[Comparison between predicted equations obtained by standard Japanese values and present predicted equations for vital capacity and forced expiratory volume in one second].

Until recently, predicted values of vital capacity (VC) and forced expiratory volume in one second (FEV1) have been calculated with Baldwin's equation (VC-B) and Berglund's equation (FEV1-B) respectively, in Japan. Due to several problems using these equations, new prediction equations of VC (VC-J) and FEV1 (FEV1-J), which were created using data from healthy Japanese, were provided by the Japanese Respiratory Society in 2001. In the present study, we studied the validity of these prediction equations. Also, we compared the outcomes of patients who match respiratory handicap "indexes" with VC-B and VC-J. The subjects were all adult patients whose respiratory function was tested in Asahikawa Medical College Hospital between 1998 and 2006. Cases which were diagnosed as contractive respiratory disorder increased approximately 2-fold when %VC was calculated with VC-J compared with VC-B. Grade 4 or higher respiratory handicap scores increased 20% if the index was calculated with VC-J compared with VC-B. There was no significant difference in mortality between the respiratory handicap grade 3 scores calculated with VC-J and VC-B. Also, there was no significant difference in mortality between grade 4 respiratory handicap scores calculated with VC-J and VC-B. These findings suggest that the prediction equations using Japanese data increase the number of predicted respiratory disorders, and those additional cases have the same prognoses as those cases diagnosed with the former criteria.

Color auto-fluorescence from cancer lesions: improved detection of central type lung cancer.

A fluorescence endoscopic system, PDS-2000, enabled observation of color auto-fluorescence from the human body. We performed a clinical study to determine whether color auto-fluorescence bronchoscopy using PDS-2000 improved the accuracy of central type lung cancer diagnosis, as compared to white light bronchoscopy. White light bronchoscopy followed by auto-fluorescence bronchoscopy was performed in 71 subjects with either bronchogenic cancer, previous lung cancer, bloody sputum or who were at a high risk of developing lung cancer. Findings of white light bronchoscopy and auto-fluorescence bronchoscopy were classified into three categories. Two hundred eighty-eight biopsy specimens were taken from all sites which were considered to be abnormal by white light bronchoscopy as well as by auto-fluorescence bronchoscopy. The pathological findings were classified into nine categories. The sensitivity of only white light bronchoscopy (WLB) regarding the detection of severe dysplasia and cancer was compared with that of only auto-fluorescence bronchoscopy (AFB) and that of WLB+AFB. We quantified color endoscopic fluorescence images and compared the red/green signal intensity ratio (R/G ratio) according to the pathological diagnosis. The pathological diagnosis was normal in 123, inflammation, hyperplasia or metaplasia in 120, mild or moderate dysplasia in 8, severe dysplasia in 14 and cancer in 23. The sensitivity of WLB, AFB and WLB+AFB regarding the detection of severe dysplasia or cancer was 54.1%, 81.1% and 89.2%, respectively. The R/G ratio was significantly increased in the areas with severe dysplasia and cancer.

Alterations in penicillin binding protein gene of Streptococcus pneumoniae and their correlation with susceptibility patterns.

Penicillin binding protein (pbp) gene alterations of 328 clinical isolates of Streptococcus pneumoniae were examined for a correlation with their antibiotic-resistance. The frequency of penicillin G (PEN-G) resistance was determined to clarify susceptibility to several antibiotics, namely PEN-G, ampicillin, sulbactam/ampicillin, cefozopram, panipenem (PAPM), clarithromycin (CLR), azithromycin (AZM) and levofloxacin (LVX). Oligonucleotide primers for three pbp genes (pbp1a, pbp2x and pbp2b) were used to detect mutations in pbp. Of the strains, 25.9% were classified as Pen-Gs, 68.0% as Pen-Gir and 6.1% as Pen-Gr. The polymerase chain reaction product for wild-type pbp1a was found in 185 isolates, that for wild-type pbp2x was found in 66 isolates and that for wild-type pbp2b was found in 213 isolates. None of these three genes was detectable in 100 isolates while all of them were detected in 64 isolates (1aw/2xw/2bw). Of those 64 isolates with 1aw/2xw/2bw, the minimum inhibitory concentration (MIC) of PEN-G was < or =0.06 mg/l for 54 isolates and 0.12 mg/l for 10 isolates. Of the 272 strains for which the MIC of PAPM was < or =0.03 mg/l, there were 85 Pen-Gs, 184 Pen-Gir and three Pen-Gr isolates. Three strains for which the MIC of LVX was > or =4.0 mg/l included one Pen-Gs and two Pen-Gir isolates. The MICs of CLR correlated significantly with those of AZM. The MIC of CLR was > or =1 mg/l for 216 isolates, and the MIC of AZM was > or =1 mg/l for 244 of them. These data suggested that PAPM may be effective against S. pneumoniae infection, although acquisition of resistance should be considered. LVX also seemed to be effective against S. pneumoniae.

