bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective study of corticosteroid as an adjunct in the treatment of endobronchial tuberculosis in adults
Authors: PARK In Won , CHOI Byoung Whui , HUE Sung Ho
Published: February 2008

Abstract
Although endobronchial tuberculosis frequently causes bronchial stenosis, there are no specific therapies to prevent the sequelae. The use of corticosteroids remains controversial and there have been no prospective comparative studies about the effectiveness of corticosteroids. This study was undertaken in order to determine the effectiveness of corticosteroids in the prevention of complications of endobronchial tuberculosis. Thirty‐four patients with endobronchial tuberculosis who were admitted to Chung‐Ang University hospital from March 1991 to December 1995 were evaluated prospectively to determine the effect of corticosteroid in the treatment of endobronchial tuberculosis. All patients were randomly divided into two groups: group 1 (n=17, anti‐tuberculosis chemotherapy only) and group 2 (n= 17, combining anti‐tuberculosis chemotherapy with oral corticosteroid). Serial bronchoscopies, pulmonary function tests and chest roentgenograms were analyzed every 2 months until the complete resolution of endobronchial tuberculosis. Before treatment commenced there were no significant differences between the two groups with respect to sex, mean age, pulmonary function, chest roentgenogram and morphologic patterns of endobronchial lesion. After treatment, the healing rate of bronchoscopic findings and changes in pulmonary function showed no significant differences between the two groups. Radiologic improvements were observed in all eight patients (five in group 1 and three in group 2) with segmental atelectasis on chest roentgenograms after 2 months of treatment. This study suggests that corticosteroid therapy would not influence the outcome of endobronchial tuberculosis and that prompt treatment with early diagnosis, before formation of fibrosis would be necessary to prevent complications of endobronchial tuberculosis, such as bronchostenosis.
Thromboxane inhibition and monocrotaline‐induced pulmonary hypertension in rats
Authors: NAGATA Taiji , UEHARA Yoshio , HARA Kei , IGARASHI Kouichi , HAZAMA Hisanori , HISADA Tetsuya , KIMURA Kenjiro , GOTO Atsuo , OMATA Masao
Published: February 2008

Abstract
Monocrotaline (MCT)‐induced pulmonary hypertension (PH) is a useful model for the investigation of this disorder in humans. The role of thrombocytes in the genesis of PH has already been addressed; however, the exact mechanism by which they induce PH remains to be elucidated. We investigated the effects of a thromboxane A2 (TXA2) synthase inhibitor (OKY‐046) and a TXA2/ prostaglandin H2 (PGH2) receptor antagonist (ONO‐8809) on the development of MCT‐induced PH. A single dose of MCT (60 mg/kg bodyweight; BW) was injected subcutaneously in Wistar rats 24 h after the administration of OKY‐046 or ONO‐8809. The TXA2 inhibitors were administered by gavage daily for 3 weeks. Urinary excretion of eicosanoids was determined by radioimmunoassay. At the end of the treatment period, the lungs, heart and kidneys were morphologically examined. The per cent medial thickness of the muscular pulmonary arteries (%MT) and the ratio of the right to the left ventricular mass including the septum (RV/LV+S) increased significantly in MCT‐treated rats compared with the control rats. The %MT was attenuated by the administration of ONO‐8809. Either OKY‐046 or ONO‐8809 attenuated the increase in RV/LV+S. In addition, both TXA2 inhibitors reduced urinary excretion of 11‐dehydro‐TXB2, particularly during the early phase of PH, suggesting that platelet aggregation was reduced. These findings suggest that the inhibition of TXA2 by synthase inhibition or receptor antagonism reduces or delays the development of MCT‐induced PH in rats, probably by inhibiting platelet aggregation.
Successful removal of a 12 year long intrabronchial fishbone through fibreoptic bronchoscopy
Authors: TONG Maorong , KANG Xiaoming , SAKAKIBARA Hiroki , SUETSUGU Susumu
Published: February 2008

Abstract
We report a 54 year old male with an intrabronchial fishbone that had been impacted for 12 years and presented as recurrent pneumonia of the right lower lobe. The fishbone was successfully removed by fibreoptic bronchoscopy.
Progressive interstitial pneumonia associated with myelodysplastic syndrome: Implication of superoxide hyperproduction by neutrophils
Authors: TAMAKI Yumi , SEYAMA Kuniaki , TAKAHASHI Hideki , HIRANO Takao , UEKUSA Toshimasa , DAMBARA Takashi , KIRA Shiro , FUKUCHI Yoshinosuke , TOMINAGA Shigeru
Published: February 2008

Abstract
Interstitial pneumonia and aseptic neutrophilic infiltration in the lung are rare pulmonary manifestations of myelodysplastic syndrome (MDS). We report a patient with progressive interstitial pneumonia associated with MDS. Histological examination of the lung revealed infiltration of atypical haematopoietic cells associated with MDS and diffuse alveolitis with honeycombing. Neutrophils obtained from the patient showed superoxide hyperproduction after stimulation with phagocytosis and phorbol myristate acetate, which might be attributed to the pathogenesis of interstitial pneumonia.
Large cell carcinoma of the lung metastatic to nuchal muscle
Authors: NISHIKAWA Masanori , AKAHORI Tadashi , KURIYAMA Hitoshi , KIMURA Seiko , NAKATANI Yukio , KAKEMIZU Nobumasa , IKEDA Hirotada , OKUBO Takao
Published: February 2008

