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

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

The Clinical Significance of CT in the Preoperative Diagnosis of Colon and Rectal Cancer

The clinical significance of CT in the preoperative diagnosis of colon and rectal cancer was studied. Thirty four patients were investigated in this series. The diagnostic criteria of the CT examination were previously established in a study of wall invasion (S factor), lymph node metastasis (N factor), liver metastasis (H factor) and peritoneal dissemination (P factor). The CT diagnosis was done prospectively according to these criteria, and the CT diagnosis was compared with the macroscopic and histological diagnosis. The accuracy of the prospective diagnosis as to H, S, N and P factors was 79.4%, 55.9%, 41.2% and 20.6%, respectively. The diagnostic value of CT seemed to be acceptable as to the H factor, but limited to some extent to the S and N factors

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

Spa therapy for patients with respiratory disease. Clinical efficacy and action mechanisms of the therapy on asthma

呼吸器疾患に対する温泉療法は,最近の22年間にわたり行われてきた結果,その有用性は十分明かとなっている｡この22年の間に,温泉療法を受ける対象もかなり変わってきており,例えば気管支喘息では,ステロイド依存性重症難治性喘息の全症例に対する割合は明 らかに低くなってきている｡また,COPDでは最近全症例に対する肺気腫の割合も,また症例数も著明に増加しつつある｡一方,温泉療法を求めて来院される症例数は年ごとに増加する傾向にあり,初期の5年間と比べ,最近の5年間では,気管支喘息では8.2倍,また肺気腫では 34.8倍の増加が観察されている｡呼吸器疾患に対する温泉療法の作用機序としては,直接作用として,自･他覚症状の改善,換気機能の改善,気道過敏性の改善,気道抵抗の低下,肺の過膨脹の改善,過分泌の抑制などが観察される｡一方,間接作用としては,副腎皮質機能の改善,精神的リラックス,抗酸化酵素であるSOD活性の克進などが観察され,これらの間接作用も気管支喘息の病態改善に重要な役割を果しているものと考えられる｡Spa therapy which has been performed for patients with respiratory disease, particularly for those with asthma and pulmonary emphysema for last 22 years demonstrates that spa therapy is effective for asthma and pulmonary emphysema. The characteristics of patients with respiratory disease has been changing during last 22 years : the frequency of patients with steroid-dependent intractable asthma (SDIA) tends to decrease inspite of an increase in number of those with asthma who has been admitted at Misasa Medical Center for spa therapy. The frequency and number of patients with pulmonary emphysema has been increasing in recent years. Spa therapy has direct action mechanism for airways such as improvement of subjective and objective symptoms, and improvement of ventilatory function, bronchial hyperresponsiveness, and hyperinflation of the lungs. The therapy has also indirect action mechanism for other organs excluding the airways such as improvement of suppressed function of adrenocortical glands, psychological relaxation, and an increase in SOD activity. These indirect actions of spa therapy play an important role in treatment of the disease

Revisiting Discrete Dark Matter Model:\theta_{13}\neq0 and \nu_{R} Dark Matter

We revisit the discrete dark matter model with $A_4$ flavor symmetry originally introduced by M.Hirsch {\it et.al}. We show that radiative corrections can lead to non-zero $\theta_{13}$ and non-zero mass for the lightest neutrino. We find an interesting relation among neutrino mixing parameters and it indicates the sizable deviation of $s_{23}$ from the maximal angle $s_{23}^2=1/2$ and the degenerate mass spectrum for neutrinos. Also we study the possibilities that the right-handed neutrino is a dark matter candidate. Assuming the thermal freeze-out explains observed dark matter abundance, TeV-scale right-handed neutrino and flavored scalar bosons are required. In such a case, flavor symmetry plays an important role for the suppression of lepton flavor violating processes as well as for the stability of dark matter. We show that this scenario can be viable against currently existing constraints from collider, low energy experiments and cosmological observations.Comment: The wrong estimations in Eq(4.9) and Fig.14 in the published version of this paper are corrected. As the result, the prefered mass range for $\eta$ bosons are lowered. Some comments on constraints from rare lepton decays and SM precision test adde

慢性閉塞性肺疾患患者における温泉療法の６分間歩行に対する効果

Our previous studies have shown that subjective symptoms and ventilatory function are improved by spa therapy in patients with chronic obstructive pulmonary disease (COPD). In the present study, we investigated the effects of spa therapy on six-minute walk distance in patients with COPD . Subjects were 10 patients with chronic obstructive pulmonary disease (9 males and 1 female) admitted to our hospital to undergo pulmonary rehabilitation. All patients had complex spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution, and fango therapy) for 4 weeks. Ventilatory function, six-minute walk distance, oxygen saturation and Borg scale were measured. Vital capacity, forced expiratory volume in one second, sixminute walk distance and oxygen saturation increased, but not significantly. Significant decreases were observed for Borg scale. We found that spa therapy improved ventilatory dysfunction and six-minute walk distance in patients with COPD. The results demonstrated that spa therapy may lead to better disease control and exercise tolerance in patients with COPD.我々は温泉療法が慢性閉塞性肺疾患患者に対して, 呼吸機能改善効果を有することを報告してきた｡今回我々は慢性閉塞性肺疾患患者を対象に温泉療法の６分間歩行試験に及ぼす影響について検討した｡当院入院中の慢性閉塞性肺疾患患者10例(男性９例, 女性１例) を対象として, 温泉プール水中運動, 鉱泥湿布療法, ヨードゾル吸入療法等による複合温泉療法を4週間施行し, その間の呼吸機能, ６分間歩行試験における歩行距離, 動脈血酸素飽和度, 修正Borgスケールの変化を比較検討した｡呼吸機能検査では, 肺活量, １秒量 等の改善傾向が認められた｡６分間歩行距離, 動脈血酸素飽和度は上昇傾向にあった｡修正Borgスケールは有意に低下傾向した｡温泉療法により呼吸機能の改善が得られ, これにより動脈血酸素 飽和度及び６分間歩行距離が上昇したと考えられた｡温泉療法が慢性閉塞性肺疾患の治療に有用であることが示唆された

