Chronic effects of oxitropium bromide were studied in patients with pulmonary emphysema. Pulmonary function tests, an exercise test, and a questionnaire were used. Seven subjects underwent two successive studies, including a questionnaire on QOL, pulmonary function tests, and an exercise test before and after one month or more of regular inhalation of ocitropium bromide (600μg/day).
The complaint of breathlessness was significantly reduced and the ability to perform activities of daily living had improved slightly after the treatment. There were no significant differences in the values of arterial oxygen pressure at rest. The VC, RV/TLC, and peak expiratory flow rate improved. A significant decrease in oxygen uptake at rest, a slight decrease in minute ventilation at rest, and a significant prolongation of exercise time were observed after the treatment. No other changes were noted.
We conclude that oxitropium bromide may improve lung mechanics and reduce the work of respiratory muscles.

View full abstract

Pulmonary manifestatioins of rheumatoid arthritis were studied in 26 patients. Pulmonary complications could be divided into four subgroups: Interstitisal pneumonia/Pulmonary fibrosis (n=18), Bronchiolitis Obliterans Organizing Pneumonia (n=4), Bronchiolitis Obliterans (n=2), and Pleuritis/Pericarditis (n=1). Analysis of cells in broncho-alveolar lavage fluid (BALF) revealed abnormally high percentages of lymphocytes in one-half of the patients and abnormally high percentages of neutrophils in one-third of the patients. The percent of BALF cells that were neutrophils was higher with higher chest radiograph grades. Analysis of soluble constituents of BALF indicated local production of IgG in two cases, but IgM-rheumatic factor was not detected. In 18 of 26 patients corticosteroid or immunosupressive drugs were needed, and most of the patients responsed to the therapy and had good outcomes. The conditions of 6 patients with interstitial pneumonia/pulmonary fibrosis deteriorated and 4 patients died of progressive respiratory failure. The subclassification of rheumatoid lung was useful for predicting its outcome.

View full abstract

To study the relationship between proliferation of smooth muscle cells and structual changes in arteries of rats given monocrotaline, light microscopy with immunohistchemistry for bromodeoxyuridine (BrdU) was done after a single subcutaneous injection of monocrotaline. In increase in DNA synthesis in smooth muscle cells was seen from 3 days until 14 days after administration. Since this increase was seen before pulmonary hypertension and medial thickness developed some mechanisms that induce proliferation of pulmonary artrial smooth muscle may have been triggered soon after monocrotaline injection.

View full abstract

Production of interferon (IFN)-α and IFN-γ were examind in 31 patients with acute tuberculosis, 12 patients with atypical mycobacterial disease. IFN production was examined in cultures of unseparated fresh whole blood. Production of IFN-α was induced by hemagglutinating virus of Japan and production of IFN-γ was induced by PHA. Patients with mycobacterial desease produced significantly less IFN-α than healthy subjects. In patients with acute tuberculosis, effective chemotherapy for 2 months restored IFN-α production. Patients produced less IFN-γ than healthy subjects, but the difference was not significant. Patients with high serum CRP levels tended to produce little IFN-α. These results suggest that measurement of IFN production is useful for immunological evaluation of patients with mycobacterial disease.

View full abstract

Hydraulic conductivity of the visceral pleura was measured in situ in anesthetized dogs. There were two groups: control (n=7), and edema (n=5). The 7th intercostal space of the left thorax was opened. In each group, a hemispherical capsule, filled with physiological salt solution, was attached to the visceral pleura of left lobe by negative pressure made with a vacuum pump. In the edema group, pulmonary venous pressure was increased by ligation of the pulmonary vein. The transpleural fluid flow (V) was measured at different intracapsular pressures (ΔP). The hydraulic conductivity was calculated from the relation between the fluid flow rate (v) and the intracapsular pressure, i. e., the slope of the linear regression line. The hydraulic conductivities in the control and edema groups were 1.49±0.68 and 3.19±1.13 nL·min^-1·cmH₂O^-1·cm^-2, respectively. We conclude that the pleural tissue may play an important role in hydraulic conductivity of the visceral pleura when pulmonary venous pressure is high.

View full abstract

Bronchography is not routinely done. We analyzed the state of bronchography with questionnaires returned from 57 hospitals.
Bronchography is now done at 30 hospitals. The number done in 1992 ranged from 1 to 27 (median 3). Peripheral lung cancer and bronchiectasis were the two most frequent diseases for which bronchography was done. In other hospitals, bronchography was once done, but had been stopped. Two reasons for discontinuation of bronchography are: recent progress in radiographic diagnostic techniques such as high resolution CT, and discomfort of the patient. Now that propyliodone is no longer available, some hospitals may use iopydol-iopydone or iopamidol instead.
It is necessary to elucidate the true need for bronchography and for an appropriate contrast medium to take the place of propyliodone.