Abstract
Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72‐year‐old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well‐defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.
The US Lung Health Study
Authors: BUIST A S
Published: February 2008

Abstract
The US Lung Health Study was a randomized clinical trial carried out in 10 clinical centres in the United States of America and Canada that enrolled 5887 male and female smokers age 35–60 years with early chronic obstructive pulmonary disease (COPD). Its purpose was to determine whether a programme incorporating smoking intervention and use of an inhaled bronchodilator (ipratropium bromide) can slow the rate of declinein the forced expiratory volume in one second (FEV1) in middle aged smokers with early COPD. Participants were randomized with equal probability into three groups: (i) smoking intervention plus bronchodilator; (ii) smoking intervention plus placebo; or (iii) no intervention. The primary outcome was rate of change and cumulative change in FEV1 over a 5 year period. The primary finding was that the use of the bronchodilator did not influence the long‐term decline in FEV1. However, the aggressive smoking intervention programme significantly reduced the age‐related decline in FEV1.
Bronchodilator therapy for chronic obstructive pulmonary disease
Authors: LU Chong‐Chen
Published: February 2008

Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of diseases characterized by cough, sputum production, dyspnoea, airflow limitation and bronchial hyperreactivity. The airflow limitation declines progressively and is irreversible or partially reversible. Bronchodilator therapy is prescribed to relieve the symptoms, reverse airway obstruction and hopefully slow the rate of disease progression and decelerate the decline in pulmonary function. During acute exacerbation, inhalation of β2‐agonists remain the therapy of choice. The usefulness of anticholinergic inhalation in acute attacks is investigated in order to determine if a higher dose and more frequent administration have same benefit as β2‐agonists inhalation. Theophylline is usually given orally as a sustained release formulation for chronic maintenance therapy. Some patients may benefit from theophylline infusion during an acute phase when appropriately used; however, sympathomimetic agents fail to produce adequate bronchodilation. During interim periods of stability, inhalation of ipratropium bromide has increased in popularity as a regular long‐term bronchodilator therapy. Although ipratropium and β2‐agonists are equally efficacious when the dosage is adequate enough, a combination of both provides a rapid onset of action of the adrenergic agents and a prolonged action of the anticholinergic. Furthermore, this combination can be given in a reduced dose, thereby avoiding side‐effects. Inhalation techniques can influence the efficacy of bronchodilator therapy. For severe dyspnoeic patients or patients with poor technique of co‐ordination with metered‐dose inhaler (MDI), attachment of a spacer to the MDI or using a nebulizer will overcome these difficulties. Bronchodilator therapy can not prevent the development of COPD or slow down the decline of pulmonary function, other interventions should be included in a comprehensive management programme.
Computed tomographic findings in non‐specific interstitial pneumonia/fibrosis
Authors: KATOH Toshiyuki , ANDOH Takayuki , MIKAWA Kenichiro , TANIZAWA Makoto , TANIGAWA Masayoshi , SUZUKI Ryujiro , TAKAGI Kenzo
Published: February 2008

Abstract
The entity of non‐specific interstitial pneumonia/fibrosis (NIP) has recently been recognized as an addition to the current classification of idiopathic interstitial pneumonia, which includes usual interstitial pneumonia, desquamative interstitial pneumonia, diffuse alveolar damage, and bronchiolitis obliterans organizing pneumonia. We studied the computed tomographic (CT) findings of nine NIP patients who were diagnosed pathologically. The main findings were ground glass opacities (66.7%), airspace consolidation (88.9%) and reticular opacities (89.7%), distributed predominantly in the bilateral and lower lung. In all cases, the clinical and abnormal opacification observed on the chest CT was improved by the administration of corticosteroid. Both the subpleural and patchy distributed opacifications predominantly in the bilateral and lower lung, and the good response to treatment may help to differentiate non‐specific interstitial pneumonia from other types of idiopathic interstitial pneumonia.
Medical thoracoscopy in the diagnosis of unexplained pleural effusion
Authors: WILSHER Margaret L , VEALE Andrew G
Published: February 2008

Abstract
Approximately 20% of pleural effusions remain without an established aetiology after evaluation. Thoracoscopy has a very high sensitivity for the diagnosis of both benign and malignant diseases and greatly increases the diagnostic yield for pleural effusion. We sought to evaluate the diagnostic yield and safety of medical thoracoscopy at this institution. The records of all patients undergoing medical thoracoscopy for the evaluation of undiagnosed pleural effusion between 1990 and 1996 were reviewed. The procedure was performed under local anaesthesia with sedation using a Stortz rigid thoracoscope. Fifty‐eight patients had thoracoscopy, most having had two (range: 1–6) non‐diagnostic pleural aspirations and biopsies of the pleura. Nineteen patients were found to have mesothelioma and nine metastatic malignancy. Three patients were considered likely to have tuberculous pleural disease, six had asbestos related benign pleural fibrosis and three post‐cardiotomy syndrome. There was one chylous effusion of uncertain aetiology, one post‐traumatic and two other benign effusions, both of which resolved without clear aetiology. On seven occasions the pleural space could not be adequately accessed, but none of these patients had prior computerized tomography (CT) or ultrasound of the pleural space. There were five false negative diagnoses of malignancy, but no false positives. The diagnostic sensitivity for pleural malignancy was 85% and specificity 100%. There were no major complications, but four patients had late tumour seeding at the thoracoscopy site. Medical thoracoscopy is a safe procedure with a high diagnostic yield. Pre‐operative evaluation of the pleural collection using ultrasound or CT increases the likelihood of successful access to the pleural space and may increase diagnostic yield.
Patients prefer sedation for fibreoptic bronchoscopy
Authors: MAGUIRE Graeme P , RUBINFELD Abe R , TREMBATH Peter W , PAIN Michael CF
Published: February 2008

