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Tsugu T, Murata M, Kawamura T, Kataoka M, Minakata Y, Tsuruta H, Itabashi Y, Maekawa Y, Mitamura H, Fukuda K. P4007Right ventricular strain predicts exercise tolerance after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moriyama H, Murata M, Kawakami T, Kataoka M, Minakata Y, Endo J, Tsuruta H, Itabashi Y, Maekawa Y, Fukuda K. P4330Right ventricular diastolic strain rate reflects right ventricular diastolic function in patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Matsunaga K, Yanagisawa S, Hirano T, Ichikawa T, Koarai A, Akamatsu K, Sugiura H, Minakata Y, Matsunaga K, Kawayama T, Ichinose M. Associated demographics of persistent exhaled nitric oxide elevation in treated asthmatics. Clin Exp Allergy 2012; 42:775-81. [PMID: 22515393 DOI: 10.1111/j.1365-2222.2011.03945.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The fraction of exhaled nitric oxide (FENO) is reduced by anti-inflammatory treatment in asthma. However, the FENO level is also regulated by individual demographics and there is considerable variation among clinically stable patients. OBJECTIVE We hypothesized that some demographics may be responsible for persistent FENO elevation despite inhaled corticosteroids (ICS) therapy in asthma. METHODS This was a prospective observational study. We initially screened 250 stable asthmatics and determined the FENO cut-off point for identifying poorly controlled asthma defined by one of the following criteria: Asthma control test <20, or forced expiratory volume in one-second % of predicted <80%, or peak expiratory flow variability <80% (Study 1). After 12-weeks, 229 patients who maintained high or low FENO were selected and the independent factors which might contribute to a high FENO were examined (Study 2). RESULTS A FENO level >39.5 p.p.b. yielded 67% sensitivity and 76% specificity for identifying the patients with poorly controlled asthma. The persistent high FENO group (≥ 40 p.p.b.) was more likely to be ex-smokers, to show evidence of atopy (positive specific IgE, higher serum IgE and blood eosinophils), and to have allergic comorbidities. Especially, past smoking history, blood eosinophils, and chronic rhinosinusitis were identified to be independent predictors of high FENO. Neither the dose of ICS nor other medication use showed any difference between the groups. CONCLUSIONS AND CLINICAL RELEVANCE These results suggested that past smoking history, blood eosinophilia, and chronic rhinosinusitis are involved in the persistent airway inflammation detected by FENO. Although their relative contributions on FENO values should be further quantified, clarification of the features of the subjects with high FENO might provide clues for adjustment of the treatment approach in asthma.
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Affiliation(s)
- K Matsunaga
- Third Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan
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Akamatsu K, Yamagata T, Takahashi T, Miura K, Maeda S, Yamagata Y, Ichikawa T, Yanagisawa S, Ueshima K, Hirano T, Nakanishi M, Matsunaga K, Minakata Y, Ichinose M. Improvement of pulmonary function and dyspnea by tiotropium in COPD patients using a transdermal β2-agonist. Pulm Pharmacol Ther 2007; 20:701-7. [PMID: 17049894 DOI: 10.1016/j.pupt.2006.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 08/21/2006] [Accepted: 08/29/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND A combination of bronchodilators may be effective in the treatment of chronic obstructive pulmonary disease (COPD). We examined the effect of adding a long-acting anti-cholinergic agent (tiotropium) to a transdermal-type beta(2)-agonist (tulobuterol) on dyspnea as well as pulmonary function. METHODS In a multicentre, randomized, parallel design study, 60 COPD patients treated with the transdermal beta(2)-agonist tulobuterol were divided into a tiotropium added group (Tulo+Tio group, n=40) or transdermal beta(2)-agonist tulobuterol alone group (Tulo group, n=20), and then treated for 4 weeks after a 2 week run-in period. Pulmonary function and a dyspnea (Medical Research Council (MRC)) scale were assessed before and after the treatment. Daily peak expiratory flow (PEF) monitoring was also performed. RESULTS After 4 weeks, the Tulo+Tio group showed a significant increase in pulmonary function compared with the Tulo group; DeltaFVC (0.31+/-0.06 L vs. 0.06+/-0.05 L, p< 0.01), DeltaFEV(1) (0.15+/-0.03 L vs. -0.02+/-0.02 L, p<0.0001), and DeltaPEF (41.0+/-5.1 L/min vs. 0.5+/-3.5 L/min, p<0.0001). The MRC dyspnea scale was also significantly improved in Tulo+Tio, but not in Tulo group. CONCLUSION These results suggest that tiotropium caused a significant improvement in both pulmonary function and dyspnea in COPD patients already treated with the transdermal beta(2)-agonist tulobuterol.
