Epileptic syndromes in neonates: nosological problems from etiological aspects.
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Brain↗
Biomedical subjects
M Fujimura
Publications and source records attributed to M Fujimura.
Effect of inhaled procaterol on cough receptor sensitivity to capsaicin in patients with asthma or chronic bronchitis and in normal subjects.
BACKGROUND: To evaluate the effect of inhaled beta 2 adrenergic agonists on the sensitivity of airway cough receptors, the effect of inhaled procaterol on cough induced by aerosolised capsaicin, a stimulant of C fibres, was studied in patients with asthma or chronic bronchitis and in normal subjects. METHOD: Eleven patients with asthma and 10 with chronic bronchitis and 14 normal subjects participated. Increasing concentrations of capsaicin solution were inhaled for 15 seconds by tidal breathing through the mouth at one minute intervals until five or more coughs were elicited, before and 30 minutes after inhalation of 20 micrograms procaterol or placebo (freon gas alone) through a metered dose inhaler. Cough threshold was defined as the lowest concentration of capsaicin that elicited five or more coughs. To evaluate the bronchodilator effect of procaterol and the bronchoconstrictor effect of inhaled capsaicin, forced expiratory volume in one second (FEV1) was measured before and one minute after a capsaicin provocation test. This test was carried out both before and 30 minutes after treatment with procaterol or placebo. RESULTS: The geometric mean value of cough threshold to capsaicin was significantly increased by procaterol and placebo in both groups of patients but not in the control subjects. The increment in the cough threshold was not significantly different between the treatments with procaterol and placebo in each group. FEV1 was significantly increased by procaterol but not by placebo in all three groups. CONCLUSIONS: Inhaled procaterol has no effect on airway cough receptor sensitivity to capsaicin. The attenuation of the cough sensitivity seen after inhalation of procaterol in patients with asthma and bronchitis may result from tachyphylaxis to capsaicin.
Administration, Inhalation↗
Aerosolized acetaldehyde induces histamine-mediated bronchoconstriction in asthmatics.
It has been reported that acetaldehyde may be a main factor of alcohol-induced bronchoconstriction in Japanese patients with asthma. The purpose of this study was to investigate the direct action of acetaldehyde on the airway in asthmatic and healthy nonasthmatic subjects. We investigated the bronchial response to inhalation of ascending doses (5, 10, 20, and 40 mg/ml) of acetaldehyde in nine asthmatic subjects, who were treated with placebo or terfenadine for 4 days in a double-blind, randomized, placebo-controlled, crossover fashion, and in nine age- and sex-matched healthy subjects. The bronchial responsiveness to inhaled methacholine was also measured in the same asthmatics on a separate day. Inhaled acetaldehyde caused marked (more than 20%) significant decrease in FEV1 in asthmatics after placebo, which was larger than that in asthmatics after terfenadine and in healthy subjects. There was no significant difference in the decrease in FEV1 between asthmatics treated with terfenadine and healthy subjects. There was a significant correlation between the methacholine and acetaldehyde concentrations producing a 20% fall in FEV1 in asthmatics. We conclude that acetaldehyde causes bronchoconstriction indirectly via histamine release in asthmatics, and that nonspecific bronchial hyperresponsiveness is a necessary precondition for the expression of acetaldehyde-produced bronchoconstriction.
Acetaldehyde↗
Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia.
The clinicopathologic features of five patients with acute eosinophilic pneumonia who presented with transient wheeze as well as acute onset of high fever, severe hypoxemia, and diffuse pulmonary infiltrates are described. Eosinophilic pneumonia was diagnosed by bronchoalveolar lavage and transbronchial lung biopsy. The illness resolved rapidly with or without corticosteroid therapy. No relapse occurred. To characterize the transient wheeze, a transbronchoscopic bronchial biopsy and pulmonary function tests were performed. Specimens of bronchial wall revealed eosinophil infiltration into the bronchial mucosa. Pulmonary function tests demonstrated reduced diffusing capacity and small airway dysfunction. These findings suggested that eosinophil infiltration into the bronchial mucosa might temporarily cause transient wheeze, different from bronchial asthma, due to small airway dysfunction in acute eosinophilic pneumonia.
Acute Disease↗
Correlation of nonspecific bronchial responsiveness to baseline pulmonary function in patients with asthma and sinobronchial syndrome.
To examine the relationship of nonspecific bronchial responsiveness to baseline pulmonary function, and to compare the reactivity in asthma and sinobronchitis, we measured the provocative concentration of methacholine, causing a 20% fall in forced expiratory volume in one second (PC20-FEV1) in 82 asthmatic patients, 54 patients with sinobronchial syndrome and 57 normal subjects. Log PC20-FEV1 was directly correlated to baseline pulmonary function. The strongest correlation was seen between log PC20-FEV1 and baseline FEV1 as a % of the predicted FEV1 (%FEV1), both in asthma (log PC20-FEV1 = 0.020 x %FEV1-1.988, r = 0.54, p < 0.01) and in sinobronchial syndrome (log PC20-FEV1 = 0.025 x %FEV1-1.233, r = 0.64, p < 0.01). From the regression equations, the mean value of PC20-FEV1 at 100% FEV1 was calculated as 1.02 and 18.5 mg/ml in asthmatic and sinobronchitic patients, respectively, and the value was 35.5 mg/ml in normal subjects. The PC20-FEV1 to %FEV1 relationship may be helpful to assess individually measured PC20-FEV1 values in patients with airway obstruction.
