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Biomedical subjects

M Sakatani

Publications and source records attributed to M Sakatani.

At least 37 records · Page 2Linked to original sources
PubMed1998

KL-6 as a serologic indicator of Pneumocystis carinii pneumonia in immunocompromised hosts.

KL-6, a serum marker for interstitial pneumonitis, was evaluated in patients with Pneumocystis carinii pneumonia (PCP). Patient 1 was a 56-year-old woman with rheumatoid arthritis treated with immunosuppressive drugs and corticosteroids. Patient 2 was a 59-year-old man with a glioblastoma who received anti-cancer drugs and corticosteroids. In both patients, serum KL-6 showed an abnormally high level due to the complication of PCP, and it decreased following successful treatment. These results indicate that PCP is one of the diseases in which serum KL-6 increases.

Antigens↗
PubMed1998

Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses.

OBJECTIVE: The purpose of this study was to describe the CT features and clinical features in bronchiolitis obliterans organizing pneumonia (BOOP) that manifest as multiple large nodules or masses. MATERIALS AND METHODS: We reviewed thin-section CT scans and clinical records of 12 patients with histologically proven BOOP manifesting as multiple large nodules or masses. For all patients follow-up CT scans were available, which we also reviewed. RESULTS: Of 60 lesions found in the 12 patients, 53 (88%) had an irregular margin, 27 (45%) had an air bronchogram, 23 (38%) had a pleural tag, and 21 (35%) had spicules. Ancillary findings included focal thickening of the interlobular septa in five (42%) of the 12 patients, pleural thickening in four (33%) patients, and parenchymal bands in three (25%) patients. Follow-up CT scans showed that the lesions with surrounding ground-glass attenuation evolved into lesions with pleural tags or parenchymal bands or both. CONCLUSION: BOOP should be considered when multiple large nodular lesions are seen on chest CT. In particular, BOOP should be considered when the lesions contain air bronchograms; have irregular margins, relatively broad pleural tags in contact with the pleura, parenchymal bands, or subpleural lines; or are associated with focal thickening of interlobular septa.

Cryptogenic Organizing Pneumonia↗
PubMed1998

[Multidrug-resistant tuberculosis. 4. Treatment and prognosis of multidrug-resistant tuberculosis].

We studied the clinical characteristics, treatment and prognosis of multidrug-resistant pulmonary tuberculosis patients retrospectively. In this study, multidrug-resistant is defined as both resistant to 0.1 microgram/ml of INH and 50 micrograms/ml of RFP at least. From 1990 to 1997, out of 1841 culture positive pulmonary tuberculosis patients, 76 patients (4%) proved to be multidrug-resistant (53 males, 23 females, age 18-84, 40 originally treated cases and 36 relapse cases). Most of cases revealed resistance to other drugs in addition to INH and RFP. The combination of anti-tuberculous drugs were complicated and changed repeatedly. The incidences of administration of drugs were as follows; TH 62%, EB 58%, PZA 58%, KM 33%, PAS 33%, SM 29%, CS 20%, EVM 14%, CPM 3%. New quinolones, for example OFLX/LVFX, CPFX and SPFX, were also used frequently (62%). Eight percent of patients were operated. Bacteriologically effective drugs that meant culture negative were TH (14%), PZA (12%), KM (12%), EB (12%), SM (5%), new quinolones (16%). 67% of originally treated cases and 43% of relapse cases became culture negative. Many cases were treated for a long period. 19% of originally treated cases and 33% of relapse cases were treated more than three years. 11% of patients were died of tuberculosis. Major prognostic factors were diabetes mellitus (17%), malignancies (10%), non-adherence (9%) and other complications. Because of no absolutely effective treatment, we have to choose a treatment according to each patient. Development of new treatment is crucial.

Adolescent↗
PubMed1998

[Evaluation of eosinophilic cationic protein levels in patients with eosinophilic pneumonia].

