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Volume 55 (2004)
- Issue 6 Pages 433-
- Issue 5 Pages 367-
- Issue 4 Pages 305-
- Issue 3 Pages 229-
- Issue 2 Pages 55-
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Volume 55, Issue 5
Displaying 1-10 of 10 articles from this issue
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Special Issue of Tracheoesophageal Studies and Coughing
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Masaki Fujimura2004 Volume 55 Issue 5 Pages 367-374
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSAlthough a cough is one of the presenting symptoms of many respiratory diseases, many patients complain of isolated cough, the causes of which cannot be identified by routine examination at the initial visit. In addition, an increasing number of patients exhibit isolated cough lasting more than 3 weeks (prolonged cough) or more than 8 weeks (chronic cough). The basic and clinical studies described here, conducted over more than 10 years and supported by the Japanese Cough Research Society, have led us to understand the causes and pathogenesis of chronic cough in Japan. Specific therapy is available for each cause of chronic cough when the cause is appropriately diagnosed. The triad of causes of chronic cough are recognized in the West to be gastroesophageal reflux-associated cough, postnasal drip-induced cough and asthma, while in Japan they consist of sinobronchial syndrome (productive cough), cough variant asthma (nonproductive cough) and atopic cough (nonproductive cough). Gastroesophageal reflux-associated cough is not common in Japan and postnasal drip-induced nonproductive cough has not been reported. One of the reasons for the discrepancy between causes in Western countries and in Japan may be the difference in diagnostic approach : anatomical in Western countries and pathophysiological in Japan.View full abstractDownload PDF (656K) -
Yuji Tohda, Fumio Tsuji2004 Volume 55 Issue 5 Pages 375-379
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSCough is one of the major symptoms of respiratory diseases.
As coughing is a defensive reflex in the airway to expel sputum and noxious particles, basically it should not be suppressed by medication. However, progressive persistent cough requires specific treatment which should aim to improve the quality of the patient's life. To establish a diagnosis for patients who have chronic cough, assessment of the detailed medical history and appropriate testing should be implemented.
If anti-cough agents taken daily on a long-term basis fail to reduce chronic cough, doctors are encouraged to change the initial medications and focus on the respiratory disease characterized by an underlying hyper-responsiveness of the airway. In the case of patients whose diagnosis is not confirmed or who respond poorly to treatment, referral to health care professionals is recommended.View full abstractDownload PDF (439K) -
Kunio Dobashi2004 Volume 55 Issue 5 Pages 380-386
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSRecently, clinicians' awareness of gastroesophageal reflux disease (GERD) as a cause of chronic cough and asthma has increased. Several mechanisms have been implicated in GERD-induced pulmonary diseases. These include vagally mediated reflux triggered by acid in the esophagus and microaspiration of gastric acid. Postnasal drip, asthma and GERD are the causes of chronic cough in 86% of patients in Europe and the USA. In addition, it has been reported that coughing is the only symptom of the subclinical GERD patients. We found, by endoscopic examination, that 86.3% of asthmatics over the age of 50 simultaneously have grade M or higher GERD according to Los Angels classification.
With respect to treatment, studies using proton pump inhibitors to control acid reflux have demonstrated improvement in asthma symptoms. In our examination, we applied an asthmatic PPI, and improvement of peak expiratory flow was noted in 2 of 3 examples after 4-8 weeks.
