Kimihide Tada

A pilot study of aerosolized N‐acetylcysteine for idiopathic pulmonary fibrosis

Objective:  Idiopathic pulmonary fibrosis poses a significant therapeutic challenge because of its progressive course. Since oxidative stress plays an important role in the pathogenesis of idiopathic pulmonary fibrosis, an open, randomized trial of long‐term inhalation therapy with the antioxidant, N‐acetylcysteine was conducted.

Establishment of an erythroid cell line (JK‐1) that spontaneously differentiates to red cells

The authors established a new hemopoietic cell line (JK‐1) from a patient with chronic myelogenous leukemia in erythroid crisis. This JK‐1 line predominantly consists of immature cells, but a small number of mature erythroblasts and red cells can be consistently seen without any specific differentiation inducer. The JK‐1 cells grow in suspension culture supplemented with human plasma and carry double Philadelphia chromosomes. Hemoglobin staining with benzidine was positive for about 20% of cells and the type of the hemoglobin was for the most part HbF. Surface‐marker analysis revealed JK‐1 cells positive for glycophorin A, EP‐1, and HAE9. The proportion of mature cells was elevated by the addition of δ‐aminolevulinic acid. Erythropoietin (EPO) enhanced the growth of JK‐1 cells either in the suspension or in methylcellulose semisolid culture. The total number of EPO receptors was 940 per cell, of which 220 sites had an affinity higher than the other 720 sites. This is the first report of an established human erythroid cell line which spontaneously undergoes terminal differentiation.

Reversed halo sign in pneumocystis pneumonia: a case report

BackgroundThe reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases.Case presentationWe present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkins lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia.ConclusionPhysicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia.

Hypersensitivity pneumonitis associated with inhalation of catechin-rich green tea extracts.

A 51-year-old man presented with fever and fatigue after 3.5 months of antituberculosis therapy. High-resolution computed tomography of his chest revealed new ground-glass opacities and poorly defined centrilobular nodules. He had undergone catechin inhalation for 1 month. We diagnosed hypersensitivity pneumonitis (HP) based on the clinical course, bronchoscopy and a challenge test. Cases of HP due to inhalation of extracted catechin powder are rare. Although it has many known positive attributes, it is necessary to be aware that catechin can cause HP.

Retrospective case series analysing the clinical data and treatment options of patients with a tubercular abscess of the chest wall

The tubercular abscess of the chest wall remains one of the differential diagnoses of a chest wall tumour, and the management strategy is controversial. We reviewed the medical records of 22 patients treated at our institution. Two patients were managed by antitubercular medications alone; eight patients were managed by medication and open drainage. Five patients underwent open drainage with subsequent radical surgery at a constant interval of time, and the mean duration between open drainage and radical surgery was 9.8 weeks (range, 3-12). Seven patients underwent radical surgery without prior open drainage. Five patients required rib resections, and curettage of infected pleural peel was necessary in 5 patients. Antitubercular drugs were administered basically for more than 6 months regardless of surgical management, including for more than 1 month prior to radical surgery. Postoperative empyema was seen in 1 patient after radical surgery. The mean follow-up duration was 32.8 months (range, 3-100), and there was no recurrence. Complete resection of the tubercular abscess with sufficient antitubercular therapy resulted in a satisfactory outcome. Antitubercular therapy with or without open drainage can be a viable choice.

Covered Gianturco stent for tracheal stricture: application of polychlorovinylidene and polyurethane as covering materials.

Abstract. The aim of this study was to assess the efficacy and safety of thin membranes of polychlorovinylidene (PCV) or polyurethane (PU) as covering materials for Gianturco stents in the treatment of severe tracheal stricture caused by intraluminal tumor. Manufactured Gianturco stents covered with PCV or PU membrane were used to treat six malignant and one benign tracheal stricture. The initial results, complications, clinical follow-up, bronchoscopic findings, and three autopsy microscopic examinations were reviewed. Informed consent was obtained after the nature of the treatment had been fully explained before every procedure. The stents successfully dilated the tracheal strictures, providing immediate relief of respiratory symptoms in all patients with no major complications. During the follow-up period, the covering materials prevented tumor ingrowth until death or intraluminal granuloma formation. Autopsies proved that no histological change occurs in the tracheal mucosa in response to the presence of PCV or PU; however, ulcer formation occurred in one patient and penetration of the stent struts into the tracheal wall in two. Bloody sputum with ulcer formation, minimal granuloma formation at the distal end of the stent, and abnormal bacterial load in the sputum were long-term complications. The Gianturco stent covered with PCV or PU membrane is a useful option as a palliative treatment for malignant and an emergent salvage for benign tracheal stricture, because both materials are thinner and less voluminous than the others. However, the indications for its use are limited to patients with poor prognoses, because hemoptysis, granuloma formation, and bacterial propagation remain problematic.

Disease-specific Severity Measures and Health-related Quality of Life in Idiopathic Pulmonary Fibrosis

Objective: To elucidate the correlation between two disease-specific severity measures (CPI, composite physiologic index; GAP, gender, age, lung physiology variables) and health-related quality of life in patients with idiopathic pulmonary fibrosis (IPF). Methods: We used data from a previously reported observational cohort study using the Medical Outcome Study Short Form 36 (SF-36) for measuring health-related quality of life. Of the 44 patients with IPF who participated in the initial cross-sectional study, 32 patients participated in the follow-up study. The CPI and the GAP index were calculated at baseline and follow-up. Results: In the cross-sectional study, the CPI only correlated with one SF-36 domain and the GAP index did not correlate with any of the SF-36 domains. In the current longitudinal study (the median follow-up; 14 months), there was a significant increase in both indices: ΔCPI = 11.5 (95% confidence interval; 6.8, 16.1) and ΔGAP index = 0.59 (95% confidence interval; 0.25, 0.93). Within-subject changes in the CPI and the GAP index were significantly correlated with those of 5 and 3 subscales of the SF-36, respectively. Declines in 4 subscales of the SF-36 were significantly more severe in subjects whose CPI increased by ≥ 5 than in subjects whose CPI did not. Similarly, declines in 3 subscales were significantly more severe in subjects whose GAP stage increased than in subjects whose GAP stage did not. Conclusion: Serial changes in the CPI and the GAP index may be useful to predict changes in the healthrelated quality of life of IPF patients.