We investigated the significance of eosinophilic cationic protein (ECP) as a biological indicator of disease activity in patients with eosinophilic pneumonia (EP). ECP levels were measured in serum and bronchoalveolar lavage fluid (BALF) samples from patients with EP or other diffuse interstitial lung diseases and from healthy subjects. Also we performed immunohistochemical staining of lung tissue sections from patients with EP using anti-EG 2 antibody, and computed the correlation between the number of EG 2-positive cells in lung tissues and ECP levels in serum and BALF from patients with EP. Levels of ECP in serum and BALF samples from patients with EP were significantly elevated compared to the levels in samples from other interstitial lung-disease patients and healthy subjects. Additionally, changes in serum ECP levels reflected the clinical courses for EP patients. Approximately 90 percent of the infiltrated eosinophils in tissue sections from patients with EP were EG 2-positive and activated. The number of EG 2-positive cells in lung tissues correlated significantly with levels of ECP in serum and BALF samples from patients with EP. These findings suggested that ECP levels in serum and BALF reflect the degree of eosinophil activation in lung tissues and the degree of disease activity in patients with EP. We concluded that ECP may serve as a useful biological indicator in EP.

Biomarkers↗
PubMed1997

Utility of hyaluronic acid in pleural fluid for differential diagnosis of pleural effusions: likelihood ratios for malignant mesothelioma.

The level of hyaluronic acid (HA) was determined in the pleural fluid of 99 patients, including 19 with malignant mesothelioma, 27 with lung cancer, 1 with breast cancer, 1 with mediastinal tumor and 51 with non-malignant diseases. With a cut-off level at 100 micrograms/ml, the pleural fluid concentration of HA was high in 36.8% of patients (7 of 19) with malignant mesothelioma and 1.3% of patients (1 of 80) with lung cancer and other malignant and non-malignant diseases. The mean concentration of pleural fluid HA was significantly higher in patients with mesothelioma than in those with lung cancer and other malignant and non-malignant diseases. The pre-test probability of MM was 5.9% in this series. The LRs for > or = 100, 50-99 and < or = 49 micrograms/ml are 28.3, 3.3 and 0.5, respectively; these put the post-test probabilities at 64, 17 and 3%, respectively. Indeed, in cases of uncommon disease such as MM, the post-test probability is low even if the cut-off level of HA is > or = 100 micrograms/ml. The discrimination between malignant mesothelioma and lung cancer needs special attention. In these two diseases, the LRs of MM for pleural fluid CEA > 30, 10-30 and < 10 ng/ml were 0.2, 1.9 and 2.4, respectively. The pre-test probability of MM for HA > or = or 100 micrograms/ml is 64%. Furthermore, because the LR for CEA is < 10 ng/ml, the post-test probability is 81%. When the combination of two markers is considered, the high level of HA and the low level of CEA may be useful for the differential diagnosis of MM from pleuritis carcinomatosa.

Biomarkers, Tumor↗
PubMed1997

Serial computed tomographic evaluation in desquamative interstitial pneumonia.

BACKGROUND: Desquamative interstitial pneumonia (DIP) may represent the early stage and usual interstitial pneumonia (UIP) the late stage of the same disease. The purpose of this study was to evaluate the computed tomographic (CT) features of DIP, to evaluate the changes in pattern and extent of disease over time, and to determine whether the appearances of DIP on the CT scan change to those of UIP during follow up. METHODS: Sequential CT evaluation was conducted on eight patients with DIP over a mean (SD) follow up period of 3.2 (1.3) years (range 1.6-6.5). The relative extents of ground glass and honeycombing were determined from serial CT scans. Changes in the extent and appearance of the disease were examined in paired anatomically comparable CT sections. RESULTS: Common features on the CT scans of patients with DIP were a homogeneous increase in lung attenuation (n = 5), linear areas of attenuation (n = 5), relatively well preserved lung architecture (n = 5), and the presence of small cysts (n = 6). Uncommon features were architectural distortion (n = 3), and traction bronchiectasis (n = 1). In six patients with DIP with cystic spaces these did not change with time in three cases, in two they regreased, and in one patient they increased. Open lung biopsy samples from patients with DIP with many cystic lesions showed dilated alveolar ducts and bronchioles and/or pulmonary cysts, as well as numerous macrophage-filled air spaces and mild fibrosis, but no typical honeycomb cysts were seen. CONCLUSIONS: Some of the microcysts in DIP are different from the honeycomb cysts seen in UIP, and some of the cysts seen in patients with DIP resolve with time. DIP does not progress to UIP in the short term.

