Asthmatic patients have a circadian rhythm in peak expiratory flow rate (PEFR). The present study was done to measure the effect of inhaled beclomethasone dipropionate (BDP) on the circadian rhythm of PEFR in asthmatic patients. After two weeks of observation, BDP (400μg) was given by metered dose inhaler to nine asthmatic patients. The dose of inhaled BDP (800-1200μg) was increased every two weeks until PEFR varied by no more than 20% each day. PEFR was measured four times daily: on waking, around noon, in the evening, and at bedtime. Nine asthmatic patients had a significant (p<0.05) rhythm detectable by single cosinor analysis, both during the observation period and during treatment. Analysis by the group mean-cosinor method showed that the mean mesor was 397.3±6.8l/min, the mean amplitude was 54.3±7.1l/min, and the mean acrophase was at 16:31±0.27 before treatment. After treatment, the mean mesor was 543.8±4.4l/min, the mean amplitude was 30.5±4.9l/minm, and the mean acrophase was at 16:25±0.31. The mean mesor had increased significantly (p<0.05), and the mean amplitude had decreased significantly (p<0.05) after treatment. The mean acrophase did not change. These data indicate that inhaled BDP increases PEFR at a constant acrophase in asthmatic patients.

View full abstract

Digital analysis of 80 plain chest radiographs was done to differentiate benign from malignant pulmonary nodules. Each of 80 radiographs had a solitary pulmonary nodule, of which 40 were benign and the other 40 were malignant. Radiographic features of nodules were visually evaluated. Frequencies of the radiographic features described below were significantly different between benign and malignant nodules: irregular shape, vague density, well-defined contour, spicular formation, and vascular convergene. To digitally evaluate the density characteristics, two kinds of concentric circular windows were used, to allow analysis of intra-nodular, marginal and surrounding regions of the nodules. Seventeen digital parameters were obtained by computerized analysis with the windows. There were significant differences in six digital parameters; three of density gradient (one of intra-nodular and two of marginal regions), one DCF-N (directional contrast filter for nodule) output of intra-nodular region, and two of density entropy values of intra-nodular and surrounding regions. Density gradient parameters of marginal regions are believed to represent the features of nodular shape and spicula formation.
With these six parameters, 70% of benign nodules and 85% of malignant nodules were correctly discriminated. These results suggest that computer-aided diagnosis may be used to differentiate benign from malignant nodules.

View full abstract

To determine whether beraprost sodium (beraprost) can cause pulmonary vasodilation in chronic hypoxic pulmonary hypertension, we measured the hemodynamic effects of intravenous beraprost, a stable and orally active agent with a PGI₂-like structure, in chronic hypoxic (H) and normoxic (N) rats. During anesthesia baseline pulmonary artery pressure (PAP) was 32.0±1.0 in H rats and 18.0±0.4mmHg in N rats. Intravenous beraprost (20μg/kg) elicited acute pulmonary vasodilation by 17.7±4.6% (5.6±1.4mmHg) in H rats and by 16.8±2.1% (3.0±0.6mmHg) in N rats, which indicates that the relative degree of acute pulmonary vasodilation caused by beraprost was similar in H and N rats. Thirty minutes after the drug was injected, PAP had not returned to baseline levels in either H or N rats, and it was lower in H rats (90±2%) than in N rats (95±2%). Lungs were isolated and perfused with saline, and those from H rats and N rats showed similar pulmonary vasodilator responses to 2 and 20μg/kg beraprost. These results indicate that although beraprost caused a similar degree of acute pulmonary vasodilation in H and N rats, in H rats the response lasted longer. Thus PGI₂ derivatives may be useful as vasodilators in some patients with primary and secondary pulmonary hypertension.

View full abstract

To study the effects of an inhaled steroid on airway hyperresponsiveness (AHR) in chronic stable asthma, AHR was measured every month for 1 year in seven patients after their asthma had stabilized, i. e., when they had no wheezing or dyspnea, and their peak expiratory flow rates (PEFR) were at least 80 percent of the highest value. During the study period, no patient wheezed or had dyspnea, and daily variation in PEFR was less than 20 percent. In six patients, FEV₁ was stable, and PEFR was always at least 80 percent of the highest value. AHR became less severe, by a factor of at least 2, in five of these six patients, but one patient's condition did not improve. The one patient whose PEFR fell below 80 percent of the highest value had more than a 4-fold increase in the severity of AHR. In conclusion, the severity of AHR can be reduced, even in patients with chronic stable asthma, if daily PEFR can be maintained in an optimal range by long-term use of inhaled corticosteroids.

