Biomedical subjects

K Kusajima

Publications and source records attributed to K Kusajima.

At least 73 records · Page 4Linked to original sources

PubMed1996

[Interstitial pneumonia complicated by rapidly progressive glomerulonephritis associated with anti-myeloperoxydase antibody].

A 78-year-old man was admitted to our hospital in October 1994 because of renal dysfunction. The level of anti-myeloperoxidase antibody in serum was 500 EU/ml, and examination of a specimen obtained by open renal biopsy revealed crescentic glomerulonephritis. A chest roentgenogram revealed no abnormality. Administration of prednisolone was started at 50 mg/day, and the dosage was then tapered. Renal function remained stable, but on interstitial shadow appeared on the chest roentgenogram. Pulmonary function tests showed a restrictive ventilatory abnormality and a low diffusing capacity. A thoracoscopic lung biopsy was done in April 1995, and microscopic examination of the specimen showed interstitial pneumonia with relatively young granulation. The dosage of prednisolone was increased to 50 mg/day, after which the interstitial shadow decreased and pulmonary function improved. The level of anti-myeloperoxydase antibody in serum was 16 EU/ml (weakly positive). Alveolar hemorrhage can occur in cases of rapidly progressive glomerulonephritis. In addition, interstitial pneumonia or pulmonary fibrosis can also complicate this condition. In the present case, glomerulonephritis associated with anti-myeloperoxydase antibody co-existed with interstitial pneumonia. This case is valuable because both renal biopsy and lung biopsy specimens were available.

Aged↗

PubMed1995

[A case of bronchial mucoepidermoid carcinoma in a 7-year-old girl].

Mucoepidermoid carcinoma of the lung presenting in childhood is extremely uncommon. A 7-year-old girl was referred to our hospital with complaint of persistent cough and abnormal shadow on the chest roentgenogram. Bronchoscopic biopsy revealed a bronchial mucoepidermoid carcinoma and a left pneumonectomy was performed. The histopathological examination revealed intermediate grade malignancy without any metastasis in mediastinal lymph nodes. She is now doing well without any evidence of recurrence 2 years after the operation.

Age of Onset↗

PubMed1995

[A case of extramedullary plasmacytoma of the lung associated with nodular deposit of amyloid].

A 63-year-old man underwent left upper lobectomy because of a 35-mm tumor in the lingula. Microscopic findings showed that the tumor was composed of a proliferation of plasma cells, and that in some areas eosinophilic amorphous material had been deposited between the tumor cells. By immunoperoxidase staining, the tumor cells were positive for IgG and kappa chain, but they were negative for lambda chain. In addition to the tumor in the lingula, another nodule was found in the left lower lobe and was resected at thoracotomy. The nodule was composed of diffuse eosinophilic amorphous material, which was found to be amyloid after Congo red staining and observation in polarized light. In and around the nodule, a few plasma cells were noted and these cells were also positive for IgG and kappa chain, but negative for lambda chain immunoperoxidase staining. In serum taken from the patient before surgery, M-protein was not detected by immuno electrophoresis but polyclonal hypergammaglobulinemia was noted, and it continued after the thoractomy. Bone marrow examination and a bone scintigram revealed no abnormality. In this case, a pulmonary plasmacytma co-existed with nodular pulmonary amyloidosis. We could not determine which lesion developed first, but the results of the immunoperoxidase staining of plasma cells in both lesions indicate that the origin of the plasmacytoma was probably the same as that of the nodular amyloid.

Amyloidosis↗

PubMed1995

[Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated endoscope disinfection machine--on the relationship between the presence of the organism in the intestinal tract and contamination of disinfection machine, and a case of gallbladder and bile duct infection with M. chelonae].

