Nihon Kyōbu Shikkan Gakkai zasshi
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
[Diagnosis of acute respiratory distress syndrome: analysis of bronchoalveolar lavage fluid].
To better understand the pathogenesis of acute respiratory distress syndrome (ARDS), we analyzed bronchoalveolar lavage fluid (BALF) from patients with ARDS (n = 89, survival rate = 56.2%), who were admitted to our intensive care units over the past 7 years. ARDS was diagnosed when the lung injury score proposed by Murray et al was greater than 2.5. The BALF had very high centrations of albumin, a marker of permeability edema, along with remarkably high neutrophil counts, percent neutrophils, neutrophil-elastase, and interleukin-8, markers of neutrophil-related lung injury. ⋯ Moreover, the level of soluble thrombomodulin in BALF was higher in non-survivors than in survivors. There were significant relationships between these neutrophil-related markers and markers of abnormal coagulation. The results of the BALF analysis suggest that accumulation and activation of neutrophils can affect thrombomodulin on vascular endothelial cells, which can activate thrombin and cause the coagulopathy seen in ARDS.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
Randomized Controlled Trial Clinical Trial[High-dose inhaled beclomethasone dipropionate and maximal improvements in patients with stable chronic obstructive pulmonary disease].
High doses of inhaled beclomethasone dipropionate (BDP) are effective in some patients with chronic obstructive pulmonary disease (COPD). However, dose-response data for this agent are limited. To determine whether patients receive maximum benefit from 1600 micrograms of BDP, we performed a randomized, double-blind, placebo-controlled, cross-over trial. ⋯ In addition to end-point spirometric assessments daily peak expiratory flow rate, symptom scores, and scores on a chronic respiratory disease questionnaire were recorded for the last week of each 3-week period. Oral prednisolone did not improve FEV1, FVC, symptoms or scores on the questionnaire. We conclude that 1600 micrograms of BDP in addition to inhaled bronchodilators produces maximal improvements in stable patients with COPD.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
Case Reports Clinical Trial[Interstitial lung disease in patients with connective tissue diseases].
Interstitial lung disease is a significant prognostic factor in connective tissue diseases. To further clarify clinical and immunological features of interstitial lung disease, we studied 894 consecutive patients with connective tissue diseases first evaluated between 1970 and 1993. Interstitial lung disease was found in 101 of 181 (56%) patients with systemic sclerosis, 92 of 183 (50%) with overlap syndrome, 35 of 76 (46%) with polymyositis/dermatomyositis, and 13 of 444 (3%) with systemic lupus erythematosus (p < 0.05, systemic lupus erythematosus vs. other connective tissue diseases). ⋯ As a cause of death, respiratory failure was associated with autoantibodies to topoisomerase I and aminoacyl tRNA synthetase but not anti-U1 RNP. Autoantibodies to aminoacyl tRNA synthetases were detected before the development of interstitial lung disease in 9 patients with polymyositis/dermatomyositis. We conclude that the clinical features of interstitial lung disease associated with connective tissue diseases vary with the type of connective tissue disease, and that analysis of autoantibodies can be useful in establishing a diagnosis and in forecasting the course and outcome.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
Clinical Trial[Bronchoscopy in the diagnosis of diffuse pulmonary infiltrates, and corticosteroid treatment in patients with acute respiratory failure].
Forty patients with acute respiratory failure underwent fiberoptic bronchoscopy for evaluation of diffuse pulmonary infiltrates. Immunohematological diseases were the commonest underlying conditions; they were present in 48% of patients. Twenty-five percent of patients had pulmonary disease. ⋯ The average initial dose was 851 +/- 373 mg, and more than 100 mg was administered for 8 +/- 6 days. Seventeen of these patients recovered from the pulmonary disease. A controlled randomized study is needed to reevaluate the role of corticosteroids in the treatment of acute respiratory distress syndrome.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
[Frequency analysis of crackles recorded with a stethoscope-equipped recorder].
Crackles were recorded with one of two systems in a total of 58 cases and compared. In one system a stethoscope was attached to a microphone; in the other system no stethoscope was used (see reference 9). Coarse crackles were recorded with the stethoscope system in 11 patients, and with the microphone-only system in 12 patients. ⋯ For both kinds of equipment, the %Type II differed significantly between coarse and fine crackles (p < 0.01). The stethoscope-transmitted sound had components that could be used to differentiate fine crackles from coarse crackles. For clinical purposes, crackles recorded with a stethoscope are as useful as those recorded with a microphone only.