Relationship between vertebral transformation (or fracture) and bone mineral density in lumbar vertebrae.

QCTによる腰椎海綿骨骨塩量と,圧迫骨折を含む,椎体(第11胸椎～第4腰椎)の変形率の関係を検討した｡椎体変形率と腰椎QCT値の間の強い相関関係が確認され,椎体変形者全体の50%はQCT値70mg/cm(3)以下に分布し,90%は125mg/cm(3)以下に分布した｡さらに,この70mg/cm(3)付近での椎体変形者の割合は50%であり,125mg/cm(3)付近での椎体変形の割合は10%であった｡QCTによる腰椎海綿骨骨塩量測定値は,腰椎の変形および骨折の危険性を予 測する良好な指標であることが確認できた｡In 360 females, Bone mineral density (BMD) in lumbar vertebrae (L2-L4) was assessed by quantitative computed tomography (QCT), and the values obtained were compared with the frequency of vertebral transformation or fracture as assessed by lateral scan image (scanogram) by X-ray CT. A correlation was observed between the frequency of vertebral transformation (or fracture) and lumbar BMD values : BMD under 125mg/cm(3) was observed over 90% of women with vertebral transformation, and BMD under 70mg/cm(3) was found about 50% of them. These results suggest that decrease in BMD in lumbar vertebrae leads to vertebral transformation or fracture. Thus, measurement of BMD by QCT would be very useful in predicting vertebral transformation or fractures

気管支喘息患者における腰椎海綿骨骨塩量と脊椎圧迫骨折の臨床的特徴

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<O.01) or female (p<0.05) patients. All the five patients developing vertebral compression fractures were female and more than 64 y.o., and received systemic glucocorticoid (GC) therapy for more than 3 years with a lot of cumulative gramdosage of GC. No significant correlation was demonstrated between the BMD and the dose of systemic GC per day, but multiple regression analysis demonstrated a significant relationship (p<O.o1) between the BMD and lifetime cumulative gramdosage of GC. Multiple regression analysis also demonstrated significant relationships (p<O.01) between the BMD and clinical factors such as age and sex. These results indicates that the bone loss and vertebral fractures of patients with asthma are influenced by the patient's age, sex, and the lifetime cumulative GC dose.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

気管支喘息におけるCTによる気腫性変化｡喫煙症例と非喫煙症例の比較｡

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

気管支喘息症例における皮質骨海綿化

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

ステロイド依存性気管支喘息症例の病的骨折と皮質骨傷害の検討

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

気管支喘息におけるHRCTによるLow attenuation area(LAA)と平均CT numberとの関連

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<0.05). The % FVC value was also significantly lower in patients with high % LAA (77.1%) compared to the value in those with low % LAA (101.2%). The results suggest that a large volume of LAA<-950HU of the lungs can be observed in patients with asthma, and the % LAA is closely correlated with mean CT number and the values of FEV1% and % FVC.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<0.05)。% FVC値も同様% LAA値が低い症例(101.2%)に比べ高い症例(77.1%)で低い値を示したが両群間に有意の差は見られなかった｡これらの結果より,気管支喘息においも,HRCT上肺野で-950HU以下のLow attenuation area(LAA)を示す症例が見られること,そして,% LAAは,mean CT number,FEV1.0%や% FVC値とある程度関連していることが示唆された

Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.

Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination

Study on the relationship between the bone mineral densities measured by QCT and biochemical parameters.

