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Enomoto N, Yazawa S, Mochizuka Y, Fukada A, Tanaka Y, Naoi H, Aono Y, Inoue Y, Yasui H, Karayama M, Suzuki Y, Hozumi H, Furuhashi K, Toyoshima M, Kono M, Imokawa S, Sano T, Akamatsu T, Koshimizu N, Yokomura K, Matsuda H, Kaida Y, Shirai M, Mori K, Masuda M, Fujisawa T, Inui N, Nakamura Y, Sugiura H, Sumikawa H, Kitani M, Tabata K, Ogawa N, Suda T. Radiological and histopathological features and treatment response by subtypes of interstitial pneumonia with autoimmune features: A prospective, multicentre cohort study. Respir Med 2024; 224:107577. [PMID: 38408707 DOI: 10.1016/j.rmed.2024.107577] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients with idiopathic interstitial pneumonia (IIP) have a favourable prognosis when they have interstitial pneumonia with autoimmune features (IPAF). However, precise IPAF-related findings from high-resolution computed tomography (HRCT) and lung histopathological specimens and the treatment response have not been fully determined. Therefore, this study was conducted to evaluate the relationship between findings on HRCT or lung histopathological specimens and the progression of interstitial pneumonia in patients with IPAF. METHODS This multicentre cohort study prospectively enrolled consecutive patients with IIP. At the diagnosis of IIP, we systematically evaluated 74 features suggestive of connective tissue diseases and followed them up. HRCT, lung specimens, serum antibodies, and the clinical course were also evaluated. RESULTS Among 222 patients with IIP, 26 (11.7%) fulfilled the IPAF criteria. During a median observation period of 36 months, patients with IPAF showed better survival than those without IPAF (p = 0.034). While histopathological findings were not related to IPAF, nonspecific interstitial pneumonia (NSIP) with organizing pneumonia (OP) overlap was the most prevalent HRCT pattern (p < 0.001) and the consolidation opacity was the most common radiological finding in IPAF (p = 0.017). Furthermore, in patients with IPAF, the diagnosis of COP or NSIP with OP overlap was associated with a higher increase in %FVC in 1 year than in those with idiopathic pulmonary fibrosis, NSIP, or unclassifiable IIP (p = 0.002). CONCLUSIONS This study shows the presence of consolidation opacity on HRCT and the diagnosis of COP or NSIP with OP overlap are associated with IPAF and its favourable treatment response in patients with IPAF.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Health Administration Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Shusuke Yazawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasutaka Mochizuka
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsuki Fukada
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuko Tanaka
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hyogo Naoi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuya Aono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yusuke Inoue
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Takehisa Sano
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Taisuke Akamatsu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Naoki Koshimizu
- Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroyuki Matsuda
- Department of Respiratory Medicine, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yusuke Kaida
- Department of Respiratory Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Masahiro Shirai
- Respiratory and Allergy Medicine, National Hospital Organization Tenryu Hospital, Hamamatsu, Japan
| | - Kazutaka Mori
- Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Masafumi Masuda
- Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Respiratory and Allergy Medicine, National Hospital Organization Tenryu Hospital, Hamamatsu, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Kazuhiro Tabata
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Department of Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Sekiguchi R, Takeda K, Suzuki J, Enomoto Y, Kitani M, Narumoto O, Tashimo H, Yamane A, Nagai H, Watanabe A, Kamei K, Matsui H. Chronic Pulmonary Aspergillosis Caused by Aspergillus tubingensis Diagnosed by a Bronchoscopic Biopsy. Intern Med 2024; 63:289-292. [PMID: 37258165 PMCID: PMC10864089 DOI: 10.2169/internalmedicine.1695-23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/09/2023] [Indexed: 06/02/2023] Open
Abstract
We herein report a case of chronic pulmonary aspergillosis (CPA) caused by Aspergillus tubingensis diagnosed by a bronchoscopic biopsy with negative serological and sputum culture findings. A 66-year-old man was referred for the assessment of a pulmonary cavity. Computed tomography showed a thick-walled cavity in the upper right pulmonary lobe. Serum β-D glucan, Aspergillus galactomannan, and Aspergillus antibody tests were negative. Aspergillus species were not detected in the sputum. Culture and pathological specimens were obtained from the mass by bronchoscopy. Microscopic examination findings were consistent with Aspergillus niger complex morphologically and identified as Aspergillus tubingensis through DNA sequencing. The patient was diagnosed with chronic pulmonary aspergillosis.
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Affiliation(s)
- Ryo Sekiguchi
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
- Department of Respiratory Medicine, Toho University School of Medicine, Japan
| | - Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Junko Suzuki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Yu Enomoto
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Osamu Narumoto
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hiroyuki Tashimo
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Akira Yamane
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Japan
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
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Takeda K, Kawashima M, Masuda K, Kimura Y, Igei H, Kusaka K, Kitani M, Fukami T, Morio Y, Sasaki Y, Hebisawa A, Matsui H. A 65-Year-Old Man With Massive Hemoptysis. Chest 2023; 164:e9-e13. [PMID: 37423707 DOI: 10.1016/j.chest.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 01/05/2023] [Indexed: 07/11/2023] Open
Abstract
CASE PRESENTATION A 65-year-old man experienced a cough and mild hemoptysis suddenly one morning. He was prescribed tranexamic acid and carbazochrome salicylate by the local clinic at the first visit, and his hemoptysis stopped. However, 2 days later, he experienced recurrent hemoptysis that was prolonged intermittently. He had slight dyspnea and chest discomfort, but no other symptoms, such as sputum, fever, or chest pain. He was referred to our hospital for further assessment of hemoptysis. He had experienced mild hemoptysis of unknown causes 8 years earlier without recurrence until this episode. He had bronchial asthma that was treated with an inhaled corticosteroid and hypertension and hyperuricemia that were untreated with medication. He had no known allergies or family history of lung disease. He did not smoke. The patient denied alcohol consumption, any recent travel, or exposure to TB.
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Affiliation(s)
- Keita Takeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Kimihiko Masuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yuya Kimura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hiroshi Igei
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Kei Kusaka
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Takeshi Fukami
- Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yoshiteru Morio
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan; Center for Pulmonary Circulation and Hemoptysis, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yuka Sasaki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Akira Hebisawa
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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Imoto S, Suzukawa M, Takada K, Watanabe S, Igarashi S, Kitani M, Nagase T, Ohta K. Immunoglobulin A promotes IL-6 and IL-8 production, proliferation, and migration by the human bronchial smooth muscle cells. Cell Immunol 2022; 381:104612. [PMID: 36130412 DOI: 10.1016/j.cellimm.2022.104612] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/24/2022] [Accepted: 09/11/2022] [Indexed: 11/03/2022]
Abstract
Immunoglobulin A (IgA) is important in biological defense, mainly in the mucosal area, and plays pathogenic roles in various diseases by activating both inflammatory and structural cells. The current study aimed to validate the effects of IgA on the human bronchial smooth muscle cell (BSMC), which plays a major role in airway inflammation and remodeling. Serum IgA induced interleukin (IL)-6 and IL-8 production at both mRNA and protein levels, and enhanced cell proliferation and migration by the BSMCs. The synthetic phenotype markers were regulated and the contractile phenotype markers were downregulated by serum IgA. Mitogen-activated protein kinase, phosphatidylinositol 3-kinase/Akt, and nuclear factor-κB pathways were involved in IgA-induced IL-6 and IL-8 production. The BSMCs expressed transferrin receptor (TfR), and TfR siRNA transfection inhibited IL-6 and IL-8 production by serum IgA. In summary, serum IgA is a potent activator of the BSMCs at least partially via TfR.
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Affiliation(s)
- Sahoko Imoto
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan.
| | - Kazufumi Takada
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shizuka Watanabe
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sayaka Igarashi
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Masashi Kitani
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo 204-8585, Japan; Japan Anti-Tuberculosis Association, JATA Fukujuji Hospital, 3-1-24 Matsuyama, Kiyose-City, Tokyo 204-8522, Japan.
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5
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Watanabe S, Kobayashi K, Suzukawa M, Igarashi S, Takada K, Imoto S, Kitani M, Fukami T, Nagase T, Ohta K. Identification of ANXA2 on epithelial cells as a new receptor for secretory IgA using immunoprecipitation and mass spectrometry. Clin Exp Immunol 2022; 208:351-360. [PMID: 35511485 PMCID: PMC9226145 DOI: 10.1093/cei/uxac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Secretory immunoglobulin A plays an important role in the protection against exogenous pathogens and antigens, but it has also been reported to have pathogenic potential. We previously found that secretory immunoglobulin A accumulated in the peripheral lungs during idiopathic pulmonary fibrosis and that transferrin receptor/CD71 was partially involved in secretory immunoglobulin A-induced inflammatory cytokine production in A549 cells. This study aimed to identify the receptor responsible for the induction of cytokine production by secretory immunoglobulin A-stimulated airway epithelial cells. To this end, immunoprecipitation followed by time-of-flight mass spectrometry and peptide mass fingerprinting were performed and Annexin A2 was detected as a novel receptor for secretory immunoglobulin A. Enzyme-linked immunosorbent assay demonstrated binding of secretory immunoglobulin A to Annexin A2, and flow cytometry showed robust expression of Annexin A2 on the surface of BEAS-2B cells, A549 cells, and normal human bronchial/tracheal epithelial cells. Experiments in A549 cells using Annexin A2 small interfering RNA and neutralizing antibodies suggested that Annexin A2 was partially involved in the production of interleukin-8/CXCL8 and C-C motif chemokine ligand 2/monocyte chemoattractant protein-1 induced by secretory immunoglobulin A. Immunohistochemistry using lung sections revealed clear expression of Annexin A2 on airway epithelial cells, although the staining remained equivalent in idiopathic pulmonary fibrosis, asthma, and healthy control lungs. In conclusion, we identified that Annexin A2 expressed in airway epithelial cells is a novel receptor for secretory immunoglobulin A, which is involved in cytokine synthesis.
