Reduced pulmonary function is associated with enhanced inflammation and tissue inhibitor of metalloproteinase 1 concentration in the bronchoalveolar lavage fluid of patients with lung parenchymal sarcoidosis.

Lung parenchymal disease is associated with reduced pulmonary function in patients with sarcoidosis, however, the underlying pathophysiology of the condition is unclear. The present study was conducted to characterize the association between pulmonary function and bronchoalveolar lavage (BAL) findings in patients with sarcoidosis. Twenty-three patients with lung parenchymal disease (stage 2) and twenty-five patients without lung parenchymal disease (stage 1) underwent pulmonary function tests, including blood gas analysis, spirometry and diffusing capacity for carbon monoxide (DLco) and BAL, to determine the number of inflammatory cells, matrix metalloproteinase (MMP) 9 activity and tissue inhibitor of metalloproteinase (TIMP) 1 concentration in the lower airway. Vital capacity (VC) to its reference value (%VC) and %DLco were significantly reduced in patients with stage 2 disease in comparison with those with stage 1 disease. BAL fluid analysis revealed that the numbers of total inflammatory and CD8 cells, and TIMP-1 concentration were significantly higher in patients with stage 2 disease in comparison with those in patients with stage 1 disease. There were significant correlations between %VC and the numbers of inflammatory cells and TIMP-1 in the BAL fluid. These results suggest that inflammation and enhanced TIMP-1 concentration in the lower airway play critical roles in the impaired pulmonary function in patients with lung parenchymal sarcoidosis.

Venous hemangioma arising from the diaphragm: a case report of computed tomography and magnetic resonance imaging findings.

We report a rare case of diaphragmatic hemangioma with computed tomography and magnetic resonance imaging findings. A routine chest radiograph in a 75-year-old woman revealed a nodular opacity in the right lower lung field. Multidetector-row computed tomography revealed a well-circumscribed nodule arising from the diaphragm or pleura. Dynamic magnetic resonance imaging of the nodule showed a pattern of gradually increasing signal intensity. On the basis of the intraoperative and histopathologic findings, venous hemangioma arising from the diaphragm was diagnosed.

Exophiala dermatitidis infection in non-cystic fibrosis bronchiectasis.

A 54-year-old female presented with an exacerbation of right middle lobe bronchiectasis. A bronchoscopic bronchial washing and repeated trials of sputum culture consistently recovered no other infectious agent except Exophiala dermatitidis. Her illness was improved by administrations of intravenous miconazole and nebulized amphotericin B when sputum cultures yielded no fungi, demonstrating a pathogenic role of the fungi. The present case illustrates E. dermatitidis as a pathogenic agent in non-cystic fibrosis bronchiectasis.

Determinants of bronchodilator responsiveness in patients with controlled asthma.

Short-term bronchodilator responsiveness to an inhaled ss 2 adrenergic agonist was assessed by changes in forced expiratory volume in 1 second (FEV(1)) in nonsmoking adults with controlled asthma (mild disease, 20 patients; moderate disease, 20 patients; severe disease, 18 patients). Responsiveness correlated significantly with age and with percent of predicted FEV(1) (%FEV(1)) except in patients with severe asthma, who showed significantly less responsiveness than others. Thus, responsiveness is closely associated with degree of airflow limitation in patients with controlled asthma and is significantly influenced by severity of disease and by aging.

Characterisation of patients with frequent exacerbation of asthma.