Adult↗
Log normal distribution of bronchial responsiveness to methacholine in normal young adults.
It has not been well known whether or not the distribution of non-specific bronchial responsiveness is log normal in normal subjects. We measured bronchial responsiveness to methacholine using partial flow-volume curves. The expiratory flow at 40% (above RV) from the full forced vital capacity (MEF40) was obtained and used as a reference volume to compare the isovolume flow from the partial flow-volume curve (PEF40). Provocative concentrations of methacholine causing a 20% fall in FEV1 (PC20-FEV1) and a 35% fall in MEF40 (PC35-MEF40) and PEF40 (PC35-PEF40) were measured as indices of bronchial responsiveness in 93 Japanese college students including 36 atopic and 57 non-atopic normal subjects. A 35% or more fall in PEF40 was produced by 160 mg/ml or less of methacholine in all the subjects whereas 20% or more fall in FEV1 did not occur in 4 atopic and 10 non-atopic subjects, and 35% or more fall in MEF40 did not occur in 4 non-atopic subjects at the final concentration of methacholine (160 mg/ml). The geometric mean value of PC35-PEF40 was 2.41 (GSEM, 1.21), 3.74 (GSEM, 1.16), and 3.16 (GSEM, 1.12) mg/ml in atopic, non-atopic, and both subjects, respectively. The distribution of log PC35-PEF40 could not be differentiated at the 5% level from a normal distribution using chi-square test to examine the goodness of fit in each group of subjects and in the whole subjects. These results directly confirm the log normal distribution of non-specific bronchial responsiveness in normal humans.
Adult↗
[Thecomas (theca cell tumours)].
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Female↗
Bronchoalveolar lavage cell analysis in measles viral pneumonia.
Although the immunological changes due to measles virus infection, such as suppression of delayed skin reactivity and increase in soluble CD8 in peripheral blood, have been demonstrated, the immunological changes in the lung during measles viral pneumonia (MVP) have not been reported. The aim of this study was to clarify the intrapulmonary immunological changes in MVP. We analysed cell differentials and lymphocyte surface antigens of bronchoalveolar lavage (BAL) cells, both in the acute and the convalescent phase of MVP by flow-cytometry, using CD4+, CD8+, CD8+CD11b+ and CD8+CD11b- monoclonal antibodies in five patients and six healthy control subjects. The absolute numbers of CD8+ and CD8+CD11b- cells were significantly greater both in the acute and the convalescent phase compared with those in controls. The percentages of CD8+ and CD8+CD11b- cells in the acute phase were significantly greater than those in controls and the convalescent phase. The CD4/CD8 ratios in the acute phase were significantly smaller than those in the convalescent phase and controls. In conclusion, the intrapulmonary immunological changes with an increase in CD8+ and CD8+CD11b- cells in BAL fluid of MVP are thought to be the primary reaction in measles virus-infected lungs.
Acute Disease↗
[Metastatic lung cancer presenting with multiple thin-walled cavity-like shadows in a young adult with gallbladder cancer].
A rare case of metastatic lung cancer presenting with multiple thin-walled cavity-like shadows in a young adult with gallbladder cancer is reported. A 30-year-old man consulted our hospital with fever, cough, and general malaise. His chest X-ray film and computed tomogram showed multiple nodular shadows and thin-walled cavity-like shadows. Cytology of sputum and bronchoalveolar lavage fluid showed class V (adenocarcinoma). Although two cycles of systemic combination chemotherapy (CDDP+VDS+MMC) were performed, his lung cancer progressed. Finally, he died of obstructive jaundice from lymph node metastasis at the pancreatic head. At autopsy, the primary site of adenocarcinoma was found to be the gallbladder. Metastatic lung tumor from gallbladder cancer is common, and thin-walled cavity-like metastasis to the lung in a young adult is a rare occurrence.
Adenocarcinoma↗
[A case of post-traumatic eosinophilic pleural effusion improved by direct infusion of corticosteroid into the pleural space].
A 49-year-old man was admitted with non-productive cough and left chest discomfort. About one month prior to the admission, he suffered a non-penetrating injury to the left anterior chest. Although rib fracture or pleural effusion was not reported, left chest discomfort and non-productive cough progressed gradually. Chest X-ray film and chest CT scan on admission showed left massive pleural effusion. Close examination revealed a marked increase of eosinophils in the pleural effusion (77% of total cell counts). Because malignancy, parasitic disease, and collagen disease were differentiated, we diagnosed this case as post-traumatic eosinophilic pleural effusion, and decided to administers corticosteroid therapy; hydrocortisone 300 mg was infused into the left pleural space. Seven days after the treatment, the pleural effusion and peripheral eosinophilia had completely disappeared. This case suggests that direct infusion of corticosteroid into the pleural space provides greater drug availability in the treatment of post-traumatic eosinophilic pleural effusion related to immunological reaction of the pleura. The indication and dosage of corticosteroids should be established, however, because there have been some reports of cases of improvement without any special treatment.
