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Biomedical subjects

T Mieno

Publications and source records attributed to T Mieno.

At least 19 recordsLinked to original sources
PubMed1997

Gorham massive osteolysis.

Gorham syndrome (massive osteolysis) is a very rare tumour-like lesion characterized by progressive osteolysis. The diagnosis must be confirmed by the microscopic finding of intramedullary angioma-like vascular structures. We report a case of a 15-year-old boy with a pathological fracture in his left humerus. Imaging modalities such as magnetic resonance imaging, computed tomography, angiography and bone scintigraphy failed to disclose to tumorous lesion that filled a cavity in the left humerus. After observing the boy's progress for 6 months, a temporary diagnosis of Gorham syndrome was made, and surgical treatment was chosen. After resection of the left humeral head and the proximal one-quarter of the humerus, thorough curettage was performed in the distal humerus and an intramedullary artificial humeral head fixed with adequate success. Pathological examination of the specimen revealed intramedullary haemangioma of the humerus.

Adolescent↗
PubMed1996

Disintegration of the 'waterfall phenomenon' in the inferior vena cava due to right heart failure.

The concept of the waterfall phenomenon in Zone 2 in the pulmonary vasculature is well known from West's lung model. It is believed that the flow through this zone is determined by the pressure difference between the pulmonary artery and alveoli, and the left atrial pressure is not transmissible to the alveolar capillaries. However, it is impossible to see whether alveolar capillaries are really displaying the waterfall phenomenon or not. In this review, the interrelation between the flow and geometry of the alveolar capillaries in the waterfall phenomenon is analyzed based on physiological studies using a model system and isolated lung lobe experiments. Further, extending the concept to the analysis of ventilatory changes of the inferior vena cava (IVC) configuration, it is ascertained that the waterfall phenomenon normally occurs in the IVC during inspiration just before it enters the thorax and the waterfall phenomenon in the IVC disintegrates with elevation of the central venous pressure. Because these configurations of the IVC in normal and abnormal conditions are visible with ultrasonography, the technique is very useful as a noninvasive approach to diagnose right heart failure.

Blood Flow Velocity↗
PubMed1996

[Pancoast syndrome in a patient with malignant lymphoma arising from the pleura].

A 79-year-old man was admitted to the hospital because of left shoulder pain. He presented with signs and symptoms typical of Pancoast syndrome. A chest roentgenogram and computed tomogram revealed a mass lesion that was connected to old pleural thicking due to tuberculosis in the left superior sulcus. A cervical lymph node biopsy was done and non-Hodgkin's lymphoma was diagnosed. Chemotherapy was effective but the patient died of severe pneumonia. Pancoast syndrome associated with malignant lymphoma is very rare. Care must be taken in the management of patients with shoulder pain, chest pain, and old pleural tuberculosis.

Aged↗
PubMed1995

[Clinical features of subacute interstitial pneumonia--clinico-pathological study based on open lung biopsy findings].

A clinico-pathological study was done to elucidate characteristic features of subacute interstitial pneumonia. The patients were four men and mine women, with a mean age of 60 years. In ten patients, the disease was idiopathic, three had collagen vascular disease, (and one was undergoing gold therapy for rheumatoid arthritis). The time interval between onset of symptoms and open lung biopsy was 80 +/- 40 days. Eleven patients had progressive dyspnea, seven had coughing, and only one complained of fever. Fine crakles were heard in ten patients. Mild increases in CRP were observed in all cases. Mild increases in total serum IgG concentration were observed in five of eight cases. Multiple patchy infiltration or diffuse interstitial shadows, located predominantly in the lower fields of both lungs were the characteristic chest roentgenographic findings. The average %VC was 62.7 +/- 17% and the average PaO2 was 68.3 +/- 10 Torr. Bronchoalveolar lavage was done in nine patients, and the mean total cell count was 16.5 +/- 10.2 x 10(4)/ml. A moderate increase in lymphocytes (30.8 +/- 18.6%) with a low CD4/8 ratio (0.48 +/- 0.57), a mild increase in neutrophils (6.2 +/- 9.1%), and a mild increase in eosinophils (2.3 +/- 3.7%) were observed. Pathologically, interstitial cellulo-fibrous changes associated with alveolar space closure due to organization of exudate were the main features. Patients were given steroid pulse therapy or oral steroids. The results were mild to marked improvements in chest roentgenographic findings and lung function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[A case of pulmonary lymphangiomyomatosis diagnosed by biopsy of retroperitoneal tumor and treated with hormonal therapy].