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

気管支喘息に対する年間薬剤費の重症度別検討

Costs of drugs used for the treatment for 1 year were examined in 32 pa-tients with asthma in relation to disease severity. Asthma severity was classified as : 1) intermiitent; 2) mild persistent; 3) moderate persistent; 4) severe persistent. 1. The total cost of drugs used for each patient for 1 year was the highest (￥263,710) in patients of stage 4 (severe persistent) and the lowest (￥74,670) in those of stage 1 (intermittent). The costs of bronchodilators and antiallergics were predominant at all stages, and their cost increased significantly with increasing severity. 2. The costs of drugs such as antiallergics and bronchodilators were predominant, and the costs of drugs such as inhaled corticosteroids and mucolytics were considerably high in pa-tients of all stages. 3. The costs of bronchodilators, inhaled corticosteroids, and antiallergics were the largest in patients of stage 4. The results suggested that the costs of durgs used for the asthma treatment tended to increase as the disease sever-ity became stronger from stage 1 to stage 4, and the maln drugs related to the in-crease in total costs were bronchodilators, antiallergics, and inhaled corticosteroids.気管支喘息32例を対象に,治療のために要した年間薬剤費を,国際ガイドラインの重症度分類(stage1-4)により検討した｡1.年間の総薬 剤費はstage4の症例で最も高く(平均¥284,370)、-万,stage1(平均¥74,670)で最も低い値を示した｡2.個々の薬剤費の検討では,抗アレルギー薬,気管支拡張薬などの薬剤費が高く,次で副腎皮質ホルモン(主として吸入薬),去疾薬の順であった｡3.気管支拡張薬,副腎皮質ホルモン,抗アレルギー薬などの薬剤費は,いずれもstage4で最も高い値を示した｡気管支晴息に対する薬剤費は,疾患が重症になるにつれて高くなる傾向を示した｡また,その主たる薬剤は気管支拡張薬,抗アレルギー薬,吸入用副腎皮質ホルモンなどであっ

Spa therapy for patients with respiratory disease. Analysis of 2485 patients admitted at Misasa Medical Center for last 23 years from 1982 to 2004

1982年から2004年までの23年間に三朝医療センターで入院加療した呼吸器疾患患者は2485例であった. これらの症例を対象に5年間毎にその年次推移を検討した. 2485例のうちわけは, 気管支喘息1489例(59.9%), COPD551例(22.2%),　その他445例であった. 1. 気管支喘息は, 第1期(1982-1986年)の5年間では, 平均11.4例/年であったが第4期(1997-2001年)では平均91.8例と初期と比べ8.1倍の増加が見られた. また, 第5期(最近の3年間)では87.7例/年であった. そのなかのステロイド依存症重症難治性喘息(SDIA : steroid-de-pendent intractable asthma)の占める割合は初期の68.4% から第4期では28.9％, 第5期の3年間では22.0% にまで低下する傾向を示した. 2. COPD症例は, 初期の5年間(1982-1986年)では平均5.2例/年から第4期には45.4例/年へと8.7倍の, また第5期では45.3例/年へと同様に8.7倍の増加が見られた. また, そのなかの肺気腫が占める割合は初期の19.2％ から第4期では76.7%, 第5期では87.4%と明らかな増加傾向を示した. 3. 気管支喘息および COPD 症例の年齢別検討では, 60歳以上の症例の頻度は第1期では30.1％ であったが, 第4期では68.0%, 阻止いて第5期では87.6% と, 年々その頻度は高くなっていく傾向が見られた. すなわち, 最近23年間の年次推移からは, 温泉療法を必要とする呼吸器疾患患者が増加しつつあること, そしてその年令は年々高くなる傾向にあること, そして, 以前とは異なり必ずしも重症難治性の症例ばかりでなく, むしろ比較的軽症例の入院が増加しつつあることなどが, 最近の傾向として注目される.Analysis of 2485 patients with respiratory disease admitted at Misasa Medical Center for last 23 years from 1982 to 2004 was performed every five years. Of all patients with respiratory disease, 2040 (82.1%) patients had asthma and chronic obstructive pulmonary disease (COPD). 1. Of 2040 patients showing obstructive ventilatory dysfunction, 1489 (73.0%) patients had asthma. The frequency of asthma in all patients with respiratory disease was 53.8% for the first 5 years from 1982 to1986, 71. 7% for the second 5 years, 73.6% for the third 5 years, 53.9% for the fourth 5 years and 47.8% for the last three years. 2. The frequency of steroid-dependent intractable asthma (SDIA) was from 22.0% to 41. 3% except the frequency (68.4%) for the first 5 years. The frequency of patients with SDIA showed a tendency to decrease in recent years. The frequency of patients with pulmonary emphysema in those with COPD was very low (19.2% for the first 5 years) tended to increase and 78. 5% for the fourth 5 years and 87.5% for the last three years. The frequency of patients over age 60 was 31. 0% for the first 5 years, and showed a tendency to in crease, and 68.0% for the fourth 5 years and 84.2% for the last three years. 3. The frequency of patients from distant areas outside Totton prefecture was larger compared to the frequency inside Totton prefecture. The number of patients from Okayama, Osaka, Hyogo, Tokyo, Ehime, Yamaguchi, and Kyoto was larger than the number from other distant areas