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The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 67 patients with asthma. 1. The generation of leukotriene B4 (LTB4) by leucocytes was significantly more increased in patients with asthma than in those with pulmonary emphysema (PE) and healthy subjects. The generation of leukotriene C4 (LTC4) was also signficantly more increased in patients with asthma compared to the generation in those with PE and healthy subjects. The generation of both LTB4 and LTC4 was significantly more increased in patients with PE than in healthy subjects. 2. The generation of both LTB4 and LTC4 was larger in patients with asthma over age 70 than in those of other age groups, however, the difference was not significant. 3. The generation of LTC4 was significantly higher in attack stage than in non-attack stage in all age groups of patients with asthma, however, the generation of LTB4 was not significantly different between the two stages. 4. Bronchial hyperresponsiveness to methacholine in patients with asthma tended to decrease with aging, and the bronchial hyperresponsiveness was to a certain extent correlated with the generation of LTB4, but not LTC4. 5. The generation of LTC4 was correlated with value of FEV1.0%. These results may suggest that both LTB4 and LTC4 participate in the pathophysiology of asthma in the elderly., 気管支喘息67例を対象に, Ca ionophoreA23187刺激時の白血球からのロイコトリエンB4(LTB4)およびC4 (LTC4)の産生を観察し,高齢者喘息の臨床病態におけるLTB4,LTC4の役割について検討した｡ 1.LTB4の産生は,気管支喘息において肺気腫および健康人に比べ有意に高い値を示した｡LTC4の産生も同様に気管支喘息において,肺気腫,健康人に比べ有意に高い値30を示した｡LTB4,LTC4いずれの産生も,肺気腫症例において健康人と比べ有意に高い値が観察された。 2.LTB4,LTC4の産生は,70才以上の喘息症例において,他の年齢層の症例に比べより高い値が示されたが,推計学的な有意差は見られなかった｡ 3.高齢者を含めいずれの年齢層の気管支喘息においても,LTC4の産生は発作時に,非発作時に比べ有意の亢進が見られたが,LTB4に関しては発作時,非発作時の間に有意の差は見られなかった｡ 4.気道の過敏性は,年齢が高くなるにつれて低下する傾向が見られた｡そして,この気道の過敏性はLTB4産生とある程度関連していることが示されたが,LTC4との関連は見られなかった｡ 5.FEV1.0%値は,ある程度LTC4産生亢進と関連があることが示された｡ 以上の結果より,70才以上の喘息においても,LTB4,LTC4がその発作時病態に重要な役割を果していることが示唆された｡

Changes in the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes after spa therapy were examined in 30 patients with asthma. 1. The efficacy of spa therapy was marked in 8 (26.7%), and moderate in 16 (53.3%) of 30 patients with asthma, and slight or no efficacy of the therapy was observed in the residual 6 patients (20.0%). 2. Bronchial reactivity to methacholine was the highest in patients with slight or no efficacy of spa therapy, however. there were no significant differences among the three groups classified by clinical efficacy. 3. The generation of LTC4 was significantly higher in patients with slight or no efficacy compared with the generation in those with marked (p, 気管支喘息30例を対象に,温泉療法によるロイコトリエンB4 (LTB4),C4 (LTC4)産生の変動および気道過敏性と臨床効果との関連について検討を加えた｡ 1.温泉療法の臨床効果は,著効8例(26.7%),有効16例(53.3%),やや有 効あるいは無効6例(20.0%)であった｡ 2.メサコリンに対する気道過敏性は,やや有効あるいは無効例で高い傾向が見られたが,著効,有効例と比べ有意の差は見られなかった。 3.LTC4産生はやや有効あるいは無効例において著効例(P

The clinical significance of low attenuation area, 気管支喘息80例(全例非喫煙者)を対象に,high resolution computedt omography (HRCT)上の肺の-950HU以下のLow attenuation area (LAA)の臨床的意義について, 患者年齢, CT number,残気率(% RV),拡散能(% DLco)を含む肺機能検査,白血球のコイコトリエンB4,C4の産生能などとの関連のもとに検討を加えた｡ 1.% LAAは,年齢が高くなるにつれて増加する傾向を示し,60才以上の症例の% LAAは,49歳以下の症例に比べ有意に高い値を示した｡また,CT numberも,年齢が高くなるにつれて有意の増加を示した｡ 2.% FVC,% FEV1.0およびFEV1.0%値は,いずれも70才以上の症例で49歳以下の症例に比べ有意に低い値を示した｡ 3.残気率(% RV)は,年齢が高くなるにつれて増加する傾向を示し,70才以上の症例の% RVは,50-59才および49才以下の症例の% RVに比べ有意に高い値を示した｡ 4.一方,拡散能(% DLco)は,年齢が高くなるにつれて有意に低下する傾向を示し,70才以上の症例の% DLcoは,50-59才および49才以下の症例のDLcoに比べ有意に低い値を示した｡ 5.% LAAと% RVとの間には有意の相関が見られたが,% LAAと% DLco,および% LAAと換気機能(% FVC,% FEV1.0,FEV1.0%)との間には関連は見られなかった｡ 6.白血球のLTB4およびLTC4の産生能においては年齢による差は見られなかった｡これらの結果は,% LAAが年齢とともに増加すること,そして% LAAは% RVと密接な関連を有していることを示している｡

Effects of aging and glucocorticoid therapy on bronchoalveolar lavage (BAL) cells, particularly lymphocytes, neutrophils and eosinophils, were examined in 81 patients with asthma. 1. The proportion of BAL lymphocytes tended to increase with aging in asthmatics under age 69 years, and the proportion was significantly higher in patients with asthma between the ages of 60 and 69 than in those under age 39 and between the ages of 40 and 49. 2. The proportions of BAL neutrophils and eosinophils were not related to aging. 3. The proportion of BAL lymphocytes was higher in patients without glucocorticoid therapy than in those with steroid-dependent intractable asthma (SOIA) in those under age 69 years. In patients between the ages of 50 and 59, the proportion of BAL lymphocytes was significantly higher in patients without glucocorticoids than in those with SOIA. 4. The proportion of BAL neutrophils was higher in patients without glucocorticoid therapy than in those with SOIA, and the difference was significant in patients between the ages of 60 and 69. 5. The proportion of BAL eosinophils was not related to glucocorticoid therapy. These results suggest that the proportion of BAL lymphocytes and neutrophils is affected by aging and glucocorticoid therapy, but not BAL eosinophils., 気管支喘息81例を対象に,気管支肺胞洗浄(BAL)液中の細胞成分,特にリンパ球,好中球および好酸球に対する加齢および副腎皮質ホルモ ンの影響について検討を加えた｡ 1.BAL液中のリンパ球頻度は,69才以下の症例では加齢とともに増加する傾向を示し,60-69才の年齢層では,39才以下および40-49才の年齢層の症例に比べ有意に高い値を示した｡ 2.BAL液中の好中球および好酸球頻度と加齢との間には関連が見られなかった｡ 3.BAL液中のリンパ球頻度は,69才以下の症例では,ステロイド依存性重症難治性喘息(SDIA)に比べ,ステロイド非使用例で有意に高い値を示し,50-59才の年齢層ではその差は有意であった｡ 4.BAL液中好中球頻度は,ステロイド非使用例に比べSDIA症例において高い値を示し,60-69才の年齢層ではその差は有意であった｡ 5.BAL液中好酸球頻度は,ステロイド使用の有無との関連は見られなかった｡これらの結果は,BAL液中リンパ球および好中球頻度は加齢や副腎皮質ホルモン投与の影響を受けるが,BAL液中好酸球額度には影響しないことを示唆している｡

The purpose of this study is to establish a new, non - invasive diagnostic technique for peripheral circulation in patients with diabetes mellitus in the early stage of arteriosclerosis obliterans (ASO) as one of the complications of diabetes mellitus. We observed peripheral circulation quantitatively by thermography and Laser- Doppler blood flowmetry. The body surface peripheral circulation in 27 patients with diabetes mellitus, including 14 males and 13 females with a mean age of 67.4 years (range from 51-82 years), and with a mean hemoglobin A1C (HbA1C) 019.5% (range from 6.8%-13.0%), and who were suffering coldness, numbness or pain in their feet, was examined using thermography and Laser- Doppler blood flowmetry. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio= [Total counts of thermography (Pixels) over temperature (T) after cold -loading] + [Initial counts over T after hot-loading] Xl00 (%). Results of recovery ratios for 27 cases were 0% - 93.5%, and the average was 34.0%. At the same time, the blood flow after cold -loading was 0.91 - 5. 36ml/min/lOOg tissue and the average was 2.04ml/min/l00g tissue. We found that the recovery ratio and the blood flow were correlated (r=O. 634, p, 糖尿病患者における閉塞性動脈硬化症の合併を早期に診断,予知,予防する目的で末梢循環障害の程度を非侵襲的にかつ客観的に測定することを試みた｡非侵襲的測定方法としてサーモグラフィーとレ-ザードップラー血流計を同時に用い,得られた結果を数量化した｡症例は,下肢に冷え症,しびれ感,下肢痛を有した51歳から82歳までの 27症例(平均年齢67.4歳)であった｡性別は,男性14例,女性13例,HbA1Cは6.8%-13.0%,辛均9.5%であった｡サーモグラフィーで得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率-【20℃冷水負荷後の27℃以上の体表面温度のサーモグラフィーの画素(pixel)の総数】÷【36℃の温水負荷後の27℃以上の体表面温度のサーモグラフィーのPixelの総数】×100%で求めた｡ サ-モグラフィーにより測定された回復率は0%-93.5%の範囲にあった｡平均は34.0%であった｡レーザードップラー血流計により20℃冷水負荷後に測定された血流量は0.91-5.36ml/min/100g tissueの範囲にあった｡平均は2.04mi/min/100g tissueであった｡得られたサーモグラフィーの回復率とレ-ザードップラ-血流計の血流量との間には正の相関関係を認めた(p

