Self-assessment of Allergic Rhinitis and Asthma (SACRA) Questionnaire-based Allergic Rhinitis Treatment Improves Asthma Control in Asthmatic Patients with Allergic Rhinitis.

Objective This study was conducted to investigate whether the add-on treatment of allergic rhinitis (AR) based on the Self-assessment of Allergic Rhinitis and Asthma (SACRA) questionnaire for assessing AR control improves both AR and asthma control in asthmatic patients with AR. Methods This multi-center prospective study was performed in Nagano prefecture, Japan. Two hundred five asthmatic patients and 23 respiratory physicians participated in the study. We administered add-on AR treatments based on the results of the SACRA questionnaire. After the first SACRA questionnaire, 67 asthmatic patients agreed to receive an add-on AR treatment. Three months after the AR treatment, a secondary SACRA questionnaire, asthma control test (ACT), and pulmonary function tests were performed. Results After the add-on AR treatment, the visual analogue scales (VASs) for AR and asthma, as assessed by the SACRA questionnaire and ACT score, were significantly improved in the patients of the AR+ group. With regard to the pulmonary function tests, the percent predicted vital capacity, and percent predicted forced expiratory volume in one second were also significantly improved. Regardless of whether the patients had previously undergone leukotriene receptor antagonists (LTRA) treatment, the VASs for AR and asthma and the ACT score were significantly improved in the AR+ group. However, the vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume (FEV1) were only significantly improved in the AR+ group that had previously undergone LTRA treatment. Conclusion SACRA questionnaire-based add-on AR treatment would be convenient for the detection of AR by respiratory physicians and would offer improved asthma control. This questionnaire can also be used to assess the therapeutic effects.

Sivelestat prevents cytoskeletal rearrangements in neutrophils resulting from lung re-expansion following one-lung ventilation during thoracic surgery.

Patients undergoing lobectomy are at risk of developing acute lung injury resulting from one-lung ventilation (OLV) during surgery. We investigated the morphological and functional behavior of neutrophils in patients who underwent lobectomy and assessed the ability of sivelestat to inhibit neutrophil activity. This was a blinded randomized study. Sixteen patients who underwent lobectomy were given intravenous sivelestat (n = 8) or intravenous saline (n = 8). We studied the cytoskeletal rearrangements of circulating neutrophils by determining the localization of filamentous actin (F-actin). Pulmonary oxygenation was evaluated by measuring the partial pressure of arterial oxygen. We found that the number of circulating, F-actin-rimmed neutrophils increased during OLV and after lung re-expansion. Our results suggest that, in addition to the surgical procedure and OLV, re-expansion of the remaining lung after lobectomy increases the neutrophil activation levels. Furthermore, administration of sivelestat limited neutrophil activation and improved pulmonary oxygenation in our patients.

Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators.

The purpose of this study was to clarify the additive efficacy of short-acting ß(2)-agonists (SABA) or muscarinic antagonists (SAMA) on dynamic hyperinflation and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) who had been treated with long-acting bronchodilators. Thirty-two patients with stable COPD who had been treated with long-acting bronchodilators, including long-acting muscarinic antagonists (LAMA), were examined by pulmonary function tests, dynamic hyperinflation evaluated by the method of step-wise metronome-paced incremental hyperventilation, and the incremental shuttle walking test before and after inhalation of SABA or SAMA. The additive efficacy of the two drugs was analyzed. Inhalation of SABA and SAMA improved airflow limitation and dynamic hyperinflation in stable COPD patients who had been treated with LAMA. Inhalation of SABA decreased respiratory resistance and the difference in respiratory resistance at 5 Hz and 20 Hz. On the whole, the additive efficacy of SABA on airflow limitation and dynamic hyperinflation was superior to that of SAMA. Furthermore, inhalation of SABA resulted in relief of breathlessness during exercise and significant improvement in exercise capacity. Inhalation of SABA resulted in significant improvement in exercise tolerance, which may have been due to improvement in dynamic hyperinflation. Single use of SABA before exercise, in addition to regular treatment with LAMA, may therefore be useful in stable COPD patients.

Increased interleukin-8 in epithelial lining fluid of collapsed lungs during one-lung ventilation for thoracotomy.