A 34-year-old woman was admitted to our hospital because of exertional dyspnea and ascites. Chest roentgenogram showed hyperinflation of the lung and diffuse reticular shadows. Abdominal CT showed retroperitoneal tumors. Ascites was considered to be chylous. These findings strongly suggested the diagnosis of pulmonary lymphangiomyomatosis. Under lumbar anesthesia, laparotomy was performed, and the histological finding of the retroperitoneal tumor revealed angiomyoma. Bilateral oophorectomy was performed. Medroxyprogesterone at 15 mg/day was administered postoperatively. In advanced cases of this disease, open lung biopsy or even transbronchial lung biopsy is often avoided because of severe cardiopulmonary dysfunction. However, such cases associated with retroperitoneal tumor, laparotomy is quite useful not only in making the diagnosis but also in the treatment of this disease.

Adult↗
PubMed1993

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique.

We developed a method for the estimation of three-dimensional acetabular coverage of the femoral head with use of only an anteroposterior radiograph of the hip. This technique also allows recalculation of the corrected value for coverage at neutral pelvic tilt. Provided that the acetabulum and femoral head are spherical and congruent, the results are as accurate as those obtained with computerized tomographic reconstruction, the dose of radiation is much lower, and much less time is required for calculation. The hips of 286 normal subjects showed increases with age in both anterior and posterior coverage and backward tilt of the pelvis, along with a decrease in the anterior-posterior ratio of coverage. The proportion of anterior acetabular coverage in female subjects was smaller than that in male subjects. There was more backward tilt of the pelvis and the anterior-posterior ratio of coverage was smaller when the subjects were standing than when they were supine.

Acetabulum↗
PubMed1992

[A case of tracho-bronchial aspergillosis complicated with acute myeloblastic leukemia].

A 59-year-old male was admitted to our hospital in Jan. 1991 with complaints of general malaise and palpitation. Laboratory findings on admission showed anemia, thrombocytopenia and leukopenia consisted of 2.0% myeloblasts with Auerbodies. The bone marrow study showed granuloid hyperplasia with 45.5% myeloblasts. The diagnosis of acute myeloblastic leukemia (M1) was made. After BHAC-AMP therapy, he obtained complete remission. However, he complained of fever and cough, and his chest X ray film showed a focal infiltrative shadow in the right upper lung field. Antibiotics for bacteria and fungus were administered and the abnormal shadow improved in a week. However, as he had hemosputum, the bronchoscopic examination was performed, and multiple ulcers covered by yellow-white tissue were revealed on the wall of the trachea and bilateral main bronchi. Biopsy specimens obtained by transbronchial biopsy showed bronchial aspergillosis. Though intravenous infusion and inhalation of amphotericin B were effective for aspergillosis, he had a relapse of the leukemia and died in autumn, 1991.

Aspergillosis↗
PubMed1992

Three-dimensional evaluation of acetabular coverage of the femoral head in normal hip joints and hip joints with acetabular dysplasia.

Compared with the assessment by data processing-coupled CT scanning, three dimensional evaluations of the acetabular coverage of the femoral head from a plain X-ray picture of the hip joint is found to be a simpler and easier procedure. In addition, the calculated values agree well with those obtained by CT in reconstruction. Consequently, this method is of great value in evaluating the severity of diseases of the hip joint. The acetabular coverage of the anterior portion of the hip joint is decreased in the elderly even if the hip joint is normal. Because this decrease may result in primary arthrosis deformans, it should be studied further. Rotational acetabular osteotomy (RAO) is a far better method than Salter's for the early stage of coxarthritis. The present study concludes that it is vitally important to maintain the normal ratio of the anterior and posterior coverage and the shape of the acetabular coverage in the treatment of coxarthritis.

Acetabulum↗
PubMed1990

[A case of pulmonary thromboembolism due to circulating lupus anticoagulant].

A 22-year-old man was admitted because of hemosputum and progressive dyspnea with 3 attacks of chest pain and dyspnea over the previous 4 months. Chest roentgenography showed pulmonary infarction of the left lower lobe, and the diagnosis was confirmed by pulmonary perfusion and inhalation scintigraphy and pulmonary arteriography. Thrombolytic therapy was performed, but no significant effect could be obtained and anticoagulant therapy was performed continuously. No deep-vein thrombosis could be seen. He was considered to have autoimmune hemolytic anemia with lupus anticoagulant on the basis of auto-antibody data. Lupus anticoagulant is an antibody to phospholipid, and it is suggested that a decrease in the production of prostanoid in the endothelium causes thrombosis. In this case, as the patient showed a low level of 6-keto-PGF1 alpha in the blood, it is suggested that one of the etiological factors of pulmonary thromboembolism is a disorder of prostacyclin production in the endothelium, causing thrombosis by lupus anticoagulant.

Adult↗
PubMed1989

[CT findings of post-pneumonectomy patients].