Dietary sources of a -linolenic acid, such as perilla seed oil, may have the capacity to inhibit the generation of leukotrienes (LTs) by leucocytes in patients with asthma, as has been reported with the consumption of other long - chain n- 3 fatty a-cids. The factors affecting the suppression of leukotriene (LT) C4 generation by leucocytes were examined by comparing the clinical features of patients with asthma who had been given dietary perilla seed oil (n - 3 fatty acids). Group A consisted of patients in whom the leucocyte generation of dietary perilla seed oil LTC4 was suppressed by this procedure. Group B consisted of those in whom LTC4 generation was not suppressed. LTC4 generation by leucocytes significantly decreased in group A for two (P, エゴマ油のようなα-リノレン酸食が他のn-3系不飽和脂肪酸食において報告されてきた様に喘息患者の白血球ロイコトリエン(LTs)産生能を抑制すると考えられる｡そこでエゴマ油(n-3系脂肪酸)を摂取した気管支喘息患者の臨床所見を比較することによって白血球ロイコトリエン(LT)C4の抑制に影響する因子を検討した。A群はエゴマ油摂取により白血球LTC4の産生能が抑制された群であり､B群は白血球LTC4の産生能が抑制されなかった群である｡A群では食事摂取2週後(P

The influence of smoking on pulmonary function and emphysematous changes of the lung (percentage of attenuation area < -950 HU (% LAA) on high resolution computed tomography (HRCT) was examined in 49 patients with bronchial asthma. 1. In patients with asthma, the % residual volume (RV) in many nonsmokers was less than 129%, in contrast, the % RV in many smokers was between 130% and 189% , which was higher than that in nonsmokers. 2. Significant correlations between % RV and 96LAA value, and between % RV and CT number were observed both in nonsmokers and smokers with asthma, in which as % RV more increased, % LAA value was larger, and CT number was lower. 3. % DLco value was lower in smoking patients with asthma, whose % RV was between 130% and 189% and larger than 190% , however, the % DLco value did not change in nonsmoking patients despite of higher valure in % RV. 4. A significant correlation was also observed between % FEV1.0 value and % RV both in smoking and nonsmoking patients with asthma; as % RV value more increased, % FEV1.0 value was lower. 5. Any correlation between % FVC value and % RV was not observed. These results suggest that smoking affects the % LAA of the lung on HRCT and % DLco in patients with asthma., 気管支喘息49例を対象に､肺機能およびHigh resolution computed tomography(HRCT)上のLow attenuation are (LAA)

Clinical effects of spa therapy were examined in 150 patients with asthma in relation tobronchial hyperresponsiveness and patient age. 1. The efficacy rate of spa therapy was larger as the patient age was higher: the rate was 73.3% in patients under age 49, 81.8% in those between the ages of 50 and 59, 86.4% in those between the ages of 60 and 69, and 90.6% in those over age 70. The mean of efficacy rates was 83.3% in all subjects. 2. The bronchial hyperresponsiveness (BH) was lower as patient age was higher: the BH in patients between the ages of 60 and 69 and in those over age 70 was significantly lower compared to the BH in those under age 49 (p < O.OOl). 3. Clinical effects of spa therapy tended to be lower in patients with increased bronchial hyperresponsiveness. The bronchial hyperresponsiveness showed a tendency to decrease after spa therapy in whom the therapy was effective, however, the BH did not change in patients with slight or no efficacy during spa therapy., 1.温泉療法では,年齢が高くなるほどその有効率も高くなると言う傾向が見られ､49才以下の症例では73.3% ,50-59才の症例では81.8% , 60-69才の症例では86.4% ,70才以上では90.6% であり,全症例の平均有効率は73.3% であった｡ 2.気道過敏性は,年齢が高くなるほど低下する傾向が見られ,60-69才および70才以上の症例の気道過敏性は,49才以下の症例と比べ有 意に低い値を示した(P < 0.001)。 3.温泉療法の臨床効果は,気道過敏性が強くなるにつれて低下する傾向が見られた｡また,温泉療法の著効例や有効例では,治療により 気道過敏性が低下してくるが､やや有効例や無効例では,気道過敏性はほとんど変化しないことが示された｡

The correlation between the efficacy of 4-weeks administration with pranlukast, leukotriene receptor antagonist, and LTs generation by peripheral leukocytes were evaluated in 18 patients with mild-persistent asthma. The efficacy of pranlukast administration was assessed by symptom, morning PEF and pulmonary function. Pranlukast were effective in 12/18(67%) patients. In those patients, LTC4 generation before pranlukast administration was significantly high, compared with that in pranlukast-ineffective patients. LTC4 generation decreased after 4-weeks administration with pranlukast in effective patients. In ineffective patients, however, LTC4 generation increased after 4-weeks administration. LTB4 had shown no significant difference between effective and ineffective patients before administration, and LTB4 decreased after 4-weeks in both groups. Proport ion of peripheral eosinophi Is in effective patients were higher than that in ineffective patients, however not significant. After 4-weeks, proportion of eosinophi Is was decreased in effective patients and increased in ineffective patients. These findings suggest that pranlukast is effective for patients with high LTC4 generation and has the effect to suppress the accumulation of eosinophils in such patients., 軽症気管支喘息18例にロイコトリエン受容体桔抗薬プランルカストを4週間投与し，その効果と末梢血白血球からのLTC4，LTB4産生能の関係を検討した．プランルカストの効果は臨床症状，起床時ピークフロー値，肺機能の変化によって判定し，効果群，非効果群の2群に分類した．18例中12例（67％）の症例がプランルカスト投与により，臨床症状の軽減，ピークフロー値の増加，肺機能の改善が認められた．効果群におけるプランルカスト投与前のLTC4値は，非効果群のLTC4値に比較して有意に高値であった．4週間の投与後には 効果群ではLTC4値は減少し，非効果群では増加した．両群のLTB4値はプランルカスト投与前で有意な差は認められず，投与後には両群で減少した．投与前の好酸球分画は，効果群において非効果群に比べ高値であったが，有意な差は認められなかった．4週間の投与後，効果群においては好酸球は減少し，非効果群においては増加した．以上の結果より，プランルカストは末梢血白血球のLTC4産生能が高い症例において効果的であり，好酸球集積を抑制する作用を有すると考えられる．

In a previous study, we demonstrated that chronic administration of systemic glucocorticoids decreases cortical bone mineral density (BMD) and induces development of pathologic fractures in asthmatic patients. To investigate cortical bone porosity due to glucocorticoids, we studied cortical bone volume, BMD, bone strength, and fractures in patients with asthma in this report. A total of 82 postmenopausal asthmatic patients were enrolled in the study. Vertebral fractures were diagnosed via plain spinal radiograms. Peripheral quantitative computed tomography (pQCT) was used to measure cortical BMD, relative cortical volume, and Strength Strain Index (SSI). Multiple regression analysis, Student's t test, and other statistical analyses were performed. Patients with systemic glucocorticoids therapy had lower cortical BMD, relative cortical volume, SSI, and more number of vertebral fractures than patients without it. Lifetime cumulative dose of glucocorticoids was related to cortical BMD, relative cortical volume, SSI, and the number of vertebral fractures. The cortical volumedensity relationship appeared to remain constant regardless of systemic glucocorticoid administration. The number of vertebral fractures correlated highly with cortical BMD, relative cortical volume, and SSI at the radius. In conclusion, systemic glucocorticoid administration decreases cortical bone density, cortical bone volume, and bone strength. G lucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites. Given that both cortical bone density and volume provide bone strength, cortical bone porosity was seen to contribute to glucocorticoid - induced bone strength loss and fractures., 【目的】骨強度には皮質骨の状態が主に関与するため，全身ステロイド療法に伴う病的骨折と皮質骨障害について検討した。【方法】閉経後女性気管支喘息患者82例で，ステロイド依存性群と非依 存群において，椎体骨折数，槙骨皮質骨骨密度，皮質骨容量，骨強度（SSI）をⅩ線側面像とpQCTを用いて検討した。 【結果】ステロイド依存群はステロイド非依存群に比べて，椎体圧迫骨折数は有意に多く，榛骨皮質骨骨密度，皮質骨容積比，骨強度は各々有意に低下していた。また，皮質骨骨密度と容積は一定の割合で減少していた。椎体圧迫骨折数は皮質骨骨密度，皮質骨容積比，骨強度の全てと高い相関を認めた。 【結論】ステロイド依存性気管支暗息症例においては，皮質骨の骨 密度と容量が同時に減少して骨強度が減少することによって，病的骨折が発症すると考えられた。

N-3 fatty acids have been reported to be effective for asthma. In the present study, the effects of perilla seed oil (n-3 fatty acids) on asthma were compared with the effects of corn oil (n-6 fatty acids) in terms of pulmonary function, lipometabolism and the generation of leukotriene C4 (LTC4) by leucocytes. A total of 28 asthmatic patients were randomly divided into two groups : Group A patients (15 subjects) consumed perilla seed oil-rich supplementation, while Group B patients (13 subjects) consumed corn oil-rich supplementation for 4 weeks. Generation of LTC4 by leucocytes, respiratory function and the serum levels of lipids were compared between the two groups. The generation of LTC4 by leucocytes decreased significantly in Group A subjects following perilla seed oil-rich supplementation for 2(P < 0.05) and 4 weeks(P < 0.01). A significant difference in the generation of LTC4 was observed between the two groups after different dietary supplementations for 4 weeks (P < 0.05). Significantly increased values for PEF (P < 0.01), FVC (P < 0.05) and FEV1.0 (P < 0.05) were found in Group A subjects following perilla seed oil supplementation for 4 weeks, compared with the initial value prior to supplementation. A significant decrease in the serum level of total cholesterol, LDL-cholesterol and phospholipid was detected in Group A subjects following perilla seed oil supplementation for 4 weeks. The present results suggest that peril la seed oil-rich supplementation is effective in the treatment of asthma in terms of its ability to suppress LTC4 generat ion by leucocytes, and in inducing an improvement in pulmonary function associated with changes in the serum level of lipids., n－3系脂肪酸は喘息に有効であることが報告されている。今回、エゴマ油（n－3系脂肪酸）の喘息に対する効果を呼吸機能、イコトリエンC4（LTC4）産生能の観点から、コーン油（n－6系脂肪酸）のそれと比較した。28例の喘息患者を無作為に2群に分け、A群（15例） はエゴマ油食を、B群（13例）はコーン油食をそれぞれ4週間摂取した。白血球LTC4産生能、呼吸機能、血清脂質を2群間で比較した。白血球LTC4産生能はエゴマ抽食を摂取したA群で2週後（P < 0．05）、4過後（P < 0．01）に有意に低下した。食事摂取4過後に岳群間でLTC4産生能に有意差が認められた（P < 0．05）。エゴマ油食を4過摂取したA群ではピークフロー（P < 0．05）、肺活量（P < 0.01）、1秒量（P < 0．05）が食事摂取前に比し、有意に増加した。またA群ではエゴマ坤食摂取4週後に血清総コレステロール値、LDL－コレステロール値、リン脂質の有意な低下がみられた。こ れらの結果より、エゴマ油食は白血球LTC4産生能を抑制することにより、呼吸機能を改善し、血清脂質の変化と関連して、喘息の治療に有効であることが示唆された。

