Biomedical subjects

F Yamasawa

Publications and source records attributed to F Yamasawa.

At least 19 recordsLinked to original sources

PubMed1992

The role of recombinant human tissue-type plasminogen activator in the treatment of acute pulmonary thromboembolism.

The effect of intravenous recombinant human tissue-type plasminogen activator (tPA) on arterial blood gases was compared with the effect of heparin treatment in acute pulmonary thromboembolism. Fifteen patients received heparin alone (group A), 5 cases were treated with 7.7 x 10(6) I.U. of tPA (group B) and 10 cases with 15 x 10(6) I.U. of tPA (group C) combined with heparin treatment. Arterial oxygen tension before treatment was not significantly different among the three groups. PaO2 was dramatically improved on the 1st day in group C. By the 7th day, PaO2 of group B had improved to the level of group C. However, the PaO2 of group A on the 7th day was not significantly different compared to the pre-treatment value. In group C, post-treatment perfusion lung scintigrams were improved compared to the pre-treatment images, but this was not the case in group B. Treatment with tPA is more effective for acute pulmonary thromboembolism than heparin alone and a high dose of tPA (15 x 10(6) I.U.) leads to rapid improvement in arterial blood gases and lung perfusion images.

Acute Disease↗

PubMed1992

[Measurements of plasmin-alpha 2 plasmin inhibitor complex and FDP.D dimer levels in the fibrinolytic therapy of acute pulmonary thromboembolism].

The key enzyme for fibrinolysis is plasmin, which is converted from plasminogen by plasminogen activator. Activated plasmin lyses fibrinogen and fibrin to make fibrin degradation products(FDPs) and plasmin is inactivated immediately by alpha 2 plasmin inhibitor. As FDP.D dimer is derived solely from insoluble fibrin, FDP.D dimer is thought of as an index for clot lysis. We measured plasmin-alpha 2 plasmin inhibitor complex(PIC) and FDP.D dimer plasma levels in 3 patients with acute pulmonary thromboembolism treated with recombinant tissue plasminogen activator(tPA). Fifteen million units of tPA(TD-2061) were infused in one hour on the first, second and third hospital days. PIC and FDP.D dimer before tPA infusion showed slightly elevated values as compared to normal ranges. They increased markedly after tPA infusion. These findings suggest that the fibrinolytic system is slightly activated in the acute phase of pulmonary thromboembolism and also strongly activated by tPA infusion. Increased FDP D dimer suggests that fibrin clots are dissolved by activated plasmin. Improvement of arterial oxygen tension was observed after tPA infusion. As sustained higher FDP.D dimer means the existence of fibrin clots, heparin treatment should be continued for prevention of clot formation as long as FDP.D dimer shows higher value. In conclusion, PIC and FDP.D dimer are useful indices not only to detect the activated state of the fibrinolytic system but also to know clot lysis in tPA treatment.

Acute Disease↗

PubMed1992

[Standard values and normal limits for arterial blood gases in healthy elderly Japanese subjects].

We studied the standard values and normal limits for arterial blood gases in healthy elderly Japanese subjects. The criteria for inclusion were; 1) older than 60 years and able to walk independently, 2) non-smoker, 3) no respiratory symptoms, 4) no thoracic deformity, 5) no clinical signs of chest disease, 6) no abnormal findings in chest X ray, and 7) no cardiac disease or obesity. The number of subjects was 78. The oldest subject was a 96-year-old female. Arterial punctures were performed with the subjects in a recumbent position. PaO2 ranged from 79 to 106 Torr, with a mean value of 89.8 Torr. PaCO2 ranged from 32 to 48 Torr with a mean value of 39.6 Torr. Maximum values of alveolar-arterial O2 tension difference and arterial-alveolar N2 tension difference were 20.2 Torr and 11.6 Torr, respectively. The regression equation for PaO2 with respect to age was; PaO2 = 99.32-0.126 x (age), and its residual standard deviation was 6.06 Torr. These values were not different from those obtained in healthy young Japanese subjects.

