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| 1.
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清水, 淳三 ; 渡辺, 洋宇 ; 林, 義信 ; 小田, 誠 ; 岩, 喬 ; 高松, 秀行 ; 藤村, 政樹 ; 水上, 勇治 ; Shimizu, Junzo ; Watanabe, Yoh ; Hayashi, Yoshinobu ; Oda, Makoto ; Iwa, Takashi ; Takamatsu, Hideyuki ; Fujimura, Masaki ; Mizukami, Yuji
概要:
Leiomyoma of the trachea and bronchus is a rare tumor. Only 45 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the intermediate bronchus which was successfully operated on. A 45-year-old man
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suffered from a repeated episode of pneumonia in the right lower lobe. Bronchoscopy revealed a polypoid mass on the intermediate bronchus. The diagnosis of leiomyoma was made by bronchoscopic biopsy. Sleeve resection of the intermediate bronchus including the tumor and end-to-end anastomosis was performed. His postoperative course was uneventful and bronchoscopic findings showed clear healing of the anastomotic site. The resected specimen contained a tumor with smooth surface having protrusion into the bronchial lumen with 6 x 5 x 4 mm in size. The final pathological diagnosis was leiomyoma of the intermediate bronchus with no evidence of malignancy.
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| 2.
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Hara, Johsuke ; Fujimura, Masaki ; Ohkura, Noriyuki ; Sakai, Tamami ; Yamamura, Kenta ; Abo, Miki ; Koba, Hayato ; Watanabe, Satoshi ; Yoneda, Taro ; Nishikawa, Shingo ; Sone, Takashi ; Kimura, Hideharu ; Ishiura, Yoshihisa
概要:
Background: We demonstrated that heightened cough response to bronchoconstriction is a fundamental feature of cough vari
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ant asthma (CVA). To evaluate this physiological feature of CVA in daily clinical practice, it is necessary to clarify the cough response to bronchoconstriction in healthy subjects. We evaluated cough response to methacholine (MCh)-induced bronchoconstriction in healthy subjects. A forced oscillometry technique was used to measure airway resistance changes with Mch. Methods: Healthy never-smokers (21 men, 20 women; mean 22.3 ± 3.7 years) participated. None had a >3-week cough history, clinically significant respiratory or cardiovascular disorders, or disorders that might put subjects at risk or influence the study results or the subjects’ ability to participate. Twofold increasing concentrations of Mch chloride diluted in phosphate-buffered saline (0.039 to 160 mg/mL) were inhaled from nebulizers at 1-minute intervals during subjects’ tidal breathing after the baseline respiratory resistance (Rrs) was recorded. Mch inhalation continued until Rrs reached twice the baseline value and forced expiratory volume in 1 second (FEV1) decreased to <90% of baseline value. Spirometry was measured before Mch inhalation and immediately after Rrs had increased twofold. Coughs were counted during and for 30 minutes after Mch inhalation. The cough reflex sensitivity to capsaicin was also examined. Results: The number of coughs was 11.1 ± 14.3 (median, 7.0; range, 0 to 71; reference range, 0 to 39.7). There was no significant difference in the cough response between the sexes. The reproducibility of the cough response to bronchoconstriction was sufficient. No correlation existed between the bronchoconstriction-induced cough response and capsaicin cough-reflex sensitivity. Conclusions: Using the Astograph method, cough response to bronchoconstriction could be measured easily, safely and highly reproducibly in healthy subjects. © 2017 Taylor & Francis<br />Embargo Period 12 months
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| 3.
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Higashi, Tomomi ; Ohkura, Noriyuki ; Fujimura, Masaki ; Nakai, Satoshi ; Honda, Yasushi ; Saijoh, Kiyofumi ; Hayakawa, Kazuichi ; Kobayashi, Fumihisa ; Michigami, Yoshimasa ; Olando, Anyenda Enoch ; Hitomi, Yoshiaki ; Nakamura, Hiroyuki ; 東, 朋美 ; 大倉, 徳幸 ; 藤村, 政樹 ; 西條, 淸史 ; 早川, 和一 ; 小林, 史彦 ; 道上, 義正 ; 人見, 嘉哲 ; 中村, 裕之
概要:
金沢大学医薬保健研究域医学系<br />Asian dust, known as kosa in Japanese, is a major public health concern. In this panel study, we eva
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luated the effects of exposure to kosa on daily cough occurrence. The study subjects were 86 patients being treated for asthma, cough variant asthma, or atopic cough in Kanazawa University Hospital from January 2011 to June 2011. Daily mean concentrations of kosa and spherical particles were obtained from light detection and ranging (LIDAR) measurements, and were categorized from Grade 1 (0 μg/m3) to 5 (over 100 μg/m3). The association between kosa and cough was analyzed by logistic regression with a generalized estimating equation. Kosa effects on cough were seen for all Grades with potential time lag effect. Particularly at Lag 0 (the day of exposure), a dose-response relationship was observed: the odds ratios for Grades 2, 3, 4, and 5 above the referent (Grade 1) were 1.111 (95% confidence interval (CI): 0.995-1.239), 1.171 (95% CI: 1.006-1.363), 1.357 (95% CI: 1.029-1.788), and 1.414 (95% CI: 0.983-2.036), respectively. Among the patients without asthma, the association was higher: the odds ratios for Grades 2, 3, 4 and 5 were 1.223 (95% CI: 0.999-1.497), 1.309 (95% CI: 0.987-1.737), 1.738 (95% CI: 1.029-2.935) and 2.403 (95% CI: 1.158-4.985), respectively. These associations remained after adjusting for the concentration of spherical particles or particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5). Our findings demonstrate that kosa is an environmental factor which induces cough in a dose-response relationship. © 2014 Elsevier B.V.<br />Embargo Period 12 months
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| 4.
