Kyoichiro Toyoshima

Idiopathic bronchiolitis obliterans organizing pneumonia (idiopathic BOOP) in childhood

Idiopathic bronchiolitis obliterans organizing pneumonia (idiopathic BOOP) is a clinicopathological entity of unknown origin first described by Epler and colleagues in 1985. We report our findings from a study of two Japanese boys aged 12 and 13 years with idiopathic BOOP. The patients showed no respiratory symptoms nor signs of infection. There was no history of exposure to noxious agents or medications in either case. Laboratory data, including hematological, biochemical, and immunological tests, were normal, and pulmonary function tests showed only a slight nonprogressive decrease from normal predicted values in vital capacity and diffusing capacity. Serial radiographs in both cases showed migration of patchy infiltrates. Fiberoptic bronchoscopy was performed for evaluation of eosinophilic pneumonia, but the bronchoalveolar lavage (BAL) revealed no increase in eosinophils and a decrease in CD4/CD8 ratio in the BAL fluid. Histopathological findings of transbronchial lung biopsy (TBLB) specimens were compatible with a diagnosis of BOOP. As neither case has shown clinical abnormalities apart from migratory patchy infiltrates on chest radiographs, both patients have been observed without drug therapy for 3–4 years. Pediatr Pulmonol. 1996; 22:67–72.

CD4 T-lymphocyte activation is associated with peak expiratory flow variability in childhood asthma

BACKGROUND Asthma has been recognized as a chronic inflammatory disorder of the airway. We have investigated the relationships among the activation markers on lymphocytes, eosinophils, their serum products in the peripheral blood, and the variability of airway obstruction in childhood asthma. METHODS Twenty-two patients with atopic asthma (mean age, 12 years) were treated regularly and asked to measure their peak expiratory flow (PEF) twice daily for 7 days, Peripheral venous blood was obtained on day 8. RESULTS The absolute counts of CD4 T lymphocytes expressing the activation marker CD25 in the peripheral blood on day 8 correlated significantly with the values of the coefficient of variation (CV) of both morning PEF (p < 0.01) and night PEF (p < 0.05) obtained over 7 days, but those of CD8+/CD25+ T lymphocytes, those of CD23+ B lymphocytes, and the serum concentrations of soluble CD25 did not. The absolute counts of peripheral blood eosinophils also demonstrated a significant correlation with the CV values of both morning PEF (p < 0.01) and night PEF (p <0.05). CONCLUSION CD4 T-lymphocyte activation and increased counts of eosinophils in peripheral blood correlate with CV of PEF in patients with asthma, suggesting that CV of PEF is a good marker for assessing not only the variability of airway obstruction but also the degree of airway inflammation.

Video-assisted thoracoscopic bullectomy for spontaneous pneumothorax in a Swyer-James syndrome patient

We treated a 15-year-old patient with spontaneous pneumothorax associated with Swyer-James syndrome using video-assisted thoracoscopic surgery (VATS). Thoracic computed tomography showed hyperlucent areas in the bilateral lungs. Due to major air leakage continuing for a week, we conducted VATS bullectomy. Because the opposite lung suffered hypoplasia, intermittent bilateral pulmonary ventilation was required to sustain an adequate PaO2 in arterial blood gas analysis during surgery. Because of recurrent pneumothorax, we performed reoperation 10 months later, finding a few newly generated bullae. To the best of our knowledge, this is the first report of VATS used to treat a Swyer-James syndrome patient with pneumothorax.

Airway Obstruction in a Child with Esophageal Achalasia

A 13‐year‐old Japanese boy who had respiratory symptoms and had been treated as a case of chronic bronchitis was found by us to have esophageal achalasia. He had complained of cough for one year and a half, and pulmonary function studies showed severe airway obstruction. The chest radiogram showed the trachea compressed by the dilated esophagus. After operation, the symptoms disappeared and marked improvement was found in the flow‐volume curve. Esophageal achalasia should be considered as one of the differential diagnoses of airway obstructive disease.

