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Ōhara, Japan

Ishida T.,Fukushima Medical University | Asano F.,Gifu Prefectural General Medical Center | Yamazaki K.,Hokkaido University | Shinagawa N.,Hokkaido University | And 4 more authors.
Thorax | Year: 2011

Background: Bronchoscopy using endobronchial ultrasound (EBUS) can help to diagnose small peripheral pulmonary lesions. However, although biopsy sites can be confirmed, a bronchoscope cannot be guided in EBUS. Virtual bronchoscopic navigation (VBN) can guide a bronchoscope with virtual images, but its value has not been confirmed. Methods: This prospective multicentre study examines the value of VBN-assisted EBUS for diagnosing small peripheral pulmonary lesions. 199 patients with small peripheral pulmonary lesions (diameter ≤30 mm) were randomly assigned to VBN-assisted (VBNA) or non-VBN-assisted (NVBNA) groups. A bronchoscope was introduced into the target bronchus of the VBNA group using the VBN system. Sites of specimen sampling were verified using EBUS with a guide sheath under fluoroscopy. Results: The diagnostic yield was higher for the VBNA than for the NVBNA group (80.4% vs 67.0%; p=0.032). The duration of the examination and time elapsed until the start of sample collection were reduced in the VBNA compared with the NVBNA group (median (range), 24.0 (8.7-47.0) vs 26.2 (11.6-58.6) min, p=0.016) and 8.1 (2.8-39.2) vs 9.8 (2.3-42.3) min, p=0.045, respectively). The only adverse event was mild pneumothorax in a patient from the NVBNA group. Conclusions: The diagnostic yield for small peripheral pulmonary lesions is increased when VBN is combined with EBUS. Clinical trial number: UMIN000000569. Source

Shibusa T.,Ohara General Hospital | Onuma K.,Iwaki Kyoritsu General Hospital
Japanese Journal of Chest Diseases | Year: 2015

We observed a case of drug-induced lung injury following levofloxacin (LVFX) administration. A 39-year-old man who underwent surgery due to a hemorrhoid was treated with LVFX after the operation. Chest radiographs showed diffuse, small, patchy infiltration shadows in both lungs after the treatment. Furthermore, bronchoalveolar lavage fluid (BALF) analysis revealed an increase in lymphocytes. A drug lymphocyte stimulation test (DLST) for LVFX yielded positive results. The chest radiographs did not show a pulmonary edema shadow, shift infested infiltration shadow, and diffuse ground glass opacities. However, the radiographs showed diffuse patchy infiltrate shadows in both lower lung fields, and a chest CT scan demonstrated OP pattern shadows. © 2015, Kokuseido Publishing Co. Ltd. All rights reserved. Source

Satoh H.,Fukushima Medical University | Matsuzuka T.,Fukushima Medical University | Omori K.,Fukushima Medical University | Kano M.,Ohara General Hospital
Practica Oto-Rhino-Laryngologica | Year: 2015

Tracheal diverticula are relatively rare among tracheobronchial anomalies and are categorized pathologically as congenital or acquired. The majority of tracheal diverticula are asymptomatic. They are usually discovered incidentally. In cases of symptomatic tracheal diverticula, the symptoms are usually pain and blood-stained sputum caused by infection, dysphagia and so on. Conservative treatments such as antibiotics, mucolytic agents and physiotherapy are usually chosen. Surgery is indicated in patients in whom conservative treatment has been unsuccessful. A patient in our hospital had a cervical tracheal diverticulum suspected of being a mediastinal abscess. After the infection was conservatively treated with antibiotics, surgery was performed. The patient was a 54 year-old woman who complained of anterior chest pain for two days. She had similar pain for five years each time she had a cold. A CT scan revealed a right posterior paratracheal region of low density with a high density area. The lesion was suspected to be a mediastinal abscess. The patient was referred to our hospital. Four years previously at our hospital, a CT scan had demonstrated an air-filled lesion in the same region. It was thought that the tracheal diverticulum had become infected and an abscess had formed. The infection was cured conservatively with antibiotics. However, because the diverticulum had acquired an infection a number of times through the years, the probability that it might become infected again was very high. Surgical removal of the diverticulum was therefore decided on. Pathologically, the specimen was lined with simple ciliated epithelium, and had no cartilage. It was regarded as an acquired diverticulum. The surgical approach to diverticula varies according to the location. Because our case was an extrathoracic diverticulum, we chose a cervical incision and were able to resect it. A CT scan after surgery revealed no abnormal lesion, and anterior chest pain has been non-recurrent. It was thought that the surgery was effective. Source