View full abstract

Indicies of asthma were measured in smokers with chronic bronchitis (CB) + pulmonary emphysema (PE), smokers with CB only, and non-smokers with CB, to examine whether smoking is involved in the development of asthma-like condition in patients with chronic obstructive pulmonary disease (COPD). Airway hypersensitivity was measured with an Astrograph method, and the reversibility of airway obstruction was measured as improvement in FEV_1.0 and as percent change in FEV_1.0 after inhalation of a β-agonist. Both hypersensitivity and reversibility were significantly higher in smokers with CB + PE and in smokers with CB only than in non-smokers with CB. The number of eosinophils in sputum, but not in peripheral blood, was slightly higher in the smokers than in the non-smokers. The serum levels of IgE were significantly higher in the smokers than in the non-smokers. No significant difference in the rate of positive skin tests for common allergens was observed among the three groups, but the rate of positive tests for Broncasma Berna was very high in the smokers, and all such tests were negative in the non-smokers.
These results indicate that among patients with COPD an asthmatic component is more frequently found in smokers than in non-smokers, and suggest that smoking plays some part in the development of asthma-like condition in these diseases.

View full abstract

The frequency of chronic sinusitis among the family members of 26 patients with diffuse panbronchiolitis were analyzed, and were compared with the frequency in 127 control families. In the diffuse panbronchiolitis group, 50% of families suffered from chronic sinusitis, in contrast to 18.9% of families in the control group. The difference was significant.
Analysis of HLA antigens in families of patients with diffuse panbronchiolitis revealed that family members with chronic sinusitis had the same HLA haplotype as these patients with diffuse panbronchiolitis in the same family. These results indicate that patients with chronic sinusitis only and those with diffuse panbronchiolitis have similar genetic background. They also suggest that the patients with chronic sinusitis may be seen as a mild or incomplete type of diffuse panbronchiolitis.

View full abstract

A 62-year-old man had an occupational history of exposure to asbestos for 27 years (1947-1974). Dry mouth, dry eyes and swellen gums were noted in 1974. Sjögren's syndrome was diagnosed in 1975. The chest radiograph in 1984 showed bilateral pleural thickening and small reticular opacities in the left lower lung field. In 1990, he complained of dyspnea and cough, and diffuse interstitial pneumonia was diagnosed. While being treated for diffuse interstitial pneumonia, pulmonary fibrosis progressed rapidly, and advanced pulmonary fibrosis was obvious in 1992.
Laboratory data showed hyper γ-globulinemia (36.8%) and a high level of IgG (3772mg/dl) in 1976. These values decreased to within the normal ranges during the subsequent clinical course. The results of lymphocyte subset counts in 1988 were normal. With the progression of diffuse interstitial pneumonia in 1990, the lymphocyte subset counts showed a low percentage of CD₄ (19.2%), a low CD_4/8 ratio (0.46), and a low perrcentageof CD₂₀ (26.8%). In 1992, as pulmonary fibrosis progressed despite treatment, the disorder of lymphocyte subsets became worse. The CD₄ percentage was very low (5.0%), as was the CD_4/8 ratio (0.08), and the percentage of CD₂₀ (1.4%); the CD₈ percentage was high (64.7%), as was the percentage of Leu 7 (49.0%).
These immunologic and pulmonary changes could be not explained by Sjögren's syndrome. Determining what factor induced these changes is difficult, but asbestos exposure is a likely cause.

View full abstract

A 23-year-old man was admitted because of an attack of chest pain and dry cough. Chest roentogenogram showed a solitary pulmonary nodule in the left upper lobe. Chest CT showed a nodule and a small pleural effusion on the same side. Pulmonary thrombosis was diagnosed by pulmonary Ventilation/perfusion scintigraphy and palmonary arteriography. Deep vein thrombosis was not detected except in a distal pulmonary artery. The solitary nodule disappeared spontaneously without thrombolytic therapy. An anticardiolipin antibody (IgG) test was positive. Primary antiphospholipid syndrome was diagnosed, because of the absence of physical findings suggesting other collagen vascular diseases. Patients with antiphospholipid syndrome have a high frequency of pulmonary complications that include pulmonary hypertension and pulmonary embolism. Most of the patients with pulmonary embolism have deep vein thrombosis, and pulmonary vessel thrombosis as seen in the present case is a rare complication.

View full abstract

A 73-year-old man had been treated with cilostazol for antithrombotic therapy after a myocardial infarction. Seventy days after the start of cilostazol therapy, he developed dyspnea, dry cough, and fever. He was admitted to our hospital on April 13, 1923. Chest radiography and CT revealed a ground glass appearance. All drugs except isosorbide dinitrate were discontinued and he was treated with steroids under the presumptive diagnosis of drug-induced pneumonitis. Steroid therapy was effective. The result of a lymphocyte stimulation test was positive for cilostazol. Based on the above findings, cilostazol-induced pneumonitis was diagnosed. To our knowlege, there have been no previous reports of cilostazol-induced pneumonitis.