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Affiliation(s)
- Shizuka Watanabe
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.,Department of Respiratory Medicine, University of Tokyo, Tokyo, Japan
| | - Koichi Kobayashi
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.,Department of Respiratory Medicine, University of Tokyo, Tokyo, Japan.,Department of Internal medicine, Yoshikawa Central General Hospital, Saitama, Japan
| | - Maho Suzukawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Sayaka Igarashi
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Kazufumi Takada
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.,Department of Geriatric Medicine, University of Tokyo, Tokyo, Japan
| | - Sahoko Imoto
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.,Department of Respiratory Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Takeshi Fukami
- Department of Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, University of Tokyo, Tokyo, Japan
| | - Ken Ohta
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.,Japan Anti-Tuberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan
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Tamura A, Kawashima M, Suzuki J, Yamane A, Inoue Y, Fukami T, Kitani M, Takahashi F. Impact of lung cancer surgery on comorbid Mycobacterium avium complex lung disease-A case series. Respir Med Case Rep 2022; 37:101664. [PMID: 35585903 PMCID: PMC9108527 DOI: 10.1016/j.rmcr.2022.101664] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
The number of cases with Mycobacterium avium and Mycobacterium intracellulare lung diseases (Mycobacterium avium complex lung disease [MACLD]) are increasing globally. Lung cancer can sometimes present as a comorbidity with MACLD; however, the clinical presentation and outcomes of comorbid MACLD following lung cancer resection remain unclear. Therefore, we retrospectively assessed 17 patients with MACLD undergoing lung cancer resection to determine the impact of lung cancer surgery on comorbid MACLD. Of the 17 patients, Mycobacterium avium and Mycobacterium intracellulare were present in 15 and 2 patients, respectively; 14 patients had stage I lung cancer and underwent lobectomy. Ten patients were postoperatively observed for MACLD without any further intervention, five patients underwent additional resection for conspicuous MACLD lesions, and the remaining two patients underwent complete resection for MACLD and lung cancer within the same lobe followed by rifampicin, ethambutol, and clarithromycin (RECAM) therapy. Seven patients exhibited postoperative MACLD exacerbation, six of whom developed exacerbation in the operated ipsilateral residual lobes. Six of these seven patients received RECAM, three of whom (43%) subsequently exhibited improvement. Attention should be paid to MACLD exacerbation during postoperative follow-up, especially in ipsilateral lobes. Although RECAM therapy may be beneficial in alleviating MACLD exacerbation, further investigation is warranted to validate these results.
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Affiliation(s)
- Atsuhisa Tamura
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Masahiro Kawashima
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Junko Suzuki
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Akira Yamane
- Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Yuta Inoue
- Department of Chest Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Takeshi Fukami
- Department of Chest Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, 204-8585, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Yahaba, Iwate, 028-3694, Japan
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Abstract
The use of biologic agents has enabled control of severe asthma, but there is a risk that eosinophilic granulomatosis with polyangiitis (EGPA) may be masked in some cases. We herein report a 71-year-old man who was administered dupilumab for 2 years to stabilize his asthma symptoms. A few months after discontinuation of dupilumab administration, an increase in the eosinophil count in peripheral blood, leg pain, and a rash appeared. Based on pathology, he was diagnosed with EGPA. EGPA in this case was considered to have become apparent due to the discontinuation of dupilumab administration.
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Affiliation(s)
- Miki Ikeda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Nobuharu Ohshima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Meiko Shiina
- Department of Neurology, National Hospital Organization Tokyo National Hospital, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Maho Suzukawa
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
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Kato T, Akagawa S, Kusaka K, Kawashima M, Ohshima N, Kitani M, Hebisawa A, Matsui H. An autopsy case report of yellow nail syndrome coincided with primary biliary cholangitis. Respir Med Case Rep 2020; 32:101332. [PMID: 33511030 PMCID: PMC7817504 DOI: 10.1016/j.rmcr.2020.101332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/19/2020] [Accepted: 12/27/2020] [Indexed: 12/19/2022] Open
Abstract
Yellow nail syndrome (YNS) is a rare entity characterized by thickened yellowish nails, lymphedema and respiratory manifestations such as pleural effusion. Lymphatic dysfunction is considered as a cause of YNS. However, evidence of systemic dilatation/hyperplasia of lymphatics based on autopsy in YNS is not available. In this report, autopsy revealed dilatation and hyperplasia of lymphatic vessels in lungs, visceral and parietal pleurae, and intestines. We identified the direct opening of lymphatic vessels of the visceral pleura to the pleural cavity, which indicated the pathophysiology of uncontrollable pleural effusion in YNS. The current case was compromised with primary biliary cholangitis (PBC). The onset of PBC seemed to be related with the progression of YNS.
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Affiliation(s)
- Takafumi Kato
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Shinobu Akagawa
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Kei Kusaka
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Nobuharu Ohshima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masashi Kitani
- Division of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Akira Hebisawa
- Division of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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9
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Kishaba T, Hozumi H, Fujisawa T, Nei Y, Enomoto N, Sugiura H, Kitani M, Suda T. Predictors of acute exacerbation in biopsy-proven idiopathic pulmonary fibrosis. Respir Investig 2020; 58:177-184. [PMID: 32205147 DOI: 10.1016/j.resinv.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). Current evidence on AE-IPF has been largely based on clinical, rather than pathological, analyses. METHODS We investigated AE incidence and its predictors using clinical, radiological, and pathological data of patients diagnosed with IPF by multi-disciplinary discussion. This study, a secondary analysis of previous research, included 155 patients with IPF who underwent surgical lung biopsy (SLB). Cumulative AE incidence was evaluated by the Kaplan-Meier method. Predictors of AE-IPF were analyzed with a Fine-Gray sub-distribution hazard model. Sub-analysis was performed using propensity score-matching analysis. RESULTS In this cohort, the median age of the patients was 66 years and the median percent-predicted forced vital capacity was 82.8%. The cumulative AE incidence rates at 30 days and one year post SLB were 1.9% and 7.6%, respectively. On multivariable analysis, a lower percent-predicted diffusing capacity of the lung for carbon monoxide (%DLCO) (hazard ratio 0.98 per 1% increase, P = 0.02) and fibroblastic foci (FF)-present (vs. absent; hazard ratio 3.01, P = 0.04) were independently associated with a higher incidence of AE. The propensity score-matching analysis with adjustment for age, gender, and %DLCO revealed that the cumulative AE incidence rate was significantly higher in the FF-present subgroup than in the FF-absent subgroup (1-year incidence rate, 10.5% vs. 0%, respectively; P = 0.04 by Gray's test). CONCLUSIONS FF and %DLCO were independent predictors of AE in patients with biopsy-proven IPF. FF may be associated with the pathogenesis of AE-IPF.
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Affiliation(s)
- Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan.
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichiro Nei
- Department of Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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10
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Inoue E, Yotsumoto T, Inoue Y, Fukami T, Kitani M, Hirano Y, Nagase M, Morio Y. Mediastinal metastasis from ovarian serous carcinoma 29 years after initial treatment. Respir Med Case Rep 2020; 29:101003. [PMID: 32257787 PMCID: PMC7118409 DOI: 10.1016/j.rmcr.2020.101003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/19/2020] [Indexed: 12/01/2022] Open
Abstract
Ovarian cancer is a critically lethal gynecologic malignancy. More than 80% of patients with ovarian cancer have relapses within 5 years after initial treatment. However, recurrence from ovarian cancer more than 20 years later is extremely rare. We report a case of a 67-year-old female with mediastinal metastasis from ovarian cancer 29 years after initial gynecologic surgery and chemotherapy.
