Comparison of Distance of 6-min Walk Test and the Incremental Shuttle Walk Test with Lung Function or Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Article信州医学雑誌 61(2):57-64(2013)journal articl

Associations between the distance covered in the incremental shuttle walk test and lung function and health status in patients with chronic obstructive pulmonary disease

Background: Field walk tests such as the incremental shuttle walk test (ISWT) are simple tests for assessing the degree of disability in individuals with chronic obstructive pulmonary disease (COPD). In the present study, the correlations between exercise performance in the ISWT, lung function, and health status were examined in patients with COPD of varying seventies. Methods: A retrospective examination of 277 COPD patients was performed using the ISWT and lung function tests along with assessment of health status using St. George's Respiratory Questionnaire (SGRQ). In addition, we assessed the correlations between the walking distance, lung function parameters, and SGRQ scores. Results: ISWT distances were poorly correlated with lung function parameters and SGRQ scores in mild COPD patients. In contrast, ISWT distances were significantly correlated with pulmonary function parameters, such as vital capacity (%predicted) and forced expiratory volume in one second, and SGRQ scores in moderate and severe COPD patients. Conclusions: The ISWT is more independent of health status and pulmonary function in patients with mild COPD compared to moderate or severe cases. Therefore, the exercise capacity of patients with mild COPD should be estimated by the ISWT. (C) 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.ArticleRESPIRATORY INVESTIGATION.55(1):33-38(2017)journal articl

An Unusual Case of Multicentric Castleman's Disease, Complicated by Pleural Effusion

Article信州医学雑誌 65(1): 51-56(2017)journal articl

Predictive Factors for Tracheal Intubation in Patients with Coronavirus Disease 2019 Treated Using a High-flow Nasal Cannula

Background : In Japan, patients with coronavirus disease 2019 (COVID-19)＊ requiring a high-flow nasal cannula (HFNC) are often initially treated in non-specialized facilities and transferred to an intensive care unit if tracheal intubation is required. We aimed to investigate the factors associated with severe respiratory failure requiring tracheal intubation at an early stage in patients with COVID-19 treated using HFNCs. Methods : This retrospective cohort study compared the clinical features of consecutively enrolled patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus-2 infection admitted to two centers in Japan between early February 2020 and late June 2021. Results : A total of 35 patients with COVID-19 treated using HFNCs were included. Treatment success and failure occurred in 25 and 10 patients, respectively. The oxygen saturation (ROX) index (ratio of oxygen saturation [SpO2] to fraction of inspired oxygen [FiO2] and the respiratory rate) 12 h post-HFNC insertion was a useful predictor of HFNC failure (success group, 8.0 ; failure group, 6.5 : P＝0.0005). Moreover, the time from symptom onset to respiratory failure was significantly shorter in the failure group than in the success group (3.0 and 5.0 days, P＝0.004). Conclusions The ROX index and time from symptom onset to respiratory failure were useful predictors of HFNC failure.Article信州医学雑誌 71(6) : 403-409, (2023)journal articl

Usefulness of the forced oscillation technique in assessing the therapeutic result of tracheobronchial central airway obstruction

Background: Pulmonary function tests (PFTs) comprise the traditional method for detecting central airway obstruction (CAO) and evaluating therapeutic effects, but are effort dependent. By contrast, the forced oscillation technique (FOT) is performed during tidal breathing in an effort-independent mode and is universally used to assess respiratory function in patients with chronic obstructive pulmonary disease (COPD) and asthma. We used the FOT to measure airway resistance and reactance in patients with CAO before and after interventional bronchoscopy and compared the results to data obtained using PFTs. Methods: Twelve patients with CAO were recruited from December 2013 to July 2016. The FOT, PFTs, chest computed tomography (CT), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale were employed before and after interventional bronchoscopy. The minimum airway cross-sectional area (MACSA) was calculated using a CT image calculator. Results: Of the 12 patients, 6 had tracheal obstruction and 6 had bronchial obstruction. All FOT measurements, except Delta XS, were significantly improved after interventional bronchoscopy in all cases. The significance of the improvement was greater with the FOT than PFTs. The MACSA, CAT, and mMRC dyspnea scale scores also significantly improved in all cases. Furthermore, only alteration of resistance at 20 Hz (R20) significantly correlated with the alteration of the MACSA after intervention. No significant correlations were found for PFTs. Conclusions: The FOT is suitable and convenient for assessing therapeutic results in patients with tracheobronchial CAO. The alteration of R20 is useful for estimating the airway dilation of CAO after interventional bronchoscopy. (C)2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.ArticleRESPIRATORY INVESTIGATION.56(3):222-229(2018)journal articl

An Assessment by In Situ Hybridization Method for Pathogens of Severe Respiratory Infection

It has been shown that the in situ hybridization (ISH)method for the detection of phagocyted bacteria in polymorphonuclear neutrophils is more sensitive than conventional blood culture in patients with sepsis.The present study was designed to further evaluate the clinical utility of the ISH method, using a commercially available kit (Hybrizep(R)), for detecting pathogens in patients with severe respiratory infections. Peripheral blood was taken from patients with severe respiratory infections for both routine blood culture and the ISH method,respectively.In addition,focal samples including sputum,bronchoalveolar lavage,central and thoracic catheter, etc. were simultaneously examined for bacterial culture. A total number of 22 specimens was examined.The positive cases by ISH were 50.0% in the respiratory infections,which were significantly higher than those in blood cultures (9.1%).However, identical pathogens in the ISH method were not isolated from blood and/or other sources in respiratory sites. These findings suggest a possibility of high frequency of bacteremia or multifactorious pathogens in severe respiratory infections.The ISH method may provide additional information on serious respiratory infections for the detection of bacteremia. However, the clinical utility by the ISH method for patients with severe respiratory infection remains undetermined. Shinshu Med J 59 : 223―228, 2011Article信州医学雑誌 59(4): 223-228(2011)departmental bulletin pape

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for the Diagnosis of Intrathoracic Lesions : Experience of a Single Academic Medical Center

Article信州医学雑誌 60(5): 249-255(2012)journal articl

Colonic Sarcoidosis Presenting Multiple Submucosal Tumor-Like Lesions

Here, we describe a case of colonic sarcoidosis that developed over a 7-year period of observation of intrathoracic sarcoidosis. The patient was asymptomatic, but colonoscopy showed multiple elevated lesions mimicking submucosal tumors in several areas of the colon. The specimens obtained by biopsy showed non-caseating granuloma, suggesting sarcoidosis. The observations in the present case indicate that colonic involvement should be considered in patients with sarcoidosis. Furthermore, the macroscopic appearance of multiple submucosal tumor-like lesions in colonic sarcoidosis is extremely rare.ArticleINTERNAL MEDICINE. 48(20):1813-1816 (2009)journal articl

A Case of Organizing Pneumonia Induced by Tocilizumab

A 66-year-old woman rheumatoid arthritis was treated with methotrexate and tocilizumab. Chest radiography revealed bilateral consolidation of an upper lesion in the lung. Laboratory data indicated a hepatic disorder and increased eosinophils. Transbronchial lung biopsy specimens showed organizing pneumonia. Infection was unfavorable based on culture and PCR. Drug lymphocyte stimulation test showed positive results both for methotrexate and tocilizumab. We were concerned that her pneumonitis was drug-induced. And the symptoms appeared after the infusion of tocilizumab. Here, we report a case of tocilizumab-induced organizing pneumonia.ArticleINTERNAL MEDICINE. 50(19):2191-2193 (2011)journal articl