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J Arisawa

Publications and source records attributed to J Arisawa.

At least 37 records · Page 2Linked to original sources
PubMed1994

High-resolution CT and pulmonary function tests in collagen vascular disease: comparison with idiopathic pulmonary fibrosis.

To estimate whether the lung abnormalities seen in collagen vascular diseases (CVD) were similar or distinct to those seen in idiopathic pulmonary fibrosis (IPF), and to ascertain whether the extent of the abnormalities on high-resolution CT (HRCT) correlated with pulmonary function, we reviewed HRCT findings and pulmonary function test results of 64 patients with either CVD (n = 55) or IPF (n = 9). Response to corticosteroid treatment was also evaluated in 20 of the 64. High incidence of honeycomb lesion was observed in IPF (9/9, 100%) and in progressive systemic sclerosis (PSS) (11/14, 79%). CVD, except for PSS, had a low incidence of honeycomb lesion (27%). On the other hand, incidence of ground-glass shadow in CVD (47/55, 85%) was the same as that in IPF (8/9, 89%). Diffusing capacity significantly correlated with the extent of all parenchymal abnormalities in all CVD and IPF, with honeycomb lesion in PSS, and with ground-glass shadow or air-space consolidation in CVD except for PSS (r < -0.7, P < 0.001). In all 15 cases in which corticosteroid therapy was effective, no honeycomb lesions were seen. Collagen vascular disease, except for PSS, had a different pattern of disease than IPF. The morphologic changes seen on HRCT correlated well with pulmonary function in CVD.

Collagen Diseases↗
PubMed1994

Interpretation of subtle interstitial lung abnormalities: conventional versus film-digitized radiography.

PURPOSE: To evaluate the reliability of film-digitized radiography in detection of subtle interstitial lung abnormalities. MATERIALS AND METHODS: The differences in interpretation of conventional screen-film (SF) and film-digitized (FD) radiographs obtained in 80 patients were studied. Forty patients with subtle interstitial lung abnormalities and 40 patients with no lung abnormalities were selected. SF radiographs of all patients were digitized (spatial resolution, 0.175 mm; 2,000 x 2,000 pixels; 10 bits). Five chest radiologists and five residents evaluated the images with a five-level scale of confidence. Results were evaluated with receiver operating characteristic techniques. RESULTS: For the entire group, no statistically significant differences in performance were found between SF and FD radiographs. Chest radiologists performed better on SF radiographs (P = .003). For residents, no statistically significant differences were observed between the modalities. CONCLUSION: FD radiographs may be inadequate compared with SF radiographs in the diagnosis of subtle interstitial lung abnormalities.

Adult↗
PubMed1993

Mixed type of total anomalous pulmonary venous connection with hemi-pulmonary vein atresia.

This reports a successfully corrected case of an 8-day-old baby who had a rare mixed type of total anomalous pulmonary venous connection in which the left pulmonary vein connected to the portal vein and the right one was atretic as demonstrated by pulmonary artery wedge angiography. The left common pulmonary vein and right pulmonary veins were anastomosed to the left atrium, separately. The patient tolerated the operation and has been well. Early total repair after accurate diagnosis was successful for this rare combination of anomalous pulmonary venous connection.

Anastomosis, Surgical↗
PubMed1993

Pulsed Doppler echocardiographic assessment of portal venous flow patterns in patients after the Fontan operation.

OBJECTIVE: To assess the effect of the condition of the right heart after the Fontan operation on portal venous flow, and to determine whether the characteristics of portal venous flow were different when there was an atriopulmonary connection with atrial septal closure rather than an atriopulmonary or total cavopulmonary connection with intra-atrial routing. PATIENTS AND METHODS: After the Fontan operation six patients with an atriopulmonary connection (group 1), three patients with an atriosubpulmonary connection (group 2), four patients with intra-atrial routing and an atriopulmonary connection (group 3), and five patients with a total cavopulmonary connection (group 4) were studied by pulsed Doppler echocardiography. The flow signals were recorded for the pulmonary artery, hepatic vein, and intrahepatic portal vein in each patient. Postoperative cardiac catheterisation was performed in 16 of the 18 patients. The Doppler findings were compared with those of 14 controls. RESULTS: The portal flow was pulsatile in 13 patients and constant in five patients. Reversed flow was shown at or just after the QRS wave after hepatic venous regurgitation in two group 1 patients. The flow signal was interrupted in two group 1 patients and two group 2 patients. Decrease in velocity of flow was recorded in two group 1 patients, one group 2 patients, three group 3 patients, and one group 4 patient. Portal flow was constant in one group 3 patient and four group 4 patients. The pulsatility ratio ranged from -0.46 to 0.49 (mean (SD), 0.03 (0.32)) in the patients from group 1 and 2, from 0.41 to 0.76 (0.54 (0.15)) in group 3, and from 0.70 to 0.80 (0.75 (0.04)) in group 4. The ratio in the controls ranged from 0.29 to 0.83 (0.61 (0.13)). The ratio was significantly lower in groups 1 and 2 than in group 3 (p < 0.01), group 4 (p < 0.01), or the controls (p < 0.005). There was no significant difference in the ratio between group 3 and group 4 and no correlation between the pulsatility ratio and the cardiac index (r = 0.26), mean right atrial pressure (r = 0.25), or pulmonary vascular resistance (r = 0.17). CONCLUSION: The larger hepatic venous regurgitation caused by atrial contraction in patients with an atriopulmonary connection correlated with the higher portal pulsatility and a total cavopulmonary connection reduced portal pulsatility.

