Suguru Hanzawa

Effects of Hemoglobin on Pulmonary Arterial Pressure and Pulmonary Vascular Resistance in Patients with Chronic Emphysema

Background: The increase in viscosity caused by secondary polycythemia is thought to be one of the major causes of pulmonary hypertension secondary to chronic emphysema. However, very few clinical studies considered the relation between pulmonary hypertension and polycythemia in the case of chronic obstructive pulmonary disease. Objective: The purpose of this study is to elucidate the relative contribution of an increase in hemoglobin level (Hb) to mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Methods: We retrospectively investigated 41 patients with chronic emphysema who had undergone a right heart catheterization. Multiple-regression analysis and F test were performed to investigate both direct effects of Hb and PaO2 as independent variables on mPAP and PVR as dependent variables. Results: Significant correlations were found between PaO2 and mPAP (or PVR), or Hb and mPAP (or PVR), indicating that both Hb and PaO2 are contributory to mPAP and PVR. The F test demonstrated that Hb and PaO2 could directly affect the level of either mPAP or PVR. Conclusions: It was concluded that Hb had a direct effect on mPAP and PVR, independently of hypoxia in patients with chronic emphysema.

A Clinicopathological Study of Bronchioloalveolar Carcinoma with Aerogenous Dissemination with Regard to the Relationship between Cell Type, Growth Pattern and Surgical Outcome.

経気道性進展が示唆される細気管支肺胞上皮癌 (以下BAC) の臨床像を明らかにするために, 今回新たに組織学的診断基準を設けてこれに合致した対象例16例について腫瘍細胞の細胞亜型の面から検討するとともに, その進展様式の特徴ならびに切除成績を検討した. 細胞亜型をみると下里, 児玉分類による杯細胞型 (Gob型) (11例) と気管支表面上皮細胞型 (BS型) (5例) で占められていた. 全例胸膜浸潤は認められず (P0), リンパ節転移はN2のBS型の1例を除いてすべてNOであった. 切除成績をみると腫瘍が区域内にとどまっている小型のI型は全例生存中である. 腫瘍が1葉あるいはそれ以上に進展したII型では進展が1葉に限局していた2例に比較的長期生存 (23, 38カ月) が得られている. 非切除剖検例2例の全経過期間は19カ月, 31カ月であった。BACはBS型の一部の症例を除いて肺内進展の程度が予後を決定すると考えられ, 非切除例の全経過期間と比較しても, 1葉内に限局するものは積極的に外科治療を考慮すべきであると考える.

Recent practical problems in pulmonary cytodiagnosis and their clinico-pathologic backgrouds;(Part II) Diagnostic difficulties based on the complexity of clinico-pathologic backgrounds.

本総説の前編 (その一) として肺癌細胞診における細胞採取に関係のある実際的問題について論じた.その後編 (その二) として以下の諸点についての問題点を論じたい.1. 異常な肺の転移性腫瘍2. 肺門部扁平上皮癌の異時多発性3. 肺のKulchitzky細胞由来と考えられている一連の腫瘍4. 肺癌細胞診におけるfalse positive診断の原因

La broncho-fibroscopie sous anesthésie générale et ses possibilités

Les auteurs ont rapporté les résultats d’une étude portant sur 559 cas de cancer du poumon étudiés pendant 19 ans de pratique bronchoscopique. Ils notent que dans 116 cas de cancer d’origine périphérique, les techniques bronchoscopiques traditionnelles ne sont pas suffisantes pour faire le diagnostic. Il montrent l’intérêt des examens cytologiques des frottis obtenus par la technique du brossage sélectif de la muqueuse, de la biopsie bronchique par pince et de la biopsie transbronchique à l’aiguille. The authors have reported the results of a study involving 559 cases of lung cancer seen during a 19-year period of bronchoscopic examination. They found that in the 116 cases of cancer of peripheral origin, classic bronchoscopy techniques were not sufficient to establish the diagnosis. The authors point out the importance of cytological examination of smears obtained by selective mucosal brusch biopsy, of transbronchial punch biopsy and of transbronchial needle biopsy.RésuméLes auteurs ont rapporté les résultats d’une étude portant sur 559 cas de cancer du poumon étudiés pendant 19 ans de pratique bronchoscopique. Ils notent que dans 116 cas de cancer d’origine périphérique, les techniques bronchoscopiques traditionnelles ne sont pas suffisantes pour faire le diagnostic.Il montrent l’intérêt des examens cytologiques des frottis obtenus par la technique du brossage sélectif de la muqueuse, de la biopsie bronchique par pince et de la biopsie transbronchique à l’aiguille.SummaryThe authors have reported the results of a study involving 559 cases of lung cancer seen during a 19-year period of bronchoscopic examination. They found that in the 116 cases of cancer of peripheral origin, classic bronchoscopy techniques were not sufficient to establish the diagnosis.The authors point out the importance of cytological examination of smears obtained by selective mucosal brusch biopsy, of transbronchial punch biopsy and of transbronchial needle biopsy.

Pulmonary biopsy through bronchofiberscope

First of all, I would like to consider the indications of this biopsy. As you know, at present, even if the tumors are located in either central area or peripheral area, more than 70 % are diagnosed exactly by scrubbing of the mucous membrane or /and percutaneous needle biopsy. Therefore, other kinds of combined examinations have to be the ones that can elevate this ratio. This condition must be applied to the transbronchial pulmonary biopsy.

A cuffed bronchoscope in an emergency haemorrhage in particular

ConclusionIn the preceeding paragraphs, we have described the structure of our cuffed bronchoscope with general anaesthesia and further pointed out the widspread indications of bronchoscopy and reported the important role in an emergency, haemorrhage in particular.In the preceeding paragraphs, we have described the structure of our cuffed bronchoscope with general anaesthesia and further pointed out the widspread indications of bronchoscopy and reported the important role in an emergency, haemorrhage in particular.