長期間喫煙による気管支唱息,肺気腫の病態的変化

The influence of long-term cigarette smoking on the pathophysiology of chronic respiratory diseases with obstructive ventilatory dysfunction was discussed in patients with asthma and pulmonary emphysema (PE). 1. In patients with asthma, significant differences in the pathophysiology of the disease were observed between smokers and nonsmokers. A positive RAST score against inhalant allergens, bronchial hyperresponsiveness, and LTB4 generation by leucocytes were significantly more increased in smokers than in nonsmokers. The values of FEV1/FVC and OLco were significantly more decreased, and % RV was significantly more increased in smokers than in nonsmokers. 2. In comparison of asthma with PE, IgE-mediated allergy was significantly more increased in smokers with asthma than in nonsmokers with asthma and in smokers with PE. The values of % FEV1, FEVl %, and % OLco were significantly higher in nonsmokers with asthma than in smokers with PE, however, the % OLco and % RV were not significantly different between smokers with asthma and those with PE. The % LAA of the lungs on HRCT was larger in patients with PE than in smokers and nonsmokers with asthma. The results suggest that cigarette smoking influences the pathophysiology of asthma and PE.長期間喫煙による気管支喘息および肺気腫の病態的変化について若干の検討を加えた｡1.気管支嘱喘息に関しては,喫煙例と非喫煙例との間に以下のような病態的特徴に差が見られた｡吸入抗原に対する特異的IgE抗体の陽性率,気道過敏性,白血球のI:TB4産生能はいずれも,喫煙例で非喫煙例に比べ有意の亢進を示した｡また,喫煙例では,非喫煙例に比べ,FEV1%や% DLcoは有意の低下,% RVは有意の増加傾向を示した｡2.喘息と肺気腫の比較では,IgEにmediateされるア レルギー反応は,喘息の非喫煙例や肺気腫(全て喫煙例)に比べ,喘息の喫煙例で有意の亢進が見られた｡% FEVl,FEV1,% DLco値はいずれも喘息の非喫煙例で,肺気腫と比べ有意に高い値を示したが,% DLcoと% RV値には,喘息の喫煙例と肺気腫の間に有意の差は見られなかった｡また,肺のHRCT上の% I.AAは,肺気腫において,喘息の喫煙例,非喫煙例いずれよりも有意に高い値を示した｡以上の結果より,長期間の喫煙が喘息や肺気腫の病態に影響を与えることが示された

温泉療法による気管支喘息に対する年間薬剤費の削減

Costs of drugs used for the treatment for 1 year were compared before and after spa therapy in 16 patients with asthma in relation to disease severity. Asthma severity was classified as : stage 1 (intermittent), 2 (mild persistent), 3(moderate persistent), and 4(severe persistent). 1. The total cost of drugs used for each pa-tient for 1 year clearty decreased in all groups. The % decrease of the costs of drugs in each group was 27.2% in patients with stage 1, 43.5% in those with stage 2 and 34.1% in those with stage 3-4 (mean 34.5% ). The reduction of the cost of bronchodilators was predominant in patients with stage 3-4, and the decrease in the cost of corticosteroids predominant in those with stage 2. The reduction of costs of antiallertgics, mucolytics, and antibiotics was predominant in patients with stage 2 and stage 3-4. The % reduction in the cost of corticostroids was remarkable in patients with stage 2. The % decrease in the costs of mucolytics and antibiotics was predomi-nant in patients with stage 2 and stage 3-4. The results obtained here suggest that the costs of drugs used for asthmatics could be reduced by long-term spa therapy, and the reduction of the costs was larger as asthma stage became more severe.気管支喘息16例を対象に,治療のために要した年間薬剤費が温泉療法により削減可能であるのかどうかについて,国際ガイドラインの重症度分類(stageト4)別に若干の検討を加えた｡1.年間の総薬剤費は重症度別の全てのグループにおいて明らかに減少した.2.その削減率は,ステージ1で27.2%,ステージ2で43.5%,ステージ3-4で34.1%であり,その平均は34.5%であった｡3.気管支拡張剤の薬剤費の減少はステージ3-4で高度であり,副腎皮質ホルモンの薬剤費の減少はステージ2で著明であった｡また,抗アレルギー薬,去痩薬,抗生物質などの薬剤費の削減は,ステージ2および3-4で高度であった｡4.削減率では,去壊薬,抗生物質の削減率が,2および3-4で著明であった｡ 以上の結果より,温泉療法により,気管支喘息の治療に必要な薬剤費は削減可能であること,そして,温泉療法による薬剤費の削減は職息の重症度が高い症例でより高度であることが示唆された

