Biomedical subjects

M Akira

Publications and source records attributed to M Akira.

At least 37 records · Page 2Linked to original sources

PubMed1997

A pilot study of concurrent whole-brain radiotherapy and chemotherapy combined with cisplatin, vindesine and mitomycin in non-small-cell lung cancer with brain metastasis.

We have evaluated the feasibility, toxicity, and tumour response of concurrent whole-brain radiotherapy (WBRT) and chemotherapy with cisplatin, vindesine and mitomycin in the treatment of 33 patients with brain metastasis from non-small-cell lung cancer (NSCLC). The imaging response demonstrated that 25 patients (75.8%) responded to brain lesions, including five complete responders, and the response rate to primary lesion was 18%. The treatment improved at least one grade of performance status in 30% and of neurological functions in 55% of the patients. The major toxicity was leucopenia (> or = grade 3, 84.4%). Median survival was 9.7 months and the 1-year survival rate was 40%. Concurrent WBRT and chemotherapy can be safely administered to patients with brain metastasis from NSCLC, with a remarkable response rate, improvement of neurological functions and encouraging survival duration.

Adult↗

PubMed1997

Serial computed tomographic evaluation in desquamative interstitial pneumonia.

BACKGROUND: Desquamative interstitial pneumonia (DIP) may represent the early stage and usual interstitial pneumonia (UIP) the late stage of the same disease. The purpose of this study was to evaluate the computed tomographic (CT) features of DIP, to evaluate the changes in pattern and extent of disease over time, and to determine whether the appearances of DIP on the CT scan change to those of UIP during follow up. METHODS: Sequential CT evaluation was conducted on eight patients with DIP over a mean (SD) follow up period of 3.2 (1.3) years (range 1.6-6.5). The relative extents of ground glass and honeycombing were determined from serial CT scans. Changes in the extent and appearance of the disease were examined in paired anatomically comparable CT sections. RESULTS: Common features on the CT scans of patients with DIP were a homogeneous increase in lung attenuation (n = 5), linear areas of attenuation (n = 5), relatively well preserved lung architecture (n = 5), and the presence of small cysts (n = 6). Uncommon features were architectural distortion (n = 3), and traction bronchiectasis (n = 1). In six patients with DIP with cystic spaces these did not change with time in three cases, in two they regreased, and in one patient they increased. Open lung biopsy samples from patients with DIP with many cystic lesions showed dilated alveolar ducts and bronchioles and/or pulmonary cysts, as well as numerous macrophage-filled air spaces and mild fibrosis, but no typical honeycomb cysts were seen. CONCLUSIONS: Some of the microcysts in DIP are different from the honeycomb cysts seen in UIP, and some of the cysts seen in patients with DIP resolve with time. DIP does not progress to UIP in the short term.

Biopsy↗

PubMed1997

Pancreatitis: evaluation with MR cholangiopancreatography in children.

PURPOSE: To determine the usefulness of magnetic resonance (MR) cholangiopancreatography in assessing the cause of pancreatitis in children. MATERIALS AND METHODS: Twenty healthy volunteers (aged 2-11 years) and 10 patients with acute pancreatitis (aged 3-12 years) who underwent MR cholangiopancreatography between December 1993 and February 1996 were studied retrospectively. The rate of visualization of the common bile duct and main pancreatic duct with MR cholangiopancreatography was assessed in the volunteer group. Depiction of pancreaticobiliary disease at MR cholangiopancreatography was assessed in the patient group. RESULTS: MR cholangiopancreatography clearly showed the common bile duct in 20 of 20 volunteers (100%) and the main pancreatic duct in 13 of 20 volunteers (65%). MR cholangiopancreatography depicted a dilated common bile duct in six of 10 patients (60%) and an abnormal arrangement of the pancreaticobiliary duct in five of the six patients (83%) in whom this structural abnormality was proved at surgery. In the four patients without structural abnormality, MR cholangiopancreatography depicted a pseudocyst in one patient who had traumatic pancreatitis; the other three patients had normal findings. In one of these three patients, familial pancreatitis was considered to be the underlying disorder, and in the other two patients no cause was identified. CONCLUSION: MR cholangiopancreatography may be helpful in diagnosing the cause of pancreatitis in children, especially in those with an abnormal pancreaticobiliary ductal junction.

