Biomedical subjects
Y Tanizaki
Publications and source records attributed to Y Tanizaki.
[Clinical features of bronchial asthma with mucus hypersecretion].
Fifty patients with bronchial asthma were divided into four groups according to the amount of expectoration per day: 0-24, 25-49, 50-99 and 100+ ml/day. Clinical features of patients with mucus hypersecretion (more than 50 ml/day of expectoration) were evaluated by age, severity of disease, cellular composition of bronchoalveolar lavage (BAL) fluid, and ventilatory function. 1. The proportion of patients with steroid-dependent intractable asthma (SDIA) in each group increased with increase in mucus hypersecretion. 2. Many of the patients with mucus hypersecretion (more than 50 ml/day) were over the age of 40. 3. The proportion of BAL eosinophils was significantly higher in patients with hypersecretion (more than 50 ml/day) than in those with expectoration of less than 49 ml/day. There was a significant correlation between the proportion of BAL eosinophils and the amount of expectoration per day (r = 0.48, p < 0.05). Proportions of lymphocytes and neutrophils in the BAL fluid were not related to the amount of expectoration per day. 4. There was no significant correlation between the amount of expectoration per day and ventilatory function in patients with asthma in this study.
[Changes in bronchoalveolar cell profiles of asthma patients induced by long-term glucocorticoid therapy].
Effects of long-term glucocorticoid therapy on airway inflammatory cells were examined in 40 patients with bronchial asthma. 1. The dose of glucocorticoids required by asthmatic patients tended to increase and the level of serum cortisol tended to decrease with prolongation of the period of glucocorticoid therapy. 2. The proportion and number of lymphocytes in bronchoalveolar lavage (BAL) fluid decreased with prolongation of the period of glucocorticoid therapy. The proportion of BAL lymphocytes in asthmatic patients treated with glucocorticoids for more than 5 years was significantly lower than that in those treated for less than 4.9 years. 3. The proportion and number of BAL neutrophils increased with prolongation of the period of glucocorticoid therapy and the proportion of BAL neutrophils in patients treated with glucocorticoids for more than 10 years was significantly higher compared with those treated for less than 9.9 years. These findings indicate that long-term glucocorticoid therapy induces changes in airway inflammatory cell profiles, with a decrease in the number of lymphocytes and increase in the number of neutrophils.
Clinical effects of complex spa therapy on patients with steroid-dependent intractable asthma (SDIA).
The clinical effects of spa therapy (swimming training in a hot spring pool+inhalation of iodine salt solution+fango therapy) were examined in 52 patients with steroid-dependent intractable asthma (SDIA). Clinical effects were found in 36 of the 52 (69.2%) patients with SDIA. The efficacy was higher in the patients between the ages of 41 and 50 (87.5%) and between 51 and 60 (84.2%) than in those in the other age groups. Regarding clinical asthma types, the efficacy of spa therapy was higher in patients with type Ia-2 (83.4%), type Ib (77.8%) and type II (80.0%) than in those with type Ia-1 (54.2%). Efficacy seemed to be related to airway inflammation: the proportion of neutrophils and eosinophils in bronchoalveolar lavage (BAL) fluid was higher in patients with marked and moderate improvement compared with those with slight and no improvement. Ventilatory function was improved by complex spa therapy. %MMF and %V25 values increased by more than 20% after therapy in patients with type Ia-2, Ib and II asthma. Bronchial hyperreactivity to methacholine was suppressed after therapy. Any decreased function of the adrenocortical glands expressed by low serum cortisol levels improved after therapy, accompanied by a reduction in the dose of glucocorticoids necessary to control asthma attacks.
Characteristics of airway responses in patients with bronchial asthma. Evaluation of asthma classification systems based on clinical symptoms and clinical findings.
Asthma was classified into three types according to clinical symptoms (clinical diagnosis, C.D.): Ia. simple bronchoconstriction type (further divided into two subtypes, type Ia-1 with 0-49 ml/day of expectoration and type 1a-2 with 50-99 ml/day); Ib. bronchoconstriction + hypersecretion type, and II. bronchiolar obstruction type. Asthma was also classified by a score related to clinical findings and examinations (score diagnosis, S.D.). The clinical features of each type of asthma according to the two classifications methods were compared. Type 1a-2 and 1b patients (C.D.) were characterized by mucus hypersecretion (more than 50 ml/day) and eosinophilia in the bronchoalveolar lavage (BAL) fluid. The characteristic findings for type II asthmatics (C.D.) were a lower %V25 value (less than 10%) and an increased proportion of neutrophils (more than 20%) in the BAL fluid. All of the patients classified as types 1a-1, Ib, and II by clinical diagnosis were evaluated as having the same types of asthma by score diagnosis. Patients with type Ia-2 evaluated by clinical diagnosis were classified as type Ib by score diagnosis, since these two types had similar pathophysiological features represented by the increased proportion of eosinophils in the BAL fluid.
