Papers - KURONUMA Kouji

Validation of the Japanese disease severity classification and the GAP model in Japanese patients with idiopathic pulmonary fibrosis

Shun Kondoh, Hirofumi Chiba, Hirotaka Nishikiori, Yasuaki Umeda, Koji Kuronuma, Mitsuo Otsuka, Gen Yamada, Hirofumi Ohnishi, Mitsuru Mori, Yasuhiro Kondoh, Hiroyuki Taniguchi, Sakae Homma, Hiroki Takahashi

Respiratory Investigation ( Elsevier B.V. )  54 ( 5 ) 327 - 333  2016.09  [Refereed]

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Background The clinical course of idiopathic pulmonary fibrosis (IPF) shows great inter-individual differences. It is important to standardize the severity classification to accurately evaluate each patient׳s prognosis. In Japan, an original severity classification (the Japanese disease severity classification, JSC) is used. In the United States, the new multidimensional index and staging system (the GAP model) has been proposed. The objective of this study was to evaluate the model performance for the prediction of mortality risk of the JSC and GAP models using a large cohort of Japanese patients with IPF. Methods This is a retrospective cohort study including 326 patients with IPF in the Hokkaido prefecture from 2003 to 2007. We obtained the survival curves of each stage of the GAP and JSC models to perform a comparison. In the GAP model, the prognostic value for mortality risk of Japanese patients was also evaluated. Results In the JSC, patient prognoses were roughly divided into two groups, mild cases (Stages I and II) and severe cases (Stages III and IV). In the GAP model, there was no significant difference in survival between Stages II and III, and the mortality rates in the patients classified into the GAP Stages I and II were underestimated. Conclusions It is difficult to predict accurate prognosis of IPF using the JSC and the GAP models. A re-examination of the variables from the two models is required, as well as an evaluation of the prognostic value to revise the severity classification for Japanese patients with IPF.

DOI PubMed

Surfactant protein D is a useful biomarker for monitoring acute lung injury in rats

Makoto Murata, Mitsuo Otsuka, Noriyuki Ashida, Gen Yamada, Koji Kuronuma, Hirofumi Chiba, Hiroki Takahashi

Experimental Lung Research ( Taylor and Francis Ltd )  42 ( 6 ) 314 - 321  2016.07

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Purpose: The purpose of this study is to investigate the serial changes in the SP-D concentrations of serum and bronchoalveolar lavage fluid (BALF) in a bleomycin-induced lung injury rat model and compare them with the levels of conventional biochemical markers. Materials and Methods: Male Wister rats were anesthetized and intratracheally administered bleomycin (1.0 mg/kg). We evaluated the histological changes and SP-D expression of their lung tissues. We also measured the concentrations of SP-D, albumin, and lactate dehydrogenase (LDH) and the numbers of various types of cells in BALF, and the serum levels of SP-D and conventional markers, including LDH, high mobility group box 1, monocyte chemoattractant protein-1, and C-reactive protein. Results: The BALF SP-D level increased and peaked on day 3, and then gradually decreased. These variations were significantly correlated with the changes in the BALF albumin level and granulocyte cell count. The serum SP-D level increased from day 5, peaked on day 10, and then gradually decreased until day 28. The changes in the serum SP-D level accurately reflected the extent of the histological changes caused by the lung injury. On the other hand, the serum levels of conventional biomarkers were only elevated for a few days or did not change during the study period. Conclusions: The SP-D level is the most useful marker of the severity of lung injuries. These results suggest that the measurement of SP-D levels is an additional tool for monitoring acute lung injuries in rats.

DOI PubMed

高周波スネアによる気管支鏡下腫瘍摘出術を施行した気管支原発炎症性筋線維芽腫瘍の一例

黒沼 幸治, 梅田 泰淳, 横山 早織, 高橋 知之, 柳 昌弘, 近藤 瞬, 浅井 悠一郎, 小林 智史, 汐谷 心, 亀田 優美, 錦織 博貴, 大塚 満雄, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  38 ( Suppl. ) S309 - S309  2016.05

