Alleviation of Dyspnea and Changes in Physical Activity Level by Air Flow to the Face With a Fan.

BACKGROUND: Dyspnea is an unpleasant subjective symptom and is associated with decreased physical activity level (PAL). Effect of blowing air toward the face has received a great deal of attention as a symptomatic therapy for dyspnea. However, little is known about the duration of its effect and its impact on PAL. Therefore, this study aimed to measure dyspnea severity and changes in dyspnea and PALs with air blasts to the face. METHODS: The trial conducted was open-label, randomized, and controlled. This study included out-patients with dyspnea caused by chronic respiratory deficiency. Subjects were provided a small fan and instructed to blow air toward their faces either twice a day or when having trouble breathing. Subsequently, severity of dyspnea and PALs was measured using visual analog scale and physical activity scale for the elderly (PASE), respectively, before and after 3-week treatment. Amounts of changes in dyspnea and PALs before and after treatment were compared using analysis of covariance. RESULTS: Overall, 36 subjects were randomized, and 34 were analyzed. Mean age was 75.4 y (26 males [76.5%] and 8 females [23.5%]). Visual analog scale score for dyspnea (SD) before treatment was 33 (13.9) mm and 42 (17.5) mm in the control and intervention groups, respectively. PASE score before treatment was 78.0 (45.1) and 57.7 (38.0) in the control and intervention groups, respectively. No significant difference in changes in dyspnea severity and PAL was observed between the 2 groups. CONCLUSIONS: No significant difference was observed for dyspnea and PALs in subjects after blowing air toward their own faces with a small fan for 3 weeks at home. Disease variability and impact of protocol violations were high due to small number of cases. Further studies with a design focused on subject protocol adherence and measurement methods are required to understand impact of air flow on dyspnea and PAL.

Multi-Institutional Prospective Cohort Study of Patients With Pulmonary Hypertension Associated With Respiratory Diseases.

BACKGROUND: There is limited evidence for pulmonary arterial hypertension (PAH)-targeted therapy in patients with pulmonary hypertension associated with respiratory disease (R-PH). Therefore, we conducted a multicenter prospective study of patients with R-PH to examine real-world characteristics of responders by evaluating demographics, treatment backgrounds, and prognosis.Methods and Results:Among the 281 patients with R-PH included in this study, there was a treatment-naïve cohort of 183 patients with normal pulmonary arterial wedge pressure and 1 of 4 major diseases (chronic obstructive pulmonary diseases, interstitial pneumonia [IP], IP with connective tissue disease, or combined pulmonary fibrosis with emphysema); 43% of patients had mild ventilatory impairment (MVI), whereas 52% had a severe form of PH. 68% received PAH-targeted therapies (mainly phosphodiesterase-5 inhibitors). Among patients with MVI, those treated initially (i.e., within 2 months of the first right heart catheterization) had better survival than patients not treated initially (3-year survival 70.6% vs. 34.2%; P=0.01); there was no significant difference in survival in the group with severe ventilatory impairment (49.6% vs. 32.1%; P=0.38). Responders to PAH-targeted therapy were more prevalent in the group with MVI. CONCLUSIONS: This first Japanese registry of R-PH showed that a high proportion of patients with MVI (PAH phenotype) had better survival if they received initial treatment with PAH-targeted therapies. Responders were predominant in the group with MVI.

Mediastinal peripheral T-cell lymphoma diagnosed by repeated biopsies after an initial diagnosis of fibrosing mediastinitis.

We report a case of mediastinal peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) diagnosed by repeated biopsies. A 44-year-old man was admitted to our hospital with a 2-week history of facial swelling, neck distension, and dyspnoea on exertion. Computed tomography of the chest showed a mediastinal mass. Initial needle biopsy and video-assisted thoracoscopic biopsy revealed the pathological diagnosis of fibrosing mediastinitis (FM). Glucocorticoid therapy (prednisolone) was temporarily effective in reducing tumour size. However, other laboratory features suggested that the diagnosis of FM might not be correct. After repeated biopsies, we established the diagnosis of mediastinal PTCL-NOS. With this correct diagnosis, appropriate therapy for PTCL resulted in the improvement of the clinical manifestations. This report suggests that the presence of malignant lymphoma should be considered in cases of mediastinal tumours, and repeated biopsies may be occasionally needed for consistent diagnosis.