Biopsy↗
PubMed1997

CT findings during phase of accelerated deterioration in patients with idiopathic pulmonary fibrosis.

OBJECTIVE: Most patients with idiopathic pulmonary fibrosis (IPF) show slowly progressive deterioration. However, accelerated deterioration also occurs in patient with IPF who have previously shown slowly progressive deterioration. The purpose of this study was to evaluate the CT findings of accelerated deterioration in patients with IPF. MATERIALS AND METHODS: We evaluated the CT findings of 17 patients with IPF who fulfilled all the following criteria for accelerated deterioration of IPF: exacerbation of dyspnea within 1 month, new diffuse pulmonary opacities on chest radiography, a decrease in arterial oxygen tension (PaO2) of more than 10 mm Hg under similar conditions, and absence of apparent infectious agents and heart failure. Seven patients underwent sequential CT examination. Pathologic specimens were obtained from nine patients. RESULTS: CT findings were classified as peripheral parenchymal opacification (n = 6), multifocal parenchymal opacification (n = 6), and diffuse parenchymal opacification (n = 5). Multifocal lesions developed diffusely in two of the seven patients who underwent sequential CT. These two patients both died. Three of the six patients with a multifocal pattern responded to corticosteroid therapy. All patients with a peripheral pattern showed various degrees of improvement following corticosteroid therapy. Multifocal and diffuse parenchymal opacification corresponded pathologically to acute diffuse alveolar damage. Peripheral parenchymal opacification corresponded pathologically to active fibroblastic foci. CONCLUSION: CT patterns seen during periods of rapid deterioration in patients with IPF may allow predictions of prognosis and of response to treatment.

Aged↗
PubMed1997

[The clinical study of clarithromycin for pulmonary Mycobacterium avium-intracellulare complex infection].

A nationwide study was conducted to investigate the efficacy of Clarithromycin (CAM) on pulmonary atypical mycobacteriosis caused by the Mycobacterium avium-Mycobacterium intracellulare complex, including intractable cases. Out of total 97 patients examined, the analysis for bacteriological efficacy was possible in 69 cases. The negative conversion of bacilli was observed in 18 cases (26.1%), and 5 out of 12 cases in which the follow-up was conducted turned out continued negative status. The efficacy of CAM was relatively high in the following cases: the duration of the disease was less than 6 months the extent of pulmonary lesions on chest roentogenograms was limited or moderate; and antituberculous agents which were previously unused were applied in combination with CAM. Also, the efficacy was high in cases where the dose of CAM was 600 mg/day or higher. Major side effect was mill to moderate digestive symptoms. In conclusion, at daily dose of 600 mg or higher, CAM was effective in the elimination or reduction of M avium M. intracellulare complex that caused atypical mycobacteriosis, without developing serious side effect. Treatment with this drug should be attempted in intractable cases.

Anti-Bacterial Agents↗
PubMed1997

[Chronic eosinophilic pneumonia successfully treated with suplatast tosilate].

The patient was a 45-year-old woman in whom a chest X-ray film obtained on admission showed bilateral infiltrative shadows. A chest CT scan revealed areas of consolidation and ground-glass opacities. Examination of bronchoalveolar lavage fluid revealed many eosinophils, and specimens obtained by transbronchial lung biopsy showed thickened alveolar septa with infiltration of eosinophils. The numbers of eosinophils and the level of IgE in blood were low. The radiographic appearance improved after administration of suplatast tosilate. The level of interleukin 5 was high both in plasma and in bronchoalveolar lavage fluid before treatment, but the level of IL-5 in plasma was low after suplatast tosilate was given. Suplatast tosilate, which suppresses the production of cytokines, may be useful in patients with chronic eosinophilic pneumonia.

Anti-Allergic Agents↗
PubMed1997

[A cooperative clinical study on the evaluation of an antibody detection test kit (MycoDot Test) for mycobacterial infections. Cooperative Study Group for MycoDot Test].

