Biomedical subjects

T Kawashiro

Publications and source records attributed to T Kawashiro.

At least 55 records · Page 3Linked to original sources

PubMed1993

Detection of tracheal stenosis by frequency analysis of tracheal sounds.

To develop a simple noninvasive method for detecting tracheal stenosis, tracheal sounds were analyzed using fast-Fourier transform. The subjects were all female and included 5 normal volunteers and 13 patients with tracheal stenosis mostly secondary to thyroid cancer (11 extrathoracic and 2 intrathoracic lesions). Tracheal sounds were recorded during spontaneous breathing and were digitized with an analog-to-digital converter. Pulmonary functions, including forced expiratory volume in 1 s (FEV1) expressed as percentage of vital capacity, peak expiratory flow rate (PEFR), the ratio of FEV1 to PEFR (Empey's index), and the ratio of expiratory to inspiratory flow rates at 50% vital capacity, were measured. A computed tomography scan was used to obtain the tracheal minimum cross-sectional area. Whereas PEFR demonstrated a weak correlation with the stenotic area, FEV1%, Empey's index, and the ratio of expiratory to inspiratory flow rates at 50% vital capacity did not. The power of the fast-Fourier transform spectrum of normal tracheal sounds decreased as the frequency increased up to 500 Hz. A small spectral peak was observed at approximately 1 kHz. Patients with significant tracheal stenosis demonstrated an increase in the peak spectral power at approximately 1 kHz and in the mean spectral power from 600 to 1,300 Hz in their tracheal sounds. In patients with extrathoracic lesions, the peak and mean spectral powers correlated well with the area of the stenosis as defined by computed tomography scan. In patients with intrathoracic lesions, abnormalities in the pulmonary functions as well as tracheal sound spectra appeared more evident despite milder stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

[Measurement of myeloperoxidase and thiobarbituric acid-reactive material in plasma and bronchoalveolar lavage in E. coli-induced acute lung injury].

Myeloperoxidase (MPO), which is exclusively contained in neutrophils, is released on their activation. Therefore, MPO may possibly be used as a parameter of neutrophil activation. Thiobarbituric acid-reactive material (TBARM) reflects lipid peroxidation and is a parameter of oxygen radical-mediated cell membrane damage. Using our guinea pig model of septic lung injury we measured MPO and TBARM in the setting of acute lung injury. The two experimental groups were saline controls (n = 8) and an E. coli septic group to which 2 x 10(9) live E. coli were administered intravenously (n = 8). Lung damage was assessed by measuring wet to dry lung weight ratio (W/D) and lung tissue to plasma accumulation of 125I-albumin (AL: albumin leakage). We measured MPO and TBARM in plasma and BAL fluid. Increased W/D and AL were observed in the E. coli group suggesting the development of acute lung injury. In the E. coli group, plasma MPO increased and MPO in BAL fluid was significantly increased as compared with the saline control group. There was no difference in plasma TBARM between the two groups, while TBARM in BAL fluid of the E. coli group was greater than in that of controls. Although BAL fluid TBARM correlated with both W/D and AL, there was no relation between BAL fluid MPO and either of these parameters. We conclude that TBARM in BAL fluid may be useful for assessing E. coli-induced acute lung injury in guinea pigs.

Animals↗

PubMed1993

[A case of congenital antithrombin III deficiency with pulmonary thromboembolism and cerebellar infarction].

A 41-year old woman was admitted to a local hospital because of leg pain, chest pain and dyspnea after taking estrogen for two months for irregular menstruation. On admission to the hospital, her lung scintigram showed multiple segmental perfusion defects in the right lung. Pulmonary angiography showed several thrombi in the proximal pulmonary artery. A diagnosis of pulmonary thromboembolism was made. AT-III activity was found to be only 50% of normal value, indicating that the pulmonary thromboemboli were due to AT-III deficiency. The patient was then put on anticoagulants for two years. When she was 43-year-old, she was admitted to Keio University Hospital because of worsening of dyspnea. After admission her dyspnea had got better due to bed rest. Her brain CT, which was performed because of her gait disturbance, indicated past right cerebellar infarction. We gave her 2 mg of warfarin and maintained a thrombotest of about 30%. The investigation of her family revealed that her son also showed decrease AT-III activity, indicating a congenital abnormality. 26 families with this disease have been reported in Japan. Most had venous thromboemboli, but only a few cases had brain infarction as well. In addition, it is suggested that an estrogen therapy for irregular menstruation may have contributed, in this particular case, to the onset of thromboemboli.

