Tracing Photoinduced Hydrogen Migration in Alcohol Dications from Time-Resolved Molecular-Frame Photoelectron Angular Distributions.

The recent implementation of attosecond and few-femtosecond X-ray pump/X-ray probe schemes in large-scale free-electron laser facilities has opened the way to visualize fast nuclear dynamics in molecules with unprecedented temporal and spatial resolution. Here, we present the results of theoretical calculations showing how polarization-averaged molecular-frame photoelectron angular distributions (PA-MFPADs) can be used to visualize the dynamics of hydrogen migration in methanol, ethanol, propanol, and isopropyl alcohol dications generated by X-ray irradiation of the corresponding neutral species. We show that changes in the PA-MFPADs with the pump-probe delay as a result of intramolecular photoelectron diffraction carry information on the dynamics of hydrogen migration in real space. Although visualization of this dynamics is more straightforward in the smaller systems, methanol and ethanol, one can still recognize the signature of that motion in propanol and isopropyl alcohol and assign a tentative path to it. A possible pathway for a corresponding experiment requires an angularly resolved detection of photoelectrons in coincidence with molecular fragment ions used to define a molecular frame of reference. Such studies have become, in principle, possible since the first XFELs with sufficiently high repetition rates have emerged. To further support our findings, we provide experimental evidence of H migration in ethanol-OD from ion-ion coincidence measurements performed with synchrotron radiation.

[Relationship between flow volume curve and CT findings in non-smoking patients with long histories of bronchial asthma].

AIM: This study was conducted to verify whether bronchial asthma (BA) alone causes pulmonary emphysema (PE), and to examine the computed tomography (CT) findings in non-smokers with BA demonstrating the flow volume curve (FV curve) characteristic of PE. SUBJECTS AND METHODS: Non-smoking patients with a history of BA for more than 20 years were divided into 2 groups: the dogleg pattern group (n = 5), with an FV curve characteristic of PE, and the concave pattern group (n = 16) with an FV curve characteristic of BA. CT scans was performed using CT values (level, 900 H.U.; width, 400 H.U.) that facilitate detection of a low attenuation area (LAA), and using conventional CT values (level, 700 H.U.; width, 1,300 H.U.). LAA (including air trapping), thickness of the bronchial wall, and partial atelectasis were compared between the 2 groups. RESULTS: PE was not detected, although air trapping was found in all subjects. The thickness of the airway was greater in the dogleg pattern than in the concave pattern. The incidences of air trapping and partial atelectasis were higher in the former than in the latter. DISCUSSION: BA alone may not cause PE. Some BA patients without PE show the FV curve characteristic of PE, reflecting an increase in the thickness of the airway wall and a decrease in the pulmonary ventilation probably due to the air trapping and the partial atelectasis.

[Development of a case of Mycobacterium avium complex disease from right pleural effusion].

Moist pleurisy in patients with Mycobacterium avium Complex (MAC) is rarer than tuberculosis. We encountered an extremely rare case of MAC disease in a 75-year-old man who initially had only right pleural effusion. Gaffky VII was detected in the pleural effusion, and Mycobacterium avium was identified by culture and PCR. Although administration of antitubercular agents (RFP, INH, EB, and SM) + CAM and thoracic lavage were repeated, the Gaffky persisted strongly. Accordingly, pulmonary decortication and filling of the cavity with an omental flap were performed as surgical treatments. However, fistulas were formed between the remaining empyema cavity and the surgical wounds. Fenestration was also carried out. Postoperatively, centriacinar abnormalities appeared on computed tomography (CT). It has been reported that MAC disease begins with centriacinar abnormalities and the incidence of the lymphatic developmental pattern was low. Tuberculosis (the idiopathic pleuritis type) is considered to be caused this pattern from the primary infection focus. Therefore, the onset of unilateral effusion is extremely rare in patient with MAC disease, suggesting that the lymphatic developmental pattern occurs less frequently in patients with MAC disease. Furthermore, in this case, we speculated that centriacinar abnormalities were the MAC infection foci and could be detected by CT due to surgical invasion.

[Desensitization therapy for antituberculous drugs].

