Hypersensitivity to intravenous succinate corticosteroids in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease

Although there are many case reports of asthma exacerbations with intravenous corticosteroids, especially hydrocortisone succinate, in nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), the frequency and mechanism remain unclear. We hypothesized that N-ERD patients are potentially hypersensitive to succinates, especially succinate corticosteroids, based on the results of previous provocation studies and considered specific mechanisms. The objective of this study was to determine the frequency and mechanism of succinate corticosteroids hypersensitivity in patients with N-ERD. Eleven patients with stable, moderate to severe N-ERD were tested with hydrocortisone sodium succinate (HCs), hydrocortisone sodium phosphate (HCp), methylprednisolone sodium succinate (MPSLs), prednisolone sodium succinate (PSLs), and chloramphenicol sodium succinate (CPs, without a steroidal chemical structure) at doses below the normal dose through intravenous administration using a single-blind test. As a comparison, seven patients with aspirin-tolerant asthma (ATA) also underwent an intravenous provocation test of HCs. The positive intravenous provocation test rates of HCs 100–500 mg, HCp 500 mg, MPSLs 80 mg, PSLs 20 mg, and CPs 500 mg in N-ERD patients were 82% (9/11), 9% (1/11), 50% (5/10), 33% (1/3), and 86% (6/7), respectively. Most positive reactions began with a severe cough within 5 min of intravenous injection. The course of these hypersensitivity symptoms differed from those seen with the usual aspirin challenge test. The HCs 100–500 mg intravenous test was negative in all seven patients with ATA. In conclusion, patients with N-ERD have high rates of potential hypersensitivity to the succinate ester structure, which is not linked to the corticosteroid structure, but to the succinate ester structure. We hypothesized that the mechanism of hypersensitivity observed during rapid intravenous administration of succinate corticosteroids is mast cell activation via succinate receptor stimulation, rather than due to the corticosteroid itself

Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL) for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1) the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2) this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones

Treatment for Churg-Strauss Syndrome: Induction of Remission and Efficacy of Intravenous Immunoglobulin Therapy

ABSTRACTChurg-Strauss syndrome (CSS) is characterized by the presence of asthma, eosinophilia, and small-vessel vasculitis with granuloma. It is a distinct entity, as determined from all classifications of systemic vasculitis. The poor prognostic factors in CSS are renal insufficiency, cardiomyopathy, severe gastrointestinal (GI) tract, and central nervous systems (CNS) involvement. The initial management of CSS should include a high dose of a corticosteroid: prednisone at 1 mg/kg/day or its equivalent for methylprednisolone with tapering over 6 months. In patients with severe or rapidly progressing CSS, the administration of methylprednisolone pulse at 1 g/body/day for 3 days is recommended. When corticosteroid therapy does not induce remission, or when patients have poor prognostic factors, immunosuppressive cytotoxic therapy is indicated. However, some patients with severe CSS often show resistance to conventional treatment. We think that IVIG therapy is a hopeful candidate for second-line treatment for CSS patients, particularly in the case of neuropathy and/or cardiomyopathy, which are resistant to conventional therapy. However, there is not much evidence supporting the effectiveness of IVIG in CSS, and the mechanisms underlying the action of IVIG remain unclear. Now we are performing clinical trials of IVIG therapy for CSS patients who are resistant to conventional treatment, through a nationwide double-blinded placebo-controlled study in Japan

Large-scale Filamentary Structure around the Protocluster at Redshift z=3.1

We report the discovery of a large-scale coherent filamentary structure of Lyman alpha emitters in a redshift space at z=3.1. We carried out spectroscopic observations to map the three dimensional structure of the belt-like feature of the Lyman alpha emitters discovered by our previous narrow-band imaging observations centered on the protocluster at z=3.1. The feature was found to consist of at least three physical filaments connecting with each other. The result is in qualitative agreement with the prediction of the 'biased' galaxy-formation theories that galaxies preferentially formed in large-scale filamentary or sheet-like mass overdensities in the early Universe. We also found that the two known giant Lyman alpha emission-line nebulae showing high star-formation activities are located near the intersection of these filaments, which presumably evolves into a massive cluster of galaxies in the local Universe. This may suggest that massive galaxy formation occurs at the characteristic place in the surrounding large-scale structure at high redshift.Comment: 11 pages, 3 figures, accepted for publication in ApJ Letter

