A 56-year-old man with rheumatoid arthritis was admitted to our hospital with dyspnea on exertion, fever and right chest pain. Chest X-ray showed bilateral, predominantly lower interstitial shadows and right pleural effusion. Open lung biopsy specimen showed bronchiolitis obliterans organizing pneumonia (BOOP) with prominent alveolitis, and corticosteroid therapy was introduced. Because the patient showed little response to corticosteroids, an immunosupressant (cyclophosphamide) was added. There was marked clinical, physiological and roentgenographic improvement in response to combined therapy. The therapeutic response of some BOOP patients seems to vary according to its pathogenesis and pathological findings, and these should be taken into consideration in the selection of therapeutic strategies.
SUMMARY 1. Lysophosphatidylcholine (Lyso‐PC), which is synthesized by phospholipase A 2 , is generally considered to induce adhesion molecules. However, little is known about the involvement of Lyso‐PC in the pathogenesis of bronchial asthma. The present study was designed to examine whether pre‐exposure to Lyso‐PC causes eosinophil recruitment and an increase in resistance in airways. 2. Eosinophils in bronchoalveolar lavage fluid (BALF) and the airway walls were enumerated after inhalation of 0.5 mg/mL Lyso‐PC to guinea‐pigs for 10 min. Respiratory resistance (R rs ) was recorded continuously over 6 h after inhalation of an equi‐dose of Lyso‐PC for an equivalent period. 3. The proportion of eosinophils was increased from 10.7 ± 3.3 to 27.5 ± 3.1% ( P < 0.0001) in BALF 6 h after inhalation of Lyso‐PC, whereas the proportion of neutrophils and lymphocytes was not increased. Histological examination also showed uniform distribution of eosinophils in the airway wall of bronchi and bronchioles 6 h after inhalation of Lyso‐PC. The number of eosinophils (/10 h.p.f.) in the bronchi and bronchioles was increased from 43.5 ± 16.8 to 154.8 ± 21.7 ( P < 0.0001) and from 34.8 ± 0.7 to 106.0 ± 26.6 ( P < 0.01), respectively. This eosinophil infiltration was similarly observed 24 h later. 4. Next, we examined the effects of eosinophil infiltration induced by Lyso‐PC on R rs . Inhalation of Lyso‐PC caused a slow increase in R rs and the percentage increase in R rs was 19.8 ± 1.9% ( P < 0.0001) 6 h later. Eosinophil infiltration and an increase in R rs did not occur after inhalation of physiological saline. These phenomena induced by Lyso‐PC were diminished by pretreatment with dexamethasone (6 µg/kg per day for 3 days). 5. Lysophosphatidylcholine causes eosinophil infiltration and a subsequent increase in resistance in airways. Our results indicate that Lyso‐PC may be involved in the pathophysiology of bronchial asthma.
A double blind comparative study was conducted to objectively evaluate the clinical efficacy and safety of Cefuzonam (CZON) in the treatment of chronic respiratory infections. Cefmenoxime (CMX) was used as a control drug. Each drug was administered by intravenous drip infusion 1g at a time, twice daily, for 14 days as a rule.The results were as follows:1. Treated in this study were 167 cases in total, 88 of CZON group and 79 of CMX group, but subjected for clinical evaluation by the evaluation committee were 147 cases, 77 of CZON group and 70 of CMX group, with 20 cases (11 of CZON group and 9 of CMX group) excluded from the committee's evaluation.2. Clinical effectiveness assessed by the committee showed the efficacy rates of 81.8%(63 cases our of 77) for CZON group and 80.0%(56 cases out of 70) for CMX group, with no significant difference observed between the two drug groups. Also, there was no significant difference between the two groups in clinical efficacy evaluation by physicians in charge.3. Classified by causal bacteria, clinical efficacy rates were 85.2% for CZON group and 78.6% for CMX group, and in single infection cases of gram-positive bacteria the effectiveness rates were 100% for CZON group and 75.0% for CMX group. In these two evaluations, CZON group showed higher efficacy percentages but no statistically significant difference was observed between the two drug groups. As for bacterial eradication rate, CZON group showed higher percentage but no significant difference was noted.4. The incidence rate of abnormality in laboratory tests was lower for CZON than for CMX, but no significant difference was observed. Side effects incidence rates showed no significant difference between the two groups.5. Usefulness rates by the evaluation of the committee were 77.9%(60 cases out of 77) for CZON group and 77.1%(54 cases out of 70) for CMX group, whereas evaluation by physicians in charge were 71.1%(54 cases out of 76) for CZON group and 82.6%(57 cases out of 69) for CMX group. In either evaluation, there was no significant difference observed between the two drug groups.These results show that CZON is a useful drug in the treatment of chronic respiratory infections.
Background: Early studies of community-acquired pneumonia showed that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may identify patients with community-acquired pneumonia who are becoming critically ill. This study investigated the correlation between commonly used laboratory markers, in particular the B/A ratio, and clinical outcomes of community-acquired pneumonia. Methods: This observational study was performed in consecutive patients with community-acquired pneumonia admitted to our hospital over a period of one year. Blood counts, commonly used laboratory markers, microbiological tests, and calculation of Pneumonia Severity Index (PSI) and CURB-65 were done on admission. The endpoints were mortality within 28 days of admission and requirement for intensive care. Results: One hundred and seventy-five patients with community-acquired pneumonia were enrolled. Nineteen patients died within 28 days of admission and 29 patients required intensive care. Using multivariate analysis, independent factors associated with mortality were the requirement for intensive care (odds ratio [OR] 14.96, 95% confidence interval [CI] 3.73–60.03, P < 0.001), PSI class (OR 3.55, 95% CI 1.08–11.66, P = 0.037), and B/A ratio (OR 1.10, 95% CI 1.01–1.20, P = 0.037). Similarly, independent factors associated with need for intensive care were PSI class (OR 5.35, 95% CI 1.90–15.06, P = 0.002), CURB-65 (OR 2.37, 95% CI 1.26–4.45, P = 0.007), and B/A ratio (OR 1.27, 95% CI 1.09–1.47, P = 0.002). Conclusion: The B/A ratio is a simple but independent predictor of mortality and severity of community-acquired pneumonia. Keywords: blood urea nitrogen to serum albumin ratio, Pneumonia Severity Index, CURB-65, community-acquired pneumonia, mortality, severity
A 21-year-old woman with a 6-year history of ulcerative colitis admitted to our hospital with chest pain, cough and fever of unknown origin in August 1998. On admission, laboratory data showed positive inflammatory signs. A chest radiograph and chest computed tomogram (CT) revealed nodular shadows in the right upper lung field. Fifty days after admission, hypertension developed and a bruit was audible in the neck and the upper abdomen. Digital subtraction angiography showed stenosis in carotid, renal and right upper pulmonary arteries. On the basis of these results, a diagnosis of aortitis syndrome was made. Moreover, these findings indicated pulmonary infarction in the right upper lobe due to aortitis syndrome. Aortitis syndrome preceded by pulmonary infarction involvement is very rare. Autoimmune disorders may have been involved in this case because of the association with ulcerative colitis.
