Biomedical subjects
S Yamori
Publications and source records attributed to S Yamori.
Diagnostic value of the Amplicor PCR assay for initial diagnosis and assessment of treatment response for pulmonary tuberculosis.
We evaluated the Amplicor PCR assay as an initial diagnostic tool on the basis of clinical diagnosis, and assessed this assay as a follow-up test for patients with pulmonary tuberculosis during chemotherapy. Of the 208 specimens from 155 patients who were bacteriologically and/or clinically diagnosed with active tuberculosis before chemotherapy, 144 were Amplicor PCR-positive (sensitivity, 69.2%), which was equal to the results of culturing. Among 89 specimens which showed positive results by smear and culturing, the Amplicor PCR assay detected 87 (97.8%), whereas among 55 specimens which showed smear-negative but culture-positive results, the Amplicor PCR assay detected 46 (83.6 %)(P= 0.003). No false positive results were found in the two systems (specificity, 100%, 120/120). The Amplicor PCR assay was also evaluated as a follow-up test using 926 specimens from 207 patients receiving active tuberculosis chemotherapy. Among 433 specimens which showed Amplicor-PCR positive, 222 (51.3%) were culture-negative. On the other hand, among 233 culture-positive specimens, only 12 (5.2%) were Amplicor PCR-negative. Therefore, this assay is useful for the rapid diagnosis of tuberculosis. The duration of Amplicor PCR-positive after culture-negative conversion was significantly associated with the presence of cavitary lesion, smear-positive specimens before treatment, and smear-positive specimens with negative cultures during chemotherapy.
Diagnostic value of the strand displacement amplification method compared to those of Roche Amplicor PCR and culture for detecting mycobacteria in sputum samples.
We compared the ability of the semiautomated BDProbeTec-SDA system, which uses the strand displacement amplification (SDA) method, with that of the Roche Amplicor-PCR system and the Septi-Chek AFB culture system to directly detect Mycobacterium tuberculosis complex (MTB) and other mycobacteria in sputum samples. A total of 530 sputum samples from 299 patients were examined in this study. Of the 530 samples, 129 were culture positive for acid-fast bacilli with the Septi-Chek AFB system; 95 for MTB, 29 for M. avium-M. intracellulare complex (MAC), and 5 for other mycobacteria. The BDProbeTec-SDA system detected 90 of the 95 samples culture positive for MTB (sensitivity, 94.7%), and the Amplicor-PCR system detected 85 of the 95 samples culture positive for MTB (sensitivity, 89.5%). The specificity of each system, based on the clinical diagnosis, was 99.8% for SDA and 100% for PCR, respectively. Among the 29 samples culture positive for MAC, the BDProbeTec-SDA system detected MAC in 24 samples (sensitivity, 82.8%), whereas the Amplicor-PCR system detected MAC in 23 samples (sensitivity, 79.3%). The specificities of the systems were 98.3 and 100%, respectively. The high degrees of sensitivity and specificity of the BDProbeTec-SDA system suggest that it should be very useful in clinical laboratories for the rapid detection of mycobacteria in sputum samples.
Mycobacterium growth indicator tube testing in conjunction with the AccuProbe or the AMPLICOR-PCR assay for detecting and identifying mycobacteria from sputum samples.
We have compared the ability of the Mycobacterium Growth Indicator Tube (MGIT) system, a new culture method with an oxygen-sensitive fluorescent sensor, to recover mycobacteria from sputum samples with the abilities of egg-based medium and the Septi-Chek AFB system. We have also assessed the clinical utility of the AccuProbe or the AMPLICOR-PCR assay to directly identify Mycobacterium tuberculosis complex and M. avium-M. intracellulare complex (MAC) from positive MGITs. From 382 sputum samples, 99 isolates of M. tuberculosis complex and 20 isolates of MAC were recovered. The MGIT system had the highest recovery rates for M. tuberculosis complex (97.0%) and MAC (100%), compared to recovery rates of 51.5 and 65.0%, respectively, with the egg-based medium and 81.8 and 85.0%, respectively, with the Septi-Chek AFB system. The shortest recovery times were also achieved with the MGIT system: 16.6 days for M. tuberculosis complex and 12.0 days for MAC, compared to 27.1 and 20.1 days, respectively, with the egg-based medium and 21.4 and 13.2 days, respectively, with the Septi-Chek AFB system. The AccuProbe identified 74 (77.1%) of the 96 M. tuberculosis complex-positive MGITs and 17 (85.0%) of the 20 MAC-positive vials. The AMPLICOR system correctly identified 94 (97.9%) of the 96 M. tuberculosis complex-positive MGITs and all 20 MAC-positive vials. Therefore, the MGIT system used in conjunction with the AMPLICOR system is a rapid and sensitive method for detecting and identifying M. tuberculosis complex and MAC isolates from sputum samples.
