Ryozo Yoneda

Long-Term Low-Dose Administration of Erythromycin to Patients with Diffuse Panbronchiolitis

Although diffuse panbronchiolitis (DPB) has carried a poor prognosis, long-term low-dose administration of erythromycin (EM) is very effective. We administered EM at a daily dose of 400-600 mg to 19 DPB subjects for more than 2 months. Sixteen subjects were relieved from productive cough and dyspnea, and their chest X-ray pictures were improved. We performed a pharmacokinetic study of EM in 11 DPB subjects (8 responders; 3 nonresponders) after the long-term low-dose administration. The maximal serum and sputum levels of EM were below the MICs of clinically pathogenic H. influenzae and P. aeruginosa which were often isolated from the sputum of DPB patients. No difference was observed in the absorption of EM between responders and nonresponders. The results suggested that DPB patients might respond favorably to EM due to mechanisms other than antibacterial activity. Individual variation in the absorption of EM was observed. As EM was effective at very low serum and sputum levels, it was suggested that even 200 mg/day of EM would be effective in DPB patients who had high serum and sputum EM levels and it was necessary to monitor the concentrations of EM in serum and sputum for the treatment of DPB to determine the appropriate dose of EM individually.

Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer type hypersensitivity pneumonitis, farmer's lung, ventilation pneumonitis, and bird fancier's lung: Report of a nationwide epidemiologic study in Japan.

We performed a nationwide epidemiologic study of hypersensitivity pneumonitis (HP) in Japan by questionnaire and found that 835 cases of HP were recognized during the 1980s; 74.4% were summer-type HP, 8.1% farmers lung, 4.3% ventilation pneumonitis, 4.1% bird fanciers lung, 2.3% other types, such as chemical workers lung, and 6.8% of unknown causative agent. It was found that the CD4/CD8 ratios of bronchoalveolar lavage (BAL) lymphocytes were significantly different with the type of disease. The ratio was 0.6 +/- 0.1 (mean +/- SEM) in summer-type HP (N = 271), 4.4 +/- 0.7 in farmers lung (N = 22), 1.6 +/- 0.3 in ventilation pneumonitis (N = 19), and 2.0 +/- 0.5 in bird fanciers lung (N = 19). In farmers lung, the CD4/CD8 ratio in smokers was 6.2 +/- 1.9 (N = 6) in contrast with 3.4 +/- 0.7 for nonsmokers (N = 16) (p less than 0.05). It has been generally considered that the phenotypes of BAL lymphocytes in patients with HP are predominately CD8 cells. Our present results, however, indicate that the phenotypes of BAL lymphocytes vary with the type of HP, probably depending on factors such as causative agent, smoking, or staging of the disease.

Sequential Changes of Perivascular Edema Cuffs in Models of Permeability and Hemodynamic Pulmonary Edema

The areas of perivascular edema cuffs surrounding pulmonary arteries and veins were sequentially measured as an index of the fluid transport unit in lung interstitium (FTULI) in epinephrine-induced and oleic acid-induced pulmonary edema in rats. The former edema represents a model of hemodynamic edema and the latter, permeability pulmonary edema, respectively. In epinephrine-induced pulmonary edema, both the ratio of edema cuff area to cross-sectional area of the pulmonary artery (Rr) and the ratio of lung weight to body weight (L/B) were increased in parallel, reached maximum levels at 0.5 h after the treatment, and returned to the control levels after 3 h. In oleic acid-induced pulmonary edema, the changes in Rr and L/B were not parallel, and the maximum levels were reached at different times, Rr at 3 h and L/B at 1.5 h. Rr returned close to the control level in 24 h but L/B remained elevated so that rate of recovery was delayed. The cuffs around the veins appeared similar to those around the arteries, but were very slight in both models. The difference in the time course of Rr and L/B in the two models may suggest that the recruitment of FTULI is insufficient in oleic acid-induced pulmonary edema; this limitation seems to be an important factor which makes the permeability edema refractory to treatment, together with the damage to the blood gas barrier.

Relationship between cytologic characteristics and the prognosis in small cell carcinoma of the lung.

肺小細胞癌の気管支擦過標本を用い, その細胞所見, 核内DNA量と化学療法に対する反応性, 予後との関係を検討した.化学療法に有効な症例は, 無効例に比較しあきらかにその予後は良好であり, 細胞診によりあらかじめその反応性を予測することは重要であると思われる.クロマチン所見から腫瘍細胞をI型: 腫瘍細胞が小型 (9μ前後) で粗顆粒, II型: I型より大型で粗顆粒, III型: 網状不均等, IV型: 細顆粒状均等, V型: 微細顆粒状均等, の5型に分類した.化学療法に有効な症例ではIV, V型の割合が多く, 無効例にはI, II型の割合が多かった.核内DNA量と腫瘍細胞の大きさとの問には相関関係がみられた.化学療法に有効な症例は, 無効例に比較し大型の細胞が多く, 核内DNA量もやや多い傾向がみられた.