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Affiliation(s)
- Eri Inoue
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Takuma Yotsumoto
- Center for Pulmonary Diseases, Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Yuta Inoue
- Center for Pulmonary Diseases, Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Takeshi Fukami
- Center for Pulmonary Diseases, Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Masashi Kitani
- Department of Diagnostic Pathology, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Yuta Hirano
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Maki Nagase
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Yoshiteru Morio
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan.,Center for Pulmonary Circulation and Hemoptysis, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
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11
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Fujisawa T, Mori K, Mikamo M, Ohno T, Kataoka K, Sugimoto C, Kitamura H, Enomoto N, Egashira R, Sumikawa H, Iwasawa T, Matsushita S, Sugiura H, Hashisako M, Tanaka T, Terasaki Y, Kunugi S, Kitani M, Okuda R, Horiike Y, Enomoto Y, Yasui H, Hozumi H, Suzuki Y, Nakamura Y, Fukuoka J, Johkoh T, Kondoh Y, Ogura T, Inoue Y, Hasegawa Y, Inase N, Homma S, Suda T. Nationwide cloud-based integrated database of idiopathic interstitial pneumonias for multidisciplinary discussion. Eur Respir J 2019; 53:13993003.02243-2018. [PMID: 30880283 PMCID: PMC6853800 DOI: 10.1183/13993003.02243-2018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
Abstract
Multidisciplinary discussion (MDD) requiring close communication between specialists (clinicians, radiologists and pathologists) is the gold standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). However, MDD by specialists is not always feasible because they are often separated by time and location. An online database would facilitate data sharing and MDD. Our aims were to develop a nationwide cloud-based integrated database containing clinical, radiological and pathological data of patients with IIPs along with a web-based MDD system, and to validate the diagnostic utility of web-based MDD in IIPs. Clinical data, high-resolution computed tomography images and lung biopsy slides from patients with IIPs were digitised and uploaded to separate servers to develop a cloud-based integrated database. Web-based MDD was performed using the database and video-conferencing to reach a diagnosis. Clinical, radiological and pathological data of 524 patients in 39 institutions were collected, uploaded and incorporated into the cloud-based integrated database. Subsequently, web-based MDDs with a pulmonologist, radiologist and pathologist using the database and video-conferencing were successfully performed for the 465 cases with adequate data. Overall, the web-based MDD changed the institutional diagnosis in 219 cases (47%). Notably, the MDD diagnosis yielded better prognostic separation among the IIPs than did the institutional diagnosis. This is the first study of developing a nationwide cloud-based integrated database containing clinical, radiological and pathological data for web-based MDD in patients with IIPs. The database and the web-based MDD system that we built made MDD more feasible in practice, potentially increasing accurate diagnosis of IIPs. Acloud-based integrated database of idiopathic interstitial pneumonias containing clinical, radiological and pathological data along with a web-based multidisciplinary discussion system can make discussions more feasible and improve disease managementhttp://ow.ly/NqqD30nYenb
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Affiliation(s)
- Tomoyuki Fujisawa
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazutaka Mori
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masashi Mikamo
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Kensuke Kataoka
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Hideya Kitamura
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Noriyuki Enomoto
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryoko Egashira
- Dept of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Tae Iwasawa
- Dept of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | - Hiroaki Sugiura
- Dept of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mikiko Hashisako
- Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Tomonori Tanaka
- Dept of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuhiro Terasaki
- Dept of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinobu Kunugi
- Dept of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masashi Kitani
- Dept of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Ryo Okuda
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yasuoki Horiike
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunori Enomoto
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junya Fukuoka
- Dept of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Johkoh
- Dept of Radiology, Kinki Central Hospital of Mutual Aid Association of Public-School Teachers, Itami, Japan
| | - Yasuhiro Kondoh
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Takashi Ogura
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yoshinori Hasegawa
- Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naohiko Inase
- Dept of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sakae Homma
- Dept of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Takafumi Suda
- Second Division, Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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12
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Enomoto N, Egashira R, Tabata K, Hashisako M, Kitani M, Waseda Y, Ishizuka T, Watanabe S, Kasahara K, Izumi S, Shiraki A, Miyamoto A, Kishi K, Kishaba T, Sugimoto C, Inoue Y, Kataoka K, Kondoh Y, Tsuchiya Y, Baba T, Sugiura H, Tanaka T, Sumikawa H, Suda T. Analysis of systemic lupus erythematosus-related interstitial pneumonia: a retrospective multicentre study. Sci Rep 2019; 9:7355. [PMID: 31089189 PMCID: PMC6517420 DOI: 10.1038/s41598-019-43782-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/01/2019] [Indexed: 01/01/2023] Open
Abstract
Thoracic diseases in patients with systemic lupus erythematosus (SLE), especially interstitial pneumonia (SLE-IP), are rare and have been poorly studied. The aims of this multicentre study were to evaluate SLE-IP and elucidate its clinical characteristics and prognosis. Fifty-five patients with SLE-IP who had attended the respiratory departments of participating hospitals were retrospectively evaluated in this multicentre study. Clinical information, high-resolution computed tomography (HRCT), and surgical lung biopsy/autopsy specimens were analysed by respiratory physicians, pulmonary radiologists, and pulmonary pathologists. IP patterns on HRCT and lung specimens were classified based on the international classification statement/guideline for idiopathic interstitial pneumonias. The most frequent form of SLE-IP at diagnosis was chronic IP (63.6%), followed by subacute (20.0%), and acute IP (12.7%). Radiologically, the most common HRCT pattern was “Unclassifiable” (54%). Histologically, “Unclassifiable” was the most frequently found (41.7%) among 12 patients with histologically proven IP. Interestingly, accompanying airway diseases were present in nine of these patients (75%). In multivariate analysis, current smoking (hazard ratio [HR] 6.105, p = 0.027), thrombocytopenia (HR 7.676, p = 0.010), anti-double-strand DNA titre (HR 0.956, p = 0.027), and nonspecific interstitial pneumonia (NSIP) + organizing pneumonia (OP) pattern on HRCT (vs. NSIP, HR 0.089, p = 0.023) were significant prognostic factors. In conclusion, chronic IP was the most frequent form of IP in patients with SLE-IP, and “Unclassifiable” was the commonest pattern radiologically and histologically.
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Affiliation(s)
- Noriyuki Enomoto
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan. .,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Ryoko Egashira
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuhiro Tabata
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Mikiko Hashisako
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan.,Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan
| | - Masashi Kitani
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yuko Waseda
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shinyu Izumi
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Akira Shiraki
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine, Ogaki Municipal Hospital, Gifu, Japan
| | - Atsushi Miyamoto
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, Tokyo, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, Tokyo, Japan
| | - Tomoo Kishaba
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Chikatosi Sugimoto
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Clinical Research Centre, National Hospital Organization Kinki-Chuo Chest Medical Centre, Osaka, Japan
| | - Yoshikazu Inoue
- Clinical Research Centre, National Hospital Organization Kinki-Chuo Chest Medical Centre, Osaka, Japan
| | - Kensuke Kataoka
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Yutaka Tsuchiya
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Allergy and Respiratory Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Tomohisa Baba
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Centre, Yokohama, Japan
| | - Hiroaki Sugiura
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Tanaka
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Pathology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hiromitsu Sumikawa
- Diffuse Lung Disease Study Group for Young Generations, Nagasaki, Japan.,Department of Diagnostic Radiology, Sakai City Medical Centre, Osaka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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13
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Ueki S, Hebisawa A, Kitani M, Asano K, Neves JS. Allergic Bronchopulmonary Aspergillosis-A Luminal Hypereosinophilic Disease With Extracellular Trap Cell Death. Front Immunol 2018; 9:2346. [PMID: 30364279 PMCID: PMC6193060 DOI: 10.3389/fimmu.2018.02346] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/21/2018] [Indexed: 12/16/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is characterized by an early allergic response and late-phase lung injury in response to repeated exposure to Aspergillus antigens, as a consequence of persistent fungal colonization of the airways. Here, we summarize the clinical and pathological features of ABPA, focusing on thick mucus plugging, a key observation in ABPA. Recent findings have indicated that luminal eosinophils undergo cytolytic extracellular trap cell death (ETosis) and release filamentous chromatin fibers (extracellular traps, ETs) by direct interaction with Aspergillus fumigatus. Production of ETs is considered to be an innate immune response against non-phagocytable pathogens using a "trap and kill" mechanism, although eosinophil ETs do not promote A. fumigatus damage or killing. Compared with neutrophils, eosinophil ETs are composed of stable and condensed chromatin fibers and thus might contribute to the higher viscosity of eosinophilic mucus. The major fate of massively accumulated eosinophils in the airways is ETosis, which potentially induces the release of toxic granule proteins and damage-associated molecular patterns, epithelial damage, and further decreases mucus clearance. This new perspective on ABPA as a luminal hypereosinophilic disease with ETosis/ETs could provide a better understanding of airway mucus plugging and contribute to future therapeutic strategies for this challenging disease.
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Affiliation(s)
- Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Akira Hebisawa
- Clinical Research Center and Pathology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masashi Kitani
- Clinical Research Center and Pathology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Josiane S Neves
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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14
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Ando T, Kawashima M, Matsui H, Takeda K, Sato R, Ohshima N, Nagai H, Kitani M, Hebisawa A, Ohta K. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis. Respiration 2018; 96:507-513. [PMID: 30286448 DOI: 10.1159/000490548] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/29/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies. OBJECTIVES The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis. METHODS Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients. RESULTS Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2-4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up. CONCLUSIONS Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis.
