[A questionnaire survey on the self-assessment to the asthmatic treatment in Saitama Prefecture: results from 2825 cases].

The aim of this study was to survey the self-assessment to the treatment of adult bronchial asthmatics in Saitama prefecture. A questionnaire on daily symptoms and medications was distributed to 2825 adult asthmatic subjects who were treated at 125 hospitals/clinics in Saitama prefecture between September 15th and October 30th 1998. More than half (52.7%) of patients described that their general condition of asthma was poorly controlled. Even among the patients described that their condition was good or fair, 30.2% of them had some asthmatic symptoms such as shortness of breath or nocturnal awakening. Although inhaled corticosteroids were used in 66.2%, the ratio of patients who used spacer and kept drug compliance as prescribed were 59.6% and 45.8%, respectively. According to the physician's reports, cysteinyl leukotriene antagonist was used in 35.7%, which was comparable to the total of another anti-allergic drugs (37.3%). These results suggest that more than half of asthmatic patients in Saitama prefecture were not satisfied with their conditions of the disease control. Furthermore, more thorough education on the technique and compliance of inhaled corticosteroids would be required.

[Comparative study on quality of life between weekly and monthly chemotherapy with cisplatin, vindesine and mitomycin C in patients with non-small cell lung cancer].

A comparative study between weekly and monthly chemotherapy with CDDP, VDS and MMC was performed on the basis of QOL in patients (stage III A/III B/IV) with non-small lung cancer from September 1993 to August 1996. Arm A received CDDP (80 mg/m2) monthly on day 1, VDS (3 mg/m2) on days 1 and 8, MMC (8 mg/m2) on day 1. Arm B received CDDP (40 mg/m2), VDS (3 mg/m2) and MMC (4 mg/m2) on day 1, and followed by CDDP (20 mg/m2), VDS (1.5 mg/m2) and MMC (2 mg/m2) weekly. A diary-type QOL self-rating questionnaire was devised for this study, consisting of 5 scales including 13-item questionnaires and a face scale as the global scale. Chronological QOL data from 20 days during chemotherapy (total dose of CDDP was 80 mg/m2 in both A and B arm) were analyzed using summary measures. In the 78 eligible subjects of the study, 34 were QOL subjects of the 27 eligible subjects, 13 were in arm A and 14 in arm B. 1. The questionnaire was confirmed to be satisfactory with regard to reliability and validity as a questionnaire for the evaluation of this study by factor and correlation analysis. 2. Although each scale changed to the worth level after chemotherapy, there was no significant difference between arm A and B. 3. Summary statistics were assessed using indices of the area under the curve (AUC) and the maximum fluctuations of QOL scores (Dif max) arm B showed a tendency to smaller changes than arm A in AUC and Dif max. There was a significant difference in the physical well-being scale of Dif max. 4. Three items, including the physical well-being in arm B, revealed a better score than those of arm A. Abdominal condition showed a significant difference between the two arms. 5. No obvious difference in anti-cancer effectiveness was found between arm A and B. Arm B showed a longer median survival, less nausea and vomiting, leukopenia and thrombocytopenia compared with arm A. The above results suggested that weekly chemotherapy is as effective, less toxic and shows less influence against patients QOL than the conventional monthly chemotherapy in this study.

Cancer-associated retinopathy with presumed vasculitis.

PURPOSE: To treat a 63-year-old woman who experienced fairly rapid vision loss in association with small-cell carcinoma of the lung. METHODS: She underwent a full ophthalmologic examination, including fluorescein angiography and an immunologic study by Western blot analysis. RESULTS: Fluorescein angiography demonstrated diffuse staining of the retinal vessels. She had 62-kd antiretinal antibody in her serum. Cancer-associated retinopathy was diagnosed. CONCLUSION: The staining seen on the angiogram appears to indicate vasculitis, which would cause the characteristic attenuation of retinal vessels in this disease.

[Prediction of lowest PaO2 during unilateral whole lung lavage in a patient with pulmonary alveolar proteinosis--unilateral ventilation with nitrogen].

Unilateral whole lung lavage (UWLL) was performed four times in a patient with pulmonary alveolar proteinosis. PaO2 was 94 Torr even under ventilation with 100% O2. Because of the difficulty in providing adequate arterial oxygenation, extracorporeal membrane oxygenation (ECMO) was indispensable in accomplishing the first right UWLL. During the second left UWLL, the left lung was ventilated with nitrogen (N2) and an attempt was made to predict the lowest PaO2 occurring during lavage in order to establish criteria for the use of ECMO during UWLL. When both lungs were ventilated with 100%. O2, PaO2 rose to 150 Torr. PaO2 fell to 65 Torr after ventilation of the left lung with N2 while the right lung was ventilated with 100% O2 for 7 minutes. The N2 was replaced with 100% O2 and ventilation was continued for another 10 minutes to wash the N2 out of the left lung. When the tracheal tube in the left lung was clamped for 7 minutes for degassing, PaO2 fell to 59 Torr. Subsequently 1,200 ml of physiological saline was injected into the left lung, and PaO2 rose to 155 Torr. A 6 Torr difference was found between the value of PaO2 under ventilation with N2 and that of degassing, but this difference was not statistically significant. The lowest PaO2 occurring during UWLL was considered to be predictable if the unilateral lung was ventilated with N2.

[Changes in plasma electrolytes during exercise in normal subjects--with special reference to the concentration of potassium and inorganic phosphate (Pi)].

In 8 healthy adults, changes in plasma electrolyte levels (Na+, Cl-, Ca2+, Pi and lactate) and respiratory parameters (VE, VO2 and VCO2) were examined during incremental exercise on a treadmill. Na+, Cl- and Ca2+ increased significantly near the end of maximal exercise and the early phase of the recovery period. Considering the 14% decrease in plasma volume, the increases in Na+, Cl-, and Ca2+ were not significant, while the increases in K+, Pi and lactate were significant. During incremental exercise, the concentration of K+ significantly correlated with minute ventilation (r = 0.994, p < 0.0001). Two minutes after the completion of exercise, K+ decreased below the pre-exercise level. The inflection point of VE on VO2 appeared earlier than that of K+ on VO2. The results suggest that some other factor which may contribute to the control of ventilation during exercise should be considered in addition to K+. Lactate and Pi began to increase 5 and 8 minutes, respectively, after the start of exercise. Even after the completion of exercise, these two parameters remained significantly higher than the pre-exercise level. During incremental exercise, the concentration of Pi increased concomitantly with time, and significantly correlated with VE. On the other hand, in the early stage of exercise, the concentration of lactate remained at the pre-exercise level. These results suggest that the increase in plasma Pi is responsible for the state of metabolism in the muscle in addition to lactic acidosis.