[Correlation between proportion of BAL cells and ventilatory function in patients with asthma].
The correlation between proportions of cells in bronchoalveolar lavage (BAL) fluid and ventilatory function was examined in 52 patients with asthma. 1. There was no significant correlation between the proportion of BAL lymphocytes and ventilatory function. 2. The proportion of BAL eosinophils correlated to a certain extent with ventilatory function: the values of %MMF, %V50 and %V25 were lower in patients with BAL eosinophils of 10-19.9% than in those with BAL eosinophils below 4.9%, and %V25 value was significantly lower in patients with a high proportion of BAL eosinophils (10-19.9%) compared with those with a low proportion of BAL eosinophils (0-4.9%). However, ventilatory function was not decreased in patients with BAL eosinophils of more than 20%. 3. The values of ventilatory parameters showed a tendency to decrease with increase in BAL neutrophils. The values of all parameters of obstructive ventilatory dysfunction were significantly lower in patients with BAL neutrophils of > 10% than in those with BAL neutrophils < 4.9%. A significant difference between patients with BAL neutrophils > 10% and < 9.9% was found in values of %V50 and %V25, and the values of %V50 and %V25 were significantly lower in patients with a high proportion of BAL neutrophils (> 10%) than in those with BAL neutrophils < 9.9%. These results suggest that the proportion of BAL eosinophils is to a certain extent related to ventilatory function of asthma patients and that the increase in proportion of BAL neutrophils is closely related to a decrease in values of obstructive ventilatory parameters.
Actions and cross-reactivity of antiallergic agents and a calcium channel antagonist on rat peritoneal mast cells. Difference in the action mechanisms and cross-reactivity among the agents.
The actions of the antiallergic agents, disodium chromoglycate (DSCG), tranilast and ketotifen, and of a calcium channel antagonist, nicardipine, and cross-reactivity among the agents were examined by observing the inhibition of 45Ca uptake and histamine release in rat mast cells stimulated by antigen and compound 48/80 (comp. 48/80). 1) All agents inhibited 45Ca uptake and histamine release in mast cells stimulated by antigen. The inhibition of 45Ca uptake by the antiallergic agents paralleled the inhibition of histamine release, while nicardipine inhibition of 45Ca uptake was stronger than its inhibition of histamine release. 2) The action of DSCG on 45Ca uptake and histamine release was significantly decreased in cells stimulated with antigen and phosphatidylserine (PS), while tranilast inhibition of histamine release was not affected by the addition of PS despite a significant decrease in the inhibition of 45Ca uptake. 3) The inhibitory effect of DSCG and tranilast was significantly lower in mast cells stimulated by comp. 48/80 than in the cells stimulated by antigen. 4) Tachyphylaxis was observed in cells re-exposed to DSCG and tranilast following previous exposure to the agents. 5) Cross-reactivity was found between DSCG and tranilast.
Asthma classification by a score calculated from clinical findings and examinations in subjects sensitive to inhalant allergens.
Twenty-one patients with atopic asthma were classified into three types according to their symptoms (clinical diagnosis): Ia, simple bronchoconstriction; Ib, bronchoconstriction + hypersecretion; and II, bronchiolar obstruction, and this classification was compared with a classification made according to clinical findings and examinations (score diagnosis). Type Ib asthma was characterized by the increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF), while type II was characterized by ventilatory dysfunction in small airways and the increased incidence of neutrophils in BALF. Four patients, whose expectoration was between 50 and 99ml/day, of the 12 with type Ia assessed by clinical diagnosis were evaluated as type Ib by score diagnosis. One patient with type II by clinical diagnosis was assessed as questionable type II by score diagnosis. In the other 16 patients, the clinical and score diagnoses were the same.
Asthma classification by pathophysiology and IgE-mediated allergic reaction: new concepts for classification of asthma.