Acute Disease↗

PubMed1997

CT findings during phase of accelerated deterioration in patients with idiopathic pulmonary fibrosis.

OBJECTIVE: Most patients with idiopathic pulmonary fibrosis (IPF) show slowly progressive deterioration. However, accelerated deterioration also occurs in patient with IPF who have previously shown slowly progressive deterioration. The purpose of this study was to evaluate the CT findings of accelerated deterioration in patients with IPF. MATERIALS AND METHODS: We evaluated the CT findings of 17 patients with IPF who fulfilled all the following criteria for accelerated deterioration of IPF: exacerbation of dyspnea within 1 month, new diffuse pulmonary opacities on chest radiography, a decrease in arterial oxygen tension (PaO2) of more than 10 mm Hg under similar conditions, and absence of apparent infectious agents and heart failure. Seven patients underwent sequential CT examination. Pathologic specimens were obtained from nine patients. RESULTS: CT findings were classified as peripheral parenchymal opacification (n = 6), multifocal parenchymal opacification (n = 6), and diffuse parenchymal opacification (n = 5). Multifocal lesions developed diffusely in two of the seven patients who underwent sequential CT. These two patients both died. Three of the six patients with a multifocal pattern responded to corticosteroid therapy. All patients with a peripheral pattern showed various degrees of improvement following corticosteroid therapy. Multifocal and diffuse parenchymal opacification corresponded pathologically to acute diffuse alveolar damage. Peripheral parenchymal opacification corresponded pathologically to active fibroblastic foci. CONCLUSION: CT patterns seen during periods of rapid deterioration in patients with IPF may allow predictions of prognosis and of response to treatment.

Aged↗

PubMed1997

[Chronic eosinophilic pneumonia successfully treated with suplatast tosilate].

The patient was a 45-year-old woman in whom a chest X-ray film obtained on admission showed bilateral infiltrative shadows. A chest CT scan revealed areas of consolidation and ground-glass opacities. Examination of bronchoalveolar lavage fluid revealed many eosinophils, and specimens obtained by transbronchial lung biopsy showed thickened alveolar septa with infiltration of eosinophils. The numbers of eosinophils and the level of IgE in blood were low. The radiographic appearance improved after administration of suplatast tosilate. The level of interleukin 5 was high both in plasma and in bronchoalveolar lavage fluid before treatment, but the level of IL-5 in plasma was low after suplatast tosilate was given. Suplatast tosilate, which suppresses the production of cytokines, may be useful in patients with chronic eosinophilic pneumonia.

Anti-Allergic Agents↗

PubMed1997

[High levels of elastolytic activity in bronchoalveolar lavage fluid from a patient with idiopathic interstitial pneumonia].

A 63-year-old female with acure exacerbution of idiopathic interstitial pneumonia (IIP) showed high levels of elastolytic activity in bronchoalveolar lavage fluid (BALF). She was admitted to our hospital with progressive dyspnea. Arterial blood gas analysis and pulmonary function tests were abnormal. Examination of the bronchoalveolar lavage fluid revealed an increased numbers of neutrophils. Despite the administration of corticosteroids, the patient died of respiratory failure. A high level of elastolytic activity was present in the BALF. Western immunoblot analysis, using an anti-alpha 1-protease inhibitor (PI) antibody, revealed a truncated alpha 1-PI in the BALF. These findings suggest that an imbalance between protease and PI in the lower respiratory tract contribute to lung tissue damage in patients with IIP.

Bronchoalveolar Lavage Fluid↗

PubMed1996

[Two cases of von Recklinghausen's disease with diffuse pulmonary changes].