[A case of a septic pulmonary embolism-related implanted central venous port].

We report a case of a 32-year-old woman with a septic pulmonary embolism-related implanted central venous port. She was treated with S-1/cisplatin(CDDP)chemotherapy for recurrent gastric cancer. Her disease was progressive after five courses of S-1/CDDP combination therapy. Because of peritonitis carcinomatosa, her oral intake was poor, so we placed an implanted central venous port in her right subclavian vein. We administered 5-FU/Leucovorin/paclitaxel combination therapy and total parenteral nutrition from the port. Chemotherapy was effective, so we stopped total parenteral nutrition after one month. Two months later, multiple nodular shadows appeared in her left lung fields without apparent symptoms. Because we suspected septic pulmonary embolism related to the venous port, we removed the venous port promptly and administered antibiotics with a broad spectrum. Pulmonary shadows disappeared immediately, and no recurrence was observed afterward.

[Case of Toxocara canis larva migrans cured by additional treatment with albendazole].

A 42-year-old man presented at our emergency department with fever, sputum, and dyspnea. His chest X-ray films showed ground-glass opacities mainly in the upper and middle lung fields. We diagnosed pneumonia, gave antibiotic treatment, and his symptoms improved. However he later showed eosinophilia. We performed additional workup, and diagnosed Toxocara canis larva migrans. We treated him with albendazole for four weeks, but his eosinophil count rose again from the end of treatment one month later. Therefore we performed additional treatment with albendazole for 8 weeks, after which the clinical imaging findings and serum antibody titer improved. There are few reports about additional treatment for Toxocara canis larva migrans, and there is not yet a consensus. We think that we should consider additional treatment in cases that do not show improvement on initial treatment.

Additive inoculation of influenza vaccine and 23-valent pneumococcal polysaccharide vaccine to prevent lower respiratory tract infections in chronic respiratory disease patients.

BACKGROUND: An increased incidence of pneumococcal infection triggered by influenza infection has been reported. OBJECTIVE: To examine the effectiveness of the additive inoculation of influenza vaccine (I-V) and 23-valent pneumococcal vaccine (P-V) to prevent lower respiratory tract infections. METHODS: 105 Japanese patients with chronic respiratory disease underwent the additive inoculation of I-V and P-V between October 2002 and January 2003, and their medical records were used to retrospectively examine the number of bacterial respiratory infections, number of hospitalizations, and length of hospital stay in the 2 years prior to and after P-V inoculation. Among them [chronic obstructive pulmonary disease (COPD): 45; bronchial asthma: 24; bronchiectasis: 20 (including diffuse panbronchiolitis); and other diseases: 16], 98 patients were evaluated, except for seven patients who died of diseases other than respiratory infections within the 2 years after P-V inoculation. Subjects were 51 to 91 years of age (median: 74 yrs), the male-female ratio was 63:42, and 32 patients were on home oxygen therapy. RESULTS: After P-V inoculation, decreases in the number of respiratory infections (3.16 vs. 1.95 infections; p=0.0004) and in the number of hospitalizations (0.79 vs. 0.43 hospitalizations; p=0.001) were observed. Furthermore, an analysis including other factors, i.e., number of patients on home oxygen therapy and influenza season, also revealed a decreased number of hospitalizations. CONCLUSIONS: The additive inoculation of I-V and P-V in Japanese patients with chronic respiratory disease prevented the development of bacterial respiratory infections and warrants further study in patients with respiratory disease.

Clinical relevance of sputum cytology and chest X-ray in patients with suspected lung tumors.