Nagatani Y.,Shiga University of Medical Science | Takahashi M.,Shiga University of Medical Science | Murata K.,Shiga University of Medical Science | Ikeda M.,Nagoya University | And 11 more authors.
European Journal of Radiology | Year: 2015

Abstract Purpose To compare lung nodule detection performance (LNDP) in computed tomography (CT) with adaptive iterative dose reduction using three dimensional processing (AIDR3D) between ultra-low dose CT (ULDCT) and low dose CT (LDCT). Materials and methods This was part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases (ACTIve) Study, a multicenter research project being conducted in Japan. Institutional Review Board approved this study and informed consent was obtained. Eighty-three subjects (body mass index, 23.3 ± 3.2) underwent chest CT at 6 institutions using identical scanners and protocols. In a single visit, each subject was scanned using different tube currents: 240, 120 and 20 mA (3.52, 1.74 and 0.29 mSv, respectively). Axial CT images with 2-mm thickness/increment were reconstructed using AIDR3D. Standard of reference (SOR) was determined based on CT images at 240 mA by consensus reading of 2 board-certificated radiologists as to the presence of lung nodules with the longest diameter (LD) of more than 3 mm. Another 5 radiologists independently assessed and recorded presence/absence of lung nodules and their locations by continuously-distributed rating in CT images at 20 mA (ULDCT) and 120 mA (LDCT). Receiver-operating characteristic (ROC) analysis was used to evaluate LNDP of both methods in total and also in subgroups classified by LD (>4, 6 and 8 mm) and nodular characteristics (solid and ground glass nodules). Results For SOR, 161 solid and 60 ground glass nodules were identified. No significant difference in LNDP for entire solid nodules was demonstrated between both methods, as area under ROC curve (AUC) was 0.844 ± 0.017 in ULDCT and 0.876 ± 0.026 in LDCT (p = 0.057). For ground glass nodules with LD 8 mm or more, LNDP was similar between both methods, as AUC 0.899 ± 0.038 in ULDCT and 0.941 ± 0.030 in LDCT. (p = 0.144). Conclusion ULDCT using AIDR3D with an equivalent radiation dose to chest x-ray could have comparable LNDP to LDCT with AIDR3D except for smaller ground glass nodules in cases with normal range body habitus. © 2015 The Authors. Source

Sato M.,Fukushima Medical University | Ito M.,Soma General Hospital | Suzuki S.,Ohara General Hospital | Sakuma H.,Hoshi General Hospital | And 7 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2015

We estimated the efficacy of the current single administration of peramivir on the basis of peramivir pharmacokinetics in the upper respiratory tract (URT) and determined the predictive peramivir concentration-time curve to assess its efficacy against viruses with decreased susceptibility to neuraminidase inhibitors. Serum, nasal swab, or aspiration samples were collected from 28 patients treated with 10 mg/kg body weight peramivir. The sequential influenza viral RNA load and susceptibility after peramivir administration were measured using a quantitative real-time reverse transcription-PCR and neuraminidase inhibition assay. The peramivir concentrations in the serum and URT after a single administration at 10 mg/kg were measured, and the predictive blood and URT peramivir concentration-time curves were determined to assess various administration regimens against resistant variants. The peramivir concentration decreased to < 0.1% of the maximum concentration of drug in serum (Cmax) at 24 h after administration. Rapid elimination of peramivir from the URT by 48 h after administration may contribute to an increase in the influenza A viral load after day 3 but not to a decrease in the influenza B viral load, despite the absence of a decrease in the susceptibility to peramivir. A longer maintenance of a high level of peramivir in the URT is expected by divided administration rather than once-daily administration. When no clinical improvement is observed in patients with normal susceptibility influenza A and B, peramivir readministration should be considered. In severe cases caused by resistant variants, better inhibitory effectiveness and less frequent adverse events are expected by divided administration rather than once-daily administration with an increased dosage. Copyright © 2015, American Society for Microbiology. Source

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