[Sustainable efficacy of oral varenicline for smoking cessation].

Varenicline (Champix) is an alpha4beta2 nicotinic receptor antagonist that is used orally for treatment of nicotine dependence. We conducted a study to examine the sustainable efficacy of varenicline in smoking cessation. The subjects were 148 outpatients (113 men, 35 women; average age; 54.4 +/- 14.0 years) at 6 different hospitals, and their adverse events were monitored in each hospital. The 4-week continuous abstinence rates of smoking cessation were 17.6%, 75.0%, and 84.6% in groups treated for 4 or fewer weeks, 5 to 8 weeks, and 9 to 12 weeks, respectively, with the rate showing a significant increase according to treatment period. Among 83 patients who had adverse events, the abstinence rates were 76.9%, 92.3%, 54.5%, and 55.6% in an observed (OB) group, a nosotropic medication (NM) group, a dose-reduction (RD) group, and a drug-discontinuation (DC) group, respectively. Among 56 patients with nausea, the respective rates were 80.8%, 100.0%, 61.1%, and 50.0%, respectively, with a significantly higher success rate in the NM group than in the RD or DC groups (each p < 0.05). To sustain the efficacy of varenicline in patients with adverse events, we recommend a therapeutic strategy in which the active nosotropic medicine is administered over 12 weeks at the regular dosage.

A comparison of the clinical features of ANCA-positive and ANCA-negative idiopathic pulmonary fibrosis patients.

BACKGROUND: The existence of antineutrophil cytoplasmic antibody (ANCA)-positive pulmonary fibrosis (PF) has recently been recognized. OBJECTIVES: The aim of this study was to clarify whether there is any difference in the clinical features between ANCA-positive PF and ANCA-negative PF. METHODS: A retrospective study was carried out on 53 patients with idiopathic PF whose myeloperoxidase (MPO)- and proteinase 3 (PR3)-ANCA levels were measured. After dividing the patients into ANCA-positive and ANCA-negative PF, we compared their symptoms, pulmonary function tests, chest CT findings, bronchoalveolar lavage findings, the effects of therapy and survival rates. RESULTS: 17 of the 53 patients with idiopathic PF were MPO-ANCA-positive, 2 were PR3-ANCA-positive and 34 were negative for both ANCA types. Lactate dehydrogenase was lower in ANCA-positive PF than in ANCA-negative PF. However, there was no significant difference in the symptoms, lung function tests, CT findings and bronchoalveolar lavage findings. Corticosteroid therapy tended to be more effective in ANCA-positive PF, but the overall survival rate in ANCA-positive PF was not different from that in ANCA-negative PF. However, the low-titer (<50 EU) group showed better survival than the high-titer (> or =50 EU) group in ANCA-positive PF. ANCA titers of the patients who developed microscopic polyangiitis were higher than of those who did not develop it in ANCA-positive PF. CONCLUSIONS: Our studies showed little difference in the clinical features between ANCA-positive and ANCA-negative PF. However, it may be important to measure ANCA when idiopathic PF is diagnosed, because a high titer of ANCA suggests a poor prognosis and the association with microscopic polyangiitis.

[Case of loxoprofen sodium-induced eosinophilic pneumonia that occurred ipsilaterally after VATS lobectomy for lung cancer].

A 76-year-old man was admitted because of dry cough and dyspnea two weeks after VATS lobectomy for lung cancer. Chest radiographs and computed tomography showed interstitial shadows in the only operative lung side. Although antibiotic drugs were given because we believed it to be postoperative pneumonia, abnormal shadows on chest radiographs increased. A bronchoalveolar lavage fluid (BALF) study performed on the 21" day after operation showed that the proportions of eosinophils, basophils and mast cells had increased, and the CD4/CD8 ratio was 4.42. The drug lymphocyte stimulation test for loxoprofen sodium was positive. Based on the clinical course, laboratory data and BALF study, we arrived at a diagnosis of drug-induced pneumonia caused by loxoprofen sodium. Treatment with corticosteroid resulted in marked improvement of the chest radiographs and clinical findings. Drug-induced pneumonia usually occurs bilaterally, but it occurred only on the operative side in this case. Although rare, it is important to recognize that unilateral drug-induced pneumonia is one of the differential diagnose of postoperative pneumonia.