Kazuhisa Urushihata

Combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds for advanced thymic carcinoma.

Introduction: Thymic carcinoma is a rare epithelial neoplasm that tends to be aggressive and metastasize widely. The optimal chemotherapy for unresectable advanced thymic carcinoma has not yet been established because of its rare occurrence. The purpose of this study was to evaluate the efficacy and tolerability of combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds for advanced thymic carcinoma. Methods: A retrospective analysis of 34 patients with untreated and unresectable thymic carcinoma who received chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds between 1996 and 2010 was conducted. Twenty-nine patients were treated with a combination of cisplatin (50 mg/m2) and doxorubicin (40 mg/m2) on day 1, vincristine (0.6 mg/m2) on day 3, and cyclophosphamide (700 mg/m2) on day 4. Five patients were treated with carboplatin (area under the curve of 3.0 minutes · mg/ml) instead of cisplatin. Results: The responses of all 34 patients to the current regimen were assessed. The median number of treatment cycles for the present chemotherapy was 4. The overall response rate and disease control rate were 50.0% and 88.2%, respectively. The median survival was 21.3 months (95% confidence interval [CI], 15.0–37.2 months), and the 1-year and 3-year survival rates were 72.7% (95% CI, 56.8–88.6%) and 34.4% (95% CI, 16.2–52.6%), respectively. The most common adverse event was leukopenia/neutropenia, and nonhematological toxicities were mild. Conclusions: Combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds is an effective and well-tolerated treatment for unresectable advanced thymic carcinoma.

A novel device (SD-101) with high accuracy for screening sleep apnoea-hypopnoea syndrome

Background and objective:  The SD‐101 is a non‐restrictive, sheet‐like medical device with an array of pressure sensors, to detect sleep‐disordered breathing by sensing gravitational alterations in the body corresponding to respiratory movements. This study evaluated the accuracy of the SD‐101 for screening sleep apnoea‐hypopnoea syndrome (SAHS) by comparison with polysomnography.

Effects of bronchodilators on dynamic hyperinflation following hyperventilation in patients with COPD

Background and objective:  The present study was performed to examine the occurrence of dynamic hyperinflation following hyperventilation in COPD patients and former smokers without COPD, and the efficacy of short‐acting anticholinergic agents (SAAC) and β2‐agonists (SABA) for lung hyperinflation following metronome‐paced hyperventilation in COPD.

Airway hyper-responsiveness in young adults with asthma that remitted either during or before adolescence

Background and objective:  More than 50% of patients with childhood asthma enter clinical remission by puberty, although 40–50% of these people will probably develop asthma symptoms during early adulthood. The mechanism of relapsing asthma in early adulthood remains unclear. This study determined the characteristics of young adults whose asthma remitted either during or before adolescence.

Comparison of efficacy of long-acting bronchodilators in emphysema dominant and emphysema nondominant chronic obstructive pulmonary disease

Background: The purpose of this study was to clarify the association between morphological phenotypes according to the predominance of emphysema and efficacy of long-acting muscarinic antagonist and β2 agonist bronchodilators in patients with chronic obstructive pulmonary disease (COPD). Methods: Seventy-two patients with stable COPD treated with tiotropium (n = 41) or salmeterol (n = 31) were evaluated for pulmonary function, dynamic hyperinflation following metronome-paced incremental hyperventilation, six-minute walking distance, and St George’s Respiratory Questionnaire (SGRQ) before and 2–3 months following treatment with tiotropium or salmeterol. They were then visually divided into an emphysema dominant phenotype (n = 25 in the tiotropium-treated group and n = 22 in the salmeterol-treated group) and an emphysema nondominant phenotype on high-resolution computed tomography, and the efficacy of the two drugs in each phenotype was retrospectively analyzed. Results: Tiotropium significantly improved airflow limitation, oxygenation, and respiratory impedance in both the emphysema dominant and emphysema nondominant phenotypes, and improved dynamic hyperinflation, exercise capacity, and SGRQ in the emphysema dominant phenotype but not in the emphysema nondominant phenotype. Salmeterol significantly improved total score for SGRQ in the emphysema phenotype, but no significant effects on other parameters were found for either of the phenotypes. Conclusion: These findings suggest that tiotropium is more effective than salmeterol for airflow limitation regardless of emphysema dominance, and also can improve dynamic hyperinflation in the emphysema dominant phenotype, which results in further improvement of exercise capacity and health-related quality of life.