Abstract
This study was carried out in order to determine if intravenous (i.v.) sedation with diazepam, at the time of procedure, made fibreoptic bronchoscopy more tolerable and if these perceptions persisted on later questioning. Methodology consisted of a sequential, parallel group design comparing sedation with no sedation for bronchoscopy in a tertiary referral hospital. Patient comfort and sedation desired for hypothetical repeat bronchoscopy were assessed both immediately and after at least 1 month. Patients who received sedation rated bronchoscopy as more comfortable (P=0.01). Those who received sedation were also more likely to want no change in sedation if the bronchoscopy were repeated (P<0.01). These differences were more evident at later questioning. Sedation was not associated with an increased complication rate but was associated with a prolonged recovery room stay (no sedation, 19.2 min (SEM 3.8) compared with sedation, 76.1 min (5.4), P<0.001). In contrast to previous studies, our patients found bronchoscopy more comfortable with i.v. diazepam sedation. This was supported by patients who received sedation being less likely to want any change in future sedation if a repeat bronchoscopy were required. The benefit seen with sedation was more marked at later questioning supporting a previously postulated amnesic effect. However, sedation was associated with a prolonged room stay and potentially greater attendant cost.
Effect of chinonin on acute hypoxic pulmonary vasoconstriction in Sprague‐Dawley rats
Authors: LI Hui‐Ping , FU Zhi‐Gang , LI Ming , XIANG Yang , XIA Xiao‐Ming
Published: February 2008

Abstract
The objective of this study was to determine the influence of chinonin on acute hypoxic pulmonary vasoconstriction (HPV) in Sprague‐Dawley (SD) rats and investigate its mechanism. Sixty‐five SD rats were divided into five groups at random: six in the control group; six in the hypoxia group; 13 in the group of hypoxia with chinonin; 20 in the group of endothelin‐1(ET‐1) with chinonin and 20 in the group of platelet activating factor (PAF) with chinonin. Their mean pulmonary arterial pressures (mPAP) were measured and the concentration of molondialdehyde (MDA) in plasma and the activity of phospholipase A2 (PLA2) of the lung tissues were detected. The PAF and ET‐1 levels of plasma and lung homogenates were detected in the control and hypoxia groups. There was evidence of an increase in mPAP, MDA, PAF and ET‐1 in the plasma, and activity of PLA2, PAF and ET‐1 of the lung tissues when the rats inhaled a 10% mixture of oxygen in nitrogen. It appeared that chinonin may have been inhibiting the action of ET‐1 and PAF. Chinonin could have prevented an increase in MPAP caused by hypoxia and inhibited the action of ET‐1 and PAF. But chinonin had no influence on the increase in MDA in the plasma and the PLA2 activity of the lungs when hypoxia occurred. Chinonin can reduce HPV, but does not influence normal mPAP. It may do this by blocking the action of ET‐1 and/or PAF or others. The definite mechanism needs to be studied further.
Positional changes and drug interventions in acute respiratory failure
Authors: BADIA JR , SALA E , RODRIGUEZ‐ROISIN R
Published: February 2008

Abstract
Acute respiratory failure is often a life‐threatening condition that determines the outcome of acutely ill patients. This review discusses the physiological basis and results of two complementary approaches for the management of such patients: positional changes and drug interventions. In unilateral pulmonary disease locating the healthy lung in a dependent position may improve gas exchange; in bilateral involvement, as occurs in the acute respiratory distress syndrome (ARDS), both the theoretical principles and the observed benefits fully support the use of the prone position. The effect of vasoactive drugs on pulmonary circulation and gas exchange is also reviewed. Selelective vasodilators, such as inhaled nitric oxide and prostacycline‐12, may provide a useful alternative in ARDS.
Kartagener's syndrome: A re‐visit with Chinese perspectives
Authors: TSANG KWT , IP M , OOL CG , WONG MP , HO CS , SUN Z , TAM CY , LAM WK
Published: February 2008