Atrial Function, Right↗
PubMed1993

Focal organizing pneumonia: CT appearance.

PURPOSE: To clarify the computed tomographic (CT) features of focal organizing pneumonia. MATERIALS AND METHODS: The authors retrospectively studied CT scans of 18 patients with histologically proved focal organizing pneumonia. Chest radiographs in all 18 patients suggested bronchogenic carcinoma. RESULTS: Seventeen of the 18 lesions (94%) had an irregular margin, 10 (56%) had satellite lesions, nine (50%) had a pleural tag, and nine (50%) had an air bronchogram. The pneumonia could be classified into three types: Type A (n = 5) was a small round mass (pleural tag, n = 4). Type B (n = 7) was an oval mass with broad contact with the pleura (satellite lesions and convergence of peripheral vessels, n = 6). Type C (n = 6) was an oval mass along the bronchovascular bundle (satellite lesions, n = 3; pleural tag, n = 4). CONCLUSION: The CT features of focal organizing pneumonia show wide variation, and some type B and C lesions are suggestive of benign lesions. However, other lesions may be difficult to differentiate from bronchogenic carcinoma even with CT.

Adult↗
PubMed1993

Mechanism of gravity-dependent atelectasis. Analysis by nonradioactive xenon-enhanced dynamic computed tomography.

RATIONALE AND OBJECTIVES: The physiologic mechanism of gravity-dependent atelectasis (GDA), a common finding identified during anesthesia, is not well understood. The purpose of this study was to determine whether an inherent reduction in alveolar volume or a reduction in alveolar ventilation is the more important causative factor for the development of GDA in an experimental animal model. METHODS: After uniform reduction of lung volume in ten rabbits by artificially induced pneumoperitoneum, dynamic inhalation computed tomography (CT) was performed using 50% nonradioactive xenon in oxygen. Time-CT attenuation value curves were fitted to an exponential function, CT value = a - b x e(-kt), and K value, which is proportional to the alveolar ventilation/alveolar volume ratio, was calculated by regression analysis. RESULTS: Gravity-dependent atelectasis occurred only in 5 of 10 rabbits. In this group, K values in the dorsal regions increased before the appearance of GDA. No significant change in K values in the ventral regions was observed. CONCLUSION: One mechanism of GDA may be a preferential reduction in alveolar volume without small airway collapse rather than alveolar volume loss secondary to decreased ventilation.

Animals↗
PubMed1992

[Thinning of ventricular septum in tetralogy of Fallot].

Cross sectional echocardiography was used to evaluate the thickness of the ventricular septum in tetralogy of Fallot (TOF). Forty-six patients with TOF and 20 patients with pseudo-truncus arteriosus underwent echocardiography during a five-year period beginning in 1984. Thicknesses of the right ventricular anterior wall (RVAWT), trabecular septum (IVST) and left ventricular posterior wall (LVPWT) were measured in end diastole on parasternal short axis view at the level of the tips of papillary muscles. The ratios of IVST to RVAWT and IVST to LVPWT were assessed. The ratio of IVST to RVAWT was 1.09 +/- 0.15 in the group aged less than 7 years (less than 7 y.o.) and 0.94 +/- 0.15 in the group aged of 7 years or more (greater than = 7 y.o.). The ratios of IVST to LVPWT were 1.10 +/- 0.14 (less than 7 y.o.) and 0.90 +/- 0.15 (greater than = 7 y.o.), respectively. Both ratios were significantly different (p less than 0.01) in the two age groups, and relative thinning of the septum was demonstrated in the older patients. It is speculated that thinning of the interventricular septum is caused by the lower systolic wall stress of the ventricular septum compared with that of the free walls, which is produced under equal systolic pressure of the two ventricles. It is suggested that this thinning is one of the factors that reduces left ventricular function after repair of TOF.

