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Biomedical subjects

T Kurasawa

Publications and source records attributed to T Kurasawa.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Two cases of idiopathic pulmonary hemosiderosis: analysis of chest CT findings].

Chest CT findings are reported in two cases of idiopathic pulmonary hemosiderosis. In both cases, CT was performed after remission of an acute exacerbation following corticosteroid therapy. Case 1 was a 17-year-old woman with Down's syndrome. Chest radiograph showed diffuse ground-glass like and reticulonodular shadows, which were predominant in the bilateral lower lung fields. Chest CT showed a diffuse increase of lung filed density, especially in the dorsal zone of both lower lobes. Open lung biopsy revealed hemorrhage and numerous hemosiderin-laden macrophages in the alveoli, and in addition, marked fibrous thickening of the alveolar septa. Case 2 was a 7-year-old girl. Chest radiograph showed diffuse micronodular shadows in both lungs. Chest CT showed diffuse poorly-circumscribed micronodular lesions with uniform distribution, and lung field density was normal except for the right upper lobe with patchy infiltrates. Although lung biopsy was not performed, fibrous thickening of the alveolar septa was presumed to be mild even if present, since pulmonary function and blood gas analysis were within normal limits. In these two cases, lung field density of CT seemed to reflect the degree of diffuse fibrous thickening of the alveolar septa, and it is suggested that CT is valuable in the evaluation of fibrous thickening of the alveolar septa secondary to recurrent pulmonary hemorrhages. Comprehensive review of CT findings of idiopathic pulmonary hemosiderosis was also performed.

Adolescent↗
PubMed1992

[Two cases of pericardial diverticulum].

Two cases of resection of pericardial diverticulum are reported. The lesion was located in the right upper mediastinum in case 1 (66-year-old woman) and at the right anterior cardio-phrenic angle in case 2 (20-year-old woman). In case 1, the shape of the lesion varied on fluoroscopic observation when the position of the patient was changed, and in case 2, ICG instilled into the lesion operation diffused into the pericardial cavity. These procedures seemed to be useful in the diagnosis of pericardial diverticulum, differentiating it from pericardial cyst.

Adult↗
PubMed1992

[Clinical study on cough variant asthma].

Chronic cough may be the sole presenting manifestation of bronchial asthma (reference 3; Corrao et al, 1979), and "cough variant asthma (CVA)" has been used to categorize such patients. In order to clarify the clinical picture of CVA, we evaluated the clinical history, laboratory data, sputum cytology and pulmonary function in 14 subjects (5 males and 9 females, aged 14 to 65 years) compatible with the following diagnostic criteria: (1) chronic cough persistent for more than 8 weeks, (2) no wheeze nor dyspnea, (3) no rales, (4) no past history of asthma, (5) bronchial hyperreactivity to methacholine proven by Takishima's method (reference 13), (6) effectiveness of bronchodilators against cough, (7) normal chest X-ray film, (8) afebrile and negative CRP, (9) absence of sinusitis and postnasal drip, or if present, they are proved not to be responsible for the cough, and (10) no other causes of cough such as heart disease, prescription of ACE inhibitors, current smoking. The results were as follows. 1) Many of the subjects were atopic, with positive skin tests to one or more common allergens in 10 subjects, elevated serum IgE in 4 subjects, and past history and family history of atopy in 4 and 7 subjects, respectively. 2) Respiratory infection preceded the onset of CVA in 3 subjects. 3) Cough was generally nocturnal, but 2 subjects coughed only in the daytime. 4) FEV1.0% was decreased (less than 70%) in only 2 subjects, whereas V25 was decreased (less than 80% of predicted value) in 11 out of 12 evaluable subjects, which suggested peripheral airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[A clinical study on coexistence of active pulmonary tuberculosis and lung cancer].

Twenty-two patients were diagnosed as coexisting active pulmonary tuberculosis and lung cancer during last ten years until 1989. They were nineteen men and three women and their age ranged from 61 to 84 years with a mean age of 71.3. Six patients had history of tuberculosis, three had undergone gastrectomy and four patients were complicated with diabetes mellitus. Histological types of lung cancer were epidermoid cell carcinoma in 13, adenocarcinoma in 3, large cell carcinoma in 2, and small cell carcinoma in 4 and clinical stages were "stage I" in 2, "stage II" in 2, "stage IIIA" in 5, "stage IIIB" in 4 and "stage IV" in 7, except 2 patients after surgical treatment. Localizations of lesions of cancer and tuberculosis were in the same lobes in 6, in ipsilateral lung in 6, and in contralateral lung in 6, except 4 cases, whose lesion of tuberculosis was not detectable roentgenologically and all cancers of "same lobe" cases were peripheral origins. Although, the prognosis was poor, which reflects the prognosis of lung cancer as a whole, the efficacy of anti-tuberculous chemotherapy was as good as patients without lung cancer. We mainly discussed the diagnostic points to detect the coexistence of lung cancer and pulmonary tuberculosis at early stage.

