Akira Kawasaki

Effect of Ibudilast: A Novel Antiasthmatic Agent, on Airway Hypersensitivity in Bronchial Asthma

Ibudilast, a unique agent with vasodilating and antiallergic actions, was studied in 13 asthmatics for its effect on airway hypersensitivity to histamine inhalation. The PC20 values improved significantly from 355.6 to 620.5 micrograms/ml at 3 months and further to 731.4 micrograms/ml at 6 months following the initial treatment with ibudilast (20 mg twice daily orally). In addition, the severity of the attacks decreased significantly. Improvements in the PC20 and asthmatic symptoms also were observed in the disodium chromoglycate group, but these were equal to or lesser than those in the ibudilast group. No improvement was observed in the untreated control group. These results suggest that ibudilast would be an effective agent for improving nonspecific airway hypersensitivity in asthmatics.

Urinary excretion of leukotriene E4 and 11-dehydrothromboxane B2 in patients with spontaneous asthma attacks.

BACKGROUND Cysteinyl leukotrienes (LTs) and thromboxane A2 (TXA2) are known to play an essential role in the pathogenesis of atopic asthma. However, their role in nonatopic asthma has not as yet been clarified. The objectives of this study were to define (1) the participation of LTs and TXA2 in nonatopic asthma and (2) the relationship between LTs and TXA2 in asthma attacks. METHODS Urinary excretion of leukotriene E4 (LTE4) and 11-dehydrothromboxane B2 (11DTXB2) was measured in 10 atopic and 10 nonatopic asthmatics who were admitted to hospital with either an acute asthma attack or status asthmaticus. RESULTS In atopic asthmatics, urinary excretion of LTE4 and 11DTXB2 was significantly higher on admission with an asthma attack, and returned to control levels when the patients were in the improved state (179+/-29 to 65+/-16 ng/day in LTE4, 1,085+/-250 to 440+/-90 ng/day in 11DTXB2). Similar findings were observed in nonatopic asthmatics (148+/-13 to 61+/-11 ng/day in LTE4, 1,089+/-206 to 457+/-60 ng/day in 11DTXB2). However, when the individual data during the attack were analyzed, there was no correlation between urinary excretion of LTE4 and that of 11DTXB2 in both types of asthma. CONCLUSION Both LTs and TXA2 may be implicated in the pathogenesis of the nonatopic as well as the atopic type of asthma, but no correlation between these two metabolites was observed in the individuals.

A useful diagnostic method for drug-induced pneumonitis: a case report.

A 51 year-old male was admitted to our hospital with chief complaints of fever, dry cough and dyspnea. Chest X-ray films and his history of taking Chinese medicine for liver dysfunction were suggestive of drug-induced pneumonitis. Lymphocyte stimulation test (LST) to causative Chinese medical drugs of Sho-saiko-to and Dai-saiko-to was negative with peripheral blood lymphocytes (PBL), but was positive with lymphocytes from bronchoalveolar lavage fluid (BALF). In vivo challenge test for Sho-saiko-to was positive. The LST with BALF-lymphocytes proved to be very useful in making a diagnosis of drug-induced pneumonitis.

Therapeutic Effect of Pranlukast, a Selective Cysteinyl Leukotriene Receptor Antagonist, on Bronchial Asthma

This study was undertaken to evaluate whether the therapeutic effect of pranlukast, a selective cysteinyl leukotriene (LT) C4/D4/E4 receptor antagonist, can be observed in patients with the non-atopic or atopic type of asthma, or in asthmatics taking oral steroids. Twenty-two patients with moderate to severe bronchial asthma receiving an inhaled corticosteroid (beclomethasone dipropionate) were treated with pranlukast (225 mg b.i.d.) for 4 weeks, and their peak expiratory flow (PEF) and asthmatic symptoms were monitored during the treatment period. In the patients with the non-atopic type of asthma (n = 13), an increase in their PEF was observed both in the morning and evening following a 4-week administration ofpranlukast, but the degree was slightly inferior to that in patients (n = 9) with the atopic type of asthma. On the other hand, no significant increase was observed in the patients (n = 6) taking oral prednisolone (PSL, 5-15 mg/day). Changes in the symptom score at the end of the 4-week treatment period were closely associated with those in the PEF values; namely, a significant improvement in symptom score was observed for patients with the atopic and non-atopic type of asthma, but no improvement for the patients taking oral PSL. Pranlukast, a selective LT receptor antagonist, will be a valuable asset in the treatment of bronchial asthma, especially asthma requiring no oral steroids.

A case of T-cell lymphoma accompanying marked eosinophilia, chronic eosinophilic pneumonia and eosinophilic pleural effusion. A case report.

A 57-year-old woman was admitted to our hospital for lumbago, weight loss and weakness of her right lower extremity. Leukocytosis was evident with marked eosinophilia (65.5 % = 46,000/mm3), and the chest roentgenogram showed diffuse reticular shadows throughout both lung fields and a left pleural effusion. The pleural effusion contained 22.4 % eosinophils with no immature cells. Biopsy of a thumb-sized mass on the chest wall revealed a T-cell lymphoma of pleomorphic type. The diffuse pulmonary shadow was diagnosed as chronic eosinophilic pneumonia by autopsy. This was a relatively rare case of T-cell lymphoma, in which an eosinophilic pneumonia and eosinophilic pleural effusion were observed.

Clinical Features of Adult-Relapse Asthma in Comparison with Those of Child-Onset Asthma and Adult-Onset Asthma

Clinical features of adult-relapse asthma (group B, n = 15) were compared with those of child-onset asthma (group A, n = 18) and adult-onset asthma (group C, n = 34) in terms of allergic component and bronchial hypersensitivity. The percentage of patients with high levels of serum IgE (> 300 U/ml) in groups A, B, and C was 83%, 73%, and 50%, respectively, and the percentage of patients with positive IgE RAST for house dust was 87.5%, 78.6%, and 46.7%, and that for mite was 93.3%, 92.9%, and 58.6% in groups A, B, and C, respectively. The histamine concentration of PC20 for the bronchial hypersensitivity test in groups A, B, and C was 196 micrograms/ml, 500 micrograms/ml, and 724 micrograms/ml, respectively. Thus, the adult-relapse asthma was closer to the child-onset asthma type in allergic state and closer to the adult-onset asthma type in bronchial hypersensitivity state. The classification employed here seemed to provide some merits in delineating the features of adulthood asthma.

Preliminary study on auxiliary value of serum basic fetoprotein in diagnosing lung cancer.

To characterize basic fetoprotein (BFP) as a new tumor marker, we measured serum levels of BFP and 5 other tumor markers (CA19-9, CEA, NSE, SCC, and TPA) concomitantly in 65 patients with lung cancer, 57 patients with benign pulmonary disease, and 40 healthy volunteers. The sensitivity of BFP was 43%, the specificity 82% and the accuracy 61%. The positivity increased in relation to stage of the disease. There was no correlation between positivity of BFP and histologic type. On the whole, BFP appeared to be analogous to TPA in terms of broad spectrum and to have an auxiliary value in diagnosing lung cancer.