To determine the usefulness of a diagnostic kit for mycobacterial infection, we performed a five-hospital cooperative clinical study using serodiagnosis kits (MycoDot Test) to detect antibody for lipoarabinomannan (LAM) which is a membrane-derived component of mycobacterial species. We tested LAM antibody in the sera of patients with mycobacterial infection as well as healthy persons. Procedures for using the serodiagnosis kit are actually simple. Out of 130 cases of active pulmonary tuberculosis, 103 cases (79%) were positive for anti-LAM, and cases out of 24 cases of active atypical mycobacterial infection, 15 (63%) were positive. On the contrary, only 4% of healthy volunteers (1 out of 25 persons) were positive on this test. In conclusion, this diagnostic kit might be a useful test for early and supportive diagnosis of mycobacterial infections based on its sensitivity and specificity.

Antibodies, Bacterial↗
PubMed1997

[An observation on tuberculosis associated with HIV infection in Japan].

OBJECTIVE: To observe the reported cases of tuberculosis (TB) with HIV infection in Japan, in terms of their main clinical features and related factors. METHODS: A voluntary reporting network has been organized by the authors who are specialists of TB or respiratory medicine in tuberculosis institutions located roughly all over the country. The members have been encouraged to report not only their own cases but cases seen by their friends or in other institutions. RESULTS: By the end of 1996, a total of 71 cases have been reported of which 59 were TB and 12 NTM cases. Nationality of the cases were; Japan 48, Other Asian countries 16, Others 7. All of the NTM cases were Japanese. 30% of the cases were aged less than 30 years, 24% were thirties, 24% forties, 17% fifties and 6% were those aged 60 years or older. The cases were clearly younger than the TB cases in the national TB registry, and older than HIV-infected persons as known from the HIV surveillance system. 97% of the TB cases were bacteriologically confirmed cases. Eight of NTM cases were positive for MAC, others for M.kansasii. 42% of the cases had extra-pulmonary disease, including disseminated infections seen among 19%. Of TB cases 25% were excreting bacilli resistant to any of the anti-TB drugs which was higher than in the case of general TB population (10-15%). 11% of TB cases had past history of TB treatment. The cases had severe immunological impairment, 79% of the cases having CD4+ cell count less than 100. The route of HIV infection were; 51% heterosexual, 13% homosexual, 13% through blood preparations, etc. DISCUSSION: Although there may be many cases not included in this observation, it is considered to well reflect the real situation of the problem of Japan. More attention should be paid to HIV infection of the patients in the clinical practice of TB in Japan.

AIDS-Related Opportunistic Infections↗
PubMed1997

[High levels of elastolytic activity in bronchoalveolar lavage fluid from a patient with idiopathic interstitial pneumonia].

A 63-year-old female with acure exacerbution of idiopathic interstitial pneumonia (IIP) showed high levels of elastolytic activity in bronchoalveolar lavage fluid (BALF). She was admitted to our hospital with progressive dyspnea. Arterial blood gas analysis and pulmonary function tests were abnormal. Examination of the bronchoalveolar lavage fluid revealed an increased numbers of neutrophils. Despite the administration of corticosteroids, the patient died of respiratory failure. A high level of elastolytic activity was present in the BALF. Western immunoblot analysis, using an anti-alpha 1-protease inhibitor (PI) antibody, revealed a truncated alpha 1-PI in the BALF. These findings suggest that an imbalance between protease and PI in the lower respiratory tract contribute to lung tissue damage in patients with IIP.

Bronchoalveolar Lavage Fluid↗
PubMed1996

[Two cases of von Recklinghausen's disease with diffuse pulmonary changes].

Two patients with von Recklinghausen's disease had diffuse pulmonary diseases. The pulmonary diseases were interstitial fibrosis and emphysematous bullae. In case 2, examination of a specimen obtained by transbronchial lung biopsy revealed fibrotic interstitial thickening and adenomatous hyperplasia. Diffuse pulmonary abnormalities in von Recklinghausen's disease have been said to be fibrotic changes and emphysematous changes, as shown in roentgenograms in these two cases. The biopsy specimen obtained in case 2, however, revealed fibrotic changes only, which could not be distinguished from findings in cases of idiopathic interstitial pneumonia. In case 2, bronchoalveolar lavage fluid was also examined but it did not reveal any unique features of von Recklinghausen's disease. Since 1978, von Recklinghausen's disease has been diagnosed 10 times in our hospital, but diffuse pulmonary diseases was seen in only two of those 10 cases.