Aged↗
PubMed1991

Cooperation between accessory cells and T lymphocytes in patients with tuberculous pleurisy.

We studied interleukin 1 (IL-1) activity of pleural fluid macrophages and peripheral blood monocytes obtained from ten patients with tuberculous pleurisy and ten patients with malignant pleurisy, using purified protein derivative (PPD) as a stimulating agent. Tuberculous pleural fluid macrophages and peripheral blood monocytes tended to produce higher IL-1 activity than malignant pleural fluid macrophages and blood monocytes and showed significantly more IL-1 activity than healthy control monocytes. However, no significant difference in IL-1 activity was observed between tuberculous pleural macrophages and blood monocytes. With the cooperation of these accessory cells, pleural fluid T lymphocytes in patients with tuberculous pleurisy showed a significant level of interleukin 2 (IL-2) activity in the presence of PPD. Tuberculous pleural fluid macrophages promoted greater IL-2 production than blood monocytes from either tuberculous pleural fluid or blood T lymphocytes despite relative equivalence in measured IL-1 production. Combination of tuberculous pleural fluid macrophages and pleural fluid T lymphocytes was the most effective for increasing IL-2 activity when compared with other combinations. These results suggest that tuberculous pleural fluid macrophages and T lymphocytes may contribute to the immunopathogenesis of tuberculosis at a local site of disease.

Adult↗
PubMed1991

[A case of fulminant hepatic failure secondary to congestive heart failure].

It has been generally accepted that congestive heart failure does not lead to fulminant hepatic failure, unless it is associated with cardiac shock or low cardiac output. Only three cases have been reported, in which liver congestion is followed by fulminant hepatic failure without a history of shock or low cardiac output. Here we present a case of a 48-year-old man with dilated cardiomyopathy and pulmonary infarction, who developed fulminant hepatic failure from congestion. When he was admitted for the control of diabetes mellitus, hepatomegaly of 3-finger breadth and marked cardiomegaly without pulmonary congestion was noted. Diabetes was controlled using insulin. But 3 weeks after admission, he sometimes complained of back dullness because of pulmonary infarction. His heart gradually increased in size, and Jugular venous dilatation and pretibial pitting edema also worsened. Jaundice was noted and serum GOT and GPT increased. A large liver of 6-finger breath below the right costal margin was able to be felt. But within one week, the size of the liver markedly decreased and the signs of hepatic failure such as jaundice, hepatic encephalopathy and numerous petechiae appeared. Blood pressure was maintained and no hypotension or cardiac shock was noted. The patient died of fulminant hepatic failure on the 20th days after onset of the hepatic failure. The autopsy revealed liver atrophy with severe central lobular necrosis, and thrombus in the right main pulmonary artery which caused severe pulmonary infarction. The mechanism of fulminant hepatic failure not accompanied with low cardiac output is discussed.

Cardiomyopathy, Dilated↗
PubMed1990

[Tuberculin skin test of patients with active pulmonary tuberculosis and non-tuberculous pulmonary diseases].

The maximum diameter of redness of tuberculin skin test (PPD) was studied in patients with active pulmonary tuberculosis (TB) (257 cases) and with various non-tuberculous pulmonary disorders (Non-TB) (328 cases). Negative rate of PPD (maximum diameter under 9 mm) was 9.3% in patients of TB; 6.5% in patients without underlying disorders and 16.3% with underlying disorders, which may affect the break-down of tuberculosis. In patients with miliary tuberculosis, the negative rate was high and PPD reaction became weaker in advanced patients and patients with pleurisy. High age, hypoalbminemia and lymphocytepenia in peripheral blood were the factors influencing the negative conversion of PPD skin test. In Non-TB patients, positive rate of PPD was similar between patients with and without past history of tuberculosis and the rate of patients with maximum redness over 35mm were about 10%, regardless of sex, age and disorders. But there was a difference in the positive rates of PPD between male and female; the positive rate of PPD skin test was highest in male with lung cancer, and there was a difference in the positive rate of PPD between the age groups in male, but there was no difference in females regardless of age with or without lung cancer.

Adult↗
PubMed1990

[Clinical and ultrastructural study on primary ciliary dyskinesia].