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Tanaka, Rie ; Sanada, Shigeru ; Fujimura, Masaki ; Yasui, Masahide ; Tsuji, Shiro ; Hayashi, Norio ; Nanbu, Yuko ; Matsui, Osamu
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金沢大学医薬保健研究域保健学系<br />Purpose: Pulmonary ventilation and circulation dynamics are reflected on fluoroscopic images as cha
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nges in X-ray translucency. The purpose of this study was to investigate the feasibility of non-contrast functional imaging using a dynamic flat-panel detector (FPD). Methods: Dynamic chest radiographs of 20 subjects (abnormal, n = 12; normal, n = 8) were obtained using the FPD system. Image analysis was performed to get qualitative perfusion mapping image; first, focal pixel value was defined. Second, lung area was determined and pulmonary hilar areas were eliminated. Third, one cardiac cycle was determined in each of the cases. Finally, total changes in pixel values during one cardiac cycle were calculated and their distributions were visualized with mapping on the original image. They were compared with the findings of lung perfusion scintigraphy. Results: In all normal controls, the total changes in pixel value in one cardiac cycle decreased from the hilar region to the peripheral region of the lung with left-right symmetric distribution. In contrast, in many abnormal cases, pulmonary blood flow disorder was indicated as a reduction of changes in pixel values on a mapping image. The findings of mapping image coincided with those of lung perfusion scintigraphy. Conclusions: Dynamic chest radiography using an FPD system with computer analysis is expected to be a new type of functional imaging, which provides pulmonary blood flow distribution additionally. © CARS 2009.
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| 5.
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Heki, Utako ; Fujimura, Masaki ; Ogawa, Haruhiko ; Matsuda, Tamotsu ; Kitagawa, Masanobu
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金沢大学医薬保健研究域医学系<br />A 57-year-old man was admitted to our hospital because of dyspnea and abnormal shadow on chest roent
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genogram. He had received two herbal drugs: Saikokeisikankyou-tou (SKT) for one month and Licium Halimifolium Mil (LHM) for two weeks. After admission, all medication was stopped and his symptoms were gradually diminished. Transbronchial lung biopsy specimens showed interstitial pneumonia. Lymphocyte stimulation test, skin test and challenge test were positive to these herbal drugs. We diagnosed him as drug-induced pneumonitis. This is the first report on pneumonitis caused by Saikokeisikankyou-tou diagnosed by lymphocyte stimulation test, skin test and challenge test.
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| 6.
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新屋, 智之 ; 笠原, 寿郎 ; 藤村, 政樹 ; 丹保, 裕一 ; 田森, 俊一 ; 曽根, 崇 ; 中尾, 眞二 ; Araya, Tomoyuki ; Kasahara, Kazuo ; Fujimura, Masaki ; Tanbo, Yuichi ; Tamori, Shunichi ; Sone, Takashi ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />Background. Skeletal muscle metastases from lung cancer are considered to be extremely rare. We enco
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untered 3 cases of lung cancer associated with skeletal muscle metastases on initial medical examination or during disease progression. Cases. Case 1: A 46-year-old man was trismic due to metastasis of lung adenocarcinoma to the lateral pterygoid muscle. He was resistant to radiotherapy and chemotherapy, and died 9 months after the occurrence of symptoms. Case 2: A 57-year-old man had a large cell lung carcinoma or poorly differentiated lung adenocarcinoma. He had metastasis to the right femoral muscle in addition to multiple metastases to many other organs. His disease was also resistant to any treatment, and died 7 months after he became symptomatic. Case 3: A 64-year-old man with adenocarcinoma had a single metastasis to the biceps muscle. He died 3 months after the diagnosis of muscle metastasis due to resistance to therapy. Conclusion. Upon diagnosis of tumorous lesions of skeletal muscles, whole body examination and subsequent percutaneous biopsy of muscle involvement are required to determine the possibility of skeletal muscle metastasis of lung cancer. 背景.肺癌の骨格筋転移は極めて稀とされているが,今回我々は,初診時もしくは経過中に骨格筋転移を来した非小細胞肺癌の3症例を経験した.症例.症例1は46歳男性,肺腺癌の外側翼突筋転移のために開口障害を来した.放射線及び化学療法に対して抵抗性であり,原疾患の悪化により症状発現から約9ヶ月の経過で死亡した.症例2は57歳男性,肺大細胞癌もしくは低分化腺癌の症例で右大腿部の筋転移に加え,他臓器への広範な転移を認めた.治療抵抗性で症状出現より約7ヶ月の経過で死亡した.症例3は64歳男性,腺癌の症例で,右上腕二頭筋に転移を来し,治療抵抗性の経過で筋転移出現より約3ヶ月で死亡した.結論.骨格筋の腫瘤性病変の診断の際には転移性悪性腫瘍,特に肺癌の骨格筋転移を念頭に置き,全身精査と病変部位の生検により速やかな確定診断が必要と考えられた.
