[Terminal care in patients with lung cancer].
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Biomedical subjects
Publications and source records attributed to H Teshima.
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One hundred and four patients with acute leukemia treated by allogeneic bone marrow transplantation in Japan were analysed for the incidence of interstitial pneumonitis (IP). Thirty-six (35%) of 104 marrow graft recipients developed IP. Cytomegalovirus (CMV) was the most frequent organism (61%). Using multivariate analysis, remission at transplant (P = 0.0001) and use of cyclosporin A to prevent graft-versus-host disease (P = 0.0363) were found to be significant factors associated with a decreased incidence of IP. For preventing IP, anti-CMV hyperimmune globulin was effective, while interferon and acyclovir were not.
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Febrile episodes in 147 patients undergoing first remission induction therapy for acute leukemia were analyzed. Febrile episodes occurred 254 times in 136 patients. The cause of fever could not be identified in 54.3% of all episodes. Antibiotic therapy was effective in 81.1% of these episodes with no cause determined. Postmortem examinations proved infections in 65.2% of patients who had fever of unknown origin before death. Sepsis and pneumonia together accounted for 53.4% of documented infections. Sepsis and pneumonia occurred most often when the patients had neutropenia (less than 500/mm3). Increase in neutrophil count and achievement of hematologic remission produced good prognosis of the infections, and the reverse was also true in some patients. Fifty percent of fetal patients died of infection. The incidence of infections, especially pneumonia and infections caused by fungi and Proteus species indicating such infections were exogenous, reduced markedly in laminar air flow rooms.
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The atopic disposition, indicated by positive skin reactions and IgE antibody titers etc., and the bronchial reactivity to inhaled acetylcholine were examined on the following three groups: (1) 20 young adults with a history of childhood asthma who have been symptom-free for more than 4 yr; (2) 20 current asthmatics, and (3) 20 healthy young adults. Young adults with a history of childhood asthma remained atopic in their disposition even after complete clinical remissions of their childhood asthma. However, they had a lower bronchial reactivity as compared with current asthmatics, although the bronchial reactivities of both groups were apparently higher than the control group.
A 74-year-old woman with a right ovarian tumor had a high level of the serum tumor marker alpha-fetoprotein (AFP). After combination chemotherapy, the serum AFP level decreased significantly. Histopathologic study of surgically excised tumor tissue revealed a serous papillary cystadenocarcinoma. By the indirect immunoperoxidase technique, the AFP was stained in the cytoplasm of the differentiated tumor cells, showing papillary or tubular structures. Serial sections showed that the cells containing PAS-positive substances did not correspond to those producing AFP.
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