Biomedical subjects
Publications and source records attributed to S Kira.
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To assess clinical significance of breath-by-breath variation of tidal volume and its distribution pattern displayed as a histogram, continuous measurement of tidal volume was made with electrical impedance pneumography for about 60 minutes. Subjects were composed of 26 normal male and 46 patients including 17 patients with restrictive lung disease and 29 patients with obstructive lung disease. To evaluate variation of tidal volume quantitatively, coefficient of variance (C.V.) was used. In comparison to the normal pattern of distribution (C.V. = 26.0 +/- 7.5%, mean +/- S.D.), patients with restrictive lung disease showed extremely narrow pattern of the distribution and significantly smaller C.V. (17.5 +/- 4.6% in old pulmonary tuberculosis, P less than 0.005 and 18.9 +/- 9.3% in pneumonitis, P less than 0.025). Whereas, patients with obstructive lung disease showed widespread pattern of the distribution and significantly greater C.V. (43.2 +/- 13.0% in pulmonary emphysema with hypercapnia, 33.0 +/- 7.5% in normocapnia and 35.8 +/- 9.4% in asthmatic attack, P less than 0.005). In all the patients with bronchial asthma after the treatment, the extremely widespread pattern of histogram was returned toward the normal one and the C.V. was decreased (22.4 +/- 6.4%). It was suggested that the distribution pattern of tidal volume was affected by the change of clinical condition, and was well correlated to the pathophysiological process related to restrictive or obstructive lung disease. We conclude that analysis of tidal volume distribution by the histogram is one of the useful approach to manage patients with respiratory diseases.
An increased incidence of lung cancer and epithelial metaplasia or hyperplasia which is felt to be as a precursor of cancer, has been reported in patients with idiopathic pulmonary fibrosis (IPF). In this study, carcinoembryonic antigen (CEA) in bronchoalveolar lavage (BAL) fluid was measured in 53 control patients, 31 patients with sarcoidosis, 10 patients with hypersensitivity pneumonitis, 16 patients with primary lung cancer and 26 patients with histologically confirmed IPF. High ratio of CEA to albumin (Alb), exceeding mean + 2SD of nonsmoking control patients, were found in 8 (25%) out of 32 smoking control patients, 4 (44%) out of 9 nonsmoking patients with IPF, 8 (62%) out of 13 smoking patients with IPF, 3 (75%) out of 4 smoking patients with IPF and lung cancer and 13 (81%) out of 16 patients with primary lung cancer, although BAL was performed at the noncancerous parts of the lung in the cases of lung cancer. Furthermore, it was confirmed that CEA increased in BAL fluid in these subjects were different from nonspecific cross-reacting antigen (NCA) which was detectable in the normal lung. Thus we consider that the increase of CEA/Alb ratio in BAL fluid is a possible marker of these early histological disorders in the lung, and also suggests a greater risk of malignant change in the clinical course of IPF.
The effects of chemotherapy by single administration of Cisplatin were studied in 26 patients with non-small cell carcinoma of the lung. There were 22 males and 4 females with a median age of 63 years. 21 cases were epidermoid carcinoma, 4 cases were adenocarcinoma and 1 case was atypical carcinoid. Cisplatin 20 mg/m2 with hydration and diuresis was given daily for 5 consecutive days. The course was repeated every 3 weeks. Partial response was observed in 4 patients (3 epidermoid carcinoma and one atypical carcinoid). The response rate was 19%. Side effects induced by Cisplatin were gastrointestinal toxicity including vomiting, nausea and appetite less, bone marrow toxicity and renal damage. These were not so severe, and reversible. Gastrointestinal toxicities were controlled successfully by corticosteroids. In 12 patients gastrointestinal toxicities were not observed. We conclude that Cisplatin is effective for non-small cell carcinoma, especially for epidermoid carcinoma. Hematologic toxicities of Cisplatin were not so severe. Therefore, combination chemotherapy including Cisplatin would improve the quality of life of patients suffering from non-small cell carcinoma of the lung.
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To study the dynamics of pleural liquid, 250 ml of saline labeled with markers were injected into the pleural cavity of anesthetized dogs. For 3 h, liquid volume and concentration of these markers were measured. In a control group of dogs, the turnover rate of pleural liquid was 19.6 +/- 5.6 ml/min and lymphatic flow was 0.58 +/- 0.07 ml/min. In a group of pneumonectomized dogs, the turnover rate and lymphatic flow fell to about one fourth of those in the control group. When the left pulmonary artery was occluded, the turnover rate was halved, but lymphatic flow was not significantly different from that in the control group. These results suggest that the turnover rate of pleural liquid is dependent on the area of contact between pleural liquid and pleura and on the blood flow of the pleura. In addition, it appears that changes in pleural liquid volume are dependent on lymphatic flow.
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Diffuse panbronchiolitis (DPB) is a disease with chronic inflammation exclusively located in the region of respiratory bronchioles. The pathologic features of the disease are characterized by thickening of the wall of the respiratory bronchiole with infiltration of lymphocytes, plasma cells and histiocytes, and extension of the inflammatory changes toward peribronchiolar tissues. In the advanced stage, secondary ectasia of proximal bronchioli may occur. These changes appear as diffusely disseminated small nodular shadows throughout both lungs on the chest roentgenogram. Obstructive respiratory functional impairment, occasional symptoms of wheezing, and also cough and sputum resemble the feature of emphysema, bronchial asthma, or chronic bronchitis, respectively. In the advanced stage, large amounts of purulent sputum and dilatation of proximal terminal conducting bronchioli resemble bronchiectasis. However, diffuse panbronchiolitis belongs to a distinctly different category from these diseases, and should be distinguished from them, because it may often show rapid progression with fatal outcome. The disease is dominant in males and the onset is unrelated to age. More than 1,000 cases of probable diffuse panbronchiolitis and 82 histologically-confirmed cases have been collected in Japan.
Transesophageal ultrasound endoscopy by the linear array transducer built-in on top of the fiber optic gastroduodenoscope was applied for 13 clinical cases with various mediastinal lesions. It was quite valuable to diagnose mediastinal lesions such as lymphadenopathy in sarcoidosis, lymph node metastasis and direct invasion of lung cancer, dilatation of the diameter of the right pulmonary artery in pulmonary hypertension.