Adult↗

PubMed1993

[Roles of serotonin in glass-bead pulmonary microemboli].

We investigated the role of serotonin release from aggregating platelets in glass-bead microemboli on isolated perfused rabbit lungs. The perfusion was performed at 70 ml/min with a roller pump. The temperature of the perfusion circuit was maintained at 37 +/- 1 degrees C by means of a heat exchanger. 100 microns-diameter glass beads (1 g) were infused via the main pulmonary artery. We examined the concentration of serotonin and the number of platelets in the perfusate and the mean pulmonary arterial pressure before and after glass bead embolization. Administration of PRP (platelet-rich plasma) to the perfusate caused the concentration of serotonin to significantly increase after microembolization. Specific serotonin S2 receptor antagonist (DV-7028) inhibited the increase of serotonin concentration in the perfusate, platelet aggregation, and vasoconstriction. We concluded that in the glass-bead embolization model, serotonin was released from aggregating platelets surrounding the glass beads, and constricted pulmonary microvessels via serotonin S2 receptors on the vascular smooth muscles cells.

Animals↗

PubMed1993

[A case of chronic necrotizing pulmonary aspergillosis treated with itraconazole].

An 84-year-old woman was admitted because of fever, hemoptysis and productive cough with infiltrative shadows in the right lung field on chest X-ray. Chronic necrotizing pulmonary aspergillosis was diagnosed on the basis of her clinical and radiographic features, positive cultures and positive serological tests. Conventional chemotherapy with fluconazole and 5-FC produced only minimal improvement. A course of itraconazole was initiated and proved to be effective.

Administration, Oral↗

PubMed1993

[Pulmonary disease due to Mycobacterium xenopi].

A 54-year old man with pulmonary disease due to Mycobacterium xenopi is described. He had a history of pulmonary tuberculosis at 8 years of age. He was admitted to our hospital in October 1992, complaining of productive cough and fever. A chest X-ray on October 20 showed an infiltrative shadow with a cavity, although chest X-ray picture on October 2 showed only inactive shadow, in the right upper lobe. Acid-fast organisms were seen in his sputum specimens and M. xenopi was identified by culture. The isolates were confirmed to be M. xenopi by the DNA-DNA hybridization method. He was treated with isoniazid, rifampicin and streptomycin. The fever decreased within a week. After two months of therapy, sputum cultures became negative and chest X-ray findings improved. It was concluded that this is a case of rapidly progressed pulmonary disease caused by M. xenopi in the normal host. This patient's condition responded to antituberculosis drugs.

Humans↗

PubMed1993

[Gastric metastasis of primary lung cancer].

A 74-year-old man was admitted to Keio University Hospital because of an abnormal shadow in the right upper lung field on chest roentgenogram. Bronchoscopic examination revealed malignant cells, by which large cell carcinoma of the lung was diagnosed. Systemic survey for metastasis disclosed an ulcerated tumor on the greater curvature of the stomach. Endoscopic examination showed an elevated submucosal tumor suggesting submucosal metastasis of lung cancer to the stomach. A review of 473 autopsies of primary lung cancer at Keio University from 1958 to 1987 showed 16 cases with gastric metastasis (3.4%). Two of 16 cases were detected clinically. Gastric metastases were proven in 15.6% of autopsy cases of large cell carcinoma of the lung. Forty-three cases of primary lung cancer with gastric metastasis were reported in the Japanese literature from 1965 to 1990. Thirteen of these cases had large cell carcinoma.

Aged↗

PubMed1993

[Effect of diffusion limitation on gas exchange in the lung--analysis in oleic acid-induced lung injury].

To assess the effect of diffusion limitation on gas exchange in injured lungs with non-cardiogenic pulmonary edema, an experimental model of acute lung injury with alveolar flooding was produced in six mongrel dogs by intravenously injecting oleic acid at 0.06 ml/kg. The effect of diffusion limitation was quantitatively examined by measuring the excretion (E) of three indicator gases (acetylene, ethylene and freon-22) with differing solubility (lambda) and tissue diffusivity (d). The indicator gases were dissolved in normal saline and infused at a constant rate through a peripheral vein. Since acetylene and ethylene have nearly identical of d but differing lambda, the difference in E values of these two gases may solely reflect the effect of uneven distribution of ventilation-perfusion ratios (VA/Q) in the lung. Thus, measured E values of acetylene and ethylene allowed us to approximately predict the E of freon-22, the value corresponding to the condition where d of freon-22 was taken to be equal to that of acetylene or ethylene. The difference between predicted and measured E values of freon-22 is indicative of the limitation of diffusion in the lung periphery. In all the lungs studied, measured E values of freon-22 were consistently smaller than those predicted from acetylene and ethylene, leading to the conclusion that gas exchange in injured lungs with widespread pulmonary edema was partly impaired by diffusion in aqueous media.

