[Does the present medical care system satisfy patients with home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) in Japan?: an answer from a questionnaire analysis].

The aim of this study was to determine whether the present Japanese medical care system for home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) satisfies patients (HOT & HTAV Pts) who receive these therapies. To clarify this issue, we sent questionnaires to 807 patients with HOT and HTAV, 816 practitioners (DRs), and 110 nursing stations (NSs) in metropolitan Tokyo. Responses were eventually received from 79.9% of HOT & HTAV Pts, 32.7% of Drs and 60.9% of NSs. As a result, going to hospitals on regular basis itself (1.3 times a month) forces HOT & HTAV Pts to spend a lot of money and time at present (22.4% spent more than 5,000 yen, and 15.5% more than 60 minutes for a consultation). Although a majority of HOT & HTAV Pts now see a respiratory specialist in larger hospitals, HOT & HTAV Pts wish to see DRs, if the DRs have sufficient ability in HOT and HTAV management. On the other hand, both DRs (86.9%) and NSs (90.6%) consider that case conferences and lectures regarding HOT and HTAV on a regular basis are essential. These meetings are attended by respiratory specialists, DRs, NSs, medical equipment dealers, HOT & HTAV Pts's family members and so forth, because both DRs and NSs feel a certain anxiety about seeing HOT & HTAV Pts (68.3% DRs and 7.5% NSs do not want to see HOT & HTAV Pts). In summary, 1) a majority of HOT & HTAV Pts remain unsatisfied with the present medical care system, 2) a vague anxiety about seeing HOT & HTAV Pts makes DRs tend to avoid HOT & HTAV Pts consultations, 3) NSs frequently feel unsure how to recognize and respond properly to problems concerning HOT & HTAV Pts (62.3%). We therefore conclude that if we could succeed in organizing a better medical care system for HOT & HTAV Pts than the present one, we could turn substantially improve the quality of life of HOT & HTAV Pts in Japan.

[Effects of bathing on lung mechanics in patients with severe COPD].

Although it is well known that the majority of patients with severe COPD complain of exacerbated dyspnea while taking a Japanese-style bath, the mechanism has not been elucidated. We therefore investigated changes in lung volume (LV) and SaO2 in 16 seated patients with severe COPD, receiving treated with home oxygen therapy (HOT), and in 10 healthy subjects (C) immersed to the navel (N) and to the shoulder (S). We then subdivided the COPD patients into 2 groups, A and B. Group A was composed of patients taking less than 2 L oxygen/min, while group B was taking equal to or greater than 2 L oxygen/min. Expiratory reserve volume (ERV) decreased with statistical significance (p < 0.05) while inspiratory capacity (IC) substantially increased as immersion progressed. However, changes in LV were smaller, as obstructive ventilatory changes progressed. It also appeared that a significant O2 desaturation occurred in patients with COPD when movement was associated with taking a bath. The drop in SaO2 during bathing was significantly improved after patients received instructions concerning posture, slow movements, and pursed-lip breathing. These findings suggest that immersion, such as when taking a Japanese-style bath, 1) may change various LV to a lesser degree than in healthy subjects because of previously existent airway obstruction in COPD, 2) may aggravate arterial desaturation through further impairment of the VA/Q imbalance, 3) instructions for COPD patients could improve, their condition while bathing and, 4) the 6 minute walking distance (6 MD) might be important in predicting the severity of arterial desaturation while COPD patients are immersed.

[Analysis of pulmonary manifestations in patients with rheumatoid arthritis].

We studied chest X rays of 911 patients with rheumatoid arthritis (RA). The findings showed interstitial shadow in 28 patients (3.1%), pleuritis in 13 patients (1.4%) and nodular shadow in 3 patients (0.3%). RA patients with interstitial pneumonia were commonly male and older. And they had significantly high levels of rheumatoid factor (RF), RAPA and IgG-RF in serum, but they were not associated with high score of Lansbary index. All patients with more than 1500 IU/ml in RF value had a complication of interstitial pneumonia. These results suggest the importance of chest X-ray in the management of RA patients with high titer in RF.

Pyothorax-associated lymphoma: development of Epstein-Barr virus-associated lymphoma within the inflammatory cavity.

