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Biomedical subjects

S Kohno

Publications and source records attributed to S Kohno.

At least 541 records · Page 30Linked to original sources
PubMed1994

Erythromycin inhibits neutrophil chemotaxis in bronchoalveoli of diffuse panbronchiolitis.

The efficacy of low dose long-term erythromycin (EM) therapy in the treatment of chronic lower respiratory tract disease, including diffuse panbronchiolitis (DPB), has been reported, but its therapeutic mechanism is still unclear. In 13 patients receiving oral EM therapy the accumulation of neutrophils in bronchoalveolar lavage (BAL) fluid was significantly reduced (p < 0.05), this reduction corresponds with an improvement in clinical symptoms. We sought to determine whether neutrophil chemotactic activity (NCA) in lavage fluid obtained from these 13 patients with DPB would respond to EM therapy. Pretreatment NCA in all patients was significantly elevated compared with levels in normal healthy nonsmoking volunteers (p < 0.001), and the level was greatly reduced after EM therapy (p < 0.001). In addition, this reduction correlated with increased percentages of neutrophils in the BAL fluid (r = 0.737, p < 0.01). Gel-filtration chromatography was also performed to characterize chemotactic factors. Pre-EM treatment BAL fluid revealed four NCA peaks (about molecular weight 15,000, 8,000, 1,500, and 300 daltons) in the elution profile, and chemotactic activity was reduced in all areas after EM therapy. These findings indicate that NCA in lavage fluid from patients with DPB consists of various components. Although it was not clear which component is predominantly affected, these results indicate that EM may inhibit the migration of neutrophils to inflammatory sites by reducing the intrapulmonary chemotactic gradient, thus, ultimately reducing pulmonary inflammation.

Adult↗
PubMed1994

The pattern of respiratory infection in patients with lung cancer.

We examined retrospectively the pattern of respiratory infection in 579 patients with lung cancer admitted to Nagasaki University Hospital during the past 15 years. A total of 139 patients (24.0%) developed respiratory infection. The rates of pulmonary infection associated with large (36.2%) and small cell carcinomas (33.6%) were significantly higher than those with squamous cell carcinoma (26.0%) and adenocarcinoma (17.3%). Advanced stages of lung cancer were associated with higher complication rates (stage I: 6.3%, stage II: 15.9%, stage III: 27.9%, and stage IV: 33.8%). Deceased patients showed a significantly higher rate of pulmonary infection than alive patients during the period of investigation. Isolated organisms in excess of 10(7) cfu/ml in sputum or 10(4) cfu/ml in bronchial aspirate were mainly gram-negative bacteria (68.8%), such as Haemophilus influenzae, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter sp. and Pseudomonas aeruginosa. The number of patients infected with gram-positive bacteria increased markedly after 1982. Our results suggest that a successful control of pulmonary infection associated with lung cancer is important in improving the prognosis of lung malignancy.

Adenoma↗
PubMed1994

Pulmonary infiltration with eosinophilia and increased serum levels of squamous cell carcinoma-related antigen and neuron specific enolase.

We report a case of pulmonary infiltration with eosinophilia (PIE), associated with increased serum levels of squamous cell carcinoma-related antigen (SCC) and neuron specific enolase (NSE). The diagnosis of PIE was confirmed by examination of bronchoalveolar lavage fluid and specimens of transbronchial lung biopsy. It was suggested that PIE was probably induced by a course of amoxicillin for a sore throat. Corticosteroid therapy resulted in clinical improvement of symptoms, resolution of pulmonary infiltrates on chest roentgenogram and reduction in serum levels of SCC and NSE.

Adrenal Cortex Hormones↗
PubMed1994

Radiologically occult lung cancer in the peripheral region.

A rare case of radiologically occult lung cancer in the peripheral region beyond bronchoscopic visibility is reported. A 69-year-old female was referred because of positive sputum cytology. Despite detailed bronchoscopic and otorhinoralyngologic examinations, the source of malignant cells was not localized. During the follow-up period, squamous cell carcinoma of the lung periphery was detected radiologically three years after its presence was detected in sputum. Awareness of the existence of this type of cancer and careful follow-up are important in the management of patients with positive sputum cytology and no evidence of cancer.

Aged↗
PubMed1994

[Six cases of allergic bronchopulmonary aspergillosis].

Six cases of allergic bronchopulmonary aspergillosis (ABPA) were evaluated. In four cases, diagnosis and steroid therapy were delayed, which resulted in irreversible pulmonary dysfunction. The important points for early diagnosis were: (1) Differentiation from pulmonary tuberculosis, (2) the presence of bronchial asthma was not essential for diagnosis, and (3) fungi other than Aspergillus fumigatus might cause this syndrome.

