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Biomedical subjects

N Tokunaga

Publications and source records attributed to N Tokunaga.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Treatment of cancer and counter-measures for MRSA infections].

Patients with malignancy, especially those with hematological malignancy, are well known to be very susceptible to infection in general, because of bone marrow suppression induced by anticancer chemotherapy in addition to the nature of the disease itself. Accordingly, the risk of MRSA infection is very high in these patients, and the infection is often fatal. In an attempt to establish effective measures to prevent MRSA infection, we investigated the nosocomial spread of strains of MRSA and studied the characteristics of patients from the clinical standpoint. We found that strict isolation of patients with MRSA infection is an urgent necessity to prevent the intrahospital spread of MRSA strains and that disinfection of the hands of medical staff and sterilization of the environment are extremely important. In addition, due care must be taken to select an adequate antimicrobial agent and to determine the optimal dose and period for treatment of the infection in patients with malignancy to avoid selecting MRSA strains or inducing resistance in mecA positive strains of S. aureus. For treatment of MRSA infections in patients with malignancy, a combination chemotherapy with vancomycin (VCM), or arbekacin (ABK) plus beta-lactam antibiotic is recommended, and granulocyte colony stimulating factor (G-CSF) is clinically useful when the granulocytopenia was induced by chemotherapy.

Adult↗
PubMed1993

[In vitro and clinical studies of MRSA infections in compromised hosts].

From January to December 1991, 47 clinical cases in when methicillin-resistant Staphylococcus aureus (MRSA) strains were isolate were investigated at our internal medicine ward. The MRSA infection rate was 57.4% (27/47). The mortality due to MRSA bacteremia was 75.0% (9/12) and that due to MRSA pneumonia was 57.1% (4/7). We think that MRSA infections must be treated by multiple antibiotics. At out institution, most of the patients were given a combination therapy of imipenem + fosfomycin or imipenemt + mynocycline. Although in vitro the MICs of imipenem did not show excellent activity against MRSA strains, in vivo these combination therapy including imipenem showed excellent activity against MRSA infections. We think that this result was due to the additive effect of the two drug combination. We determined the MICs of single antibiotics against MRSA strains. Most of the MRSA strains were sensitive to minocycline and arbekacin. All MRSA strains were sensitive to vancomycin we think that vancomycin is a highly useful drug to combat MRSA infection.

Adult↗
PubMed1992

Direct expression in Escherichia coli and characterization of bovine adrenodoxins with modified amino-terminal regions.

Four forms of bovine adrenodoxin with modified amino-termini obtained by direct expression of cDNAs in Escherichia coli are Ad(Met1), Ad(Met-1), Ad(Met-12), and Ad(Met6). The shoulder numbers represent the site of translation initiator Met at the amino-termini. The adrenodoxins, except for Ad(Met-1), were purified from the cell lysate and the ratios of A414-to-A276 of the purified proteins were over 0.92. NADPH-cytochrome c reductase activities of the three forms of adrenodoxin in the presence of adrenodoxin reductase were the same as that of purified bovine adrenocortical adrenodoxin. However, as cytochrome P-450SCC reduction catalyzed by Ad(Met6) was about 60% of that by Ad(Met1), the contribution of the amino-terminal region for the electron transfer or binding to cytochrome P-450SCC would need to be considered.

Adrenodoxin↗
PubMed1992

Erythromycin reduces neutrophils and neutrophil-derived elastolytic-like activity in the lower respiratory tract of bronchiolitis patients.

Diffuse panbronchiolitis (DPB) is a disease of adults characterized by chronic inflammation of the respiratory bronchioles and the infiltration of chronic inflammatory cells. The clinical efficacy of erythromycin therapy has been demonstrated in DPB patients, but the mechanism of action of this drug is unknown. We investigated the localization of neutrophils in lung biopsy specimens, as well as the cell population and elastolytic-like and chemotactic activity of bronchoalveolar lavage (BAL) fluid, before and after treatment with erythromycin or ampicillin in 11 DPB patients (six biopsy-proven and five clinically diagnosed) and one follicular bronchiolitis patient. These bronchiolitis patients had a high percentage of neutrophil and a high neutrophil-derived elastolytic-like activity in BAL fluid compared with chronic bronchitis patients and normal control subjects. The number of neutrophils and the neutrophil-derived elastolytic-like activity in BAL fluid decreased significantly after treatment with erythromycin along with a significant improvement in pulmonary function studies, although there was no significant change in the chemotactic activity of BAL fluid. No significant reduction in BAL fluid neutrophilia was found in the ampicillin-treated patients. These results suggest an important role for the neutrophil in the pathogenesis or development of bronchiolitis, and also suggest that erythromycin may be useful for the treatment of bronchiolitis through its direct action upon host phagocytic cells.

Adolescent↗
PubMed1992

A 72-year-old female with adult Still's disease.