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Affiliation(s)
- Takahiro Ando
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo,
| | - Masahiro Kawashima
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotoshi Matsui
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Keita Takeda
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Ryota Sato
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Nobuharu Ohshima
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hideaki Nagai
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Akira Hebisawa
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Ken Ohta
- Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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15
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Yokoyama A, Tamura A, Miyakawa K, Kusaka K, Shimada M, Hirose T, Matsui H, Kitani M, Hebisawa A, Ohta K. Pulmonary Adenocarcinoma, Harboring Both an EGFR Mutation and ALK Rearrangement, Presenting a Stable Disease to Erlotinib and a Partial Response to Alectinib. Intern Med 2018; 57. [PMID: 29526950 PMCID: PMC6148164 DOI: 10.2169/internalmedicine.0383-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 63-year-old woman with pulmonary adenocarcinoma (stage IIIB) that was positive for an epidermal growth factor receptor (EGFR) mutation and an anaplastic lymphoma kinase (ALK) rearrangement was treated with erlotinib as the first-line treatment, resulting in a stable disease. Due to skin rashes, fatigue and anorexia, erlotinib was suspended on erlotinib day 44. Alectinib was administered as the second-line treatment, exhibiting a partial response. On alectinib day 56, drug-induced lung injury forced suspension of alectinib, which was cured with corticosteroid therapy. ALK-tyrosine kinase inhibitors may be more effective for patients positive for both EGFR mutation and ALK rearrangement than other agents.
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Affiliation(s)
- Akira Yokoyama
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
- Department of Respiratory Medicine, Graduated School of Medicine, The University of Tokyo, Japan
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Kazuko Miyakawa
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Kei Kusaka
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masahiro Shimada
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Takashi Hirose
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Akira Hebisawa
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
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16
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Nakamura Y, Sugino K, Kitani M, Hebisawa A, Tochigi N, Homma S. Clinico-radio-pathological characteristics of unclassifiable idiopathic interstitial pneumonias. Respir Investig 2017; 56:40-47. [PMID: 29325680 DOI: 10.1016/j.resinv.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/26/2017] [Accepted: 09/01/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The purpose of this study was to clarify the clinico-radio-pathological characteristics and prognostic factors of unclassifiable-idiopathic interstitial pneumonias (U-IIPs) diagnosed by surgical lung biopsy. METHODS Among 86 patients with interstitial pneumonia who underwent surgical lung biopsy from January 2005 to September 2013, 33 (38.4%; 16 male patients; mean age, 64.4 ± 8.8 years) were diagnosed with U-IIPs. They were subsequently categorized into rapidly progressive (n = 7), slowly progressive (n = 7), and stable (n = 19) groups based on the decrease of the percent predicted forced vital capacity or percent predicted diffusing capacity of the lung carbon monoxide and the occurrence of acute exacerbation. The clinico-radio-pathological features and survival rates of the patients who were followed up for at least 3 years were examined. These cases were reevaluated retrospectively by multidisciplinary discussion. RESULTS The rapidly progressive group had a significantly poorer prognosis than that of the other groups (p < 0.0001). Although there were no significant pattern differences on the chest high-resolution computed tomography, the fibrosis scores were significantly higher in the rapidly progressive group (p = 0.002). Furthermore, the percentage of fibroblastic foci assessed by the pathological analysis was also significantly higher in the rapidly progressive group (p = 0.006). Nine (27.3%) patients developed connective tissue diseases during follow-up. CONCLUSIONS The radiologic patterns were not significantly different among the three clinical U-IIPs subgroups. Nevertheless, our findings suggested that the fibrosis scores and the percentage of fibroblastic foci could provide a prognostic assessment in U-IIPs.
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Affiliation(s)
- Yasuhiko Nakamura
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan.
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Masashi Kitani
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Akira Hebisawa
- Department of Pathology, National Hospital Organization Tokyo National Hospital, Japan
| | - Naobumi Tochigi
- Department of Pathology, Toho University Omori Medical Center, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
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17
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Kitani M, Ogawa A, Sarashina T, Yamadori I, Matsubara H. Histological changes of pulmonary arteries treated by balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv 2015; 7:857-9. [PMID: 25516761 DOI: 10.1161/circinterventions.114.001533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Masashi Kitani
- From the Department of Clinical Pathology (M.K., I.Y.), Department of Clinical Science (A.O., H.M.), and Department of Cardiology (T.S., H.M.), National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Aiko Ogawa
- From the Department of Clinical Pathology (M.K., I.Y.), Department of Clinical Science (A.O., H.M.), and Department of Cardiology (T.S., H.M.), National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Toshihiro Sarashina
- From the Department of Clinical Pathology (M.K., I.Y.), Department of Clinical Science (A.O., H.M.), and Department of Cardiology (T.S., H.M.), National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ichiro Yamadori
- From the Department of Clinical Pathology (M.K., I.Y.), Department of Clinical Science (A.O., H.M.), and Department of Cardiology (T.S., H.M.), National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- From the Department of Clinical Pathology (M.K., I.Y.), Department of Clinical Science (A.O., H.M.), and Department of Cardiology (T.S., H.M.), National Hospital Organization Okayama Medical Center, Okayama, Japan.
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18
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Kobayashi S, Yamaguchi S, Katsube T, Kitani M, Okada K, Kitamura J, Tsunematsu T. Influence of social environmental factors on cerebral circulation and mental function in the normal aged. Monogr Neural Sci 2015; 11:163-8. [PMID: 6738548 DOI: 10.1159/000409206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Okamoto N, Suzuki H, Kawahara K, Honda K, Miura N, Hirashima T, Tamiya M, Morishita N, Shiroyama T, Tanaka A, Tani E, Hamaguchi M, Kitani M, Yamada T, Kawase I. The alternatively spliced actinin-4 variant as a prognostic marker for metastasis in small-cell lung cancer. Anticancer Res 2015; 35:1663-1667. [PMID: 25750325] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The alternatively spliced actinin-4 variant (ACTN4va) is expressed in small-cell lung cancer (SCLC) and is thought to be a potential diagnostic marker. However, ACTN4va expression has not been examined in transbronchial biopsy specimens. MATERIALS AND METHODS We retrospectively examined the relationship between ACTN4va expression, clinical factors and survival in 104 consecutive newly-diagnosed SCLC patients. RESULTS Of the 104 screened cases, 83 (median age=69 years; transbronchial biopsy, 71) were included in our study. Survival was significantly different in the group with no distant metastasis (1996 vs. 422 days, respectively; p=0.000115) but was not significantly different with regard to ACTN4va expression in the group with distant metastasis (293 vs. 254 days, respectively; p=0.678). CONCLUSION ACTN4va expression was identifiable in small biopsy samples. ACTN4va expression was also significantly related to distant metastasis and could stratify SCLC patients according to prognosis.
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Affiliation(s)
- Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kazufumi Honda
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Nami Miura
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Eriko Tani
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Masanari Hamaguchi
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Masashi Kitani
- Department of Clinical Investigation, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tesshi Yamada
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ichiro Kawase
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
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Ogawa A, Kitani M, Mizoguchi H, Munemasa M, Matsuo K, Yamadori I, Andou A, Matsubara H. Pulmonary microvascular remodeling after balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension. Intern Med 2014; 53:729-33. [PMID: 24694486 DOI: 10.2169/internalmedicine.53.1343] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We herein report a case of peripheral type chronic thromboembolic pulmonary hypertension treated with medical therapy and subsequent balloon pulmonary angioplasty (BPA). After a series of BPA procedures, the patient's hemodynamics almost completely normalized. The patient was later diagnosed with lung carcinoma, and the vasculature of the resected lung demonstrated intimal thickening and luminal stenosis in the pulmonary arteries in both the areas where BPA was performed and not performed, in spite of a marked reduction in pulmonary arterial pressure. The present case is the first report on the histology of the pulmonary vasculature following BPA.
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Affiliation(s)
- Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan
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22
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Okamoto N, Suzuki H, Shiroyama T, Tamiya M, Kitani M, Kurata K, Otsuka T, Yamadori T, Kawahara K, Hirashima T. The Bronchoscopy-Guided Re-Biopsy of Non-Small Cell Lung Cancer in Patients Who Relapse After Gefitinib Therapy. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.149] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Takahashi K, Kitani M, Fukuda H. [A case of Avellis' syndrome with ipsilateral central facial palsy due to a small medullary infarction]. Rinsho Shinkeigaku 2000; 40:409-11. [PMID: 10967664] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We report a 51-year-old man with mild left central facial palsy and left Avellis' syndrome due to a small medullary infarction. On admission, neurological examination revealed hoarseness, dysphasia, absent left gag reflex, palsies of the left vocal cord and left soft palate, and hypalgesia and thermohypesthesia on the right side of the trunk and extremities. In addition, he had a mild left central facial palsy. He had no nausea, vomiting, vertigo, hiccups, nystagmus, Horner's sign, facial numbness, or paresis or ataxia of the limbs. A T2 weighted MRI showed a small, high signal intensity area in the left dorsal region of the medulla and this lesion was presumed to involve the nucleus ambiguus and a part of the spinothalamic tract. These findings suggest that an aberrant supranuclear pathway, looping around the nucleus ambiguus to the facial nucleus exists in our patient.
