJapan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
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Nakamura T, Imai R, Kitamura A, So C, Ro S, Okafuji K, Tomishima Y, Jinta T, Nishimura N. Investigating Viral Involvement in Immunocompromised Patients Using Comprehensive Infectious Disease Testing Including FilmArray Respiratory Panel 2.1 on Bronchoscopy: A Retrospective Study. Cureus 2023; 15:e38820. [PMID: 37303378 PMCID: PMC10256251 DOI: 10.7759/cureus.38820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Reports are rare on the usefulness of the FilmArray Respiratory Panel 2.1 (FARP) using lower respiratory tract specimens. This retrospective study assessed its use, as part of a comprehensive infectious disease panel, to detect the viral causes of pneumonia using bronchoalveolar lavage samples from immunosuppressed patients. Methods This study included immunocompromised patients who underwent bronchoalveolar lavage or bronchial washing by bronchoscopy between April 1, 2021, and April 30, 2022. The collected samples were submitted for comprehensive testing, including FARP test; reverse transcription polymerase chain reaction (RT-PCR) for cytomegalovirus, varicella-zoster virus DNA, and herpes simplex virus; PCR for Pneumocystis jirovecii DNA; antigen testing for Aspergillus and Cryptococcus neoformans; and loop-mediated isothermal amplification method for Legionella. Results Out of 23 patients, 16 (70%) showed bilateral infiltrative shadows on computed tomography and three (13%) were intubated. The most common causes of immunosuppression were anticancer drug use (n=12, 52%) and hematologic tumors (n=11, 48%). Only two (9%) patients tested positive for severe acute respiratory syndrome coronavirus 2 and adenovirus by FARP. Four patients (17%) tested positive for cytomegalovirus by RT-PCR, but no inclusion bodies were identified cytologically. Nine (39%) patients tested positive for Pneumocystis jirovecii by PCR, but cytology confirmed the organism in only one case. Conclusions Comprehensive infectious disease testing, performed using bronchoalveolar lavage samples collected from lung lesions in immunosuppressed patients, showed low positive detection by FARP. The viruses currently detectable by FARP may be less involved in viral pneumonia diagnosed in immunocompromised patients.
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Affiliation(s)
- Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Ryosuke Imai
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Clara So
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Shosei Ro
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Kohei Okafuji
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, JPN
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Morita C, Kitamura A, Kinoshita K, Sueyoshi K, Murakami M, Ro S, Imai R, Okafuji K, Kojima F, Tomishima Y, Jinta T, Bando T, Nishimura N. A case of a thoracic mass negative on thoracentesis diagnosed by cryobiopsy from the visceral pleura. Respirol Case Rep 2022; 10:e01050. [PMID: 36268501 PMCID: PMC9577260 DOI: 10.1002/rcr2.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Thoracoscopy under local anaesthesia is recommended for malignant tumours with negative pleural effusion cytology. Cryobiopsy from the visceral pleura by thoracoscopy under local anaesthesia can provide more diagnostic options for patients with thoracentesis‐negative malignant effusions. Here we present the first case in which this technique was used. The patient had a pleural metastasis that could not be diagnosed even with rapid cytology of the parietal pleura biopsy. Indications, technical pitfalls, and safety tips are discussed.
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Affiliation(s)
- Chie Morita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan,Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Atsushi Kitamura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Katsuhito Kinoshita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kuniyo Sueyoshi
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Manabu Murakami
- Department of Anesthesia and Intensive Care UnitSt. Luke's International HospitalTokyoJapan
| | - Shosei Ro
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Ryosuke Imai
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kohei Okafuji
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Yutaka Tomishima
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Torahiko Jinta
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Toru Bando
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Naoki Nishimura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
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Imai R, Yamada D, Tomishima Y, Nakamura T, So C, Ro S, Okafuji K, Kitamura A, Jinta T, Nishimura N. Elevated plasma levels of Krebs von den Lungen-6 and geographic appearance on high-resolution computed tomography are associated with diffuse alveolar damage in autopsy cases of acute respiratory distress syndrome: a retrospective study. BMC Pulm Med 2022; 22:308. [PMID: 35953795 PMCID: PMC9367020 DOI: 10.1186/s12890-022-02102-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although diffuse alveolar damage (DAD) is a histopathological hallmark of acute respiratory distress syndrome (ARDS), its detection without lung biopsy is challenging. In patients with ARDS, the specificity of the Berlin definition to diagnose DAD as a reference standard is not adequately high, making it difficult to adequately diagnose DAD. The purpose of this study was to investigate the relationship between DAD and clinical findings, including KL-6 and geographic appearance, in ARDS patients and to identify more specific diagnostic criteria for DAD. Methods Among all adult autopsy cases at a tertiary hospital in Japan between January 2006 and March 2021, patients with ARDS who met the Berlin definition criteria were included. The patients’ conditions were classified according to histopathological patterns as DAD or non-DAD, and clinical characteristics, laboratory data, and high-resolution computed tomography (HRCT) findings were compared between the two groups. Results During the study period, 27 met the Berlin definition (median age: 79 years, 19 men), of whom 18 (67%) had DAD and 9 (33%) did not. In the non-DAD group, histopathologic findings revealed organizing pneumonia in seven patients and pulmonary hemorrhage in two patients. On HRCT at onset, patients with DAD had more geographic appearance than those without DAD (89% vs. 44%). In patients with geographic appearance and elevated KL-6 (> 500 U/mL), the sensitivity and specificity for DAD diagnosis were 56% and 100%, respectively. All three patients with no geographic appearance and normal KL-6 did not have DAD. Conclusions Geographic appearance on HRCT combined with KL-6 levels may predict the presence of DAD in patients with ARDS.
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Affiliation(s)
- Ryosuke Imai
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan.
| | - Daisuke Yamada
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Clara So
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Shosei Ro
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Kohei Okafuji
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan
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Kitamura A, Tomishima Y, Imai R, Nishimura N, Okafuji K, Ro S, Jinta T, Tamura T. Findings of virtual bronchoscopic navigation can predict the diagnostic rate of primary lung cancer by bronchoscopy in patients with peripheral lung lesions. BMC Pulm Med 2022; 22:270. [PMID: 35836220 PMCID: PMC9284836 DOI: 10.1186/s12890-022-02071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being minimally invasive, bronchoscopy does not always result in pathological specimens being obtained. Therefore, we investigated whether virtual bronchoscopic navigation (VBN) findings were associated with the rate of diagnosis of primary lung cancer by bronchoscopy in patients with peripheral lung lesions. METHODS This study included patients with suspected malignant peripheral lung lesions who underwent bronchoscopy at St. Luke's International Hospital between October 2013 and March 2020. Patients diagnosed with primary lung cancer were grouped according to whether their pathology could be diagnosed by bronchoscopy, and their clinical factors were compared. In addition, the distance between the edge of the lesion and the nearest branch ("distance by VBN") was calculated. The distance by VBN and various clinical factors were compared with the diagnostic rates of primary lung cancer. RESULTS The study included 523 patients with 578 lesions. After excluding 55 patients who underwent multiple bronchoscopies, 381 patients were diagnosed with primary lung cancer. The diagnostic rate by bronchoscopy was 71.1% (271/381). Multivariate analysis revealed that the lesion diameter (odds ratio [OR] 1.107), distance by VBN (OR 0.94) and lesion structure (solid lesion or ground-glass nodule; OR 2.988) influenced the risk of a lung cancer diagnosis. The area under the receiver operating characteristic curve for diagnosis based on lesion diameter and distance by VBN was 0.810. CONCLUSION The distance by VBN and lesion diameter were predictive of the diagnostic rates of primary lung cancer by bronchoscopy in patients with peripheral lung lesions.