Eosinophilia↗
[A successful repair of traumatic thoracic aortic injury and descending colon perforation at acute phase].
A 41-year-old man suffered from traffic accident was referred to us because of chest and back pain. The CT examination showed periaortic hematoma and aortography revealed aneurysmal formation at the distal site to the left subclavian artery. We repaired the aortic injury with prosthetic graft at the acute phase successfully. As the results of the conservative treatment of the traumatic aortic injury are poor, we recommend operation at the acute phase.
Accidents, Traffic↗
[A case of hypersensitivity pneumonitis induced by toluene diisocyanate presenting with transient bronchoconstriction].
A 50-year-old male spray paint worker was admitted with non-productive cough and dyspnea on exertion. Chest X-ray and chest CT showed diffuse interstitial shadows in the bilateral lung fields. After admission, the symptoms and chest X-ray findings improved over several days, and he was followed as an outpatient. He then developed nocturnal dyspnea with wheezing and dry cough every day. About two months later, chest X-ray showed more severe diffuse interstitial shadows which did not disappear after admission. Bronchoalveolar lavage and transbronchial lung biopsy revealed allergic exudative interstitial pneumonia, and he was treated with steroid therapy. Paint contains toluene diisocyanate, and challenge test to toluene diisocyanate was positive. In the early course, this case presented with bronchoconstriction; bronchial reversibility and bronchial hyperresponsiveness to methacholine were positive. Bronchoconstriction may cause worsening of respiratory symptoms in patients with hypersensitivity pneumonitis induced by isocyanates.
Alveolitis, Extrinsic Allergic↗
[A case of eosinophilic pneumonia due to tolfenamic acid].
We report a case of pneumonitis induced by tolfenamic acid. A 23-year-old woman was admitted to our hospital because of cough and fever. She had been treated with tolfenamic acid and other medications for lumbago. Nine days after the treatment, she developed erythema, fever, cough and dyspnea. Her chest X-ray revealed multiple patchy and micronodular shadows in both lung fields. Bronchoalveolar lavage fluid (BALF) showed increased total cells, lymphocytes, eosinophils and CD4/CD8 ratio. Microscopic examination of transbronchial lung biopsy (TBLB) specimens showed infiltration of mononuclear cells and eosinophils into the alveolar wall and the interstitium. After discontinuation of all drugs, her complaints, laboratory data and chest X-ray findings markedly improved. The lymphocyte stimulation test (LST) and challenge test for tolfenamic acid were positive. Based on these findings, we diagnosed this case as pneumonitis (eosinophilic pneumonia) due to tolfenamic acid. To our knowledge, there has been no reported case of pneumonitis due to this drug in Japan.
Adult↗
[Effect of erythromycin on mucociliary transport and clinical symptoms in patients with sinobronchial syndrome].
The effect of erythromycin (EM) on mucociliary transport function assessed by saccharin test and clinical symptoms were studied in 19 patients with sinobronchial syndrome (SBS). Before treatment with EM, the mean nasal clearance time (NCT) of SBS patients was 51.9 +/- 40.5 (SD) min, which was significantly (p < 0.01) longer than that of control subjects (12.4 +/- 5.3 min). After 4-week treatment with oral EM (600 mg/day), NCT of SBS patients significantly (p < 0.01) improved (29.2 +/- 34.2 min). In 11 of 19 SBS patients, bacteria from sputum culture disappeared after EM therapy. Frequency of cough and volume of sputum were significantly (p < 0.05) decreased by EM therapy. Nasal symptoms (such as nasal obstruction and rhinorrhea) were also significantly (p < 0.05) improved by EM therapy. These findings suggested that disorder of mucociliary transport function was present in patients with SBS, and EM therapy improved this function. EM clinically improved not only the lower airway symptoms, but also the nasal symptoms.
Adult↗
[A case of Behçet's disease presenting with Hughes-Stovin syndrome].
A 27-year-old man suffering from incomplete type of Behçet's disease presented with swelling of the left thigh. Venography showed obstruction of the left femoral vein by thrombus, and he was diagnosed as having deep vein thrombosis of the left femoral vein. The next year, he developed recurrent hemoptysis. Pulmonary angiography showed aneurysm and mural thrombosis of the left pulmonary artery. Fiberoptic bronchoscopy showed a reddish eminence of the left Behçet bronchus, suggestive of broncho-pulmonary artery fistula. After treatment with colchicine, the hemoptysis decreased. We report a very rare case of Behçet's disease presenting with Hughes-Stovin syndrome.
Adult↗