View full abstract

The effects of supplemental oxygen on exercise tolerance and exercise-induced dyspnea in patients with chronic obstructive pulmonary disease (COPD) and an artrial oxygen tension (PaO₂) over 60Torr were studied. Twenty two men who met the criteria stated above underwent three 6-minute walk tests while breathing room air, compressed air, or supplemental oxygen, in a double-blind randomized crossover fashion. The distance walked in 6 minutes was recorded, and the degree of dyspnea during exercise was quantified on a visual analog scale with a questionnaire that had eight descriptors of dyspnea sensations.
The distances walked were: 535±27 (SE) for room air, 545±27 for compressed air, and 563±23m for O₂. These data indicate a significant placebo effect and an effect of supplemental oxygen. The data regarding dyspnea also indicated both a significant placebo effect and an effect of supplemental oxygen, but the descriptors for the placebo effect differed from those for the effect of supplemental oxygen. Patients in whom arterial desaturation (below 88%) developed during exercise with compressed air benefited from supplemental oxygen: they walked significantly farther and their dyspnea scores for two of the eight descriptors were significantly lower. However, patients in whom artrial desaturation (below 88%) did not develop during exercise with compressed air did not benefit from supplemental oxygen. Nonetheless, the degree of dyspnea during exercise with compressed air could not be used to predict the beneficial effect of supplemental oxygen.

View full abstract

Plasma was sampled from patients with lung cancer (LC: n=38), patients with atherosclerotic disease (AS: n= 20), and healthy persons (H: n=32). Lipid peroxide and lipid constituents of low density lipoprotein (LDL) were measured after sequential ultracentrifugation.
Lipid peroxide levels in LDL were in the following order: LC>AS>H. Cholesteryl ester, triglycerides, free fatty acid, free cholesterol, and phospholipids were stained on plates of thin-layer chromatography of LDLs in healthy persons. However, spot X₁ between triglycerides and free fatty acid was clearly colored on those of patients with atherosclerotic disease, and clear spot X₂ between free fatty acid and free cholesterol, and a little spot X1 was stained on those of patients with lung cancer except for the lipid constituents mentioned above. No significant differences in lipid constitutents were found among the patients with different histological types of lung cancer.
Although lipid peroxide concentrations were significantly higher in the patients with lung cancer and artherosclerotic disease than in healthy persons, there were marked differences between patients with lung cancer and patients with artherosclerotic disease in the constituents of LDL lipid peroxide.

View full abstract

A 72-year-old woman was admitted to our hospital on May 7, 1990. She had suffered from dyspnea since April and complained of a continuing cough, sputum, and wheezing. A chest roentgenogram revealed bilateral, diffuse infiltration shadows, mainly in the outer zones. A considerable increase in the number of eosinophils was seen in samples of blood and of bronchoalveolar lavage fluid. Chest computed tomography showed a subpleural band-shaped infiltration shadow that was separated from normal lung fields by a subpleural curvilinear shadow. Examination of the specimen taken during open lung biopsy showed considerable eosinophil and lymphocyte infiltration, mainly in alveolar septa. No other abnormality was seen in the alveoli and there was no vasculitis or bronchiolitis. Therefore, we diagnosed this condition as chronic eosinophilic pneumoia., In addition, we discuss the subpleural curvilinear shadow.

View full abstract

A 26-year-old man was admitted to our hospital for evaluation of cavitary lesions on his chest X-ray film. Chest CT and conventional tomograms showed multiple cavities in both lung fields, as well as hilar and mediastinal lymphadenopathy. He had uveitis and the laboratory data showed a high level of angiotensin converting enzyme in the serum. Histological findings of the specimen obtained by transbronchial lung biopsy showed non-caseating epithelioid cell granuloma, consistent with sarcoidosis. Corticosteroid therapy (prednisolone 40mg/day) resulted in reduction of the cavitary lesions and the lymphadenopathy. Nagative bacteriological studies and the clinical course strongly suggested primary cavitation, a relatively rare form of pulmonary parenchymal involvement in sarcoidosis.

