Nobuo Yanase

Effect of gefitinib on warfarin antithrombotic activity.

BackgroundDespite the literature indicating adverse interactions between warfarin and cytotoxic agents, whether such an interaction occurs when warfarin and gefitinib are used concomitantly is unknown. We analyzed the prevalence of the concomitant use of warfarin and gefitinib, and the incidence of prothrombin time-international normalized ratio (PT-INR) alterations or adverse interactions in concomitant users of warfarin and gefitinib.MethodsWe conducted a retrospective study of patients with non-small cell lung cancer treated at the Kitasato University Hospital who received concomitant warfarin and gefitinib between September 2002 and January 2007. Medical information, including the indication for warfarin use, warfarin dosing and dosing changes, and exposure to gefitinib were collected from computerized databases and medical records.ResultsTwelve (4.1%) of 296 patients treated with gefi— tinib received warfarin. PT-INR elevation occurred in 6 patients (50.0%). Two (16.7%) of the 12 patients had liver metastases. Liver dysfunction was associated with PT-INR elevation (P = 0.0100).ConclusionAs there is a possibility of PT-INR abnormalities occurring during the concomitant use of gefitinib and warfarin, clinicians should be aware of this interaction. Because of the potentially severe consequences of this interaction, close monitoring of PT-INR and warfarin dose adjustment are recommended for patients receiving warfarin and gefitinib, especially during the first 2 weeks in the beginning of warfarin therapy.

Acquired Reactive Perforating Collagenosis in a Patient with Lung Fibrosis

Reactive perforating collagenosis (RPC) is a rare disorder characterized by the transepidermal elimination of altered collagen. The inherited form of RPC begins in early childhood, but acquired reactive perforating collagenosis (ARPC) begins in adult life. ARPC is associated with diabetes mellitus, renal disease, and malignancy. ARPC with lung fibrosis has not previously been reported in the literature, and the relationship between ARPC and lung fibrosis has not been studied. The etiological relationship between the two disorders appears to be uncertain. Although their association in this case could be due to chance, it may be due to the transforming growth factor β abnormalities seen in both diseases. In this report, we describe a case of ARPC with lung fibrosis and propose an etiological association between the two diseases.

Valor Diagnóstico do Aumento dos Eosinóftlos e Linfocitos no Lavado Bronco-Alveolar em Doentes com Insuficiência Respiratória Aguda e Infiltrados Pulmonares Difusos

RESUMO Os autores analisaram de 1983 a 199 1, a utilidade da contagem diferencial de celulas no Lavado Bronco-Alveolar (LBA) em doentes com Insuficiencia Respiratoria Aguda (IRA) e Infiltrados Pulmonares Difusos (IPD) , com particular interesse nos que apresentavam niveis elevados de eosinoflos ou de linfocitos no LBA . Foram estudados 118 doentes com insuficiencia respiratoria para aguda e com PaO 2 2 /FiO 2 Infiltrados Pulmonares Difusos (IPD) na radiografia de torax. A doenca pulmonar foi avaliada em bases clinicas, resultados dos exames Bacteriologicos das Secrecoes Bronquicas recolhidas por Broncofibroscopia, por Biopsia Pulmonar Transbronquica c eventualmente. outros exames. O aumemo da percentagem dos eosinoflos no LBA foi encontrado em detcnninadas doencs especificas como: Pneumonia Eosinofila e Bronquiolite Obliterante com Pneumoniu. Por outro lado os autores, constataram que outras doencas como a Tuberculose Miliar, a Pneumonia de Hipersensibilidadc e a Pneumonia a Pneumocystis carinii tem uma percentagern muito elevada de linfocitos no LBA. COMENTARIO A identificoo das causas da Insuficiencia Respiratoria Aguda (IRA) acompanhada por Infiltrados Pulmonares Difusos (IPD) e a maior parte das vezes difficil. O LBA tem sido utilizado como meio de diagnostico nas mais variadus situacooes clinicas. Os autores neste estudo so chegaram a djagnostico definitivo quando isolaram no LBA o Mycobacterium tuberculosis , a Legionella pneumofila eo Pneumocyslis carinii , sendo os outros diagnosticos de suspeicao. Os autores constataram Eosinofilia e Linfocitose no LBA em 2% e 30% dos casas respectivamente. Relacionando estes dados com diagnosticos referidos, verificaram que 50% das eosinofilias constatadas no LBA estavam relacionadas com a Pneumonia eosinofila e como BOOP,que 76% dos casas com linfocitose no LBA estavam relacionados com a Tuberculose Miliar, a Pneumonia de Hipersensibilidade e a Pneumonia a Pneumocystis carinii .