In 1993, thirteen strains (8.7%) of M. chelonae were isolated from bronchoalveolar lavage fluid (BALF) obtained by bronchoscopy of 150 patients in Tachikawa-sogo (T) hospital, where the same automated disinfection machine was commonly used for cleaning, sterilization and disinfection of fiberbronchoscope and fibercolonoscope except 3 bronchoscopes disinfected by gas sterilization. Since January 1994, manual cleaning and sterilization has been applied for bronchoscope, and thereafter no strain of M. chelonae was isolated from BALF of 55 patients in the T hospital. While only one strain (3%) of M. chelonae was isolated from BALF of 33 patients in Ota (O) hospital, but many strains of M. chelonae were isolated from intestinal fluid obtained by fibercolonoscopy of the patients. Manual method of cleaning and disinfection was performed for both bronchoscopes and colonoscopes in the O hospital from the beginning. Based on these results, it was suggested that M. chelonae are commonly present in the colon (intestine) of normal persons. Thus colonoendscope may be often contaminated with the organism and subsequently the automated disinfecting machine may also be contaminated with the organism which is resist and against usual disinfection procedure, and resulted in bronchoscope contamination. If the presence of M. chelonae in intestinal tract is not rare, bile duct may be naturally infected with the organism. A case of cholecystitis and cholangitis caused by M. chelonae, which has not been reported previously, was found in the T hospital.

Aged↗

PubMed1994

Pleural multicystic mesothelial proliferation.

We report a rare case of pleural multicystic mesothelial proliferation occurring in a 62-year-old Japanese woman. Macroscopically, the lesion consisted of multiple thin wall cysts containing clear serous fluid. Histologic studies, including hematoxin-eosin stain, as well as the immunohistochemical method, revealed that the lesion was mesothelial in origin and consistent with a reactive change.

Antigens↗

PubMed1994

[The status of extrapulmonary tuberculosis in community hospital].

Fifty patients with extrapulmonary tuberculosis were diagnosed at 4 community hospitals in Tokyo during 1981 to 1992. The percentage of extrapulmonary tuberculosis among the all types of tuberculosis was 10.5% as a whole, and 16% in females and 7.9% in males. The number of patients older than fifth generation was about two times more than that of younger generations. And the patients were more in males than in females under the forties, but were more in females than in males over the sixties. On chest radiogram, there was no pathological findings in 52% of the patients and active pulmonary tuberculosis was detected in 32% of the patients. The majority of the extrapulmonary tuberculosis (30 cases, 60%) was of lymph nodes, especially of cervical lymph nodes, and the remaining were 10 cases of tuberculosis in bone and joint, 4 each in intestine and pericardium, 2 each in liver, peritoneum, kidney, urinary bladder, epididymis and skin. Among 30 cases with tuberculous lymphadenopathy, the disease were observed in cervical lymph nodes by 19 cases, in pulmonary hilar and axillary node by each 4 cases and in abdominal cavity by 3 cases.

Adult↗

PubMed1994

[Mediastinal lymph node dissection in left lung cancer].

It is usually impossible to perform a complete systemic mediastinal lymph node dissection in left-side pulmonary carcinomas because the aortic arch gets in the way. The purpose of this study was to determine if incomplete lymph node dissection influences late mortality. We retrospectively analyzed 222 patients who had complete resection of non-small-cell lung cancer, 141 on the right lung and 81 on the left lung. There were 155 men and 67 women. They ranged in age from 35 to 78 years. 146 patients were in Stage I, 41, in the Stage II and 35, in the Stage III A, except for T3 diseases. The 5-year survival rates of left lung cancer were 82% and 35% in the Stage I group and the Stage II group, respectively. There was no difference when compared with the corresponding groups with right lung cancers. The 3-year survival, however, was 0% in the Stage III A group with left lung cancer excluding T3 diseases; this was significantly lower than that of right lung cancer (p < 0.01). The results recommend extended mediastinal lymph node dissection on the left-side squamous cell carcinoma to improve the survival of patients with left-side N2 diseases, when the tracheobronchial lymph nodes are involved.

Adult↗

PubMed1993

[Two cases of M. avium complex infection presenting as solitary pulmonary nodule].

Case 1 was a 75-year-old woman. Her chest X-ray showed a 3 cm solitary nodule in the right S4, and biopsy obtained by fiberoptic bronchoscopy revealed epithelioid cell granuloma. Four weeks later, Mycobacterium avium complex (MAC) was detected on culture of the bronchial lavage fluid. She was treated with INH, RFP and EB for 12 months and recovered with no relapse. Case 2 was a 75-year-old man with mild diabetes mellitus and hypertension. Chest X-ray showed a 4 cm solitary nodule in the right S9. Percutaneous pulmonary aspiration revealed numerous acid-fast bacilli on smear, and he was treated with INH, RFP and EB. Culture proved M. avium complex. The patient was unable to continue his medications because of gastrointestinal side effects, so right lower lobectomy was performed. Cases of M. avium complex infection presenting as solitary pulmonary nodule are very rare. We found only 12 reported cases in Japan and in other countries. The most usual site of cavitary lesions in M. avium complex infections is both upper lobes, in contrast to the relatively even distribution of solitary pulmonary nodules of the 14 cases (12 reported cases and our 2 cases).