Background: Assessment of low attenuation areas and lung densitometry on high resolution computed tomography (HRCT) have been reported in studies of patients with chronic obstructive pulmonary disease. Objective : The purpose of this study was to examine if HRCT could separate asthmatic patients from normal control subjects and patients with emphysema. Methods : Subjects were divided into three groups : 24 patients with bronchial asthma, 23 patients with pulmonary emphysema and 15 normal controls. HRCT scans of the lung were performed at three different levels at both end inspiration and expiration in all patients and control subjects. Results : The mean CT number of three slices was significantly lower in asthmatic subjects compared with normal individuals at both end inspiration (p < 0.05) and expiration (p < 0.01). The relative area of the lung with an attenuation value lower than -950 HU (% LAA) for three slices was significantly higher in asthmatic subjects than in normal individuals at end inspiration (p < 0.05), but there was no significant difference at end expiration. The mean CT number and % LAA obtained from studies that were performed at three cm above the top of the diaphragm provided the best separation among three anatomic levels. In comparison between asthmatic and emphysema patients, both parameters were significantly different in asthmatic subjects than in those with emphysema at both end inspiration and expiration on each scan and in the total scans (p < 0.001). Conclusions : HRCT is a useful method to separate asthmatic subjects from patients with emphysema and normal subjects., 【目的】肺野low attenuation area（LAA）は、慢性閉塞性肺疾患（COPD）における肺気腫の存在ならびに程度を反映することが知られている。そこで喘息患者におけるLAAの意義を明らかにすることを目的として、COPD患者、コントロールとの比較検討を行った。 【対象と方法】喘息症例24例、COPD症例23例、コントロール15例を対象として、上・中・下肺野の3スライスで深吸気、深呼気時において胸部高分解能CT（HRCT）を施行し3群間で比較検討を行った。CTパラメーターとしては、平均m値、肺野面積に対する－950HU以下のLAAの割合（% LAA）を採用した。 【結果】1．3スライスの平均CT値は、吸気および呼気とも3群間での有意の差が認められた。2．3スライスの% LAAは、吸気では3群間での有意の差が認められたが、呼気では喘息とコントロール間での有意の差は認められなかった。3．COPD症例では、吸気、呼気ともに平均CT値は他の2群より有意に低値を示し、% LAAは他の2群よりより有意に高値を示した。4．3群間の平均CT値と% LAAの相違は下肺野のスライスで最も顕著であった。 【考案】平均CT値および% LAAは、喘息、COPD、コントロールにおいて有意に異なっており、喘息およぴCOPDの病態を反映する可能性が示唆された。

The generation. of leukotrienes 84 (LT84) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 71 patients with asthma (42 with atopic and 29 with nonatopic asthma) and 23 healthy controls. Of these patients,22 had SDIA (steroid-dependent intractable asthma). 1. The generation of LT84 and LTC4 by leucocytes was significantly more enhanced in patients with atopic, non-SOIA asthma than in healthy subjects, but not in patients with nonatopic asthma. The generation of LT84 and LTC4 in atopic asthma was significantly more decreased in patients with SOIA than in those with non-SOIA. 2. The LTC4 generation was significantly larger in attack stage than in attack-free stage of patients with atopic and nonatopic asthma when they had not SOIA. However, no significant difference was found in LT84 generation between attack and nonattack stages in these patients. 3. In patients with SOIA, no significant differences were observed in the generation of LT84 and LTC4 between attack and nonattack stages. The results suggest that IgE-mediated allergy and asthma attacks enhance and glucocorticoids inhibit the generation of LT84 and LTC4 by leucocytes., 気管支喘息71例および健康人23名を対象に､Ca ionophore A23187刺激時の末梢血白血球のロイコトリエンB4 (LTB4)およびC4(LTC4)の産生能について検討を加えた｡なお､71例中ステロイド依存性重症難治性喘息(SDIA)は22例であった。1.アトピー性､16非SDIA症例におけるLTB4､LTC4産生は､健康人と比べ有意に高い値を示したが､非アトピー性喘息では健康人との間に有意の差は見られなかった｡また､アトピー性喘息では､SDIA症例において非SDIA症例に比べ､LTB4､LTC4産生が有意に抑制されていた｡2.非SDIA症例では､アトピー性､非アトピー性を問わず､LTC4産生は､非発作時に比べ発作時に有意に亢進した状態であった｡しかし､LTB4産生には､非発作時､発作時との間に有意の差は見られなかった｡3.SDIA症例では､LTB4､LTC4産生と発作との有意の関連は見られなかった｡以上の結果より､IgE にmediateされるアレルギー反応や喘息発作はLTB4､LTC4産生に促進的に､また副腎皮質ホルモンは抑制的に作用することが示唆された｡

The purpose of this study was to examine the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP). The study group, 19 patients with low back pain (2 subjects aged 32-39 years and 17 aged 59-78), underwent MRI of the lumbar spine. Disc degeneration at L4/5 was the most common finding (68.4%). Overall in present study, all patients with LBP had abnormalities around the lumbar spine (evidence of disc degeneration, deformity of lumbar spine, disc bulging or protrusion, facet hypertrophy, nerve root compression and so on)., この研究の目的は腰痛評価におけるMRIの役割を検討することであった｡対象は腰痛を訴え腰椎MRIを受けた19名(32歳から39歳2名,59歳から78歳17名)であった｡椎間板変成はL4/5levelで最も多く認められた(68.4%)｡本研究において腰痛を有する全患者に腰椎の異常(椎間板変性,disc bulging, protrusion, facet hypertrophy,神経根圧迫,腰椎変形など)を認めた｡

The significance of the low attenuation area (LAA) of the lungs on high resolution computed tomography (HRCT) has not been determined in patients with asthma. We examined the relationship between the percentage of lung area with CT numbers lower than -950HU (% LAA) and the mean CT number in 81 patients with reversible airway obstruction (asthma) and in 22 healthy subjects, as well as the relationship between maximal % LAA and various parameters of pulmonary function, smoking history, disease severity and allergic type in the asthmatic subjects. The mean CT number was obtained by scans at three anatomic levels, and maximal % LAA was the % LAA which had the largest value of those measured at the three anatomic levels of the lung. We found that: 1. The mean CT number was closely related to the maximal % LAA of the lungs in all subjects studied (r= -0.916, p, 【目的】気管支喘息症例において胸部HRCTを用いて% LAA(Lowattenuationarea)を評価し,臨床病態との関連を検討する｡ 【対象と方法】気管支喘息症例81例ならびに健常者22例を対象とした｡大動脈弓部,下葉分岐部,横隔膜上3cmの3スライスを撮影し,胸部CT値の演算によりCT値が-950HU以下の% LAA,さらに3スライス中の最大% LAAと3スライスの平均CT値を算出した｡その値と年齢,発症年齢,罹病期間,性別,喫煙歴,重症度,病型,肺機能との関連を検討した｡【結果】1.最大% LAAは平均CT値と強い相関を示した(r=-0.916,p

Dietary supplementation with perilla seed oil, a vegetable oil rich in α -lin- olenic acid, inhibits the generation of leukotrienes(LTs) by leucocytes in patients with bronchial asthma. We examined the factors that affect the suppression of LT generation by leucocytes with perilla seed oil-rich supplementation in patients with asthma, by comparing the clinical features of patients with asthma, whose generation of leukotriene (LT) C4 was suppressed by dietary supplementation with perilla seed oil (n-3 fatty acids) (group A), with those of patients who showed no suppression of LTC4 generation (group B). Group A showed a significant increase in the generation of LTB4 and L TC4 by leucocytes after corn oil-rich supplementation (n-6 fatty acids), and a significant decrease in the generation of LTB4 and LTC4 after perilla seed oil-rich supplementation (n-3 fatty acid). However, this was not observed in group B. The level of serum IgE and peak expiratory flow (PEF) in group A were significantly higher than in group B. Furthermore, the serum levels of LDL-cholesterol, β-lipoprotein and phospholipid were significantly lower in group A than in group B. These results suggest that the clinical features differ between these two asthmatic populations with respect to suppression of LTB4 and LTC4 generation by n-3 fatty acids in perilla seed oil-rich supplementation., a-リノレン酸の豊富なエゴマ油の食事は気管支喘息患者の白血球ロイコトリエン(LT)産生能を抑制する｡気管支喘息患者の内,エゴマ油食によりLTC4の産生が抑制された群(A群)と抑制されない群(B群)の臨床データを比較することにより,気管支喘息患者の白血球ロイコトリエン産生能に影響する因子を検討した｡A群はコーン油(n-6系脂肪酸)の豊富な食事後,白血LTB4,LTC4の産生能が増加し,エゴマ油(n-3系脂肪酸)の豊富な食事後LTB4,LTC4の産生能が減少した｡これらの変化はB群では認められなかった｡A群のIgE値,ピークフロー(PEF)値はB群に比し,有意に高値であった｡またLDL-コレステロール,β-リポ蛋白,リン脂質はA群ではB群に比し,有意に低値であった｡これらの結果はエゴマ油の豊富な食事のn-3系脂肪酸によるLTB4,LTC4の産生能の抑制に関して2群の気管支喘息患者群間に臨床データの相違があることを示唆している｡