Adult↗
PubMed1996

[The characteristics of clinical features of pulmonary tuberculosis in female].

We studied the clinical features of culture-positive, previously untreated patients with pulmonary tuberculosis (77 in females and 200 in males), with special reference on the gender differences in clinical features. The mean age was 50.8 y.o. for female and 54.4 y.o. for male, and the age distribution was almost similar to that of newly-registered patients of whole Japan in 1993, namely, small peak in 20s decade and large peaks in the age group over 50 in female, and gradual increase up to 50 years and get to plateau in male. Thirty-nine % in female and fifty-four % in male had various past histories and/or complications which might affect to the deterioration of tuberculosis, such as diabetes mellitus, liver function distress, respiratory failure, malignancy, stomach resection and so on. The rates with each complication were, in general, higher in male than in female. The positive rate to Mantoux reaction was higher in female than in male, and stronger reactions were observed in female than in male. According to the classification of pulmonary tuberculosis designed by the Japanese Society for Tuberculosis (GAKKAI classification), the site(s) of affected lung, the stage and the extent of lesions were more advanced in male than in female, and the positive rate and the amount of bacilli on smear were higher in male than in female. The most marked difference was the location of the main lesions, 80% in the apical and posterior segments of upper lobe (S1,2) and 8% in the superior segments of lower lobe (S6) in male, while 60% in S1,2 and 25% in S6 in female. The rate of complete resistance against to anti-tuberculosis agents was higher in male than in female, but the combination chemotherapy of isoniasid and refampicin with streptomycin or ethambutol was almost equally effective both in males and females, and almost all patients converted to bacilli negative within three months after the initiation of the chemotherapy, except in a few male patients.

Adult↗
PubMed1996

[II. multidisciplinary analysis of chronic excretors of Mycobacterium tuberculosis bacilli].

For the most patients with pulmonary tuberculosis, treatment are successful and the chemotherapy can be finished within a year. Few patients, though receiving standard anti-tuberculous chemotherapy, expectorate tubercle bacilli continuously for more than a year. They are named "chronic excretors of mycobacterium tuberculosis bacilli" or "intractable tuberculosis patients". Being suspected that this phenomenon is produced by many factors, it is necessary to correspond suitably to these patients for eradication of tuberculosis. This symposium was organized to search for some factors on the bacterium and on the host, which caused patients to be the chronic excretors or intractable patients. We hope that our discussion may contribute to take the appropriate measures for such hard diseases. The main results are summarized as follows. 1) Dr. TSUCHIYA conducted a epidemiologic study by questionaire method to 33 Japanese national sanatoriums. The total number of tuberculosis patients admitted to these hospitals on a optimal day from September to October 1994 were 1,295. Numbers of patients who had expectorated bacilli continuously for more than 12 months were 85 (6.6%). The male/female ratio was about 3, their average age was 64. They had a tendency of thin-physique and most of them had past histories of tuberculosis, being the refractory cases. The average clinico-epidemiologic conditions of the patients came before our eyes. 2) Dr. OGATA analysed the results of drug sensitivity tests of mycobacterium tuberculosis bacilli from 2,630 pulmonary tuberculosis patients which contained 179 chronic excretors. The only 2.2% of bacilli from the chronic excretors were sensitive to RFP (50 gamma). The 99.4% of bacilli showed to be resistant to INH (0.1 gamma). The 39.1% of bacilli were sensitive to streptomycin (20 gamma). To EB (2.5 gamma) 34.1% of bacilli were sensitive. However, the ratio of chronic excretors in tuberculosis patients was not increased in these 17 years, and for many cases of these chronic excretors, they are all inexperienced in PZA, multi-sensitive-drug chemotherapy including PZA and OFLX were useful. Some of them underwent lobectomy combined for effective chemotherapy. The chronic excretors are likely to be affected multidrug-resistant bacilli, and it is important for such cases to treat intensively with several kinds of sensitive drugs. 3) Dr. FUJIWARA studied Interleukin-10 (IL-10) producing function of monocytes stimulated by Mycobacterium tuberculosis (M-TB). The IL-10 usually down-regulates a number of different macrophage functions, including microbicidal activity against intracellular bacteria such as Mycobacterium species. They found that the mean IL-10 production by peripheral blood mononuclear cells (PBMC) obtained from a healthy tuberculin-reactor stimulated with multidrug-resistant M-TB was greater than that with drug-sensitive M-TB. The IL-10 producing cells were monocytes, not T-lymphocytes. They moreover found that PBMC from intractable tuberculosis patients secreted greater amounts of IL-10 than those of healthy subjects. These data may give a hint for development of new immunotherapeutic methods for multi-drug-resistant tuberculosis patients. 4) Dr. HARA analysed clinical courses of 580 consecutive cases of bacilli positive pulmonary tuberculosis admitted in his hospital from a point of underlying diseases. All of dead 24 cases had some underlying diseases; diabetes mellitus 3, chronic liver diseases 4, others 17 (malignant neoplasms, central nerve vascular diseases, malnutritional condition, etc). (ABSTRACT TRUNCATED)