Two patients with von Recklinghausen's disease had diffuse pulmonary diseases. The pulmonary diseases were interstitial fibrosis and emphysematous bullae. In case 2, examination of a specimen obtained by transbronchial lung biopsy revealed fibrotic interstitial thickening and adenomatous hyperplasia. Diffuse pulmonary abnormalities in von Recklinghausen's disease have been said to be fibrotic changes and emphysematous changes, as shown in roentgenograms in these two cases. The biopsy specimen obtained in case 2, however, revealed fibrotic changes only, which could not be distinguished from findings in cases of idiopathic interstitial pneumonia. In case 2, bronchoalveolar lavage fluid was also examined but it did not reveal any unique features of von Recklinghausen's disease. Since 1978, von Recklinghausen's disease has been diagnosed 10 times in our hospital, but diffuse pulmonary diseases was seen in only two of those 10 cases.

Adult↗

PubMed1995

Uncommon pneumoconioses: CT and pathologic findings.

PURPOSE: To correlate the computed tomographic (CT) features of pneumoconioses with histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 48 patients with a history of occupational exposure to dust and radiographic changes suggestive of pneumoconiosis were retrospectively reviewed. Histologic samples were available in 22 cases. RESULTS: The most common CT features were as follows: in 21 arc welders, ill-defined micronodules concentrated in the centrilobular regions (n = 15); in 19 graphite workers, small nodular hyperattenuating areas (n = 17) (ill defined or well defined, corresponding to macular lesions along the walls of bronchioles and nodules, respectively), interlobular septal thickening (n = 11), and large hyperattenuating areas (n = 10); in aluminum pneumoconiosis, predominant reticular (n = 2), nodular (n = 2), and upper-lobe fibrosis (n = 2); and in hard-metal pneumoconiosis, multilobular ground-glass attenuation and consolidation with shrinkage (corresponding to marked intra-alveolar desquamation and multinucleated giant cells with mural mononuclear cell infiltrate). CONCLUSION: Predominant findings are characteristic in each type of pneumoconiosis and are depicted at thin-section CT.

Adult↗

PubMed1995

Phase II study of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer. Southern Osaka Lung Cancer Study Group.

PURPOSE: To evaluate the response rate, toxicity, and 2-year survival rate of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Between July 1989 and October 1990, 65 patients with histologically or cytologically proven unresectable stage III NSCLC without T3N0-1M0 disease were entered onto this study. Sixty-one patients were eligible for response, survival, and toxicity analysis. Chemotherapy consisted of vindesine (3 mg/m2 on days 1, 8, 29, and 36), cisplatin (100 mg/m2 on days 1 and 29), and mitomycin (8 mg/m2 on days 1 and 29). Radiotherapy was administered for 3 weeks (2 Gy given 13 times, five fractions per week), followed by 10-day rest periods and then the previous schedule of radiotherapy repeated for 3 weeks. RESULTS: Of 61 eligible patients, 53 (86.9%) had a partial response (PR). The median response duration was 39.1 weeks (range, 8.4 to 163+). The median survival time was 16 months and the 2-year survival rate was 36.7%. Of 53 responding patients, 10 (16.4%) are alive and disease-free after 2 years. The major toxicity was leukopenia (> or = grade 3, 95%). Other toxicities of > or = grade 3 included thrombocytopenia (45%), anemia (28%), nausea/vomiting (16%), fever (11%), and esophagitis (6%). Treatment-related death occurred in two patients. One patient died of pulmonary toxicity (interstitial pneumonitis) and the other of esophagobronchial fistula with pulmonary infection. CONCLUSION: Concurrent radiotherapy plus chemotherapy with mitomycin, vindesine, and cisplatin (MVP) can be safely administered to patients with stage III NSCLC, with excellent response rates and 2-year survival rates.

Adult↗

PubMed1994

Pulmonary hyalinizing granuloma with Castleman's disease.

A case of pulmonary hyalinizing granuloma (PHG) with Castleman's disease in a 43-year-old man is presented. He was asymptomatic, but the disease was recognized due to a routine chest roentgenographic study. Anemia, multiple lymphadenopathy, hypoalbuminemia and polyclonal hypergamma-globulinemia were observed. Histological examination of cervical lymph nodes revealed the plasma cell type of Castleman's disease. The diagnosis of PHG was confirmed by video-assisted thoracoscopical lung biopsy, and the immuno-histochemical staining of lamellar fibrosis for types I and III collagen was positive.