Acute neurogenic pulmonary edema following electroconvulsive therapy: a case report

OBJECTIVE We report the case of a 47-year-old man with depression who developed acute dyspnea, hypoxemia, and mild hemoptysis after electroconvulsive therapy (ECT). METHOD Intravenous carbazochrome sodium sulfate hydrate as a hemostatic drug (100 mg/day) was prescribed for 2 days. On the day of ECT, oxygen inhalation (4 L/min) was continued, and SpO2 was maintained at 94-96%. RESULTS Chest radiography showed improvement in alveolar infiltration. Chest CT 6 days after ECT also confirmed the disappearance of ground glass opacities in the lung fields. CONCLUSION(S) NPE is life threatening and should be recognized as an uncommon adverse event associated with ECT.

Pulmonary haemodynamic changes in patients with severe COPD

Abstract:  Worsening gas exchange during exercise and during exacerbations of COPD contributes to systemic hypoxaemia and reduces quality of life. However, pulmonary haemodynamic changes under such conditions are not well understood. Right heart catheterization was performed in six patients with severe COPD (%FEV1 < 50%) during rest, exercise and during an exacerbation. Pulmonary artery pressure (Ppa) was slightly elevated at rest. The Ppa, as well as pulmonary artery wedge pressure (Pawp) and cardiac index were significantly increased during bicycle ergometer exercise. In contrast, pulmonary vascular resistance increased significantly during an exacerbation accompanied by a slightly increased Ppa. Supplemental oxygen resulted in significant decreases in Ppa and Pawp during exercise and Ppa during exacerbations. In patients with COPD, haemodynamic changes in the pulmonary circulation may differ during exercise and with exacerbations. Supplementary oxygen is beneficial and associated with reductions in pulmonary arterial pressures.

Reduced Lung Uptake of Iodine-123 Metaiodobenzylguanidine in Patients with Myeloperoxidase Antineutrophil Cytoplasmic Antibodies-Positive Vasculitis

Background: Iodine-123 metaiodobenzylguanidine (123I-MIBG) lung uptake in the early phase has been proposed as a potential marker of endothelial function because MIBG behaves qualitatively similarly to norepinephrine in pulmonary circulation. Objectives: The purpose of the present study was to examine the lung uptake of 123I-MIBG in patients diagnosed with myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA)-associated vasculitis without clinical or radiological abnormalities of the thorax. Methods: Six patients with MPO-ANCA-associated vasculitis were enrolled. They had severe renal damage (mean creatinine: 5.1 mg/dl, mean blood urea nitrogen: 54.6 mg/dl), but no respiratory symptoms clinically or radiographic findings on chest computed tomography. The total lung to upper mediastinum ratio of 123I-MIBG uptake (L/M) 15 min after the injection was measured. The result was compared with those for 6 patients with renal damage due to other diseases (mean creatinine: 6.2 mg/dl, blood urea nitrogen: 51.7 mg/dl) and for 8 healthy subjects. Results: The mean value of L/M in patients with MPO-ANCA-positive vasculitis was 1.21 ± 0.04, which was significantly less than that of other groups (1.41 ± 0.06 for patients with renal failure and 1.45 ± 0.03 for normal volunteers). There were no significant differences in MIBG accumulation in the heart among the groups. Conclusions: The reduction in kinetic behavior of MIBG in the lung reflects the presence of pulmonary endothelial impairment in patients with MPO-ANCA-associated vasculitis, even though there are no clinical manifestations in the lungs.

Reduced lung uptake of Iodine‐123 metaiodobenzylguanidine in high‐altitude pulmonary oedema

Background and objective:  Iodine‐123 metaiodobenzylguanidine (123I‐MIBG) uptake in the lungs is a potentially suitable marker of pulmonary endothelial function because MIBG behaviour in the pulmonary circulation is quantitatively similar to that of norepinephrine. In addition, hypoxia reduces 123I‐MIBG transport in pulmonary endothelial cells in vitro. The present study was undertaken to evaluate 123I‐MIBG uptake in the lungs of patients with high‐altitude pulmonary oedema (HAPE).

Comparison of the clinical efficacy of salmeterol and sustained-release tulobuterol (patch) on inadequately controlled asthma patients on inhaled corticosteroids.

Patients with inadequately controlled asthma on inhaled corticosteroid (400 to 1,600 μg/day chlorofluorocarbon beclomethasone equivalent) were treated with concomitant salmeterol (n = 18) or sustained-release tulobuterol (patch) (n = 18), or the inhaled corticosteroid dose was doubled (add-on) (n = 13) to compare clinical efficacy. (1) At 8 weeks, morning and evening peak expiratory flow rates were significantly improved in the salmeterol group only (p < 0.01). (2) Symptom and sleeplessness scores improved in the order, salmeterol (symptom score; p < 0.0001), inhaled corticosteroid add-on, and tulobuterol groups. (3) Only the salmeterol group showed significant improvement in the total Asthma Quality of Life Questionnaire score (p < 0.05). (4) No adverse reactions considered related to the study drugs were observed.