We retrospectively evaluated the effectiveness of desensitization therapy for antituberculous drugs (Rifampicin and Isoniazid) in 28 cases (29 episodes) with adverse reactions to these drugs. Desensitization therapy for RFP was performed in 23 cases (24 episodes) with administration of a first dose of 1-150 mg and a final dose of 300-450 mg for 1-29 days. The success rate of this therapy was 79% (19 of 24 episodes). Desensitization therapy for INH was performed in 12 cases with administration of a first dose of 2.5-100 mg and a final dose of 200-400 mg for 3-25 days. The success rate of this therapy was 83% (10 of 12 cases). Based on a comparative study of cases between successful and unsuccessful desensitization to RFP and INH it was concluded that there were no significant differences with regard to allergic history, adverse effects and their periods of appearance, the first dose and final dose of administration and the interval of administration, starting periods of the desensitization therapy and the periods of appearance of adverse effects due to this therapy. We evaluated desensitization therapy for two antituberculous drugs (RFP and INH) for tuberculous patients for whom the use of such drugs was restricted because of adverse effects, and we found it is a useful treatment, showing a high rate of success (80%).

[Desensitization therapy for allergic reactions of antituberculous drugs--evaluation of desensitization therapy according to the guideline of the Japanese Society for Tuberculosis].

We prospectively evaluated the effectiveness of desensitization therapy for cases showing side-effects to antituberculous drugs (Isoniazid and Rifampicin) according to the guideline proposed by the Treatment Committee of the Japanese Society for Tuberculosis. Nineteen patients (23-88 years old, male 9, female 10) who had experienced adverse effects after receiving antituberculous drugs and underwent desensitization therapy between August 1998 and March 2000 were studied. Underlying diseases were 14 cases of pulmonary tuberculosis, 2 cases of cervical tuberculous lymphadenitis, 1 case of pulmonary atypical mycobacteriosis, 1 case of pulmonary tuberculosis and tuberculous pleuritis, 1 case of pulmonary tuberculosis and tuberculous lymphadenitis. The regimens of treatment for tuberculosis were INH + RFP + EB in 8 cases, INH + RFP + EB + PZA in 7 cases, INH + RFP + SM in 2 cases, INH + RFP + SM + PZA in 1 case, and INH + RFP in 1 case. Adverse reactions were 8 cases of eruption, 7 cases of drug fever, 3 cases of drug fever and eruption, and 1 case of drug fever and cervical lymphadenopathy. The causative drugs suggested from DLST or the clinical course were RFP in 17 cases and INH in 8 cases. The clinical effect of desensitization therapy for these antituberculous drugs was good in 14 out of the 17 cases (82%) for RFP, and in 6 out of 8 cases (75%) for INH. The effectiveness rate of the present desensitization therapy according to the guideline of the Japanese Society for Tuberculosis was almost equal to that of previous desensitization therapy, and the clinical results were almost same in present and previous studies despite the different methods of administration of the antituberculous drugs.

[Expired nitric oxide concentration derived from nasal cavity and that derived from airway and lung in Japanese cedar pollinosis].

AIM: Japanese cedar pollinosis (Type I allergy to Japanese cedar pollen) shows a high incidence in spring in Japan, demonstrating symptoms such as pituita, rhinostenosis, lacrimation and sometimes pharyngeal pain. The following study investigated whether expired nitric oxide (NO) concentration is increased in Japanese cedar pollinosis, and whether expired NO concentration can be used to discriminate from cold syndrome which symptoms are similar to Japanese cedar pollinosis. SUBJECTS AND METHODS: In 20 healthy subjects, 20 patients with Japanese cedar pollinosis and 20 patients with cold syndrome, expired NO concentrations derived from nasal cavity and those derived from airway and lung were measured. Expired NO concentrations derived from nasal cavity and those derived from airway and lung were compared among the groups. RESULTS: In patients with Japanese cedar pollinosis expired NO concentrations derived from nasal cavity and those derived from airway and lung markedly increased. In patients with cold syndrome there were no significant increases in these concentrations. DISCUSSION: It is considered that expired NO concentration is useful for discriminating Japanese cedar pollinosis from cold syndrome. It seems interesting that not only expired NO concentrations derived from nasal cavity but also those derived from airway and lung were clevated. Generalized airway inflammation may be present, even without clinical asthma, in patients with Japanese cedar pollinosis.