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Affiliation(s)
- K Takahashi
- Department of Neurology, Masuda Red Cross Hospital
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24
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Kishi T, Uegaki J, Kitani M, Fujimoto A, Naganuma R. The usefulness of single photon emission computed tomography in Charles Bonnet syndrome: a case with occipital lobe involvement. Gen Hosp Psychiatry 2000; 22:132-5. [PMID: 10896496 DOI: 10.1016/s0163-8343(99)00053-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Experimental studies have demonstrated that mild hyperthermia exacerbates ischemia-induced neuronal injury. MATERIAL AND METHODS We examined the relationship between body temperature and functional outcome in 183 patients suffering from cerebral infarction, and admitted within 24 h from the onset of stroke. Patients' functional capacities in daily life were evaluated by Rankin's score before the attack (RS0), on the day of admission (RS1), and 3 months after the onset of stroke (RS90). RESULTS RS90 showed an independent correlation with RS0, RS1, age, infarct size and maximum body temperature recorded within the first 7 days from the onset of stroke by multivariate analysis. History of previous cerebrovascular accidents, atrial fibrillation, hemorrhagic transformation, infection, and a hypothalamic lesion showed significant associations with RS90 by the Mann-Whitney U-test, but not by multivariate analysis. Infarct size correlated with body temperature, atrial fibrillation, and hemorrhagic transformation. CONCLUSION Body temperature correlated well with both functional outcome and infarct size in patients with an acute cerebral infarction.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital, Shimane, Japan
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26
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Takahashi K, Kitani M, Fukuda H, Kobayashi S. Vascular risk factors for atherosclerotic lesions of the middle cerebral artery detected by magnetic resonance angiography (MRA). Acta Neurol Scand 1999; 100:395-9. [PMID: 10589800 DOI: 10.1111/j.1600-0404.1999.tb01059.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 12/01/2022]
Abstract
OBJECTIVES To examine the relationship between atherosclerotic lesions of the middle cerebral artery (MCA) detected on MRA and vascular risk factors. MATERIAL AND METHODS We retrospectively assessed 279 patients (mean age, 69.0+/-11.3 years) who visited the Department of Neurology of Masuda Red Cross Hospital and underwent three-dimensional, time-of-flight MRA of the head between January 1996 and October 1998. Cases of cerebral embolism and internal carotid artery occlusion were excluded. Diagnoses were cerebral infarction (n = 152) and others (n = 127). We evaluated stenotic or occlusive lesions of the MCA (M1 portion), using MRA. Age, sex, history of hypertension, HbA1c, total cholesterol, fasting triglyceride, high density lipoprotein, lipoprotein(a), blood pressure, hematocrit, smoking and left ventricular hypertrophy (LVH) on ECG were included in the analysis. RESULTS 36 patients (12.9%) had stenotic or occlusive lesions of the MCA on MRA. Univariate analysis showed that age, hypertension and HbA1c were significantly correlated with MCA lesions. Multiple logistic regression analysis showed that HbA C and hypertension were significant and independent predictors for MCA lesions. CONCLUSION Hypertension and high serum HbAlc levels may contribute to the development of atherosclerotic lesions of the MCA in Japanese people.
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Affiliation(s)
- K Takahashi
- Department of Neurology, Masuda Red Cross Hospital, Japan
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Kitani M, Asada Y, Sakata J, Kitamura K, Sumiyoshi A, Eto T. Cell density of adrenomedullin-immunoreactive cells in the gastric endocrine cells decreases in antral atrophic gastritis. Histopathology 1999; 34:134-9. [PMID: 10064392 DOI: 10.1046/j.1365-2559.1999.00573.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
AIMS Adrenomedullin (AM) is a novel hypotensive and vasorelaxing peptide recently isolated from human phaeochromocytoma tissue, and is widely distributed in various organs. In this study we examined the localization of AM-immunoreactive (IR) cells in the gastric mucosa and AM-IR cell density in antral atrophic gastritis. METHODS AND RESULTS Gastric mucosal tissues were taken from the gastric body and antral mucosa of 52 patients (27 men, 25 women; mean age 56.0 (range 20-86) years). Immunohistochemical analysis revealed that AM-IR cells were present in the pyloric glands, but not in the fundic glands, and that AM-IR cells were stained positively for chromogranin A and gastrin. The percentage of AM-IR cells vs chromogranin A- and gastrin-IR cells was 42 and 56%, respectively. The number of AM-IR cells decreased with the progression of severity of atrophic changes in the pyloric gland, and also of mononuclear cell infiltration. There was no correlation between the number of AM-IR cells and the degree of neutrophilic infiltration. Similar findings were also obtained for gastrin-IR cells. CONCLUSION AM-IR cells are present in the endocrine cells including gastrin-IR cells in the pyloric glands. These results suggest that AM may contribute to gastrin secretion in the pyloric glands.
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Affiliation(s)
- M Kitani
- First Department of Internal Medicine, Kihara Kiyotake, Japan
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Sakata J, Asada Y, Shimokubo T, Kitani M, Inatsu H, Kitamura K, Kangawa K, Matsuo H, Sumiyoshi A, Eto T. Adrenomedullin in the gastrointestinal tract. Distribution and gene expression in rat and augmented gastric adrenomedullin after fasting. J Gastroenterol 1998; 33:828-34. [PMID: 9853555 DOI: 10.1007/s005350050183] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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] [Indexed: 02/04/2023]
Abstract
The aim of this study was to investigate the regional distribution, molecular forms, and gene expression of adrenomedullin in the rat gastrointestinal tract and to examine physiological changes in gastric adrenomedullin after 24-h fasting. The tissue concentration was measured by radioimmunoassay. The molecular forms were analyzed by high performance liquid chromatography. mRNA levels were quantified by Northern blotting and cells positive for adrenomedullin immunoreactivity were localized by immunohistochemistry. A high concentration of adrenomedullin was found in stomach, cecum, and colon (450-520 fmol/g wet tissue). Adrenomedullin immunoreactivity was also detected in duodenum, jejunum, and ileum (200-250 fmol/g wet tissue). Transcripts of the adrenomedullin gene were widely expressed throughout the gastrointestinal tract. The major form of adrenomedullin immunoreactivity in stomach and colon corresponded precisely with authentic adrenomedullin peptide. Adrenomedullin immunoreactive cells were present in the gastrointestinal endocrine system. The concentration and mRNA level of gastric adrenomedullin after fasting were significantly increased compared with findings in controls. Adrenomedullin is ubiquitous in the gastrointestinal tract, and may be produced by endocrine cells. The results suggest that adrenomedullin, through its potent vasodilating activity, may play some role, in the stomach including the regulation of the mucosal blood flow.
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Affiliation(s)
- J Sakata
- First Department of Internal Medicine, Miyazaki Medical College, Japan
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Otani S, Taniguchi T, Matsui T, Kishimoto H, Hinohara T, Komatsu K, Kitani M, Shimatani Y. [A case of leiomyosarcoma of the jejunum with postoperative hepatic encephalopathy]. Gan To Kagaku Ryoho 1998; 25:2127-30. [PMID: 9838918] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report a case of leiomyosarcoma of the jejunum with postoperative hepatic encephalopathy. A 60-year-old man was operated for tumor of the abdomen. He was diagnosed as leiomyosarcoma of the jejunum with disseminated peritoneal metastasis, but no liver metastasis and cirrhosis. A palliative resection of the jejunum was performed. After operation, disturbance of orientation and apraxia with electroencepharographic abnormality and hyperammonemia developed. He was diagnosed as hepatic encephalopathy without lesion of the liver, and died 11 months after surgery. We consider that the portosystemic shunt and bleeding from the digestive tract due to invasion of metastatic lesions caused hepatic encephalopathy.
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Affiliation(s)
- S Otani
- Dept. of Surgery, Masuda Red Cross Hospital
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Abstract
Adrenomedullin (AM) is a biologically active peptide recently isolated from phaeochromocytoma. We report here the distribution and characterization of immunoreactive AM and gene expression of AM in human gastrointestinal tissue. Using a sensitive radioimmunoassay system for the peptide, immunoreactive human AM was detected in the stomach, duodenum, jejunum, ileum and colon. The AM concentration of these tissues was about 0.4-0.8 pmol/g wet tissue. Reverse phase and gel filtration high-performance liquid chromatographies showed that most of the immunoreactive AM in stomach and jejunum was identical to authentic human AM. By northern blot analysis, human AM mRNA was found to be expressed ubiquitously in the human gastrointestinal tissues. Furthermore, an immunohistochemical study revealed that immunoreactive AM cells were present in the gastrointestinal glands. These results suggest that AM may play some role as a gastrointestinal hormone.
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Affiliation(s)
- M Kitani
- First Department of Internal Medicine, Miyazaki Medical College, Japan
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Abstract
Magnetic resonance imaging (MRI) of thigh and leg muscles was performed in a patient with alcoholic myopathy showing myalgia, hypercreatine kinasemia, and hypermyoglobinemia. High signal intensities in both T1- and T2-weighted images were widely distributed in the affected muscle groups, which most likely reflected lipid accumulation. Although he had hypermyoglobinemia, MRI and muscle biopsy did not show findings of rhabdomyolysis, such as necrosis, regeneration, and edema. We suggest that the high signal intensities in this case may have indicated "prerhabdomyolysis" related to alcohol abuse and that muscle MRI is useful in the evaluation of alcoholic myopathy, mainly predicting the onset of rhabdomyolysis.
