Biomedical subjects

T Kawashiro

Publications and source records attributed to T Kawashiro.

At least 19 recordsLinked to original sources

PubMed1992

Influence of chest background on pulmonary 99mTc-DTPA clearance in interstitial lung disease.

We examined the effect of chest extracellular 99mTc-diethylenetriamine pentaacetate (DTPA) as a background in the measurement of pulmonary 99mTc-DTPA clearance in patients with interstitial lung disease (ILD). Eight healthy nonsmokers (HN) and eight patients with ILD were studied. We monitored changes in gamma counts after the inhalation of 99mTc-DTPA aerosol by using a gamma camera placed over the anterior chest. The rate constant of pulmonary 99mTc-DTPA clearance (k; %/min) was assessed by calculating the slope of the decrease in the gamma counts. The chest background, estimated by 99mTc-DTPA intravenous injection, was subtracted from the original data to obtain the corrected DTPA clearance (kc; %/min). In patients with ILD, k was significantly greater [2.19 +/- 1.03 (SD) %/min; n = 8] compared with HN (0.86 +/- 0.17%/min; n = 8; P < 0.01). In patients with ILD, kc was also greater (2.80 +/- 1.15%/min; n = 8; P < 0.01) compared with HN (1.20 +/- 0.12%/min; n = 8). There was no difference in percent underestimation of k between the two groups (29.1 +/- 8.8% for HN, 22.5 +/- 7.9% for patients with ILD). There was a significant correlation between k and kc among all subjects (r = 0.987, P < 0.01). We conclude that background causes significant underestimation of pulmonary 99mTc-DTPA clearance.

Adult↗

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

[Alteration of oxygen extraction and blood flow in various organs under acute hypoxia].

To assess the compensatory mechanisms involved in maintaining aerobic metabolism in various organs during exposure to acute hypoxia, five anesthetized and paralyzed dogs were ventilated with either normoxic (FIO2: 0.21) or hypoxic gas mixture (FIO2: 0.13). Under both conditions, we examined systemic and pulmonary hemodynamic parameters, and took samples of arterial and mixed venous blood as well as venous blood from various organs including the heart, brain splanchic organs (hepatic vein) and kidney. Based on PO2, PCO2 and pH values as measured with electrodes, we calculated O2 and CO2 contents in each blood sample. The values thus obtained were then used to estimate the O2 extraction ratio (ER), gas exchange ratio (R) and difference of base excess between arterial and venous blood (avBE) in the whole body as well as in each organ. In addition, both O2 delivery (DO2) and O2 consumption (VO2) in the whole body were calculated. Although the whole body showed a decrease in DO2 and an increase in ER during hypoxic gas breathing, other parameters including R, avBE and VO2 did not change significantly. Higher ER values were found in the heart and brain than those in the splanchic organs and kidney, the qualitative trend being the same irrespective of FIO2. On the other hand, increase in ER during hypoxic gas breathing was considerably larger in the splanchic organs and kidney than that in the heart and brain. There was no significant difference in R and avBE in any of the organs between normoxic and hypoxic conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

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

[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↗

PubMed1992

[Usefulness of vitamin A binding protein as a marker for capillary endothelial permeability].

We performed a preliminary study to assess the usefulness of Vitamin A binding protein (VABP) as a gamma-camera marker for capillary endothelial permeability. We used a guinea pig model of endotoxin (LPS) induced acute lung injury. We calculated the concentration ratio of either 125I-albumin or 125I-VABP in lung tissue to that in plasma (tissue plasma ratio; T/P) as a parameter of capillary endothelial permeability. 99mTc-diethylene triamine pentaacetic acid (DTPA) was used as a marker for pulmonary interstitial volume. We estimated wet to dry lung weight ratio as a parameter of lung water accumulation (W/D). LPS increased the T/P of 125I-albumin and W/D, suggesting the development of permeability edema. The T/P for 125I-VABP was also increased, indicating that 125I-VABP can be used to detect elevated capillary endothelial permeability. In both groups, LPS and saline, the T/P was higher for 125I-VABP than for 125I-albumin. These data suggest that the pulmonary capillary endothelium is more permeable to VABP than albumin.

Animals↗

PubMed1991

Distribution of ventilation and of diffusing capacity to perfusion in the lung.