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| 7.
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Yoshimoto, Akihiro ; Nakamura, Hiroyuki ; Fujimura, Masaki ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />Objective: To evaluate severe community-acquired pneumonia (SCAP) patients in an intensive care unit
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(ICU) with regard to risk factors for mortality and to compare ICU patients with matched non-ICU patients to evaluate whether our judgement for ICU admission was appropriate or not. Materials and methods: During a 7-year period, all patients with CAP who were admitted to the ICU were examined. They underwent clinical and radiographic evaluations, and two commonly used severity of illness scores were also calculated using the Simplified Acute Physiological Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II methods. To detect risk factors for ICU admission using existing guidelines, each study patient was matched with two patients hospitalized in a general medical ward. Results: Seventy-two patients were identified during the study period. Their mean age was 72.9 years, and 35 patients (48.6%) subsequently died. For the univariate analysis, there were significant differences with the pulse rate ≥130/min, blood urea nitrogen ≥30 mg/dl, multilobar shadow, SAPS ≥43, APACHE II ≥23, and the occurrence of septic shock between the survivors and those who died. For the multivariate analysis, septic shock (p=0.0005, odds ratio of 26.6) and blood urea nitrogen ≥30 mg/dl (p=0.037, odds ratio of 5.38) were associated with mortality. Regarding the characteristics of different clinical predictions for ICU admission, the revised American Thoracic Society criteria might have been the most accurate. Conclusion: Septic shock was associated with high mortality, which is a more accurate and higher predictor of mortality than was physical examination, laboratory or radiographic findings.
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| 8.
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Takato, Hazuki ; Yasui, Masahide ; Ichikawa, Yukari ; Fujimura, Masaki ; Nakao, Shinji ; Zen, Yoh ; Minato, Hiroshi
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金沢大学医薬保健研究域医学系<br />Recently, great attention has been drawn to IgG4-related diseases such as autoimmune pancreatitis (A
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IP) sclerosing sialadenitis, retroperitoneum fibrosis, sclerosing cholangitis. IgG4-related diseases are characterized by high serum IgG4 concentrations, sclerosing inflammation with numerous IgG4-positive plasma cells, and steroid sensitivity irrespective of their organs of origin. In this report, we describe a case of nonspecific interstitial pneumonia, in which possible involvement of IgG4 was suggested. The patient was 59-year-old man, who was found to have bilateral interstitial pneumonia. Laboratory tests revealed that he had antinuclear antibody and a high serum IgG4 concentration. Pathological examination of the video-assisted thoracic surgery biopsy taken from the right lower lobe showed interstitial thickening associated with lymphoplasmacytic infiltration containing many IgG4-positive plasma cells. He was effectively treated by corticosteroid. The present case had many clinical and clinicopathologic similarities to systemic IgG4-related autoimmune disease. There have been no descriptions on isolated interstitial pneumonia with IgG4-positive plasma cell infiltration. This case suggested that IgG4-related disorders could also occur in the lung, and interstitial pneumonia may be a pulmonary manifestation of systemic IgG4-related autoimmune disease © 2008 The Japanese Society of Internal Medicine.
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| 9.
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Fujimura, Masaki ; Myou, Shigeharu
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金沢大学医薬保健研究域医学系
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| 10.
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Ishiguro, Takashi ; Yasui, Masahide ; Takato, Hazuki ; Kimura, Hideharu ; Katayama, Nobuyuki ; Kasahara, Kazuo ; Fujimura, Masaki
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金沢大学医薬保健研究域医学系<br />We describe a 73-year-old woman with systemic sclerosis (SSc)-polymyositis (PM) overlap syndrome, pr
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imarily SSc followed by PM. She had suffered from SSc and had interstitial pneumonia (IP), which was stable. Eight years after the initial diagnosis of SSc, proximal muscle weakness, myalgia, and dyspnea on effort developed. A chest computed tomography (CT) showed reticular shadows, and serum markers of IP such as KL-6 and surfactant protein-D were elevated at 1,170 U/mL and 176 ng/ mL, respectively. Bronchoalveolar lavage fluid showed a remarkably increased number of lymphocytes. Exacerbation of SSc-IP 8 years after the initial diagnosis of SSc is not usual, and a marked increase in the number of lymphocytes in bronchoalveolar lavage fluid is also uncommon in SSc-IP, indicating overlap of another connective tissue disease. The diagnostic criteria for PM were satisfied; thus, SSc-PM overlap syndrome was diagnosed. We emphasize the need to investigate whether another connective tissue disease has developed when symptoms or laboratory findings cannot be explained by the usual clinical course of an existing connective tissue disease. © 2007 The Japanese Society of Internal Medicine.
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