Abstract
The objective of this study was to evaluate the clinical, radiological investigation profiles, and ciliary function and ultrastructure in Chinese patients with Kartagener's syndrome (presence of dextrocardia, sinusitis and bronchiectasis). All patients with dextrocardia were assessed for the presence of sinusitis and bronchiectasis in our hospital network. Patients identified with Kartagener's were assessed when they were at steady state for their bronchiectasis. Seven cases (4 males; mean age 34.9 years) were identified and systematically reviewed. The mean 24 h sputum volume was 26.6±32.77 mL/day and the patients suffered from a mean of 2.9 exacerbations/year. Nasal symptoms (anosmia in one, obstruction in six and persistent discharge in three patients) were common. Only two cases (1 M) were married and both had normal fertility. Lung function assessment showed a mean FEV1/FVC of 83.3±38.78/86.5±36.72 (% predicted) with little reversibility. High resolution computerized tomography (HRCT) revealed bronchiectactic involvement of the lower lobes in seven and middle lobe/lingula in four cases. Assessment of α‐1‐anti‐trypsin, aspergillus precipitins, auto‐antibodies and serology for Pseudomonas pseudomallei was normal. Sputum culture yielded Pseudomonas aeruginosa in three, Haemophilus influenzae in three and commensals in one case. Phase contrast microscopy assessment of respiratory cilia, obtained by brushing the inferior turbinate, revealed that most of the mucosa was unciliated. The mean ciliary beat frequency was 5.2 ± 6.76 Hz (range 0–13.7; normal range 12–18 Hz). Four patients had immotile cilia whilst the rest had normal ciliary movement. Transmission electron microscopy showed the absence of dynein arms in four patients. The results of this study show that patients with Kartagener's syndrome may have normal ciliary ultrastructure and the absence of dynein arms is not necessarily associated with ciliary immotility. The presence of ciliary immotility might have prognostic value as these patients appear to have more active bronchiectasis. Our experience on this series should help clinicans in the investigation and management of these patients.
Nitric oxide expression in airway epithelial cells in response to tubercle bacilli stimulation
Authors: KWON O Jung , KIM Jung Hee , KIM Ho Cheol , SUH Gee Young , PARK Jung Woong , CHUNG Man Pyo , KIM Hojoong , RHEE Chong H
Published: February 2008

Abstract
In order to investigate the role of airway epithelial cells in pulmonary tuberculosis, inducible nitric oxide synthetase (iNOS) expression and nitric oxide (NO) production were studied in A549 cells. Peripheral blood mononuclear cells (PBMC) from normal volunteers were separated and cultured for 24h with LPS or tubercle bacilli (H37Rv, H37Ra). Thereafter, A549 cells were stimulated for another 24h with culture supernatant fluids of PBMC. iNOS messenger RNA (mRNA) expression was measured with Northern blot analysis and NO production was measured with the Griess reaction, which can measure nitrite concentration. iNOS mRNA expression and NO production were minimal in the control cells. iNOS mRNA expression and NO production were significantly increased with LPS (P < 0.05) or tubercle bacilli (P < 0.01) stimulation. However, there was no difference in iNOS mRNA expression and NO production between H37Rv and H37Ra stimulations. Interestingly, iNOS mRNA expression and NO production were greater in A549 cells stimulated with tubercle bacilli‐conditioned media than in the cells stimulated with LPS‐conditioned media. IL‐1β, tumour necrosis factor‐alpha and interferon gamma concentrations were increased in culture supernatant fluids of PBMC stimulated with tubercle bacilli. These findings suggest that airway epithelial cells may play a certain role in the pathogenesis of pulmonary tuberculosis by producing NO. However, the role of airway epithelial cells, regarding the virulence of tubercle bacilli, was not clear in this study.
Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer
Authors: WONGSURAKIAT Phunsup , WONGBUNNATE Sommit , DEJSOMRITRUTAI Wanchai , CHAROENRATANAKUL Suchai , TSCHEIKUNA Jamsak , YOUNGCHAIYUD Praparn , PUSHPAKOM Rungsun , MARANETRA Nanta , NANA Arth , CHIERAKUL Nitipatana , SAKIYALAK Usana , RUENGJAM Chairat
Published: February 2008

Abstract
The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non‐endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.
New insights into the therapy and pathophysiology of patients with obstructive sleep apnoea syndrome
Authors: CHIN Kazuo , OHI Motoharu
Published: February 2008

Abstract
The objective of this study was to investigate the effects of obstructive sleep apnoea on: (i) PaCO2 levels; (ii) coagulation systems (plasma fibrinogen levels and whole blood viscosity); and (iii) heat shock proteins (HSPs) levels, which are also called stress proteins, in patients with obstructive sleep apnoea syndrome (OSAS). Patients treated with or without nasal continuous positive airway pressure (NCPAP) had arterial blood gases, plasma fibrinogen, haematocrit, serum total protein and changes in PaCO2 (estimated by transcutaneous PaCO2) measured before and after polysomnography. Heat shock protein 72 levels in peripheral blood mononuclear cells were also measured during sleep with and without NCPAP. OSAS patients with hypercapnia demonstrated significant increases in PaCO2 in the morning compared with the previous night. In such OSAS patients, treatment with NCPAP resulted in a normalization of the 20 mg/dL increase in fibrinogen levels which had been seen previously in the morning after sleep. Basal HSP 72 levels (08.00 pm before sleep) were high in OSAS patients compared to normal subjects and progressively decreased during sleep in the absence of NCPAP therapy. NCPAP relieved disabling day‐to‐day symptoms in addition to improving cardiovascular morbidity in patients with OSAS. Therefore it is important to understand the effects of OSAS on various organ systems as the prevalence of patients with OSAS is high.
Chemotherapy for advanced (stage IIIB and stage IV) non‐small cell lung cancer: The Hong Kong perspective
Authors: LAM Wah Kit , TSANG Kenneth WT , IP Mary SM
Published: February 2008

