[Progress in the field of pulmonary medicine in the last 100 years: Home oxygen therapy].
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History, 20th Century↗
Biomedical subjects
Michiaki Mishima
Publications and source records attributed to Michiaki Mishima.
Longitudinal changes in airflow limitation and airway hyperresponsiveness in patients with stable asthma.
BACKGROUND: There are few long-term studies of the effects of treatment on the natural course of asthma. OBJECTIVE: To investigate the longitudinal changes in airflow limitation and airway hyperresponsiveness (AHR) in asthma. METHODS: We recruited 81 outpatients (never smokers) with stable asthma from the Kyoto University Hospital. They were evaluated for pulmonary function and AHR, expressed by forced expiratory volume in 1 second (FEV1) and the provocation dose that caused a 20% fall in FEV1 (PD20-FEV1), respectively, at entry and every 6 months over 3 years. We used random effects models to estimate the slopes of these changes, and then evaluated the relationship between these changes and their predictive factors. RESULTS: Using random effects models, the percentage of the predicted FEV1 (%FEV1) declined significantly but slightly at a mean rate of 0.5%/year (P = 0.002; 95% confidence interval, 0.3 to 0.8). The mean decline rate of FEV1 was 34 mL/year. However, Log(PD20-FEV1) showed significant improvement at a mean rate of 0.088 cumulative units/year (P < 0.001; 95% confidence interval, 0.053 to 0.122). Multiple regression analysis showed that the baseline values of %FEV1 and Log(PD20-FEV1) were the most significant predictive factors for their subsequent changes, respectively. CONCLUSIONS: In stable asthmatic patients treated according to international guidelines, airflow limitation progressed at a nearly normal rate over 3 years. However, AHR continued to improve despite its ceiling effects. Multiple regression analysis revealed a significant negative relationship between the initial values and the subsequent changes in airflow limitation and AHR, respectively.
Adult↗
Hyper-IgM syndrome with systemic tuberculosis.
A 33-y-old man with Hyper-IgM syndrome developed a severe tuberculous disease complicated by pleuritis and spondylitis. An abnormally decreased CD4/CD8 ratio, decreased CD4 + T-cell count and depressed natural killer cell activity implicated a coexistent cell-mediated immunodeficiency. To our knowledge, this is the first detailed report of tuberculosis associated with Hyper-IgM syndrome.
Adult↗
Serial evaluation of high-resolution computed tomography findings in patients with idiopathic pulmonary fibrosis in usual interstitial pneumonia.
BACKGROUND: The development of well-matured fibrosis in usual interstitial pneumonia (UIP) is strongly associated with an unfavorable outcome of patients with idiopathic pulmonary fibrosis (IPF). However, differences in the rates of development are likely to result in variable clinical courses in IPF patients. OBJECTIVE: We tried to evaluate the progression of honeycombing and ground-glass opacity on CT using a scoring system, and to examine those serial changes in the clinical course of disease. METHODS: A hospital-based, retrospective cohort study. Twenty-three patients with IPF diagnosed as UIP by surgical lung biopsy were analyzed during the initial examination by scoring the presence of honeycombing (HC: range, 0-24) and ground-glass opacity (GG: range, 0-24) on CT scan. We also compared the serial changes observed in the CT scores (interval: 2-42 months, 2-6 examinations). RESULTS: (1) The serial change in the HC score in treated patients (n = 10) was similar to that in untreated patients (n = 16); (2) the HC score at the time of the initial examination and the rate of HC progression were both higher in the non-surviving patients (HC 12.3 +/- 3.7, mean +/- SD; deltaHC 4.2 +/- 1.3 per year) than in the surviving patients (HC 5.8 +/- 2.7; deltaHC 1.2 +/- 0.7 per year) (p < 0.05); (3) the GG score did not correlate with the HC score at any of the examinations; (4) the HC score was higher in the lower lung field than in the upper and middle lung fields. CONCLUSIONS: Scoring of the honeycombing and its serial changes using the high-resolution computed tomography scoring method was useful for predicting the prognosis in patients with IPF/UIP. Corticosteroid treatment did not prevent the progression of HC.