In previous studies, we have demonstrated that chronic administration of systemic glucocorticoids decreases cortical bone mineral density (BMD), cortical bone volume, bone strength, and induces development of pathologic fractures in asthmatic patients. We have also demonstrated that glucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites in postmenopausal asthmatic patients. There is a difference of gonadal hormones between male and female. To investigate the influence of hormonal difference on glucocorticoid-induced cortical bone porosity, we studied cortical bone volume and BMD in both male and female patients with asthma in this report. A total of 99 asthmatic patients (male 26 cases, female 73 cases) were enrolled in the study. Peripheral quantitative computed tomography (pQCT) was used to measure cortical BMD and relative cortical volume. The cortical volume-density relationship appeared to remain constant regardless of the level of systemic glucocorticoid administration, age or sex, suggesting cortical bone porosity causes similar and simultaneous decreases in cortical bone volume and density. In conclusion, glucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites despite the gonadal hormonal differences., 【目的】これまでに我々は,気管支喘息症例において経口ステロイドによる皮質骨骨密度,容積の減少が骨折に関与する新知見を報告し,閉経後女性では皮質骨骨密度一容積の減少はステロイド投与量にかかわらず一定であることを報告してきた｡この皮質骨骨密度-容積の関係において性差による違いを検討するために,男性,女性患者の両方について検討を行った｡【方法】対象はステロイド依存性喘息99例(男性26例,女性73例)｡性別,年齢,経口ステロイド積算総投与量により6群に分類した｡椎体圧迫骨折はⅩ線側面像にて評価 し,皮質骨容積比および皮質骨骨密度はpQCT(Stratec XCT960)を用いて測定した｡それぞれの群の皮質骨骨密度-容積比の関係を算出し比較検定をおこなった｡【結果】それぞれの群の皮質骨の骨密度と容積比は有意に相関した｡それぞれの群の皮質骨骨密度-容積比の傾きは,いずれも有意差を認めなかった｡【結論】気管支喘息症例におけるステロイド投与による皮質骨の骨密度と容積の減少は,性別にかかわらずほぼ一定で,皮質骨は内側と外側において同様に海綿化してゆくと考えられた｡

Pathological changes of nasosinus occur often in subjects with bronchial asthma. Coexisting nasosinus lesion may affect pathophysiology of lower respiratory tract in asthmatics. The extent of nasal and sinus lesion was quantified in 17 patients with bronchial asthma, and their relationships to atopic status, asthma severity and bronchial hyperresponsiveness were evaluated in this study. Opacification degree of maxillary sinuses and nasal mucosa thickening were quantified using CT scans. The opacification degree was evaluated as (total opacification area)/(total maxillary sinus area). Although the opacification degree of maxillary sinuses in atopic patients showed no significant difference compared with that in non-atopic patients, maximum nasal mucosa thickening in atopic patients had a significant difference compared with that in non-atopic patients (p=0.028). In severe asthmatics, the opacification degree of maxillary sinuses was significantly more prominent compared with those in moderate and mild asthmatics (p=0.0005, p=0.036, respectively). Significantly marked nasal mucosa thickening was recognized in mild asthmatics compared with that in moderate asthmatics (p=0.0462). Regarding bronchial hyperresponsiveness, a significant correlation between Dmin and the opacification degree of maxillary sinuses was observed (rs= -0.551, p=0.0276). Nasal mucosa thickening had no correlation with bronchial hyperresponsiveness. The results suggest that sinusitis may affect bronchial hyperresponsiveness and asthma severity. Treatment of sinusitis may lead to improvement of asthma symptoms., 鼻腔･副鼻腔疾患はしばしば気管支喘息症例に合併が認められ,喘息症例の下気道病態に影響を及ぼしている可能性が考えられる｡今回,気管支喘息17例において,CTを用いて上顎洞の不透明化率･鼻腔粘膜肥厚を計測し,アトピー性の有無,喘息の重症度,気道過敏性との関係を検討した｡上顎洞不透明化率は全上顎洞面積の総計に対する不透明化領域面積総計として計算を行った｡上顎洞不透明化率はアトピー性の有無で差は認められなかったが,鼻腔粘膜はアトピー性喘息症例で有意に肥厚していた｡重症気管支喘息における上顎 洞不透明化率は,中等症および軽症喘息症例に比べ有意に高値であった｡鼻腔粘膜肥厚は中等症喘息症例に比べ,軽症症例で有意に肥厚していた｡気道過敏性(Dmin)は上顎洞不透明化率とのあいだに弱い負の相関が認められた(rs=-0.551,p=0.0276).鼻粘膜肥厚と気道過敏性は相関が認められなかった｡今回の結果から副鼻腔病変が気道過敏性･喘息重症度に影響を及ぼしている可能性が考えられ.副鼻腔疾患の治療により喘息症状の改善に繋がる可能性が考えられた。

The body surface peripheral circulation in 12 cases, including 9 patients with diabetes mellitus who were suffering coldness, numbness or pain in their feet, and 3 healthy volunteers was examined using Laser-Doppler blood flowmetry. At the same time, the body surface temperature was estimated by thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio = [Total counts of thermography(Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). The recovery ratio and the blood flow were correlated, r=0.68, p, 末梢神経障害を有する糖尿病患者の末梢循環障害の程度を数量的に検討する目的で､下肢に冷感ならびにしびれ感または疼痛を訴える糖尿病患者9症例と健常ボランティア3例の計12例(平均年齢59歳)についてサーモグラフィーを用いて体表面温度を測定した｡更に,サーモグラフィーで得られた結果と末梢皮膚血流量をレーザードプラー血流計を用いて測定して得られた結果と比較した｡サーモグラフィーによる測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率= [冷水負荷後の特定温度27℃以 上の体表面温度のサーモグラフィーのPixelの総数]÷ [冷水負荷前の特定温度27℃以上の体表面温度のサーモグラフィーのPixelの総数]×100%で求めた｡レーザードプラ-血流計を用いて測定して得られた末梢血流量は左右それぞれ5カ所,計10カ所の測定値の平均で表示した｡その結果,末梢皮膚温度の回復率と末梢皮膚の血流量との問には正の相関関係(r=0.68,p

Clinical features of asthmatics with a low % FVC (, 努力肺活量(% FVC)低値を示す気管支喘息の臨床病態を明らかにするために気道炎症ならびに臨床病型との関連について検討を行った｡% FVCが80%未満の気管支喘息患者32名を対象として,スパイロメトリー,気管支肺胞洗浄(BAL)を施行し,臨床病態を解析し,治療効果の評価を行なった｡1.対象中24名(75%)の患者がステロイド依存性重症難治性喘息であった｡2.細気管支閉塞型喘息患者において,% FVC値の有意の低下が認められ,BAL液中のリンパ球の減少と好中球の増加が認められた｡3.FVC値,FEV1.0億の治療による改善は,BAL液中好酸球の増加を示す過分泌型喘息においては認められが,BAL液中好中球の増加を示す細気管支閉塞型喘息においては認められなかった｡ 以上より喘息患者における% FVC値の低下は気道炎症と関連しており,細気管支閉塞型喘息における治療による可逆性は著しく低下していることが示唆された｡

The body surface temperature of 41 patients suffering coldness, numbness or pain in their feet was examined using thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio =[Total counts of thermography (Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). Three different baseline temperatures, 26℃. 27℃ and 28℃, were used in processing the thermographic results into pictures. The recovery ratio was susceptible to temperature, and we recommend a baseline temperature limitation of 27℃ for clinical study. A bi-modal distribution of recovery ratio was observed in 18 patients with diabetes mellitus. One group (6 subjects) had high recovery ratio between 80%-100%, and another group (10 subjects) had a low recovery ratio between 0%-19%. The results of thermography were also influenced by weather. To reduce the effect of outside temperature, we used pre-loading with hot water at 36℃ for 5 min (hot loading). A large difference in recovery ratio between presence and absence of hot loading was observed in 6 of the 30 subjects. The difference was over-estimated in more than 20% of recovery ratio without hot loading as compared with hot loading in these 6 subjects. The effect of drugs on peripheral circulation, such as beraprost sodium and sarpogrelate hydrochloride, was clear and quantified using thermography under these conditions of hot loading., 下肢に冷感ならびにしびれ感または疼痛を訴える患者41症例についてサーモグラフィーを用いて体表面温度を測定した｡測定で得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率=[冷水負荷後の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]÷[温水負荷前の特定温度T℃以上の体表面温度のサーモグラフィーのPixelの総数]× 100%で求めた｡サーモグラフィーで得られた結果と画像処理の過程で用いられた,26℃,27℃,28℃の3つの異なる特定温度T℃ との関連について検討を行なった｡その結果,回復率は特定温度T℃に影響を受けやすいことが明らかとなった｡下肢の体表面温度の低い臨床症例においては27℃の条件が適当と考えられた｡前述の41症例中の18症例の糖尿病患者について検討を行なった｡そのサーモグラフィーの結果は,比較的回復率の高い(80%～100%)群の6症例と比較的回復率の低い(0%～19%)群の10症例の2群に別れた｡わずかに残り2症例が20%から79%の間であった｡下肢の症状が気温の低い時期に出親しやすいためにサーモグラフィーの検査を冬期に行なう必要性が高まった｡しかし,天候の影響を受けやすいために冷水負荷前の測定領域の下肢が冷えすぎているために20℃の室温に15分間の安静時間では体表面温度が十分に暖まることが出来ず,27℃以上の領域として測定範囲全体を観察できない 問題に直面した｡この間温点を解決する手段として36℃の温水に5分間下肢を入れて暖める温水負荷を加えることにした｡そこで, 温水負荷を行なった症例30症例について,温水負荷を行なう前(室温)の回復率と温水負荷を行なった後の回復率について比較検討を行なったところ,20%にあたる6症例において温水負荷を行なわなかった場合に20%以上の回復率の過剰評価が認めら れた｡温水負荷を行なうことにより年間を通じて天候の影響を最小限にすることが可能となり,この結果,長期間の内服薬の末梢循環に及ぼす影響の測 定を行なった場合に,季節の影響を最小限にしてサーモグラフィーにより回復率を用いて数値化された測定結果を検討することが可能となった｡具体的に末梢循環の改善に薬効が有ると言われている薬剤であるベラプロストおよびサルポグレラートを3ヵ月間内服した場合の前後のサーモグラフィーで得られた回復率について検討を行なった｡その結果はベラプロストにおいては,6.9%から41.9%に上昇または回復率の6.1倍の上昇を認めた。サルポグレラートにおいては,1.9%から17.3%に上昇または回復率の9.1倍の上昇を認めた。以上より,温水負荷を加えたサーモグラフィーの測定結果の数値化は下肢に症状の有る患者の末梢循環の評価ならびに薬効の評価の比較に有用であることが表わされた｡