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Affiliation(s)
- Atsushi Kitamura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan.
| | - Yutaka Tomishima
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Ryosuke Imai
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Naoki Nishimura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Kohei Okafuji
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Shosei Ro
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Torahiko Jinta
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
| | - Tomohide Tamura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Akashicho 9-1, Chuo City, Tokyo, 104-8560, Japan
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Morita C, Kitamura A, Okafuji K, Ro S, Imai R, Shirasaki K, Watanabe Y, Nishimura N. Combined treatment with endobronchial Watanabe spigot and
N
‐butyl‐2‐cyanoacrylate for refractory pneumothorax in
COVID
‐19. Respirol Case Rep 2022; 10:e0923. [PMID: 35309960 PMCID: PMC8918464 DOI: 10.1002/rcr2.923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19) causes pneumothorax or mediastinal emphysema in approximately 1% of patients. According to the British Thoracic Society guidelines, the next treatment option for patients with persistent pneumothorax despite chest drainage is pleurodesis or surgery. In fact, there are reports of autologous blood pleurodesis or surgery for the treatment of pneumothorax caused by COVID‐19. However, elderly patients or patients in poor general condition may not be able to tolerate surgical invasion. In this report, we present two patients who did not respond to chest drainage or pleurodesis and who were not suitable for surgery because of their poor general condition. These patients were successfully treated with an endobronchial Watanabe spigot and N‐butyl‐2‐cyanoacrylate. This method may be an option for the treatment of refractory pneumothorax in COVID‐19.
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Affiliation(s)
- Chie Morita
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
| | - Kohei Okafuji
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
| | - Shosei Ro
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
| | - Ryosuke Imai
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
| | - Kasumi Shirasaki
- Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Yu Watanabe
- Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine Thoracic Center, St. Luke's International Hospital Tokyo Japan
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Tomishima Y, Urayama KY, Kitamura A, Okafuji K, Jinta T, Nishimura N, Tamura T. Bronchoscopy for the diagnosis of nontuberculous mycobacterial pulmonary disease: Specificity and diagnostic yield in a retrospective cohort study. Respir Investig 2022; 60:355-363. [PMID: 34998716 DOI: 10.1016/j.resinv.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchoscopy is a recognized method for obtaining specimens for the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its diagnostic properties remain to be elucidated. The aim of this study was to determine the specificity of bronchoscopy for the diagnosis of NTM-PD, and to examine the diagnostic yield of bronchoscopy for detecting nontuberculous mycobacteria (NTM) when patients cannot expectorate sputum with NTM. METHODS This retrospective cohort study included 2657 patients who underwent bronchoscopy and mycobacterial culture between January 2004 and June 2018 in a tertiary care center in Tokyo, Japan. To examine the specificity of bronchoscopy, the first cohort comprised patients who underwent bronchoscopy for the diagnosis of lung cancer and mycobacterial culture. To investigate the diagnostic yield, patients with nodular bronchiectasis who underwent bronchoscopy for the diagnosis of NTM-PD were enrolled into the second cohort. RESULTS In total, 919 patients were diagnosed with lung cancer, 19 patients showed positive culture for NTM, and 14 patients showed findings for NTM-PD. Accordingly, the specificity was calculated as 900/905 (99.4%). In addition, NTM-PD was suspected before bronchoscopy in 199 patients; the diagnostic yield was 105/199 (52.8%). Four factors were associated with NTM-PD: upper lobe examination, absence of specific bacteria, absence of connective tissue disease, and a higher total computed tomography score. CONCLUSIONS Bronchoscopy has a high specificity for the diagnosis of NTM-PD. In addition, even when NTM is undetected in sputum, bronchoscopy may detect mycobacteria in approximately half of the patients suspected of having NTM-PD.
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Affiliation(s)
- Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan; Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Kevin Y Urayama
- Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan; Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kohei Okafuji
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tomohide Tamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Imai R, Mizuno A, Miyashita M, Okafuji K, Kitamura A, Tomishima Y, Jinta T, Nishimura N, Tamura T. Bereaved Family Members' Perceived Care at the End of Life for Patients with Noncancerous Respiratory Diseases. Palliat Med Rep 2021; 2:265-271. [PMID: 34927152 PMCID: PMC8675229 DOI: 10.1089/pmr.2021.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Data regarding the quality of end-of-life care for patients with noncancerous illnesses are lacking. Objective: This study aimed to evaluate end-of-life care for patients with noncancerous respiratory disease from the perspective of bereaved family members and explore the factors associated with the quality of patient death and care. Design: This cross-sectional study included patients who had died of noncancerous respiratory disease in general wards of pulmonary department in Japan between 2014 and 2016 and conducted an anonymous self-report questionnaire survey for the patients' bereaved family members. Measurements: We evaluated overall satisfaction with care and the quality of death and end-of-life care using the Good Death Inventory (GDI) and Care Evaluation Scale (CES), respectively. A multiple linear regression analysis was performed to explore the factors associated with these outcomes. Results: In total, 130 questionnaires were distributed, and the effective response rate was 38% and 50 patients were included (median age: 82 [range 58–101] years; 37 men [74%]). Primary diagnoses at death included 29 cases of pneumonia (58%), 15 interstitial lung disease (30%), and 3 chronic obstructive pulmonary disease (6%). Of the bereaved family members, 26 (52%) were spouses, and 19 (38%) were children (median age [range]: 68 [33–102] years, 15 men [30%]). The overall CES and GDI scores (mean ± standard deviation) were 77 ± 15 and 79 ± 15, respectively. The presence of dementia was an independent factor associated with high CES and GDI scores in the multiple linear regression analysis. Conclusions: In patients who died of noncancerous respiratory disease, the presence of dementia could be associated with the higher quality of patient death and care. In dementia, an understanding of the terminal nature of this condition may lead to an appropriate end-of-life care.