免疫グロブリン製剤補充により改善を認めた原発性免疫不全症に伴う気管支拡張症の1例

小林 智史, 錦織 博貴, 黒沼 幸治, 高橋 弘毅

感染症学雑誌 ( (一社)日本感染症学会 )  90 ( 3 ) 398 - 399  2016.05

北海道における成人侵襲性肺炎球菌感染症症例のサーベイランス

黒沼 幸治, 小林 智史, 錦織 博貴, 常 彬, 大石 和徳, 高橋 弘毅

感染症学雑誌 ( (一社)日本感染症学会 )  90 ( 3 ) 376 - 376  2016.05

内視鏡・画像診断 気管支鏡検査における呼吸器内科医による迅速細胞診の有用性の検討

梅田 泰淳, 大塚 満雄, 小林 智史, 汐谷 心, 池田 貴美之, 亀田 優美, 黒沼 幸治, 高橋 守, 山田 玄, 高橋 弘毅

日本呼吸器学会誌 ( (一社)日本呼吸器学会 )  5 ( 増刊 ) 162 - 162  2016.03

SP-AおよびSP-A由来ペプチドはヒトβ-デフェンシン3による肥満細胞の遊走を抑制する

有木 茂, 上原 康昭, 村田 雅樹, 高宮 里奈, 長谷川 喜弘, 斎藤 充史, 千葉 弘文, 黒沼 幸治, 高橋 素子, 高橋 弘毅, 黒木 由夫

分子呼吸器病 ( (株)先端医学社 )  20 ( 1 ) 120 - 123  2016.03

北海道における外国籍結核患者とそのHIV感染症合併の現状

池田 貴美之, 錦織 博貴, 近藤 瞬, 小林 智史, 多屋 哲也, 森 勇樹, 汐谷 心, 黒沼 幸治, 高橋 弘毅

結核 ( (一社)日本結核・非結核性抗酸菌症学会 )  91 ( 2 ) 33 - 39  2016.02

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[背景と目的]国際交流の発展に伴い、北海道においても外国籍のHIV合併結核患者を経験するようになり、その実態を把握する必要がある。[方法]2001年1月から2014年9月までに北海道内で発生した外国籍の結核患者および外国籍のHIV合併結核患者に関するアンケート調査を行った。前者については各保健所に、後者についてはエイズ治療拠点病院および結核病床を有する病院に、調査用紙を郵送し回答を得た。[結果]各保健所の調査では、外国籍の結核患者は71名であった。20〜30歳代の若年層が中心で、職業は留学生や職業研修生が多かった。国籍はアジア地域が中心であったが、アフリカ地域も7名みられた。発症から受診までの期間が1ヵ月以上である患者は21%で、一部で受診の遅延がみられた。発見方法も多くが医療機関の直接受診であった。エイズ治療拠点病院および結核病床を有する病院の調査では、外国籍のHIV合併結核患者は4名であった。全て20〜30歳代で、サハラ以南のアフリカ国籍だった。[考察]入国時の胸部X線による健診の徹底と、発症時の医療機関の受け入れ態勢の整備が重要と考えられた。また、結核とHIVの二重感染が多発している地域を母国とする結核患者の場合は、HIVの感染の有無を積極的に確認する必要がある。(著者抄録)

[THE CURRENT SITUATION OF FOREIGN TUBERCULOSIS PATIENTS AND THEIR CONCURRENT HIV INFECTION IN HOKKAIDO].

Kimiyuki Ikeda, Hirotaka Nishikiori, Shun Kondo, Tomofumi Kobayashi, Tetsuya Taya, Yuki Mori, Makoto Shioya, Koji Kuronuma, Hiroki Takahashi

Kekkaku : [Tuberculosis]   91 ( 2 ) 33 - 9  2016.02  [Domestic journal]

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BACKGROUND AND PURPOSE: According to recent news, patients with concurrent tuberculosis (TB) and human immunodeficiency virus (HIV) infection are increasingly common worldwide. This study aimed to investigate whether TB/HIV co-infected patients are visiting Hokkaido. METHOD: We conducted a questionnaire survey regarding foreign patients infected with TB or TB/HIV who visited Hokkaido between January 2001 and September 2014. We mailed questionnaires to health centers, AIDS treatment care hospitals, and TB hospitals in Hokkaido prefecture. RESULTS: Seventy-one TB patients were of foreign nationality according to the answers obtained from health centers. Most of them were foreign students or occupational trainees between 20-30 years old. Approximately half these patients were from East Asia, and 7 patients were from Africa. As 21 % of the patients with TB who visited medical examination were over 1 month from disease onset, and the delay in visiting was recognized. The TB infection was mostly detected coincidentally during the physician visit. In the hospital survey, four TB patients with HIV were of foreign nationality. They were also of the age group from 20-30 years and hailed from sub-Saharan Africa. DISCUSSION: During immigration, medical examination by performing a chest radiograph is important. If the immigrant hails from an area where TB and HIV co-infection is common, it is necessary to confirm whether HIV infection is present.