Adult↗
PubMed1994

[A case of pulmonary tuberculosis developed immediately after a chest wall injury].

A 75-year-old female was admitted to our hospital for further examination of the cause of blood-stained sputum and abnormal shadow on chest radiogram which had developed immediately after an injury of right chest wall. The bacteriological examination of sputum on admission revealed negative Gaffky score, but positive PCR, and Mycobacterium tuberculosis was isolated by culture. Her symptoms and chest radiogram were improved by the administration of isoniazid, ethambutol and rifampicin. Although development of pulmonary tuberculosis induced by chest wall injury is rare, in case of the aged persons such possibility should be considered. PCR may be useful for rapid diagnosis of tuberculosis, even in such case.

Aged↗
PubMed1994

[Clinical studies on the time-difference combination therapy with netilmicin and minocycline in methicillin-resistant Staphylococcus aureus infections].

Twenty-eight patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were clinically studied for the effectiveness of the time-difference combination use of netilmicin (NTL) and minocycline (MINO). The patients were treated with NTL 100 mg and two hours later, with MINO 100 mg intravenously, twice daily, in the morning and evening for 14 days. Of 26 patients, MRSA was eradicated in 16 (61.5%), decreased in one, and unchanged in nine. Superinfections occurred with Serratia marcescens and Pseudomonas aeruginosa in two patients. The clinical efficacies were assessed in two patients with septicemia, 16 with pneumonia, and eight with chronic bronchitis. The obtained results were excellent in four patients, good in 15, fair in six, and poor in one patient. The rate of effectiveness was 73.1% (19/26). The overall clinical effectiveness judged by the committee was good in 19, fair in five, and poor in two patients. The efficacy rate was also 73.1% (19/26). Coagulase type II of MRSA was found in 23 patients, and coagulase type III in three patients, with overall clinical efficacy rates of 73.9% (17/23) and 66.7% (2/3), respectively. A side effect of eruption was observed in one patient, and its incidence was 3.6% (1/28). Abnormal laboratory test results were observed in 16 patients (57.1%), including abnormal liver function in 14 patients, abnormal kidney function in three, and increased eosinophils in three. Laboratory abnormalities occurred twelve of 16 bedridden patients, and this rate was higher than that in non bedridden patients. However, these abnormalities were all mild, transient, and immediately recovered after the treatment. In conclusion, the time-difference combination therapy using NTL and MINO was effective in the treatment of MRSA infections.

Adolescent↗
PubMed1994

[A case of HTLV-1 carrier associated with pulmonary cryptococcosis and thymoma].

A 46-year-old female was admitted to our hospital on December 1991 for further examination of an abnormal shadow on chest X-ray. A huge mass in the upper mediastinum and a thin-walled cavitary lesion in the right upper lobe were found by chest radiography and computed tomography. On March 2, 1992, surgical resection was performed with pathological diagnosis of thymoma for the mediastinal mass and pulmonary cryptococcosis for the cavitary lesion. Although ATL cells were not found in the peripheral blood, anti-HTLV-1 antibody was found to be positive. Natural killer cell activity was lower than normal control and other tests of humoral and cell-mediated immunity were normal. Histological examination of the specimens obtained from the thymoma revealed lymphocytic predominance without atypical cells such as ATL cells, but with integration of HTLV-1 proviral DNA. There seemed to be a causal relationship between HTLV-1 carrier state and thymoma. Since there are no reported cases of HTLV-1 carrier associated with pulmonary cryptococcosis and thymoma, we report the first case with a review of the literature.

Carrier State↗
PubMed1994

[Rapid identification of mycobacteria by combined method of polymerase chain reaction and the gen-probe DNA hybridization system].

We developed the rapid detection and identification method of mycobacteria, involving amplification of mycobacterial 16S rRNA gene by nested PCR and identification of M. tuberculosis complex or M. avium-intracellulare complex (MAC) by hybridization protection assay (HPA) using the acridinium-ester (AE) labeled DNA probe. The specificity of the nested PCR combined with DNA probe test was excellent in terms of detection of mycobacterial organisms and identification of M. tuberculosis or MAC. The detection limits of the present method were 10 fg DNA for M. tuberculosis, and 100 fg DNA for MAC, respectively. We further investigated on the optimum temperature for hybridization in HPA with AE labeled DNA probe because there was the difference in the mode of DNA-RNA hybridization from that of DNA-DNA hybridization. In our method, the optimum temperature of hybridization was estimated as 55 +/- 1 degrees C. In preliminary experiments on two clinical cases, we practically detected and identified M. tuberculosis and MAC in clinical specimens, such as sputa, by using this newly devised method. We concluded that this method is useful for rapid detection and identification of M. tuberculosis and MAC in clinical specimens.