Abstract
Non‐small cell lung cancer (NSCLC) accounts for about 80% of all primary lung cancers, and 60% of cases present as advanced stages IIIB and IV disease. Traditionally, treatment of stages IIIB and IV disease was only symptomatic (including radiotherapy) and supportive care, and cytotoxic chemotherapy was relatively ineffective. Our initial clinical trials, using MACC, FuAM, FAM, Hi‐FAM and cisplatin‐VP16, gave response rates of 5–20% and a stabilization rate of 7–25%, with no impact on median survival. Our most recent chemotherapy regimen MIP (mitomycin‐C, ifosfamide and cisplatin) proved to be more effective with a 44% response rate and a 28% stabilzation rate, and produced a significantly longer median survival (32 weeks) than best supportive care alone (19.5 weeks, P< 0.05). The response rate further increased to 62.5% with dose intensification and GM‐CSF support. Chemotherapy can now be recommended to motivated, well‐informed patients with good performance status in institutions with experience in cancer chemotherapy on a protocol basis. The most recent addition of new effective cytotoxic agents such as paclitaxel, docetaxel, gemitabine and vinorelbine gave promising results in NSCLC, and optimal combinations and dose schedules are being defined by multicentred studies.
Non‐surgical therapy for patients with advanced non‐small cell lung cancer
Authors: LIAO ML
Published: February 2008

Abstract
Advanced non‐small cell lung cancer (NSCLC) denotes those of TNM stage III and IV. NSCLC has its specific characteristics in respect of oncological behaviour, molecular biology, sensitivity to chemotherapy (CT) and radiotherapy (RT), and requires different therapeutic strategies in comparison with small cell lung cancer. The therapies include: (1) surgery in combination with new effective drugs is resulted in improved RR from 15% a decade ago to 40–60% today. Cisplatin (C‐DDP) is the most attractive drug in the treatment of NSCLC, in lengthening the life‐span of Stage IV NSCLC patients and as an indispensable sensitizer in RT. Taxinol, Gemcitabine (GEM), Navelbine (NVB), Edatrexate (ETX), CPT‐11 and high dose Epirubicin (EPI HD) are recommended as new effective drugs. Response rates recently reported for the combination CT with the drugs mentioned above for NSCLC are from 30–65%, and with 8–42 weeks of MST. Induction or neoadjuvant therapies for advanced NSCLC, with 40–69% of RR, 25–29% of complete resection rate, 8–34% of CR and 17–45% of one year SR are reviewed. Eight random studies comparing MST between CT with C‐DDP and best supportive care for NSCLC are statistically significant. (2) RT for Stage III NSCLC with 2 year and 5 year survivals of 20 and 5% respectively. Although such outcome is hardly acceptable, RT sensitizer, modified RT techniques and chemoradiotherapy (CRT) are imperative to improve the effect of RT in advanced NSCLC. Clinical literature suggest that CRT is better than RT, though without marked difference. Further studies and sufficient follow‐up are necessary to judge the efficacy in terms of long‐term survival and toxic reaction. (3) Biological therapy: gene therapy of NSCLC is still in the experimental and developmental stage. Of biological response modifier (BRM), α IFN in 11 cases of NSCLC with RR of 9% and MST of 14 months, IL‐2 and LAK cell treatment in 11 cases with RR of 9% and MST of 18 months are reported. Instillation of BRM such as IL‐2 or α‐IFN into the pleura after drainage of cancerous effusion has been reported as the most effective for those whose RR is of 80–90% and the clinical response time is fairly long. Hematological cytokine as a protective adjuvant therapy against CT/RT toxicity makes high dose of CT possible and raises the response and patient tolerance. In multimodality therapy, it plays an important role to reduce post CT infection and septicemia.
Non‐surgical treatment of advanced non‐small cell lung cancer in Japan
Authors: KUNITOH Hideo
Published: February 2008

Abstract
The cisplatin‐based conventional combination chemotherapy has been shown to prolong survival of patients with advanced non‐small cell lung cancer (NSCLC), but the treatment effect is only modest and of little clinical significance. Several promising ‘new‐generation’ anti‐cancer drugs, such as taxanes, vinorelbine, gemcitabine and irinotecan, have offered both chance and challenge to develop effective chemotherapy against NSCLC. In Japan, large‐scale phase III trials of cisplatin‐irinotecan combination regimen vs. conventional chemotherapy have been conducted; patient accrual has been completed and the final results will be presented in a couple of years. Other new agents will also be available by the end of 1999, and it will be our important task to evaluate those drugs efficiently.

The current standard treatment strategy against unresectable stage III NSCLC is chemoradiotherapy. However, there remain many questions to be answered through well‐designed clinical trials. Those include optimal timing and schedule of the chemoradiotherapy, dose and fractionation of radiation and best chemotherapy regimen. An important randomized trial of concurrent vs. sequential chemoradiotherapy has been conducted in Japan, which has suggested that the concurrent schedule has survival benefit. Many trials of concurrent chemoradiotherapy with the new agents are currently performed or planned, but potential toxicity of the concurrent chemoradiotherapy must be carefully evaluated.
Non‐surgical therapy for patients with advanced non‐small cell lung cancer
Authors: CLARKE Stephen J , BOYER Michael J
Published: February 2008