Although we cannot conclude clearly that GERD aggravates chronic respiratory disease, available data support the need for active consideration of GERD and treatment in patients with chronic cough and asthma. Further studies should be multicentered and placebo-controlled using acid-suppressive therapy to clarify this point.View full abstractDownload PDF (544K) -
Kensei Naito2004 Volume 55 Issue 5 Pages 387-392
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSPersistent cough without accurate pathological findings in the lower respiratory airway can present a difficult diagnostic dilemma. The most common causes, such as chronic bronchitis, asthma, postnasal drip, cough variant asthma, atopic cough, laryngeal allergy and gastroesophageal reflux, can usually be suspected on the basis of history and physical examination and subsequently confirmed by appropriate diagnostic tests and responses to specific therapy. In otolaryngology, postnasal drip, laryngeal allergy, gastroesophageal reflux disease and tracheobronchial foreign body are the primary causes of persistent cough, these clinical features are described in this review. However, when we examine patients complaining of persistent cough, we must also consider the possibility of more severe condition such as lung cancer, bronchial tuberculosis, hypopharyngeal cancer, maxillary malignancy and mycosis.View full abstractDownload PDF (521K) -
Kazuteru Kawasaki2004 Volume 55 Issue 5 Pages 393-397
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSThere are many types of cough specific to or frequent in childhood. Chronic aspiration of milk in infants requires attention to choking during sucking. RSV bronchiolitis is prevalent mostly in winter. Recurrent episodes of bronchitis or pneumonia from infancy may suggest the presence of congenital anomaly of the airway. Pertussis, characterized by bursts of cough followed by inspiratory stridor, causes severe illness in neonates. Croup syndrome exhibits barking cough, inspiratory stridor, and hoarseness. Foreign body aspiration, seen most frequently in 1-year-old boys, shows respiratory symptoms after an apparent aspirated episode. Chronic cough severe only in daytime may be psychic.
Infantile cough lasting more than 3 weeks suggests the possibility of sinobronchitis. Productive cough and positive sinus X-ray (Waters view) findings lead to the diagnosis. Macrolides are usually effective in treatment.
Antitussive drugs must be used with caution, especially in children unable to expectorate spontaneously. Besides antibiotics, chest physiotherapy, e.g. tapping and postural drainage, combined with fluid intake is indispensable for children with significant secretion in the lower respiratory tract.View full abstractDownload PDF (436K) -
Masato Murakami2004 Volume 55 Issue 5 Pages 398-403
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSCoughing occurs not only due to irritation of the air tract but also by emotional irritation. Symbolic cough reaction and cough symptoms develop when human feelings are stimulated. So-called “nervous cough” is not necessarily a common disorder, but easily takes a chronic course and is difficult to improve unless precise diagnosis and treatment are performed. Nervous cough is characterized by paroxysmal or continuous dry cough induced by some psychogenic mechanism. However, even when psychogenic or neurogenic mechanisms are suspected, episodes of acute upper respiratory infection, pharyngolaryngitis or bronchitis may play an important role in the development of nervous cough. Differential diagnosis with lasting chronic cough is very important, particularly with cough variant asthma. It is assumed that some psychosocial stressor contributes to processing sensitivity to cough reflex and developing of nervous cough. Nervous cough is sometimes expressed as a symbolic symptom (conversion symptom) caused by hysteria, cough as an outlet of internal strain, and similar symptom as myospasia impulsive (vocal tic). Bio-psycho-social understanding and approach are required for diagnosis and treatment of nervous cough. Anxiety disorder and depressive state often accompany the disease, and antianxiety agents and antidepressants are often effective for treatment. Specific psychotherapy may be applicable when symptoms are aggravated by remarkable psychological factors.View full abstractDownload PDF (557K)
Case Report
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Yoshimi Miyajima, Hiroyuki Fukunaga, Kazunori Mori, Tadashi Nakashima2004 Volume 55 Issue 5 Pages 404-407