[Significance of area under the flow volume curve--useful index of bronchial asthma].

Some studies have reported that area under the flow volume curve (AUFVC) can be an index of pulmonary function. However, the significance of AUFVC remains to be clarified. We have clarified that AUFVC reflects the momentum of expired air. Size of flow volume curve (= AUFVC) has been commonly recognized to be changeable visually in patients with asthma. To clarify whether size of flow volume curve (= AUFVC) is a useful index of the course of bronchial asthma, we compared the rate of improvement forced expiratory volume in 1 second (FEV1.0), peak expiratory flow rate (PEFR) or forced vital capacity (FVC) to the rate of improvement in AUFVC after admission in 20 patients with bronchial asthma. The rate of improvement in AUFVC positively correlated with the rate of improvement in FEV1.0, PEFR or FVC. AUFVC demonstrated more marked improvement than other indices. Since AUFVC reflects the momentum of expired air, bronchial asthma's patients could understand visually that the momentum of expired air decreased due to airway stenosis by presenting flow volume curve. Therefore, visual size of flow volume curve helped patients with asthma to understand the condition of asthma. Size of flow volume curve (AUFVC) may be useful index of the course of bronchial asthma.

[A mild case of acute eosinophilic pneumonia].

We encountered a mild case of acute eosinophilic pneumonia in a 24-year-old man who developed symptoms once he started smoking. Bronchoalveolar lavage revealed eosinophilia. Chest computed tomography revealed a small amount of bilateral pleural effusion and multicentric panacinar shadows with peripheral ground-glass opacities. During the clinical course, the patient suffered only cough and fever, which subsided in 13 days without the administration of steroids. Although the clinical course in this case resembled that of simple pulmonary eosinophilia, we diagnosed it as a mild case of acute eosinophilic pneumonia because pleural effusion rarely accompanies simple pulmonary eosinophilia, symptoms developed when the patient began smoking, and interstitial involvement was suggested by bilateral effusion and ground-glass opacity. We look forward to the establishment of the disease concept of acute eosinophilic pneumonia, including mild cases, and a classification system for eosinophilic lung diseases, including acute eosinophilic pneumonia.

Effects of a long-term inhalation of fragrances on the stress-induced immunosuppression in mice.

The aim of this study was to determine the effects of the long-term application of various fragrances on the suppression of immune response induced by high-pressure stress in mice. The immune response was analyzed based on plaque-forming cell (PFC) count, using mice sensitized with sheep red blood cells. The decreased PFC involving thymic involution induced by high-pressure stress in mice was restored by exposing the stressed mice to tuberose, lemon, oakmoss and labdanum for 24 h following exposure to stress. The decreased PFC and thymic involution from stress were restored by exposure to lemon and oakmoss, but not to tuberose and labdanum when the mice were exposed to those fragrances continuously for 3 weeks before the stress was given, followed by exposure to the same fragrances for 24 h after the stress. The decreased PFC and thymic involution from stress were restored by exposure to lemon and labdanum for 24 h after the stress, but not to tuberose over 3 weeks before the stress was given. These data suggest that the neuroimmunomodulatory effects of fragrances may be affected by tolerance depending on the kinds of fragrances in the case of a long-term application.

[Measurement of expired nitric oxide concentration].

UNLABELLED: Much interest has been focused on standardization of measurement of expired nitric oxide (NO) concentration. The aim of this study was establish a simple measurement of expired NO concentration. SUBJECTS AND METHODS: This study included 5 healthy male adults. To clarify whether NO is excreted in expired air constantly, its concentrations were measured while changing the flow rate. To examine the influence of NO derived from the nasal cavity, we compared expired No concentrations sampled from the month with those sampled from the endotracheal tube inserted to the trachea at a constant flow rate serially. RESULTS: Expired NO concentrations decreased in inverse with the flow rate. No may be serially excreted in expired air. When serial changes of expired No concentrations sampled from the mouth were examined, its NO concentration initially reached a peak, then showed a plateau. Serial changes of those sampled from the endotracheal tube showed only a plateau. Plateau levels were not different between the two kinds. Therefore the peak values may have been influenced by NO derived from the nose that fell in the trachea by inspiration. Plateau values appeared to represent airway and lung-derived NO. CONCLUSIONS: A simple measurement of expired NO concentration should be sampled from the mouth at a constant flow rate serially. Evaluating plateau values is appropriate for expired NO concentration.