Studies on prophylaxis of cow's milk allergy by digestive enzymes.

Morohashi et al.6) noted by Schultz+ + Dale phenomenon that the antigenicities of trypsin digested cow’s milk and pepsin + * digested cow’s milk were markedly dei t t i t t i t + is no decrease in the antigenicity of anaphylaxis in cow’s milk preparations which are not treated with heat, such as in powder milk, sterilized milk, and acidified milk. Morohashi et a1.6) examined the antigenicity of heated cow’s milk by SchultzDale’s phenomenon and noted that the degree of decrease in the antigenicity is in the following order: milk heated in high pressure, evaporated milk, adjusted powder milk, skimmed milk, and heated milk ( 60°C, 30 minutes). The authors examined the decrease in the antigenicity of cow’s milk heated with 100°C, but the lowering was not so marked in precipitin reaction or in PCA reaction (Table I).

Inhaled steroid inhibits development of total and mite IgE

Abstract Serum levels of total immunoglobulin E (IgE) and allergen-specific IgE are related to asthma severity and risk factors for persistent asthma in childhood wheezing. Inhaled corticosteroids (ICS) have been the most effective therapy in children with asthma, as well as in adults. The serum levels of total and mite specific IgE in children with asthma and the effects on IgE levels of beclomethasone dipropionate (BDP) treatment on IgE levels in asthmatic children were investigated. First, a cross-sectional study of 255 children with asthma was carried out to measure IgE levels. Children under three years of age with asthma who were negative for Df-specific IgE were then treated with BDP or disodium cromoglycate (DSCG) as controls for one year. Serum IgE levels, numbers of eosinophils in peripheral blood and clinical variables were determined before and after treatment. After one-year DSCG treatment, the total IgE levels increased significantly, whereas the levels remained the same during BDP treatment. Five of 22 (23%) patients in the DSCG-treated group became positive for Df-specific IgE; however, only one of 13 (8%) in the BDP-treated group became positive. Taken together, ICS therapy may modulate the levels of total IgE and allergen-specific IgE.

THE EFFECT OF ORAL ANTI-ALLERGIC DRUGS ON PREVENTION OF ASTHMA

Iikura et al. and Hirota et al. reported that one year treatment with ketotifen could prevent the development of asthma in atopic dermatitis young children. We had a question that this prophylactic effect is unique for ketotifen or common effects of oral anti-allergic drugs, and planned to study ketotifen and tranilast by open study. One hundred and fifty seven atopic dermatitis patients aged from 2 to 42 months who had no history of wheezing were enrolled to this study and 120 patients gave complete data for analysis: K group (71 patients) received ketotifen, T group (19 patients) received tranilast for 1 year and C group (30 patients) received no anti-allergic drugs. Development of asthma in the studying period (1 year) is 28.2% in K group, 15.2% in T group and 60.0% in C group. Our conclusion is that ketotifen and tranilast have equal prophylactic ability on development of asthma in atopic dermatitis young children. This fidings show the probability that other oral anti-allergic drugs have similar asthma preventing effects, too. The question whether prevention of development of asthma in studying period is life long effect or delay of development should be solved by long follow up of patients. We think it is valuable to study the asthma preventing effect of oral anti-allergic drugs other than ketotifen and tranilast.

An Epidemiological Study on Tuberculosis in Childhood

最近5年間に当科で経験した小児結核67例について疫学的に検討した。BCG接種歴は全体では41.8% (28/67) に認めたが, 未就学児では11.4% (4/35) にすぎず, 乳児期早期のBCG接種が望まれる。感染源は46例 (68.7%) で推定でき多くは大量排菌者であった。結核菌は33例 (49.3%) に証明され, 有症状受診者に高率であった。感染源発見から患児発見までの期間は年長児では3ヵ月以上の場合がほとんどであるのに対し, 乳幼児では大部分が3ヵ月以内で感染から発病までの期間が短く急速に重症化するので, 感染源発見後一刻も早い家族検診の実施が必要である。