Clinical significance of spa therapy in the treatment of patients with chronic obstructive pulmonary disease (COPD). A study on 520 patients with COPD admitted for last5 years.

1992年1月より1996年12月までの5力年間に当院へ入院した慢性閉塞性呼吸器疾患520例を対象に,疾患の種類,年齢,地域分布などについて検討を加えた｡1.最近5年間に当院へ入院した呼吸器疾患患者は588例で,このうち,慢性閉塞性呼吸器疾患患者は520例(88.4%)であった｡これらの慢性閉塞性呼吸器疾患のなかでは,気管支喘息が433例(83.3%)と最も多く,その他,慢性気管支炎19例,閉塞性細気管支炎33例,肺気腫35例であった｡2.慢性閉塞性呼吸器疾患の年齢別検討では,鳥取県内および遠隔地(鳥取県外)いずれの症例においても,60-69才および70才以上の症例が多い傾向が見られた｡3.入院患者の地域分布では,鳥取県内からの入院患者に比べ,遠隔地(鳥取県外)からの入院患者がより多く,その分布別検討では,岡山県,兵庫県,大阪腐,広島県,山口県,愛媛県からの入院患者が多い傾向が見られた｡The kind of respiratory diseases, age, and areas where patients came from were discussed in 520 patients with chronic obstructive pulmonary diseas (COPD) admitted at Misasa Medical Branch for last 5 years from 1992 to 1995. 1. For the last 5 years 588 patients with respiratory diseases were admitted at Misasa Medical Branch. Of these patients, 520 were those with chronic obstructive pulmonary disease (COPD). Of the 520, 433 (83.3%) were patients with asthma" 19 with chronic bronchitis, 33 with obstructive bronchiolitis, and 35 with pulmonary emphysema. 2. Regarding the distribution of age of these patients, patients between the ages of 60 and 69, and those over the age of 70 were more frequently observed, regardless of the area where patients came from (inside or outside Tottori prefecture). 3. The number of patients from distant areas (outside Tottori prefecture) was larger than the number of those inside Tottori prefecture. The number of patients from Okayama, Hyogo, Hiroshima, Osaka, Yamaguchi, and Ehime prefectures was predominantly larger than the number from other distant areas

呼吸器疾患のリハビリテーション.気管支喘息の病態的特徴と関連した温泉療法の効果

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

Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report

Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis

Inferior Vena Caval Thrombosis After Traumatic Liver Injury

We report here the case of a 35-year-old man who presented with inferior vena cava thrombosis (IVCT) after blunt hepatic trauma. The IVCT was incidentally detected by computed tomography (CT) 35 days after deep parenchymal suturing and suture approximation for liver lacerations. The patient denied any symptoms of thrombophlebitis. However, he had presented with significantly elevated values of FDP-D-dimer and a modest increase in plasminogen concentration, which indicated that he had been in a hypercoagulable and hypofibrinolytic state after the operation. He had not undergone any prophylactic anticoagulant therapy because of his concomitant subarachnoid hemorrhage and huge hepatic hematoma. The patient was treated with an emercy thrombectomy. Posttraumatic IVCT is extremely rare phenomenon. We should consider IVCT in patients with a severe hepatic injury, particularly if their coagulation system change into hypercoagulable and hypofibrinolytic state. Additionally, this case made us reflect on the treatment of traumatic liver injury

気管支喘息症例における臨床的特徴と鼻腔･副鼻腔のCT所見の関連について

Extent of nasal and maxillary mucosa lesion was estimated in 26 asthmatics using computed tomographic scan in relation to clinical features of the disease. 1. No significant differences were present in nasal mucosal thickening between atopic and non-atopic subjects. No significant differences were also present in occupancy rate of mucosa in maxillary sinuses between the two asthma types. 2. Nasal mucosal thickening was not significant different between subjects with steroid-dependent intractable asthma (SDIA) and those without SDIA. Maxillary mucosal lesions were more extensive in subjects with SDIA than in those without SOIA. However, no significant differences were observed in occupancy rate between the two types. 3. No significant differences were observed in nasal mucosal thickenings between in subjects with and without aspirin-induced asthma (AlA). Although maxillary mucosa lesion in subjects with AlA was more extensive than that in those without AlA, the differences was not significant. 4. There was not any correlation between nasal mucosal thickening and amount of expectoration per day. However, significant differences were observed in maxillary sinus lesion between subjects with less amount (<50mℓ/day) and those with large amount of expectoration (100mℓ/day≦)(p<0.002), and between subjects with moderate amount (50-99mℓ/ day) and those with large amount of expectoration (p<0.002). The results might suggest that in asthmatics with large amount of expectoration, sinus diseases affect pathophysiology of asthma, and asthmatics with large amount of expectoration should have therapy for sinus disease to improve asthmatic status.気管支喘息26症例において喘息の臨床的特徴と,鼻腔･上顎洞のCT所見の関連について検討を加えた｡1.鼻腔粘膜肥厚はアトピー症例,非アトピー症例間で有意な差は認められなかった｡上顎洞における粘膜肥厚比率(1slice上の上顎洞面積に対し,上顎洞粘膜が占める割合)も,アトピー･非アトピーで差は認められなかった｡2.ステロイド依存群･非依存群においても,鼻腔粘膜肥厚･上顎洞粘膜肥厚に有意な差は認められなかった｡3.アスピリン喘息症例においては,非アスピリン喘息症例に比べ,上顎洞粘膜肥厚が顕著であっ たが有意ではなかった｡鼻腔粘膜肥厚は2群間で差は認められなかった｡4.発作時の一日喀痰量との関連では一日喀痰量が100mℓ以上の症例群では,喀痰量が50mℓ以下の群･50-100mℓの群に比較して有意に上顎洞粘膜肥厚比率が高値を示した｡鼻腔粘膜比率に関しては3群間で有意な差を認めなかった｡以上の結果から,喀痰量の多い気管支喘息症例では,その病態に副鼻腔病変が影響を及ぼしている可能性が考えられ,副鼻腔病変に対する治療により,気管支喘息が改善する可能性が考えられた