PubMed

気管支内腔に発生した炎症性筋線維芽腫瘍に対し高周波スネアによる気管支鏡下腫瘍摘出術を施行した1例

横山 早織, 高橋 知之, 柳 昌弘, 近藤 瞬, 浅井 悠一郎, 小林 智史, 梅田 泰淳, 汐谷 心, 亀田 優美, 錦織 博貴, 黒沼 幸治, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  38 ( 1 ) 55 - 55  2016.01

A Case of Recurrent Cryptogenic Organizing Pneumonia Complicated by Primary Pulmonary Malignant Lymphoma

Umeda Yasuaki, Otsuka Mitsuo, Kuronuma Koji, Kodera Yuki, Kondo Shun, Taya Tetsuya, Ikeda Kimiyuki, Shioya Makoto, Chiba Hirofumi, Yamada Gen, Takahashi Hiroki

The Journal of the Japan Society for Respiratory Endoscopy ( The Japan Society for Respiratory Endoscopy )  38 ( 2 ) 134 - 139  2016

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Background. Cryptogenic organizing pneumonia (COP) usually responds well to corticosteroid treatment and typically has a good prognosis. However, a few cases are refractory to corticosteroid treatment. Immunosuppressant drugs are associated with an increased risk of malignant lymphoproliferative disorders. Case. A 63-year-old man presented with a history of cough for a month. High resolution computed tomography (HRCT) of the chest showed air-space consolidation predominantly in both lungs. We diagnosed COP by transbronchial lung biopsy (TBLB) specimens. Clinical data and HRCT findings were improved by prednisolone therapy, but recurrent exacerbation occurred during steroid tapering. Although, we re-examined the abnormal lesions in the left lower lobe by video-assisted thoracoscopy and those in the right lower lobe by TBLB, histopathological examinations of all lesions revealed organizing pneumonia. We continued immunosuppressive therapy with a combination of prednisolone and immunosuppressive agents. However, lung lesions gradually deteriorated. In order to obtain a histopathological diagnosis again, we performed TBLB from the right lower lobe. Histopathological examination revealed lung invasion of diffuse large B cell type lymphoma. Conclusion. We experienced a rare case of recurrent COP complicated by primary pulmonary malignant lymphoma. It is necessary to pay attention to the possibility that malignant lymphoma may be involved in recurrent COP during immunosuppressive therapy.

DOI CiNii

IgG補充療法により改善を認めた原発性免疫不全症に伴う気管支拡張症の1例

小林 智史, 黒沼 幸治, 高橋 弘毅

Therapeutic Research ( ライフサイエンス出版(株) )  36 ( 6 ) 557 - 558  2015.06

呼吸器内科医による気管支鏡検査における迅速細胞診の有用性の検討

梅田 泰淳, 大塚 満雄, 小林 智史, 汐谷 心, 池田 貴美之, 亀田 優美, 成田 欣史, 北田 順也, 黒沼 幸治, 高橋 守, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  37 ( Suppl. ) S290 - S290  2015.05

続発性難治性気胸に対しEWSを用いて気管支充填術を施行した7症例の検討

小林 智史, 黒沼 幸治, 梅田 泰淳, 汐谷 心, 成田 欣史, 亀田 優美, 北田 順也, 大塚 満雄, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  37 ( Suppl. ) S247 - S247  2015.05

血痰を契機に発見された心房細動カテーテルアブレーション後の肺静脈狭窄症の1例

夏井坂 元基, 亀田 優美, 大塚 満雄, 黒沼 幸治, 北田 順也, 成田 欣史, 梅田 泰淳, 横尾 慶紀, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  37 ( 1 ) 87 - 93  2015.01

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背景. 肺静脈狭窄症は稀な疾患であり、先天性のものと術後に起こるものがある。術後発症例ではカテーテルアブレーション治療によるものと、総肺静脈還流異常症の矯正などの外科的手術によるものがある。症例. 57歳男性。2008年4月および2010年4月に発作性心房細動に対しカテーテルアブレーション治療を施行された。2011年1月頃よりしばしば血痰を認めるようになった。2011年8月の胸部単純CT上、左上下葉に浸潤影、すりガラス病変、小葉間隔壁肥厚を認め、さらに胸部造影CTにて左肺の上肺静脈の完全閉塞と下肺静脈の狭窄を認めた。また、肺換気血流シンチグラムでの左肺の血流低下・換気正常のミスマッチ、さらに経食道心エコーでの左下肺静脈狭窄所見を認めた。気管支鏡検査では気管支粘膜の浮腫と粘膜下血管増生を認めた。以上より、血痰の原因は心房細動カテーテルアブレーション後に生じた左肺静脈狭窄症と診断した。左下肺静脈狭窄部へステントを留置し、狭窄肺静脈の開大を得た。結論. 血痰の原因は多岐にわたるが、本症例のようにアブレーション治療などの既往がある際には、医原性の肺静脈狭窄症も鑑別に入れるべきである。(著者抄録)