[A case of cervical-mediastinal lymph node tuberculosis progressed to pulmonary lesion through a bronchial fistula].

The patient was a 25-year-old man who had been admitted to a local hospital due to fever and trachelophyma. Tubercle bacillus was detected in pus culture obtained by biopsy of the trachelophyma, but not in sputum culture. Because combined therapy with 3 antituberculous drugs (RFP, INH and SM) failed to reduce the fever or drainage from the biopsy region, the patient was transferred to our hospital. Chest X-ray films taken on admission revealed dilatation of the superior mediastinal shadow; chest CT images revealed cervical and mediastinal lymphadenopathy and an anterior mediastinal abscess, but no pulmonary lesion. About 2 months after admission, cough developed and Gaffky type 2 was detected in the patients sputum. Bronchoscopy and bronchography revealed a bronchomediastinal fistula. Forty days after the onset of cough, reticulogranular shadows were observed in the right upper lobe on chest X-ray films, and a diffuse centrilobular lesion was observed in the right upper lobe on chest CT images. From these clinical observations, the patient was given a diagnosis of cervical-mediastinal lymph node tuberculosis, which had progressed to pulmonary lesion through a bronchial fistula due to lymphadenitis.

[Clinical analysis of foreign patients with tuberculosis found in Chugoku-Shikoku area].

In this study, we investigated 45 foreign patients who had been diagnosed as having tuberculosis in Chugoku-Shikoku area during the past 12 years. Regarding regional characteristics, in Hiroshima prefecture an epidemic of tuberculosis was experienced among patients coming from South America, but antituberculous therapy was performed for 87% of the patients because of the high coverage of the health insurance scheme. But in Okayama prefecture, most of the patients were female and came from Asian countries, such as, the Philippines. Antituberculous therapy was not performed for nine patients because of no coverage of the health insurance scheme. In the other prefectures, only a few cases of tuberculosis were experienced, but in Yamaguchi prefecture two of three foreign patients were multidrug-resistant tuberculosis.

[Evaluation of home-oxygen-therapy for old tuberculosis cases, especially emphasis on the medical support for more comfortable life].

We investigated the home-oxygen-therapy (HOT) for old tuberculosis patients. Tuberculosis cases are 100 of 296 all home-oxygen-therapy during the period from Aug. 1986 to Dec. 1997. 36 dead cases of these 100 were evaluated. Average period for HOT was 988 days (32.9 months). The mean rate of home stay was 78.9%. HOT is very useful for supporting comfortable home stay life. Our Medical respiratory Care (MRC) system is consist of primary education on HOT start, respiratory rehabilitation, mass education, annual rehabilitation trip and home nursing. Our MRC team is consist of 2 doctors, 12 nurses, 3 physical therapists, a dietician, a pharmacist and a medical clerk. We consider that it's important to support more comfortable life of the patients with chronic respiratory distress syndrome due to old tuberculosis.

[A case of embryonal carcinoma successfully treated by neoadjuvant chemotherapy: report of a case].

A 20-year-old man was admitted with a complaint of cough and dyspnea. Chest X-ray revealed a large anterior mediastinal tumor. On chest CT scan, the inferior vena cava was found to be enclosed, and tumor invasion to the right pulmonary artery and left atrium was observed. The serum alpha-fetoprotein (AFP) level was increased. A diagnosis of primary mediastinal embryonal carcinoma was made by the needle biopsy. After three courses of chemotherapy, consisting of cisplatin, etoposide and bleomycin, the tumor became smaller and the serum AFP level became normal. Complete resection of the tumor was performed successfully. The resected tumor showed no evidence of active disease. The patient has been free of the disease for 3 years.

[The epidemiology of nontuberculous mycobacterial diseases in Hiroshima Prefecture].

