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Takayanagi N.,Saitama Cardiovascular and Respiratory Center
Respiratory Investigation | Year: 2015

Biological agents are increasingly being used to treat patients with immune-mediated inflammatory disease. In Japan, currently approved biological agents for patients with rheumatoid arthritis (RA) include tumor necrosis factor inhibitors, interleukin-6 receptor-blocking monoclonal antibody, and T-cell costimulation inhibitor. Rheumatologists have recognized that safety issues are critical aspects of treatment decisions in RA. Therefore, a wealth of safety data has been gathered from a number of sources, including randomized clinical trials and postmarketing data from large national registries. These data revealed that the most serious adverse events from these drugs are respiratory infections, especially pneumonia, tuberculosis, nontuberculous mycobacteriosis, and Pneumocystis jirovecii pneumonia, and that the most common risk factors associated with these respiratory infections are older age, concomitant corticosteroid use, and underlying respiratory comorbidities. Because of this background, in 2014, the Japanese Respiratory Society published their consensus statement of biological agents and respiratory disorders. This review summarizes this statement and adds recent evidence, especially concerning respiratory infections in RA patients, biological agents and respiratory infections, and practice management of respiratory infections in patients treated with biological agents. To decrease the incidence of infections and reduce mortality, we should know the epidemiology, risk factors, management, and methods of prevention of respiratory infections in patients receiving biological agents. © 2015 The Japanese Respiratory Society. Published by Elsevier B.V.

Wakabayashi Y.,Saitama Cardiovascular and Respiratory Center
Nippon Hoshasen Gijutsu Gakkai zasshi | Year: 2010

A non-uniform attenuation correction is necessary for the myocardial perfusion image (MPI) SPECT that is one of the images of the trunk. Simultaneous non-uniform attenuation correction during the process of SPECT reconstruction was enabled by developing hybrid SPECT/CT. Image acquisition of (99m)Tc MPI with hybrid SPECT/CT was performed in a phantom study and clinical cases. We evaluated the effect of non-uniform attenuation correction by Filtered Back Projection (FBP) or Ordered Subsets-Expectation Maximization (OS-EM) using visual analysis and quantitative analysis with a 17-segment model. The phantom study and the clinical cases differed somewhat as follows. In the phantom study, the count increased significantly with non-uniform attenuation correction in visual analysis and quantitative analysis. In the clinical cases, non-uniform attenuation correction increased the quantitative count in the basal and middle layer of the heart, and visual uniformity of the whole heart improved. However, the visual and quantitative count in the apex decreased with non-uniform attenuation correction. As a result, diagnostic performance for coronary heart disease is expected to be improved by this new technique using hybrid SPECT/CT.

Yamaguchi S.,Saitama Cardiovascular and Respiratory Center
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2010

A 37-year-old man was admitted with complaints of continuous cough and sputum production for 1 month. Computed tomography (CT) of the chest revealed a solitary mass with a cavity in the apex of the left lung and bilateral ground-glass opacities (GGO). Thereafter, the patient complained of fever, and an increase in the mass shadow size and expansion of the ground-glass opacities were observed on serial CT. The patient was given diagnoses of pulmonary nocardiosis and pulmonary alveolar proteinosis by bronchoscopic examination. Serum anti-GM-CSF antibody tests were positive. On the basis of these findings, we diagnosed autoimmune pulmonary alveolar proteinosis. After beginning antituberculosis drugs and antibiotics, the tumor shadow and GGO reduced. The pulmonary alveolar proteinosis rapidly worsened on exacerbation of the pulmonary nocardiosis, but prompt overall improvement was obtained after treating the latter. We believe this to be a valuable case for examining the time progression of autoimmune pulmonary alveolar protein syndrome, because of the clinical course of the exacerbation, and the improvement in the pulmonary alveolar proteinosis after treatment of pulmonary nocardiosis.

Hayashi M.,Saitama Cardiovascular and Respiratory Center | Takayanagi N.,Saitama Cardiovascular and Respiratory Center | Kanauchi T.,Saitama Cardiovascular and Respiratory Center | Miyahara Y.,Saitama Cardiovascular and Respiratory Center | And 2 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: The prognostic factors of Mycobacterium avium complex lung disease (MAC-LD) are not clearly defined. Objectives: To assess the prognostic factors of all-cause and MAC-specific mortality in patients with MAC-LD, especially in accordance with radiographic features, first-line treatment, and host predisposition. Methods: Medical records of 634 HIV-negative patients with MAC-LD treated at our institution in Saitama, Japan were retrospectively analyzed. Measurements and Main Results: Patients' mean age was 68.9 years, and median follow-up period was 4.7 years. Radiographic features included nodular/bronchiectatic (NB) disease: 482 patients (76.0%); fibrocavitary (FC) disease: 105 patients (16.6%); FC1NB disease: 30 patients (4.7%); and other types: 17 patients (3.0%). First-line treatments were observation or one drug: 479 patients (75.6%); 2 to 5 drugs: 131 patients (20.7%); and unknown: 24 patients (3.8%). A multivariate Cox proportional hazard model showed male sex, older age, presence of systemic and/or respiratory comorbidity, non-NB radiographic features, body mass index (BMI) less than 18.5 kg/m2, anemia, hypoalbuminemia, and erythrocyte sedimentation rate greater than or equal to 50 mm/h to be negative prognostic factors for all-cause mortality, and FC or FC1NB radiographic features, BMI less than 18.5 kg/m2, anemia, and C-reactive protein greater than or equal to 1.0 mg/dl to be negative prognostic factors for MAC-specific mortality. Conclusions: The first-line treatment regimen was not associated with all-cause mortality. FC or FC1NB disease, BMI less than 18.5 kg/m 2, and anemia were negative prognostic factors for both all-cause and MAC-specific mortality. Copyright © 2012 by the American Thoracic Society.

Ishiguro T.,Saitama Cardiovascular and Respiratory Center
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 65-year-old man without a history of cancer presented to our hospital because he was suspected of having acute pulmonary thromboembolism. Dyspnea that had developed 1 month before admission, had worsened 1-week before admission. Chest computed tomography showed faint ground-glass opacities in the lung fields without filling defects in the pulmonary arteries. He was transferred to the department of respiratory medicine for further investigation. Perfusion scintigraphy showed multiple, small perfusion defects throughout both lungs, and laboratory data showed increased lactic dehydrogenase value and thrombocytopenia. We suspected intravascular lymphoma, and a bone marrow aspiration smear detected malignant cells. We started chemotherapy on a diagnosis of intravascular lymphoma, which resulted in remarkable improvement of respiratory failure and pulmonary hypertension. After that, further evaluation of bone marrow specimen with immunostaining, the malignant cells were found not to be lymphoma cells but cancer cells. The primary site of the cells was not found by further investigation. Because of improvement of oxygenation and pulmonary hypertension, we performed transbronchial lung biopsy and diagnosed pulmonary tumor thrombotic microangiopathy. Here, we report this case and review previous reports.

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