Nihon Kyōbu Shikkan Gakkai zasshi
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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
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[Treatment of obstructive sleep apnea syndrome with a mandibular positioning device and other nonsurgical modalities].
The therapeutic approach to a patient with obstructive sleep apnea syndrome (OSAS) must be individualized because of the heterogeneity in the pathogenesis of the disorder. Although nasal continuous positive airway pressure (CPAP) is effective no matter what the pathogenesis, risk factors for this disorder should be identified in each patient. Nasal CPAP will be discussed by others. ⋯ No serious complications were observed. The mandibular positioning device is an effective treatment for some patients with OSAS. The effectiveness of the device should be predicted from polysomnographic and cephalometric data, and from CT measurements of the upper airway and other characteristics of the patients.
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Helical CT was used on a trial basis for secondary screening of lung cancer, and its clinical usefulness is discussed in this report. The subjects 157 patients with abnormal shadows on plain chest X-ray images acquired between November 1993 and August 1994. Imaging parameters used for screening CT were as follows: 50 mA, 120 kV, a couch-top movement speed of 20 mm/s, and a beam width of 10 mm. ⋯ Lung cancers in clinical stage I (3 patients) and stage IV (1 patient) were difficult to see on plain chest X-ray films. We conclude that screening CT is useful for early diagnosis of lung cancer because the entire lung field can be imaged during a single breath-hold. Therefore, helical CT can be expected to be useful in screening for lung cancer.
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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.