View full abstract

A 68-year-old woman had a pulmonary aspergilloma in the left upper lobe, with old cavitary pulmonary tuberculosis. Surgery was not possible because of marginal ventilation, and the patient was treated by transbronchial injection of Fulconazole. After five injections of 50mg of Fulconazole, the fungus ball had decreased in size.
To study the pharmacokinetics of Fulconazole after transbronchial injection, its concentration in serum was measured. The values of serum Fulconazole concentration were 0.7μg/ml at 1h, 0.8μg/ml at 4h, 0.8μg/ml at 8h, 0.7μg/ml at 12h, 0.7μg/ml at 24h, and 0μg/ml at 48h after transbronchial injection. These results indicate that Fulconazole was absorbed well. Furthermore, these values are equal to those obtained after intravenous administration of 50mg and are higher than those obtained after intravenous administration of 25mg. Fulconazole may have been absorbed via the bronchial epithelium, because of destruction of alveoli, connective tissue proliferation in the cavitary wall and secondary bronchiectasis.

View full abstract

A 63-year-old woman was taken to a hospital by ambulance because of dyspnea. She was admitted in nearly complete cardiopulmonary arrest. CPR was started immediately, and the patient was mechanically ventilated via a tracheostomy tube. Abnormally high airway pressures 40-50cm H₂O were required during positive pressure ventilation. Saber-sheath like stenoses of the lower trachea 3cm long and left main stem bronchus 2cm long were found by bronchoscopy. It was difficult to pass a 3-mm-diameter bronchoscope through these stenoses. The right main stem bronchus was completely obstructed. A chest radiograph showed a completely collapsed right lung and a scarred upper lobe of the left lung, probably caused by previous tuberculosis. Weaning from the ventilator was attempted over three months. However, the patient could not breathe by herself because of airway obstruction. She was referred to our hospital for the placement of stents into the stenotic parts of the airways. A longitudinally connected Gianturcotype EMS, 15mm in diameter and 50mm long was placed in each area of stenosis under general anesthesia. During the placement of EMSs, POPS was used for 113 minutes instead of mechanical ventilation of the lungs. Hemodynamics were stable during PCPS. A bypass flow of 2.0-2.8l/min/m² was used. Oxygen saturation of arterial blood taken from an earlobe was maintained at 100%. Blood taken from the left radial artery had a PaO₂ of 269.4mmHg and a PaCO₂ of 40.2mmHg. There were no complications after the procedure. One month later, the stenoses had become slightly dilated. The patient was able to walk when oxygen 0.5L/min was given through the tracheostomy tube. At that time, arterial blood gas analysis showed a pH of 7.346, a PaO₂ of 122.3mmHg and a PaCO₂ of 48.8mmHg.

View full abstract

A 53-year-old woman was admitted with diabetes mellitus. After admission, a tumor shadow was detected by chest radiography and blood was found in her sputum. Despite further investigations, no definite diagnosis was made. Pulmonary wedge resection was performed because malignancy could not be excluded. Histological examination of the resected lung specimen led to the diagnosis of pulmonary actinomyosis. In Japan, 59 cases of pulmonary actinomycosis were reported between 1964 and 1993. These reports indicate that many cases of this disease are diagnosed by histological examination of resected lung specimens. Pulmonary actinomycosis has become even rarer recently because of the development of chemotherapy. We report this case and discuss the relevant literature.

View full abstract

A 59-year-old woman had a four-year history of rheumatoid arthritis. Despite treatment with prednisolone for interstitial pneumonia, her chest X-ray films revealed gradual progression of reticular shadows, mainly in the left lung, and during the third hospitalization she died of respiratory failure due to acute exacerbation of pneumonia. At autopsy, there was a remarkable difference in lung weight: left 250g, right 510g. Microscopically, the pulmonary lesion was mild fibrosing interstitial pneumonia, with remarkable luminal organization and macrophages in parts. The features of unilateral interstitial pneumonia with bronchiolitis obliterans organizing pneumonia were clearer in the left lung. The cause of the acute exacerbation and of the difference in interstitial pneumonia between sides could not be identified.