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Affiliation(s)
- K Akamatsu
- Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan
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Ichikawa T, Matsunaga K, Minakata Y, Yanagisawa S, Ueshima K, Akamatsu K, Hirano T, Nakanishi M, Sugiura H, Yamagata T, Ichinose M. Possible Impact of Salivary Influence on Cytokine Analysis in Exhaled Breath Condensate. Anal Chem�Insights 2007. [DOI: 10.4137/117739010700200007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Exhaled breath condensate (EBC) is thought to contain substances of the lower airway epithelial lining fluid (ELF) aerosolized by turbulent flow. However, contamination by saliva may affect the EBC when collected orally. Objective The purpose of this study was to compare the cytokine expression levels in EBC with those in saliva, and to clarify the influence of saliva on cytokine measurements of EBC. Methods EBC and saliva samples were obtained from 10 adult subjects with stable asthma. To estimate differences in the contents of substances between EBC and saliva, the total protein concentration of each sample was measured. Further, we also measured the total protein concentration of ELF obtained from another patient group with suspected lung cancer using a micro sampling probe during bronchoscopic examination and roughly estimated the dilution of EBC by comparing the total protein concentration of EBC and ELF from those two patient groups. The cytokine expression levels of EBC and saliva from asthmatic group were assessed by a cytokine protein array. Results The mean total protein concentrations in EBC, saliva and ELF were 4.6 μg/ml, 2,398 μg/ml and 14,111 μg/ml, respectively. The dilution of EBC could be estimated as 1:3000. Forty cytokines were analyzed by a cytokine protein array and each cytokine expression level of EBC was found to be different from that of saliva. Corrected by the total protein concentration, all cytokine expression levels of EBC were significantly higher than those of saliva. Conclusion These results suggest that the salivary influence on the cytokine assessment in EBC may be negligible.
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Affiliation(s)
- T. Ichikawa
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - K. Matsunaga
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Y. Minakata
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - S. Yanagisawa
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - K. Ueshima
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - K. Akamatsu
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - T. Hirano
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - M. Nakanishi
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - H. Sugiura
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - T. Yamagata
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - M. Ichinose
- The Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
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Ichikawa T, Matsunaga K, Minakata Y, Yanagisawa S, Ueshima K, Akamatsu K, Hirano T, Nakanishi M, Sugiura H, Yamagata T, Ichinose M. Possible impact of salivary influence on cytokine analysis in exhaled breath condensate. Anal Chem Insights 2007; 2:85-92. [PMID: 19662182 PMCID: PMC2716811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Exhaled breath condensate (EBC) is thought to contain substances of the lower airway epithelial lining fluid (ELF) aerosolized by turbulent flow. However, contamination by saliva may affect the EBC when collected orally. OBJECTIVE The purpose of this study was to compare the cytokine expression levels in EBC with those in saliva, and to clarify the influence of saliva on cytokine measurements of EBC. METHODS EBC and saliva samples were obtained from 10 adult subjects with stable asthma. To estimate differences in the contents of substances between EBC and saliva, the total protein concentration of each sample was measured. Further, we also measured the total protein concentration of ELF obtained from another patient group with suspected lung cancer using a micro sampling probe during bronchoscopic examination and roughly estimated the dilution of EBC by comparing the total protein concentration of EBC and ELF from those two patient groups. The cytokine expression levels of EBC and saliva from asthmatic group were assessed by a cytokine protein array. RESULTS The mean total protein concentrations in EBC, saliva and ELF were 4.6 microg/ml, 2,398 microg/ml and 14,111 microg/ml, respectively. The dilution of EBC could be estimated as 1:3000. Forty cytokines were analyzed by a cytokine protein array and each cytokine expression level of EBC was found to be different from that of saliva. Corrected by the total protein concentration, all cytokine expression levels of EBC were significantly higher than those of saliva. CONCLUSION These results suggest that the salivary influence on the cytokine assessment in EBC may be negligible.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - M. Ichinose