An effective treatment for the advanced stages of chronic obstructive pulmonary disease (COPD) has not been established yet. We report our recent experience of one patient with pulmonary emphysema treated by dietary supplementation of n-3 fatty acid for two months. He presented improvements in clinical symptoms and pulmonary function, and suppression of leukotriene B(4) generation by peripheral leukocytes. We consequently suppose that dietary treatment with n-3 fatty acids (perilla seed oil) may offer benefits for the treatment of pulmonary emphysema by competitively inhiabiting the conversion of arachidonicacid to leukotrienes and prostanoids., 今回我々は,肺気腫の症例に対してn-3系脂肪酸を強化した食事療法をおこない,臨床症状,呼吸機能検査所見ともに速やかに改善を認め,同時に白血球のロイコトリエンB4産生能が著明に減少した一例を経験したので報告する｡ 症例は67歳,男性｡主訴は労作時呼吸困難｡【第一回目入院】3カ月間入院し,薬物療法,温泉を用いた理学療法を行った｡自覚症状はやや改善が見られたが,呼吸機能検査所見の改善は得られなかった｡【第二回目入院】1年後に再入院｡n-3系脂肪酸強化食事療法も併用した｡自覚症状および,呼吸機能検査上,FVC,FEV1.0,PEFなどに改善を認めた｡n-3系脂肪酸はアラキドン酸代謝を通してロイコトリエン合成に関与すると推定されるが,経渦中に白血球のLTB4産生能の減少を認めた｡この症例は肺気腫に対するn-3系脂肪酸強化食 事療法の有用性が示唆され,病態を考える上でも興味深いと考えられた｡

We experienced a case of 59-year-old woman with intractable asthma, who had aspirin intolerance. Despite various treatments including systemic corticosteroid administration, she was often admitted due to severe asthma attacks. Furthermore, she had allergic rhinitis and sinusitis. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa and air-fluid level in maxillary sinuses. Although her asthma symptoms such as wheezing and dyspnea were improved by administration of bronchodilator, systemic corticosteroids and beclomethasone diisoccyanate (BDI) accompanied with spa therapy, her peak expiratory flow (PEF) showed no improvement. After readmission due to asthma attacks, clarithromycin (CAM) administration for sinonasal disorders was started. The PEF value showed marked improvement after starting CAM administration, and pulmonary functions and bronchial hyperresponsiveness were also improved. It is suggested from her clinical course that CAM may have beneficial effects in asthmatic patients with sinonasal disorders., 気管支喘息にアレルギー性鼻炎や副鼻腔炎を合併する症例は頻回に経験される｡副鼻腔炎症状の増悪が喘息症状の増悪を引き起こす症例も存在し,鼻腔･副鼻腔における炎症が気管支喘息の病態と何らかの関係を持っていることが考えられる｡今回,59才の難治性アスピリン喘息症例を呈示する｡副腎皮質ホルモンの全身投与を含めた様々な治療にも関わらず頻回に重篤な喘息発作を呈し,入退院を繰り返している症例である｡アレルギー性鼻炎も合併し,CTでは著明な鼻粘膜肥厚と上顎洞の鏡面形成が認められた｡入院後の投薬や温泉療法によって呼吸困難は改善したが,ピークフロー値は上昇が認められないまま退院となった｡再入院後,副鼻腔炎に対しクラリスリマイシン投与を開始したところ､ピークフロー値は著明に改善を示し,肺機能･気道過敏性も改善した｡この症例のように,鼻腔･副鼻腔疾患を合併する気管支喘息症例に対しては,クラリスロマイシン投与が有効である可能性が考えられた。

Recently, we experienced two asthmatic patients with advanced gastric cancer. The two patients had steroid-dependent intractable asthma (SDIA) who had been on administration of corticosteroids for more than 2 years. To determine the influence of pathophysiology of SDIA on stomach mucous lesion, gastroscopic examinations and immunological examinations were performed in eight patients with SDIA, compared with 25 patient with non-SDIA. In patients with SDIA, gastric cancer, its precursor condition and immunosuppressive state were observed. These results suggest that the immunosuppressive state in SDIA induced by the long-term administration of corticosteroids may lead to the risk of gastric cancer development., 最近,進行胃癌を合併した気管支喘息症例を2例経験した｡2症例ともにステロイド依存性重症難治性喘息(SDIA)症例であり,SDIAが胃悪性腫瘍に関与している可能性が考えられた｡今回,SDIA症例における胃粘膜病変の臨床像および背景因子を検討する目的で,8例のSDIA症例における胃内視鏡検査,末梢血液分画,免疫グロブリン定量を行い,非SDIA症例と比較検討を行った｡SDIA症例においては胃癌･前癌状態が認められたが,非SDIA例では認められなかった｡SDIA群において,末梢血白血球は有意に増加し,リンパ球分画･IgGは有意に減少していた｡これらの結果より,ステロイド依存性重症難治性気管 支喘息症例においては免疫状態が抑制され,胃悪性腫瘍が発生する危険性があるものと考えられた｡

We report a patient who developed giant cell (temporal) arteritis during treatment of rheumatoid arthritis. The patient was a 57-year-old Japanese woman and had been well controlled with anti-rheumatic drugs, when she presented to our hospital with severe bitemporal headaches and marked fatigue. An exclusive diagnosis was rapidly made and she was diagnosed as having giant cell arteritis based on the classification criteria by American College of Reumatology. Additionally, magnetic resonance (MR) angiography was performed, from which stenotic change in the bilateral superficial temporal arteries was strongly suspected and then corticosteroid therapy was quickly started. The patient followed an uneventful course without developing any complications such as visual dysfunctions. Therapeutic effect was confirmed by MR-angiographic findings obtained 4 weeks after the initiation of therapy., 慢性関節リウマチ治療経過中に巨細胞動脈炎(側頭動脈炎)を合併した1例を報告した｡症例は抗リウマチ剤投与で良好にコントロールされていた慢性関節リウマチの57歳の女性で,強い両側頭部痛と全身倦怠感を主訴に来院した｡アメリカリウマチ学会(ACR)の分類基準に基づき巨細胞動脈炎と診断し,MR-アンギオグラフィーで両側浅側頭動脈の狭窄性変化を強く疑い,発症 早期よりステロイド投与を開始した｡眼合併症等を来すことなく良好な経過をとり,治療開始4週間後のMR-アンギオグラフィー再検でその治療効果を確認し得た｡MR-アンギオグラフィーで巨細胞動脈炎病変部を観察しえた報告は極めて少なく,文献的考察を加え報告する｡

The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 16 patients with asthma (8 with atopic and 8 with nonatopic asthma) and 12 healthy controls. 1. The LT84 generation by leucocytes was not significantly different between patients with asthma and healthy controls. The generation of LTC4 was significantly larger in patients with asthma than in healthy controls. The LTC4 generation was also significantly larger in patients with attacks (58.4 ± 38.5 ng/5x10(6) cells) than in those without attacks (23.3 ± 25.9 ng/5x10(6) cells)(p, 気管支喘息16例(アトピー型喘息8例,非アトピー型喘息8例)を対象に,Ca ionophore A23187 刺激時の末梢血白血球のロイコトリエンB4(LTB4)およびC4(LTC4)産生能について検討した｡1.LTB4産生能は,喘息症例と健康人 の間に有意の差は見られなかった｡LTC4産生能は,健康人に比べ喘息症例で有意に高い傾向が見られた｡また,喘息症例では,非発作時(23.3±25.9ng/5xl0(6)cells)に比べ発作時(58.4±38.5ng/5xl0(6)cells)に有意に高い値を示した(p

To analyze the pathophysiological changes ot the airways in emphysema, bronchial responsiveness and the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by peripheral leucocytes were examined in 22 patients with emphysema. The subjects were divided into two groups according to the presence or absence of IgE antibodies against inhalant allergens; RAST positive group and RAST negative group. 1. Smoking history, mean CT number and mean maximum % low attenuation area (% LAA), 肺気腫患者の気道病変を解析する目的で,22例の肺気腫患者を対象に,その気道反応および白血球のロイコトリエンB4,C4産生能について検討を加えた｡この際対象症例はIgE抗体の有無によってRAST陽性症例RAST陰性症例に分類された｡1.喫煙歴,平均CT値,high resolution computed tomography(HRCT)上の-950HU以下の% low attenuation area(% LAA),DLcoなどの値は,いずれも対象症例が高度な気腫化病変を有してい ることを示した｡2.血清IgE値は,RAST陽性例で陰性例に比べ有意の高値を示した｡3.β受容体刺激薬吸入後のFEV1.0の増加は,RAST陽性例で陰性例に比べ高度であった｡そして,吸入後のFEV1.0が15%以上の増加を示した症例は,RAST陽性例では9例中4例(44.4%),陰性例では12例中2例(16,7%)であった｡4.白血球のLTC4産生量は,RAST陽性例で陰性例に比べ有意に高い値であったが,LTB4産生は両者間に有意の差は見られなかった｡以上の結果より,IgEにmediateされるアレルギー反応が,肺気腫患者 の気道反応に関与している可能性が示唆された。

The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by peripheral leukocytes stimulated with Ca ionophore A23187 was examined in 17 patients with pulmonary emphysema. They were divided into three groups according to the mean CT number; A (, 肺気腫患者17名を対象として,カルシウムイオノフォアA23187による末梢血白血球からのロイコトリエンB4(LTB4), ロイコトリエンC4(LTC4)の産生能の検討を行った｡対象は高分解能CTによる平均CT値によってA(