BACKGROUND: Exacerbation is one of the most significant problems in patients with asthma. Although subpopulation of patients is more susceptible to exacerbations than others, which clinical features characterise susceptibility to exacerbation are not well understood. METHODS: Consecutive non-smoking adult patients with asthma who had multiple exacerbations (ME) despite regular maintenance treatment were compared with those who had at most single exacerbation as control during the previous 1 year. Exacerbation of asthma is defined initiations or escalations of systemic corticosteroid as part of the management for aggravated asthma condition. RESULTS: Patients with ME (n=32, male: 6, mean age: 46.7 years) were characterised by intensive current maintenance treatment (dose of inhaled corticosteroid; 1037.5+/-452.8 vs 621.6+/-257.3 microg, P=0.0005, proportion of oral corticosteroid users; 28.1% vs 2.7%, P=0.008), severe episodes of exacerbation (asthma-related hospitalisations; 71.9% vs 23.4%, P=0.0002, arrival on ambulance; 37.5% vs 8.1%, P=0.008), concomitant chronic sinusitis (34.4% vs 10.8%, P=0.038) and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) (34.4% vs 5.4%, P=0.006) in comparison with controls (n=37, male:11, mean age:44.4). Pulmonary function in patients with ME was characterised by persistent airflow limitation and reduced reversibility. CONCLUSION: Patients with ME are at increased risk for severe exacerbation despite more intensive maintenance anti-inflammatory treatment. Persistent irreversible airflow limitation and complications of chronic sinusitis and/or NSAIDs intolerance are characteristics to this subpopulation.

Prevalence of previously undiagnosed airflow limitation in patients who underwent preoperative pulmonary function test.

Although being a rapidly expanding socioeconomical burden worldwide, chronic obstructive pulmonary disease (COPD) is often overlooked because of its insidious progression. Since spirometry is the primary tool for the diagnosis of COPD, physicians should be aware of the disease in any situation where interpreting spirometry. This study was to estimate the prevalence of undiagnosed COPD among patients who underwent spirometry as a preoperative evaluation for elective surgeries. Patients aged 40 years or older who completed routine spirometry as a preoperative evaluation for elective surgeries between January to December, 2000. Medical records were reviewed for medical history, clinical findings, smoking status, and discharge diagnoses for patients who demonstrated airflow limitation (AL), defined as FEV(1)/FVC<70% on spirometry. Of the 1031 patients who qualified for the study, 263 (26%) presented AL. Sixty-nine of these patients with AL (26%) had underlying conditions that could account for AL, such as asthma and previously diagnosed COPD. The remaining 194 patients with AL (74%) were suspected to have undiagnosed COPD, 90% of which was mild in severity. Only 30 (15%) of these patients appeared to be diagnosed have received a diagnosed as COPD by physician on this occasion. This study testifies that COPD is often unnoticed, and demonstrates that every spirometry, such as in preoperative evaluation, gives a clue to identify affected individuals, for which awareness of the disease is essential.

[Successful treatment with micafungin in a case of candidemia associated with pneumonia].

A 63-year-old woman was admitted to our hospital with fever and cough. Candidemia was diagnosed by blood culture and culture of IVH catheter. Although, the patient was treated with fluconazole, clinical symptoms and chest radiographic findings worsened. After micafungin was replaced with fluconazole, her symptoms, chest radiographic findings improved and stabilized. It is suggested that micafungin is useful for the treatment of candidemia associated with Candida parapsilosis.

Clinical utility of lipoarabinomannan antibody in pleural fluid for the diagnosis of tuberculous pleurisy.

We studied the clinical utility of the detection of lipoarabinomannan antibody, using MycoDot, in pleural fluid for the diagnosis of tuberculous pleurisy. Nine patients with active tuberculous pleurisy, 1 patient with chronic tuberculous empyema, and 16 patients with nontuberculous pleural effusions were studied. The results were positive in 5 patients with tuberculous pleural disease. Sensitivity was 50% (5 of 10; including the 1 patient with chronic tuberculous empyema) and specificity was 93.8% (15 of 16). Detection of lipoarabinomannan antibody using MycoDot in pleural fluid is a specific diagnostic tool for tuberculous pleurisy; furthermore, this diagnostic method is simple, rapid, and cost-effective.

[A case of spontaneous bilateral chylothorax].