We evaluated laboratory and radiological findings and examined tracheobronchial cilia by transmission electron microscopy in 9 patients with primary ciliary dyskinesia (PCD), in order to elucidate the clinical pictures of PCD and the relationship between PCD and diffuse panbronchiolitis (DPB) which was proposed as a new disease entity in Japan in 1969. The clinical pictures of our PCD patients were almost the same as that already described in several articles in Europe and North America; early onset of respiratory symptoms, high incidence of chronic sinusitis and otitis media exudative as well as infertility, continuous infections in the lower respiratory tracts (Hemophilus influenzae, Pseudomonas aeruginosa etc.). Tracheobronchial cilia obtained by brushing technique were immotile (6 out of 8 patients) or dyskinetic (2 out of 8 patients). Ultrastructural study of cilia revealed the lack of dynein arms in all patients: the lack of both outer and inner arms (4 patients), the lack of outer arms (2 patients), the lack of inner arms (2 patients). Chest X-ray films revealed situs inversus in six out of nine patients. According to the radiological findings (chest X-ray film, CT-scan, bronchogram), the patients were divided into three groups; I: localized bronchiectasis (5 patients), II: diffuse micronodular lesions without definite bronchiectasis (3 patients), III: diffuse micronodular lesions with bronchiectasis (1 patient). Two patients of the second group satisfied the clinical diagnostic criteria for DPB (Chest 83:63, 1983). In conclusion, PCD can cause a variety of respiratory tract lesions such as bronchiectasis, DPB and other types of peripheral airway disorders.

Adult↗
PubMed1989

[Three cases of chronic respiratory failure].

Three patients with chronic respiratory failure of various etiology, who have (had) been in the hospital for some years, were presented. The case 1 is male and was 57 years old on admission. He has been suffered from right thoracic emphysema from October '83, which is under chronic infection of Pseudomonas aeruginosa, with bronchial fistula and aortic valve insufficiency. His pulmonary function is severely restrictive and the grade of his dyspnea has been V of Hugh-Jone's criteria and he is now unable to leave from bed. The case 2 is male and was 41 y.o. on admission. He has been ill with diffuse cystic bronchiectasis from 33 y.o. and bronchorrhea (greater than 200 ml/day) with chronic infection of Pseudomonas aeruginosa has been lasting and recurrent attacks of infection have progressively worsened of his pulmonary and cardiac functions. He is now indispensable to assist ventilation by artificial respirator every 2-3 days. The case 3 was male and 27 y.o. on admission. He had admitted because of severe dyspnea due to familial pulmonary fibrosis on August '86. His disorder had been progressive and resistant against repeated corticosteroid therapy. He died of respiratory failure at 30 years old. The transplantations of lung and heart-lung for critical patients with respiratory failure have been challenged in North America and Europe, but in Japan, many social and medical problems about transplantation have yet been unresolved. The indications for and against lung or heart-lung transplantation to these three patients was discussed with reference to English literatures.

Adult↗
PubMed1989

[The cause of paradoxical growth of intracranial tuberculomas during anti-tuberculous chemotherapy].

A case of multiple intracranial tuberculomas diagnosed by enhanced brain CT scan and MRI, which developed during the course of miliary tuberculosis under anti-tuberculous chemotherapy was experienced. Chemotherapy with an increased dose of each agent and corticosteroid was administered, and eventually intracranial tuberculomas nearly disappeared. After 1970, there have been 29 reported cases of intracranial tuberculomas in Japan, which were diagnosed by brain CT and treated with anti-tuberculous agents. Among them, 27 evaluable cases were classified into 3 groups. Group A: Intracranial tuberculomas were proved by CT before chemotherapy in 7 cases. Four of them enlarged during chemotherapy. Group B: During chemotherapy of tuberculous meningitis, neurological symptoms worsened or prolonged, and finally intracranial tuberculomas were found by CT in 9 cases. In 5 of them, after meningitis was improved by chemotherapy, neurological symptoms worsened and intracranial tuberculomas were found. Group C: During chemotherapy of pulmonary tuberculosis or miliary tuberculosis, neurological symptoms appeared and intracranial tuberculomas were found by CT in 11 cases (including our own case). Getting 3 groups together, intracranial tuberculomas seem to have worsened during chemotherapy in 24 out of 27 evaluable cases. In view of response to chemotherapy, these 24 cases can be divided into 2 categories: 1) non-responders to chemotherapy; 2) cases finally cured by chemotherapy ("transient worsening").(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Diagnostic value of cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) in exudative pleural effusions.

Pleural fluid levels of the cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) were determined in 40 patients with carcinomatous pleural effusions and in 41 patients with tuberculous pleural effusions. Using a cut off level of 16 U/ml, 15 of the 40 carcinomatous fluids but none of the 41 tuberculous fluids were positive. Pleural fluid levels of CA15-3 were not correlated with those of carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA19-9). Combined assay of CEA and CA15-3, or CA19-9 and CA15-3, increased the positive rate from 79 to 82% and from 67 to 73%, respectively. Measurement of pleural fluid CA15-3 levels are less useful in separating carcinomatous from tuberculous effusions than is measurement of CEA or CA19-9.

Adult↗