The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30 min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.

Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma may overlap and converge in older people (overlap syndrome). It was hypothesized that patients with overlap syndrome may have different clinical characteristics such as sputum eosinophilia, and better responsiveness to treatment with inhaled corticosteroid (ICS). METHODS: Sixty-three patients with stable COPD (forced expiratory volume in 1 second [FEV(1)] ≤80%) underwent pulmonary function tests, including reversibility of airflow limitation, arterial blood gas analysis, analysis of inflammatory cells in induced sputum, and chest high-resolution computed tomography. The inclusion criteria for COPD patients with asthmatic symptoms included having asthmatic symptoms such as episodic breathlessness, wheezing, cough, and chest tightness worsening at night or in the early morning (COPD with asthma group). The clinical features of COPD patients with asthmatic symptoms were compared with those of COPD patients without asthmatic symptoms (COPD without asthma group). RESULTS: The increases in FEV(1) in response to treatment with ICS were significantly higher in the COPD with asthma group. The peripheral eosinophil counts and sputum eosinophil counts were significantly higher. The prevalence of patients with bronchial wall thickening on chest high-resolution computed tomography was significantly higher. A significant correlation was observed between the increases in FEV(1) in response to treatment with ICS and sputum eosinophil counts, and between the increases in FEV(1) in response to treatment with ICS and the grade of bronchial wall thickening. Receiver operating characteristic curve analysis revealed 82.4% sensitivity and 84.8% specificity of sputum eosinophil count for detecting COPD with asthma, using 2.5% as the cutoff value. CONCLUSION: COPD patients with asthmatic symptoms had some clinical features. ICS should be considered earlier as a potential treatment in such patients. High sputum eosinophil counts and bronchial wall thickening on chest high-resolution computed tomography might therefore be a good predictor of response to ICS.

[A case of pulmonary pleomorphic carcinoma treated with S-1 following radiotherapy].

Pleomorphic carcinoma is a rare malignancy of the lung. Here we present a 68-year-old man who was admitted to our hospital for examination of an abnormal radiogram of the chest. The radiogram revealed a large mass in the right lung field. A chest computed tomographic (CT) scan demonstrated a nonsegmentalmass like consolidation. Percutaneous CT-guided fine-needle needle biopsy from the lung was performed, and the specimen demonstrated pulmonary pleomorphic carcinoma. The patient was initially treated with two courses of cisplatin (CDDP) and docetaxel (DOC), and still showed progressive disease (PD). Therefore, we administered S-1 following radiotherapy. The chest CT revealed partial response after 4 months. We experienced a pulmonary pleomorphic carcinoma which showed a response to salvage chemotherapy with S-1.

[A case of lung cancer showing marked reduction of pleural effusion by bevacizumab in combination with carboplatin and paclitaxel].

A 63-year-old man was admitted to our hospital because of dyspnea. Chest computed tomographic(CT)scans showed right pleural effusion. He was diagnosed with adenocarcinoma of the lung(cTXN2M1a, stage IV). Although combination chemotherapy with 80 mg/m / 2 cisplatin(CDDP)and 60 mg/m2 docetaxel hydrate(DOC)was performed for 3 courses, the pleural effusion increased. As he had a progressive disease, his chemotherapy was changed to a new combination of AUC5 carboplatin(CBDCA), 200mg/m / 2 paclitaxel(PTX)and 15 mg/kg bevacizumab. After 2 courses, the pleural effusion dramatically decreased. During 6-month follow-up after the initial consultation, there has been no exacerbation.

Successful S-1 monotherapy for chemorefractory thymic carcinoma.

The optimal chemotherapeutic regimen for inoperable thymic carcinoma remains uncertain and little information is available regarding the usefulness of salvage chemotherapy. S-1, a newly developed oral fluorouracil antitumor drug, has been reported to be effective in the treatment of gastrointestinal tumors and non-small cell lung cancer. This case study reports a case of chemorefractory thymic cancer with a good response to S-1 monotherapy. S-1 was used as sixth-line chemotherapy and the response was the first remarkable tumor regression in the patient's clinical course. S-1 appears to have significant activity against thymic carcinoma.