Aged↗

PubMed1993

[Surgical treatment of thymomas].

Forty-eight patients were evaluated. These cases were classified to stage I in 17, stage II in 11, stage III in 13, and stage IV in 7 by Masaoka staging. In 43, a complete resection was performed and in 5, an incomplete resection was carried out. Twelve patients between stage III and IV received postoperative radiotherapy because of incomplete resection and advanced invasive case (defined as high-risk group). Survival at 10 years was 55% for patients who were in high-risk group. This result was disappointed because survival was low in spite of surgical resection combined with postoperative radiation. From that reason, more concentrated therapy might be necessary with not only enlargement of radiation field but also chemotherapy for vascular invasive thymoma in addition to resection.

Adolescent↗

PubMed1993

[A case of idiopathic chylothorax].

A 29-year-old female was admitted to our hospital because of right pleural effusion. Chyle was obtained by thoracocentesis. She received conservative therapy, however, the pleural effusion did not decrease. Thoracic duct ligation was performed, and improvement of the chylothorax was observed. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. Idiopathic chylothorax is a rare disease and only 24 cases have been reported in Japan.

Adolescent↗

PubMed1992

[Tuberculosis in young generation: a report from six general hospitals].

We investigated epidemiologic and clinical aspects of tuberculosis in young generation and pointed out problems in ambulatory treatment. In six general hospitals in Tokyo, 418 cases of tuberculosis (285 males and 133 females) were diagnosed between 1983 and 1991. They were divided into three groups; 1) young group, 10 to 29 yr (62 cases), 2) middle age group, 30 to 69 yr (255 cases), 3) elderly group, above 70 yr (101 cases). And the risk of clinical breakdown, method of case finding, radiological findings, extra-pulmonary lesions, method of diagnosis, relationship with epidemics, patient's delay, doctor's delay, drug regimens and patient's compliance in each group were investigated. In addition, after completion of therapy we sent them survey questions about relapse and attack of tuberculosis among their families. Results were followings. 1) Estimated risk of clinical breakdown by age was calculated as follows, (the number of patients)/(the population of Tokyo)/(estimated incidence of infection). This was extremely high in young group. 2) Sixteen percent of patients in young group were related with epidemics and another eight percent with familial outbreaks. 3) Although many patients in young group showed focal lesions in chest radiographies, the rate of symptomatic patients was 61% and that was almost same as in other groups. 4) The rate of patients showing atypical radiographic findings, extra-thoracic lymphadenopathy and idiopathic pleuritis were relatively high in young and elderly group. 5) Results of survey questions showed no relapse among ambulatory treated patients. Familial outbreaks (three cases) were thought to be caused by long patient's delay and not by ambulatory treatment of smear-positive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

[A study of arrhythmia following pulmonary operation in patients with bronchogenic carcinoma].

A total of 238 patients undergoing resection of lung cancer were studied for the occurrence of postoperative arrhythmia. Transient arrhythmia was observed in 43 of them (18.1%). Ninety-one percent of 43 patients developed atrial fibrillation (Af), even though no arrhythmia was noted on ECG in any patient preoperatively. Cardiac dysrhythmia occurred 5.2 +/- 3.8 days after operation and lasted for 1.3 +/- 0.9 days (mean +/- SD). There was a significant difference (p less than 0.05) in the incidence of postoperative arrhythmia between the male group (39/188 = 21%) and the female group (4/50 = 8%), however the cause of a difference is unknown. The incidence was higher in patients undergoing pneumonectomy than in those undergoing lobectomy. Patients, who suffered from postoperative arrhythmia, has significantly low values on pulmonary function test (FEV1.0% = 68.7%) preoperatively. The increased cardiac load after the reduction of the pulmonary vascular bed was regarded as the most important factor of arrhythmia. Prophylactic administration of digoxin was performed in another 61 male patients after resection of lung cancer. And it was found to be effective in decreasing the incidence of postoperative atrial fibrillation (5/61 = 8%).