当院内科に通院または入院中の女性患者24例(57～89才,平均71.8才)を対象とし,定量的QCT法による骨塩量測定と同時に血中骨代謝マーカーを測定し検討を行った｡年齢についての検討では,カルシウム(Ca)が70才台で60才台に比べ有意に高値であった以外は年代による有意差は認められなかった｡オステオカルシン(OC)とイオン化Ca(Ca(2+))との間にr=-0.50,p<0.01の有意の逆相関を認め,OCとBody mass indexとの間に有意の正の相関(r=0.41,p<0.05)を認めた｡平均骨塩量と各生化学parameterとの間には有意な相関はみられなかった｡副腎皮質ステロイド剤(ステロイド)投与群では非投与群に比べ,投与群でALP骨型アイソザイム(ALP3)高値,OC低値の傾向がみられた｡またステロイド投与症例はすべてOC値が8.4ng/mℓ以下であり,ステロイドによる骨粗鬆症誘発の機序として骨形成の抑制が関与している可能性が考えられた｡今後骨塩量と骨代謝マーカーとの関連について,若年者を含めた検討が必要と考えられた｡Bone mineral densities (BMD) were measured with QCT (quantitative computed tomography) in 24 females aged 57 to 89 years old to evaluate about relationship between BMD and biochemical parameters on bone metabolism (calcium : Ca, ionized calcium : Ca(2+), alkaline phosphatase : ALP, bone type isozyme of alkaline phosphatase : ALP 3 and osteocalcin : OC) in blood. As for exception that Ca was significantly higher in patients aged of 60's in comparison with those of 70's in the examination with regard to age, no significant differences were observed. Significant opposite correlation (r=-0.50, p<0.01) between OC and Ca(2+) and significant positive correlation (r=0.41, p<0.05) between OC and body bass index were observed. No significant correlation was observed between mean BMD and biochemical parameters. A trend of higher ALP 3 and lower OC was observed in adrenocortical steroid (steroid) administration group in comparison with patients with no steroid therapy. Also in steroid administration group, OC value was below 8.4ng/mℓ in all patients. Thus, it was suspected that the suppression of bone formation was related to the mechanism of osteoporosis induced by steroid. Then, the further studies on the relationship of BMD and these biochemical parameters including those of younger cases were considered necessary to clarify the mechanism of osteoporosis

Clinical opplication of a newly developed radiographic system including a fluoroscope equiped with CCD and digital image processor

画像の入力部に世界初100万画素の多画素･高精細のCCD(電荷結合素子)を用いたテレビカメラを搭載したX線テレビ装置とDigital・Radiography装置を導入し,主に消化管検査を中心に多目的に任用した｡このシステムは従来のscreen/filmシステムの持つ膨大な情報量を確保しながらCCDカメラのメリットを最大限に生かしており,DRシステムの特長であるリアルタイムのCRT撮影画像表示,透視像のFREEZE確認,動態解析,画像処理等を導入することにより診断能の向上がはかれた｡更に,従来X線フィルム･撮像管に比較して被曝量の大幅な低減が期待できた｡また,デジタルであるため撮影像をHDに保管すると共にMODにも記録･再生が可能である｡今後,PACSやフイルムレス電子媒体保管への展開の可能性についても確認できた｡We have clinically applied a newly developed radiographic system which was introduced into our institute in April 1994. This system consists of a fluoroscope, CCD (charge-coupled device) which had a million matrix, and digital image processor. This system has following advantages comparison with a conventional radiographic system ; (1) doses of x-ray exposuce during examination is less, (2) a sharp fluoroscopic image can be obtained by real-time image processing, (3) radiographic images can be kept in the recording device such as hard disc (HD) and magnetic optical disc (MOD) since this has a digital radiographic system. By connecting this system with main online system, it is expected to be able to see the various diagnostic images simulataneously as well as laboratory data at different spots of the hospital which is now available in other hospltal

Effects of vitamin D and exercise on bone mineral density (BMD) measuured by QCT

40才～84才(平均64.1才)の患者38例における骨塩量を,ある期間(1～15カ月,平均8.2カ月)をおいて2回,定量的QCT(quantitative computed tomography)法を用いて測定し,その経時的変化によって,骨粗鬆症に対する治療法の効果判定を試みた｡その結果,(1)全体として骨塩量に有意の増加は認められなかった｡(2)骨強化剤使用例についても骨塩量に有意の増加は認められなかった｡(3)運動療法施行者においても骨塩量に有意の増加は認められなかった｡以上のことから骨粗鬆症の治療においては,約1年弱の経過では著明な反応は得られにくいものと思われた｡ただし,一部の運動療法施行者,骨強化剤使用者において,骨塩量の著明な上昇が認められており,さらに経時的な観察が必要と思われた。Bone mineral density (BMD) was measured twice in 38 patients aged 40 to 84 years old for the last one year to evalute the effects of vitamin D and exercise on BMD. 1) In all patients, The BMD did not significantly increase. 2) In patients with vitamin D for osteoprosis, the BMD did not significantly increse compared to those without the drug. 3) In patients with exercise therapy, the BMD did not show any significant increase compared to those without exercise