Nihon Kyōbu Shikkan Gakkai zasshi
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Helical CT was used on a trial basis for secondary screening of lung cancer, and its clinical usefulness is discussed in this report. The subjects 157 patients with abnormal shadows on plain chest X-ray images acquired between November 1993 and August 1994. Imaging parameters used for screening CT were as follows: 50 mA, 120 kV, a couch-top movement speed of 20 mm/s, and a beam width of 10 mm. ⋯ Lung cancers in clinical stage I (3 patients) and stage IV (1 patient) were difficult to see on plain chest X-ray films. We conclude that screening CT is useful for early diagnosis of lung cancer because the entire lung field can be imaged during a single breath-hold. Therefore, helical CT can be expected to be useful in screening for lung cancer.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
Clinical Trial[Treatment of obstructive sleep apnea syndrome with a mandibular positioning device and other nonsurgical modalities].
The therapeutic approach to a patient with obstructive sleep apnea syndrome (OSAS) must be individualized because of the heterogeneity in the pathogenesis of the disorder. Although nasal continuous positive airway pressure (CPAP) is effective no matter what the pathogenesis, risk factors for this disorder should be identified in each patient. Nasal CPAP will be discussed by others. ⋯ No serious complications were observed. The mandibular positioning device is an effective treatment for some patients with OSAS. The effectiveness of the device should be predicted from polysomnographic and cephalometric data, and from CT measurements of the upper airway and other characteristics of the patients.
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Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
[Mechanical ventilation and long-term respiratory care in the intensive care unit of a general hospital].
We studied the need for mechanical ventilation in 265 patients with respiratory failure who came to our medical ICU over the past 3 years. The time required for weaning from mechanical ventilation and the percentage of patients who needed oxygen therapy or mechanical ventilation at home after their condition was no longer acute were also studied. Of the patients treated in the medical ICU, 143 (54%) required mechanical ventilation; 104 (39%) had acute respiratory failure and the others had acute exacerbations of chronic respiratory failure. ⋯ Ten other survivors received home oxygen therapy. Chest physicians bear the greatest responsibility for managing mechanical ventilation in medical emergencies. Moreover, the prognosis for patients with chronic respiratory failure can be improved with a long-term program for respiratory care that includes home mechanical ventilation and home oxygen therapy.
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Nihon Kyobu Shikkan Gakkai Zasshi · Nov 1995
Case Reports[Three patients with spontaneous pneumomediastinum, including one in whom pneumomediastinum recurred].
We encountered three patients with spontaneous pneumomediastinum. All three (two men and one woman) were previously healthy. They complained of chest pain or dyspnea. ⋯ All other findings were normal. All patients were treated with bed rest and all recovered in 7 to 9 days. Pneumomediastinum recurred in one patient after 20 months.
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Nihon Kyobu Shikkan Gakkai Zasshi · Oct 1995
Case Reports[Chronic necrotizing pulmonary aspergillosis treated with itraconazole and inhaled amphotericin B].
A 52-year-old man with chronic necrotizing pulmonary aspergillosis complicated by a residual tuberculous cavity was admitted to the hospital because of fever and a new infiltration shadow in the right lower lobe. Aspergillus was isolated repeatedly from his sputum, though he had been treated with itraconazol for 9 months. Combination therapy with itraconazol (200 mg) and inhaled amphotericin B (AMPC, 10 mg, 4 times a day) was begun. ⋯ This case shows that, contrary to previous opinion, AMPC can be effectively administered by inhalation. We know of no previous reports of similar cases. In addition, itraconazol and inhaled AMPC may have had a synergistic effect in this case.