Kazushige Minemura

Sarcoidosis induced by interferon therapy for chronic myelogenous leukaemia

A 31‐year‐old male was diagnosed as having chronic myelogenous leukaemia and has been treated with hydroxyurea and interferon‐α since February 1995. After 16 months, he complained of low‐grade fever and a cough. Bilateral hilar lymph node enlargement was detected on the chest X‐ray film and multiple subcutaneous erythematous nodules appeared. A skin biopsy revealed subcutaneous sarcoid granuloma. Two months after the cessation of interferon therapy, the subcutaneous nodules and the hilar lymph node enlargement resolved. It is possible that continuous interferon administration can promote granuloma formation in sarcoidosis by activating T cells and macrophages.

Peripheral airway findings in chronic obstructive pulmonary disease using an ultrathin bronchoscope

The authors performed bronchoscopic examination using an ultrathin bronchoscope to determine the characteristics of the peripheral airways in chronic obstructive pulmonary disease (COPD). The study population comprised 13 healthy control subjects, 10 patients with chronic bronchitis without airflow limitation, and 20 patients with COPD. The COPD patients were divided clinically into 10 with chronic bronchitis and 10 with pulmonary emphysema. The peripheral airways were examined using an ultrathin bronchoscope. In chronic bronchitis, peripheral airways of the 11th or 12th generation showed a high frequency of obstruction and mucosal changes such as granulation. In pulmonary emphysema, the peripheral airways frequently showed a net-like appearance of the bronchial epithelium and obstruction at the 11th or 12th generation. Morphological changes of the small airways in chronic obstructive pulmonary disease can be detected by an ultrathin bronchoscope, and this method is likely to be useful for investigating the small airways in vivo.

Alpha-fetoprotein producing pulmonary blastoma in a patient with systemic sclerosis: pathogenetic analysis

We describe a rare case of pulmonary blastoma complicated with systemic sclerosis. The serum alpha-fetoprotein level was elevated at presentation and the biopsied tumour stained positively against anti-alpha-fetoprotein antibody. The alpha-fetoprotein produced autonomously by tumour cells was of yolk-sac origin. Although the pathogenesis of pulmonary blastoma has not been clarified, we suggest that this pulmonary blastoma is a type of yolk-sac tumour.

Increased collagenase activity in macrophages from bronchial lavage as a diagnostic marker of non-small cell lung cancer.

Background: The roles of matrix metalloproteinases (MMPs) in cancer metastasis have been studied. Macrophages are considered to release MMPs in the tissues of patients with lung cancer. Methods: Intracellular collagenase activity was measured in CD14+ CD45+ cells from bronchial lavage fluid to establish a new diagnostic tool for lung cancer. Between August 2000 and November 2001 bronchoscopy and bronchial lavage were performed in 45 patients with abnormal shadows on the chest radiograph; 21 had lung cancer and 24 had non-malignant disease. Results: Collagenase activity in patients with primary lung cancer (5.54 (0.65)) or non-small cell lung cancer (NSCLC) (5.62 (0.71)) was significantly higher than in those with non-malignant disease (3.63 (0.78), p=0.006 and p=0.008, respectively). Only three of 18 patients in the low activity group were diagnosed as having cancer compared with 18 of 27 in the high activity group (p=0.001). This significance was not seen in non-smokers but it was apparent in smokers/ex-smokers. Excluding non-smokers improved the specificity of collagenase activity in differentiating cancer and non-malignant disease from 62.5% to 80.0%. The sensitivity of the test was 85.7% in all patients and 88.2% in smokers/ex-smokers. Conclusions: Measurement of intracellular collagenase activity in macrophages in bronchial lavage fluid is a useful diagnostic tool for distinguishing between cancer and non-malignant diseases, especially in smokers and ex-smokers.

A Study of Peripheral Airway Findings Using an Ultrathin Bronchofiberscope and Bronchoalveolar Lavage Fluid with Diffuse Panbronchiolitis

We investigated the peripheral airways using an ultrathin bronchofiberscope and analyzed bronchoalveolar lavage fluid (BALF) in 10 patients with diffuse panbronchiolitis (DPB; refractory and responsive to treatment with macrolide antibiotics) and 10 healthy volunteers. Refractory DPB patients had obstruction at the 11th or 12th level of bronchial branches and secretion from the 5th to 6th order bronchi to the 11th–12th level of bronchial branches. In responsive DPB patients, there was no obstruction of peripheral airways, but secretion in the bronchial lumens still remained in nearly all observed bronchial branches. Despite macrolide therapy, BALF from patients with refractory DPB contained a high percentage of neutrophils and had a lower CD4/CD8 ratio. Two-color analysis of T cell subsets in BALF revealed a high percentage and number of CD8+S6F1+ cells (activated cytotoxic T cells) in refractory DPB patients. Our findings suggest that obstruction around the terminal bronchioles may be correlated with BALF abnormalities and may be irreversible despite macrolide therapy in progressive DPB.