Pyothorax-associated lymphoma (PAL) is a B cell lymphoma that develops in Japanese patients with tuberculosis-associated chronic pyothorax (TaCP). Epstein-Barr virus (EBV) has been shown to be causally related to PAL. To clarify the developmental process of PAL, the systemic and local presence of EBV, and serum profile of anti-EBV antibodies was investigated in TaCP. EBV genome was found in peripheral blood mononuclear cells by PCR in a 10(-4)-10(-5) amount of Raji cell-DNA in three of four patients with TaCP, but was also identified in patients with pyothorax caused by other diseases (2/2) or without pulmonary diseases (2/6). EBER1 in situ hybridization and EBNA2 immunocytochemistry revealed clusters of EBV-carrying cells in the cavity content (3/18) but not at the pyothorax wall; EBV(+) histological lymphoma cells were found in two cases and EBV(+) mononuclear cells were found in one case. A simultaneous increase in serum titers of anti-EBV viral capsid antigen IgG and IgA antibodies was observed in TaCP (4/16). These results suggest that a local factor, an inflammatory cavity, has a pivotal role in the development of PAL, which might be reflected in the serum titers of anti-EBV antibodies in patients with TaCP.

In vitro investigation of a combination of two drugs, cisplatin and carboplatin, as a function of the area under the c/t curve.

The log/log relationship between the IC50 of cisplatin or carboplatin and the exposure time, determined by human tumor clonogenic assay (HTCA) and MTTAI (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay with additional incubation) using PC-14 cells, exhibited a straight line with a slope of -1, indicating that both drugs have AUC-dependent cytotoxicity (AUC, area under the c/t curve). The combined effect of cisplatin and carboplatin was estimated by the median-effect analysis using HTCA, and it was additive when the AUC ratio (AUC of free platinum from carboplatin/that from cisplatin) was low (3.2, 6.5 or 13.1 in each of PC-7, PC-9, PC-14, H-69, and K562). However, it was significantly worse at a higher AUC ratio (19.5 in PC-7, PC-9, and PC-14). The log/log relationship of each drug, determined by MTTAI using human bone marrow cells, showed that each drug exerts an AUC-dependent cytotoxicity on marrow granulocytes. When cisplatin and carboplatin were combined at an AUC ratio of 14, the therapeutic index was significantly better than that of carboplatin alone and less than that of cisplatin alone using K562, PC-9 and PC-14, indicating the usefulness of this combined therapy for tumor cells with high sensitivity to platinum compounds at this AUC ratio.

[Early phase II study of MST-16 (sobuzoxane) for breast cancer].

An early phase II study of MST-16 for breast cancer was conducted with the participation of 9 hospitals. MST-16 was administered at three doses; 1) 1,600 mg/body for 5 consecutive days repeating every 4 weeks, 2) 1,200 mg/body for 10-14 consecutive days every 5 weeks, and 3) 1,200 mg/body daily for at least 4 weeks. A total of 28 patients were entered, and 27 cases were eligible. Twenty-five cases were evaluated for efficacy and 27 cases for safety. One patient achieved complete response, 2 patients attained partial response, and the response rate thus obtained was 12.0%. Major side effects observed were myelosuppression represented by leukopenia (69.2%) followed by gastrointestinal disorders. These symptoms, however, were reversible by the cessation of administration.

[An experience of laser therapy of lung cancer complicated with hemophilia A].

We applied an endoscopic Nd-YAG laser therapy for an early hilar lung cancer complicated with hemophilia A in a patient of 62-year-old male. Abnormality was pointed out by means of sputum cytology. But, no shadow of tumor was observed by chest x-ray films and computed tomogram. By a bronchoscopy, a mild irregular mucomembrane and stenosis without tumor were exhibited. By means of cytological diagnosis of an abrasive-washing specimen of that region, the presence of squamous cell carcinoma was proved. Also, he was diagnosed as factor VIII deficient hemophilia A. So we performed him a laser therapy in place of the operation and with an intrabronchial arterial infusion. After the laser treatment, the conditions progressed better without any recurrence but about one and a half years later, an intrapulmonary metastasis occurred. Then, radiation and chemotherapy have been applied and at present, the patient is in a good state although under the tumor-bearing condition.