[Spontaneous resolution of primary pulmonary cryptococcosis].
A 22-year-old man underwent chest roentgenography to obtain a health certificate, and the film showed a nodular lesion in the left lung. Computed tomography of the chest revealed a 25 x 20 mm nodular lesion in the S4 segment of the left lung. Fiberoptic bronchoscopy was done and transbronchial biopsy specimens showed fungal elements consistent with Cryptococcus. Further examinations, including cereberospinal fluid examination, were negative. This patient's pulmonary cryptococcal lesion resolved without treatment and without complications.
Adenosine deaminase isozymes in tuberculous pleural effusion.
Total adenosine deaminase (ADA) activity and its isozyme (ADA1 and ADA2) activities were measured in pleural effusions and serum samples from patients with tuberculosis and in those from patients with lung cancer as controls. To analyze the cellular source of ADA isozymes in tuberculous pleural effusions, ADA isozyme activities in CD2+ T lymphocytes purified from tuberculous pleural effusions and cultured human cell lines derived from hematopoietic tumors were measured. Tuberculous pleural effusions had a much higher ADA activity than cancerous effusions, and high ADA activity mainly originated from the increase in ADA2 activity. Further, total ADA activity in tuberculous pleural effusions decreased after antituberculosis treatment, because of the decrease in ADA2 activity. On the other hand, measurement of ADA and ADA isozyme activities in T lymphocytes purified from tuberculous pleural effusions and human hematopoietic cell lines showed dominant expression of ADA1 in total ADA activity. In conclusion, we found that ADA2 is a dominant component of tuberculous pleural effusions and that ADA1 is a major component of lymphoid cells. These results suggest that elevation of ADA activity in tuberculous pleural effusions does not always reflect the activation of cell-mediated immunity.
Randomized study of vinorelbine (VRB) versus vindesine (VDS) in previously untreated stage IIIB or IV non-small-cell lung cancer (NSCLC). The Japan Vinorelbine Lung Cancer Cooperative Study Group.
PURPOSE: We compared the activity of vinorelbine (VRB) and vindesine (VDS) in a randomized crossover study in patients with previously untreated stages IIIB or IV non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Two hundred four patients were assessable for response and toxicity. VRB was administered at a dose of 25 mg/m2 weekly and VDS at a dose of 3 mg/m2 weekly. Patients who failed to respond after 4 cycles of initial monotherapy were switched to a combination chemotherapy (VRB-->VDS + cisplatin (P) or VDS-->VRB + P). RESULTS: Objective response was observed in 31.1% of patients in the VRB arm versus 8.9% of those in the VDS arm (P = 0.0002). The median duration of response to VRB was 18.5+ weeks (range, 7.9 to 107.5+ weeks) compared with 11.7+ weeks (range, 6.0 to 35.0+ weeks) for VDS. Of the 69 patients who failed to respond to initial monotherapy, 33 in the VRB group who subsequently received VDS + P did not respond and 13 (26.5%) of 49 initially on VDS who received subsequent VRB + P responded. The rates of grades 3 and 4 leukopenia were similar in the two monotherapy arms (VRB, 55.3% vs. VDS, 48.5%). However, grade 3 anemia was more frequent in the patients on VRB than in those on VDS. The incidence of peripheral neurotoxicity was significantly higher with VDS than with VRB (P = 0.002), but VRB induced a slightly higher rate of local cutaneous reaction than VDS (P = 0.012). With the combination of cisplatin and these vinca alkaloids, peripheral neurotoxicity was less frequent in the VRB group than in the VDS group. CONCLUSION: Our results demonstrate that VRB yields a higher response rate than VDS in stage IIIB or IV NSCLC, with the same extent of toxicity in terms of leukocytopenia. The peripheral neurotoxic effects were also milder with VRB than with VDS. In second-line chemotherapy, there was a notable difference in response between the VRB + P and VDS + P regimens.
[Detection of Mycobacterium tuberculosis DNA from pleural fluid].
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Evaluation of Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test and Roche PCR-microwell plate hybridization method (AMPLICOR MYCOBACTERIUM) for direct detection of mycobacteria.