Malignant hepatic epithelioid hemangioendothelioma with rapid progression and fatal outcome.

A 46-year-old woman was admitted to our hospital because of pain in the right upper quadrant and dyspnea. Abdominal and chest computed tomography (CT) scans revealed areas of low attenuation in both hepatic lobes, left pleural effusion, and multiple nodules in both lungs. Laboratory data indicated disseminated intravascular coagulation. She developed rapidly progressive respiratory and hepatic failure despite intensive treatment including mechanical ventilation and died of respiratory failure 3 weeks after admission. Immunohistochemical analysis of liver necropsy and cytology of the left plural effusion stained positive for factor VIII-related antigen and CD31. Based on these observations, a diagnosis of hemangioendothelioma (EHE), a rare vascular tumor, was made. A rapid clinical course and fatal outcome, as in the present case, are rare clinical manifestations in EHE.

Evaluation of respiratory impedance in asthma and COPD by an impulse oscillation system.

OBJECTIVE: The purpose of this study was to clarify the differences in physiological properties of the airways between asthma and COPD using an impulse oscillation system (IOS). PATIENTS AND METHODS: Subjects comprised 95 stable COPD patients, 52 never-smoker asthma patients and 29 healthy never-smokers >60 years old, all matched for age, in whom respiratory impedance was examined by IOS. RESULTS: In both asthma and COPD patients, a significant increase in respiratory resistance (Rrs5) and more negative value of respiratory reactance (Xrs5) at 5 Hz of oscillatory frequency with an increase in resonant frequency (fres) were observed when compared with healthy never-smokers. In asthma, a significant increase in respiratory resistance at 20 Hz (Rrs20) was also observed when compared with healthy never-smokers and COPD. The increases in Rrs5 and relative changes of Xrs5 to more negative were remarkable with increasing severity of COPD. On the other hand, among patients with asthma, these changes in Rrs5 and Xrs5 were also observed in asthmatics with normal FEV(1)/FVC. Interestingly, Xrs5 showed further changes to more negative in expiration of tidal breath in severe COPD, whereas no significant changes in Xrs5 to more negative in expiration was observed in healthy never-smokers and asthmatics with and without normal FEV(1)/FVC. CONCLUSION: IOS may be useful for detecting pathophysiological changes of respiratory system in accordance with severity of COPD and even in asthmatics with normal FEV(1)/FVC. The larger within-breath changes of Xrs5 to more negative in severe COPD may represent easy collapsibility of small airways in expiration of tidal breath. These properties may help to analyze airway mechanics and to identify abnormalities of the airways that cannot be found by spirometry alone.

Salvage chemotherapy with amrubicin and platinum for relapsed thymic carcinoma: experience in six cases.

It has been reported that cisplatin-based chemotherapy shows beneficial effects in certain patients with advanced thymic carcinoma. However, the usefulness of salvage therapy has not been reported. We focused on a new anthracycline agent, amrubicin, combined with platinum compounds as salvage chemotherapy in patients with thymic carcinoma. Six cases of unresectable and locally advanced thymic carcinoma relapsed from prior cisplatin-containing chemotherapy were treated with amrubicin (30-40 mg/m(2) day 1-3) plus platinum compounds (cisplatin 60 mg/m(2) day 1 or nedaplatin 70 mg/m(2) day 1) chemotherapy as salvage chemotherapy. Two patients showed a partial response. However, Grade 3/4 neutropenia and thrombocytopenia occurred in all and two of the patients, respectively. We conclude that thymic carcinoma is sensitive to platinum-based chemotherapy and that amrubicin appears to have significant activity against thymic carcinoma. The major toxicity is hematological toxicities.

A novel device (SD-101) with high accuracy for screening sleep apnoea-hypopnoea syndrome.