Bronchial asthma was classified by the pathophysiology and by the mechanism of onset of the disease. Forty asthmatics who had serum IgE levels lower than 200 IU/ml were evaluated by two classification methods. 1. In asthma classified by a score based on clinical findings and examinations, the characteristics of the findings and examination results were compared among three asthma types, i.e., Ia. simple broncho-constriction type, Ib. bronchoconstriction+hypersecretion type, and II. bronchiolar obstruction type. Type Ib patients, in addition to manifesting hypersecretion, had a significantly higher proportion of eosinophils in the bronchoalveolar lavage (BAL) fluid compared to other asthma types. Significantly decreased values for ventilatory parameters and an increased proportion of BAL neutrophils were found in type II compared with other asthma types. 2. In a new classification by mechanism of onset, asthma was classified into three types according to the degree of participation of IgE-mediated reactions associated with specific IgE antibodies and serum levels of total IgE: asthma induced by definite IgE-mediated reaction (atopic asthma), possible IgE-mediated reactions (asthma), and asthma induced by non-IgE-mediated reaction (asthma syndrome).
Spa therapy improves ventilatory function in the small airways of patients with steroid-dependent intractable asthma (SDIA).
The improvement of ventilatory function by spa therapy was examined in 37 patients with steroid-dependent intractable asthma (SDIA) in relation to clinical asthma types. All subjects had been on long-term corticosteroid therapy before spa therapy. Spa therapy was found to improve the values of ventilatory parameters. The percent improvement in all subjects was +4.1% in %FVC, +8.9% in FEV1.0%, +9.8% in %PEFR, +22.0% in %MMF, +19.7% in %V50 and +28.2% in %V25, respectively. Relating to clinical asthma types, moderate improvement in %MMF and %V25 from 16.7% to 16.9% was observed in type Ia cases, and marked increase in %MMF, %V50 and %V25 was observed from 42.2% to 43.2% in type Ib cases. However, no significant increase was found in these parameters of types Ia or Ib after spa therapy. In patients with type II, a significant increase was shown in %V50 (p less than 0.05) and %V25 (p less than 0.01) after spa therapy. The results show that spa therapy improves the condition of small airways disorder in patients with SDIA.
Food-dependent exercise-induced anaphylaxis.
A 58-year-old farmer was admitted to our hospital because of repeated episodes of anaphylaxis. He had experienced 12 episodes of anaphylactic shock over the previous 17 years. These attacks included three episodes of bee sting. In general, the episodes occurred during farm work (exercise) and within two hours of eating cake in the afternoon. Because an immediate skin reaction to wheat flour was highly positive, a diagnosis of wheat allergy was considered. These findings suggested that his illness was consistent with food-dependent exercise-induced anaphylaxis.
Cellular composition of fluid in the airways of patients with house dust sensitive asthma, classified by clinical symptoms.
The cellular composition of bronchoalveolar lavage (BAL) fluid was observed in 28 patients with house dust mite-sensitive asthma. The proportion of neutrophils in the BAL fluid was significantly higher in the patients between the ages of 50 and 59 and those over 60 than in the patients younger than age 39. There was a significant difference in the number of neutrophils in patients aged 30-39 years and in those over 40 at the onset of disease. The cellular composition varied among the three types of asthma; the mean percentage of cells in the BAL fluid was 1.1% neutrophils and 21.3% eosinophils in type Ia (simple bronchoconstriction), 9.1% neutrophils and 23.0% eosinophils in type Ib (bronchoconstriction + hypersecretion), and 34.4% neutrophils and 12.0% eosinophils in type II (bronchiolar obstruction). The results suggested that an increased frequency of both neutrophils and eosinophils correlates with the mechanism of hypersecretion, and that a marked increase in the proportion of neutrophils is involved in bronchiolar obstruction.
Humoral and cellular immunity to Candida albicans in patients with bronchial asthma.
Delayed cutaneous reactivity to Candida albicans (C. albicans) and PPD (purified protein derivative) was examined in 52 patients with bronchial asthma in relation to the production of specific IgG4 antibodies against the antigen. 1. The frequency of a positive, immediate skin reaction to C. albicans was similar among the five age groups, ranging from 60.0% to 66.7%. 2. The incidence of a positive delayed skin reaction to C. albicans was lower in patients between the ages of 10 and 30 and tended to decrease with aging in the patients over the age of 51. 3. A delayed skin reaction to PPD was positive in patients between 31 and 50 with a higher incidence; this incidence decreased in patients over age 51. 4. The level of C. albicans-specific IgG4 antibodies was significantly higher (26.7 u/ml) in patients with a negative delayed skin reaction to the antigen than in those with a positive reaction (5.9 u/ml) (p less than 0.001). There was no correlation between delayed skin reaction to PPD and production of specific IgG4 antibodies.
An increased level of specific IgG4 antibodies against Candida albicans in patients with bronchial asthma.
Specific IgG4 antibodies against Candida albicans in sera were measured in 76 asthmatics. The increased level of specific IgG4 was found in cases 10-40 years old sensitive to house dust mite and/or Candida albicans, in cases with steroid-dependent intractable asthma (SDIA) and in elderly cases. The frequency of SDIA was the highest in cases 41 to 60 years old with higher frequency of increased IgG4 antibodies. The results show that specific IgG4 increases in relation to IgE-mediated immune response, long-term steroid therapy, and aging. All of these conditions may induce depressed cell-mediated immunity.