Adult↗

PubMed1993

Acute interstitial pneumonia: radiographic and CT findings in nine patients.

The radiologic findings were reviewed in nine patients with biopsy- or autopsy-proved acute interstitial pneumonia (AIP). All patients had bilateral air-space opacification on radiographs and bilateral, symmetric areas of ground-glass attenuation on computed tomographic (CT) scans. The areas of ground-glass attenuation had a patchy distribution in six patients (67%) and were diffuse in three patients. Air-space consolidation was seen at CT in six patients (67%) and involved mainly the lower lung zones in three patients and upper lung zones in one patient and was diffuse in two patients. A predominantly subpleural distribution of the consolidation was present in two patients. Eight of the nine patients died within 3 months of presentation. The authors conclude that the radiographic and CT features of AIP are similar to those of adult respiratory distress syndrome and represent acute alveolar damage. AIP differs from the more chronic forms of interstitial pneumonia in clinical presentation and in pathologic and radiologic findings.

Acute Disease↗

PubMed1993

Diffuse panbronchiolitis: follow-up CT examination.

PURPOSE: The authors reviewed serial computed tomographic (CT) scans obtained in 19 patients with diffuse panbronchiolitis (DPB) to evaluate changes in disease pattern over time. MATERIALS AND METHODS: Nineteen patients with DPB were entered into the study. After initial CT examination, 12 patients were randomly assigned to receive long-term low-dose (200 mg three times daily) erythromycin therapy; seven patients received no treatment. RESULTS: Follow-up CT scans revealed that centrilobular areas of high attenuation observed initially had progressed to dilatation of the proximal airway in some patients in the untreated group. In the treated group, the centrilobular and branched linear areas of high attenuation were decreased in number and size, although the airway dilatation and decreased lung attenuation in the peripheral areas remained unchanged or were slightly increased. CONCLUSION: CT scans are valuable in the study of the disease process and response to therapy in DPB.

Adult↗

PubMed1993

Idiopathic pulmonary fibrosis: progression of honeycombing at thin-section CT.

PURPOSE: To evaluate the progression of honeycombing at computed tomography (CT) and to determine serial changes in the pattern of disease. MATERIALS AND METHODS: CT scans, obtained in 29 patients with idiopathic pulmonary fibrosis who had undergone at least two serial CT examinations 1-52 months apart, were reviewed. Twelve patients had received no treatment, and 17 patients had received corticosteroids. Initial and follow-up CT scans were evaluated independently and then directly compared with each other. RESULTS: Twenty-six of the 29 patients showed progression of honeycombing, which was variable at CT (median, 0.4% [range, 0%-11%] per month) but not significantly different between untreated and treated patients. Areas of ground-glass attenuation on CT scans preceded and were predictive of the development of honeycombing in that location. Corticosteroid treatment reduced areas of ground-glass attenuation, but honeycombing on CT scans was irreversible. CONCLUSION: Low-dose therapy with corticosteroids does not suppress alveolitis sufficiently to prevent continued deterioration of the alveolar structures.

Female↗

PubMed1992

Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings.

Summer-type hypersensitivity pneumonitis is an immunologic disease that occurs only in Japan. It is a form of hypersensitivity pneumonitis in which the clinical symptoms appear in the summer and subside spontaneously in mid autumn. The purpose of our study was to determine the CT findings in this condition, to compare the CT findings with those on chest radiographs, and to assess the variations in the CT findings over time. Accordingly, high-resolution CT scans and chest radiographs of 15 patients with summer-type hypersensitivity pneumonitis were retrospectively studied. Seven patients had sequential CT examinations 18-37 days apart. The CT scans and chest radiographs were reviewed by two observers independently. CT findings included diffuse micronodules (n = 15), slightly elevated lung density (n = 13), and patchy air-space consolidation (n = 13). In one patient, the findings on a chest radiograph were normal, while CT showed parenchymal abnormalities. In two cases, follow-up CT showed micronodular abnormalities after findings on the chest radiograph had returned to normal. Our results show that high-resolution CT findings of summer-type hypersensitivity pneumonitis include pulmonary micronodules, increased lung density, and air-space consolidation. High-resolution CT appears to be more useful than plain chest radiographs in the evaluation of pulmonary parenchymal abnormalities in this condition.