Animals↗

PubMed1993

[Assessment of pulmonary aerosol deposition and epithelial permeability in 99mTc-DTPA inhalation scintigram].

The degree of lung injury in bronchiolo-alveolar lesions may be quantitated from the pulmonary epithelial permeability estimated by 99mTc-DTPA (diethylene triamine penta acetate) aerosol inhalation scintigram. However, significant aerosol deposition sometimes occurs in the central airways and obscures the permeability change in the lung periphery. The radioaerosol deposition pattern and its effect on assessing the pulmonary epithelial permeability was studied. 99mTc-DTPA aerosol scintigraphy was performed in 47 patients with pulmonary fibrosis (PF), 12 patients with chronic obstructive pulmonary diseases (COPD), and 27 non-smoking and 17 smoking healthy volunteers. The scintigraphic images of the lungs were classified into 4 grades, 0; homogeneous distribution, 1; patchy distribution, 2; hot spots with partial defect, and 3; hot spots with little deposition in the lung field. The rate constant was used as a parameter for the permeability. The smokers and patients with PF showed increased kep values of 2.36 +/- 1.21%/min (mean +/- SD) and 2.49 +/- 1.29%/min as compared with the nonsmokers with 0.94 +/- 0.27%/min, respectively. The nonsmokers, smokers and 36 patients with PF were classified as deposition grade 0 or 1, suggesting good aerosol penetration to the lung periphery. All patients with COPD showed either grade 2 or 3 deposition. Aerosol deposition in the central airways can cause underestimation of the permeability because of the thicker lining layer in the bronchus than in the alveolus. In conclusion, the aerosol deposition pattern should be analyzed when the method is applied clinically to assess the permeability of the bronchiolo-alveolar epithelium.

Adult↗

PubMed1993

[Effects of antioxidant enzymes in erythrocytes on pulmonary arterial pressure during hypoxic gas breathing].

Using isolated rabbit lungs (n = 72) perfused at a constant flow of 70 ml/min, we analyzed whether the antioxidant system in erythrocytes significantly contributes to maintaining pulmonary vascular responsiveness to alveolar hypoxia (HPV) in normal lungs. As a measure of HPV, we observed the difference (delta P) between mean pulmonary arterial pressure during ventilation with normoxic gas mixture (21% O2, 5% CO2 in N2) and that during hypoxic gas breathing (3% O2, 5% CO2 in N2). Autologous erythrocytes obtained from the animals treated with various substances inhibiting either superoxide dismutase (SOD), the anion channel of the membrane, catalase (CAT) or glutathione peroxidase (GSH-Px). Subsequently, delta P was systematically measured in the perfusate, whose hematocrit was adjusted to 6-7% with normal or treated erythrocytes as described above. Further, the effects of adding SOD (75 U/ml) or CAT (1000 U/ml) to the perfusate on delta P were examined. The following results were obtained. (1) Inhibition of the superoxide scavenging mechanism in erythrocytes (SOD and anion channel) exerted no significant influence on delta P. (2) Inhibition of hydrogen peroxide scavengers in erythrocytes did not alter the scope of delta P. (3) Addition of either SOD or CAT to the perfusate did not show any significant effect on delta P. The findings are highly consistent with the idea that HPV in normal lungs is essentially independent of antioxidant enzymes in erythrocytes, which are expected to be one of the important factors determining the total capacity to deal with oxidant stress in the lung.

Animals↗

PubMed1993

[Mechanism of constriction and dilatation of pulmonary artery induced by hydrogen peroxide].