Adult↗

PubMed1992

[Characteristics of chronic interstitial pneumonia seen in the lung operated for lung cancer].

A total of 480 lungs operated for lung cancer were reviewed in an attempt to clarify the characteristics of idiopathic chronic interstitial pneumonia (UIP), seen in the cancer bearing lungs. UIP was identified in 30 cases (6.3%). The mean patients age was 68 years, and 26 cases were male. Squamous cell carcinoma was the dominant tumor type (17 cases) and the lower lobe was the dominant location (18 cases). All cancers were situated in the periphery of lungs which had UIP, but not necessarily in the center of the fibrosis. According to extent, UIP is divided into two categories, localized and diffuse types. Twenty-seven cases had localized type UIP. UIP can be divided into another three categories, according to its microscopic findings; Intramural (IM), emphysematous (E), and intraluminal (IL) types. Eight cases had IM-type and 22 cases had E-type UIP. Some IM-type UIP cases showed only increased density of the subpleural space on CT, without visible cysts. E-type UIP cases had no decrease of lung capacity, and showed various sized cysts on CT. Some cases showed postoperative worsening of UIP and acute exacerbation. We feel that the existence of localized UIP (especially emphysematous type) is important in the early detection of cancer, and as a cue for careful post-operative management to prevent serious complications.

Adult↗

PubMed1992

[Clinico-pathological study of collagen-related pulmonary lesions in cases of open lung biopsy].

We studied the clinico-pathological correlation of collagen disease-related pulmonary lesions to examine the pathological and radiological features of collagen lung, and the effect of steroid therapy. Ten open lung biopsy cases were examined; 4 male, and 6 female. The mean age was 55 years old. Seven cases developed pulmonary shadows after the diagnosis of collagen disease, and 3 cases showed pulmonary shadow prior to diagnosis. Pathologically, 6 cases proved to be bronchiolitis obliterans organizing pneumonia (BOOP), 3 cases were chronic interstitial pneumonia (UIP), and 1 case was acute interstitial pneumonia. All cases had inflammatory thickening of the interstitium involving the pleura, bronchial wall, and perivascular connective tissue. Half of the cases had bronchiolar inflammatory lesions. Radiologically BOOP cases showed either localized ground glass shadows, or diffuse reticulonodular shadows predominantly in the lower lung fields with shrinkage of affected areas. UIP cases showed reticulonodular shadows, and active UIP cases showed overlapping ground glass shadows. Steroids were administered in cases of BOOP and active UIP, and all cases showed improvement. We consider that open lung biopsy is of use in the diagnosis of some cases and in assessing whether steroid therapy is indicated.

Aged↗

PubMed1992

[Changes of immunity in the patients undergoing surgery for esophageal cancer].

The kinetics of subpopulations and functional subsets of circulating immune cell, humoral antibody and complement were examined in the 18 patients undergoing surgery with thoracotomy and laparotomy for esophageal cancer. The following results were obtained. 1. Preoperative IgG-Fc-receptor (+) T cell (Tr cell) level was higher than normal level. 2. From 1st post operative day (1POD) to 14POD, WBC counts have increased, lymphocyte counts (especially T cell counts) have decreased significantly as compared with preoperative level. 3. In T cell subsets, counts of Tr cell have decreased significantly from 1POD to 3POD as compared with preoperative counts. 4. Counts of OKT8 positive cells (suppressor or cytotoxic T cell) and OKT4 positive cells (helper or inducer T cell) have decreased significantly from 1POD to 3POD as compared with preoperative count. OKT4/OKT8 ratio increased at 3POD (2.31 +/- 1.33). 5. In B cell subsets divided into using the type of cell surface immune antibody (sIgG, sIgA, sIgD), all subsets have decreased significantly as compared with preoperative counts. 6. Immune globulin (IgG, IgA, IgM, IgD) have decreased significantly from 1POD to 7POD, but at 14POD they increased significantly as compared with preoperative levels. 7. Complements (C3, C4) have decreased significantly from 1POD to 7POD. 8. The count of sIgG positive B cell had significant, negative correlation with carcinogenic factor and positive correlation with preoperative serum total protein. The other immune factors had no correlation with the factors before and during operation. These results suggest that cellular immunity of patients undergoing surgery with thoracotomy and laparotomy for esophageal cancer lose its autoregulation function especially in T cell, it does not recover until 14POD.