N-3 fatty acids, such as fish oil, have been reported to have some beneficial effects in patients with bronchial asthma by suppressing leukocyte function, followed by reduction of the need for pharmacologic agents. To examine the effects of dietary supplementation with perilla seed oil rich in α-linolenic acid (ALA), 23 patients with asthma took corn oil rich in linoleic acid (LA) for the former two weeks, perilla seed oil for the later two weeks. The asthmatic patients were classified into two groups by the changes of the generation of leukotrienes B4 (LTB4), C4 (LTC4), and B5 (LTB5) during the two courses of dietary modification: one was sensitive to dietary modification, and the other was insensitive to dietary supplementation. We compared the two groups in clinical characteristics. Significant differences were observed in peak flow (PEF), forced expiratory volume in one second (FEV1.0), IgE, sex, obesity index (OI), concentration of serum total cholesterol, albumin, low density lipoprotein {LDL)-cholesterol, β-lipoprotein and phospholipids between two groups. This study indicated that these factors influence the generation of LTB4, C4 and B5 of asthmatic patients in dietary supplementation., 気道への炎症性白血球の集合が気管支喘息の病態に関わっている。魚油などのn-3系脂肪酸が白血球の機能を抑制することにより気管支喘息患者に良好な効果をもたらし,薬剤の必要性を減じたとの報告がなされている｡α-リレノン酸を豊富に含有するエゴマ油食の効果を調べるため,気管支喘息患者23名に2コースの食事-リノール酸の豊富なコーン油食を2週間摂取後,エゴマ油食を2週間-を摂取してもらった｡喘息患者は2コースの食事間のロイコトリエンB4(LTB4),CA(LTC4),B5(LTB5)の変化から2群-1群は食事に対し感受性のある群,もう1つは感受性の無い群-に分類した｡我々はこの2群を臨床的に検討したところ,ピークフロー(PEF),1秒量(FEV10),IgE,性別,肥満率(OⅠ),血清総コレステロール,アルブミン,低比重リポ蛋白(LDL)-コレステロール,β-リポ蛋白,リン脂質において2群間に有意差が認められた｡今回の研究から,これらの因子が,喘息患者において,LTB4,LTC4,LTB5の産生に対する食事療法の効果に影響を及ぼしていることが示唆された｡

Clinical risk factors associated with the development of osteoporosis and vertebral fractures were evaluated in patients with asthma in relation to sex, age, and dose of glucocorticoids (GC). In 75 asthmatic patients including 44 steroid-dependent asthma, the bone mineral density (BMD) of the lumber spines was measured by quantitative computed tomography (QCT). Thirty five patients of them were followed up with radiographs over a period of 0.5 to 4 years (average: 2.6±1.3 years). The BMD was significantly lower in older (p, 対象は気管支喘息75症例｡このうち44例はステロイド依存性難治症例であった｡35症例については,0.5年から4年間(平均:2.6±1.3年間)の経時的観察もおこなわれた｡これらの症例の骨塩量に影響を及ぼす因子について検討をおこなった｡高齢者,女性に有意な低骨塩量を認めた｡重回帰分析にて年齢,性別,経口副腎ステロイド投与総量などの項目に骨塩量と有意な関連が認められた｡また,35症例中5例に脊椎圧迫骨折が発生し,いずれも骨塩量が低く,高齢者,女性,長期ステロイド内服例であった｡これらのことから気管支喘息患者においては,女性,高齢者,長期ステロイド内服例に骨塩量減少や脊椎圧迫骨折のリスクが高いと考えられた｡また,ステロイド続発性骨粗鬆症の発生には,ステロイドの現在の一日内服量よりもこれまでの総積算内服量が重要と考えられた｡

The number of patients with respiratory disease in the elderly has been increasing in recent years. Pathophysiological characteristic of respiratory diseases in older patients is clearly different from that in younger patients. In this study, rehabilitation for patients with respiratory disease, particularly bronchial asthma, in the elderly was discussed in relation to pathophysiology of asthma. Complex spa therapy has two kinds of actions, direct and indirect actions. Subjective and objective symptoms of patients with asthma are improved by spa therapy for 1-2 months, accompanied with improvement of ventilatory function, and decrease in bronchial hyperresponsiveness and respiratory resistance. In addition to these direct action of spa therapy, increase in strength of respiratory muscle, stability of autonomic nerve syetem, psychical relaxation, and inprovement of suppressed function of adrenocortical glands are observed as indirect action of spa therapy. Regarding clinical asthma type classified by pathophysiological changes of the airways, spa therapy was more effective in patients with hypersecretion and bronchiolar obstruction. These results suggest that complex spa therapy is available as rehabilitation and/or treatment for patients with respiratory disease., 近年老年者の呼吸器疾患が増加しつつある｡老年者の呼吸器疾患の病態的特徴は若年者のそれとは明らかに異なっている｡本論文では,老年者の呼吸器疾患,なかでも気管支喘息に対する温泉療法を中心としたリ-ビリテ-ションについて,その病態的特徴と関連して若干の知見を述べる｡複合温泉療法は2つの作用,すなわち直接作用と間接作用を有している｡患者の自,他覚症状は1-2カ月の温泉療法により明らかに改善傾向を示すが,同時に,換気機能の改善,気道過敏性や気道抵抗の低下が観察される｡これらの温泉療法の直接作用のはか,呼吸筋の増強,自律神経系の安定化,精神的リラックス,低下した副腎皮質機能の改善,などの間接作用も観察される｡気道の病態生理的特徴より分類した喘息の臨床病型に関しては,過分泌や細気管支閉塞を伴うような病 型に対して,温泉療法は有効性が高い｡これらの結果は,複合温泉療法が呼吸器疾患の治療ないしリハビリテーションとして有用であることを示している｡

The maximal percent low attenuation area < -950 HU (% LAA) among three anatomic lung levels on high resolution computed tomography (HRCT) was examined in patients with asthma, classified by the degree of % LAA, in relation to the mean CT number, % FVC of the predicted value, and FEV 1/FVC (FEV1%). 1 . The mean CT number was closely related to the degree of % LAA of the lungs. The mean CT number was significantly lower in patients with high % LAA (mean CT number-915.3HU, % LAA 37.6%) than in those with low % LAA (-852.9HU, 4.7%). 2. The FEV1% value was significantly lower in patients with high % LAA (47.8%) than in those with low % LAA (62.2%)(p, HRCT (high resolution computed tomography)により,-950HU以下のlow attenuation area(LAA)を3つの高さの肺野レベルで観察し,そのなかの最も高い値をmaximal% LAAとして表し,この値と平均CT number, % FVCおよびFEV1.0%の値と比較検討した｡1.平均CT numberは,maximal% LAAと密接な関連を示した｡そして,平均CT numberは,% LAAが低い症例(% LAA :4.7%, mean CT number:-852.9HU)に比べ,% LAAが高い症例(% LAA :37.6%, mean CT number:-915.3HU)において低い傾向が見られた｡2.FEV1.0%値は,% LAA値が低い症例(62.2%)に比べ% LAA値が高い症例(47.8%)において有意に低い値を示した(P

The percentage of attenuation area < -950HU (% LAA) on high resolution computed tomography (HRCT) was compared between 17 smoking and 24 nonsmoking patients with asthma. 1. FEV1/FVC value was lower in smoking patients (56.4%) than in nonsmoking patients (66.0%), however, the difference was not significant. 2. The percentage of LAA of the lung was larger in smoking patients compared with that in nonsmoking patients in all the three anatomic levels: the % LAA was 14.4% in nonsmoking and 20.3% in smoking patients at lower lung level (3cm above the top of the diaphragm). However, this was not significant. The maximal % LAA among the three lung levels on HRCT was 21.6±12.5% in smoking, and 15.7±11.9% in nonsmoking patients. This suggested that the maximal % LAA was larger in smoking patients, however, this was not significant. 3. The mean CT number of the lung on HRCT was smaller in smoking patients (-897.3HU) than in nonsmoking patients (-884.7HU). 4. Three of 4 nonsmoking patients whose % LAA was more than 30% had severe intractable asthma with long-term glucocorticoid therapy. The results suggest the possibility that smoking influences the % LAA of the lung on HRCT in asthma. It could be also speculated that % LAA is influenced by severity of asthma., HRCT (high resolution computed tomography)による-950HU以下の肺野のlow attenuation area(LAA)について,17例の喫煙喘息症例と24例の非喫煙喘息症例で比較検討した｡1.FEV1.0%値は,喫煙症例(56.4%)で非喫煙症例(66.0%)に比べ低い値が示されたが,両群間に有意の差は見られなかった｡2.% LAAは,肺野のいずれの高さにおいても,非喫煙症例に比べ喫煙症例で高い傾向が見られたが,有意の差ではなかった｡Maximal % LAAは,喫煙症例で21.6%,非喫煙症例15.7%であり,同様に喫煙症例で高い傾向が見られたが,有意の差は見られなかった｡3.平均CT値は,非喫煙症例(-884.7HU)に比べ,喫煙症例(-897.3HU)で低い値であった｡4.% LAAが30%以上を示 す4例の非喫煙症例のうち,3例がステロイド依存性の重症難治性喘息であった｡これらの結果より,喫煙が肺野の% LAAに影響をあたえる可能性もあるものの,疾患の重症度がより影響が強い可能性が示唆された｡