Hydrogen peroxide (H2O2) is known to cause transient pulmonary vasoconstriction in isolated lungs perfused with a solution containing no blood components, by inducing vasoactive arachidonate metabolites such as thromboxane A2 (TXA2). However, the exact site of production of the vasoactive arachidonates in the lung tissue is unclear. Using isolated main pulmonary arterial rings obtained from male Sprague-Dawley rats (B.W. 300-350 g), we attempted to examine the arachidonate metabolism, especially that mediated by cyclooxygenase, in the vascular wall of pulmonary artery without endothelium. Changes in isometric tension were used to measure contraction or dilatation of the ring preparation. H2O2 caused transient contraction of the ring, which was treated previously with a solution containing a high concentration of potassium (20 mM). The contractile response was enhanced in parallel with the concentration of H2O2 in the presence or absence of endothelium. Catalase (1000 U/ml), a H2O2 scavenger, completely inhibited the response of the isolated ring (without endothelium) to H2O2. OKY-046 (10(-5) and 10(-4) M), a TXA2 synthetase blocker, partially attenuated the contractile response induced by H2O2. ONO-3708 (10(-5) M), a TXA2 and prostaglandin H2 receptor blocker, fully inhibited the vasoconstriction and caused relaxation of the ring without endothelium after addition of H2O2. Indomethacin (5 microM), a cyclooxygenase inactivator, completely inhibited both vasoconstriction and vasodilation of the denuded ring. H2O2 also induced the release of 6-keto-prostaglandin F1 alpha, a stable metabolite of the vasodilator, prostacyclin, from the pulmonary artery without endothelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

[Effects of various doses of endotoxin on physiological and hematological parameters in conscious guinea pigs].

We investigated the effects of various doses (0.2 to 2000 micrograms/kg) of endotoxin on physiological and hematological parameters in our guinea pig model. Bronchoalveolar lavage (BAL) and lung tissue sampling were performed 6 hours after endotoxin injection. Lung damage was assessed by measuring wet to dry lung weight ratio (W/D), lung tissue to plasma accumulation of 125I-albumin (AL: albumin leakage) and BAL fluid to plasma accumulation of 125I-albumin (BALL: bronchoalveolar lavage leakage). Changes in peripheral cell counts were estimated at times 0, 1, 2, 4 and 6 hours after endotoxin injection. Pulmonary cell accumulation was determined by counting the number of cells in BAL fluid and tissue samples fixed for light microscopic examination. Increased W/D and AL were observed only in the high dose endotoxin treatment groups (200 and 2000 micrograms/kg), while BALL increased even in the low dose endotoxin treatment groups (2 micrograms/kg). Decreases in peripheral neutrophil counts at one hour were observed in all endotoxin treated groups. Increase in BAL fluid neutrophils was seen in the 20, 200, and 2000 micrograms/kg groups, while neutrophil accumulation assessed by light microscope was observed in all endotoxin treated groups. We conclude that different amounts of endotoxin are required to affect different parameters of lung injury.

Albumins↗

PubMed1993

[Detection of radiation-induced lung injury by 99mTc-DTPA aerosol inhalation method].

We prospectively monitored pulmonary 99mTc-DTPA (diethylene triamine penta acetate) clearance in patients who received chest radiation therapy, in order to determine whether this method allows us to predict the development of radiation pneumonitis. The rate constant of pulmonary 99mTc-DTPA clearance (k; %/min) was used to assess pulmonary epithelial damage. Fifteen nonsmoking patients who underwent radiation therapy were studied. The subjects included 4 patients who had already developed radiation pneumonitis at the time of study, and 11 in whom we prospectively observed 99mTc-DTPA clearance serially during the course of chest radiation therapy. In the 4 patients with pre-existing radiation pneumonitis, the mean k value obtained from the area with infiltration on the chest X-ray was significantly greater than that from the opposite lung (p < 0.02). In the prospective study, 3 out of 11 patients developed radiation pneumonitis. The mean k of the irradiated lung field in the 8 patients who did not develop radiation pneumonitis was unchanged. The mean k value obtained in the 3 patients who did develop radiation pneumonitis increased just before the onset, and further increased when the disease manifested clinically. We conclude that pulmonary 99mTc-DTPA clearance may be useful for predicting the development of radiation pneumonitis.

Adult↗

PubMed1993

[A case of slowly-growing localized malignant mesothelioma].

We report a case of localized malignant mesothelioma. The patient was a 37-year-old male, admitted to our hospital because of a solitary nodular shadow in the right middle lung field noted on chest X-ray. Five years prior to admission, a solitary nodular shadow had been seen in the same area on chest X-ray, and the diameter of the tumor had gradually increased. A transbronchial biopsy specimen revealed proliferation of spindle-shaped tumor cells, suggesting fibrosarcoma. No other lesions were identified as primary foci, so we made the tentative diagnosis of primary pulmonary sarcoma prior performing right upper lobectomy. The resected specimen revealed that the tumor, which partially touched the pleura, contained a number of large and small cystic spaces, and was composed of numerous spindle-shaped tumor cells. Some of the tumor cells were immunohistochemically positive for cytokeratin and epithelial membrane antigen, and many mitotic figures were noted. Thus, we made the histopathological diagnosis of localized malignant mesothelioma.

Adult↗

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↗