- Correspondence: Masakazu Ichinose, M.D., Ph.D., Professor and Chairman, Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan. Tel: +81-73-441-0619; Fax: +81-73-446-2877;
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Yamagata T, Hirano T, Sugiura H, Yanagisawa S, Ichikawa T, Ueshima K, Akamatsu K, Nakanishi M, Matsunaga K, Minakata Y, Ichinose M. Comparison of bronchodilatory properties of transdermal and inhaled long-acting beta 2-agonists. Pulm Pharmacol Ther 2007; 21:160-5. [PMID: 17632023 DOI: 10.1016/j.pupt.2007.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 05/16/2007] [Accepted: 05/18/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Regular use of long-acting bronchodilators is recommended for symptomatic COPD patients. A transdermal type of beta 2-agonist, tulobuterol, was recently developed. This agent shows the pharmacokinetic property of a sustained serum concentration for 24h. However, little has been reported about the bronchodilatory properties of this agent. OBJECTIVES The aim of the present study was to compare the bronchodilatory action of transdermal beta 2-agonist tulobuterol with that of inhaled long-acting beta 2-agonist salmeterol. METHODS An open-label, randomized crossover study was performed. Eleven patients with stable COPD were enrolled in the study. Tulobuterol (2mg/day) or salmeterol (50 microg, twice daily) was administered in a randomized, crossover manner. Forced expiratory volume in 1s (FEV1), forced vital capacity (FVC) and inspiratory capacity (IC) were measured before administration, every 2h from 12 to 24h, and at 36 h after the initial administration. RESULTS Transdermal beta 2-agonist tulobuterol showed an improvement in FEV1, FVC and IC after dosing compared with those at baseline. Salmeterol also improved all parameters of FEV1, FVC and IC, and showed a greater improvement compared with the transdermal beta 2-agonist tulobuterol (p<0.05). The values of the area under the curve (AUC) of FEV1, FVC and IC during the administration of tulobuterol were 2.98+/-1.05, 1.81+/-0.98, 0.75+/-0.85 L h, respectively, and during the administration of salmeterol they were 6.39+/-1.12, 6.61+/-1.34, 4.28+/-0.91 L h, respectively. CONCLUSION The transdermal beta 2-agonist tulobuterol showed bronchodilatory action for at least 24h by once daily administration. However, its bronchodilatory potency was about three times less than that of the inhaled beta 2-agonist salmeterol.
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Affiliation(s)
- T Yamagata
- Third Department of Internal Medicine, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan
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Hirano T, Yamagata T, Gohda M, Yamagata Y, Ichikawa T, Yanagisawa S, Ueshima K, Akamatsu K, Nakanishi M, Matsunaga K, Minakata Y, Ichinose M. Inhibition of reactive nitrogen species production in COPD airways: comparison of inhaled corticosteroid and oral theophylline. Thorax 2006; 61:761-6. [PMID: 16936236 PMCID: PMC2117093 DOI: 10.1136/thx.200x.058156] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reactive nitrogen species (RNS) are thought to be one of the important factors in the pathogenesis of chronic obstructive pulmonary disease (COPD). A study was undertaken to examine the effects of theophylline and fluticasone propionate (FP) on RNS production in subjects with COPD. METHODS Sixteen COPD subjects participated in the study. Theophylline (400 mg/day orally) or FP (400 mug/day inhalation) were administered for 4 weeks in a randomised crossover manner with a washout period of 4 weeks. Induced sputum was collected at the beginning and end of each treatment period. 3-nitrotyrosine (3-NT), which is a footprint of RNS, was quantified by high performance liquid chromatography with an electrochemical detection method as well as by immunohistochemical staining. RESULTS Theophylline significantly reduced the level of 3-NT in the sputum supernatant as well as the number of 3-NT positive cells (both p<0.01). FP also reduced 3-NT formation, but the effect was smaller than that of theophylline. Theophylline also significantly reduced the neutrophil cell counts in the sputum (p<0.01), while FP treatment had no effect on the number of inflammatory cells in the sputum, except eosinophils. CONCLUSIONS Theophylline reduces nitrative stress and neutrophil infiltration in COPD airways to a larger extent than inhaled corticosteroid.
