[A comparative study of the prognosis for Japanese patients with idiopathic interstitial pneumonia or BOOP based on histopathologic subsets].

We explored the prognosis for 123 patients with either idiopathic interstitial pneumonia (IIP) or bronchiolitis obliterans organizing pneumonia (BOOP). All patients underwent either open lung biopsy or thoracoscopic lung biopsy procedures. The histopathologic diagnosis of IIP included patients with usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), and desquamative interstitial pneumonia with respiratory bronchiolitis-associated interstitial lung disease. The prognosis was poorest for patients with a histologic diagnosis of UIP, and excellent for those who received a diagnosis of BOOP. Although the prognosis is generally considered to be good for patients with NSIP, some NSIP patients in our study died. Histopathologic diagnosis based on surgical lung biopsy is useful in evaluating the prognosis for patients with IIP.

[Usefulness of percutaneous instillation of antifungal agents for pulmonary aspergilloma].

We studied the usefulness of percutaneous instillation of antifungal agents for treatment of pulmonary aspergilloma. The subjects were six patients, four males and two females, with a mean age of 69 years (range, 45 to 90 years). In all cases, radiography revealed a fungus ball or thickened cavity wall in residual tuberculous cavities. The patients had clinical symptoms including hemoptysis, fever, cough and sputum, and most of them showed severe emaciation, anemia, hypoalbuminemia and hypoxia. Miconazole or fluconazole was instilled through an indwelling catheter inserted percutaneously into the cavity from the anterior chest wall or parascapular region under fluoroscopic observation. After treatment with a total dose of 610 to 2070 mg over a period of 6 to 18 weeks, clinical symptoms were diminished in all patients and radiographic findings were improved in five. Furthermore, Aspergillus fumigatus, which had been isolated from sputum samples of three patients, was eradicated. According to evaluation of the overall therapeutic effects, this therapy was considered to be effective in five patients, giving an efficacy rate of 83%. No recurrence has been detected in six patients during a mean follow-up of 13 months after treatment. Since percutaneous instillation involves less pain and stress than other kinds of

[A case of allergic bronchopulmonary fungosis caused by several kinds of fungi].

A 36-year-old man, who had been treated for bronchial asthma since 10 years of age was admitted to Haibara General Hospital because of asthma attack and abnormal chest X-ray shadows. Chest roentgenogram on admission revealed patchy and consolidation shadows in both lung fields. Blood eosinophilia (15%, 1,155/mm3) and elevation of total IgE (7,800 IU/ml) were demonstrated by laboratory examination. Bronchography showed central bronchial ectasia in right B2, B3, B6 and left B1+2, B3 and B6. Investigations of allergy demonstrated elevated specific IgE levels, positive immediate and late skin reactions, positive "dual" asthmatic responses and positive precipitating antibodies for Aspergillus fumigatus, Penicillium luteum and Cladosporium cladosporioides. Aspergillus fumigatus, Penicillium spp. and Cladosporium spp. were cultured from his sputa. From these clinical symptoms and findings of tests of allergy, all three kinds of fungi, Aspergillus fumigatus, Penicillium and Cladosporium, were considered as causative antigens in this case of allergic bronchopulmonary fungosis.

[A case of bronchiolitis obliterans organizing pneumonia with positive anti Jo-1 antibody preceding polymyositis].

We describe a 58-year-old female with BOOP associated with polymyositis. Four months prior to the appearance of distinctive manifestation of polymyositis, she presented with a two-week history of cough, dyspnea on exertion, and fever. Chest roentgenogram demonstrated bilateral basal infiltrative shadows. The patient was treated with prednisolone, 30 mg/day because of progressive hypoxemia. Open lung biopsy revealed organizing masses of granulation tissue extending from the respiratory bronchioles into the intra-alveolar spaces, which was consistent with BOOP. She developed muscle pain in her legs, fever, dry cough, hypoxemia, and high CPK value in the course of tapering of steroid dose. The findings of biopsy from the left rectus femoris muscle were compatible with polymyositis. Retrospective study of the patient's serum on admission showed positive anti Jo-1 antibody.

[Cisplatin, doxorubicin and vindesine in the treatment of advanced non-small cell lung cancer].

Thirty-seven patients with advanced non-small cell lung cancer were enrolled to evaluate a combination chemotherapy of cisplatin (80 mg/m2), doxorubicin (30 mg/m2) and vindesine (2 mg/m2 x 3). The overall response rate was 27% with ten partial remission. The median survival of whole patients was 11.4 months. The calculation of median survival of the patients with partial remission has not been completed: nine of ten patients have been still alive during the follow-up period of 4 to 16 months. The survival of the patients with PR was significantly different from those of the patients with NC or PD. The major toxicity was myelosuppression. These results indicate that a combination chemotherapy with cisplatin, doxorubicin and vindesine is a moderately effective regimen against non-small cell lung cancer compared to others.

[Calcium metabolism in tuberculosis].

To investigate the role of Ca metabolism in granulomatous lung diseases, 187 patients with pulmonary tuberculosis 42 patients with sarcoidosis, and 47 patients with pneumonia were examined. The mean value of serum Ca on admission in tuberculosis patients was significantly lower than in patients with sarcoidosis. Of 183 patients with tuberculosis, 69 patients (38%) showed Ca level lower than normal range. The longitudinal observation of serum Ca level in 33 drug-responsive patients with tuberculosis disclosed that mean Ca level rose significantly at the third month of treatment, and maintained the similar level up to the sixth month. These findings suggest that the dynamics of Ca metabolism seen in tuberculosis were similar to that in pneumonia and differed from that in sarcoidosis, although both tuberculosis and sarcoidosis are characterized histologically by granuloma formation induced by cell-mediated immunity. To explain changes in Ca level, the chronological analysis of serum Vitamin D level was done, and it showed no correlation with serum Ca level. The lower serum Ca level on admission and their normalization according to the improvement of clinical course in tuberculosis have not been reported yet. It seems that there are responsible factors other than Vit D for Ca level fluctuation, and further studies are needed.