Adult↗
Comparison of the responsiveness of different disease-specific health status measures in patients with asthma.
BACKGROUND: Disease-specific health status measures are characterized by higher responsiveness than generic measures and may be preferred in clinical trials. However, comparisons of responsiveness between various disease-specific measures have rarely been performed in asthma studies. STUDY OBJECTIVE: We investigated and compared the responsiveness of health status scores in asthmatic patients during treatment using three different disease-specific measures: the Juniper Asthma Quality of Life Questionnaire (AQLQ), the Living with Asthma Questionnaire (LWAQ), and the Airways Questionnaire 20 (AQ20). METHODS: We attempted to follow up 170 patients with newly diagnosed asthma over a 6-month period. Patients underwent treatment with inhaled corticosteroids in accordance with the guideline. A health status evaluation using three disease-specific measures, and pulmonary function tests were performed on the initial visit, and at 3 months and 6 months. The effect size and the standardized response mean were used as responsiveness indexes. RESULTS: A total of 109 patients completed the 6-month follow-up and were then analyzed. All health status scores and FEV(1) measures improved during the first 3 months (p < 0.001). The total of the AQLQ scores showed high responsiveness indexes ranging from 1.28 to 1.46 between baseline and 3 months, and baseline and 6 months. Spearman correlation coefficients were smaller between the change in FEV(1) and the change in the LWAQ. Although the AQ20 also demonstrated high responsiveness, a ceiling effect was indicated. CONCLUSIONS: The AQLQ was the most responsive measure during asthma treatment. The relationship between the change in airflow limitation and the change in the LWAQ was weaker compared to the AQLQ and the AQ20. Although the AQ20 was also responsive and its simplicity is favorable, the ceiling effect should be considered when using it.
Adolescent↗
Familial cases of psittacosis: possible person-to-person transmission.
A 29-year-old woman with primary myelofibrosis developed severe pneumonia, and 20 days later her 31-year-old sister also contracted pneumonia. The first patient had been in contact with parakeets but the second patient had not been in contact with any birds. Psittacosis was diagnosed in both cases by microplate immunofluorescence antibody technique. Person-to-person transmission between the sisters was suspected to have taken place.
Adult↗
Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification.
A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted DNA of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.
Anti-Bacterial Agents↗
Quantitative assessment of airway remodeling using high-resolution CT.
Asthma and COPD are the most prevalent of lung diseases and contribute an enormous burden of morbidity in North America and globally. In both conditions, inflammation leads to airway remodeling, which contributes to airway narrowing. To date, airway remodeling has only been assessed using histological examination of airways. However, it may now be possible to assess and quantify the extent of airway remodeling in vivo using high-resolution CT (HRCT). The aim of this article is to review the use of HRCT in the investigation of airway remodeling. A number of investigators have reported techniques to make measurements of airway dimensions using CT and an increasing number of quantitative methods are being developed. Using these techniques, airway dimensions have been examined in patients with asthma and COPD. In patients with asthma, the airway wall area was increased without a decrease in luminal area, whereas in patients with COPD, the airway luminal area was decreased and airway wall area was increased. The different pattern of remodeling may reflect fundamental differences in the inflammatory processes in asthma and COPD and could influence the reversibility of the narrowing. It has also been shown that, by quantifying both the extent of emphysema and of airway remodeling, CT is useful in differentiating COPD patients who have primarily parenchymal disease from those who have primarily airway pathology. With additional advances in technology, it is likely that quantitative assessment of airway wall dimensions will ultimately provide a valuable tool for the study of airway disease.
Airway Obstruction↗
Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease.