The degree and characteristic of airway inflammation were evaluated by the proportions of bronchoalveolar lavage (BAL) cells. Clinical asthma types such as Ia. simple bronchoconstriction, Ib. bronchoconstriction + hypersecretion, and Ⅱ. bronchiolar obstruction correlate with airway inflammation. The increased proportion BAL neutrophils is characteristic of type Ⅱ asthma, and increase in BAL eosinophil count is often observed in type Ib asthma. Bronchial hyperresponsiveness also correlates with airway inflammation. Action of spa therapy has been speculated to be related to airway inflammation, since the therapy has no action inhibiting IgE-mediated allergic reaction. In fact, spa therapy is more effective in patients with type Ib and type Ⅱ than in those with type Ia showing slight degree of airway inflammation. Bronchial hyperresponsiveness is also improved by spa therapy. From a point of view, the direct action of spa therapy may be to clean airways and improve damaged mucous membrane of the airways, leading to suppression of airway inflammation., 気道炎症反応の程度や特徴が,気管支肺胞洗浄液(BAL)中の細胞成分によって評価された｡Ia.単純性気管支攣縮型,Ib.気管支攣縮+過分泌型,Ⅱ.細気管支閉塞型などの各臨床病型は気道炎症反応と関連している｡BAL液中好中球増多は,Ⅱ型喘息の特徴的所見であり,また好酸球増多はIb型喘息でしばしば観察される｡気道過敏性もまた気道炎症反応と関連している｡温泉療法の作用機序としては,温泉療法にIgEにmediateされるアレルギー反応(液性因子相)を抑制する作用がないことから,気道炎症反応(細胞性因子相)の抑制が推測されている｡実際,温泉療法は,気道炎症反応が軽度なIa型喘息に比べ,Ib型やⅡ型などの明らかに気道炎症反応をともなう病型に対してより有効である｡気道過敏性もまた温泉療法により改善される｡これらの 結果から,温泉療法は,気道を清浄化し,気道粘膜を正常化することによって,気道炎症反応を抑制していくものと考えられる｡

Bronchial asthma is classified into three types ; type Ia (Ia-1 and Ia-2), type Ib, and type Ⅱ, by clinical symptoms (clinical diagnosis). Asthma is also classified by clinical findings and examinations (score diagnosis). Both classification systems show that markedly increased proportion of BAL neutrophils and marked decrease in % V25 value are characteristic of type Ⅱ, bronchiolar obstruction, asthma. However, there are some type Ⅱ asthma patients without BAL neutrophilia. In these patients, age is higher compared to those with BAL enutrophlia. Decrease in FEV1.0% value and decrease in the proportion of BAL lympocytes and serum IgG level, are not so remarkable as decrease in those with BAL neutrophilia. It has been suggested that type Ⅱ asthma with BAL neutrophilia correlates with suppression of humoral and cellular immunity, and same type of astma without BAL neutrophilia is in part caused by aging., 気管支喘息は,その臨床症状より,Ia型(Ia-1およびIa-2),Ib型およびⅡ型の3つの病型に分けることができる(臨床分類)｡また,同時に臨床所見および検査により分類することができる(スコアー分類)｡いずれの分類においても,BAL液中の好中球の著増および高度な% V25値の低下がⅡ細気管支閉塞型の特徴的所見である｡しかしながら,BAL液中の好中球の増加をともなわないⅡ型喘息が存在することが明らかにされている｡これらの症例では,BAL液 中好中球増加をともなう症例に比べ平均年齢が高い｡しかし,FEVl.0% 値､BAL液中リンパ球頻度や血清IgG値などは､好中球増加をともなう症例ほどの低下傾向は見られない｡これらの結果はBAL液中好中球増加をともなうⅡ型z喘息の発症機序には､液性および細胞性免疫能の低下が､また､BAL液中好中球増加をともなわないⅡ型喘息では､加齢がある程度関連していることを示 している。

Bronchial asthma is often accompanied with allergic rhinitis or chronic sinusitis. Mucosal abnormalities of sinonasal cavity may influence lower respiratory responses in patients with asthma. We experienced a case of 72-year-old woman with asthma, who had dyspnea on exertion and a large volume of expectoration of more than 100mℓ a day. Furthermore she had nasal symptoms (nasal obstruction and rhinorrea) with prominent post-nasal discharge. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa. Although her asthma symptoms such as wheezing and dyspnea improved by administration of bronchodialators, antiallergic agent, and beclomethason di isocyanate (BDI) accompanied with spa therapy after admission, the volume of expectoration revealed no decrease and her peak expiratory flow (PEF) didn't increase. The volume of expectoration and the PEF showed marked improvement after starting of intranasal glucocorticoid therapy. It is suggested from her clinical course that treatment with intranasal glucocorticoids is very important in asthmatic patients with mucosal abnormalities of sinonasal cavity., 気管支喘息症例には,アレルギー性鼻炎や慢性副鼻腔炎の合併が認められる｡鼻腔内への吸入ステロイド投与が喘息症状を改善したという報告も存在し,鼻腔病変が下気道の反応に何らかの影響を及ぼしている可能性が考えられる｡今回,気管支喘息にて入院した72才の女性の症例を呈示する｡労作性呼吸困難と多量の喀痰排出が認められ,入院後の投薬や温泉療法にて呼吸困難は改善したが,喀痰排出は減少せず,ピークフロー値も上昇が認められなかった｡明らかな後鼻漏が認められ,CTにて両側鼻腔粘膜の著明な肥厚の所見が見られたため,鼻腔内吸入ステロイド投与を開始した｡開始後,喀痰排出量,ピークフロー値は著明な改善を示した｡この症例のように,鼻腔あるいは副 鼻腔に対する治療が喘息症状を改善する症例が存在する可能性が考えられた｡

Concentrations of main bronchoconstricting chemical mediators, histamine and leukotriene C4 (LTC4), were measured in bronchoalveolar lavage (BAL) fluid, and when cells (peripheral leukocytes and BAL cells) were stimulated by Ca ionophore A23187, in 7 atopic and 7 nonatopic asthma patients. 1. The proportion of basophilic cells was significantly larger in atopic than in nonatopic asthma (p, 気管支喘息患者14人(アトピー型,非アトピー型各7人)につき気管支肺胞洗浄(BAL)液及び気管支肺胞洗浄細胞と末梢血白血球をカルシウムイオノファA23187で刺激し,主要な気管支収縮メディエーターであるヒスタミンとロイコトリエンC4(LTC4)の濃度を測定した｡1.BAL中細胞の比率では好塩基球のみ非アトピー型に比べアトピー型で優位に高い値であった｡(p

In recent years, it has been noted that there is a close correlation between leukotrienes and late asthmatic reaction (LAR). In this study, effects of dietary supplementation with perilla seed oil rich in alpha-linolenic acid, which is speculated to affect the generation of leukotrienes through metabolism of arachidonic acid (AA), were evaluated in 6 patients with asthma. The symptoms and ventilatory function were improved after 2-week dietary supplementation with perilla seed oil. The generation of LTB4 and LTC4 by peripheral leucocytes stimulated with Ca ionophore A23187 was significantly suppressed by the dietary supplementation (LTB4 and LTC4 ; p, 近年,ロイコトリエンと遅発型気管支反応(LAR)との密接な関連が注目されている｡本論文では,アラキドン酸(AA)代謝を通してロイコトリエン合成に関与すると推定される,αリノレン酸を多く含むエゴマ油による食事療法の臨床効果を,気管支喘息を対象に検討した｡臨床症状および換気機能は,2週間のエゴマ油投与で明らかな改善差傾向を示した｡Ca ionophore A23187刺激時の白血球のLTB4およびLTC4産生は,エゴマ油投与により,投与前に比べ有意の減少を示した(p

Clinical features of asthma patients with bronchiolar obstruction (type Ⅱ asthma) were studied in relation to the proportion of neutrophils in bronchoalveolar lavage (BAL) fluid. Of 13 subjects studied, 7 were accompanied with BAL neutrophilia (53.5%) (BALn(+)) and 6 were without BAL neutrophilia (3.5%) (BALn(-)). 1. The mean age was higher in BALn(-) (66.0 years) than in BALn(+) patients (55.0 years). 2. Bronchial reactivity to methacholine was slightly higher in BALn(-) patients than in those with BALn(+). 3. The value of FEV1.0% was significantly lower in BALn(+) patints than in those with BALn(-) (p, 細気管支閉塞型(Ⅱ型)喘息の臨床的特徴が,BAL液中の好中球頻度との関連のもとに検討された｡対象13例のうち,7例がBAL液中好中球増加(平均好中球頻度;53.5%)をともなう症例(BALn(+))で,残りの6例はBAL液中好中球増加 をともなわない(3.5%)症例(BALn(-))であった｡1.平均年齢は,BALn(+)症例(55.0才)に比べ,BALn(-)症例(66.0才)でより高い傾向が見られた｡2.メサコリンに対する気道過敏性は,BALn(+)症例に比べBALn(-)症例でやや高い傾向が見られたが,両者間に有意の差は見られなかった｡3.FEV1.0%値は,BALn(-)症例に比べBALn(+)症例で有意に低い値を示した(P

Actions of spa therapy on endocrine-autonomic nerve system and psychological factors were analyzed in patients with bronchial asthma. In endocrine function, serum levels of cortisol and ACTH tended to increase after spa therapy. In autonomic nerve system, decrease in concentrations of serum adrenalin and noradrenalin was observed after spa therapy, and the difference between the initial levels before spa therapy and the levels after the therapy was significant in serum levels of adrenalin. However, serum levels of substance P and Bradykinin were not affected by spa therapy. To evaluate the action of spa therapy on mental condition in patients with asthma, four kinds of psychological tests, CMI, SDS, CAl and SD, were carried out. Improvement of mental disorders in patients with asthma is observed after spa therapy in all psychological tests. These results suggest that spa therapy acts effectively on endocrine-autonomic nerve system and improve psychological conditions., 内分泌･自律神経系および心因的要素に対する温泉療法の効果が,気管支喘息を対象に検討された｡内分泌系では,血中コーチゾ-ルおよびACTH値が,温泉療法後に上昇することが示された｡また,自律神経系では,血中アドレナリンおよびノルアドレナリン濃度が温泉療法により減少することが示され,特に,血中アドレナリンは温泉療法前後の濃度に有意の差が見られた｡しかしながら,血中サブスタンスPおよびブラジキニン濃度には,温泉療法による有意の変動は見られなかった｡心因的要素に対する温泉療法の作用を検討するため,CMI,SDS,CAIおよびSDの4種類の心身医学的検査が行われた｡その結果,いずれの心身医学的検査においても,温泉療法により疾患に不利に働く心因的要素が改善する傾向が見られた｡これらの結果より,温泉療法が内分泌･自律神経系に対して有用な作用を有し,また,疾患に不利な心因的要素を改善させる作用を有していることがある程度示唆された｡