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Affiliation(s)
- Ryosuke Imai
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Mizuno
- Cardio Vascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohei Okafuji
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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Kitamura A, Okafuji K, Imai R, Murakami M, Ro S, Tomishima Y, Jinta T, Nishimura N, Tamura T. Reproducibility of peripheral branches in virtual bronchoscopic navigation using VINCENT and LungPoint software for peripheral lung lesions. Respir Investig 2021; 59:772-776. [PMID: 33992600 DOI: 10.1016/j.resinv.2021.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recently, virtual bronchoscopic navigation (VBN) has become frequently used for the pathological specimen collection of peripheral lung lesions using various VBN software packages. Herein, we examined the reproducibility of peripheral branches in VBN software using LungPoint and VINCENT versions 4.0 and 5.5. METHODS This study included patients suspected of malignant peripheral lung lesions who underwent bronchoscopy at our hospital from February 2016 to April 2017. Computed tomography was taken at a thickness of 1.25 mm in all cases, and VB images were created based on the computed tomography data using LungPoint, or VINCENT version 4.0 or 5.5. One observer read the program-generated VB images and compared how many branches could be visualized with the lobe bronchus as the primary branch. RESULTS A total of 129 patients (n = 131 lesions) underwent bronchoscopy, with 82 cases of primary lung cancer. Pathological bronchoscopic diagnosis was done in 63 cases, resulting to a diagnostic rate of 76.8%. VB images generated by LungPoint, and VINCENT versions 4.0 and 5.5 reproduced an average of 4.3, 3.47, and 5.12 branches, respectively, with significant differences (p < 0.05) between them. CONCLUSIONS VINCENT version 5.5 exhibits better reproducibility of peripheral branches than LungPoint for VBN.
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Affiliation(s)
- Atsushi Kitamura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
| | - Kohei Okafuji
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Ryosuke Imai
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Manabu Murakami
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Shosei Ro
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Yutaka Tomishima
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Nishimura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Respiratory Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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Ro S, Nishimura N, Imai R, Tomishima Y, So C, Murakami M, Okafuji K, Kitamura A, Jinta T, Tamura T. Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy. Multidiscip Respir Med 2021; 16:781. [PMID: 34322232 PMCID: PMC8273631 DOI: 10.4081/mrm.2021.781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy. METHODS This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (≥250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group. RESULTS Out of 156 patients who received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, out of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications. CONCLUSION Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.
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Affiliation(s)
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560 Japan. Tel. +81.3.3541-5151.
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12
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Kitamura A, Okafuji K, Imai R, Kanemura H, Tsugitomi R, Tomishima Y, Jinta T, Nishimura N, Tamura T. Comparison of accuracy of VBN (virtual bronchoscopic navigation) software (VINCENT vs. LungPoint) for peripheral lung lesions and trial of prediction of diagnostic yield from VBN findings. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.oa1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Kitamura A, Okafuji K, Imai R, Kanemura H, Ishii K, Tsugitomi R, Tomishima Y, Jinta T, Nishimura N, Tamura T. Comparison of abilities of virtual bronchoscopic navigation (VBN) software products to reproduce peripheral branches in diagnosing peripheral lung lesions. Imaging 2018. [DOI: 10.1183/13993003.congress-2018.oa5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Shiraishi K, Jinta T, Nishimura N, Nakaoka H, Tsugitomi R, Okafuji K, Kitamura A, Tomishima Y, Deshpande GA, Tamura T. Digital Clubbing Is Associated with Higher Serum KL-6 Levels and Lower Pulmonary Function in Patients with Interstitial Lung Disease. Can Respir J 2018; 2018:3640967. [PMID: 29610629 PMCID: PMC5828477 DOI: 10.1155/2018/3640967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Although digital clubbing is a common presentation in patients with interstitial lung disease (ILD), little has been reported regarding its role in assessing patients with ILD. This study evaluated patients with ILD for the presence of clubbing and investigated its association with clinical data. Methods We evaluated patients with ILD who visited the teaching hospital at which the study was conducted, between October 2014 and January 2015. Clubbing, evaluated using a Vernier caliper for individual patients, was defined as a phalangeal depth ratio > 1. We examined the association of clubbing with clinical data. Results Of 102 patients with ILD, we identified 17 (16.7%) with clubbing. The partial pressure of oxygen in arterial blood was lower (65.2 ± 5.9 mmHg versus 80.2 ± 3.1 mmHg; p=0.03), serum Krebs von den Lugen-6 (KL-6) levels were higher (1495.0 ± 277.4 U/mL versus 839.1 ± 70.2 U/mL; p=0.001), and the percent predicted diffusing capacity of carbon monoxide was lower (50.0 ± 6.0 versus 73.5 ± 3.1; p=0.002) in these patients with clubbing. Conclusions Patients with clubbing had lower oxygen levels, higher serum KL-6 levels, and lower pulmonary function than those without clubbing.
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Affiliation(s)
- Kazushige Shiraishi
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroshi Nakaoka
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Ryosuke Tsugitomi
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Kohei Okafuji
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Yutaka Tomishima
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Gautam A. Deshpande
- Center for Clinical Epidemiology, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Pulmonary Medicine, St. Luke's International University, St. Luke's International Hospital, Tokyo, Japan
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Ogino H, Nishimura N, Kitamura A, Ishikawa G, Okafuji K, Tomishima Y, Jinta T, Yamazoe M, Yang Y, Chohnabayashi N. A patient with lung squamous cell carcinoma presenting with severe cardiac dysfunction similar to dilated cardiomyopathy with left bundle branch block induced by myocardial metastasis. Intern Med 2014; 53:2353-7. [PMID: 25318802 DOI: 10.2169/internalmedicine.53.2616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A patient with severe cardiac dysfunction similar to dilated cardiomyopathy expired because of lung squamous cell carcinoma. He was admitted with respiratory failure and was diagnosed with congestive heart failure due to dilated cardiomyopathy based on the chest X-ray, electrocardiography, echocardiography, and coronary angiography. Chest computed tomography showed a mass shadow in the right lower lobe, and the patient was diagnosed with lung squamous cell carcinoma by bronchoscopy. The patient expired, and the autopsy revealed that a myocardial metastasis disrupted the cardiac-conduction system without dilated cardiomyopathy in myocytes. Left bundle branch block caused by myocardial metastasis presumably induced left cardiac dysfunction.
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Affiliation(s)
- Hirokazu Ogino
- Division of Pulmonary Medicine, St. Luke's Internal Hospital, Japan
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Suzuki H, Hirashima T, Kobayashi M, Okamoto N, Matsuura Y, Tamiya M, Morishita N, Okafuji K, Shiroyama T, Morimura O, Morita S, Kawase I. Carboplatin plus paclitaxel in combination with bevacizumab for the treatment of adenocarcinoma with interstitial lung diseases. Mol Clin Oncol 2013; 1:480-482. [PMID: 24649195 DOI: 10.3892/mco.2013.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/09/2013] [Indexed: 11/05/2022] Open
Abstract
Interstitial lung diseases (ILDs) are frequently associated with lung cancer. The safety of carboplatin plus paclitaxel in combination with bevacizumab (CP-B) in patients with ILD and lung cancer (ILD-LC) remains to be clarified. In the present study, the safety and efficacy of CP-B treatment in ILD-LC patients were retrospectively investigated. Four patients, who completed CP-B therapy, were included in this study. The dose of carboplatin was the area under the curve 5, paclitaxel was 200 mg/m2 and bevacizumab was 15 mg/kg at treatment initiation. The patients were males, had histologically confirmed adenocarcinoma, were smokers and demonstrated non-usual interstitial pneumonia (non-UIP) patterns on computed tomography (CT). Patients received 1-6 cycles of CP-B therapy. Three of the four patients received maintenance bevacizumab therapy for 3-10 cycles. Only one patient demonstrated a partial response. Neutropenia was the most frequent adverse event. One patient experienced gut perforation during the first course of CP-B. No pulmonary toxicity was observed. Thus, treatment of ILD-LC patients with CP-B was not associated with pulmonary toxicity, however, this study population appeared to be at a low risk.