Abstract
Non‐small cell lung cancer is the major cancer problem in the Western World. Treatment and prognosis are highly stage dependent, although overall only 5–10% of patients will be alive 5 years after diagnosis. Patients with early stage disease are treated with surgery alone. However, for patients with locally advanced disease there is increasing evidence that combined modality approaches, incorporating chemotherapy, radiotherapy and/or surgery result in modest improvements in survival. For patients with metastatic non‐small cell lung cancer there is evidence from metaanalyses and randomised studies that chemotherapy results in improvements in both duration and quality of life. Despite these advances, there is substantial room for further improvement and therefore, wherever possible, patients should be enrolled in well designed clinical studies.
Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis
Authors: BURIOKA Naoto , SUGIMOTO Yuji , SUYAMA Hisashi , HORI Shinji , CHIKUMI Hiroki , SASAKI Takao
Published: February 2008

Abstract
Expectoration of mucus is important in preventing the development of airway inflammation in patients with diffuse panbronchiolitis (DPB). To evaluate the clinical efficacy of the FLUTTER device in clearing mucus from the airways of patients with DPB who have difficulty expectorating, we assessed pulmonary function and symptoms in patients treated with FLUTTER. Eight patients in a stable clinical condition with DPB were included in the study. The study was divided into two consecutive, 1‐week periods. The initial week was an observation week. During the following week, patients used FLUTTER four times daily. Expectorated sputum was collected in a container and weighed every day during 2 weeks. Pulmonary function, partial oxygen pressure and partial carbon dioxide pressure in arterial blood were measured in all patients on the last day of the observation week and the FLUTTER treatment week. A symptom score for difficulty of expectoration was determined by questionnaire. A pneumothorax developed in one patient during using FLUTTER. The mean daily sputum weight and peak expiratory flow rate increased significantly after treatment with FLUTTER (P < 0.04 and P< 0.02, respectively). Symptom score improved significantly after using FLUTTER (P < 0.02). We conclude that the use of FLUTTER is effective in clearing mucus from the airways. However, the development of a pneumothorax may complicate use of the procedure in some cases.
Bronchiolitis obliterans organizing pneumonia in Korea
Authors: HAN Sung Koo , YIM Jae‐Joon , LEE Jae Ho , YOO Chul Gyu , CHUNG Hee Soon , SHIM Young‐Soo , KIM Young Whan
Published: February 2008

Abstract
An analysis of the clinical features in 23 cases of bronchiolitis obliterans organizing pneumonia (BOOP) in Korea is presented. Six were men and 17 were female, with a male‐tofemale ratio of 1:2.4. Idiopathic BOOP was present in 18 of these patients, connective tissue disease‐associated BOOP in five and all of them were females. The most frequent symptoms were dyspnoea and coughing in both groups; and crackles were the most prominent physical findings. Leukocytosis was observed in seven of the idiopathic BOOP group and all in the connective tissue disease‐associated BOOP group. In most cases, FVC, FEV1, diffusing capacity and arterial O2 pressure were reduced. In roentgenographic study, patchy air space consolidation was the major finding and subpleural predominance was observed in the majority of patients in both groups. Migration of lesions were identified in only two patients with idiopathic BOOP. Steroid treatment was effective in all of idiopathic BOOP. In contrast to previous reports, an analysis of the 23 Korean BOOP patients showed several interesting points. First, a female predominance was observed. Second, migration of lesion was rare. Third, it did not show any different prognosis in patients with reticular pattern on roentgenogram compared with patients with patchy air space consolidation on roentgenogram. Whether these differences were due to ethnic or environmental factors is to be determined.
Increased use of inhaled corticosteroids and reduced hospitalizations in adult asthmatics: 11 years' experience in a Japanese hospital
Authors: ISHIHARA Kyosuke , HASEGAWA Tsuyoshi , NISHIMURA Takashi , OKAZAKI Miki , KATAKAMI Nobuyuki , UMEDA Bun‐ichi
Published: February 2008

Abstract
Until recently, inhaled corticosteroids have not been recognized as a first‐line drug mainly because of the traditional polypharmaceutical approach to asthma in Japan. To examine the trend more precisely following the introduction of inhaled corticosteroids, we retrospectively analysed the relation between the number of prescriptions for anti‐asthma drugs including inhaled corticosteroids and the number of hospitalizations due to asthma exacerbation, near fatal episodes and deaths from asthma for a period of 11 years from 1986 to 1996 at Kobe City General Hospital (KCGH). A marked decline in these actual indices in patients attending KCGH, which shows the improvement in asthma control, started coincidentally with the increased use of inhaled corticosteroid, which was followed by both a discontinuation of the trend for increased use of inhaled beta‐agonists and the decreased use of oral anti‐asthma agents. There was no significant difference in the mean duration of hospital stays between 1988 and 1996. Although the intensification of patient education is likely to play an important role in enhancing the protective effect of inhaled corticosteroids, we highly suspect that the major contributory factor in the great decline in hospitalizations is the increased use of inhaled corticosteroids.
Comparative evaluation of sialylated carbohydrate antigens, KL‐6, CA19‐9 and SLX as serum markers for interstitial pneumonia
Authors: YOKOYAMA Akihito , KOHNO Nobuoki , KONDO Keiichi , UEDA Seiya , HIRASAWA Yutaka , WATANABE Keisuke , TAKADA Yasuharu , HIWADA Kunio
Published: February 2008