PURPOSE: The purpose of this study was to make comparisons between different types of exercise tests used in chronic obstructive pulmonary disease (COPD) to better interpret the results and to select the most suitable testing procedure. Therefore, we evaluated the relationship between exercise capacity and other clinical measures and their relative contributions to exercise capacity in patients with COPD. METHOD: We studied 36 patients with stable COPD. All patients underwent baseline pulmonary function testing. Dyspnea during activities of daily living was assessed with the Oxygen Cost Diagram (OCD). The Hospital Anxiety and Depression Scale and the St George's Respiratory Questionnaire were used to assess psychologic status and health-related quality of life, respectively. All patients performed the 6-minute walking test, progressive cycle ergometry, and the cycle endurance test. RESULTS: Each exercise capacity result correlated significantly with pulmonary function, the OCD, and the Activity and Total scores of the St George's Respiratory Questionnaire. Multiple regression analyses revealed that the OCD was an important predictor of exercise capacity, especially for the walking test. Diffusing capacity was also a significant predictor on progressive cycle ergometry. Body mass index was the most significant predictor of the endurance time. CONCLUSION: The 3 different exercise tests had similar characteristics in relation to pulmonary function, dyspnea, and health-related quality of life in patients with COPD. However, some differences were found in the aspects they evaluated.
Aged↗
Thioredoxin-1 suppresses systemic inflammatory responses against cigarette smoking.
Thioredoxin-1 (TRX) is a small redox-active protein with antioxidative effects and redox-regulating functions. Cigarette smoking is a major etiological factor in the pathogenesis of a variety of diseases and recruits systemic immune and inflammatory responses. This report demonstrates that TRX attenuates the systemic inflammatory responses induced by cigarette smoking. The mRNA expressions of tumor necrosis factor alpha (TNF-alpha) and macrophage migration inhibitory factor (MIF) were suppressed in the spleen of TRX overexpressing transgenic mice (TRX-tg) exposed to cigarette smoking, compared with control C57BL/6 mice. In addition, protein carbonylation, a marker of cellular protein oxidation, was enhanced by cigarette smoking in the tissues of heart and liver in control mice more than in TRX-tg mice. These findings suggest that TRX may suppress the systemic inflammatory responses against cigarette smoking.
Animals↗
Small cell lung carcinoma: Eight types of extension and spread on computed tomography.
OBJECTIVE: The aim of this study was to classify the types of tumor extension and spread of small cell lung carcinoma (SCLC) and to recognize the unusual types of spread pattern of SCLC on computed tomography (CT) including multidetector row CT (MDCT) using contrast-enhanced material. MATERIALS AND METHODS: Sixty-eight cases (53 men and 15 women aged 54-83 years old) of pathologically proven SCLC were examined mainly by contrast-enhanced CT scan. In surgically treated 7 cases, CT-pathologic correlations were performed. RESULTS: Eight types of extension and spread were recognized by the examinations of chest CT. The type of central mass + mediastinal extension (n = 20 [29.4%]) was the most common manifestation. The types of central perihilar mass (n = 12 [17.6%]), peripheral mass + mediastinal extension (n = 14 [20.6%]), and peripheral mass (n = 7 [10.3%]) were frequently observed. The primary site of SCLC was in peripheral lung tissue in 21 of 68 cases (30.9%) in this study. Unusual CT manifestations, such as the types of lymphangitic spread (n = 6 [8.8%]), pleural dissemination (n = 4 [5.9%]), lobar replacement (n = 3 [4.4%]), pneumonialike air-space infiltrative spread (n = 2 [2.9%]) were recognized in our study. Stenosis of trachea and main bronchus caused by peribronchial extension were commonly noted. In the advanced cases with mediastinal extension, we observed the extension of SCLC to superior vena cava (n = 22), main pulmonary artery (n = 18), pulmonary vein (n = 11), and thoracic aortic wall (n = 7). Peri-and intracardial invasions were also observed in 9 cases. CONCLUSIONS: Computed tomography including MDCT analysis revealed 8 types of extension and spread of SCLC including unusual forms in 68 SCLC cases. Peribronchial extension and great vessel wall involvement, such as superior vena cava, main pulmonary artery, and peri-/intra-cardial extension, were commonly observed in advanced stage.
Aged↗
Chronic eosinophilic pneumonia: treatment with inhaled corticosteroids.