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSPrimary adenocarcinoma of the larynx is a rare neoplasm. We treated a 90-year-old male who complained of hoarseness and dyspnea. By fiberscopic examination, we located a huge tumor in the left vocal fold. CT examination revealed lymph nodes metastases in the left neck. As he experienced dysphagia within several weeks, a total laryngectomy and modified radical neck dissection of the left neck were performed. Histopathological diagnosis revealed adenocarcinoma. Two weeks after operation he was able to eat and was discharged from the hospital. He remained at home for 5 months with a good quality of life.View full abstractDownload PDF (726K) -
Akemi Ozeki, Yuko Saito, Masayuki Sawashima, Yuji Tanigaki, Mamoru Tsu ...2004 Volume 55 Issue 5 Pages 408-413
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSWe reported a case of subglottic amyloidosis in the larynx. A 53-year-old female complained of hoarseness and dyspnea. At the first examination, a smooth-surfaced tumor was detected in the subglottic region. We performed a tracheostomy and resected the tumor. Histopathological findings revealed amyloidosis. Systemic amyloidosis was excluded by extensive examinations. Laryngeal amyloidosis is a rare disease, with 125 cases reported to date in the Japanese literature. Only 15 cases with subglottic lesion have been reported. Recently, the main treatment for laryngeal amyloidosis is surgical resection by laryngomicrosurgery (LMS) using laser. The tumor in this case was resected by LMS and coagulated by argon plasma coagulation (APC), with three treatments over a period of four years. After the latest operation, the patient showed a favorable outcome. The findings demonstrate that APC surgery is an effective treatment for laryngeal amyloidosis.View full abstractDownload PDF (1485K) -
Kiminori Sato, Tadashi Nakashima2004 Volume 55 Issue 5 Pages 414-422
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSWe reported three cases of laryngopharyngeal reflux disease (LPRD) which were resistant to antiacid therapy by H2 receptor antagonist (H2RA) or proton pump inhibitors (PPI). The significance of evaluating drug efficacy by tetra-probe 24-hour pH monitoring was also shown (The proximal probe was placed in the hypopharynx, just above the upper esophageal sphincter; a second in the middle esophagus; a third a few centimeters above the lower esophageal sphincter; and a distal sensor in the stomach).
One LPRD case was administered Famotidine (40 mg/day), one Omeprazole (10 mg/day), and one Lansoprazole (30 mg/day). Tetra-probe 24-hour pH monitoring revealed that these antiacid medicines were not successful in reducing gastric acid levels, and gastroesophageal and laryngopharyngeal refluxes were in evidence. It should be noted that there are cases of LPRD which are resistant to antiacid therapy, even though the patients take antiacid medicine. When an H2RA is shown to be unsuccessful in reducing gastric acid levels, LPRD patients require a PPI. When a PPI is still not successful in reducing gastric acid levels, another PPI is recommended.
As the pH of the four sensors could be monitored simultaneously, gastric acid levels and gastroesophaqeal and laryngopharyngeal refluxes could be easily examined. The pH-metry revealed the gastric acid levels and patterns of reflux, enabling the relationship between the four sensor locations to be well documented on the pH tracing. Tetraprobe 24-hour pH monitoring has become one of the most reliable functional examinations in evaluating drug efficacy for LPRD.View full abstractDownload PDF (1490K) -
Satoshi Yamamoto, Katsunobu Kawahara, Takafumi Maekawa, Takeshi Shirai ...2004 Volume 55 Issue 5 Pages 423-426
Published: 2004
Released on J-STAGE: August 24, 2007
JOURNAL RESTRICTED ACCESSAs part of our institute series, we investigated thoracoscopic Heller myotomy with modified Belsey for treatment of achalasia.
Material and methods: Three female achalasia patients, aged 27 to 37, were give a thoracoscopic Heller myotomy and modified Belsey antireflux. Two cases were Grade II, and one was Grade III. In all cases, a proton pump inhibitor was not used.
The operations were performed via the left side using thoracoscopic-assisted Heller myotomy and modified Belsey antireflux methods. The average operating time was 135±47 minutes, blood loss 54±35 ml, duration of thoracic drainage 3.8±3.3 days, and hospital stay 13.6±3.5 days. There were no severe complications after the operations, and all patients are well and drug-free, including proton pump inhibitor and H-2 antagonist.
Conclusions: The modified Belsey method via thoracoscope is a very useful and safe method for treating Grade II and III achalasia.View full abstractDownload PDF (329K)
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