Chronic Disease↗
PubMed1996

[Epidemiologic study of the actual investigation of chronic excretors of Mycobacterium tuberculosis bacilli].

Of 1,295 patients with tuberculosis who were admitted in 33 Japanese national sanatoriums from September to October, 1994, actual investigation of patients with persistent expectorate tubercle bacilli continuously for more than 12 months was carried out by questionnaire. From the result, numbers of patients who had persistently expectorated bacteria were 85 (6.6% of inpatient). The rate of male and female was 3:1, and mean age was 63.5 years old. Many slim type patients (less than 90% of the standard body weight) were observed at the rate of 55.8%. The rate of the inpatient whose admission period was for more than 10 years were found in 22%. The past history of the tuberculosis and surgical therapy were existent at the rate of 83.3% and 18.8% respectively. The chief complications such as diabetes mellitus (12.4%), pyothorax (10.1%), alcoholism (10.1%) and hepatic dysfunction (6.7%) were observed at the respective rate. As chest X-ray findings on admission, severe cases with cavity of I or II 3 by the classification of the Japanese society for tuberculosis were found in 32.2%, and many cases with much amount persistently excreted bacteria such as more than number 7 of Gaffky scale (24.7%) or 3+ by culture (55.8%) were detected by sputum-test on admission. From the result drug-resistance, resistance of the main drugs early found from initial medication, and high degree resistance of isonicotinic acid hydrazide (INH; 80%), rifampicin (RFP; 94.4%), ethambutol (EB; 85.6%) and streptomycin (SM; 76.4%) was found. As intractable causes which were indicated by doctor in charge, drug-resistance, drug allergy, disorder of life, unfavorable medication-compliance and unsuitable treatment were considered.

Adult↗
PubMed1996

[KL-6 in patients with interstitial pneumonitis].

Levels of KL-6 are high in serum and in bronchoalveolar lavage fluid (BALF) from patients with interstitial pneumonitis. To examine the usefulness of the KL-6 level as a marker of disease activity in interstitial pneumonitis, KL-6 was measured in serum and in BALF from patients with this disease. Correlations between KL-6 levels and the number of cells in BALF and between KL-6 levels and pulmonary function were computed. Serum KL-6 levels were abnormally high and correlated with the number of lymphocytes in BALF in patients with interstitial pneumonitis. Furthermore, changes in serum KL-levels reflected clinical coursed in these patients. KL-6 levels in BALF were very high and correlated with the total number of cells, and with the numbers of lymphocytes, neutrophils, and eosinophils in BALF. KL-6 levels in serum and in BALF correlated significantly with %VC, %DLco, and %DLco/VA. These results suggest that KL-6 levels in serum and in BALF reflect the degree of alveolitis and of deterioration of pulmonary function in these patients, and that KL-6 is a useful indicator of disease activity in interstitial pneumonitis.

Antigens↗