Characteristics of the elderly in high - resolution computed tomography lung densitometry

To determine the characteristics of the elderly in high - resolution computed tomography (HRCT) lung densitometry, mean lung density (MLD) and relative area of the lungs showing attenuation values less than -950 HU (RA(950)) on HRCT were evaluated in nonsmoking control subjects (n = 80) and patients with asthma (n = 80) in relation to their age and pulmonary function. MLD was significantly decreased, and RAW was significantly increased with increasing age in both asthmatics and controls. The MLD values were significantly lower in asthmatics compared with controls in subjects aged between 60 and 69 years and over age 70. RAgsov alues were significantly higher in asthmatics compared with controls in subjects aged between 50 and 59 years, between 60 and 69, and over 70. % FEV(1) and FEV(1) / FVC were significantly decreased in elderly asthmatic patients over 70 years of age compared with the values in those under 49. Percent residual volume (% RV) was significantly larger in patients over 70 years of age than in those between 50 and 59, and under 49 years. RAW was significantly larger in patients with steroid-dependent intractable asthma (SDIA) between 50 and 59 years of age, and between 60 and 69 compared with RA 950 in those without SDIA. However, RAW did not differ significantly between SDIA and non-SDIA in patients over age 70. The results suggested that in % LAA of the lungs on HRCT was significantly increased in the elderly subjects with and without asthma, and it was significantly higher in the elderly asthmatics than the elderly controls.高齢者の病態的特徴を明らかにするために，健常者80例および非喫煙喘息患者80例を対象として，平均肺CT値（MLD）ならびに高分解能CT（HRCT）による－950HU以下の肺low attenuation area（RA950）を評価し，年齢及び肺機能との関連を検討した。　 1．健常者，喘息患者いずれにおいても年齢とともにMLDは有意に減少し，RA(950)は有意に増加した。MLDは，60－69歳と70歳以上の年 齢層において，健常者に比して喘息患者で有意に低値を示した。RA(950)。は，50－59歳・60－69歳・70歳以上の年齢層において，健常者に比して喘息患者で有意に高値を示した。　 2．喘息患者において，1秒量（% FEV(1)）および1秒（FEV(1)/ FVC）は，49歳以下の年齢層に比して70歳以上の年齢層で有意に低値を示した。一方，残気量（% RV）は，50－59歳ならびに49歳以下の年齢層に比して70歳以上の年齢層で有意に高値を示した。 3．50－59歳および60－69歳の年齢層では，RA(950)は，ステロイド依存性重症難治性喘息（SDIA）患者において非SDIA患者に比して有意に高値を示した。しかし，70歳以上の年齢層では両者に有意の差は認められなかった。これらの結果より，HRCT上の肺low attenuation areaは高齢者において有意に増加すること，さらに嘱息患者の方が健常者に比してより高値を示すことが示唆された

Successful intra-postoperative extracorporeal circulatory support with atrial communication for treatment of anomalous left coronary artery from the pulmonary artery : a case report

We describe a successful case of surgical treatment for anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome with severe left ventricular dysfunction. Because of the severe left ventricular dysfunction, we planned to use an extracorporeal membrane oxygenation for heart support until a satisfactory recovery had been established. The left ventricular function signifi cantly recovered in a few days, and the patient could be discharged without any complications.</p

