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Kataoka Y.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
Skin Research | Year: 2013

More than ten years has passed after publication of Japanese guideline for atopic dermatitis treatment. However there are still considerable numbers of patients who suffer from severe symptoms which deteriorate their quality of life. In the author's view this is because atopic dermatitis is a tricky disease that has several pitfalls which traps even medical personnel. Three pitfalls are described and the way of solution and importance of appropriate anti-inflammatory treatment is emphasized. 1. Pitfall for therapeutic goal: Considerable numbers of patients loose the way of treatment because of obscure therapeutic goal and indefinite therapeutic schedule. They should be obvious. 2. Pitfall for situation of aggravating factor elimination and anti-inflammatory treatment: Persistent cutaneous inflammation induces more aggravating factors to fall into vicious circle. Management for emotional stress without anti-inflammatory treatment achieves no goal. Allergen specific IgE is not only a cause but product of skin inflammation. 3. Pitfall of topical corticosteroid treatment: Topical corticosteroid application method should be reconsidered precisely and scientifically. Several clinical evidences and practical benefit reveal that the concept of treatment strategy should be "tight control" which achieves early complete remission and long-term maintenance of scarce inflammation even subclinical. Precise procedures of adequate topical corticosteroid application based on "proactive therapy" acompanied with educational support to accomplish the treatment goal were proposed.

Kataoka Y.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
Journal of Dermatology | Year: 2014

Thymus and activation-regulated chemokine (TARC/CCL17) is a member of the T-helper 2 chemokine family. In Japan, serum TARC level has been commercially measured since 2008. After years of experience, we realized that TARC is an extremely useful clinical biomarker for atopic dermatitis (AD) treatment. Usually, physicians conduct a visual examination to determine whether their treatment has been successful; however, the visual examination results may not always be accurate; in such cases, serum TARC levels should be measured to eliminate any ambiguity regarding the treatment outcome. When the waning and waxing of eczema and fluctuations in the serum TARC levels were considered, we frequently found that AD does not follow a natural course but follows non-regulated inflammatory floating caused by insufficient intermittent topical treatment. Serum TARC is a promising biomarker for remission and can be used for accurately monitoring proactive treatment for long-term control. Abnormally high serum TARC levels indicate accelerated pathogenesis of cutaneous inflammation. Rapid normalization and maintaining normal serum TARC levels using appropriate topical treatment is a reasonable strategy for alleviating inflammation without upregulating cytokine expression. Observing serum TARC levels during early intervention for severe infantile AD is worthwhile to determine initial disease activity and evaluate treatment efficacy. Appropriate control of severe early-onset infantile AD is important for improving prognosis of eczema and for preventing food allergies. Additionally, this biomarker is useful for improving patient adherence. Dermatologists will be able to make great progress in treating AD by adopting biomarkers such as TARC for accurately assessing non-visible subclinical disorders. © 2014 Japanese Dermatological Association.

Matsumoto T.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
Kekkaku : [Tuberculosis] | Year: 2013

Multidrug resistance (MDR) involves resistance to both isoniazid and rifampicin, which makes the treatment of tuberculosis very difficult. Extensive drug resistance (XDR) occurs when, in addition to isoniazid and rifampicin resistance, the microorganisms are resistant to a fluoroquinolone and an injectable agent (e.g., kanamycin, amikacin, or capreomycin). Generally, drug susceptibility testing takes more than 3-4 weeks after the initial cultivation. There is an urgent need to identify methods that can rapidly detect both the presence of Mycobacterium tuberculosis and the status of drug resistance. This study was aimed at evaluating the line probe assay (LiPA; Nipro Co.), for the identification of Mycobacterium species and detection of mutations associated with antituberculous drugs. We found that LiPA enabled the rapid identification of M. tuberculosis, M. avium, M. intracellulare, and M. kansasii. When the results of the LiPA and conventional drug susceptibility tests were compared, there was no difference in the susceptibility to rifampicin, pyrazinamide, and levofloxacin; however, there was a difference in the susceptibility to isoniazid. Thus, LiPA can be used for the rapid identification of Mycobacterium species and the determination of susceptibility to drugs, which can help in the early initiation of appropriate treatment, leading to a reduction in infectiousness.

Matsuno O.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
Respiratory Research | Year: 2012

Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated.DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions.One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic. © 2012 Matsuno; licensee BioMed Central Ltd.

Tamiya M.,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
Internal medicine (Tokyo, Japan) | Year: 2011

The aim of this study was to evaluate the factors contributing to an accurate diagnosis of small (≤15 mm) peripheral pulmonary lesions (PPLs) by standard bronchoscopy and to determine the most suitable technology for such a diagnosis. Bronchoscopy was performed for 115 PPLs (≤15 mm diameter) on chest computed tomography (CT) between August 2003 and December 2006. Univariate and multivariate analyses were conducted retrospectively with the R software. The diagnostic yield of the 115 PPLs was 65.2%; the yield was 61.9% and 69.2% for the malignant and benign lesions, respectively. In the univariate analysis, the approach to the lesion contributed the most to successful diagnosis, followed by skill and the use of hemostasis. In the multivariate analysis, the most important factor was approach, followed by lower lobe lesion and the use of hemostasis. Although it was better to use a sedative, operator skill was not a contributing factor. The approach to the lesion is the most important factor for a successful diagnosis of PPLs by bronchoscopy. Bronchoscopy is time consuming and painful; therefore, it is very important to establish an accurate diagnosis as soon as possible. Further, endobronchial ultrasonography with a guide sheath (EBUS-GS) and navigation systems are useful tools for the diagnosis of small PPLs.

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