Aged↗

PubMed1992

[Clinical significance of gallium-67 scintigraphy in assessing pulmonary lesions of sarcoidosis and idiopathic pulmonary fibrosis].

To evaluate whether one can predict the course and prognosis of interstitial lung diseases from lung gallium-67 (67Ga) uptake, we studied 31 subjects with sarcoidosis and 28 with idiopathic pulmonary fibrosis (IPF) retrospectively. We quantified the lung 67Ga uptake using posterior scans by Line's method, and calculated a visual index (VI). The normal range of 67Ga uptake was defined as less than 65 VI values, obtained from the 95 percent confidence interval of the control subjects. All subjects with stage I sarcoidosis, having only bilateral hilar lymphadenopathy (BHL) on chest X-ray, revealed normal lung 67Ga uptake. Fifty percent of patients with stage II sarcoidosis, with both BHL and pulmonary involvement on chest X-ray, showed increased lung 67Ga uptake. The patients with increased lung 67Ga uptake showed decreased percent vital capacity and increased alveolar-arterial oxygen tension difference, but none of them showed clinical deterioration during the follow-up period of more than 6 months. Fifty-four percent of subjects with IPF showed increased lung 67Ga uptake. But there was no difference between the subgroups with normal and increased lung 67Ga uptake with respect to the severity of dyspnea, percent vital capacity, arterial oxygen tension, or alveolar-arterial oxygen tension difference. There was also no difference between the two subgroups of IPF in the cumulative percent survival after either the onset of symptoms or the 67Ga scintigram. We conclude that lung 67Ga uptake was not able to predict the clinical course or the prognosis of patients with sarcoidosis and IPF.

Adult↗

PubMed1992

[Uneven ventilation-perfusion ratio distribution during acute exacerbation of chronic pulmonary diseases].

We studied ventilation-perfusion ratio (VA/Q) unevenness in terms of alveolar-arterial gas tension difference (AaDO2 and aADN2) and of multiple inert gas elimination technique during the chronic stable periods and the acute exacerbation periods of seven cases with chronic pulmonary diseases. Three had idiopathic pulmonary fibrosis, 2 had pulmonary emphysema, 1 had bronchiolitis and the other had a sequelae of pulmonary tuberculosis. Sulfur hexafluoride and cyclopropane dissolved in saline were infused into a peripheral vein at a constant rate and these 2 gases were used as the indicator gases to make analysis of two compartmental VA/Q. During exacerbation all cases showed lower PaO2 than in the stable period. All cases except idiopathic pulmonary fibrosis showed higher PaCO2. Five cases also had higher AaDO2 and aADN2. One case with pulmonary emphysema and one with bronchiolitis actually had lower AaDO2 and aADN2 values during acute exacerbation than during the chronic stable period. We introduced the difference between the logarithm of higher VA/Q and lower VA/Q values (log [(VA/Q)H/(VA/Q)L)] as an index of VA/Q unevenness. Two compartmental VA/Q analysis revealed greater VA/Q differences in all cases during acute exacerbation. This included cases who showed lower AaDO2 and aADN2 values in the acute exacerbation period. In conclusion, worsened VA/Q distribution, during the acute exacerbation period, was elucidated quantitatively using the multiple inert gas elimination technique.

Adult↗

PubMed1991

[A case of Legionnaires' disease cured with a combination of erythromycin and steroid therapy].

A 53-year-old male was admitted to Keio University Hospital with a pneumonia shadow in the left lung field and respiratory failure. Because there was progression of respiratory failure, mechanical ventilation was required to maintain appropriate oxygenation. Although erythromycin administration was started at the time of admission, a steroid (prednisolone 60 mg/day) was added a few days later to temporarily inhibit the acute inflammatory response in the lung parenchyma. This intensive therapy resulted in resolution of the patient's pneumonia and improvement of his respiratory failure. No pathogens were detected in the clinical specimens. Indirect immunofluorescence examination demonstrated a marked increase in titers against Legionella pneumophila serogroup 1, which was sufficient to confirm a diagnosis of Legionnaires' disease. The causative organism of this disease, a gram-negative short rod, is rarely cultured on conventional culture media. Two clinical subtypes are known based on clinical manifestations: 1) the Pontiac fever-type in which the predominant symptom is fever alone; and 2) the pneumonia-type which was observed in the epidemic in Philadelphia when the disease was first reported in 1976. The present case of Legionnaires' disease was the severe pneumonia-type which was successfully treated with a combination of erythromycin and a steroid.

