Kenichi Matsuba

Respiratory involvement and immune status in yusho patients.

Clinical and experimental studies on respiratory involvement and alterations in immune status were carried out. Respiratory distress occurring in these patients has improved gradually for 14 years but still remains. Copious expectoration at an early stage of the disease may be related to the fact that a number of discrete polychlorinated biphenyls (PCBs) are distributed throughout the lung parenchyma. For accumulation in the bronchial mucosa, structural requirements and specific dose dependence of PCBs have been clearly shown; however, pathological and physiological studies have indicated that respiratory involvement in yusho is mainly small airway disease that may be caused by involvement of cellular component (Clara cells) in bronchioles and/or associated infection. Respiratory distress is often exacerbated by viral or bacterial infection. Changes in the immune status in PCB and polychlorinated dibenzofuran (PCDF) poisoning are as follows: IgA and IgM in the serum are decreased at an early stage of the disease and then return to normal; suppression of cellular immunity was reported in Taiwanese patients and some may remain in the later stages of the disease, as shown in our patients. PCDFs now appear to be the main causal agents in yusho. Rats given PCDFs showed necrosis of the Clara cells in bronchioles and marked thymus atrophy, while few such changes were noted in rats given PCBs. Therefore, further examination is needed for the difference of the toxic effects between two compounds. ImagesFIGURE 1.FIGURE 2.FIGURE 3.FIGURE 4. AFIGURE 4. BFIGURE 4. C

Respiratory involvement in polychlorinated biphenyls poisoning

Abstract Clinical, laboratory, and pathological findings on respiratory involvement in polychlorinated biphenyl (PCB) poisoning were studied in 401 patients and their pathological changes were produced in rats given PCBs orally. Respiratory symptoms included expectoration in 40% of the 289 nonsmoking patients with PCB poisoning and mild wheezing in 2%. The incidence and severity of the respiratory symptoms correlated well with the concentration of PCBs in the blood and sputa. Chest roentgenographic findings, pulmonary function tests, and pathological findings revealed bronchiolitis in many, and pneumonia or atelectasis in about one-tenth of the patients with reticulo-linear shadows. Peribronchiolar changes may be primarily due to either PCB poisoning or associated infection. Respiratory distress was often exacerbated by viral or bacterial infection persisting for more than a half year in about half of the patients examined. The IgA and IgM levels in the serum decreased considerably within 2 years after the onset of the disease and definite decreases in IgA levels may correlate well with the bacterial infection. PCBs found in sputa may have been present in association with lipid in type II cells of the lung (or with excretion from bronchial cells) and may have been phagocytosed in alveolar macrophages and may change their phagocytic function.

胸水中抗酸菌DNAの検出におけるnested polymerase chain reactionの有用性の検討

A protocol based on the polymerase chain reaction (PCR) is the most sensitive method for detecting mycobacteria in clinical samples. However, few studies have assessed the usefulness of this method in the diagnosis of tuberculous effusion. We developed a highly sensitive and specific nested PCR method, that amplifies the bovine tuberculous MPB70 gene and the mycobacterial 16S rRNA gene for use in detecting Mycobacterium tuberculosis (M. tuberculosis) and mycobacteria, respectively, in clinical samples. We determined the sensitivity of this method for detecting mycobacteria in samples containing known amounts of mycobacterial DNA and in DNA extracted from pleural effusions obtained from 10 patients with pulmonary tuberculosis in whom standard microbiological techniques had detected mycobacteria in sputum but not in pleural effusion. The nested PCR method for the bovine tuberculous MPB70 gene and the mycobacterial 16S RNA gene was able to detect M. tuberculosis and mycobacterial genomes only if there were at least 2 copies per sample. Positive results for M. tuberculosis and the mycobacterial genomes were obtained by nested PCR in 2 of 10 and in 3 of 10 samples of pleural fluid, respectively but no mycobacteria were detected in malignant effusions obtained from 9 patients with lung cancer. The nested PCR method represents a rapid means for detecting mycobacteria in some pleural effusions previously found to be negative by culture. We speculate that the reaction of the host against mycobacteria is more important than the mycobacteria themselves in the pathogenesis of pleural effusion in which mycobacteria are not detected.

Histopathologic Prognostic Factors of Small Peripheral Lung Cancer with Special Reference to Blood Vessel Invasion.

腫瘍径2cm以下の末梢型小型肺癌切除症例 (R2・MO) で他臓器の重複癌の既往の無い33例 (腺癌26例, 扁平上皮癌3例, 腺扁平上皮癌3例, 小細胞癌1例) を対象に予後の決定に関する組織学的因子 (腫瘍内及び腫瘍辺縁部血管侵襲の有無, 腫瘍径, 組織学的分化度, 腺癌亜型分類, 腺癌線維化巣内の膠原化の程度, 間質反応の程度) を検討した. また年齢, 性別, curabilityを解析因子として加えた. 全例3割面以上標本を作成し, HE染色, Elastica-van Gieson染色を行った. 単変量解析では, 血管侵襲の有無リンパ節侵襲の程度, 腺癌線維化巣内の膠原化の程度及びcurabilityが主な予後決定因子であった (p<0.006). 血管侵襲のないものは, あるものに比べ有意に予後良好で, 全例再発は見られず, 顕著な差を示した.