We evaluated the clinical utility of an rRNA amplification-based Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (AMTD) system and a PCR-based Roche AMPLICOR MYCOBACTERIUM system for direct detection of Mycobacterium tuberculosis, M. avium, and M. intracellulare. Of the 422 sputum samples from 170 patients, 137 (121 of M. tuberculosis, 14 of M. avium-M. intracellulare complex [MAC], 2 of mycobacterium other than M. tuberculosis or MAC) were culture positive with the Septi-Chek AFB system. One sample of a contaminated culture results was excluded for further analyses. The AMTD system detected all of the 121 samples which grew M. tuberculosis (sensitivity, 100%). Of the 284 culture negative samples, 28 were positive by this system (specificity, 90.1%). After resolution of the discrepant samples, based on a positive history for culture of the patient, the specificity of this system increased to 99.3%. On the other hand, the AMPLICOR system gave a positive result for 132 out of the 135 culture positive samples for M. tuberculosis or MAC (sensitivity, 97.8%). Of the 284 culture-negative samples, 37 were positive by this system (specificity, 87.0%). The specificity for this system after resolution of the discrepant samples increased to 98.9%. The agreement between the results from the AMTD system and the AMPLICOR system was 98.7%. Both of the systems are highly sensitive and specific for detecting M. tuberculosis and/or MAC directly from sputum samples within hours, and they should be recommended for routine use in the clinical microbiology laboratory.
[Infection with Mycobacterium avium presenting as polypoid lesions in left upper-lobe bronchus of an immunocompetent host].
In April 1993, a 51-year-old woman had a fever, and an infiltrative shadow was seen in the left upper lobe on a chest X-ray film. Repeated sputum cultures were positive for Mycobacterium avium complex. She underwent antituberculosis therapy consisting of pyrazinamide, ofloxacin, and streptomycin. Her symptom disappeared and the abnormal shadow resolved. In January 1994, she was admitted to the hospital because of bloody sputum and abnormal chest X-ray findings consisting of a left hilar mass and atelectasis of the left upper lobe. Bronchoscopy revealed multiple polypoid lesions without necrosis in the left upper-lobe bronchus. Histological examination showed that the tumor consisted of an aggregation of lymphocytes and plasma cells, and was positive for Ziehl-Neelsen stain. The acid-fast bacillus was identified as Mycobacterium avium by the DNA probe method. Anti-tuberculosis treatment was given: rifampicin, isoniazid, sparfloxacin, and clarithromycin. Three months later, the atelectasis and the polypoid mass in the left upper-lobe bronchus had disappeared. We believe that the polypoid lesions in the left upper-lobe bronchus were due to infection by Mycobacterium avium. The patient was HIV-negative and immunocompetent. Such endobronchial lesions caused by Mycobacterium avium are rare in HIV-negative hosts.
[A late phase-II trial comparing KW-2307 with vindesine in non-small cell lung cancer (1). Lung cancer section in KW-2307 Study Group].
A multicenter cooperative study was performed to compare KW-2307 (KW), a novel vinca alkaloid (VA) derivative, and vindesine (VDS), with respect to tumor response and toxicity in patients (pts) with non-small cell lung cancer. In the former part of the trial, pts received monotherapy with KW 25 mg/m2 or VDS 3 mg/m2. Pts refractory to treatment with KW or VDS were crossed over to treatment with VDS (3 mg/m2/W x 3) or KW (20 mg/m2/W x 3), respectively, in combination with cisplatin (CDDP) 80 mg/m2. Both drugs were administered in 4 courses or more once weekly by intravenous bolus injection in monotherapy. In the subsequent combination therapy, non-responders were treated with CDDP on day 1 and KW or VDS on day 1, 8 and 15 with a course of 28 days, and treatment was given in 2 courses or more in principle. According to the method of O'Brien/Fleming, comparison of tumor response between the 2 treatment groups in the 2nd stage was performed in 154 cases. The response rate of KW group (29.4%, 22/75) was significantly better than that of VDS group (9.3%, 7/75). The main adverse effect in both groups was leukopenia (neutropenia), and no significant difference was observed between the incidence in each group. Among other adverse effects, increased GOT, fever and phlebitis were slightly more often found in KW group, and alopecia and paresthesia a little more in the VDS group. In the later part of combination therapy with CD DP, the KW group achieved PR in 10 of 34 pts (29.4%), and no response was observed in the VDS group (28 pts).
Continuous infusion versus intermittent short infusion of metoclopramide for cisplatin-induced acute emesis.