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Affiliation(s)
- Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Masashi Kobayashi
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Yuka Matsuura
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Kohei Okafuji
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Osamu Morimura
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Satomu Morita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
| | - Ichiro Kawase
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka 583-8588, Japan
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Minami S, Kijima T, Shiroyama T, Okafuji K, Hirashima T, Uchida J, Imamura F, Osaki T, Nakatani T, Ogata Y, Yamamoto S, Namba Y, Otsuka T, Tachibana I, Komuta K, Kawase I. Randomized Phase II trial of paclitaxel and carboplatin followed by gemcitabine switch-maintenance therapy versus gemcitabine and carboplatin followed by gemcitabine continuation-maintenance therapy in previously untreated advanced non-small cell lung cancer. BMC Res Notes 2013; 6:3. [PMID: 23281805 PMCID: PMC3549766 DOI: 10.1186/1756-0500-6-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/28/2012] [Indexed: 12/02/2022] Open
Abstract
Background In recent years, maintenance chemotherapy is increasingly being recognized as a new treatment strategy to improve the outcome of advanced non-small cell lung cancer (NSCLC). However, the optimal maintenance strategy is still controversial. Gemcitabine is a promising candidate for single-agent maintenance therapy because of little toxicity and good tolerability. We have conducted a randomized phase II study to evaluate the validity of single-agent maintenance chemotherapy of gemcitabine and to compare continuation- and switch-maintenance. Methods Chemonaïve patients with stage IIIB/IV NSCLC were randomly assigned 1:1 to either arm A or B. Patients received paclitaxel (200 mg/m2, day 1) plus carboplatin (AUC 6 mg/mL/min, day 1) every 3 weeks in arm A, or gemcitabine (1000 mg/m2, days 1 and 8) plus carboplatin (AUC 5 mg/mL/min, day1) every 3 weeks in arm B. Non-progressive patients following 3 cycles of induction chemotherapy received maintenance gemcitabine (1000 mg/m2, days 1 and 8) every 3 weeks. (Trial registration: UMIN000008252) Results The study was stopped because of delayed accrual at interim analysis. Of the randomly assigned 50 patients, 49 except for one in arm B were evaluable. Median progression-free survival (PFS) was 4.6 months for arm A vs. 3.5 months for arm B (HR = 1.03; 95% CI, 0.45–2.27; p = 0.95) and median overall survival (OS) was 15.0 months for arm A vs. 14.8 months for arm B (HR = 0.79; 95% CI, 0.40–1.51; p = 0.60), showing no difference between the two arms. The response rate, disease control rate, and the transit rate to maintenance phase were 36.0% (9/25), 64.0% (16/25), and 48% (12/25) for arm A vs. 16.7% (4/24), 50.0% (12/24), and 33% (8/24) for arm B, which were also statistically similar between the two arms (p = 0.13, p = 0.32, and p = 0.30, respectively). Both induction regimens were tolerable, except that more patients experienced peripheral neuropathy in arm A. Toxicities during the maintenance phase were also minimal. Conclusion Survival and overall response were not significantly different between the two arms. Gemcitabine may be well-tolerable and feasible for maintenance therapy.
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Affiliation(s)
- Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
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18
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Suzuki H, Hirashima T, Kobayashi M, Okamoto N, Matsuura Y, Tamiya M, Morishita N, Okafuji K, Shiroyama T, Morimura O, Morita S, Kawase I. Prognostic factors in malignant pleural mesothelioma: a retrospective study. Intern Med 2012; 51:707-10. [PMID: 22466824 DOI: 10.2169/internalmedicine.51.6236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The incidence of malignant pleural mesothelioma (MPM) in Japan is predicted to increase over the next few decades. Prognostic factors remain unclear although several studies have reported this disease. In this study, we examined the prognostic factors of MPM from single institution practice data and tested the scoring systems of past reports. METHODS We retrospectively obtained clinical data from the medical records of patients who were diagnosed with MPM from 1991 to 2010. The European Organization for Research and Treatment of Cancer prognostic score (EPS) was calculated. RESULTS We surveyed the records of 68 patients. Univariate analysis showed that significant prognostic factors were histological type, stage, performance status (PS), chemotherapy, and lactate dehydrogenase (LD). Multivariate analysis identified stage, PS and LD as independent prognostic factors. Low-risk group (EPS ≤1.27) survival was significantly better than that of the high-risk group (EPS >1.27) (17.0 months vs. 8.0 months; p=0.002). CONCLUSION Stage, PS and LD were demonstrated to be independent prognostic factors. An EPS >1.27 was still considered a poor prognosis indicator in the practice data of MPM.
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Affiliation(s)
- Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan.
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Nishizawa T, Okafuji K, Murayama H. STORABILITY AND DEVELOPMENT OF PHYSIOLOGICAL DISORDER OF NETTED MELON 'LIFE' FRUIT AS INFLUENCED BY STORAGE CONDITIONS. ACTA ACUST UNITED AC 2009. [DOI: 10.17660/actahortic.2009.837.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Miura S. Non-autoimmune primary hypothyroidism in diabetic and non-diabetic chronic renal dysfunction. Exp Clin Endocrinol Diabetes 2002; 110:408-15. [PMID: 12518252 DOI: 10.1055/s-2002-36427] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to investigate the frequency and mechanisms of hypothyroidism observed in diabetic patients with advanced diabetic nephropathy, including outcomes of management for this condition. A controlled study was designed using 32 diabetic and 31 non-diabetic patients not receiving hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) who excreted mean urinary protein greater than 0.5 g/day examined on three consecutive days during admission to our hospital. Thyroid hormones in both serum and urine, anti-thyroid antibodies, renal function and iodine concentrations in serum were measured during admission in all patients included. In particular, in patients who showed overt hypothyroidism, further studies including large-needle biopsies of the thyroid and iodine-perchlorate discharge tests were performed. All patients in the two groups revealed negative antithyroid antibody titers, and the mean serum total iodine levels did not significantly differ between the two groups. Mean serum FT4 levels significantly decreased, and the TSH level was significantly elevated in the diabetic group compared to those in the non-diabetic group (p < 0.005, p < 0.02, respectively). The frequency of overt hypothyroidism in the diabetic group (22%; 7/32) was significantly higher (p < 0.05) than that in the non-diabetic group (3.2%; 1/31). The daily urinary thyroid hormone excretion in both groups did not show any significant correlation with serum thyroid hormone levels. Seven patients who revealed overt hypothyroidism in the diabetic group showed elevated serum total iodine levels during hypothyroidal status, ranging between 177 and 561 microg/l. Also, the iodine-perchlorate discharge tests carried out in six of these patients all showed a positive discharge. After management based on iodine restriction, normalization of serum thyroid hormone levels in accordance with definite decreases in the serum total iodine level was achieved, accompanied by a significant weight reduction. In conclusion, we found a significantly high prevalence of non-autoimmune primary hypothyroidism in patients with advanced diabetic nephropathy compared to those with non-diabetic chronic renal dysfunction, which may partly relate to earlier development of oedematous status. Clinical and laboratory findings suggest that impaired renal handling of iodine resulting in an elevation of serum iodine levels, rather than autoimmune mechanism or urinary hormone loss, may play a principal role in the development of these conditions, probably through a prolongation of the Wolff-Chaikoff effect. The mechanisms by which this phenomenon develops more frequently in diabetic than in non-diabetic renal dysfunction remain to be elucidated.
