Background Objective evaluation of the physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is important. We validated a triaxial accelerometer, Active Style Pro HJA-750C® (HJA), and evaluated the necessary conditions for obtaining reproducible data. Methods The PA measured by HJA was compared with that measured by two already validated accelerometers in 11 patients with COPD (age: 76.6 ± 6.9, FEV1% predicted: 57.6 ± 18.6). Then, the influence of weather and holidays on the PA and the required number of days to obtain repeatability were examined in 21 patients with COPD (age: 73.0 ± 8.0, FEV1% predicted: 58.7 ± 19.0). Results The PA values measured by HJA and those by DynaPort Move Monitor® (DMM) or Actimarker® (AM) were significantly correlated at all intensities (p=0.024 at ≥4.0 METs by DMM and p < 0.0001 at the rest) except at ≥4.0 METs by AM, though the values measured by HJA were higher than those by AM which was reported to underestimate PA. The durations of PA on rainy days were significantly shorter than those on nonrainy days, but those on holidays were not different from those on weekdays. The values of ICC for 3, 4, or 5 days were higher than 0.8 at all intensities. The PA measured by HJA was correlated with the dyspnea scale FVC and age and tended to correlate with FEV1. Conclusions The HJA was validated for evaluating the PA in patients with COPD. This trial is registered with UMIN000016363.

An 80-year-old man who had suffered from chronic lymphocytic leukemia (CLL) and achieved complete remission was admitted to our hospital due to right pleural effusion. Thoracentesis revealed that the effusion was chyle. Lymphoscintigraphy showed an obstruction of the thoracic duct below the sternum. CD45-gated flow cytometry of the pleural effusion showed elevated numbers of CD5- and CD23-positive lymphocytes and a high serum level of soluble interleukin-2 receptor. These results suggested that the chylothorax was caused by the obstruction of the thoracic duct by the sludging of either abnormal lymphocytes of CLL or transformed malignant lymphoma cells.

We examined the effect of endothelin-1 (ET-1), a novel 21-residue vasoconstrictor peptide, on pulmonary resistance (RL) in Wistar rats. The lung volume, tracheal flow, and transpulmonary pressure of tracheotomized and paralyzed rats were measured with a fluid-filled esophageal catheter and a pressure-sensitive body plethysmograph. RL was calculated by the method of von Neergaard. The femoral artery was cannulated to measure the mean arterial blood pressure. Intravenous bolus administration of synthetic ET-1 provoked a dose-dependent increase in RL in rats. The bronchoconstricting effect reached maximum at 500 pmol/kg. This bronchoconstriction was observed in less than 5 min, increased up to 15 min, and was sustained for 60 min. ET-1 increased the mean arterial blood pressure in a dose-dependent manner. We conclude that ET-1 is a hitherto unknown potent bronchoconstrictor that has a sustained effect in vivo. The potential physiological and pathophysiological role of this new peptide in the development of respiratory disease warrants further investigation.

Z-stents partially covered with an expandable Dacron mesh into which epinephrine and thrombin were infiltrated, were used to reopen both mainstem bronchi, stenosed by bronchogenic carcinoma and to deliver hemostatic agents to the lesion. On follow-up 4 and 6 weeks later, airway patency was retained, the tumor surface was compressed, and the glossy surface of the stent suggested that it was covered with mucosa. For treatment of airway stenosis due to cancer invasion, a stent covered with a Dacron mesh sheet is thought to be effective in compressing the tumor and preventing tumor ingrowth into the stent.

Z-stents partially covered with an expandable Dacron mesh into which epinephrine and thrombin were infiltrated, were used to reopen both mainstem bronchi, stenosed by bronchogenic carcinoma and to deliver hemostatic agents to the lesion. On follow-up 4 and 6 weeks later, airway patency was retained, the tumor surface was compressed, and the glossy surface of the stent suggested that it was covered with mucosa. For treatment of airway stenosis due to cancer invasion, a stent covered with a Dacron mesh sheet is thought to be effective in compressing the tumor and preventing tumor ingrowth into the stent. Key words: Metallic stent, s t e n o s i s --B r o n c h u s --D acron m e s h --D r u g delivery s y s t e m --L u n g cancer Materials and MethodsStents were prepared from a Dacron mesh sheet having a thickness of 0.25 m m (Bard, Inc., Billerica, MA, USA) and a Gianturco-Rosch type biliary Z-stent (GZS-12-3.0, Cook, Inc., Bloomington, IN, USA) 30 m m long and 12 m m in diameter (Fig. 1). The size of the Dacron sheet was chosen to cover two-thirds of the stent's circumference.The four comers of the sheet were sewn onto the Z-stent with 8-0 nylon threads. The sheet was moistened to absorb a solution containing l mg of epinephrine and 5000 units of thrombin. One-third of the Z-stent was left uncovered so as not to occulude the inlet of the upper bronchus even if the stent should slip distally. For placement, the assembled stents were loaded into a 10 Fr introducer sheath with Recently, metallic stents such as Z-stents [ 1 ] and Wallstents [2], as well as polymeric woven stents [3] and silicone stents [4] have been introduced for the palliative treatment of tracheobronchial stenosis due to tracheobronchomalacia or compression by an extramural tumor. Among these stents, the Z-stent can readily be custom made and modified by us. In the case of malignant tracheobronchial stenosis, a Z-stent consisting only of wire is not sufficient to prevent tumor invasion into the lumen [5]. Additionally, many of these tumors bleed easily and may cause massive hemoptysis. Therefore, we prepared a stent that consisted of a Z-stent externally covered with a Dacron mesh sheet that was infiltrated with a vasoconstrictive and a hemostatic agent and are presenting its use in a patient.