The patients of diseases caused by nontuberculous mycobacteria (NTM) newly diagnosed in 1993 in Hiroshima Prefecture were investigated retrospectively. During 1993, 59 newly diagnosed patients of NTM disease, who were the resident of Hiroshima Prefecture were reported from 6 hospitals. Mycobacterium avium complex (MAC) disease was most frequent (53 patients, 90%) and M. kansaii (MK) disease, which accounts for more than 20 percent of all the NTM diseases in the national survey of Japan, was found only in 3%. Other pathogenesis were M. chelonae and M. fortuitum. Incidence rate for all NTM disease per 10(5) population was 2.1. Age-specific incidence rate calculated from the estimated population of Hiroshima Prefecture was; less than 0.4/10(5) under the age 40, 4.0/10(5) in the age group 50 to 59, 4.5/10(5) in the age group 60 to 69 and 9.4/10(5) in the age group over 70. Thirty-one patients (57%) had underlying pulmonary disease such as previous lung tuberculosis (TB) and previous history of TB was found in 41 percent of patients over 60 yr. of age. The data suggest that epidemiological picture of NTM diseases may change in the future. Relative increase of elder population will lead to the increase of NTM diseases as a whole; the incidence rate calculated from the age specific incidence rate and predicted population of Japan in 2025 is 3.1/10(5), which is 1.5 fold higher than the present rate. However, secondary NTM diseases with healed TB will decrease because of the sharp decline of TB morbidity in Japan. Assuming that secondary NTM disease with healed TB decreases to one-fourth, estimated incidence rate will be 2.3. Further, the upward tend of MK disease in Japan should be taken into consideration. Thus, the future trends of NTM diseases will increase fairly due to the increase of elder population as well as the MK disease. It was pointed out that many NTM disease cases had been counted as tuberculosis in the surveillance system of Japan. In our present study, 52 (82%) were registered as tuberculosis in the beginning and only 19 cases were reported later to health centers as NTM disease. As tuberculosis classification and surveillance system in Japan were changed from 1996 to separate NTM disease from TB, NTM disease cases will be counted separately in the tuberculosis statistics. This revision in the management of NTM disease should be taken into account when discussing the trend of tuberculosis statistics in Japan.

[A case of capillary hemangioma of the testis in a child].

Testicular tumors derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. A rare case of capillary hemangioma of the testis in a child is reported. An 11-year-old boy was admitted with the chief complaint of painless mass in the right scrotum. He was diagnosed with a right testicular tumor by physical examination and ultrasonography, preoperatively. Right high orchiectomy was done on December 10, 1990. The testis measured 2.5 x 2.3 x 1.5 cm. Pathologically, the tumor was diagnosed as a capillary hemangioma of the testis.

[Clinical feature of the diabetic patients with recurrent pulmonary tuberculosis].

We investigated the clinical feature of 22 diabetic patients diagnosed as having recurrent pulmonary tuberculosis. More than half of the patients relapsed within five years after discharge from the hospital. The mean serum albumin concentration of those patients who experienced relapses within three years was significantly lower than that of the patients who experienced relapses a period of time greater than three years. We recognized a significant negative correlation between the recurrent period and body mass index or fasting plasma glucose values. Among these patients, 50% of them ceased treatment for diabetes mellitus personally or had not been diagnosed as having diabetes mellitus before the relapse. All of the patients who ceased treatment for diabetes mellitus before readmission were able to obtain good plasma glucose control only through diet therapy during their first hospital admission for pulmonary tuberculosis. From this study, We concluded that strict plasma glucose control is important for the prevention of a relapse of the mycobacterial infection in patients with diabetes mellitus.

[Clinical studies on cefoxitin in the treatment of respiratory tract infections].

The clinical effects of cefoxitin (CFX) were studied in 31 cases of respiratory tract infections. The results were as follows: As for the clinical effects, CFX was excellent in 5 cases, good in 13, fair in 8 and poor in 5 out of 31 patients; the efficacy rate was 58.1%. The efficacy rate was 57.1% in bronchopneumonia, 61.1% in pneumonia and 50.0% in acute exacerbation of chronic respiratory tract infections. The efficacy rate was 70.6% in the group of 4 g/day or less and 42.9% in the group of 6 g/day or more. The efficacy rate was 50.0% in 6 cases that had not been responded to other antibiotics previously. As for side effects, skin eruption was observed in only 1 patient. No abnormality was observed in laboratory tests due to CFX. In conclusion, CFX is a useful drug in the treatment of respiratory tract infections.