A New Constraint on the Lyα\alpha Fraction of UV Very Bright Galaxies at Redshift 7

We study the extent to which very bright (-23.0 < MUV < -21.75) Lyman-break selected galaxies at redshifts z~7 display detectable Lya emission. To explore this issue, we have obtained follow-up optical spectroscopy of 9 z~7 galaxies from a parent sample of 24 z~7 galaxy candidates selected from the 1.65 sq.deg COSMOS-UltraVISTA and SXDS-UDS survey fields using the latest near-infrared public survey data, and new ultra-deep Subaru z'-band imaging (which we also present and describe in this paper). Our spectroscopy has yielded only one possible detection of Lya at z=7.168 with a rest-frame equivalent width EW_0 = 3.7 (+1.7/-1.1) Angstrom. The relative weakness of this line, combined with our failure to detect Lya emission from the other spectroscopic targets allows us to place a new upper limit on the prevalence of strong Lya emission at these redshifts. For conservative calculation and to facilitate comparison with previous studies at lower redshifts, we derive a 1-sigma upper limit on the fraction of UV bright galaxies at z~7 that display EW_0 > 50 Angstrom, which we estimate to be < 0.23. This result may indicate a weak trend where the fraction of strong Lya emitters ceases to rise, and possibly falls between z~6 and z~7. Our results also leave open the possibility that strong Lya may still be more prevalent in the brightest galaxies in the reionization era than their fainter counterparts. A larger spectroscopic sample of galaxies is required to derive a more reliable constraint on the neutral hydrogen fraction at z~7 based on the Lya fraction in the bright galaxies.Comment: 20 pages, 7 figures, accepted for publication in Ap

The Subaru/XMM-Newton Deep Survey (SXDS). IV. Evolution of Lya Emitters from z=3.1 to 5.7 in the 1 deg^2 Field: Luminosity Functions and AGN

We present luminosity functions (LFs) and various properties of Lya emitters (LAEs) at z=3.1, 3.7, and 5.7, in a 1 deg^2 sky of the Subaru/XMM-Newton Deep Survey (SXDS) Field. We obtain a photometric sample of 858 LAE candidates based on deep Subaru/Suprime-Cam imaging data, and a spectroscopic sample of 84 confirmed LAEs from Subaru/FOCAS and VLT/VIMOS spectroscopy in a survey volume of ~10^6 Mpc^3 with a limiting Lya luminosity of ~3x10^42 erg/s. We derive the LFs of Lya and UV-continuum (~1500 \AA) for each redshift, taking into account the statistical error and the field-to-field variation. We find that the apparent Lya LF shows no significant evolution between z=3.1 and 5.7 within factors of 1.8 and 2.7 in L* and phi*, respectively. On the other hand, the UV LF of LAEs increases from z=3.1 to 5.7, indicating that galaxies with Lya emission are more common at earlier epochs. We identify six LAEs with AGN activities from our spectra combined with VLA, Spitzer, and XMM-Newton data. Among the photometrically selected LAEs at z=3.1 and 3.7, only ~1 % show AGN activities, while the brightest LAEs with logL(Lya) >~ 43.4-43.6 erg/s appear to always host AGNs. Our LAEs are bluer in UV-continuum color than dropout galaxies, suggesting lower extinction and/or younger stellar populations. Our stacking analyses provide upper limits to the radio luminosity and the f(HeII)/f(Lya) line fraction, and constrain the hidden star formation (+low-luminosity AGN) and the primordial population in LAEs.Comment: 75 pages, 27 figures; ApJS in press. High resolution version at http://www.ociw.edu/~ouchi/work/astroph/sxds_LAEs/ouchi_SXDSLAE_ApJS.pd