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Affiliation(s)
- Y Bando
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Funabashi 7-1, Wadanaka-machi, Fukui 918-8503, Japan.
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Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Fujisawa M. The relationship of fasting plasma glucose values and other variables to 2-h postload plasma glucose in Japanese subjects. Diabetes Care 2001; 24:1156-60. [PMID: 11423495 DOI: 10.2337/diacare.24.7.1156] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between fasting plasma glucose (FPG) values and other variables (e.g., age, sex, and BMI) to 2-h post-75-g oral glucose load glycemia (PG) in Japanese subjects. RESEARCH DESIGN AND METHODS Subjects included 13,694 Japanese subjects between 20 and 83 years of age (10,677 men and 3,017 women) who were undergoing a 75-g oral glucose tolerance test (OGTT) during a health screening performed at our hospital. The influences of age for 2-h PG at a fixed fasting plasma glucose (FPG) level of 126 mg/dl were analyzed. Multiple linear regression analysis was performed using a model in which the dependent variable was 2-h PG using the following explanatory variables: FPG, age, sex, BMI, blood pressure, plasma cholesterol, and triglyceride (TG) levels. RESULTS The 2-h PG at a fixed FPG of 126 mg/dl increased by 0.94 mg/dl per year in patients aged between 30 and 78 years (r = 0.68, P < 0.0001). In multiple regression, five explanatory variables (FPG, age, BMI, plasma TG levels, and systolic blood pressure levels) were all positively associated with 2-h PG. The percentages of patients with 2-h diabetes (isolated postchallenge hyperglycemia [IPH]) versus fasting plus 2-h diabetes by the World Health Organization criteria significantly (P = 0.005) increased as the patients' decades increased, whereas the impact of BMI on the percentages was significant only in young patients (P = 0.001). CONCLUSIONS Aging was found to be the second best predictor of 2-h PG on multiple regression. Therefore, OGTT should be performed especially in elderly patients because they show IPH more frequently.
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Affiliation(s)
- Y Bando
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan.
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Kaya H, Nakamura S, Okafuji K, Terasaki Y, Maeno K, Tanaka N, Ohtake S, Matsuda T. Trisomy 14 with thrombocytosis and monocytosis. Acta Haematol 2001; 103:206-9. [PMID: 11014895 DOI: 10.1159/000041051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It has been reported that trisomy 14 is associated with myeloid malignancies, but a case with increased platelet count has also been reported. However, the clinical significance of trisomy 14 is still uncertain. We report a patient with trisomy 14 with thrombocytosis and a gradual increase in monocytosis. He was treated with hydroxyurea, cytarabine and aclarubicin in low doses and his quality of life was maintained for a period of about 1 year from blastic crisis. Hydroxyurea, cytarabine or aclarubicin in low doses may be the treatment of choice for trisomy 14 patients with respect to the patients' quality of life.
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MESH Headings
- Aclarubicin/administration & dosage
- Aged
- Antibiotics, Antineoplastic/therapeutic use
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/therapeutic use
- Chromosomes, Human, Pair 14
- Cytarabine/administration & dosage
- Humans
- Hydroxyurea/administration & dosage
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/drug therapy
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukocyte Disorders/drug therapy
- Leukocyte Disorders/genetics
- Male
- Monocytes
- Quality of Life
- Thrombocytosis/drug therapy
- Thrombocytosis/etiology
- Thrombocytosis/genetics
- Trisomy/genetics
- Trisomy/pathology
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Affiliation(s)
- H Kaya
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
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23
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Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Fujisawa M. Troglitazone combination therapy in obese type 2 diabetic patients poorly controlled with alpha-glucosidase inhibitors. J Int Med Res 1999; 27:53-64. [PMID: 10446691 DOI: 10.1177/030006059902700201] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The efficacy and safety of treatment with troglitazone combined with an alpha-glucosidase inhibitor, in obese type 2 diabetic patients who were previously administered alpha-glucosidase inhibitors alone, in improving glycaemic control and reducing insulin resistance were studied. Obese type 2 diabetic patients, poorly controlled with alpha-glucosidase inhibitors, were randomized to receive either oral troglitazone 200 mg twice daily (22 patients: group A) or a placebo (20 patients: group B) in addition to their usual alpha-glucosidase inhibitor. In group A, significant decreases in the mean levels of haemoglobin A1c and basal plasma insulin levels were observed 6 months after the start of combined therapy. Serum triglyceride levels significantly decreased but serum lactic acid dehydrogenase and body weight significantly increased. New systemic oedema was observed in six patients. Combined therapy with troglitazone and alpha-glucosidase inhibitors may be effective for diabetic metabolic abnormalities, although the potential development of adverse effects such as body-weight gain and systemic oedema demands vigilance.
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Affiliation(s)
- Y Bando
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Japan
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24
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Kaya H, Aoshima K, Okafuji K, Tanaka N, Ohtake S, Nakamura S, Matsuda T. De novo acute nonlymphoblastic leukemia (M5b) having a chromosomal 3;21 translocation with immunoglobin heavy-chain gene rearrangement. Am J Hematol 1996; 53:142-3. [PMID: 8892743 DOI: 10.1002/(sici)1096-8652(199610)53:2<142::aid-ajh16>3.0.co;2-h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
MESH Headings
- Aged
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 3
- Gene Rearrangement
- Genes, Immunoglobulin
- Humans
- Immunoglobulin Heavy Chains/genetics
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Male
- Translocation, Genetic
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25
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Azuno Y, Kaneko T, Nishimura M, Okuya S, Nakai K, Nomiyama J, Mori K, Okafuji K, Okubo M, Matsutani A, Kamei S, Zaitsu Y, Takeuchi Y, Oka Y, Kaku K. Donor leukocyte transfusions and discontinuation of immunosuppressants to achieve an initial remission after allogeneic bone marrow transplantation in a patient with primary refractory acute leukemia. Bone Marrow Transplant 1996; 18:257-9. [PMID: 8832032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a female patient who received an allogeneic bone marrow transplantation for primary refractory Philadelphia-positive acute biphenotypic leukemia. Since leukemic blasts were persistently present in peripheral blood and bone marrow, in spite of the evidence for engraftment of male donor hematopoiesis, we performed donor leukocyte transfusions and discontinued immunosuppression. An initial complete remission was obtained 15 weeks after allogeneic bone marrow transplantation, and lasted for 24 weeks. We concluded that the prominent mechanism for the eradication of the refractory leukemic clone in the patient was the graft-versus-leukemia effect.