We developed a method for estimating the distribution of ventilation (VA) and of diffusing capacity (G) to perfusion (Q) in the lungs. We used O2, CO2 and CO together with six inert gases of widely differing solubility and assumed that mass transfer efficiency of each gas in a gas exchange unit is limited by both VA/Q and G/Q ratios. The underlying lung model comprised 20 units along both the VA/Q and G/Q axes. Using numerical analysis, we transformed the data into a virtually continuous distribution of Q in the VA/Q-G/Q field. We tested the precision of the numerical procedure by examining the recovery of various artificial distributions, and found that distributions with up to two modes could be recovered with reasonable accuracy. Analytical results from 15 patients with interstitial pneumonia of unknown etiology (IPF) revealed the following features. (1) In an early disease stage, most of the lung was operating in the range of normal VA/Q, without a significant contribution of diffusion limitation. (2) An advanced stage of the disease exhibited a widening of VA/Q distribution and either broad unimodal or bimodal distribution of G/Q, extending to G/Q below 10(-3) ml (STPD)/(ml.Torr) with diffusion-limited O2 exchange. (3) Severe diffusion limitation causing disequilibrium of inert gas across the blood-gas barrier was observed in three (far advanced fibrosis; active interstitial inflammation) out of 15 patients. These findings suggest that inhomogeneity of G/Q does exist and may play an appreciable role in causing impairment of gas exchange in patients with interstitial pneumonia.

Animals↗

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

[Changes in sound transmissibility through the canine thorax due to the experimental pleural effusion].

The authors studied the effects of pleural effusion on sound transmissibility through the canine thorax. In the supine position, dogs received sound ranging from 100 to 1000 Hz at the tracheostoma. Using the microphones attached to the dorsal and ventral part of the chest wall, the relative level of the transmitted sound wave was determined in reference to the amplitude of the sound wave at a tracheostom. Measurements of sound transmissibility were performed before and after injecting saline into the bilateral pleural space which was intended to be experimental pleural effusion. In the dorsal part, the experimental pleural effusion decreased sound transmissibility in the frequency range between 100 and 300 Hz. At 100 Hz, the pleural effusion of 5, 10, and 15 ml/kg/hemithorax caused a decrease in sound transmissibility by 3.7 +/- 3.7, 6.6 +/- 4.9, and 10.0 +/- 5.7 dB, respectively. In the ventral part, the reduction in sound transmissibility in the low frequency range due to the pleural effusion was small. In contrast, introduction of pleural effusion caused an increase in sound transmissibility by 5 to 9 dB in the frequency range above 500 Hz. We consider that these changes in sound transmission are implicated in the physical findings such as "aegophony" and reduction in vocal fremitus or vocal ausculation.

Animals↗

PubMed1991

[Two cases of primary lung cancer with initial symptoms due to ocular metastases].

Two cases of primary lung cancer with initial symptoms due to metastasis to the eye or the orbit are reported. Case 1 had orbital metastasis, while case 2 had intraocular metastasis. It has been reported that the survival period is short after the metastasis was found. In our cases, the survived periods for case 1 and case 2 were 3.5 months and one month, respectively.

Adenocarcinoma↗

PubMed1990

[Characteristics of impaired gas exchange in patients with chronic obstructive pulmonary disease].

Eleven patients with chronic obstructive pulmonary disease (COPD), placed in a supine position, were given a mixture of 0.1% CO and 21% O2 in N2 as inspired gas and normal saline containing the six inert gases including SF6, ethane, cyclopropane, halothane, diethyl ether and acetone via the antecubital vein. After the steady state was established, the expired gas was collected and both arterial and mixed venous blood were simultaneously sampled through the catheter inserted either into the femoral or pulmonary artery. Assuming that mass transfer efficiency of a given indicator gas at each gas exchange unit would be limited by the ratio of ventilation to perfusion (VA/Q) and by that of diffusive conductance to perfusion (G/Q), the data were analyzed by means of a lung model with 20 units along the VA/Q and G/Q axes, respectively. By application of the method of weighted least-squares combined with the idea of constrained optimization, the data were transformed into a virtually continuous distribution of Q against VA/Q and G/Q axes. Analytical results revealed that: 1) patients with advanced COPD show widening of VA/Q distribution accompanied with a significant contribution of either high VA/Q (emphysematous change) or low VA/Q area (peripheral airway involvement). and 2) their Q distributions along the G/Q axis are unimodal but have an area with a relatively low G/Q, indicating a small but appreciable contribution of diffusion limitation to their hypoxemia. In conclusion, the findings consistently suggest that inhomogeneity of G/Q may partly be responsible for the impaired gas exchange in the cases of COPD.

Humans↗

PubMed1989