We treated a 72-year-old woman with adult Still's disease. The diagnosis was made on the basis of a prolonged, high grade, quotidian fever, polyarthritis, maculopapular skin rashes and exclusion of other possible diseases. A high serum ferritin value was a key factor both in making the diagnosis and in the follow-up. The patient responded to the administration of oral prednisolone at 30 mg/day, which was tapered to 10 mg/day, with no recurrence of symptoms. This disorder can be an important cause of prolonged fever in the elderly as well as in the younger population.

Aged↗
PubMed1992

Follicular bronchiolitis associated with rheumatoid arthritis.

Follicular bronchiolitis is a rare disorder, though it has been recognized as a pulmonary involvement of rheumatoid arthritis in recent years. A 57-year-old woman with rheumatoid arthritis was admitted to the hospital with persistent productive cough and breathlessness on exertion. An open lung biopsy was performed to establish a definite pathologic diagnosis of her disease, and she was diagnosed as having follicular bronchiolitis on the basis of the histopathological findings. It is essential to differentiate this disease from other bronchiolar or lymphoproliferative disorders of the lung.

Arthritis, Rheumatoid↗
PubMed1992

Idiopathic granulomatous bronchitis. An unusual form of known granulomatous lung diseases or an unknown disease?

We describe two patients demonstrating a granulomatous inflammation of bronchial mucosa characterized clinically by a persistent dry cough, lack of manifestations of bronchial asthma, normal level of serum IgE and serum ACE, inflamed bronchial mucosal appearance consisting of edema, erythema, bleeding and narrowing and recovering without specific treatment. Histopathological findings of the bronchial inflammation of our patients were characterized by noncaseating granuloma formation consisting of epithelioid cells and multinucleated giant cells with infiltration of lymphocytes, plasma cells and eosinophils. The bronchial granulomatous inflammation of our patients was thought to differ from that of diseases which have been known, to our knowledge, as diseases demonstrating a granulomatous inflammation of bronchial mucosa. Although the pathogenesis of the disease could not be clarified by a careful search of special staining and culturing for the infective agent, it was most suggestive of non-specific inflammation with a granulomatous response to some sort of inhaled agents.

Bronchi↗
PubMed1992

[Host factors which influence the outcome of pneumonia in the elderly].

We examined 135 elderly patients with pneumonia to clarify the factors predicting on the outcomes of the elderly pneumonic patients. In the fatal cases respiratory symptoms such as cough and sputum, except for dyspnea were less frequent but pulmonary infiltrations on chest roentgenograms were more massive as compared with those in the survived cases. Thus, it was suggested that in the fatal cases the more advanced pneumonia had developed at the time when the diagnosis of pneumonia was made. The fatal cases showed hypoalbuminemia, hypocholesterolemia and hyponatlemia more frequently as compared with survived cases. Among these laboratory values, the decreased serum albumin concentration seemed to be most closely correlated with the fatal outcome of the elderly pneumonic patients. There were significant differences in the outcomes among three groups of the patients, those who were the prolonged bed-ridden, those with severe underlying diseases such as cancer and those treated as out-patients. The out patients showed the most favorable outcome and the prolonged bed-ridden patients the worst outcome. Approximately, 39% of the fatal cases were complicated with multiple organ failure. These results suggest that more important factors which affect the outcomes of pneumonia in the elderly may be not merely aging but the conditions of the host at onset of the disease.

Aged↗
PubMed1991

[A mechanism of usefulness of treatment with erythromycin for diffuse panbronchiolitis].

The clinical usefulness of treatment with erythromycin for diffuse panbronchiolitis (DPB) patients have been well reported to date, although its mechanisms remain unknown. In a previous study, we demonstrated that DPB patients were found to have large percentages of neutrophils in their lower respiratory tracts and suggested that neutrophils play an important role in the pathogenesis of DPB (Chest 99: 917-923, 1990). While in vitro and in vivo studies have demonstrated that erythromycin decreases neutrophils directed migration. In the present study, we performed bronchoalveolar lavage (BAL) on eight patients with DPB to clarify the cell populations in the lower respiratory tract before and after treatment with erythromycin. Neutrophils percentages in BAL fluid were significantly reduced after treatment with erythromycin (54.3 +/- 22.4% to 13.1 +/- 13.5%, p less than 0.01). No significant variance of BAL lymphocyte percentages was demonstrated after treatment with erythromycin. These results suggest that a main mechanism of clinical usefulness of treatment with erythromycin for DPB may be inhibition of neutrophils migration into the lower respiratory tract instead of intrapulmonary bactericidal activity against organisms.

Adolescent↗
PubMed1991

Subcutaneous and mediastinal emphysema associated with hypersensitivity pneumonitis.

We report a rare case of a patient in whom severe subcutaneous and mediastinal emphysema occurred in association with summer-type hypersensitivity pneumonitis and in whom overdistention or disruption of alveoli with obliteration of the respiratory bronchioles was revealed on open lung biopsy. This case suggests that obstructive bronchiolitis with hypersensitivity pneumonitis is an etiologic factor of mediastinal emphysema.