CT findings following pneumonectomy were studied in 28 cases with lung cancer. A total of 53 CT images were evaluated in 13 right pneumonectomy cases and 15 left pneumonectomy patients. The postpneumonectomy pleural space (PS), thoracic space of the operated site (TS) and the thoracic space of the non-operated site (CTS) were measured at 3 slice levels of the brachiocephalic level, subcarinal level and lower pulmonary vein level, using a digital planimeter. There was no significant difference in the TS/CTS ratio, between the right pneumonectomy group and the left pneumonectomy group, but the PS/TS ratio in the left pneumonectomy group was smaller than that in the right pneumonectomy group (p less than 0.01). The PS/TS ratio in both groups and the TS/CTS ratio in the right pneumonectomy group were decreased with time. In the left pneumonectomy group, the TS/CTS ratio was greater in the median sternotomy group that of the posterolateral thoracotomy group (p less than 0.01). Residual pleural effusion was accompanied with a thin circulating lesion along the outer surface. This lesion had been reported as thickening of the parietal pleura, but it could be detected in the case of panpleuropneumonectomized state. Additionally, in some cases, the parietal pleural imaging could be separated from the circulating lesion. So, this structure was thought to be mainly composed of organized effusion. CT images could detect some parts of the episodes in post operated thorax, because of the lack of the information with the sagittal direction. However, the recognition of the common changes and images on CT after the operation might be helpful for the follow-up of the patients.

Adult↗
PubMed1989

[A case of progressive muscular dystrophy with pulmonary hypertension].

A case of progressive muscular dystrophy of the limb girdle type is reported. The patient, a 37-year-old man, showed severe hypoxemia upon blood gas analysis, which had been predicted by pulmonary function tests, together with elevated pulmonary arterial pressure revealed by cardiac catheterization. He showed abnormal symptoms of respiration during the night, and so a sleep study was performed. The results revealed central type apnea not only during REM sleep but also frequently during NREM sleep. Acidosis and hypoxemia induced by sleep apnea caused vasoconstriction of the pulmonary artery and long-term repetition of this had caused pulmonary hypertension.

Adult↗
PubMed1989

[CT findings of cases of pulmonary alveolar proteinosis].

The CT findings of pulmonary alveolar proteinosis were studied. The subjects consisted of five cases; 4 men and 1 woman with an average age of 47.4 years old. The total of 19 CT views were analyzed with a mean follow-up duration of 5.7 +/- 1.2 years. The interval from the estimated onset to the first CT examination day was considered to be 6.0 +/- 3.1 years. The purposes of this report were; 1) Whether one could obtain useful information for the diagnosis by initial CT? 2) What were the changes of imaging with the passage of time on CT? 3) How one could predict the prognosis of the patients by CT? From the results of initial CT, pulmonary alveolar proteinosis showed diffuse, non-segmental densities with a mixture of various degrees of consistency, with peripheral clear zone which could be detected under posterior and lateral chest wall and/or interlobar area, and occasional air bronchograms. Irregular shaped patchy densities attached to the anterior chest wall were detected in 4 cases. These densities made the anterior pleural line irregular. In two cases, densities which were thought to represent the deposition of protein-like material in alveolar spaces decreased in the clinical course. Interstitial changes of the lung field were thought to cause the loss of lung volume, dilatation of bronchi and bronchioles, resulting in cystic changes and respiratory difficulty increased. In another case, the densities spontaneously disappeared during a period of one year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[CT findings of hypersensitivity pneumonitis].

CT findings of 22 cases of hypersensitivity pneumonitis (HP) were evaluated on 1 cm slices. All cases were diagnosed by transbronchial lung biopsy and clinical information. The study population included 8 men and 14 women with a mean age of 43 years. The causative antigens were considered to be so-called summer type in 17 cases, air humidifier in 1, pigeon in 1 and paint spray (isocyanate was suspected) in 3. CT examination were performed at a mean of 1.5 weeks after admission. In conclusion, characteristic CT findings of HP include combination of small nodular shadows and slight elevation of lung density. The size of nodular shadows was usually within 1 cm diameter, and their distribution was considered to be a centrilobular pattern, representing alveolitis and granuloma formation in a secondary lobule. It was though that the slight elevation of lung density developed when the disease extended all over the secondary lobule and the nodules developed when the disease was limited to the centrilobular lesion. In most cases, significant changes in proximal bronchi and pulmonary vasculatures could not be detected. The presence of segmental or lobar distribution of the shadows was also suggested. In addition to the typical findings, various other findings were also revealed; irregular shaped dense shadows, subpleural curvilinear shadow and honeycombing formation, especially in chronic cases. These findings have caused some difficulty in distinguishing HP from other interstitial diseases. More precise information can probably be obtained by thin slice CT than by 1 cm slice thicknesses, nevertheless, the standard method of CT should yield a useful diagnostic imaging.

Adult↗