Abstract
We compared diagnostic values of three serum carbohydrate antigens, KL‐6, CA19‐9 and SLX to discriminate interstitial pneumonia (IP) from alveolar pneumonia and healthy volunteers. Subjects consisted of 13 patients with idiopathic pulmonary fibrosis and 10 associated with collagen vascular diseases, 12 patients with sarcoidosis and 70 controls (52 healthy volunteers and 18 patients with alveolar pneumonia). Cut‐off values were determined at the level at which the diagnostic accuracy became the highest for each marker, 449 U/mL for KL‐6, 26 U/mL for CA19‐9 and 41 U/mL for SLX. The sensitivity, the specificity and the diagnostic accuracy were 74.3% (26/35), 98.6% (69/70) and 90.5% (95/105) in KL‐6, 42.9% (15/35), 94.3% (66/70) and 77.1% (81/105) in CA19‐9, and 20.0% (7/35) and 95.7% (67/70) and 70.5% (74/105) in SLX, respectively. Receiver operating characteristic curves revealed that KL‐6 was far superior to both CA19‐9 and SLX. These results suggest that KL‐6 is the best marker for interstitial pneumonia among these carbohydrate antigens.
Correlation between clinical and pathological features of pulmonary thromboemboli and the development of infarcts
Authors: KATSUMURA Yukio , OHTSUBO Koh‐Ichiro
Published: February 2008

Abstract
Factors that predispose pulmonary thromboembolism to infarction have not been completely understood. The present autopsy study was carried out to evaluate these factors both clinically and pathologically. Between 36 subjects with pulmonary infarction and 33 individuals who had multiple pulmonary thromboembolism but no infarction, clinical and pathological features including congestive heart failure (CHF), shock, sepsis, neoplasm, emphysema, pneumonia, the amount of pleural effusion, diameter of occluded arteries, and segmental and dimensional location of thromboemboli were compared. Multiple regression analysis revealed that clinically CHF was significantly associated with the development of infarction. In pathological factors, thromboemboli located in the distal artery and in the lower lobe were significantly associated with infarction. The size of the infarcts was small and all the complete infarcts were in contact with the pleura. In addition to CHF, occlusion of small arteries in the lower lobe and near the pleura seems to be associated with the occurrence of infarction.
CYFRA 21‐1 and ProGRP, tumor markers of lung cancer, are elevated in chronic renal failure patients
Authors: NAKAHAMA Hajime , TANAKA Yoshimu , FUJITA Yoshimasa , FUJII Masamitsu , SUGITA Minoru
Published: February 2008

Abstract
Serum levels of CYFRA 21‐1(cytokeratin‐19 fragment) and ProGRP (pro‐gastrin‐releasing peptide), the new prognostic markers of lung cancer, were measured by ELISA (enzyme‐linked immunoadsorbent assay) in 27 (for CYFRA 21‐1; male 13, female 14; age 54 ± 17 years) or 22 (for ProGRP; male 9, female 13; age 59 ± 18 years) patients with various serum creatinine levels, 42 haemodialysis (HD) patients (male 24, female 18; age 59 ± 14 years) and 30 continuous ambulatory peritoneal dialysis (CAPD) patients (male 18, female 12; age 48 ± 9 years). All the patients were without clinical and radiological signs of lung cancer. Positive correlations were found between serum creatinine and serum CYFRA 21‐1 and ProGRP levels. Serum levels of CYFRA 21‐1 were above the cutoff limit (3.5 ng/mL) in 57% of HD patients (mean 4.07 ± 1.56 ng/mL) and in 73% of CAPD patients (mean 4.87 ± 1.56 ng/mL). Serum levels of ProGRP were above the cutoff limit (46.0 pg/mL) in 90% of HD patients (mean 107.0 ± 59.4 pg/mL) and in 93% of CAPD patients (mean 112.4 ± 4.5 pg/mL). Our data indicate that evaluation of renal function is essential when the measurement of these tumor markers is to be applied as one of the diagnostic tools of lung cancer.
Marked elevation of CA19‐9 in a patient with idiopathic pulmonary fibrosis: CA19‐9 as a bad prognostic factor
Authors: FUJITA Jiro , OBAYASHI Yuka , YAMADORI Ichiro , OHTSUKI Yuji , MIYAWAKI Hiroshi , HOJO Satoko , FURUKAWA Yoko , TAKAHARA Jiro
Published: February 2008

Abstract
A 53‐year‐old Japanese female, who had been suffering from idiopathic pulmonary fibrosis (IPF) for 3 years, was admitted with dyspnoea. The important laboratory finding on admission was a serum CA19‐9 level of 649 U/mL. Despite steroid treatment for IPF, her respiratory condition gradually deteriorated with the increase of serum CA19‐9 level up to 3020 U/mL and she died of respiratory failure. Immunohistochemistry showed the positive stain of CA19‐9 in bronchoepithelial cells. We also reviewed the Index Medics and picked up the cases who had elevation of CA19‐9 more than 1000 U/mL, and six patients were listed. Five of these six patients died within 6 months, therefore the marked elevation of CA19‐9 seemed to be a bad prognostic factor in patients with pulmonary fibrosis.
Stenting therapy for stenosing airway diseases
Authors: PHILLIPS MARTIN J.
Published: February 2008