View full abstract

A 60-year-old woman was admitted to our hospital because of progressive cough and chest pain for 2 months. She also complained of exertional dyspnea. Bilateral diffuse infiltlative shadows were found on the chest roentogenogram. Ground-glass opacity in the middle lobe and lingula, and subpleural patchy consolidation were seen on the computed tomogram of the chest. Arterial oxygenation and diffusing capacity were low. The level of angiotensin-converting enzyme in serum was normal, but that of lysozyme was high. In the BAL (broncho-alveolar lavage) fluid, total cell count and the number of lymphocytes were high, and the CD 4/8 ratio of the lymphocytes was high.
Open lung biopsy revealed numerous confluent sarcoid granulomas with necrosis, which strongly correlated with severe vasculitis. After necrotizing sarcoid granulomatosis was diagnosed, prednisolone was administered, which resulted in improvement of symptoms and disappearance of chest-radiograph shadows.
Necrotizing sarcoid granulomatosis may be seen as a variant type of sarcoidosis. However, clinical findings including the chest-radiograph shadows and clinical course of this case differ from those of ordinary sarcoidosis. These clinical findings can be attributed to severe vasculitis, as revealed by histological examination.

View full abstract

A 34-year-old housewife presented to a hospital because of dry cough. Her chest radiograph showed bilateral multiple nodular lesions. Smaller but similar lesions had been seen on the chest radiograph 2 years carlier. Because the tissue taken during a trans bronchial biopsy was non-diagnostic, open lung biopsy was done and the diagnosis was pulmonary metastasis of alveolar soft part sarcoma. The primary tumor was found in her left calf by MRI. Malignant tumors are important for differential diagnosis of slow-growing multiple pulmonary nodules, and in some cases MRI is useful for finding the primary site.

View full abstract

A 55-year-old woman with bronchorrhea and bronchial asthma was admitted to our hospital in June, 1992. On admission, she was producing a large volume of sputum (200ml) each day. The volume decreased with oral administration of erythromycin and inhalation of beclomethasone. Next, inhalation of furosemide was added to the regimen, which lead to symptomatic improvement in mucus clearance, although the sputum increased in volume. The concentrations of albumin, fucose, sialic acid, and phosphatidylcholine in the sputum changed with these treatments, as did the lecithin/sphingomyelin ratio. These observations suggest that these drugs affect not only the quantity but also the quality of sputum.

View full abstract

A 66-year-old woman was referred to this institution for treatment of hemoptysis, atelectasis of the left upper lobe, and marked hypoxia necessitating oxygen therapy. A low anterior resection of the rectum had been performed for rectal adenocarcinoma 6 years and 3 months before this admission, and was followed by another resection after a local recurrence 20 months later.
Bronchoscopy revealed an endobronchial tumor obstructing the left upper lobe bronchus. Tissue from a transbronchial biopsy revealed metastatic rectal carcinoma of the endobronchial lumen. There was no evidence of local recurrence or metastasis to other organs.
A left pneumonectomy and lymph node dissection were performed successfully. The postoperative course was uneventful, and the patient was discharged after marked improvement of the arterial blood gas results. The pathological diagnsois of a resected tissue specimen was metastatic adenocarcinoma of the left hilar lymph nodes with invasion of the left main bronchus and protrusion into the endobronchial lumen.
The patient remained disease-free for 6 months. At that time, computed tomography of the chest disclosed small metastases in the right lung and chemotherapy was begun.

View full abstract

A 64-year-old man was admitted complaining of cough, hemoptysis, dyspnea, and fever. His chest X-ray film on admission showed reticulo-granular shadows in both lung fields. Ausculation of his chest revealed fine crackles in both lower zones. After admission, he was treated with antibiotics, but his chest-radiogtraphic appeorance worsend temporalily, and sputum cytology results were repeatedly positive. Diagnosis was difficult. Differential cell count of the bronchoalveolar lavage fluid showed lymphocytosis, with a high CD 4/8 ratio. Transbronchial lung biopsy specimens revealed Masson bodies and alveolitis. With antibiotic therapy alone, his condition improved, and he was discharged. Five and a half hours later, his symptoms worsend and he was readmitted. His chest X-ray film on the second admission was almost the same as that on the first admission. His symptoms became less severe, and his condition improved without treatment. Hypersensitivity pneumonitis was diagnosed. Because the onset was in Feburary, this was not considered to be a case of so-called summer type hypersensitivity Pneumonitis. a provocation test was done with water from the humidifier he had been using at home. The white blood cell count increased and PaO₂ decreased significantly, so the result of the provocation test was thought to be positive. Therefore, so-called humidifier lung was strongly suspected. The results of sputum cytology on the first admission were probably falsely positive.

View full abstract

A 24-year-old woman who had suffered from pulmonary alveolar proteinosis for eight years was admitted to Jichi Medical Hospital with severe pneumonia. She was mechanically ventilated, and her condition markedly improved after repeated bronchoalveolar lavage with surfactant replacement therapy. This method was used because she had been resistant to the conventional unilateral lung lavage method for 12 months. During the bronchoalveolar lavage procedure, she became progressively hypoxic, but recovered immediately after the instillation of surfactant. The combination of bronchoalveolar lavage with surfactant replacement via a fiberoptic bronchoscope may be useful in treating other patients with pulmonary alveolar proteinosis.

View full abstract