[An adult case of tuberculous meningitis].

A 36-year-old man was referred to our hospital with complaints of high fever and headache. A diagnosis of miliary tuberculosis with tuberculous meningitis was made. He was treated with isoniazid (400 mg/day), rifampicin (300 mg/day), ethambutol (750 mg/day), pyrazinamide (1.0 g/day) and prednisolone (60 mg/day). However, he lost consciousness because of hydrocephalus on the second day of hospitalization. Emergency cerebrospinal fluid drainage improved his neurological symptoms. After two months, he again complained of headache with nausea and double vision. Numerous tuberculomas were found not only in the cerebrum but also in the liver, the spleen and the retina. Recurrent hydrocephalus was treated with a V-P shunt, and combination therapy with four antituberculous agents was maintained for 18 months. He was discharged in a healthy condition, although a mild left facial palsy remained. In addition, we examined the inflammatory cytokine levels in both the CSF and the serum over the period of the patient's hospitalization. We concluded that the cytokine levels in the CSF may be associated with the progress and the prognosis of tuberculous meningitis.

[A case of pulmonary hamartoma and sclerosing hemangioma in the same lung].

A 49-year-old woman was referred to our hospital because abnormal masses had been found in the left lung on chest radiography. This examination and CT scanning on admission both revealed a 12 x 8 mm mass in the left S5 and a 31 x 25 mm mass in the left S8. Calcification was not found in the tumors. Bronchoscopy showed narrowing of the left B5 and B8 bronchi by irregularity of the mucous membrane. No malignant cells were found in the cytological specimens, which were obtained by brushing and washing of the bronchi. Although the radiological findings suggested benign tumors, surgical resection was performed to confirm the diagnosis. The tumor in the left S5 was diagnosed as a hamartoma because it contained cartilage, lipoid tissue and lymphatic follicles. The tumor in the left S8 was diagnosed as a sclerosing hemangioma because vasculo-capillary formation by the cells with epithelial origin was seen. The pathological diagnosis of the two tumors differed, but a similar mechanism of tumorigenesis was suggested.

Analysis of chest CT in patients with Mycobacterium avium complex pulmonary disease.

BACKGROUND: The radiographic changes of Mycobacterium avium complex (MAC) pulmonary disease during therapy have not been studied well. OBJECTIVE: To assess the efficacy of antituberculous drug therapy against MAC pulmonary disease using computed tomography (CT). METHOD: We analyzed chest CT scans before and after antituberculous therapy in 30 patients (21 women, 9 men) with MAC pulmonary disease. To evaluate radiographic changes during therapy, we defined a 'degree of improvement' (DI) that is calculated according to the CT appearance. RESULTS: DI was better (1.35 +/- 0.21) in patients who had converted sputum culture than in those who had not (0.44 +/- 0.25) (p < 0.05). In patients who were diagnosed by bronchial washing, DI was better (1.60 +/- 0.22) than in patients who were diagnosed by sputum (0.67 +/- 0.20) (p < 0.01). We categorized the CT appearance into 6 types: small nodules, cavities, bronchial wall thickening, infiltration, pleural thickening and atelectasis. Patients who showed pleural thickening had a significantly worse DI (0.12 +/- 0.40) than those who did not (1.23 +/- 0.18) (p < 0.01). Most of the lesions that disappeared after therapy were small nodules. CONCLUSION: These results indicate that chest CT might be a useful tool for the prediction or assessment of drug therapy for MAC pulmonary disease.