気管支喘息における長期間喫煙による病態的変化の若年者と高齢者の比較

Influence of long-term clgarette smoking on the paphophysiological changes of the disease was compared between younger and older patients with asthma. 1. The frequency of positive RAST score against inhalant allergens was significantly higher in ex-smokers than in never-smokers in older patients with astham, but not in younger subjects. 2. Ventilatory parameters such as % FVC and FEV 1.0% were not sig-nificantly different between ex-smokers and never-smokers either in younger or older patients, although a significant difference in these values was observed between younger and older subjects. 3. The % DLco was significantly lower in ex-smokers than in never-smokers both in yonger and older patients. 4. The parameters associated with hyperinflation asuch as % RV and % LAA of the lungs on HRCT were significantly higher in older patients than in younger subjects, and also significantly larger in ex-smokers than in never-smokers in older patients, but % RV was not different between ex-smokers and never-smokers in young subjects. 5. Bronchial hyperresponsiveness (BH) was significantly more increased in ex-smokers than in never-smokers in older patients, but not in younger subjects. There was a significant difference in BH be-tween younger and older patients. 6. LTB4 generation was significantly larger in ex-smokers than in never-smokers in older patients, and LTC4 generation was more in-creased in ex-smokers both in younger and older subjects. The results show that significant differences between ex-smokers and never-smokers were observed in % DLco, LTC4 generation and % LAA both in younger and older subjects, and in IgE an-tibodies production, % RV, BH and LTB4 generation only in older subjects. In contrast, the values of % FVC and FEV1.0% were not different between ex-smokers and never-smok-ers either in younger or older subjects. A significant difference between younger and older subjects was found in all other parameters except % DLco and LTC4 generation

高齢者気管支喘息における喫煙による気道過敏性の亢進と温泉療法の臨床効果

Clinical effects of spa therapy were examined in 60 elderly asthmatics in comparison between ex-smokers with a long history of cigarette smoking more than 20 years and never-smokers. Spa therapy wse effective in 47 of the 60 subjects (78.4%) with asthma. Ragarding in influence of cigarette smoking, the therapy was effective in 16 of the 24 astmatics (66.7%) with a long history of cigarette smoking. In con-trast, the therapy was effective in 31 of the 36 asthmatics (86.1%) withput smoking history. The spa efficacy was significantly larger in asthmatics without smoking history than those with (P<0.05). There was no significant correlation between spa efficacy and IgE-mediated reactions. Bronchial hyperresponsiveness was significantly higher in subjects with slight or no efficacy of spa therapy than in those with marked and mod-erate efficacy both in ex-smokers and never-smokers as well as in total subjects. The generation of leukotriene B4 (LTB4) by leucocytes was significantly increased in sub-jects with slight or no efficacy of spa therapy than in those with marked and moderate efficacy in total subjects and in those with smoking history, but not in those without smoking history. The generation of leukotriene C4 (LTC4) by leucocytes was not sig-nificantly correlated with spa efficacy in total subjects, and also either in ex-smokers or never-smokers. The results demonstrate that clinical effects of spa therapy are in-fluenced by long-term cigarette smoking, which increases bronchial hyperrespon-siveness and the generation of LTB4 by leucocytes.高齢者哨息60例を対象に,長期的喫煙の温泉療法の効果に及ぼす影響について検討した｡温泉療法は60例中47例(78.4%)に有効であった｡喫煙の影響については,喫煙歴の有る24例中16例(66.7%)で温泉療法は有効であったが,一方,非喫煙例36例では31例(86.1%)で有効であり,温泉療法の有効性は非喫煙例で有意に高いことが示された｡温泉療法の有効性とIgE系反応との間には有意の関連はみられなかった｡気道過敏性は喫煙例,非喫煙例いずれにおいても,有効例(著効ないし有効)に比べ無効例(ややで有効ないし無効)において 有意に高い傾向を示したo LTB4産生は喫煙例では,無効例で有効例と比べ有意の元進が見られたが,非喫煙例では関連は見られなかった｡これらの結果は,長期間の喫煙が,気道過敏性や白血球のLTB4産生を克進させ,その結果として温泉療法の臨床効果に影響を与える可能性が高いことを示しているものと考えられる