Adult↗
PubMed1990

[The changes in serum cold hemagglutinin titer in the clinical progress of diffuse panbronchiolitis].

Since the first description of Diffuse panbronchiolitis (DPB) was published, the elevation of serum cold hemagglutinin (CHA) titer in patients with DPB has been reported, but the mechanism of its elevation is not yet clear. We investigated the relationship between the CHA titer and the indexes of inflammation (CRP, ESR, WBC, alpha 2-gl, gamma-gl), immunoglobulin, bacterial species cultured from sputum in 24 cases with DPB. They were diagnosed clinically as DPB by the criteria of the Japanese Ministry of Health and Welfare. We found no correlation between CHA titer and CRP, ESR, WBC, alpha 2-gl, gamma-gl, but there were significant correlations between the change of CHA titer and IgA, IgM. Additionally, CHA titers which were measured when Pseudomonas aeruginosa was cultured from sputum in patients with DPB were markedly high levels. These results suggest that the elevation of CHA titer does not reflect the degree of inflammations, and it occurs by immunological abnormalities.

Adolescent↗
PubMed1990

Neutrophilia in bronchoalveolar lavage fluid of diffuse panbronchiolitis.

The clinical and pathologic features of diffuse panbronchiolitis (DPB) have been well reported to date, although its pathogenesis remains unknown. In the present study, we performed bronchoalveolar lavage (BAL) on three patients with biopsy specimen-proven DPB and eight patients with highly probable DPB (six women and five men; one smoker and ten nonsmokers), nine patients with chronic bronchitis (all men, five smokers and four nonsmokers), and nine normal control subjects (six women and three men, all nonsmokers) to clarify the cell populations in the lower respiratory tract. Neutrophils comprised 55.3 +/- 24.4 percent of recovered cells by BAL in DPB patients but only 6.6 +/- 6.4 percent in chronic bronchitis patients, and 1.8 +/- 1.5 percent in normal control subjects (p less than 0.001, all comparisons). The DPB patients also exhibited a decreased percentage of alveolar macrophages (34.9 +/- 23.5 percent) compared with chronic bronchitis patients and normal control subjects (p less than 0.001, all comparisons). The percentage of lymphocytes of the recovered lavage cells in DPB patients did not differ from that in chronic bronchitis patients and normal control subjects. These results indicate that neutrophils play an important role in the pathogenesis of DPB. They also suggest that neutrophilia of BAL-recovered fluid is a common finding in diseases associated with bronchiolar inflammation despite some clinical and pathophysiologic differences.

Adult↗
PubMed1990

[A case of pulmonary tuberculosis associated with adult respiratory distress syndrome during corticosteroid treatment of rheumatoid arthritis].

We reported a case of 64 year-old female patient of pulmonary tuberculosis associated with ARDS during corticosteroid treatment of Rheumatoid Arthritis. On admission her chief complaints were fever, fatigue and dyspnea. A chest roentgenogram showed diffuse alveolar infiltration consistent with pulmonary edema. Arterial blood gas studies showed severe hypoxemia. We clinically diagnosed so-called ARDS. Smears of sputum for acid fast bacilli were negative, but transbronchial lung brushing by bronchofiberscope revealed many acid fast bacilli. Intensive therapy with anti-tuberculosis drugs (INH, RFP, SM), high dose corticosteroid (methylprednisolone) therapy and mechanical ventilation was started. During the following 2 weeks, the PaO2 rose gradually and the alveolar infiltration on the chest roentgenogram disappeared. The experience of this case to emphasized the importance of suspecting this condition because pulmonary tuberculosis is a potentially curable cause of ARDS and it should also be emphasized that the good treatment effect could be expected with combined use of high dose corticosteroid and mechanical ventilation.

Arthritis, Rheumatoid↗
PubMed1989

A case of interstitial pneumonia antedating rheumatoid arthritis.

We describe a case report of an interstitial pneumonia in which pulmonary involvement of the both lower lobes mimicked idiopathic interstitial pneumonia (IIP) or bronchiolitis obliterans organizing pneumonia (BOOP). Its appearance antedated clinically apparent rheumatoid arthritis by one month and a half.

Adult↗
PubMed1986

[Immunological assay of the CA-125 value in pleural effusion in various types of pleuritis--its application as a differential diagnostic parameter of tuberculous or carcinomatous pleuritis].

We measured the CA-125 value in the peripheral blood and pleural effusion of 85 patients with various types of pleural effusion using an immunoradiometric assay with a monoclonal antibody (CA-125 radioimmunoassay kit). In pleuritis with primary lung cancer, the positive rate of the CA-125 value in the peripheral blood was 53.6%. The CA-125 value in tuberculous pleural effusion was significantly lower than that in carcinomatous pleural effusion (p less than 0.02). Accordingly, this assay of CA-125 in the pleural effusion is useful in the differential diagnosis of whether the pleural effusion is tuberculous or carcinomatous.

Antigens, Neoplasm↗