OBJECTIVE: To review diagnostic procedures, therapeutic modalities, and follow-up methods in patients with suspected lung tumors. METHODS: We retrospectively examined 70 patients who underwent a complete medical checkup because they had been positive for sputum cytology and had presented no chest X-ray findings for the 10-year period between 1994 and 2004. To make a diagnosis, we conducted the first complete medical checkup that included chest X-ray, sputum cytology, chest computed tomography (CT), and bronchoscopy. In the case that no diagnosis could be made, we repeated the chest X-ray and sputum cytology every 3 to 6 months and additionally conducted chest CT and bronchoscopy according to abnormal findings. RESULTS: Among 70 patients, there were 36 and 13 who were diagnosed during the first complete medical checkup and follow-up, respectively, 13 who remained undiagnosed, and eight for whom follow-up was discontinued. Among the 49 diagnosed patients, 40, 8, and 1 patient had lung cancer, upper respiratory tract carcinoma (URTC), and esophageal carcinoma (EC), respectively. Among the 40 patients with lung cancer, 34 had a stage 0 or I tumor and 15 were radically treatable by photodynamic therapy and endobronchial irradiation. Nine among 11 patients whose lung cancer was detected during follow-up had a stage 0 or IA tumor. CONCLUSION: Not only lung cancer but also URTC and EC were successfully detected in patients who were positive for sputum cytology and presented negative chest X-ray. Radical treatment was possible in 38 (76%) of 50 diagnosed patients, thus indicating the importance of follow-up through these procedures.

[A case of sarcoidosis who showed rapid swelling of mediastinal and abdominal lymph nodes].

A 49-year-old woman noticed hoarseness and facial palsey three months prior to her visit to our hospital. Chest radiograph and CT scanning revealed bilateral mediastinal and hilar lymphadenopathy. Bronchofiberoptic biopsy showed sarcoidosis. Her symptoms improved under no treatment. However, she showed rapid increase of mediastinal and abdominal lymph nodes swelling and elevation of serum level of sIL-2R during observation. Therefore, we must discriminate sarcoidosis-lymphoma syndrome from exacerbation of sarcoidosis. Mediastinoscopic biopsy was conducted for diagnosis, and it revealed exacerbation of sarcoidosis. We reported this rare case of rapid increase of mediastinal and abdominal lymph node swelling due to sarcoidosis.

[A case of intravascular lymphomatosis with no abnormal findings on chest computed tomography and with diffuse pulmonary uptake of 67Ga on scintigraphy].

A 45-year-old man was admitted to our hospital with high-grade fever uncontrolled by antipyretic drugs, and elevation of the serum LDH and sIL-2R levels, and decrease of diffusing capacity for carbon monoxide. Chest computed tomography (CT) showed no abnormal findings but 67Ga scintigraphy revealed diffuse pulmonary uptake. He was given a diagnosis of intravascular lymphomatosis (IVL) based on transbronchial lung biopsy (TBLB) and immunohistochemical analysis. The prognosis of IVL is generally bad, because antemortem diagnosis is difficult. In this case early TBLB enabled satisfactory curative effect of IVL.

[A case of chronic pleuritis by Paragonimus Westermani infection resistant to standard chemotherapy and cured by three additional cycles of chemotherapy].

A 16-year-old boy had eaten Chinese freshwater crabs soaked in liquor in October 2000, and the left pleural effusion was pointed out on chest X-ray films at a regular medical checkup at school in June 2002. Since his father and friends had suffered from Paragonimiasis Westermani and had been treated in January 2001, the patient agreed to immunoserological examination, and Paragonimiasis Westermani was diagnosed. After drainage of pleural effusion, the patient was treated with praziquantel for three days at a daily dosage of 75 mg/kg, but without effect. The patient received drainage of pleural effusion again, and was treated with praziquantel for 3 days at a daily dosage of 75 mg/kg in a series of three treatments at three week interval. After that, improvement of the disease was achieved.