Adult↗
PubMed1994

[Evaluation for rapid detection of rifampicin-resistant mycobacterium tuberculosis by polymerase chain reaction-single strand conformation polymorphism].

We evaluated usefulness of the rapid diagnostic method for detection of rifampicin (RFP)-resistant Mycobacterium tuberculosis, which was based on polymerase chain reaction. The MICs of RFP were measured for 38 clinical isolates of Mycobacterium tuberculosis which were suspected to be RFP-resistant organisms, and 12 strains were found to be resistant to RFP. The PCR primers used were the same as those reported by Telenti et al, which were targeting the RNA polymerase beta subunit gene (rpoB). We confirmed that this gene was possessed by all the strains tested. Eight strains out of the 12 strains with RFP-resistant phenotype were demonstrated to have a point mutation or some alterationin the rpoB gene on the basis of PCR-single strand conformation polymorphism (SSCP). Thus, the sensitivity of our method was calculated as 67%. In addition, we could not detect any alterations in the rpoB gene by all RFP-susceptible strains. These results indicated that rapid detection of the RFP-resistant Mycobacterium tuberculosis was possible directly from clinical specimens by using PCR-SSCP technique.

Base Sequence↗
PubMed1994

[Modified Fontan procedure for complex cardiac anomaly with nonconfluent pulmonary artery].

Modified Fontan procedure was successfully performed in two patients with complex cardiac anomaly and nonconfluent pulmonary artery. A nonconfluent portion of the pulmonary artery was interposed with a xenopericardial roll. In one patient, the central pulmonary artery was completely absent. Two-staged reconstruction of the central pulmonary artery was carried out through a left thoracotomy and a median sternotomy before the Fontan procedure. In the other patient, a juxtaductal segment of the pulmonary artery was nonconfluent. Correction of the nonconfluent pulmonary artery was performed concomitantly with the Fontan procedure. Fenestrated Fontan procedure seemed to be the beneficial modification for survival. Both patients have been day well during the midterm follow-up period.

Cardiac Surgical Procedures↗
PubMed1994

[Clinical effect of the combined therapy of arbekacin and imipenem/cilastatin against methicillin-resistant Staphylococcus aureus].

We evaluated the efficacy of combined therapy of arbekacin (ABK) and imipenem/cilastatin (IPM/CS) against infections by methicillin-resistant Staphylococcus aureus (MRSA). The MICs of ampicillin, cefmetazole, cefotiam, cefuzonam, flomoxef, fosfomycin, ofloxacin, minocycline, ABK and IPM/CS against clinically isolated strains of MRSA were examined. Almost all strains of MRSA were resistant to these antibiotics except ABK. Furthermore, combination of ABK and IPM/CS showed smaller MICs than that of ABK or IPM/CS alone. All fractional inhibitory concentration indices (FIC indices) of ABK plus IPM/CS were lower than 0.75. The efficacy rate of combined therapy of ABK and IPM/CS in 22 patients with MRSA infections (15 patients with pneumonia, 3 patients with chronic bronchitis, 2 patients with sepsis, a patient with subcutaneous abscess and a patient with DPB) was 68%. And no patients had adverse reactions. Six (27%) of 22 strains of MRSA were eradicated. Significant correlations were found between bacteriological effect and severity of disease, and between serum albumin level and clinical effect.

Aged↗
PubMed1994

[A case report of modified Bentall procedure, aortic arch replacement and mitral valve replacement for a patient with Marfan's syndrome].

A 20-year-old man of Marfan's syndrome who had mitral valve regurgitation, annuloaortic ectasia with aortic valve regurgitation and aortic arch aneurysm was successfully treated with radical operation. Mitral valve replacement was performed with superior wall incision of the left atrium directly. Complete transection of the aortic root made it easy to reach the mitral valve. The diameter of his ascending aorta was 70 mm, and modified Bentall' procedure, Carrel patch method, was performed. Aortic arch was 40 mm in diameter, and total aortic arch replacement was performed under hypothermic circulatory arrest. After the combined operation, patient was recovered uneventfully.

Adult↗
PubMed1994

[A case of endometrial tuberculosis diagnosed by polymerase chain reaction].