View full abstract

A 65-year-old laborer suffered thoracic injury in an accident. Ribs were fractured and chest X-ray films showed coincidental ground-glass, like opacities in both lung fields. CT indicated the possibility of pulmonary alveolar proteinosis, which was confirmed by histological examination of the specimen obtained during therapeutic bronchoalveolar lavage.
A modified fiberoptic bronchoscope with a wedge device was used for segmental bronchoalveolar lavage. The wedge derice on a pediatric flexible fiberoptic bronchosiope allowed irrigation of six independent pulmonary segments, with no complication.
Six months after discharge, the patient had no evidence of relapse.

View full abstract

A 42-year-old housewife was admitted to our hospital because of an asthma attack, fever, severe eosinophilia, mononeuritis-multiplex, arthralgia, skin-eruptions, transient pulmonary infiltration, and other symptoms. Chung-Strauss syndrome was diagnosed. When there were signs and symptoms of vasculitis, chest radiography revealed that pulmonary infiltrates had decreased, but her chest CT showed ground glass opacities of both lung fields and fine granular shadows. Differential cell count of bronchoalveolar lavage fluid revealed a high level of eosinophils, and transbronchial lung biopsy specimens showed vasculitis and marked infiltration of eosinophils. When signs and symptoms of vasculitis were prominent, antineutrophil cytoplasmic antibodies (ANCA) in the serum were examined. PR3-ANCA (antibodies to serine-protease, nearly equal to c-ANCA), which is specific to Wegener's granulomatosis, was negative, but MPO-ANCA (antibodies to myeloperoxidase, nearly equal to p-ANCA) was positive and the level was very high (478EU/ml). After corticosteroid therapy, her symptoms markedly improved, and MPO-ANCA became negative. MPO-ANCA appeared to reflect the disease activity in this case.

View full abstract

We report a case of primary pulmonary cryptococcosis. A 20-year-old woman was admitted to the hospital complaining of coughing, fever, and dyspnea on exertion. She had no underling disease or immunological abnormality. Chest X-ray film revealed bilateral diffuse infiltrative shadows, which were first believed to have been caused by a community-acquired pneumonia. Pulomonary cryptococcosis was diagnosed from the results of a transbronchial lung biopsy. After 2.5 years of anti-mycotic chemotherapy with amphotericin B and flucytosine, pneumothorax occurred in the left lung. Thoracotomy and open lung biopsy were done. Histological findings of the open lung biopsy specimens showed numerous broken cryptococcal organisms within alveolar macrophages. Diffuse fibrosis accompanied by multiple bullae may have punctured bullae or blebs and thus led to pneumothorax.

View full abstract

A 57-year-old woman was admitted because of dry cough and middle-grade fever. Chest rentogenogram showed a diffuse infiltrative shadow in the right middle and lower lung fields. The symptoms disappeared after treatment with minocycline, but a new dense shadow appeared in the right upper and middle lung fields. Eosinophilic pneumonia was diagnosed from the results of bronchoalveolar lavage and transbronchial lung biopsy. The symptoms were alleviated and the infiltrative shadow was effaced after treatment with predonisolone (40mg/day). The results of a bioassy with human eosinophils suggested that the serum and bronchoalveolar lavage fluid contained IL-5 and GM-CSF.

View full abstract

Some non-islet tumors can induce hypoglycemia. We report a case of an intrathoracic giant tumor accompanied by hypoglycemia. The patient was a 53-year-old woman who was found to have hypoglycemia. Chest X-ray film showed a giant tumor in the left hemithorax and rightward shift to the mediastinum. CT and MRI revealed that the tumor's border was clear. The tumor was removed by sternotomy with third and seventh inter-costal incisions. The tumor was lobulated but its border was clear. It seemed to have grown from the posterolateral thoracic wall. After the tumor was removed, re-expansion pulmonary edema occurred but was relieved by diuretics and respiratory management. Histologic findings indicated that it was probably a thymoma or a localised mesothelioma, but it could not be identified even with special stains. Solitary fibrous mesotheliomas are sometimes complicated by hypoglycemia, and some of them produce insulin-like growth facter (IGF). In this case, the pre-operative level of immuno-reactive insulin was low, so the tumor may have produced IGF.