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Affiliation(s)
- T Kishi
- Department of Psychiatry, Shimane Medical University, Izumo, Japan
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Abstract
BACKGROUND We report here a rare case of repeated syncopal episodes associated with smoking and findings of 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain single-photon emission CT (SPECT) imaging. CASE DESCRIPTION A 77-year-old man had four syncopal episodes during a half-month period. All four occurred when he stood up and walked immediately after smoking a cigarette, and syncope did not occur after cessation of smoking. Although upright testing revealed orthostatic hypotension, the patient did not complain of fainting on standing alone. Compared with brain SPECT in the supine position, perfusion was decreased in the posterior circulation structures after the subject smoked a cigarette or chewed nicotine gum. CONCLUSIONS The combination of cerebral vasoconstriction due to smoking and orthostatic hypotension probably decreased cerebral blood flow in this patient, resulting in syncope.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital, Shimane, Japan
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Kitani M, Miyamoto G, Nagasawa M, Yamada T, Matsubara J, Uchida M, Odomi M. Biotransformation of the novel inotropic agent toborinone (OPC-18790) in rats and dogs. Evidence for the formation of novel glutathione and two cysteine conjugates. Drug Metab Dispos 1997; 25:663-74. [PMID: 9193867] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The metabolism of toborinone, (+/-)-6-[3-(3,4-dimethoxybenzylamino)-2-hydroxypropoxy]-2(1H)-quin - olinone, a novel inotropic agent, was studied in rats and dogs after intravenous administration. Chemical structures of the 13 metabolites were characterized by direct-probe FAB/MS and field desorption/MS, LC/FAB/MS, and various NMR measurements. After intravenous dosing of 10 mg/kg [14C]toborinone, fecal and urinary recoveries of the 14C dose were approximately 70% and 26-30%, respectively, in both rats and dogs. The predominant component of radioactivity was the unchanged toborinone in every biological specimen in rats and dogs. Although unchanged toborinone was predominantly observed, toborinone underwent extensive conjugations with glucuronic acid, sulfate, and glutathione, either directly or following phase I reaction. Metabolites resulting from oxidative N-C cleavage were minor both in number and in quantity in every biological specimen in rats and dogs. In rats, toborinone underwent O-demethylation to form M-7 and successive phase it reaction to yield the glucuronide M-1 and the sulfoconjugate M-2, and deconjugation to yield M-7, which was a primary metabolite accounted for 35.67% of the radioactivity excreted in the feces by 48 hr. Conjugates M-1 and M-2 were the major metabolites in rat plasma. In dogs, toborinone was metabolized via mercapturic acid pathway to yield the primary metabolites, cysteine conjugates M-10 and M-11 that accounted for 19.10% and 6.70% of the radioactivity excreted in the feces by 48 hr and that were detected species specifically in dogs. The glutathione conjugate M-13, which was isolated from in vitro incubations using dog liver, led us to consider a possible mercapturic acid pathway from the parent compound to M-10. Metabolites in dog plasma and those in urine in both rats and dogs were minor in quantity. The metabolic pathways of toborinone in rats and dogs are proposed herein.
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Affiliation(s)
- M Kitani
- Tokushima Research Institute, Otsuka Pharmaceutical Co., Ltd., Japan
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Fukuda H, Kitani M. [A case of diffuse fasciitis and its MRI findings]. Rinsho Shinkeigaku 1996; 36:594-597. [PMID: 8810857] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A 36-year-old woman with diffuse fasciitis and her MRI findings are reported. The patient developed pain and swelling in the calves, right forearm, and left arm, predominantly in the right calf muscle. Her body temperature was 38.4 degrees C, the ESR 104 mm/2 hours and white blood cell count 8,000/microliter without eosinophilia. The fascia and muscle were biopsied from her right calf. The light microscopy showed that the fascia was thickened and infiltrated with mononuclear cells with no eosinophils, mostly in perivascular areas. The muscle fibers were spared. MRI of legs revealed marked hyperintensities on T2 and mild hyperintensities on T1-weighted images in the fascia, superficial flexor muscles, especially soleus muscle, and Achilles tendons. Moderate dose of prednisolone was very effective and the abnormal signals on MRI almost disappeared within a month. T2 weighted MRI was very useful to detect the lesions and to evaluate the course of diffuse fasciitis.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital
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Abstract
BACKGROUND AND PURPOSE A new studies have observed a significant inverse correlation between cigarette smoking or lipid abnormalities and periventricular hyperintensities (PVHs) on T2-weighted magnetic resonance imaging (MRI) scans of the brain, which is surprising because smoking and hyperlipidemia are considered risk factors for cerebrovascular disease. We investigated the relation between smoking and lipid abnormalities and PVHs on T2-weighted MRIs. METHODS MRI scans were performed in 253 patients over the age of 40 years, and PVHs were assessed retrospectively by use of a five-point scale. Patients who were receiving medical treatment for hyperlipidemia were excluded. Serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides were determined in the fasting state by an automated enzymatic procedure. The low-density lipoprotein (LDL) cholesterol level was calculated by use of Friedewald's equation. Age, sex, hypertensive status, antihypertensive treatment, presence or absence of diabetes mellitus, and history of stroke were included in the analysis. RESULTS Multiple linear regression analysis showed that age, hypertension, smoking, and antihypertensive treatment were significantly and independently correlated with the PVH score. The standard partial regression coefficients were .39 (P<.0001) for age, .33 (P<.0001) for hypertension, .16 (P=.0062) for smoking, and -.18 (P=.0124) for antihypertensive treatment. Hypercholesterolemia (total cholesterol level >220 mg/dL), HDL hypocholesterolemia (HDL cholesterol level <40 mg/dL, LDL hypercholesterolemia (LDL cholesterol level > 130 mg/dL), hypertriglyceridemia (triglyceride level >150 mg/dL), sex, diabetes mellitus, and a history of stroke were not correlated with the PVH score. CONCLUSIONS Cigarette smoking was a weak but significant positive predictor of the PVH score and was independent of age, hypertension, and antihypertensive treatment. Lipid abnormalities were not related to the PVH score.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital, Japan
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Inatsu H, Sakata J, Shimokubo T, Kitani M, Nishizono M, Washimine H, Kitamura K, Kangawa K, Matsuo H, Eto T. Distribution and characterization of rat immunoreactive proadrenomedullin N-terminal 20 peptide (PAMP) and the augmented cardiac PAMP in spontaneously hypertensive rat. Biochem Mol Biol Int 1996; 38:365-72. [PMID: 8850532] [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: 02/02/2023]
Abstract
Proadrenomedullin N-terminal 20 peptide (PAMP) is a novel hypotensive peptide processed from an adrenomedullin precursor. In this study, high concentrations of immunoreactive PAMP (ir-PAMP) were detected in rat cardiac atrium and adrenal gland by the radioimmunoassay (RIA) for rat PAMP. The mean plasma concentration of rat ir-PAMP was 3.8 +/- 0.3 fmol/ml. Analysis in atrium, adrenal gland and plasma with high performance liquid chromatographies showed that most ir-PAMP emerged as one major peak at the position exactly identical to that of the authentic rat PAMP. We further investigated the tissue and plasma concentrations of rat ir-PAMP in spontaneously hypertensive rat (SHR) to elucidate the role of PAMP in hypertension. The ir-PAMP concentration in heart tissue of SHR was found to be increased compared with that of the control rat. Especially, the atrial concentration of ir-PAMP of SHR (5.66 +/- 0.78 fmol/mg wet tissue) was significantly higher than that of the control (3.29 +/- 0.22 fmol/mg wet tissue). Cardiac PAMP might have a role for the protection from systemic hypertension.