Aged↗

PubMed1991

[Accuracy and clinical problems involved in the measurements of extravascular lung water, using the thermal-sodium double indicator dilution technique].

In this report, we evaluated and discussed the accuracy and the clinical problems involved in measurements of extravascular lung water volume (EVLW), using the thermal-sodium double indicator dilution technique. We measured EVLW in 2 groups, group I (normal cardiac function group) consisting of 20 patients with esophageal cancer, and group II (low cardiac function group) consisting of 27 patients with heart valvular disease. No significant difference was found between the two groups in the reproducibility (SDM/Average X 100) of measurements of Cardiac output (CO), MTT (Mean Transient Time), and EVLW. No correlation was found between circulatory parameters and the reproducibility of measurement of EVLW. So we assumed that cardiac function has no influence on the reproducibility of EVLW measurement. But the CO measured with EVLW catheter was significantly higher than that measured with Swan-Ganz catheter in group II. We thought that EVLW should be calculated using the CO measured with Swan-Ganz catheter in cases of low cardiac function. Infection, thromboembolism and bleeding after the insertion of the catheter, overload of water and sodium due to the injection of the indicator were thought to be complications of measurement of EVLW. But in our clinical cases there was no such complication.

Esophageal Neoplasms↗

PubMed1991

[Clinical and pathologic features of rounded atelectasis in patients with empyema].

Rounded atelectasis (RoA) is an uncommon pulmonary condition presenting as a peripheral round opacity on a chest roentgenogram. Six cases of empyema who underwent regional lung and pleural resection, had local atelectatic induration beneath the pleura. Their clinical and pathologic features were examined. Five cases had past histories of pulmonary tuberculosis with therapeutic pneumothorax, and one other case had tuberculous pleuritis. Five of seven atelectatic indurations displayed RoA on preoperative plain radiography ++ and/or CT and on soft X-ray films of resected lung preparations. With pathological examinations, the pleura showed one or several indentations, often with deep invaginations into the pulmonary parenchyma. In these regions, the appearance was occasionally more complex due to several small folds emanating from the larger fold. Outside the pleural folds, there was dense fibrous thickening. Fibrosis of the pleural interstitial layer itself was mild. Lung parenchyma adjacent to the folded pleura appeared collapsed with mild interstitial fibrosis. These findings lead to the hypothesis that RoA may result from pleural invaginations occuring after pleural effusion or therapeutic pneumothorax and from fibrous adhesions of the outer regions.

Aged↗

PubMed1990

[The measurement of extra vascular lung water using a thermal-sodium double indicator dilution technique in patients undergoing surgery for esophageal cancer].

The Extra Vascular Lung Water (EVLW) was measured using the thermal sodium double indicator dilution technique in 21 patients undergoing surgery for esophageal cancer. This measurement is an important parameter in the control of the respiratory function. In the 16 cases without pulmonary complications, the preoperative EVLW was 5.3 +/- 0.2 (mean +/- SEM) ml/kg and the immediate postoperative EVLW was 4.8 +/- 0.4 ml/kg. This change was significant (p less than 0.05), but within 24 hours the EVLW returned to almost the same levels as those recorded before surgery. In only 3 cases, the EVLW were elevated beyond 7.5 ml/kg, but these high EVLW levels did not continue for more than 12 hours. Of the 5 patients with pulmonary complications, only two experienced pulmonary edema. Their preoperative EVLW levels were normal, but the immediate postoperative EVLW levels were significantly elevated beyond 10 ml/kg. These elevated levels were observed before the PaO2, the portable chest roentgenograms and the other test results changed following surgery. The high EVLW levels beyond 7.5 ml/kg continued for 72 hours after surgery. We found no correlation between the EVLW and measureable hemodynamic parameters (Cardiac Index, Pulmonary Wedge Pressure, Colloid Osmotic Pressure-Pulmonary Wedge Pressure gradient) during the observation period. In the other cases with pulmonary complications (2 cases were pneumonia, one was atelectasis with pneumonia), the changes in the EVLW levels were the same as for the cases without pulmonary complications. These results indicate that the EVLW is the optimum parameter for the control of the respiratory function and early diagnosis of pulmonary edema after surgery for esophageal cancer.

Esophageal Neoplasms↗