Adult↗

PubMed1991

Early asbestosis: evaluation with high-resolution CT.

To determine the earliest stage at which lesions in asbestosis can be diagnosed and to assess their progression, 23 asbestos-exposed patients with minimal or no abnormalities at plain radiography were examined with high-resolution computed tomography (HRCT) twice, with an interval of 12-37 months between examinations. In 21 of the patients, parenchymal abnormalities were found. Major parenchymal features seen at CT included thickened intralobular and interlobular lines, subpleural curvilinear lines, pleural-based nodular irregularities, hazy patches of increased attenuation, small cystic spaces, and small areas of low attenuation. At paired serial CT, subpleural isolated dots or branching structures connected with the most peripheral branch of the pulmonary artery started to appear in lower subpleural zones and then became confluent to create pleural-based nodular irregularities. CT-pathologic correlation led to the conclusion that the confluence of subpleural peribronchiolar fibrosis creates subpleural fibrosis.

Adult↗

PubMed1990

Asbestosis: high-resolution CT-pathologic correlation.

High-resolution computed tomography (HRCT) was performed in seven inflated and fixed postmortem lungs from seven asbestos-exposed patients with pathologically proved asbestosis. The parenchymal abnormalities seen at in vitro HRCT included thickened intralobular lines (n = 7), thickened interlobular lines (n = 7), pleural-based opacities (n = 7), parenchymal fibrous bands (n = 5), subpleural curvilinear shadows (n = 4), ground-glass appearance (n = 4), traction bronchiectasis (n = 4), and honeycombing (n = 2). The thickened intralobular lines were shown histologically to be due to peribronchiolar fibrosis. Thickened interlobular lines were due mainly to interlobular fibrotic thickening in four lungs and edema in three. The peribronchiolar fibrosis was most severe in the subpleural lung regions, creating curvilinear line shadows and pleural-based areas of opacity. Some subpleural fibrosis extended proximally along the bronchovascular sheath to create bandlike lesions. Areas of ground-glass appearance on HRCT scans were shown to be the result of mild alveolar wall and interlobular septal thickening due to fibrosis or edema. Postmortem HRCT findings were similar to premortem HRCT findings and correlated well with the pathologic findings of asbestosis.

Aged↗

PubMed1989

Radiographic type p pneumoconiosis: high-resolution CT.

High-resolution computed tomography (CT) was performed in 90 patients with pneumoconiosis who had small rounded opacities on radiographs. The CT appearances of radiographic type p small rounded opacities in 55 patients were compared with the appearances of type q and r opacities. Radiographic type p pneumoconiosis on high-resolution CT scans was characterized by tiny binary branching structures or a gathering of a few dots. In 21 of the 55 patients, nonperipheral, small areas of low attenuation with a central dot were found. On the basis of CT-pathologic correlation in two postmortem specimens, these tiny opacities and areas of low attenuation corresponded to irregular fibrosis around and along the respiratory bronchioles and to focal-dust emphysema, respectively. Focal emphysema was most commonly found in pneumoconiosis with p-type changes and can be identified with high-resolution CT scanning. The addition of high-resolution CT to chest radiography is useful in achieving more accurate categorization of the lesions.

Humans↗

PubMed1988

Diffuse panbronchiolitis: evaluation with high-resolution CT.

High-resolution computed tomography (CT) was performed in 20 patients with diffuse panbronchiolitis. Images of abnormal peripheral lung were classified into four types: small nodules around the end of bronchovascular branchings (CT type I), small nodules in the centrilobular area connected with small branching linear opacities (CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles (CT type III), large cystic opacities accompanied by dilated proximal bronchi (CT type IV). CT classifications were compared with radiographic classifications and clinical stages of the disease. The comparison revealed that the classification based on CT findings reflected the clinical stages and pathologic process of diffuse panbronchiolitis. The authors conclude that high-resolution CT is useful in the evaluation of both the location and severity of the lesions.

Adult↗