Adolescent↗
PubMed1992

CT findings in lymphangitic carcinomatosis of the lung: correlation with histologic findings and pulmonary function tests.

The purpose of this study was to analyze the CT findings in lymphangitic carcinomatosis and to determine how the abnormalities seen on CT correlated with histologic findings and the results of pulmonary function tests. Accordingly, we reviewed CT findings in 20 proved cases and correlated them with histologic findings and with results of pulmonary function tests (available in 11). Special attention was given to the extent and degree of thickening of the peripheral and/or axial interstitium as seen on CT. In 15 of 20 patients, CT scans showed marked thickening of axial interstitium and subtle or no thickening of peripheral interstitium (four diffuse and 11 localized). In three cases, CT showed marked thickening of both axial and peripheral interstitium (two diffuse and one localized). In two cases, CT showed marked thickening of peripheral interstitium and subtle or no thickening of axial interstitium (one diffuse and one localized). These CT findings correlated with the pathologic findings. Marked impairment of vital capacity and alveolar-arterial oxygen gradient was observed in three patients (one with diffuse and peripheral interstitial thickening and two with diffuse and both peripheral and axial interstitial thickening). We conclude that CT findings in patients with lymphangitic carcinomatosis are variable and that marked impairment of pulmonary function occurs in patients with diffuse and peripheral interstitial thickening. Marked impairment of pulmonary function can be predicted from CT findings.

Adult↗
PubMed1991

Prevalence and risk factors of tricuspid regurgitation after correction of tetralogy of Fallot.

Tricuspid regurgitation was evaluated in 133 patients with tetralogy of Fallot after corrective operations for a real-time Doppler flow imaging system. Moderate or severe tricuspid regurgitation was found in 15% (10/66) of patients in whom the ventricular septal defect was closed through the right atrium and tricuspid valve, 13% (2/15) through the pulmonary artery, and 25% (13/52) through the right ventricle. These differences were not significant. Right ventricular systolic pressure was significantly higher (66 +/- 27 mm Hg) in patients with moderate or severe tricuspid regurgitation (group A) than in patients with mild or no tricuspid regurgitation (group B) (41 +/- 13 mm Hg) (p less than 0.01). Right ventricular end-diastolic pressure was significantly higher in group A (7.7 +/- 2.2 mm Hg) than in group B (6.1 +/- 2.9 mm Hg) (p less than 0.01). Significant pulmonary regurgitation (angiographic grades 3/4 to 4/4) was more frequent in group A (8/18; 44%) than in group B (14/64; 22%) (p less than 0.05). Residual ventricular septal defect (pulmonary/systemic flow ratio greater than 1.3) was also more frequent in group A (5/18; 28%) than in group B (0/64; 0%) (p less than 0.01). Right ventricular end-diastolic volume was significantly higher in group A (202% +/- 79% of the normal right ventricle) than in group B (158% +/- 38% of normal) (p less than 0.01). Thus significant tricuspid regurgitation was associated with high right ventricular systolic pressure, high right ventricular end-diastolic pressure, and significant pulmonary regurgitation and residual ventricular septal defect, which increased the right ventricular end-diastolic volume. Operative procedure for closing the ventricular septal defect was not related to the development of significant tricuspid regurgitation.

Adolescent↗
PubMed1991

[Late postoperative pulmonary vascular resistance in patients with tetralogy of Fallot and pulmonary atresia].

Twenty-two patients with tetralogy of Fallot and pulmonary atresia underwent cardiac catheterization and angiocardiography late after repair. In ten patients, the disease was not associated with the major aortopulmonary collateral artery (MAPCA), but in 12 patients, the disease was associated with it. Three patients died after restudy, two because of pulmonary hypertension and one because of pneumonia. Pulmonary artery mean pressure was 15-92 (28 +/- 21) mmHg, being higher in 75% of the patients with MAPCA than the normal range. The number of pulmonary artery subsegments connected to the central pulmonary arteries was determined from pulmonary arteriography, being 22-42 (38 +/- 6). Pulmonary artery mean pressure and pulmonary vasculature resistance (PVR), 0.8-35.2 (10 +/- 9), inversely correlated with the number of the centrally connected pulmonary artery subsegments (r = -0.81, p less than 0.001 vs PAP, r = -0.85, p less than 0.001 vs PVR). PVR per subsegment also inversely correlated with them (r = -0.81, p less than 0.001). These findings suggest that pulmonary vasculature resistance is abnormally high in this disease, and increase as the number of the centrally connected pulmonary artery subsegments decrease.