Bronchial hyperresponsiveness was examined in relation to age, ventilatory function, and the proportion of bronchoalveolar lavage (BAL) cells in 39 patients with type Ia asthma (simple bronchoconstriction) (25 with type Ia-1 and 14 with type Ia-2), classified by clinical symptoms. 1. The proportion of BAL eosinophils was significantly higher in type Ia-2 than that in type Ia-1 asthma patients. 2. Bronchial reactivity to methacholine was not different between type Ia-1 and type Ia-2 asthma patients. 3. Bronchial hyperreactivity tended to decrease as patient age was higher in both types of asthma. Neither ventilatory function (FEV1.0%) nor the proportions of BAL lymphocytes and neutrophils was not correlated with bronchial hyperresponsiveness in both types of asthma. 4. Bronchial reactivity to methacholine more dereased with the increase in the proportion of BAL eosinophils in both type Ia-1 and Ia-2 asthma patients. The results show that bronchial hyperresponsiveness in patients with type Ia asthma is correlated to patients age and the proportion of BAL eosinophils., 気管支喘息患者Ia型(単純気管支れん縮型)39人(Ia-1型25人,Ia-2型14人)の気道過敏性を年齢,呼吸機能検査,気管支肺胞洗浄液(BAL)中の細胞成分と関連で検討を行った｡1.BAL液中の好酸球の比率はIa-1型に比べIa-2型で優位に高値であった｡2.メサコリンに対しての過敏性はIa-1型とIa-2型とで差を認めなかった｡3.気道過敏性はどちらの病型においても年齢にともなって減弱する傾向にあったが,一秒率及びBAL液中の好中球,リンパ球の比率とは相関しなかった｡4.メサコリンに対しての気道過敏性はIa-1型,Ia-2型ともにBAL液中の好酸球の比率が増加するにしたがって亢進した｡以上より単純気管支れん縮型(Ia型)の気管支喘息患者の気道過敏性はその年齢,BAL液中の好酸球の比率に相関することが示唆された｡

Age-related changes in IgE-mediated allergic reaction were examined in patients with late onset asthma, whose asthma occured over the age at onset of 40. 1. The number of patients with a high serum IgE level over 3001U/mℓ was larger in those between the ages at onset of 40 and 49 and over age at onset 60 than in those between the ages at onset 50 and 59. 2. A positive RAST score to Hdm and cockroach allergens was more frequently found in patients between 40 and 49 and over age 60 at onset compared to those between 50 and 59 at onset. In contrast, the number of patients with a positive RAST to Candida was larger in those between 50 and 59 at onset than in those of between 40 and 49 and over 60 at onset. 3. Severe asthma was more frequently and slight asthma was less frequently observed in patients between 50 and 59 at onset than in those of the other age at onset groups. These results suggest that IgE-mediated allergic reaction in patients between the ages at onset of 50 and 59 is different from that in those with early onset asthma, and that the reaction in patients between the ages at onset 40 and 49 and over 60 resembles to the reaction in those with early onset asthma., 発症年令が40才以上の中高年発症型喘息患者におけるIgE系アレルギー反応の加令による変化について検討を加えた｡1.発症年令が40から49才と60才以上の患者では,50から59才の患者に比して血清IgE値が300IU/mℓ以上の高値を示す頻度が高い傾向が見られた。2.ダニ,ゴキブリに対するRAST陽性率は発症年令が50から59才の患者に比して,40から49才と60才以上の患者で高値を示した｡一方,カンジダに対するRAST陽性率は,発症年令が40から49才と60才以上の患者に比して,50から59才の患者で高値を示した｡3.発症年令が50から59才の患者では,他の発症年令の患者に比べて,重症例が多く,軽症例が少ない傾向が見られた｡以上の結果から,発症年令が50から59才の患者のIgE系アレルギー反応は若年発症型喘息患者と異なり,発症年令が40から49才と60才以上の患者のIgE系アレルギー反応は若年発症型喘息患者と 類似することが示唆された｡

To evaluate improvement of mental disorders by spa therapy for 1-2 months, three kinds of psychological examinations, CMI (Cornel Medical Index), SDS (Selfrating Depression Scale) and CAI (Comprehensive Asthma Inventory) tests, were performed in 37 patients with asthma before and after spa therapy. 1. In CMI test, the scores of physical symptoms, respiratory symptoms, and CIJ symptoms significantly decreased after spa therapy. The score of psychical symptoms tended to decrease after the therapy, however, this was not significant. 2. The mean score of the subjects over 40 points in SDS test significantly decreased from 45.7 points before spa therapy to 37.5 after the therapy. 3. Mental disorders evaluated by various categories in CAI test were significantly improved after spa therapy. The average score in CAI test significantly decreased from 37.1 to 27.8 after the therapy. These results demonstrate that psychological disorders in patients with asthma are improved by spa therapy., 気管支喘息に対する温泉療法(1-2ヶ月)による心理的障害の改善を評価するために,3種類の心理学的調査:CMI(Cornel Medical Index),SDS(Selfrationg Depression Scale),CAI(Comprehensive Asthma Inventory)を,気管支喘息患者37例を対象として,入院時と退院時に実施し比較した｡①CMIでは,身体的自覚症,呼吸器系症状およびCIJ症状が,温泉療法後に有意に改善した｡②SDS値が40以上の症例において,温泉療法後,平均値は45.7から37.5へ有意に減少した｡③CAIの種々の心理学的項目により評価した心理的障害は,温泉療法後に有意に改善した｡各心理項目の平均値であるCAIスコアは,治療後,37.1から27.8へ有意に低下した｡これらの結果から,気管支喘息患者に観察される心理的障害は,温泉療法により改善することが示唆された｡

Ventilatory function and inflammatory cells in airways were compared between patients with type Ⅱ (bronchiolar obstruction) asthma and those with obstructive bronchiolitis. 1. Age and age at onset were higher in patients with type Ⅱ asthma than in those with obstructive bronchiolitis. IgE-mediated allergic reaction was observed in patients with type Ⅱ asthma, but not in those with obstructive bronchiolitis. 2. In ventilatory function tests, all ventilatory parameters examined were lower in patients with type Ⅱ asthma compared to those with obstructive bronchiolitis, and the differences were significant in FEV1.0% (p, Ⅱ型喘息と閉塞性細気管支炎の臨床的特徴について,換気機能および気道炎症反応を中心に検討を加えた｡1.年齢,および発症年齢とも閉塞性細気管支炎に比べⅡ型喘息において高い傾向が見られた｡IgE系反応はⅡ型喘息では観察されたが,閉塞性細気管支炎では見られなかった｡2.換気機能では,測定された全ての換気パラメーターにおいて,その値は閉塞性細気管支炎に比べⅡ型喘息でより低い値を示し,FEV1.0%,% MMFおよび% V50では有意の差が見られた｡3.BAL液中好中球頻度は,Ⅱ型喘息(55.7%),閉塞性細気管支炎(74.4%)いずれにおいても高い値を示したが,両者間に有意の差は見られなかった｡4.一方,BAL液中の絶対数では,Ⅱ型喘息に比べ,閉塞性細気管支炎において,総細胞数,マクロファージおよび好中球数が有意の高値を示した｡5.また,lmℓあたりの細胞数の比較でも,閉塞性細気管支炎で好中球数が著明な高値を示した｡これらの結果より,この2疾患では気道内好中球増多は同様に見られるものの,その気道炎症の程度は明らかに閉塞性細気管支炎でより高度であることが示された｡

Body Surface Temperature was observed by thermography. The surface temperature of a healthy person's lower limbs, after being cooled in a water bath, increased in parallel with time. Patients with Diabetes Mellitus had different patterns in the rate of increase of the surface temperature. After cold loading, one patient had a 99% recovery ratio of surface temperature, the same level as healthy volunteers (83%, and 88%), as calculated by a picture processing program with the computerized thermotracer. However, the recovery ratio of other patients was poorer, ranging from 56% to under 6% recovery. This measurement of elevation of body temperature is useful for the estimation of peripheral blood flow in patients with lower limbcirculation failure., 健常人並びに糖尿病患者を対象にして下肢の体表面温度を測定した｡測定にはサーモグラフィーを用い,得られた画像の数値化にはコンピュータを用いた画像処理システムを利用した｡健常人を用いた実験では,20℃の水を用いた冷水負荷を5分間行うことにより,冷水負荷後,下肢の体表面温度は時間とともに上昇して30分後に良好な回復を得ることができた｡画像処理により28℃以上の体表面温度を呈した下肢の面積を負荷前と比較したところ,回復率は,2名の健常人についてみるとそれぞれ83%,88%であった｡27℃で画像処理を行った場合には回復率は93%となり過大評価される可能性があった｡また,29℃で画像処理を行ったところに,逆に,64%となり過少評価される可能性があり,28℃が最も良い条件であった｡この様な条件下で,糖尿病患者7名について同様に測定を行ったところ,1名は健常人と同じく99%の良好な回復率を呈した｡しかし,他の1名は56%であり,残りの,5名は6%以下であった｡この様に,糖尿病患者では,下肢の体表面温度の冷水負荷後の回復率に顕著な差を認めた｡この差は,糖尿病患者における,末梢循環障害の程度を反映しているものと考えられた｡この様にコンピュータを用いた画像処理システムの応用によりサーモグラフィーの画像は数値化することが出来,測定結果はより客観的に据えることが可能となった｡画像処理されたサーモグラフィーは下肢の循環障害を持つ患者の末梢血流量の評価に有用な測定方法であると考えられた。

Clinical features of asthma patients with a low % FVC (, % 肺活量が75%以下の低値を示す気管支喘息について,その臨床的特徴を,臨床病型や重症度との関連のもとに検討した｡1.% 肺活量と年齢との間には関連は見られなかった｡2.% 肺活量と臨床病型との問には有意の関連が見られ,Ⅱ型喘息(細気管支閉塞型)における% 肺活量は,Ia-1型やIa-2型などの単純性気管支攣縮型に比べ,有意に低い値を示した｡3.% 肺活量はまた喘息の重症度と有意の関連を示した｡これらの症例では,喘息の重症度が増すにつれて,% 肺活量は減少する傾向が見られた｡4.これら症例の低値を示す% 肺活量は,治療(複合温泉療法)により改善される傾向が見られた｡以上の結果より,これらの症例(% 肺活量が75%以下)では,% 肺活量と喘息の重症度との間にある程度の関連があることが明らかになった｡