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Affiliation(s)
- Y Azuno
- Department of Internal Medicine, Yamaguchi Rosai Hospital, Japan
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26
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Azuno Y, Kamei S, Kaku K, Yoshida T, Oeda E, Nishimura M, Okafuji K, Takeuchi Y, Tanaka M, Oka Y, Hiroshige Y, Kaneko T. Long-term remission obtained by intensive chemotherapy against a leukemic relapse and subsequent graft-versus-host disease following an allogeneic BMT in a patient with myelodysplastic syndrome. Bone Marrow Transplant 1996; 17:463-4. [PMID: 8704709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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27
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Nakao S, Ueda M, Yamaguchi M, Takamatsu H, Itoh T, Okafuji K, Ohtake S, Shiobara S, Matsuda T. Hematopoietic clone with karyotypic abnormalities of host origin after bone marrow transplantation: two case reports. Bone Marrow Transplant 1996; 17:435-7. [PMID: 8704702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A patient with non-Hodgkin's lymphoma in remission developed a myelodysplastic syndrome (MDS) 12 years after ABMT. This patient had undergone bone marrow harvesting prior to any chemoradiotherapy. He had received the autograft following conditioning with high-dose CY and TBI. Chromosomal analysis of BM cells revealed complicated abnormalities. Similar karyotypic abnormalities in host-derived BM cells were found in another patient with AML who had received allogeneic BM following conditioning with CY plus TBI 15 months previously. These findings suggest that MDS or clonal karyotypic abnormalities following ABMT may derive from endogenous hematopoietic stem cells that survive the BMT preparative regimen.
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Affiliation(s)
- S Nakao
- Third Department of Medicine, Kanazawa University School of Medicine, Japan
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28
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Okafuji K, Kaku K, Seguchi M, Tanaka H, Azuno Y, Kaneko T. Effects of activin A/erythroid differentiation factor on erythroid and megakaryocytic differentiations of mouse erythroleukemia (Friend) cells: evidence for two distinct modes of cell response. Exp Hematol 1995; 23:210-6. [PMID: 7875239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To further characterize activin A/erythroid differentiation factor (EDF) action on hematopoietic cell differentiation, we examined the effects of activin A/EDF on megakaryocytic and erythroid differentiation by determining acetylcholinesterase (AchE) activity and hemoglobin production in the mouse erythroleukemia (MEL) cell line F55. Activin A/EDF induced AchE activity of F55 cells in a dose-dependent manner. Erythroid differentiation of F55 cells, which was characterized by an increase in dianisidine-positive cells, was also induced by activin A/EDF. The effect of activin A/EDF on hemoglobin synthesis appeared more slowly compared with the effect on AchE activity. Erythroid differentiation induced by activin A/EDF was affected by the initial cell density, but AchE activity was not. Sodium orthovanadate, a tyrosine phosphatase inhibitor, markedly inhibited activin A/EDF-induced erythroid differentiation but not activin A/EDF-induced AchE activity. Other erythroid differentiation inducers, sodium butyrate and butyrylcholine chloride, mildly increased AchE activity in F55 cells, but N,N'-hexamethylene-bis-acetamide (HMBA), dimethyl sulfoxide (DMSO), and genistein did not. Dexamethasone inhibited HMBA-induced erythroid differentiation but did not affect activin A/EDF or sodium butyrate action. These results suggest that F55 cells potentially can differentiate into cells of a megakaryocytic lineage in addition to an erythroid lineage, and that activin A/EDF further potentiates the cell differentiation of this cell line. In addition, our results suggest that the mode of activin A/EDF effects on megakaryocytic differentiation is distinct from that on erythroid differentiation.
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Affiliation(s)
- K Okafuji
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
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29
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Kaya H, Nakamura S, Matano S, Okafuji K, Tanaka N, Yoshida T, Ohtake S, Matsuda T. Acute nonlymphocytic leukemia complicated by Garcin's syndrome. Acta Haematol 1995; 94:142-3. [PMID: 7502631 DOI: 10.1159/000203997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 15-year-old girl was diagnosed as having acute nonlymphocytic leukemia (ANLL, FAB M2) in January 1990 and achieved complete remission with chemotherapy. She was readmitted to our hospital with a hearing disturbance and hoarseness in October 1990. A suprapharyngeal tumor was found on cranial MRI, and bone marrow leukemic cells were slightly increased in number. Involvement of leukemic cells was proven by biopsy of the tumor. Therefore, we made a diagnosis of ANLL relapse with Garcin's syndrome. To our knowledge, this is the first reported case of leukemia complicated by Garcin's syndrome.
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Affiliation(s)
- H Kaya
- Department of Internal Medicine, Fukuiken Saiseikai Hospital, Fukui City
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30
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Azuno Y, Kaku K, Shino K, Kamei S, Nishimura M, Okafuji K, Inoue Y, Matsumoto N, Kaneko T. A congenital variant of thrombotic thrombocytopenic purpura in two siblings. Intern Med 1994; 33:752-8. [PMID: 7718955 DOI: 10.2169/internalmedicine.33.752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We describe two siblings affected by chronic relapsing thrombotic thrombocytopenic purpura from infancy. The elder brother, a 12-year-old boy had 50 such episodes characterized by acute onset of fever, headache, drowsiness, vomiting, dark urine, thrombocytopenia and anemia. The younger sister, a 6-year-old girl, had 8 episodes with the same clinical manifestations. Petechiae and ecchymoses on the extremities were present throughout their lives. Furthermore, anemia with evidence of red blood cell fragmentation and thrombocytopenia were present chronically. Periodical transfusion of frozen fresh plasma prevented recurrent episodes. These cases suggest that there is a congenital variant of thrombotic thrombocytopenic purpura.
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Affiliation(s)
- Y Azuno
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube
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31
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Toyoshige M, Zaitsu Y, Okafuji K, Inoue Y, Hiroshige Y, Matsumoto N, Kaku K, Kaneko T. Successful treatment of thrombotic thrombocytopenic purpura with high-dose corticosteroid. Am J Hematol 1992; 41:69. [PMID: 1503108 DOI: 10.1002/ajh.2830410119] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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32
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Nishimura M, Kaku K, Azuno Y, Okafuji K, Inoue Y, Kaneko T. Stimulation of phosphoinositol turnover and protein kinase C activation by granulocyte-macrophage colony-stimulating factor in HL-60 cells. Blood 1992; 80:1045-51. [PMID: 1323343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Phosphoinositol turnover, diacylglycerol generation, protein kinase C (PK-C) activity, and intracellular cyclic nucleotides were studied in an established human leukemia cell line, HL-60, in response to one of the hematopoietic cytokines, granulocyte-macrophage colony-stimulating factor (GM-CSF). Continuous exposure of HL-60 cells to GM-CSF induced the cell differentiation that was evaluated by the nitroblue tetrazolium (NBT) reducing activity. GM-CSF also exhibited a proliferative effect on HL-60 cells. GM-CSF at 1 nmol/L, an optimal concentration for cell growth and cell differentiation, induced significant changes in the intracellular inositoltriphosphate (IP3). Diacylglycerol generation was also stimulated by GM-CSF treatment. GM-CSF increased the membrane PK-C activity by 10-fold of the control, whereas no measurable change in cyclic nucleotides was observed. These data indicated that phosphoinositol turnover and the activation of PK-C were included in the GM-CSF signal transducing pathway in HL-60 cell. Phosphoinositol response leading to PK-C activation may act as a trigger signal of cell differentiation by GM-CSF.