A 42-year-old woman sought medical attention because of a suddenly developed neck mass. Chest radiography disclosed bilateral pleural effusion, which turned out to be chylothorax. Although lymphatic leakage was suspected, no underlying cause was identified. Her condition resolved spontaneously in seven days. A few similar cases have been described in the literature, and are collectively referred to as "spontaneous bilateral chylothorax".

Phase II study of irinotecan and ifosfamide in patients with advanced non-small cell lung cancer.

OBJECTIVES: This phase II study was conducted to investigate the efficacy and safety of irinotecan (CPT-11) and ifosfamide as first-line chemotherapy for advanced non-small cell lung cancer (NSCLC). METHODS: Eligibility criteria included histologically or cytologically confirmed NSCLC (stage IIIb or IV), no prior treatment, and measurable or evaluable disease. CPT-11 (80 mg/m(2)) was administered intravenously on days 1, 8, and 15, while ifosfamide (1.5 g/m(2)) was given on days 1 through 3 every 4 weeks. RESULTS: Forty-four patients (31 men) with a median age of 65 years (range 43-75) and a median ECOG performance status of 1 (range 0-2) were enrolled. The response rate was 29.5% [95% CI: 16.7-45.2%], with 13 partial responses. The median survival was 12.5 months, the median time to progression was 5.3 months, and the 1 and 2-year survival rates were 52.3 and 11.3%, respectively. Toxicity was generally mild; WHO grade 3-4 neutropenia was recorded in 38.6% of the patients, grade 3 diarrhea in 6.8%, and grade 3-4 nausea/vomiting in 0%. CONCLUSIONS: CPT-11 combined with ifosfamide demonstrated anti-tumor activity in advanced NSCLC, with response and survival rates similar to those of cisplatin-based chemotherapy but with a more favorable toxicity profile.

[A case of primary nasopharyngeal tuberculosis].

BACKGROUND: Although the prevalence of nasopharyngeal tuberculosis has decreased after the wide use of anti-tuberculous agents, recently the number of reports with the disease has slightly increased in accordance with advances in the diagnostic tools. A case of nasopharyngeal tuberculosis without any tuberculous lesions in other organs (primary nasopharyngeal tuberculosis) was reported. CASE REPORT: A 74-year-old female complained of vertigo and cervical masses, and naso-pharygo-laryngoscopy disclosed a polypoid lesion on her nasopharynx. The biopsy from the mass revealed epithelioid cell granulomas with caseous necrosis and multinucleated giant cells consistent with tuberculosis. Since there were no tuberculous lesions in other organs except cervical lymph nodes in clinical examinations, we diagnosed the case as primary nasopharyngeal tuberculosis with tuberculous cervical lymphadenitis. The nasopharyngeal manifestation disappeared after four months chemotherapy with INH, RFP and EB. DISCUSSION: Most reported case of nasopharyngeal tuberculosis were in the young age group. A rare case of old woman complicated with cervical tuberculous lymphadenitis was reported.

[Phase I study of biweekly paclitaxel and carboplatin administration in patients with advanced non-small cell lung cancer].

A phase I study of a biweekly outpatient regimen composed of carboplatin (CBDCA) and paclitaxel (TXL) was conducted for advanced non-small cell lung cancer. TXL was given in combination with a fixed dose of CBDCA (AUC 3) every 2 weeks. The starting dose of TXL was 100 mg/m2, and the dose was escalated in increments of 20 mg/m2. Three to six patients were allocated to each level. Toxicities were evaluated in the first 4 courses to determine the maximum tolerated dose (MTD). TXL 160 mg/m2 dosages proved to be MTD, and the dose limiting toxicity (DLT) was hematotoxicity (neutropenia). The patients, however, recovered from neutropenia using G-CSF immediately, when G-CSF was used. Gastrointestinal toxicity was well-tolerated. A response was found in 9 out of 20 patients who received 4 courses or more (45%). These results suggest that the recommended dose would be CBDCA (AUC 3) + TXL 140 mg/m2. The biweekly regimen has a high level clinical activity and excellent tolerability, and is suitable for outpatients. We started a phase II study because of these results.