Comprehensive pulmonary rehabilitation according to severity of COPD.

A new classification for the severity of COPD was proposed at GOLD 2003: stage I: FEV(1) > or = 80% predicted; stage II: 50% < or = FEV(1)<80%; stage III: 30% < or = FEV(1)<50%; and stage IV: FEV(1) < 30%. To elucidate the acute effects of pulmonary rehabilitation (PR) on patients with different stages of COPD, data on pulmonary function, arterial blood gas analysis, the 6-min walk test, respiratory muscle strength, and activities of daily living were analyzed before and after our comprehensive 4- to 8-week inpatient PR program between 1992 and 2003. A total of 225 patients (201 men and 24 women; 21 with stage II, 79 with stage III, and 125 with stage IV COPD) was assessed. There were significant differences in FEV(1)% predicted and % residual volume in stages III and IV, in % vital capacity in stages II, III and IV, and in % total lung capacity in stage II when comparing the changes between pre- and post-PR. Significant differences of PaO(2) in stages III and IV and PaCO(2) in stage IV were found when comparing the changes between pre- and post-PR. The 6-min walk distance was significantly increased after PR by an average of approximately 50m for all staged patients. Respiratory muscle strength was also significantly increased in stages III and IV. Activities of daily living were significantly improved in all stages. These results showed that patients with COPD had benefited from PR regardless of disease severity. The effects included improvement in pulmonary function, arterial blood gas analysis, 6-min walk distance, respiratory muscle strength, and activities of daily living although there were some differences among the three stages.

Distance and oxygen desaturation in 6-min walk test predict prognosis in COPD patients.

The aim of the present study was to predict the prognosis of Chronic obstructive pulmonary disease (COPD) patients who underwent comprehensive pulmonary rehabilitation (PR). A total of 144 patients who performed PR between 1992 and 1999 was assessed. After PR, 67 patients underwent lung volume reduction surgery (LVRS). Baseline data before PR consisted of body mass index, serum albumin levels, use of supplement oxygen at home, pulmonary function, arterial blood gas analysis, and distance and fall of hemoglobin oxygen saturation (DeltaSpO(2)) in 6-min walk test. In addition to pre-PR factors, treatment with LVRS was taken into the analysis. The prognostic significance of variables influencing survival was determined by univariate analysis with Log rank test or multivariate analysis using Cox's proportional hazard model. By a median follow-up time of 8.4 years, the median survival time was 8.1 years (95% confidence interval: 6.9-9.4 years). Albumin level, PaCO(2), distance and DeltaSpO(2) were significant prognostic factors in univariate analysis. LVRS did not affect the prognosis. The multivariate analysis showed short distance and increase of DeltaSpO(2) as significant independent predictors of the risk of death. 6-min walk test was very useful for predicting the prognosis of the COPD patients.

Hidradenoma papilliferum with mixed histopathologic features of syringocystadenoma papilliferum and anogenital mammary-like glands.

A case of hidradenoma papilliferum with mixed features of syringocystadenoma papilliferum (SCAP) and anogenital mammary-like glands is reported. A single, fresh red-colored nodule developed in the sulcus between the labia majora and minora of a 49-year-old Japanese woman. Histopathologically, the tumor showed epithelial lining with apocrine secretion and slight connective tissues characteristics. Our case was unique because, like SCAP, the tumor was connected to the epidermis and cystic invaginations extended downward into the deep dermis. In addition, beneath the tumor, tubular structures that resembled normal mammary tissue were present in the subcutaneous fatty tissue. In this study, it has been suggested that this tumor might have been developed from these mammary-like glands.

[Detection and diagnosis of coronary arteries using multi-detector CT].

OBJECTIVE: In this study coronary arteries were compared and evaluated in 41 cases using multidetector CT with slice thicknesses of 2 mm and 1 mm. All 323 segments including #1-3, 5-8, and 11 [based on the American Heart Association (AHA) classification system] were used: 163 segments of 2 mm and 160 segments of 1 mm. METHODS: The images obtained were separated into fivelevels (0-4 points) of cardiac motion artifacts and evaluated based on volume rendering (VR) and partial maximum intensity projection (partial MIP). RESULTS: Of the results obtained, slice images of 1 mm in thickness were superior to those of 2 mm by 15.4% for sensitivity, 7.5% for specificity, and 8.2% for accuracy. On evaluation by segment, diagnostic accuracy was 2.88 +/- 0.57 for 2-mm slices and 3.28 +/- 0.59 for 1-mm slices of the left coronary artery, and 2.11 +/- 0.82 for 2-mm slices and 2.33 +/- 0.67 for 1-mm slices of the right coronary artery. Particularly for #6, a significantly high value was found for 1-mm slices (p < 0.05). Diagnostic accuracy was low in groups #2 and #3. CONCLUSION: On the basis of these findings, we were persuaded of the usefulness of MDCT for the evaluation of coronary arterial stenosed lesions, and we consider that diagnostic capability is improved by using thinner slices. We concluded that further studies would be necessary for visualization of the right coronary artery, which was seriously affected by cardiac motion artifacts.