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Affiliation(s)
- M Nishimura
- Third Department of Internal Medicine, School of Medicine, University of Yamaguchi, Japan
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33
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Inoue Y, Yaga K, Nishimura M, Okafuji K, Fujii Y, Nagasaka Y, Tanaka M, Fujita N, Kaku K, Kaneko T. Antihypertensive and metabolic effects of long-term treatment with amosulalol in non-insulin dependent diabetics. Curr Med Res Opin 1992; 12:564-71. [PMID: 1582238 DOI: 10.1185/03007999209111523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this open study, 41 hypertensive patients with non-insulin dependent diabetes mellitus were treated with the combined alpha- and beta-adrenoceptor blocker amosulalol hydrochloride for 24 weeks, either alone or added to existing antihypertensive therapy. The effects on blood pressure, glucose and lipid metabolism were examined. Daily administration of 20 to 60 mg amosulalol caused a significant reduction in both systolic and diastolic blood pressure within 2 weeks. This effect was stable, lasting for the entire trial period. The mean systolic and diastolic blood pressure decreased from 174 +/- 13/92 +/- 9 mmHg at the beginning to 148 +/- 16/80 +/- 11 mmHg at the end of the trial. Heart rate was not affected. Plasma glucose and haemoglobin Alc levels showed a tendency to decrease without any statistical significance. Total and HDL-cholesterol and triglyceride levels also remained unchanged. Although 3 patients had complained of dizziness, all were easily manageable. The results indicate that amosulalol is effective in the treatment of hypertension in non-insulin dependent diabetics and does not affect glucose and lipid metabolism.
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Affiliation(s)
- Y Inoue
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
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34
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Inoue Y, Matsubara A, Okuya S, Okafuji K, Kaku K, Kaneko T. Myelofibrosis and systemic lupus erythematosus: reversal of fibrosis with high-dose corticosteroid therapy. Acta Haematol 1992; 88:32-6. [PMID: 1414159 DOI: 10.1159/000204592] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of myelofibrosis in association with systemic lupus erythematosus (SLE) is reported. Acute thrombocytopenia and a bleeding tendency developed in a 24-year-old woman with SLE. Bone marrow aspiration was unsuccessful due to myelofibrosis. Pulse therapy with methylprednisolone reversed both thrombocytopenia and myelofibrosis. A review of the literature revealed that the coexistence of SLE and myelofibrosis is a rare occurrence. Only 7 cases, to our knowledge, have ever been reported in detail. The present case is the 3rd in which myelofibrosis was reversed by corticosteroids.
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Affiliation(s)
- Y Inoue
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
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35
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Nishimura M, Kaku K, Azuno Y, Okafuji K, Etoh Y, Shiozaki M, Sasaki H, Inoue T, Kaneko T. Effect of erythroid differentiation factor on megakaryocytic differentiation of L8057, a murine megakaryoblastic leukemia cell line. Biochem Biophys Res Commun 1991; 181:1042-7. [PMID: 1764055 DOI: 10.1016/0006-291x(91)92042-i] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To assess the potent effect of erythroid differentiation factor (EDF) on megakaryocytopoiesis, effect of EDF on megakaryocytic differentiation of L8057, a murine megakaryoblastic cell line, was examined. EDF potentiated AchE induction of L8057 in a dose dependent manner. The potency of EDF on megakaryocytic differentiation is comparable to that on erythroid differentiation reported previously. The present results suggest that EDF may play a regulatory role in megakaryocytopoiesis as well as in erythropoiesis.
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Affiliation(s)
- M Nishimura
- Department of Pediatrics, Yokohama City University, School of Medicine, Japan
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36
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Yoshida T, Nakamura S, Ohtake S, Okafuji K, Kobayashi K, Kondo K, Kanno M, Matano S, Matsuda T, Kanai M. Effect of granulocyte colony-stimulating factor on neutropenia due to chemotherapy for non-Hodgkin's lymphoma. Cancer 1990; 66:1904-9. [PMID: 1699654 DOI: 10.1002/1097-0142(19901101)66:9<1904::aid-cncr2820660908>3.0.co;2-v] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors administered recombinant human granulocyte colony-stimulating factor (rhG-CSF) to 16 patients with advanced non-Hodgkin's lymphoma treated with combination chemotherapy. Groups of three to five patients were treated with 50, 100, 200, and 400 micrograms/m2 per day of rhG-CSF by intravenous infusion for 14 days, beginning 3 days after chemotherapy. There was a strong linear relationship between the dose and the area under the curve over this dose range. The rhG-CSF was rapidly cleared from serum, with a mean half-life of 5.97 hours for the second phase (t1/2). In patients treated with a dose of more than 100 micrograms/m2 per day, the duration of neutropenia (P less than 0.01) and the duration of fever (P less than 0.05) were significantly decreased. The rhG-CSF was well tolerated and the only clinical observation that appeared relating to rhG-CSF administration was slight bone pain. This study strongly suggests that an optimum dose of rhG-CSF in patients after chemotherapy is 100 to 200 micrograms/m2. Our study shows that rhG-CSF is a clinically useful drug for patients treated with myelosuppressive chemotherapy.
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Affiliation(s)
- T Yoshida
- Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan
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37
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38
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Abstract
A 32-year-old woman with a bleeding tendency born of a consanguineous marriage, was found to have factor XIII subunit B deficiency. An abnormally low level of factor XIII activity was initially noticed and this finding led to further studies of the proband and her family. The notable features were: undetectable subunit B of factor XIII in the proband and her brother and reduced levels of subunit B, 34-52%, in her parents and children. The proband's brother had a markedly decreased level of subunit A protein. The level of factor XIII subunit A in platelets of the proband was normal. The half-life of subunit A determined from the disappearance curve of infused factor XIII subunit A concentrate was approximately 3 d and this is the shortest estimate of the half-life of factor XIII to date. From these results, it is suggested that subunit A is unstable in plasma deficient in subunit B and subunit B stabilizes the A protein. This is the first report of congenital deficiency of factor XIII subunit B and this disorder is thought to be inherited as an autosomal recessive trait.