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Affiliation(s)
- T Hirano
- Third Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan
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Kishi K, Yoshimasu T, Shirai S, Minakata Y, Kimura M, Sonomura T, Shioyama Y, Sato M. Usefulness of mini-tracheostomy and torque controlled insertion of applicator in fractionated endobronchial brachytherapy. Br J Radiol 2006; 79:522-5. [PMID: 16714756 DOI: 10.1259/bjr/31613651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endobronchial brachytherapy was developed as effective treatment of endobronchial cancer and fractionated schedule is applied to decrease late toxicity. However, repeated bronchofiberscopy is onerous to the patient and restricts the treatment schedule itself. We applied mini-tracheostomy for a ready access route, and a torque controlled technique for easy insertion of the endobronchial applicator. Eight patients with tracheobronchial cancer invasion were treated with endobronchial brachytherapy of 18-30 Gy/3-5 fractions/1.5-2.5 weeks (median 24 Gy/4 fractions/2 weeks) at reference points of 5 mm from the bronchial surface. The averaged individual irradiation and single session times were 4 min and 24 min, respectively. There were no procedure-related complications. These technical improvements may facilitate flexible fractionated dose prescriptions.
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Affiliation(s)
- K Kishi
- Department of Radiology, Wakayama Medical University, Wakayama City, Japan
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Hirano T, Yamagata T, Gohda M, Yamagata Y, Ichikawa T, Yanagisawa S, Ueshima K, Akamatsu K, Nakanishi M, Matsunaga K, Minakata Y, Ichinose M. Inhibition of reactive nitrogen species production in COPD airways: comparison of inhaled corticosteroid and oral theophylline. Thorax 2006. [DOI: 10.1136/thx.2005.058156] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yamagata T, Nakamura Y, Yamagata Y, Nakanishi M, Matsunaga K, Nakanishi H, Nishimoto T, Minakata Y, Mune M, Yukawa S. The pilot trial of the prevention of the increase in electrical taste thresholds by zinc containing fluid infusion during chemotherapy to treat primary lung cancer. J Exp Clin Cancer Res 2003; 22:557-63. [PMID: 15053297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
It is well known that there are various adverse effects during chemotherapy for cancer treatment. A taste disorder is also seen in 35-70% of patients. It has been reported that a zinc deficiency is associated with the development of these alterations in taste sensation. The purpose of this pilot study was to determine whether the zinc including infusion had the effect on taste disorder in patients with lung cancer. Taste disorder was evaluated as the increase in electrical taste thresholds using an electrogustometer. The plasma zinc concentration was also measured. Although there was no significant correlation, the increase in taste thresholds was detected in many patients who had a low zinc concentration even before receiving chemotherapy. Moreover, after 2 weeks of chemotherapy, almost all patients who did not have a zinc containing infusion showed development of taste disorder (5/5, 100% at chorda tympani area; 4/5, 80% at glossopharyngeal area), whereas no development of taste disorder was observed in those patients receiving a zinc containing infusion. These results suggest the possibility that the administration of zinc during chemotherapy could be a useful supportive therapy for preventing taste disorder and to help maintain a better quality of life.
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Affiliation(s)
- T Yamagata
- Third Dept. of Internal Medicine, Division of Clinical Oncology and Palliative Medicine, Wakayama Medical University, Wakayama-City, Wakayama, Japan.
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Abstract
A 48-year-old man was diagnosed with primary alveolar proteinosis (PAP). Whole lung lavage was performed for treatment, and the opacity on his chest X-ray completely disappeared. The value of cytokeratin 19 fragment (CYFRA) in the serum was high at the beginning, decreased after lung lavage, and became elevated again when the disease recurred 7 months later. As PAP is thought to be a problem of surfactant secreted from type II pneumocytes, and a cytokeratin is present in the alveolar epithelial tissue, the value of serum CYFRA might be related to the severity of PAP.