View full abstract

A 49-year-old woman used an automatic bed cleaner on October 18 1990. Eight hours later, she was admitted to a hospital complaining of coughing and fever. The chest X-ray film showed small granular shadows in both lower lung fields. After a few days of antiboitic therapy, these symptoms had disappared. She used the bed cleaner again on the afternoon of November 15, 1990. The next day, she was admitted to our hospital because of coughing and fever. An envirnmental provocation test with the bed cleaner induced the same symptoms. Dust from the bed cleaner stimulated her lymphocytes. Hypersensitivity pneumonitis from the dust of a bed cleaner was diagnosed.

View full abstract

A 38-year-old woman was referred to our hospital for severe pulmonary hypertension (pulmonary arterial pressure 63/36mmHg). Digital subtraction angiography showed complete obstruction of the right main pulmonary artery and severe stenosis of the left main pulmonary artery. Although there were no symptoms or signs of systemic arterial lesions, the initial diagnosis was aortitis syndrome with pulmonary arterial involvement, and prednisolone therapy was started (60mg/day). Pulmonary arterial pressure decreased to 53/12mmHg. At a dosage of 20mg/day, however, multiple nodular shadows were present on the X-ray film of the chest, but they disappeared after the dosage was increased. The level of anti-myeloperoxidase antibodies in her serum changed at almost the same time as multiple nodular shadows appeared on the chest X-ray film. Because anti-MPO antibodies have been never detected in patients with aortitis syndrome, polyangitis overlap syndrome was suspected. However, we found no evidence of systemic vasculitis; that is, vasculitis in other organs, including the kidney and the skin. Therefore, we made a diagnosis of idiopathic pulmonary arteritis with positive anti-MPO antibodies.

View full abstract

A 31-year-old man was admitted to our hospital because of a sudden onset of thirst, polyposia, and polyuria. Five years previously he had been admitted to our hospital because of a dry cough. On the first admission, the chest X-ray film had shown reticular shadows and bullous changes in both upper lung fields. Histological examination of a transbronchial lung biopsy specimen had revealed that the nodular lesion in the interstitium of the alveolar lesion consisted of an aggregate of many Langerhans cells with pale cytoplasm and partly convoluted nuclei. In addition, immunoperoxidase stain for S-100 protein had been strongly positive in numerous Langerhans cells in a bone biopsy specimen from a left mandibullar lesion, which is the same histological appearance as the lung lesion. A diagnosis of pulmonary eosinophilic granuloma had been made. The course after discharge was not progressive without treatment for 5 years, but the patient suddenly began to have thirst, polyposia, and polyuria. Dehydration, vasopressin tests, and the findings of MRI indicated diabetes insipidus due to a pathological change in the pituitary gland. Although diabetes insipidus is known to be a common complication of pulmonary eosinophilic granuloma, only 9 cases have been reported in Japan.

View full abstract

A 61-year-old woman was admitted for evaluation of an abnormal shadow found incidentally on a chest radiograph. A 35×20mm nodule with an ill-defined margin was found at the left hilum on conventional CT. Thin-slice (2mm) CT was done, and a fine granular zone was found around the lesion. Left upper lobectomy was done and the lesion proved to be a primary pulmonary non-Hodgkin's lymphoma (small cel type, B-cell). The granular pattern seen on CT was found to correspond to intraseptal micronodules scattered along the lymphatic vessels, a finding which is considered to be pathognomonic of pulmonary lymphomas by many pathologists. We know of no previous description of how these histologic characteristics can appear on high-resolution thin-slice CT. These findings will be helpful for the CT diagnosis of pulmonary lymphoma.

View full abstract

A 70-year-old man was admitted for diagnosis of an abnormal shadow on chest X-ray film. Chest X-ray films and chest tomograms showed a club-like shadow close to the pulmonary artery. The tumor was diagnosed as a small cell lung cancer, after transbronchial biopsy. The patient underwent chemotherapy and radiation therapy. This patient had small cell lung cancer that appeared on chest X-ray films to have a strange shape.

View full abstract