A 30-year-old female was admitted to our hospital for further investigation of infertility. The menstrual culture and polymerase chain reaction (PCR) of the endometrial tissue for detection of Mycobacterium tuberculosis were both positive. The pelvic CT scan and hysterosalpingography showed a slightly expanded uterus and irregularity of the endometrium. Barium enema and pyelography showed no abnormality. Since these data established a diagnosis of early primary endometrial tuberculosis, the combined therapy of three antituberculous agents was commenced. Menstrual smear, culture and PCR for M. tuberculosis were examined monthly throughout the therapy. The mycobacterial culture became negative soon after the start of therapy, followed by a negative PCR result 3 months later. We conclude that PCR is useful for the rapid detection of M. tuberculosis not only in pulmonary but also in endometrial tuberculosis.

Adult↗
PubMed1994

[Association between diffuse panbronchiolitis and HTLV-I infection].

To determine whether HTLV-I infection is associated with diffuse panbronchiolitis (DPB), we investigated T-cell surface markers of peripheral blood and bronchoalveolar lavage fluid (BALF) in 9 healthy volunteers, 6 HTLV-I seronegative DPB patients (HTLV-I(-)DPB) and 8 HTLV-I seropositive DPB patients (HTLV-I(+)DPB). In peripheral blood, no significant difference was observed between HTLV-I(-)DBP and healthy volunteers. However, in BALF, HTLV-I(-)DPB showed a significant decrease of the CD4/CD8 ratio and an increase of CD8+HLA-DR+ cells compared with healthy volunteers. CD3+CD25+ and CD4+HLA-DR+ cells in peripheral blood were significantly increased in HTLV-I(+)DPB compared with those in HTLV-I(-)DPB. No significant difference was observed in BALF cells between HTLV-I(-) and HTLV-I(+)DPB with the exception of CD3+CD25+ cells. The most striking result was a marked elevation of CD3+CD25+ cells in 2 of 8 HTLV-I seropositive patients. Microscopic findings of open lung biopsy specimens obtained from the 2 patients differed from the typical microscopic findings in DPB. From these findings, we consider that HTLV-I infection may be associated with pulmonary lesions like DPB, but of a different, pathologically distinct, type.

Adult↗
PubMed1994

[Evaluation of (1-3)-beta-D-glucan in aspergillosis and cryptococcosis].

(1-3)-beta-D-Glucan (beta-glucan) is a major structural component of fungi. The G test is a direct method to detect beta-glucan using fractionated (1-3)-beta-D-glucan-sensitive component, factor G, eluted from the limulus lysate. Previously, we reported that the G test is a more sensitive method than the mannan detection assay for the serological diagnosis of Candida infection. In this study, we discuss beta-glucanemia in patients with pulmonary aspergillosis and cryptococcosis. The concentration of beta-glucan was less than 10 pg/ml in 9 of 10 cases of pulmonary cryptococcosis, except for one case receiving hemodialysis (16.5 pg/ml). beta-Glucan increased in 3 cases of invasive pulmonary aspergillosis (27-937 pg/ml). Galactomannan antigen was positive in all of those cases. In 8 cases of aspergilloma, which showed fungus ball on roentgenogram, the mean concentration of beta-glucan was 67.1 +/- 92.7 pg/ml. Two of 8 cases were positive for galactomannan antigen. One of three cases of PAIC (productive aspergilloma on the inner wall of a cavity) and one case of chronic necrotizing pulmonary aspergillosis showed slightly increased levels of beta-glucan and positive results of galactomannan antigen test.

Adult↗
PubMed1994

[A drug delivery system and biological response modifiers for the treatment of mycobacterial infection].

A drug delivery system (DDS) for the treatment of infectious disease has recently been developed. Since liposomal antimicrobial agents are effective on cytozoic bacteria, we applied liposomal streptomycin and amikacin for the treatment of systemic mycobacterial tuberculosis in mice. Liposomal aminoglycosides showed excellent efficacy compared to free aminoglycosides or empty liposome. This therapeutic strategy should be developed for clinical application. Although the human defense mechanism against microbial infection is very complicated, biological response modifiers (BRM) such as vaccination or cytokine therapy have been investigated. One of the most useful and protective vaccines for prevention of tuberculosis is the Mycobacterium vaccae vaccine, developed by Stanford et al. As for the cytokines, interleukin-2, granulocyte macrophage-colony stimulating factor, and tumor necrosis factor have very strong antimycobacterial activity. Interferon alone, however, has weak efficacy, and should be combined with other effective cytokines. These BRM constitute an excellent strategy for antimycobacterial chemotherapy.

Amikacin↗