Metoclopramide is an active antiemetic against cisplatin-induced acute emesis. However, the optimal administration method (continuous infusion versus intermittent short infusion) for metoclopramide has not yet been clearly defined. We have conducted a randomized crossover study to compare the antiemetic efficacy of continuous infusion of metoclopramide with that of intermittent short infusion of metoclopramide in 54 evaluable patients. Patients were stratified according to sex and were randomized to receive either a continuous-infusion regimen (regimen A) or an intermittent-short infusion regimen (regimen B). Patients were switched to the alternate therapy in the second course. In regimen A, metoclopramide at 3 mg/kg i.v. was given before cisplatin, and then metoclopramide at 4 mg/kg was infused intravenously over 7.5 hours. In regimen B, metoclopramide at 3 mg/kg i.v. was followed by 2 mg/kg i.v. for two doses. Dexamethasone and diphenhydramine were given intravenously in both regimens. There was no significant difference between two regimens in their ability to prevent emesis. Complete protection (no episode of emesis) and major protection (< or = 2 episodes of emesis), respectively, were obtained by 67% (95% confidence interval: 53-79%) and 85% (95% confidence interval: 73-93%) of all patients given regimen A and by 59% (95% confidence interval: 45-72%) and 81% (95% confidence interval: 68-91%) of those given regimen B. The two regimens were also equally effective in controlling nausea. However, male patients showed better control of nausea and vomiting than did female patients, regardless of treatment regimen. Toxicity was mild in both regimens and was well tolerated. Our findings indicate that both continuous-infusion metoclopramide and intermittent-short infusion metoclopramide are effective in controlling cisplatin-induced acute nausea and vomiting.
[Pulmonary strongyloidiasis and pulmonary dirofilariasis].
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Polymerase chain reaction for the differentiation of Mycobacterium intracellulare and Mycobacterium avium.
Polymerase chain reaction (PCR) amplification was performed using DNA purified from 15 mycobacterial type strains and from 21 specimens isolated from patients suspected to have non-tuberculous mycobacterial diseases. Using a primer set of MTB1-MTB2, 11 specimens out of 21 were Mycobacterium avium and 8 were M. intracellulare, which were verified by the Gen Probe Rapid Diagnostic System for the M. avium complex (MAC). One of the remaining 2 specimens which did not hybridize with the probe for the MAC was identified as M. kansasii and the other was not specifically identified by the conventional culture method. PCR amplification, using a primer set of TB1-TB3, was also performed for the specific identification of M. tuberculosis complex.
Bacteriostatic and bactericidal activity of antituberculosis drugs against Mycobacterium tuberculosis, Mycobacterium avium-Mycobacterium intracellulare complex and Mycobacterium kansasii in different growth phases.
Bacteriostatic and bactericidal activities of rifampicin, isoniazid, streptomycin, enviomycin and ethambutol against Mycobacterium tuberculosis, Mycobacterium avium--M. intracellulare complex and Mycobacterium kansasii were studied in different growth phases. Bacteriostatic activities of the drugs were similar in different growth phases, except isoniazid. M. tuberculosis was much less susceptible to isoniazid in the lag phase than in the log and the stationary phases. In contrast, bactericidal activity was influenced by the growth phase. M. tuberculosis was killed by isoniazid, streptomycin and rifampicin. The bactericidal activity of isoniazid was strongest. The bactericidal activity of isoniazid and streptomycin was most marked in the log phase. M. avium complex and M. kansasii resisted the bactericidal activity, but some strains of M. avium complex were killed by streptomycin and enviomycin, and the activities of these two drugs were most marked in the lag phase.
Umbilical metastasis from small cell carcinoma of the lung.
Umbilical metastases have been almost exclusively reported in patients with adenocarcinomas of intra-abdominal organs. We present a case of small cell carcinoma of the lung with umbilical metastasis that was confirmed by biopsy. To our knowledge, this is the first reported case of umbilical metastasis from small cell lung cancer.
Comparison of prognosis of pulmonary diseases caused by Mycobacterium avium and by Mycobacterium intracellulare.
A total of 55 patients with pulmonary disease caused by Mycobacterium avium and by Mycobacterium intracellulare were compared for their prognosis. Causative mycobacteria were identified by the DNA probes (Gen-Probe) method. Of the 55 patients, 28 had pulmonary disease caused by M avium and the remaining 27, by M intracellulare. Of the former group, four patients had progressive disease, and three of them died during the observation period. In contrast, only one of the latter group had progressive disease. On the other hand, only one of the former group was cured. In contrast, six of the latter group were cured, showing the closure of cavity and the disappearance of mycobacteria from the sputum. The prognosis of pulmonary disease caused by M avium appears to be worse than that caused by M intracellulare.
Chest roentgenogram classification and clinical parameters in patients with active pulmonary tuberculosis.
The relationship between the clinical parameters and chest film appearance was studied in patients with active pulmonary tuberculosis. Patients with extended disease were often malnourished and had weak tuberculin reaction accompanied by lymphopenia. They excreted a large amount of mycobacterial bacilli and a longer period was required for negative conversion of sputum culture. We confirmed that the criteria for chest roentgenogram classification established by the Japanese Society for Tuberculosis ("Gakkai Classification") is useful in the estimation of the risk of infection and the prognosis of tuberculosis patients.