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Affiliation(s)
- Y Minakata
- Third Department of Internal Medicine, Wakayama Medical University, School of Medicine
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14
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Minakata Y, Suzuki S, Grygorczyk C, Dagenais A, Berthiaume Y. Impact of beta-adrenergic agonist on Na+ channel and Na+-K+-ATPase expression in alveolar type II cells. Am J Physiol 1998; 275:L414-22. [PMID: 9700104 DOI: 10.1152/ajplung.1998.275.2.l414] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
It has been shown that short-term (hours) treatment with beta-adrenergic agonists can stimulate lung liquid clearance via augmented Na+ transport across alveolar epithelial cells. This increase in Na+ transport with short-term beta-agonist treatment has been explained by activation of the Na+ channel or Na+-K+-ATPase by cAMP. However, because the effect of sustained stimulation (days) with beta-adrenergic agonists on the Na+ transport mechanism is unknown, we examined this question in cultured rat alveolar type II cells. Na+-K+-ATPase activity was increased in these cells by 10(-4) M terbutaline in an exposure time-dependent manner over 7 days in culture. This increased activity was also associated with an elevation in transepithelial current that was inhibited by amiloride. The enzyme's activity was also augmented by continuous treatment with dibutyryl-cAMP (DBcAMP) for 5 days. This increase in Na+-K+-ATPase activity by 10(-4) M terbutaline was associated with an increased expression of alpha1-Na+-K+-ATPase mRNA and protein. beta-Adrenergic agonist treatment also enhanced the expression of the alpha-subunit of the epithelial Na+ channel (ENaC). These increases in gene expression were inhibited by propranolol. Amiloride also suppressed this long-term effect of terbutaline and DBcAMP on Na+-K+-ATPase activity. In conclusion, beta-adrenergic agonists enhance the gene expression of Na+-K+-ATPase, which results in an increased quantity and activity of the enzyme. This heightened expression is also associated with augmented ENaC expression. Although the cAMP system is involved, the inhibition of enhanced enzyme activity with amiloride suggests that increased Na+ entry at the apical surface plays a role in this process.
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Affiliation(s)
- Y Minakata
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec H2W 1T8, Canada
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Matsunaga K, Minakata Y, Yukawa S. [Primary pulmonary cryptococcosis with pleural effusion]. Nihon Kokyuki Gakkai Zasshi 1998; 36:708-12. [PMID: 9844391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 32-year woman presented at our hospital with left chest pain. Chest X-ray films revealed multiple nodular shadows (accompanied by a fusing tendency) and pleural effusion in the left lower lung field. Transbronchial lung biopsy specimens contained cryptococcal fungi. Blood and pleural effusion samples were positive for cryptococcal antigen, but cerebrospinal fluid was not. Because cryptococcus was not detected in cultures of cerebrospinal fluid, urine, or blood, and because the patient had no underlying disease, she was given a diagnosis of primary pulmonary cryptococcosis. On the second consultation 10 days later, the patient's subjective symptoms had subsided and the X-ray findings were generally improved. The condition resolved spontaneously without treatment within 4.5 months. This case is noteworthy for several reasons: (1) pleural effusion was observed, and the fluid could be examined: (2) the inflammatory reactions were pronounced at the time of first examination; and (3) the disease developed abruptly but subsided spontaneously within a short period of time. We reviewed 15 cases of primary pulmonary cryptococcosis reported recently in this journal, including this case. That review suggests that the finding concerning inflammatory reactions are associated with the motive of detection during initial examination.