Pathophysiological changes in the airways of asthma patients with aging.
Pathophysiological changes in the airways with aging were examined in 78 patients with bronchial asthma. The FEV1.0% values in patients over the age of 71, and the %MMF, %V50 and %V25 values in those over 51 were significantly lower than those of patients between the ages of 10 and 30. The frequency of lymphocytes in bronchoalveolar lavage (BAL) fluid was significantly higher in patients aged between 61 and 70 than in those aged between 41 and 50 (p < 0.05). The frequency of each clinical asthma type changed with aging; the number of patients with simple bronchoconstriction type (type Ia) decreased with increasing age in patients under the age of 60, and the number of those with bronchiolar obstruction type (type II) increased with aging. The frequency of patients with bronchoconstriction+hypersecretion type (type Ib) showed a peak between the ages of 51 and 60. Bronchial reactivity to methacholine showed a tendency to decrease with aging. The release of histamine from leucocytes induced by Ca ionophore A23187 was significantly higher in patients between the ages of 10 and 30 than in those between the ages of 51 and 60 (p < 0.05) and between 61 and 70 (p < 0.01).
Histamine release and morphological changes in basophilic granulocytes of atopic asthmatics induced by antigen, anti-IgE and Ca ionophore A 23187.
Morphological changes of basophils from atopic asthmatics were compared among antigen, anti-IgE and Ca ionophore A23187 stimulation. 1. Antigen induced rapid and marked increase of histamine release from basophils compared with Ca ionophore A23187. 2. The decrease in number of basophils following stimulation with the agents was significantly higher in antigen stimulation than in Ca ionophore A23187 stimulation. 3. The increased ratio of short to long axis diameter (L/Sb ratio) of the cells, which shows an increased motility of basophils, was significantly higher in antigen stimulation. The ratio did not change by stimulation with Ca ionophore A23187. 4. Stimulation of basophils by Ca ionophore A23187 induced marked increase in mean diameter (MD) of the cells. Activation of basophils by anti-IgE was similar to that by antigen, but slower in start and shorter in duration compared with antigen. The results show that an increase in motility is essential for release mechanism of chemical mediators from basophils in antigen and anti-IgE stimulation, but not in Ca ionophore A23187 stimulation.
[Asthma classification by score calculated from clinical findings and examinations. Comparison between clinical diagnosis and score diagnosis].
Asthma classification by clinical symptoms and signs (clinical diagnosis) was compared with the classification by score calculated from clinical findings and examinations (score diagnosis) in 25 patients with bronchial asthma. 1. Ten subjects classified as Ia (simple bronchoconstriction type) by clinical diagnosis were divided into 6 cases with expectoration of less than 49 ml a day and 4 cases with expectoration of between 50 and 99 ml. The level of serum IgE and number of eosinophils in BALF were significantly higher in the latter cases than in the former cases. The cases whose expectoration was from 50 to 99 ml a day were classified as Ib (bronchoconstriction with hypersecretion type) by score diagnosis. 2. The six subjects who were classified as type Ib by clinical diagnosis were also evaluated as type Ib by score diagnosis. 3. Nine of the 10 subjects classified as type II by clinical diagnosis were evaluated as type II by score diagnosis. One case, whose score was under 12 points, was evaluated as questionable type II by score diagnosis.
[MR evaluation of wallerian degeneration of the pyramidal tract].
This study is based on 135 magnetic resonance (MR) exams of 110 patients with wallerian degeneration of the pyramidal tract shown on MR images acquired on a mid field imaging scanner. The MR findings of wallerian degeneration were abnormal signal band along the course of the pyramidal tract and ipsilateral brain stem shrinkage. In all 110 cases an abnormal signal band was seen on T2-weighted spin-echo images, that is, a hypointense band in four exams between 30 days and 116 days after onset of symptoms, and hyperintense bands in 122 exams. The hyperintense signal on T2-weighted images was shown in most cases after 200 days from the onset. In one case a signal of the pyramidal tract showed a hyperintense band at 7 days, hypointense at 30 days, and hyperintense again at 123 days after onset. Sequential MR exams of another case showed gradual narrowing of the hyperintense signal band and progression of the ipsilateral brainstem shrinkage. The narrowing of the pyramidal tract and the ipsilateral brain stem shrinkage tended to be shown after 6 months from onset.(ABSTRACT TRUNCATED AT 250 WORDS)