BACKGROUND AND OBJECTIVE: The SD-101 is a non-restrictive, sheet-like medical device with an array of pressure sensors, to detect sleep-disordered breathing by sensing gravitational alterations in the body corresponding to respiratory movements. This study evaluated the accuracy of the SD-101 for screening sleep apnoea-hypopnoea syndrome (SAHS) by comparison with polysomnography. METHODS: Nocturnal polysomnography and SD-101 monitoring were conducted simultaneously and compared in 201 patients with suspected SAHS (suspected SAHS group) and 165 male employees of a transport company (screening group). RESULTS: Polysomnography revealed an AHI of <5, 5 < or = AHI < 15, 15 < or = AHI < 30, 30 < or = AHI < 60 and AHI > or = 60 events/h in 39, 35, 38, 68 and 21 subjects in the suspected SAHS group and 103, 34, 12, 12 and four subjects in the screening group, respectively. Central SAHS and obstructive SAHS were subsequently diagnosed in 11 (5.5%) and 135 (67.2%) of subjects in the suspected SAHS group and five (3.0%) and 39 (23.6%) of subjects in the screening group, respectively. Significant correlations were apparent between AHI and the respiratory disturbance index (RDI) measured with the SD-101 in both the suspected SAHS group (r = 0.88) and screening group (r = 0.92). Receiver operating characteristic curve analysis revealed 89.5% sensitivity and 85.8% specificity in identifying SAHS, using an RDI of 14.0 events/h. CONCLUSIONS: These findings suggest that the SD-101 is a useful device for screening SAHS.

An AIDS patient with immune reconstitution inflammatory syndrome due to pulmonary Mycobacterium kansasii infection during antiretroviral therapy.

After the recovery of pneumocystis pneumonia, amebiasis, and cytomegalovirus duodenal ulcer in a patient with AIDS, antiretroviral therapy was initiated. Fever was first noted on the 11th day of administration of the highly active antiretroviral therapy (HAART), and chest radiography showed infiltration into the right lower lobe of the lung on the 19th day. Bronchoscopy was performed, with a tentative diagnosis of pulmonary tuberculosis, but Mycobacterium kansasii was eventually identified. M. kansasii may also be a pathogenic organism causing immune reconstitution inflammatory syndrome.

Airway hyper-responsiveness in young adults with asthma that remitted either during or before adolescence.

BACKGROUND AND OBJECTIVE: More than 50% of patients with childhood asthma enter clinical remission by puberty, although 40-50% of these people will probably develop asthma symptoms during early adulthood. The mechanism of relapsing asthma in early adulthood remains unclear. This study determined the characteristics of young adults whose asthma remitted either during or before adolescence. METHODS: A comparative study was performed on 24 students whose childhood asthma had gone into clinical remission by puberty (remission group), 25 atopic students with no history of asthma (atopy group) and 19 non-atopic students without allergic diseases (control group). Examinations included spirometry, levels of serum-specific IgE-antibodies, airway responsiveness to methacholine, exhaled nitric oxide (eNO) and evidence of airway inflammation in induced sputum. RESULTS: Airway responsiveness (P < 0.01), eosinophil counts in sputum (P < 0.05) and the prevalence of sensitization to Dermatophagoides forinae (P < 0.01) were significantly higher, and FEF(25-75%) and FEF(75%) (P < 0.01) were significantly lower in the remission group than in the atopy and control groups. Furthermore, 50% and 33% of the remission group had airway hyper-responsiveness (AHR) and sputum eosinophilia, respectively. The eNO levels in the remission (P < 0.01) and atopy (P < 0.05) groups were significantly higher than in controls. Remission group members with AHR had a significantly longer period of childhood asthma, a shorter period of remission and greater airway eosinophilic inflammation than those without AHR (P < 0.05). CONCLUSION: One half of young adults with childhood asthma that remitted either during or before adolescence continued to have evidence of AHR and airway eosinophilic inflammation, and might be at risk of future relapse.

Progressive pulmonary calcification after successful renal transplantation.

In 2005, a 46-year-old woman consulted our department for an evaluation of a chest radiographic abnormality. She had undergone a successful living renal transplantation in 1999 after being treated by dialysis for four years. A chest computed tomographic scan revealed progressive bilateral fluffy, poorly defined small nodules and the bronchoscopic study revealed a unique linear and nodular lesion pattern. Based on the findings of these modalities, we confirmed the diagnosis of metaplastic pulmonary calcification. This is the first report of these bronchoscopic findings and submucosal calcification in a case of metastatic pulmonary calcification.

Selective IgM deficiency accompanied with IgG4 deficiency, dermal complications and a bronchial polyp.