Abstract Tracheobronchial stents have proved very valuable in the management of airway stenosis due to a variety of causes, both benign and malignant. These include benign strictures which are post‐traumatic (e.g. after intubation), post anastomotic (e.g. after lung transplantation), or post inflammatory (e.g. after inflammatory conditions such as tuberculosis or Wegener's granulomatosis); as well as narrowing due to malignant involvement of large airways. In addition, airway stents have been used to treat tracheobronchomalacia and oesophageal‐airway fistulae. The insertion of the stent may need to be combined with other procedures such as airway dilatation, laser photocoagulation, brachytherapy or a mixture of these treatment modalities. Stents have been fashioned out of silicone, wire mesh or a combination of these materials, but the perfect stent has yet to be devised. Common problems include displacement and obstruction with secretions or granulation tissue. Less commonly the stent may perforate the airway wall, sometimes into the accompanying blood vessel. Nonetheless, airway stents are valuable tools in the management of airway narrowing.
Stenting therapy for stenosing airway disease
Authors: Kim Hojoong
Published: February 2008

Abstract Stenosing airway disease is classified as intraluminal obstruction, extrinsic compression, and malaria by the anatomical site of the lesion. Stenting therapy is indicated for symptomatic relief of life‐threatening dyspnea caused by the last two types. Airway stents are made with metal mesh and/or silicone rubber, and currently more than 20 kinds of stent are available. The metal stent (e.g. Gianturco stent, Wallstent) is easy to insert, may not need general anesthesia, and has wider internal lumen. Because it is very hard to reposition or remove, it is mainly used in malignant airway obstruction. Among many kinds of silicone stent, the Dumon stent is most widely used for benign and malignant airway stenoses, but general anesthesia and rigid bronchoscopy are needed for insertion. It can be removed when the stenosing airway disease subsides completely. In many clinical studies, most patients (85–90%) improved immediately after stenting, and procedure‐related mortality is low (< 3%) in experienced centers. Stent displacement, mucus impaction, and granulation tissue formation are potential complications. Stenting is one of many effective therapeutic modalities for stenosing central airway disease. Careful patient selection, experiences, and continuous development of new technology will bring better results.
Airway stenting in Japan
Authors: MIYAZAWA Teruomi , ARITA Ken‐ichi
Published: February 2008

Abstract Various types of outstanding airway stents have been made commercially available. In Japan, a total of 1004 airway stents (Dumon stents (Novatech, Aubagne, France), Gianturco Z stents (Cook Ins, Bloomington, USA), Ultraflex stents (Boston Scientific Corp, Natick, MA, USA), and Dynamic Y stents (Ruesch AG, Kernen, Germany)) were implanted from July 1991 until February 1998. Of all the various stents, the Dumon stent has become the standard worldwide. Also, the Dumon stent has been replacing the Gianturco Z stent as the preferred stent throughout Japan. The Dumon stent was the first stent covered by Japanese National Health Insurance. Therefore, we present our 5‐year experience with the Dumon stent at our institusion. In our experience, stenting is effective for the immediate and lasting relief of symptoms in patients with severe malignant obstruction of major airways.
Increased perception of airway narrowing in patients with ild asthma
Authors: James Al , Carroll N. , Klerk N DE , Elliott J. , Musk Aw , Ryan G.
Published: February 2008

Abstract To compare the perception of airway narrowing of nonasthmatic subjects with those having wheeze or mild asthma (doctor‐diagnosed), the relationship between FEV1 and breathlessness was examined in 123 subjects from a general population sample. Scores for breathlessness, using the Borg scale, were recorded before and after inhaling incremental doses of methacholine to a maximal dose of 196 mcmol or a maximum change in FEV1 of 50%. A history of asthma symptoms, including wheeze in the previous 12 months, and doctor‐diagnosed asthma was obtained by questionnaire. At any given level of FEV1 there was wide variation in Borg scores between subjects, however median Borg scores and the mean slope of Borg score on FEVI was greater in the asthmatic subjects or those with wheeze compared with nonasthmatic subjects or those without wheeze. In both nonasthmatic and asthmatic subjects, those with airway hyperresponsiveness had increased maximum symptom scores and maximum changes in FEVI, but similar Borg scores relative to change in FEVI, compared with those without hyperresponsiveness. We conclude that the perception of mild and moderate degrees of airway narrowing varies widely between individuals but is increased in subjects with a history of mild asthma or wheeze in the last 12 months, independently of airway responsiveness.
Secretion of GM‐CSF by inflammatory cells in the lung of patients with sarcoidosis
Authors: ITOH Akihide , YAMAGUCHI Etsuro , FURUYA Ken , KAWAKAMI Yoshikazu
Published: February 2008

Abstract Several cytokines are involved in the pathophysiology of sarcoidosis. Granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) may be one of these cytokines because its mRNA is expressed by inflammatory cells obtained from the sarcoid lung. We thus asked two questions. Is GM‐CSF secreted by bronchoalveolar lavage (BAL) cells? What type of cells express GM‐CSF? GM‐CSF secreted by the cultured BAL cells from 19 untreated sarcoid patients was measured by an enzyme‐linked immunosorbent assay. The individual cells expressing GM‐CSF mRNA were identified by in situ hybridization in seven patients. Spontaneous release of GM‐CSF by BAL cells was demonstrated in one patient. When stimulated, BAL cells secreted GM‐CSF in all subjects studied. In situ hybridization with digoxigenin‐labelled GM‐CSF cRNA probe revealed that the positive cells were round in shape and larger than lymphocytes, but smaller than large alveolar macrophages that are often irregular in shape. These results strongly indicated that small alveolar macrophages secrete GM‐CSF in the sarcoid lesion. This phenomenon may contribute to the enhanced immunological activities observed in sarcoidosis.