Adolescent↗
PubMed1991

Hemodynamic effects of bidirectional cavopulmonary shunt with pulsatile pulmonary flow.

The effects of "pulsatile" bidirectional cavopulmonary shunt (BCPS) produced by the flow from the ventricle or Blalock-Taussig (B-T) shunt on ventricular function and pulmonary circulation were evaluated in 10 patients with univentricular heart from 3 to 37 months (mean, 16.6 +/- 9.5 months) after surgery. Age at operation ranged from 7 months to 15 years (mean, 5.5 +/- 4.5 years). In addition to the BCPS, pulmonary flow was supplied from a B-T shunt on the contralateral side of the BCPS in five patients, from the ventricle through the stenotic pulmonary valve in four patients, and from both the ventricle and a B-T shunt in one patient. There were no operative deaths; however, there were two late deaths from acute respiratory infection 10 and 13 months after operation. Mean pulmonary arterial pressure measured the first day after operation ranged from 10 to 19 mm Hg (mean, 14 +/- 3 mm Hg). Mean pulmonary arterial pressure at postoperative cardiac catheterization was less than 15 mm Hg (mean, 12 +/- 4 mm Hg). Pulse pressure ranged from 3 to 12 mm Hg (mean, 7 +/- 4 mm Hg). Arterial oxygen saturation increased significantly from 77 +/- 5% before BCPS to 86 +/- 4% immediately after discharge from the intensive care unit (p less than 0.005) and 85 +/- 3% (p less than 0.025) at late cardiac catheterization. Pulmonary arteriovenous fistula was not detected in contrast echocardiography and pulmonary arteriography. Systemic ventricular end-diastolic volume index decreased significantly (p less than 0.01) from 141 +/- 54 ml/m2 before BCPS to 98 +/- 35 ml/m2 1 month after BCPS by echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1991

[Surgical treatment of tetralogy of Fallot with pulmonary atresia: early and late results].

From 1968 to 1987, 45 consecutive patients with tetralogy of Fallot and pulmonary atresia underwent corrective surgery. In the former 10 years, there were 8 operative deaths (40%) in the 20 patients and no late death. In the recent 10 years, there were 4 operative deaths and 4 late deaths in the 25 patients. In the 17 patients associated with large aorto pulmonary collateral artery (LAPCA) which was ligated in the most patients, there were 5 operative deaths (29%) and 3 late deaths. Nine patients (53%) survived long-term. There were 7 operative deaths (25%), one late death and 20 patients (71%) being long-term survivors in the 28 patients without LAPCA. Pulmonary hemodynamics were investigated in 10 patients without LAPCA and 11 with LAPCA after corrective surgery. Pulmonary arterial mean pressure (PAm) ranged from 9-24 (17 +/- 6) mmHg in patients without LAPCA and 15-92 (37 +/- 23) mmHg in those with LAPCA. Pulmonary arteriography showed arborization abnormality in 7 of the 11 patients with LAPCA. PAm inversely correlated well with number of pulmonary artery segments connected to the central pulmonary arteries. Postoperative pulmonary hypertension was found in patients with less than 16 bronchopulmonary segments connected to the central pulmonary arteries, and two of them died of pulmonary hypertension late after surgery. These results suggested that unifocalization to connect the central pulmonary artery more than 15 bronchopulmonary segments may be an important strategy for correction of this anomaly with LAPCA.

Child↗
PubMed1990

Angiographic assessment of left ventricular volume, afterload and contractile state in normal children.

Left ventricular (LV) volume, mass and end-systolic stress were determined angiographically in 20 normal children aged 3 months to 16 years. LV contractile state was assessed by the analysis of the relation between end-systolic stress and ejection phase index or end-systolic volume. The LV volume and mass closely correlated with the body surface area. The LV mass/end-diastolic volume ratio (0.94 +/- 0.13 g/ml), ejection fraction (0.67 +/- 0.03) and circumferential end-systolic stress (163 +/- 21 kdynes/cm2, 165 +/- 21 g/cm2) remained constant despite the extensive increase in LV volume with physical growth. In all subjects significant inverse correlations were observed between end-systolic stress and ejection fraction or mean normalized systolic ejection rate. The ratio of the circumferential end-systolic stress to end-systolic volume index ranged from 5.00 to 12.57 (7.49 +/- 1.88). The ratio inversely correlated with age (r = -0.74, p less than 0.001), indicating that this ratio for estimating LV contractility is associated with ventricular size. These results suggested that the LV mass increased adequately in response to the extensive increase in LV cavity volume to maintain the end-systolic stress during growth in childhood and that physiologic cardiac growth was associated with appropriate hypertrophy with no significant change in LV contractile state.

