Akira Funahashi

Vocal cord closure pressure during volitional swallow and other voluntary tasks.

Our goal was to determine and compare vocal cord (VC) closure pressure and its associated intratracheal pressure during several physiological events such as swallowing, coughing, straining, and phonation. We studied 11 healthy subjects (age 41 ± 2 years) with no current or previous history of laryngeal or pulmonary diseases. VC closure pressure during the above-mentioned tasks was studied using a concurrent manometric and endoscopic technique. VC closure pressure during dry swallows averaged 298 ± 23 mm Hg, while intratracheal pressures exhibited a biphasic pattern ranging from ?4 ± 0.5 to +6 ± 0.8 mm Hg. Average VC closure pressure during cough was 280 ± 20 mm Hg, during straining/valsalva maneuver it averaged 330 ± 45 mm Hg, during phonation it produced an initial rapidly rising spike like pressure (222 ± 25 mm Hg) followed by a sustained minimally positive pressure during continued phonation of two tested vowel sounds (15-25 mm Hg). Between-group comparison showed that for all studied tasks, the intercordal pressures were significantly higher than those of respective intratracheal pressures (p < 0.05). The vocal cords generate closure pressures that vary depending on the performed function.

Identification of Foreign Material in Lung by Energy Dispersive X-Ray Analysis: A New Approach to Silicosis

Conventional methods for the detection of foreign material in the lungs are not only difficult but make it impossible to study any relationship between the material and the surrounding tissue. The present study employs energy dispersive x-ray analysis and scanning electron microscopy as the basis of a rapid and accurate method for determining the amount of silicon in the lungs of normal subjects and subjects with silicosis. A statistical evaluation of the data suggests that a silicon/sulfur ratio below 0.2 may be considered normal, whereas, a ratio above 0.3 may be considered to indicate silicosis.

Identification of metals in lung from a patient with interstitial pneumonia.

Cobalt has been implicated as one of the possible causes of interstitial pneumonitis-fibrosis in industrial workers. This investigation is a light and electron microscopical study of a patient with interstitial pneumonitis-fibrosis. Energy dispersion x-ray analysis of electron-dense particles in the macrophages from the lung of this patient identify the particles as containing cobalt, iron, chromium, and nickel. This technique may be useful for the discrete localization and accurate identification of certain toxic elements in tissue.

Pulmonary Eosinophilic Granuloma: Electron Microscopic Detection of X-Bodies on Lung Lavage Cells and Transbronchoscopic Lung Biopsy in One Patient

Excerpt Eosinophilic granuloma is a granulomatous disorder of uncertain cause, manifested by reactive proliferation of histiocytes that may involve the lung either as part of disseminated disease o...

Flexible fiberoptic bronchoscopy: Its role in diagnosis of lung lesions

When a lesion is suspected to be primary or metastatic lung cancer or due to certain infiltrative processes, flexible fiberoptic bronchoscopy may be the best means of evaluating the bronchial tree and its adjacent lung parenchyma. The procedure is relatively noninvasive, can be done with the patient fully awake, and has limited contraindications and few complications.

Case report progressive systemic sclerosis presenting as interstitial pulmonary fibrosis

Pulmonary involvement usually is a late manifestation of progressive systemic sclerosis. In the case reported here, dyspnea and pulmonary interstitial fibrosis developed more than a year prior to onset of skin and vascular changes. Open-lung biopsy performed early in the course of the disease failed to yield a definitive diagnosis.

The Value of the Forced Expiratory Time in the Physical Diagnosis of Obstructive Airways Disease

OBJECTIVE To evaluate the test characteristics of the forced expiratory time (FET) in the diagnosis of obstructive airways disease. DESIGN A cross-sectional diagnostic test study. The FET of 400 subjects was measured by a physician examiner and was compared with the criterion standard of spirometry. In a second sample of 100 subjects, the FET was measured by pairs of physician examiners to evaluate interexaminer agreement. SETTING A pulmonary function test laboratory at a tertiary care hospital that receives referrals for preoperative evaluations, acute and chronic pulmonary disease, and occupational lung disease. SUBJECTS A consecutive sample of patients who were referred to the pulmonary function laboratory from primary care internists, pulmonary physicians, and surgeons. INTERVENTIONS None. MAIN OUTCOME MEASURES The sensitivity and specificity of the FET in the diagnosis of obstructive airways disease at cutoff values ranging from 2 to 14 seconds. A receiver operating characteristic curve was used to evaluate the diagnostic performance of the FET. Likelihood ratio lines were determined using a logistic regression model adjusting for the subjects age. Interexaminer agreement was evaluated with a kappa statistic. RESULTS Using the FET maneuver with a cutoff value of 6 seconds will correctly diagnose the greatest number of subjects with obstructive airways disease. The FET maneuver is more discriminating for subjects 60 years or older compared with younger subjects. The positive likelihood ratio for a subject aged 60 years or older with an FET of 4 to 6 seconds is 0.42 (95% confidence interval [CI], 0.24 to 0.73); of 6 to 8 seconds, 2.19 (95% CI, 1.02 to 4.80); and of greater than 8 seconds, 4.08 (95% CI, 2.54 to 6.79). The kappa statistic for interexaminer agreement is 0.70. CONCLUSIONS The FET demonstrates moderately good performance as a diagnostic test for obstructive airways disease. The value of the test will depend on the pretest probability of disease and the clinical circumstances in which it is used.