Distinct compartmentalization of SP-A and SP-D in the vasculature and lungs of patients with idiopathic pulmonary fibrosis

Hirotaka Nishikiori, Hirofumi Chiba, Shigeru Ariki, Koji Kuronuma, Mitsuo Otsuka, Masanori Shiratori, Kimiyuki Ikeda, Atsushi Watanabe, Yoshio Kuroki, Hiroki Takahashi

BMC PULMONARY MEDICINE ( BIOMED CENTRAL LTD )  14   196  2014.12  [Refereed]

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Background: Surfactant proteins SP-A and SP-D are useful biomarkers in diagnosis, monitoring, and prognosis of idiopathic pulmonary fibrosis (IPF). Despite their high structural homology, their serum concentrations often vary in IPF patients. This retrospective study aimed to investigate distinct compartmentalization of SP-A and SP-D in the vasculature and lungs by bronchoalveolar lavage fluid (BALF)/serum analysis, hydrophilicity and immunohistochemistry. Methods: We included 36 IPF patients, 18 sarcoidosis (SAR) patients and 20 healthy subjects. Low-speed centrifugal supernatants of BALF (Sup-1) were obtained from each subject. Sera were also collected from each patient. Furthermore, we separated Sup-1 of IPF patients into hydrophilic supernatant (Sup-2) and hydrophobic precipitate (Ppt) by high-speed centrifugation. We measured SP-A and SP-D levels of each sample with the sandwich ELISA technique. We analyzed the change of the BALF/serum level ratios of the two proteins in IPF patients and their hydrophilicity in BALF. The distribution in the IPF lungs was also examined by immunohistochemical staining. Results: In BALF, SP-A levels were comparable between the groups; however, SP-D levels were significantly lower in IPF patients than in others. Although IPF reduced the BALF/serum level ratios of the two proteins, the change in concentration of SP-D was more evident than SP-A. This suggests a higher disease impact for SP-D. Regarding hydrophilicity, although more than half of the SP-D remained in hydrophilic fractions (Sup-2), almost all of the SP-A sedimented in the Ppt with phospholipids. Hydrophilicity suggests that SP-D migrates into the blood more easily than SP-A in IPF lungs. Immunohistochemistry revealed that SP-A was confined to thick mucus-filling alveolar space, whereas SP-D was often intravascular. This data also suggests that SP-D easily leaks into the bloodstream, whereas SP-A remains bound to surfactant lipids in the alveolar space. Conclusions: The current study investigated distinct compartmentalization of SP-A and SP-D in the vasculature and lungs. Our results suggest that serum levels of SP-D could reflect pathological changes of the IPF lungs more incisively than those of SP-A.

DOI PubMed

気管内挿管後の炎症性肉芽腫性閉塞に対し気管支鏡下電気焼灼術(高周波スネア)が有効であった1例

田中 優子, 宮島 さつき, 森 勇樹, 梅田 泰淳, 汐谷 心, 成田 欣史, 亀田 優美, 北田 順也, 黒沼 幸治, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  36 ( 6 ) 681 - 682  2014.11

PZA、LVFX、TH、KMによる治療が奏効した多剤耐性肺結核の1例

本田 宏幸, 森 勇樹, 梅田 泰淳, 汐谷 心, 成田 欣史, 亀田 優美, 北田 順也, 黒沼 幸治, 千葉 弘文, 山田 玄, 高橋 弘毅

結核 ( (一社)日本結核・非結核性抗酸菌症学会 )  89 ( 5 ) 588 - 588  2014.05

血痰で発見されたカテーテルアブレーション後肺静脈狭窄症の1例

亀田 優美, 黒沼 幸治, 夏井坂 元基, 梅田 泰淳, 成田 欣史, 北田 順也, 大塚 満雄, 千葉 弘文, 山田 玄, 高橋 弘毅

気管支学 ( (NPO)日本呼吸器内視鏡学会 )  36 ( Suppl. ) S216 - S216  2014.03

111In骨髄シンチグラフィが治療効果判定に有用だった肺小細胞癌・骨髄転移の1例

森 勇樹, 亀田 優美, 小寺 祐貴, 斎藤 淳, 梅田 泰淳, 汐谷 心, 成田 欣史, 北田 順也, 黒沼 幸治, 大塚 満雄, 千葉 弘文, 山田 玄, 高橋 弘毅

肺癌 ( (NPO)日本肺癌学会 )  53 ( 7 ) 917 - 917  2013.12