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Affiliation(s)
- M Saito
- Department of Internal Medicine (III), Kanazawa University School of Medicine, Japan
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39
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Shinohara K, Okafuji K, Ayame H, Ueda N. [Idiopathic autoimmune hemolytic anemia successfully treated with danazol]. Rinsho Ketsueki 1990; 31:256-7. [PMID: 2329690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 50 year old female suffered from idiopathic autoimmune hemolytic anemia. She was initially treated with prednisolone, and anemia was improved moderately. However, maintenance of Hb value was difficult with the decreased dosage of prednisolone. She was subsequently administered danazol, and anemia was completely improved. It is worth to use danazol for the treatment of the patient of autoimmune hemolytic anemia who is refractory to prednisolone therapy.
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Affiliation(s)
- K Shinohara
- Department of Hematology, Central Hospital, Yamaguchi Prefecture
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40
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Abstract
A 29-year-old woman with acute myelogenous leukemia in relapse at the end of a nine-month period of remission was admitted to hospital where intensive antileukemic therapy was started. Antibiotics were given when she developed a fever and, when oral thrush appeared, intravenous amphotericin B was initiated. After 16 days, the amphotericin B (at a total dose of 295 mg) was discontinued because of side effects and 12 days later, when a lung biopsy had revealed mucormycotic hyphae in infarcted tissue in the left upper lobe, fluconazole (300 mg daily by intravenous infusion over a period of two hours) was substituted. This was continued for one month with clinical and radiologic improvement in the lung condition and no attributable adverse effect. At this juncture the patient died of intractable heart failure. We suggest that fluconazole may be an acceptable alternative to amphotericin B in the treatment of pulmonary mucormycosis.
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Affiliation(s)
- H Funada
- Environment Unit, Kanazawa University School of Medicine, Japan
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41
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Yoshida T, Nakamura S, Ohtake S, Kobayashi K, Kanno M, Matsuda T, Matano S, Kondo K, Okafuji K, Kanai M. Salvage chemotherapy of refractory non-Hodgkin's lymphoma with aclacinomycin, behenoyl ara-C, etoposide, and prednisolone. Cancer Chemother Pharmacol 1989; 25:135-8. [PMID: 2598400 DOI: 10.1007/bf00692354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A total of 40 patients with recurrent non-Hodgkin's lymphoma were treated with ABEP combination chemotherapy (aclarubicin, N4-behenoyl-1-beta-D-arabinofuranosylcytosine, etoposide, and prednisolone). A complete remission (CR) was achieved in 37.5% of the patients and partial remission, in 15.0%. The ABEP regimen proved to be effective in T-cell as well as B-cell lymphoma. It appears that the ABEP regimen may be partially non-cross-resistant with front-line doxorubicin-containing combinations. Survival for 39 months was achieved in 42.0% of the CR responders compared with 6.7% of partial responders (PRs) and nonresponders (NRs) (P less than 0.01). Disease-free survival for 45 months was seen in 66% of the CR patients. The ABEP regimen was effective in the treatment of patients with recurrent or refractory lymphoma, enabling hope for long-term survival in the majority of CR cases.
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Affiliation(s)
- T Yoshida
- Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan
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42
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Kanno M, Ohtake S, Okafuji K, Hirai J, Itoh K, Kobayashi K, Yoshida T, Nakarura S, Matsuda T. [IgD-type multiple myeloma associated with tumor of the pancreas]. Rinsho Ketsueki 1988; 29:2312-6. [PMID: 2469811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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43
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Kanamori K, Uotani K, Takakura B, Nishioka S, Koshino T, Fujimura M, Nakazumi Y, Okafuji K, Matsuda T, Kamio T. [Bronchodilation following deep inspiration in normal subjects and patients with bronchial asthma]. Nihon Kyobu Shikkan Gakkai Zasshi 1986; 24:970-6. [PMID: 2949098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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44
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Kobayashi K, Ohtake S, Nakanishi J, Itoh K, Okafuji K, Yoshida T, Nakamura S, Matsuda T. [Detection of cell surface antigen by immunocytochemistry on air-dried smears]. Rinsho Byori 1986; 34:699-704. [PMID: 3528586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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45
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Kamio Y, Shibayama M, Kawai K, Futamata H, Matsubara F, Kanamori K, Uotani K, Okafuji K, Fujimura M, Koshino T. [Double inhalation test with ipratropium bromide and salbutamol--assessment of its effects on partial and maximum expiratory flow-volume curves]. Rinsho Byori 1985; 33:1313-8. [PMID: 2869163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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46
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Harada M, Ueda M, Nakao S, Kondo K, Ohtake S, Okafuji K, Odaka K, Shiobara S, Matsue K, Mori T. [Twenty-five patients with acute leukemia treated by bone marrow transplantation]. Rinsho Ketsueki 1985; 26:1467-74. [PMID: 3910853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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47
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Kanamori K, Okafuji K, Fujimura M, Koshino T, Nishioka S, Uotani K, Yoshida T, Matsuda T. [A case of interstitial pneumonia with autoimmune hemolytic anemia complicated with cytomegalovirus pneumonia]. Nihon Kyobu Shikkan Gakkai Zasshi 1985; 23:1030-5. [PMID: 3005735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Koshino T, Fujimura M, Nishioka S, Okafuji K, Minami S, Kanamori K, Matsuda T, Ishizaki T, Saga T, Miyabo S. Effects of Ca2+ antagonist, nicardipine, on experimental asthma with special reference to slow reacting substance of anaphylaxis. Allergy 1985; 40:311-3. [PMID: 4037252 DOI: 10.1111/j.1398-9995.1985.tb00241.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Slow reacting substance of anaphylaxis (SRS-A) is an important chemical mediator of bronchial asthma. Leukotriene C4 is a component of SRS-A and is synthesized from arachidonic acid. Its synthesizing and releasing processes are found to be Ca2+-dependent. We developed an in vivo inhalation asthma model, mainly mediated by SRS-A, and elucidated the relationship between a Ca2+-antagonist, nicardipine, and SRS-A. In the asthmatic model, mediated by endogenous SRS-A induced by antigen inhalation, continuous intravenous infusion of nicardipine 7 micrograms/kg/min depressed the open airway pressure by about 60% compared with the saline-treated group. Inhibition of mean pulmonary resistance (RL) was about 50% and that of the inverted value of dynamic compliance (1/Cdyn) about 36%. However, the same concentration of nicardipine did not significantly effect the airway response in the asthmatic model induced by the inhalation of leukotriene C4. These results suggest that nicardipine, at the concentration used in the present study. did not block the direct effect of SRS-A on the smooth muscle, but blocked the Ca2+ influx required for the synthesis of SRS-A and its release.
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Ishizaki T, Miyabo S, Koshino T, Fujimura M, Okafuji K, Minami S, Kanamori K, Saga T, Funada H, Hattori K. [Fungal pneumonia in hematologic disorders--with special reference to diagnosis of aspergillus pneumonia]. Nihon Kyobu Shikkan Gakkai Zasshi 1985; 23:86-97. [PMID: 4010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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50
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Koshino T, Nishioka S, Fujimura M, Okafuji K, Kanamori K, Mori T, Matsuda T, Kitao T, Kondo K, Hayashi S. [ELISA for IgG antibody to purified protein derivative (PPD) of patients with pulmonary tuberculosis]. Kekkaku 1984; 59:621-624. [PMID: 6335737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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