OMALIZUMAB RESCUED A ASTHMA-COPD OVERLAP SYNDROME PATIENT FROM A STATUS ASTHMATICS UNDER THE ICU MANAGEMENT.

An atopic asthmatic of 65-year-old man who was complicated with COPD and treated with inhaled corticosteroid, long-acting ß2 agonist, long-acting muscarinic antagonist, and leukotriene receptor antagonist was hospitalized with a severe asthmatic attack. He was intubated and went onto an artificial respirator. He was gradually relieved by repeated intravenous administration of high-dose corticosteroid, and a respirator was switched over to non-invasive positive pressure ventilation on 24th day. However, he repeated asthmatic attacks which needed corticosteroid to recover. Omalizumab was administered on 35th day and asthmatic attacks remarkably decreased. He left the hospital on 71st day. It was thought that the additional administration of omalizumab provided a good clinical response for an intractable asthma.

[A case of lung injury induced by long-term administration of mesalazine].

A 52-year-old man was given a diagnosis of ulcerative colitis and treated with mesalazine for 7.5 years. However, the unusually long administration of mesalazine induced lung injury and the patient complained of a dry cough and dyspnea on limited exertion. Infiltrative shadows were observed in bilateral lung fields on a chest radiograph and computed tomographic images. The histological findings obtained by transbronchial biopsy and bronchoalveolar lavage showed organizing pneumonia. His drug-induced lymphocyte stimulation test (DLST) for mesalazine was positive. Improvements in his clinical symptoms and radiographic abnormalities occurred spontaneously after the discontinuation of mesalazine. This case indicates that the long-term administration of mesalazine may lead to an adverse pulmonary reaction.

A novel needle-type sampling device for flexible ultrathin bronchoscopy.

Diagnosis of suspected cancer in the periphery of the lung is difficult. A flexible ultrathin bronchoscope has been developed for the diagnosis of peripherally located pulmonary lesions that cannot be reached with the sampling devices for standard flexible bronchoscopes. The diagnostic yield with forceps and a brush for ultrathin bronchoscopes, however, is not adequate, especially when a lesion is not exposed to the bronchial lumen. We have thus developed a novel needle-type sampling device and tested its yield in transbronchial cytology. The device consists of an elongated dental H-file (0.4 mm in diameter and 110 cm in length), a housing sheath (1.0 mm in outer diameter), and a novel handle, which enables rapid out-and-in motion of the needle. Ten consecutive patients with a peripheral pulmonary lesion who had an indication for diagnostic procedure with a flexible ultrathin bronchoscope were enrolled. The optimal bronchial route to the lesion was analyzed with virtual bronchoscopy in a data set obtained with high-resolution computed tomography, and a novel bronchial route labeling system (prior-ridge-based relative orientation nomenclature) was employed to guide insertion of the bronchoscope. Sampling with the novel needle was performed prior to use of the forceps and brush under conventional fluoroscopy. In all the cases, sampling with the needle was successful and the amount of the specimen was sufficient for cytology. Our novel sampling system with flexible ultrathin bronchoscopes may contribute to accurate and minimally invasive diagnosis of peripheral pulmonary lesions.

Inhalation and incubation with procaterol increases diaphragm muscle contractility in mice.

BACKGROUND: Although procaterol is used clinically as a beta(2)-adrenergic receptor agonist to relax airway smooth muscle, it has not yet been clarified whether procaterol has inotropic effects on respiratory muscles. METHODS: Three intervention groups were investigated: a procaterol inhalation only group; a procaterol inhalation plus endotoxin injection group (in vivo); and a procaterol incubation group (in vitro). The diaphragm muscle in all groups was dissected and measurements of its contractile properties were performed. RESULTS: The effects of procaterol inhalation shifted the force-frequency curves upward at 30 minutes after inhalation, and inhibited the decline of force-frequency curves due to endotoxin injection in vivo. In vitro administration of procaterol resulted in an increase in the force-frequency curves in a dose-dependent manner. CONCLUSIONS: It can be concluded that procaterol has an inotropic effect on the diaphragmatic muscles taken from normal animals as well as on the diaphragm muscles in a septic animal model.

Transdermal treatment with tulobuterol increases isometric contractile properties of diaphragm muscle in mice.

Clinically, patients suffering from bronchial asthma are often treated transdermally with tulobuterol patches to dilate the bronchi. Tulobuterol, a synthetic beta(2) agonist, is also thought to act as a diaphragm muscle contractor, like other beta(2) sympathomimetic drugs. However, it has not been clarified that transdermal treatment with tulobuterol influences diaphragm muscle contractility. We therefore examined its effects on contractile properties of such muscles obtained from BALB/c mice. Two systems, a tulobuterol incubation group (in vitro) and a tulobuterol transdermal treatment group (in vivo), were employed. In both groups, the contractile properties of the dissected diaphragm muscles were measured by field stimulation in an organ bath. In the incubation group, the diaphragm muscle of untreated mice was incubated in an organ buffer at 10(-7), 10(-6), or 10(-5) M tulobuterol for 1 hr and then measured for contractility. Tulobuterol significantly increased force-frequency curves at a concentration of 10(-5) M at 1 (p < 0.01), 30, 50, 70, 100, and 120 Hz (p < 0.05, each) compared with the values at 0 M. In the transdermal treatment group, the diaphragm muscle was dissected from animals at 1, 4, 8, 12, or 24 hrs after treatment and measured for contractility, showing that the force-frequency curves were significantly increased and maintained from 4 to 24 hrs (each p < 0.01 as compared with the sham-treated group). We suggest that transdermal tulobuterol treatment in case of bronchial asthma is useful not only for bronchial dilatation, but also for increasing diaphragm muscle contractility.

Effects of interleukin-18 on diaphragm muscle contraction on rats.

To evaluate the role of interleukin (IL)-18 in endotoxin-induced diaphragm muscle deterioration, we studied three treatment groups, namely, a saline+endotoxin group, an IL-18+endotoxin group and an IL-18 only group using Wistar rats. Five minutes after saline or IL-18 (0.25 microg) injection, E. coli endotoxin (30 mg/kg) was injected intraperitoneally. In the saline+endotoxin group, the force-frequency curves by ANOVA (p < 0.01), twitch tension (TT) and slope during contraction time (TT/CT) were significantly lower at 4 hours than those at 0 hours due to endotoxin (p < 0.01 and p < 0.05, respectively) and nitric oxide (NO) production had increased at 4 hours as shown by NADPH diaphorase staining. In the IL-18+endotoxin group, the decrement of the force-frequency curves in a higher frequency range (50-120 Hz), and the decrements of TT and TT/CT observed at 4 hours in the saline+endotoxin group were significantly prevented, and NO production was blocked at 4 hours. In the IL-18 only group, the force-frequency curves did not change except for fatigability, and NO production did not occur. It is suggested that IL-18 itself naturally blocks NO production, even when endotoxin coexists, resulting in the prevention of deterioration of diaphragm muscle contraction by endotoxin.