気管支喘息における気道内への好中球の出現とその意義 換気機能と関連して

Ventilatory function was compared between two age-matched asthma groups : group A (study group) consists of 8 patients with bronchial asthma with marked neutrophilia (20% or more) in the BAL fluid and group B (control group) of 8 patients with neutrophils (less than 5% of total BAL cells). The values of six ventilatory parameters were lower in group A than in group B, and a significant difference was found in FEV(1.0%), % MMF, % V(50) and % V(25) between groups A and B. Of these parameters, the value of % V(25) was markedly decreased in group A compared with group B. The results show that ventilatory dysfunction in airways, especially in small airways, is closely correlated to increased number of neutrophils in BAL fluid.気管支喘息を対象に,年令をmatchさせた2つのグループ,すなわち,気管支肺胞洗浄液(BALF)中の好中球の出現頻度が20%以上の8症例(グループA)と,BALF中の好中球の出現頻度が5%以下の8症例(グループB)における換気機能について比較検討を行った｡6つの換気パラメーターは,全般的にグループAにおいてグループBに比べ低い傾向が見られ,FEV(1.0%),% MMF,% V(50)および% V(25)値は,いずれもグループAにおいて有意に低い値が示された｡これらのパラメーターのうち,% V(25)値はグループBに比べグループAにおいて著明に低い値が示された｡これらの結果は,気道における換気障害,特に小ないし細気管支領域の換気障害は,BALF中の好中球の出現頻度とある程度関連していることを示すものと考えられた

Asthma classification by pathophysiology and IgE-mediated allergic reaction: new concepts for classification of asthma.

Bronchial asthma was classified by the pathophysiology and by the mechanism of onset of the disease. Forty asthmatics who had serum IgE levels lower than 200 IU/ml were evaluated by two classification methods. 1. In asthma classified by a score based on clinical findings and examinations, the characteristics of the findings and examination results were compared among three asthma types, i.e., Ia. simple broncho-constriction type, Ib. bronchoconstriction+hypersecretion type, and II. bronchiolar obstruction type. Type Ib patients, in addition to manifesting hypersecretion, had a significantly higher proportion of eosinophils in the bronchoalveolar lavage (BAL) fluid compared to other asthma types. Significantly decreased values for ventilatory parameters and an increased proportion of BAL neutrophils were found in type II compared with other asthma types. 2. In a new classification by mechanism of onset, asthma was classified into three types according to the degree of participation of IgE-mediated reactions associated with specific IgE antibodies and serum levels of total IgE: asthma induced by definite IgE-mediated reaction (atopic asthma), possible IgE-mediated reactions (asthma), and asthma induced by non-IgE-mediated reaction (asthma syndrome).</p

Asthma classification by a score calculated from clinical findings and examinations in subjects sensitive to inhalant allergens.

Twenty-one patients with atopic asthma were classified into three types according to their symptoms (clinical diagnosis): Ia, simple bronchoconstriction; Ib, bronchoconstriction + hypersecretion; and II, bronchiolar obstruction, and this classification was compared with a classification made according to clinical findings and examinations (score diagnosis). Type Ib asthma was characterized by the increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF), while type II was characterized by ventilatory dysfunction in small airways and the increased incidence of neutrophils in BALF. Four patients, whose expectoration was between 50 and 99ml/day, of the 12 with type Ia assessed by clinical diagnosis were evaluated as type Ib by score diagnosis. One patient with type II by clinical diagnosis was assessed as questionable type II by score diagnosis. In the other 16 patients, the clinical and score diagnoses were the same

SYMPATHETIC BLOCKADE AFTER STELLATE GANGLION BLOCK : A CONTINUOUS RECORDING USING SKIN POTENTIAL ACTIVITY

Skin potential activities (SPA) were used to assess the degree of sympathetic blockade after stellate ganglion block (SGB). The SPA were recorded bilaterally from the palmar thenar eminences in four outpatients before and after SGB. Before the SGB, the skin potential responses (SPR) on both sides were synchronous and their amplitudes were almost the same. After SGB, the SPR amplitude on the blocked side gradually fell from 1-2 minutes. Before SGB, the skin potential levels (SPL) on both sides were parallel and the lateral difference was constant. About 1-2 minutes after SGB, the SPL on the blocked side began to fall and then reached a stationary level 5 minutes after SGB. SPA variations due to factors other than peripheral blockade can be cancelled by bilateral recording. Thus, the net SPL decrease on the blocked side compared with that on the non-blocked side was proved to be a useful index for continuous, quantitative monitoring of the sympathetic blockade by the SGB