Adolescent↗
PubMed1990

Assessment of the intrapulmonary ventilation-perfusion distribution after the Fontan procedure for complex cardiac anomalies: relation to pulmonary hemodynamics.

In 12 patients who underwent the Fontan procedure for complex cardiac anomalies, lung scanning with xenon-133 was performed to assess the intrapulmonary ventilation-perfusion distribution, and comparison was made with a control group. All data were then analyzed in relation to either pre- or postoperative pulmonary hemodynamic data. In ventilation scans, the intrapulmonary distribution in the right lung was almost normal. In perfusion scans, an abnormal increased upper to lower lobe perfusion ratio greater than the normal value found in the control group was noted in seven patients (58.3%). There was a significant correlation (p less than 0.02) between the upper to lower lobe perfusion ratio and postoperative pulmonary vascular resistance. Furthermore, this perfusion ratio correlated inversely with the preoperative (p less than 0.005) and postoperative (p less than 0.02) right pulmonary artery area index, defined as the ratio of cross-sectional area to the normal value. Of five patients with less than 90% arterial oxygen saturation, four showed an abnormal distribution of pulmonary blood flow greater than the normal perfusion ratio. No patient had evidence of a pulmonary arteriovenous fistula by the echocardiographic contrast study. These results suggest that abnormal distribution of pulmonary blood flow to the upper lung segment may develop in patients after the Fontan procedure, and that insufficient size of the pulmonary artery before operation and the consequent postoperative elevation of pulmonary vascular resistance may be responsible for this perfusion abnormality.

Child↗
PubMed1990

Portal blood flow in congestive heart failure: pulsed duplex sonographic findings.

Twenty-one patients with congestive heart failure were examined with duplex sonographic scanning of the portal vein. The Doppler sonographic findings were compared with those of healthy subjects, patients with chronic liver disease, and patients with Budd-Chiari syndrome. Increasing pulsatility of the Doppler signals was demonstrated in 11 patients with severe congestive heart failure. Two patients with severe congestive heart failure showed decreasing pulsatility of portal Doppler signals in response to therapeutic procedures. Portal flow patterns suggestive of severe congestive heart failure include a monophasic forward flow with peak velocity in ventricular diastole and gradual diminution of velocity throughout ventricular systole (n = 5), a reversed flow velocity in ventricular systole (n = 3), and vena cava-like biphasic forward velocity peaks during each cardiac cycle (n = 2). The time-velocity waveform shape of portal flow is, to a large degree, influenced by the mechanical events in the right side of the heart in severe congestive heart failure.

Blood Flow Velocity↗
PubMed1990

Percutaneous biopsy of thoracic lesions: value of sonography for needle guidance.

Fluoroscopy and CT are widely used to guide percutaneous needle biopsy of thoracic lesions. However, some lesions are not sufficiently visible on fluoroscopy and others are dangerous to access on CT without real-time monitoring. When these are the circumstances, sonographic guidance may be helpful. Real-time sonography was used to guide percutaneous needle biopsy in 124 patients with thoracic lesions. The indications for sonographic guidance included pulmonary, pleural, or mediastinal lesions in contact with the chest wall, including lesions near the heart or great vessels (n = 12); lesions in the apical region (n = 5); lesions in a juxtadiaphragmatic location (n = 6); small lung nodules adjacent to the chest wall (n = 16); and peripheral tumors with adjacent pleural effusion (n = 4). A diagnosis was made in 74 (90%) of 82 malignant lesions and in 24 (67%) of 36 benign lesions. Complications included pneumothorax (n = 5), hemoptysis (n = 1), and hemothorax (n = 1). The advantages of sonographic guidance are that the sonographic equipment is mobile and real-time monitoring makes the procedure safer. Its limitations are that it cannot be used when aerated lung or free air (pneumothorax) lies between the chest wall and the lesion and that cavitary lesions are difficult to sample by biopsy. Our results show that the use of sonographic guidance considerably expands the number of thoracic lesions amenable to percutaneous biopsy.

Biopsy, Needle↗