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Affiliation(s)
- H Inatsu
- First Department of Internal Medicine, Miyazaki Medical College, Japan
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Yoshimura T, Ohnishi A, Yamamoto T, Fukushima Y, Kitani M, Kobayashi T. Two novel mutations (C53S, S26L) in the connexin32 of Charcot-Marie-Tooth disease type X families. Hum Mutat 1996; 8:270-2. [PMID: 8889588 DOI: 10.1002/(sici)1098-1004(1996)8:3<270::aid-humu12>3.0.co;2-#] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- T Yoshimura
- Department of Neurology, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Fukuda H, Kitani M. Differences between treated and untreated hypertensive subjects in the extent of periventricular hyperintensities observed on brain MRI. Stroke 1995; 26:1593-7. [PMID: 7660404 DOI: 10.1161/01.str.26.9.1593] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [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: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Several reports have stated that the periventricular abnormalities found on T2-weighted MRI or CT are associated with age and hypertension. However, there have been no reports on the effect of hypertension treatment on white matter abnormalities. We studied the association between cardiovascular risk factors and periventricular hyperintensities (PVHs) on T2-weighted MRI and the differences between treated and untreated hypertensive subjects in the extent of PVHs. METHODS The extent of PVH observed on 238 MRI scans was assessed retrospectively in 238 patients older than 40 years with the use of a five-point (0 to 4) classification scale. Hypertensive subjects were divided into two groups: patients receiving no or irregular treatment and patients receiving regular treatment for hypertension. RESULTS Age, hypertension, treatment of hypertension, and multiple cerebral vascular lesions on MRI correlated significantly and independently with the extent of PVH. Sex and diabetes mellitus did not correlate with PVH. The Mann-Whitney U test showed significantly more extensive PVH in subjects with no or irregular treatment of hypertension compared with normotensives (2.5 +/- 0.7 versus 1.9 +/- 0.6, P < .0001) and compared with subjects receiving regular treatment of hypertension (2.5 +/- 0.7 versus 2.1 +/- 0.5, P = .0019). The latter patients had more extensive PVH than normotensives, but the difference was not significant. Mean systolic and diastolic blood pressure differed significantly among the three groups. CONCLUSIONS Hypertension and age were major predictors of the extent of PVH. Regular treatment for hypertension appeared to prevent the progression of PVH.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital, Shimane, Japan
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Fukuda H, Kitani M. [Unilateral posterior spinal artery syndrome of the upper cervical cord associated with vertebral artery occlusion]. Rinsho Shinkeigaku 1994; 34:1171-4. [PMID: 7729101] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Upper cervical cord infarction in the territory of the posterior spinal artery is very rare. We present here an elderly man who developed right upper cervical (C1-2) posterior spinal artery syndrome associated with vertebral artery occlusion. A 62-year-old man suffered a right upper cervical (C1-2) posterior spinal artery syndrome. The onset was associated with neck flexion. Magnetic resonance imaging clearly showed an ischemic lesion. Cerebral angiography revealed occlusion of the distal end of an ipsilateral vertebral artery. The occlusion of the vertebral artery probably caused the cervical cord infarction. The neck flexion possibly induced thrombogenesis in the vertebral artery. Unilateral upper cervical posterior spinal artery syndrome associated with vertebral occlusion following neck flexion was suggested.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital
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Kobayashi S, Yamaguchi S, Koide H, Okada K, Kitani M, Yamashita K, Bokura H. [Prospective study on the influence of social activity on development of dementia in the neurologically normal elderly]. Nihon Ronen Igakkai Zasshi 1994; 31:293-298. [PMID: 8041024 DOI: 10.3143/geriatrics.31.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 05/22/2023]
Abstract
We investigated the rate of development of dementia in 84 neurologically normal elderly subjects living in an old-age home (30 subjects, mean 77.2 years) or their own home 954, 73.7) prospectively. We examined cerebral blood flow (CBF), Hasegawa's scale (HS) and Kohs' block design test 6 to 9 years before this study (1991). HS and Kohs' IQ were significantly lower in the old-age home group than that in their own home group at that time. However, there were no demented subjects. Mortality was 21%, and we confirmed 9 dementia and 6 stroke cases during the period of observation. Twenty-seven percent of the old-age home group showed dementia in 1991. This rate was significantly higher than that for the elderly living in their own home (6.7%). Occurrence of stroke was also significantly higher in the former group than in the latter group. The subjects who developed stroke during observation showed a high incidence of dementia. Mean CBF measured on the first examination was significantly lower in dementia cases with stroke than in dementia cases without it. We performed MRI in 4 demented cases in 1991 (Fig. 1). Two cases showed no significant lesions and the other cases showed cerebral infarction which could cause dementia. These results indicate that life style and social environment may have significant effect on aging of the brain and on development of dementia in the elderly.
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Affiliation(s)
- S Kobayashi
- Third Department of Internal Medicine, Shimane Medical University
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41
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Ohnishi A, Toyoki T, Ohno T, Takeshige Y, Fujita T, Kodama K, Mishima M, Hirayama A, Kitani M, Miyamoto G. Pharmacokinetics and pharmacodynamics of intravenous OPC-18790 in humans: a novel nonglycosidic inotropic agent. J Clin Pharmacol 1994; 34:176-83. [PMID: 8163718 DOI: 10.1002/j.1552-4604.1994.tb03983.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 01/29/2023]
Abstract
OPC-18790, a nonglycosidic intropic agent, is now under clinical development for treatment of congestive heart failure. Two separate studies (one placebo-controlled) were conducted to evaluate its pharmacokinetics and pharmacodynamics after intravenous administration to a total of 36 healthy male subjects. The drug was administered both rapidly as a .05-, .1-, .2-, or .4-mg/kg intravenous dose, and as a 1-hour infusion of .5, 1.0, 2.5, 5.0, 10.0, or 15.0 micrograms/kg/minute. Echocardiograms (ECHO) were evaluated before and immediately and 4 hours after the rapid administrations. Blood pressure (BP), heart rate (HR), and QTc in the electrocardiogram also were monitored in the rapid administration study. OPC-18790 was generally well tolerated by all subjects. Maximum peak plasma concentration and area under the curve increased linearly with dose in both studies. The t1/2, total body clearance of drug from plasma (CL), and the dose fraction excreted unchanged in the urine (fe) were comparable and dose-independent at the doses tested in both studies. The overall mean values of t1/2 alpha, t1/2 beta, CL, and fe were .08 +/- .01 hours, 3.64 +/- .22 hours, .46 +/- .01 L/kg, and 43.5 +/- 1.0%, respectively. Echocardiograms showed that, immediately after rapid administration of up to .4 mg/kg, OPC-18790 increased left cardiac function dose-proportionally (P < .05 to .01): the ejection fraction by 21.1% and fractional shortening by 26.5% compared with the predose values, blood pressure, heart rate, and QTc did not differ between subjects given OPC-18790 and these receiving placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Ohnishi
- Department of Internal Medicine, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
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42
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Koide H, Kobayashi S, Kitani M, Tsunematsu T, Nakazawa Y. Improvement of cerebral blood flow and cognitive function following pacemaker implantation in patients with bradycardia. Gerontology 1994; 40:279-85. [PMID: 7959085 DOI: 10.1159/000213597] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [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: 01/28/2023] Open
Abstract
We investigated the effects of pacemaker implantation on cerebral blood flow and cognitive function in 14 severely bradycardic patients (mean age 75.2 years). Cerebral blood flow and verbal intelligence improved after the pacemaker implantation. Systolic and mean arterial blood pressure was significantly reduced after the implantation. Changes in cerebral blood flow significantly correlated with changes in heart rate in polynomial regression analysis, but not with changes in cardiac output. Before the implantation, verbal cognitive function was lower in bradycardic patients than in age-matched control subjects, and brain CT showed significant advanced atrophy in these patients. However, verbal cognitive function was also improved after the implantation. Pacemaker implantation in the severe bradycardic elderly should be beneficial not only for cardiac function but also for brain function. We concluded that these results suggest that heart rate is one of the important factors in the regulation of cerebral circulation in patients with severe bradycardia. Pacemaker implantation in the elderly improved quality of life and may prevent mental deterioration.
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Affiliation(s)
- H Koide
- Third Division of Internal Medicine, Shimane Medical University, Japan
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Kitani M, Miyamoto G, Odomi M. Stereoselective high-performance liquid chromatographic assay for the determination of OPC-18790 enantiomers in human plasma and urine. J Chromatogr 1993; 620:97-104. [PMID: 8106598 DOI: 10.1016/0378-4347(93)80056-a] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A high-performance liquid chromatographic assay method for the quantification of OPC-18790 enantiomers in human plasma and urine is described. A human plasma or urine was extracted with organic solvent under alkaline conditions following the addition of internal standard. The enantiomers and internal standard were then derivatized by reaction with the chiral reagent GITC (2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl isothiocyanate), followed by octadecylsilica chromatographic separation of the diastereomeric products. The mobile phase consisted of acetonitrile-water (41:59). The fluorescence of the eluate was monitored at 355/405 nm. The lowest quantification limit of each enantiomer was 10 ng/ml in plasma and 0.1 micrograms/ml in urine. Both intra- and inter-day coefficients of variation were below 10%. The assay is sensitive, specific and applicable for stereoselective pharmacokinetic studies in human.
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Affiliation(s)
- M Kitani
- Tokushima Research Institute, Otsuka Pharmaceutical Co., Ltd., Japan
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44
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Fukuda H, Kitani M. [Acute respiratory arrest associated with medullary lesion in a case of multiple sclerosis]. Rinsho Shinkeigaku 1993; 33:787-90. [PMID: 8252836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present a case history of a patient with multiple sclerosis who developed an abrupt onset of respiratory arrest associated with medullary lesion. A 27-year-old man developed shallow, totally irregular, ataxic respirations with aggravation of bulbar palsy and quadriplegia in the course of multiple sclerosis. As respiration was almost arrested, artificial respiration was started and continued for five days. Respiration was almost normal after 16 days from the onset of respiratory arrest. MRI showed bilateral, medullary lesions without upper cervical lesions. Pyramidal tracts, medial lemnisci, and paramedian reticular formations in medulla were damaged bilaterally. We supposed that the medullary lesions involved dual respiratory systems: a voluntary system and an automatic system, and caused acute respiratory arrest.