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Affiliation(s)
- K Matsunaga
- Department of Respiratory Disease, Kokuho Naga Hospital, Wakayama, Japan
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Minakata Y, Kobayashi H, Sugita T, Niimi A, Horikawa S, Suzuki Y, Nishiyama H, Maekawa N. [A resuscitated case of sleep apnea syndrome with cardiac arrest]. Nihon Kyobu Shikkan Gakkai Zasshi 1992; 30:333-7. [PMID: 1602664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 71-year-old man was noted to habitually snore loudly at night and have a predisposition to somnolence during the daytime. While dozing during the day, he developed cardiac arrest at the time when snoring stopped, and was resuscitated. By means of a respiration monitor, he was diagnosed as having sleep apnea syndrome (SAS) with a combination of obstructive, central, and mixed type. However, neither respiratory insufficiency nor cardiac insufficiency was observed, and there were no abnormal findings on laboratory tests and bronchoscopy. SAS complicated by cardiac arrest is usually seen in cases with concomitant symptoms such as excessive obesity, hypertension, arrhythmia, right heart insufficiency, secondary polycythemia, or mental disorder. The present case abruptly developed cardiac arrest in the absence of such symptoms. This case therefore suggests the importance of screening tests using a respiration monitor during sleep in subjects who have a loud snore or a predisposition to somnolence during the daytime. Although treatment with UPPP alone had no noticeable effect, UPPP treatment combined with sleeping in the lateral position was effective in the present case. The efficacy rate of UPPP has been reported to be 50 to 60%. The early establishment of a method for precise evaluation of the site of obstruction as well as criteria for appropriate application of UPPP are urgently required.
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Affiliation(s)
- Y Minakata
- Third Department of Internal Medicine, Wakayama Medical College, Japan
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Ikeda T, Minakata Y, Inui H, Yukawa S, Nomoto H, Tsujimoto M. [A case of plasmacytoma of the ribs with intrathoracic tumors]. Nihon Kyobu Shikkan Gakkai Zasshi 1992; 30:133-7. [PMID: 1625389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 75-year-old male was admitted because of two tumors, one in the left middle lung field and one in the right upper lung field. Chest CT revealed intrathoracic tumors extending from destroyed ribs. Biopsy specimens of both tumors showed well-differentiated plasmacytoma. Retrospective investigation suggested that solitary plasmacytoma of bone (SPB) originating in the left fourth rib had developed into multiple myeloma (MM). Both tumors were treated with doses of 50 Gy irradiation and responded very well. Intrathoracic plasmacytomas have rarely been observed, so we have no established classification or therapy. According to reported cases, we classified intrathoracic plasmacytomas into 5 groups, and consider that treatment with doses of over 40 Gy irradiation was adequate for local control.
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Affiliation(s)
- T Ikeda
- Third Department of Internal Medicine, Wakayama Medical College, Japan
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Niimi A, Kobayashi H, Sugita T, Minakata Y, Horikawa S, Suzuki Y, Nishiyama H, Maekawa N, Kinoshita T, Wataya S. [Diagnostic value of bronchoalveolar lavage in fat embolism syndrome--a case report]. Nihon Kyobu Shikkan Gakkai Zasshi 1990; 28:362-7. [PMID: 2355705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
On the basis of the studies of autopsy cases and experimental animals, the pulmonary pathological findings of fat embolism syndrome (FES) have been reported to be (1) fat globules in the alveolar capillaries and the alveoli, (2) intra-alveolar hemorrhage, (3) alveolar edema and (4) foci of secondary infection. However, reports on lung biopsy in FES are rare, and no report has mentioned bronchoalveolar lavage (BAL) in FES. We experienced a case of FES, in which BAL was diagnostic. A 23 year-old man traffic accident victim was brought to our hospital by ambulance. His consciousness was clear and skeletal X-ray films revealed multiple fractures of the right femur, left tibia and left fibula. Direct traction of bilateral lower extremities was done. He remained stable subjectively, but anemia and thrombocytopenia progressed gradually in spite of blood transfusion. On the 4th hospital day severe hypoxemia, diffuse pulmonary infiltrates and petechiae in bilateral axillary lesions appeared, and FES was strongly suspected. O2 inhalation by face mask and high dose methylprednisolone administration was started. The hypoxemia improved, but pulmonary infiltrates worsened. For differential diagnosis, bronchoscopy and BAL was done on the 7th hospital day. Bronchoscopy revealed much fresh blood in the left main, upper lobe and lower lobe bronchus but no bleeding point was found. BAL fluid was bloody. The Sudan III stain and Berlin blue stain revealed several fat globules and numerous hemosiderin-laden macrophages. The presence of intra-alveolar fat globules and intra-alveolar hemorrhage was proved and definite diagnosis of FES was established.
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Affiliation(s)
- A Niimi
- Department of Respiratory Disease, Wakayama Red Cross Hospital, Japan
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