BACKGROUND: IgM deficiency is a rare primary immunodeficiency. As few studies of selective IgM deficiency have been reported among the various other types of primary immunodeficiencies, the detailed pathogenesis of this disorder remains to be elucidated. CASE SUMMARY: We clinically analyzed a 37-year-old woman who presented with IgM and IgG4 deficiency and ectopic bronchial pneumonia, and investigated immunological functions. Occlusive pneumonia was repeatedly observed in the right S6 area, and bronchoscopy revealed a polyp in the right B6 orifice, which was later identified as a fibroepithelial polyp after transbronchial endoscopic polypectomy. Two months later, pneumonia involving the right inferior lobe developed. Systemic erythema and pigmentation with bleb formation were also observed on the skin, and were thought to be drug-induced exanthema following a biopsy. Serum levels of IgM and IgG4 were extremely low at 3.0mg/dl and less than 2.0mg/dl, respectively. Circulating CD20 positive B cells were mildly reduced and memory B cells were markedly decreased. The majority of B cells expressed IgM on their surface. There were no abnormalities in cell counts of neutrophils, T cells, NK cells and monocytes. Chemotaxins, bactericidal activity and phagocytosis of neutrophils were normal. DISCUSSION: There have been no case reports of selective IgM deficiency with concurrent IgG4 deficiency, various dermal symptoms and a bronchial polyp, as demonstrated in our patient.

Unilateral absence of the pulmonary artery incidentally found after an episode of hemoptysis.

A 29-year-old woman was admitted to our hospital because of hemoptysis and dyspnea. A chest radiographic study revealed an enlargement of the right lung hilum, and the left pulmonary artery could not be clearly visualized on contrast-enhanced CT scan. Both perfusion scintigraphy and pulmonary angiography confirmed the absence of the left pulmonary artery, and agenesis of the right upper pulmonary artery. Her clinical status has been stable for the previous two years of follow-up, even though she required long-term oxygen therapy. This is a rare case of a young woman with the unilateral absence of the left pulmonary artery incidentally found after an episode of hemoptysis.

Successful endoscopic dilatation to alleviate airway suffocation in a case with esophageal cancer after stent implantation.

A case of esophageal cancer who suffered from tracheal stenosis at the tracheostomy after stent implantation is presented. The patient received a covered metallic tracheal stent to seal the esophago-respiratory fistulation. After six months, the tracheal retainer for his tracheostomy was difficult to insert into his trachea due to the growth of the cancer. Argon plasma coagulation (APC) has been successfully employed in the dilatation of tracheal stenosis at the tracheostomy. We herein describe the use of APC as an effective treatment for further palliative therapy of tracheal dilatation in order to treat tracheal stenosis by esophageal cancer after stent implantation.

Second-line chemotherapy of platinum compound plus CPT-11 following ADOC chemotherapy in advanced thymic carcinoma: analysis of seven cases.

BACKGROUND: Optimal chemotherapeutic regimen in thymic carcinoma remains uncertain and the efficacy of second line chemotherapy has not been established either. PATIENTS AND METHODS: We retrospectively evaluated the efficacy of an irinotecan plus cisplatin or carboplatin (IP) regimen as a salvage treatment for patients with unresectable thymic carcinoma that progressed after cisplatin, doxorubicin, vincristine and cyclophosphamide (ADOC) chemotherapy. Seven patients with histologically confirmed thymic carcinoma that was resistant to or who had relapsed after initial chemotherapy with ADOC were treated with IP. The treatment consisted of irinotecan (CPT-11, 60 mg/m2, days 1, 8 and 15) and cisplatin (80 mg/m2, day 1) or carboplatin (AUC 4) intravenously every 4 weeks, for at least 2 cycles. RESULT: Two patients achieved partial responses. Although another two patients showed a significant reduction of the primary thoracic lesion, the appearance of a new lesion was found in one and a metastatic lesion was unchanged in the other. Neutropenia over grade 3 was observed in all patients but none of the patients developed serious infections. There were no severe non-hematological toxicities, including diarrhea. CONCLUSION: We conclude that salvage chemotherapy may be useful in certain patients with thymic carcinoma and irinotecan may be a novel and alternative agent for relapsed thymic carcinoma.