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital
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Fukuda H, Kitani M, Imaoka K. [A case of hereditary motor and sensory neuropathy with vocal cords palsy and diaphragmatic weakness]. Rinsho Shinkeigaku 1993; 33:175-81. [PMID: 8319389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of hereditary motor and sensory neuropathy (HMSN) type 1 (Charcot-Marie-Tooth disease (CMT)) is reported with vocal cords palsy, deafness, diaphragmatic weakness, and cerebellopontine atrophy. A 42-year-old man was admitted to our hospital in April, 1991 with marked respiratory distress. He had been diagnosed as having CMT 14 years previously. On admission to our hospital, he revealed dyspnea with marked stridor during inspiration. Physical examination showed marked use of respiratory accessory muscles with thoracoabdominal paradox in the supine position. Neurologic examination revealed tonic pupils, mild bilateral weakness of facial muscles, deafness, mild bulbar palsy, severe wasting and weakness in both proximal and distal muscles of the arms and legs, areflexia, distal loss of all sensory modalities. Pes cavus and hammer toe were present. Movement of upper extremities was ataxic. No hypertrophic changes were noted in his peripheral nerves. Peripheral nerve conduction study showed undetectable both sensory and motor action potentials. Electromyography showed evidence of denervation, more marked in distal muscles. Auditory brain stem response was undetectable. Chest radiographic film showed a normal-sized heart with marked elevation of both hemidiaphragm. Laryngofiberscopy confirmed the presence of bilateral vocal cord paralysis without tumor formation, inflammation or anomaly. The vocal cords lay near the midline and did not show any movement during respiration. Moderate cerebellopontine atrophy was confirmed on MRI scan. A sural nerve section showed severe decrease of myelinated fibers, and onion bulbs. Diagnosis of HMSN type 1 was made by clinical, electrodiagnostic, and sural nerve sections study.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Fukuda
- Department of Neurology, Masuda Red Cross Hospital
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Kitani M, Kobayashi S, Yamaguchi S, Okada K. Cerebral atrophy precedes the change in cerebral blood flow in patients with ischemic cerebrovascular disease: a short-term follow-up study. Gerontology 1992; 38:1-8. [PMID: 1612456 DOI: 10.1159/000213300] [Citation(s) in RCA: 3] [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: 12/27/2022] Open
Abstract
Cerebral atrophy and the decrease in cerebral blood flow (CBF) progress with advancing age. Which of them takes first place, the changes in CBF or cerebral atrophy? We investigated longitudinal changes in CBF and cerebral atrophy in 14 patients with ischemic cerebrovascular disease (CVD): 11 patients with supratentorial lacunar infarction and 3 with carotid transient ischemia attack who were neurologically stable during the 1-3 years of observation. Cerebral atrophy was estimated by the brain atrophy index (BAI): one of the CT area measurement methods, and CBF was measured using the 133Xe inhalation technique. While significant progression of cerebral atrophy was observed, there was no significant change in CBF. Cerebral atrophy precedes the change in CBF and CVD.
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Affiliation(s)
- M Kitani
- Department of Neurology, Masuda Red Cross Hospital, Japan
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47
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Kobayashi S, Murata A, Yamaguchi S, Kitani M, Okada K. [Cognitive function, cerebral blood flow and brain atrophy in olivo-ponto-cerebellar atrophy]. Rinsho Shinkeigaku 1990; 30:157-63. [PMID: 2350927] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Eighteen cases of OPCA (9 males and 9 females, age 39-70, mean 57.8 +/- 8.1 years). Mean duration of illness was 65.7 +/- 36 months. Age-matched controls for Brain-CT were 34 cases (13 males and 21 females) (age 39-70, mean 56.8 +/- 9.4 years), in which CT was examined because of functional disorders, and 50 healthy volunteers (25 males and 25 females) (age 36-72, mean 56.6 +/- 7.9 years) for regional cerebral blood flow (rCBF) and mental function. Brain Atrophy Index (BAI) and Ventricular Atrophy Index (VAI) were calculated by digitizer (PCPAD) on CT films in the slice of lateral ventricle level, basal ganglia level and cerebello-pontine level. There were 10 patients of OPCA who examined CT prior to this study. Interval of the two examinations was 21-76 months, mean 53 months. Regional cerebral blood flow (rCBF) were measured by 133 Xe inhalation methods. Intelligence were evaluated with Okabe's Intelligence Scale (Shortened and modified Wechsler's Memory Scale for Japanese Aged) and Kohs' Block Design Test. Depressive state was evaluated with Zung's Self-rating Depression Scale (SDS). RESULTS 1) Cerebello-pontine atrophy was significantly prominent but no cerebral atrophy was observed in OPCA. 2) The rCBF was mildly but significantly reduced in OPCA. 3) Performance and verbal intelligence were significantly low in OPCA. 4) OPCA patients showed significant depressive state. 5) Grade of ADL did not show significant participation in the rCBF, intelligence and depressive state. 6) There was no significant correlation between duration of illness and rCBF or mental functions. 7) Cerebello-pontine atrophy significantly progressed in OPCA patients followed-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Kobayashi
- Third Department of Internal Medicine, Shimane Medical University
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Kitani M, Kobayashi S, Yamaguchi S. Computerized tomography with longitudinal follow-up of brain atrophy in patients with Parkinson's disease. Gerontology 1990; 36:361-8. [PMID: 2076835 DOI: 10.1159/000213222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 12/30/2022] Open
Abstract
Computerized tomographic (CT) studies with longitudinal follow-up of the relationship between supratentorial and infratentorial brain atrophy in Parkinson's disease (PD) using our new CT-derived brain atrophy index (BAI) are reported. In those patients with Parkinson's disease, CT analysis demonstrated a significant increase in brain atrophy compared with controls. Infratentorial BAI correlated significantly with supratentorial BAIs and the decrease in the infratentorial BAI correlated with a corresponding decrease in the supratentorial BAI in those with PD. It is postulated that the infratentorial brain atrophy found in patients with PD could well be secondary to supratentorial brain atrophy.
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Affiliation(s)
- M Kitani
- Third Division of Internal Medicine, Shimane Medical University, Izumo, Japan
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Abstract
The effect of pial arterial pressure (PAP) on brain edema was examined in cats with middle cerebral artery (MCA) occlusion. Measurements of PAP and regional CBF (rCBF) were collected in the central core and the peripheral margin of the MCA territory over 180 min post MCA occlusion. Brain water content in each region was determined at the end of the experiment. MCA occlusion resulted in decreased PAP and rCBF in both the core (PAP = 13 mm Hg, rCBF = 9 ml/100 g/min) and the peripheral region (PAP = 15 mm Hg, rCBF = 18 ml/100 g/min). Brain edema developed in both the core and the peripheral region. Brain water content was correlated inversely with PAP in the core region and positively in the peripheral region. The results indicate that decreased blood flow contributes to cytotoxic edema in the core, and a hydrostatic pressure gradient preferentially enhances edema formation in the peripheral region. Maintenance of high perfusion pressure early after ischemia onset may suppress brain edema in the core region.
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Affiliation(s)
- S Yamaguchi
- Third Division of Internal Medicine, Shimane Medical University, Izumo, Japan
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Yamaguchi S, Kobayashi S, Yamashiata K, Murata A, Kitani M. [Responses of cerebral arteries to the changes in cerebral perfusion pressure]. No To Shinkei 1989; 41:807-11. [PMID: 2803837] [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: 01/02/2023]
Abstract
The responsiveness of cerebral pial arteries and arterioles to changes in systemic arterial blood pressure (SAP) was investigated. Using 9 cats anesthetized with chloralose and urethane, direct, simultaneous measurements of pial arterial pressure (PAP) and cerebral blood flow (CBF) were made during changes in SAP. SAP was varied between 25 and 140 mmHg by the hemorrhage and blood infusion methods. After a partial craniotomy. PAP was measured with a micropipette connected to a servo-controlled micropressure recording system. Punctured pial arteries were grouped into three types according to their diameters, 1A (291 +/- 33 microns), 2A (16 +/- 26 microns), and 3A (70 +/- 10 microns). CBF on the exposed cortex was measured with hydrogen clearance method. The PAPs measured were a linear function of SAP; PAP (1A) = 0.73/SAP-6.6 (r = 0.96), PAP (2A) = 0.62 X SAP-6.6 (r = 0.90), PAP (3A) = 0.61 X SAP-6.4 (r = 0.93). The result indicates that PAPs are entirely dependent on SAP and that SAP induced changes in PAPs are less in the smaller pial arteries. Regional CBF remained constant (55 +/- 4 ml/100 g/min) between 60 and 140 mmHg of SAP. A significant decrease in CBF was observed below 60 mmHg of SAP. Cerebrovascular resistances were calculated segmentally using the following formulas; large vessel resistances (LVR) = (SAP-PAP(1A]/CBF, middle vessel resistance = (PAP (1A)-PAP (3A]/CBF, and small vessel resistance = PAP (3A)/CBF. The changes in LVR, MVR, and SVR were almost identical between 70 and 140 mmHg of SAP. Below 70 mmHg of SAP, SVR showed the greatest decrease in resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Yamaguchi
- Third Division of Internal Medicine, Shimane Medical University, Izumo, Japan
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