Drug Therapy, Combination↗

PubMed1991

[Clinical significance of antiphospholipid antibodies in cases with pulmonary thromboembolism].

Anti-cardiolipin IgG antibodies among antiphospholipid antibodies were measured qualitatively and quantitatively in 46 cases with pulmonary thromboembolism. We investigated occurrence frequency among non-collagen diseases and collagen-disease-complicated cases, clinical course, abnormalities of blood coagulation time, prosperity and decay of the antibodies in antibody positive cases. Many of the collagen-disease-complicated cases were chronic, progressive and had multiple thromboses and prolongation of blood coagulation time. Antiphospholipid antibodies were also detected in antibody-positive non-collagen disease cases and the rate was 8 out of 40 cases (20%). In such antibody-positive non-collagen disease cases multiple thromboses over the whole body, and abnormalities of blood coagulation time in vitro were also detected, but the occurrence rate was not so frequent compared with antibody-positive collagen disease cases. The antibody was continuously positive even a year after an acute episode of pulmonary thromboembolism in antibody positive collagen disease cases. On the other hand, the antibody had a tendency to disappear in antibody-positive non-collagen disease cases several months after such an acute episode.

Adult↗

PubMed1990

Diagnosis of peripheral lung cancer using a new type of endoscope.

A new fiberoptic bronchoscope, the BF-2.2T, has been designed to go through the 2.6-mm channel of the conventional fiberoptic bronchoscope (Olympus BF-1T20). It measures 2.2 mm in outer diameter; it has a visual angle of 75 degrees, a range of observation of 3 to 50 mm, an effective length of 1,150 mm, and a total length of 1,400 mm. It bends at 120 degrees in an upward direction and at 120 degrees in a downward direction. The 2.2-mm tip of the BF-2.2T bends like a conventional fiberoptic bronchoscope, and this is the main characteristic of this instrument. The BF-2.2T facilitates clinically satisfactory observation and photography, as a method for detecting peripheral lung cancer.

Adenocarcinoma↗

PubMed1989

[Diagnosis of peripheral-type lung cancer using a new type of endoscope].

A new device, the BF-2.2T, has been designed to go through the 2.6 mm channel of the conventional fiberoptic bronchoscope (Olympus BF-1T20). It measures 2.2 mm in outer diameter; it has a visual angle of 75 degrees, a focal depth of 3 to 50 mm, a working length of 1150 mm, and a total length of 1400 mm. It bends 120 degrees in an upward direction and 120 degrees in a downward direction. The tip, 2.2 mm phi, of the BF-2.2 T angulates like a conventional bronchofiberscope, and this is the main characteristic of this instrument. The BF-2.2 T yields clinically satisfactory observation and photography, as a method for determining morphological changes in peripheral type lung cancer.

Adenocarcinoma↗

PubMed1988

Endoscopic observation of peripheral airway lesions.

Peripheral airways of 2 mm or less in diameter were observed in 142 patients by means of an ultrathin bronchofiberscope measuring 1.8 mm in outside diameter. On the basis of the observed and photographed endoscopic findings, an endoscopic classification of peripheral airway lesions was proposed. The endoscopic findings showed changes in the bronchial wall consisting of reddening, pallor, absence of mucosal luster, edema, engorgement of blood vessels, irregular mucosal surface, and elevated mucosa. In the lumen, stenosis, obstruction, ectasis, and deformation due to pressure were recognized, in addition to excessive secretion and pigmentation as morphologic abnormalities or abnormal findings at bifurcation.

Adolescent↗

PubMed1988