BACKGROUND: Chronic eosinophilic pneumonia (CEP) is highly sensitive to systemic corticosteroids, but frequently relapses if the dose is tapered or treatment discontinued. Long-term usage of systemic corticosteroids may cause side effects. Alternative treatments are therefore desired. OBJECTIVES: We evaluated the response of CEP to monotherapy with inhaled corticosteroids (ICS). METHODS: Four patients who had CEP without spontaneous resolution were studied. Patients received inhaled beclomethasone dipropionate (BDP) at a dose of 0.8 mg/day in 1 patient and 1.6 mg/day in 3 patients for 2 weeks. Treatment was continued if a patient showed improvement in at least 1 of the following indices: radiological findings, symptoms, and blood eosinophilia. RESULTS: After the initial 2 weeks of treatment with BDP, the blood eosinophil count increased in 2 patients and decreased in 2. Symptoms worsened in 2 and improved in 2. Infiltrates on chest radiography increased in 3 and showed little change in 1. In the 2 patients with worsening of all 3 outcome indices, oral prednisolone was started; the indices improved. In the remaining 2 patients, BDP alone was continued. One patient had worsening of CEP after 2 months of treatment, and another had relapse of CEP at 3.5 years while receiving 1.6 mg/day of BDP. All patients thus finally had worsening or relapse of CEP during treatment with BDP. CONCLUSIONS: ICS may not be effective when given as monotherapy in patients with CEP.
Administration, Inhalation↗
Polymorphisms of B7 (CD80 and CD86) genes do not affect disease susceptibility to sarcoidosis.
BACKGROUND: B7 proteins (CD80, CD86) are costimulatory molecules expressed on antigen-presenting cells and are essential factors for T cell activation. OBJECTIVES: The aim of this study is to investigate the relationship of B7 gene polymorphisms either to disease susceptibility or to cell profile of bronchoalveolar lavage (BAL) fluid in Japanese sarcoidosis patients. METHODS: Gene polymorphisms located in CD80 promoter, CD80 exon 3 and exon 8 of CD86 were examined in 146 Japanese sarcoidosis patients and 157 healthy controls using single-strand conformation polymorphism and direct sequencing. The distribution of genotypes was compared between the two groups. BAL fluid cell profiles were compared for the various genotypes of the different polymorphisms for the 62 patients who underwent BAL. RESULTS: There were no significant differences in the distribution of genotypes or allele frequencies for all polymorphisms between sarcoidosis and controls. There were no significant differences in BAL fluid cell profiles among the different genotype groups of the various polymorphisms studied. CONCLUSIONS: There was no relationship between the B7 gene polymorphisms studied and disease susceptibility or BAL fluid cell profiles in Japanese sarcoidosis patients.
Antigens, CD↗
Cell profiles of bronchoalveolar lavage fluid as prognosticators of idiopathic pulmonary fibrosis/usual interstitial pneumonia among Japanese Patients.
BACKGROUND: The role of bronchoalveolar lavage fluid (BALF) cell profiles in predicting the clinical outcome of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP) is still under discussion. OBJECTIVE: To determine whether BALF cell profiles affect the survival of patients with UIP diagnosed by surgical lung biopsy/autopsy at the early stage of IPF. METHODS: This hospital-based retrospective cohort study used 81 Japanese patients with histologically proven IPF/UIP who underwent BAL examination. The BALF samples were obtained from non-current smokers: NCS (n = 41) and current smokers: CS (n = 40). The Kaplan-Meier and Cox's proportional hazard methods were used to estimate the survival and evaluate the risk ratio for death in the two groups. To detect the multicollinearity, a stepwise regression was employed. RESULTS: A slight increase in the absolute numbers of BALF neutrophils tended to relate to a decrease in the relative risk for death in NCS patients and CS patients in the univariate analysis. In stepwise regression, the increase in percent vital capacity and the increase in the BALF CD4/CD8 ratio in NCS was detected as a favorable predictor, while increased BALF cells affected the results due to chronic smoking in CS. CONCLUSIONS: Based on the study bias of the biopsy-proven IPF/UIP patients at stable stages, an independent variable indicating a favorable outcome was an increased BALF CD4/CD8 ratio in NCS patients, while it was difficult to identify definite prognosticators in CS patients.
Aged↗