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

気管支喘息におけるアレルギー性鼻炎と花粉抗原に対するIgE抗体

IgE antibodies against inhalant allergens were estimated in 53 patients with bronchial asthma in relation to allergic rhinitis. Of them, 20 patients (37.7%) had allergic rhinitis. 1. Asthma + allergic rhinitis were often observed in patients between the ages of 0 and 39. In contrast, asthma alone in those over age 60. 2. A RAST score was positive in house dust mite (HDm)(50.9%), cockroach(24.5%), and Candida (26.4%) in these patients, and the positive rate was not different between patients with and without allergic rhinitis. 3. The frequency of positive RAST against Japanese cedar and rice plants was higher in patients with allergic rhinitis (42.9% and 18.5%) than in those without allergic rhinitis (28.6 and 3.7%), however, the each positive rate or RAST against the two allergens was not significantly different between those with AR and without AR. 4. The number of patients with AR induced by pollen alone (pollinosis) was not large ( 5/53, 9.4%) in the patients with asthma. It was clarified from the results that allergic rhinitis was often observed in asthma patients, but not pollinosis. and that IgE antibodies against Japanese cedar and rice plants were found even in patients without AR.気管支喘息53例を対象に,吸入抗原に対するIgE抗体とアレルギー性鼻炎の合併の有無との関連について若干の検討を加えた｡対象53例中20例(37.7%)にアレルギー性鼻炎の合併が見られた｡ 1.喘息+アレルギー性鼻炎の合併は,0-39才の年齢層で最も多い傾向であったが,一方,喘息単独は60才以上の症例に多く見られた｡2,IgE抗体の陽性率は,それぞれHDm50.9%,ごきぶり 24.5%,カンジダ26.4%であった｡これら抗原のRAST陽性率は,アレルギー性鼻炎合併例と非合併例の問に有意の差は見られなかった｡3.スギおよびイネ科の花粉に対するRAST陽性率はアレルギー性鼻炎合併例で(スギ42.9%,イネ科18.5%),非合併例に比べ(28.6%と3.7%)高い傾向が見られたが,両群間に有意の差は見られなかった｡4.花粉抗原によるアレルギー性鼻炎(花粉症)の頻度は9.4% (53例中5列)とあまり高くはなかった｡以上の結果より,気管支喘息患者でしばしばアレルギー性鼻炎の合併が見られること,(しかし, 花粉症は少ない),そして,スギおよびイネ科の花粉に対するIgE抗体は,アレルギー性鼻炎の合併のない症例においても観察されること,などが明らかにされた

Clinical effect of spa therapy on lumbargo

腰痛症患者12例を対象に温泉療法の臨床効果について検討した｡臨床効果の判定は,日本整形外科学会の腰痛治療成績判定基準に基づき,自覚症状,他覚症状,及び日常生活動作などの項目を中心に,治療前後で比較検討した｡その結果,自覚症状,日常生活動作,総計では,治療前に比べ治療後に有意の改善がみられた｡また改善指数や改善率での検討でも温泉療法の有効性が示唆された｡年齢別(60才以上と60才未満),入院期間(80日以上と80日未満)別の 検討では,65才未満の症例,80日以上の入院の症例において,改善指数,改善率が,有意差はみられなかったもののより高い傾向がみられた｡Clinical effect of spa therapy was evaluated in 12 patients with lumbargo by a scoring system based on the standard judgement of therapy for lumbargo by Japanese Society of Orthopedics. The score for each category of subjective symptoms, objective symptoms, daily life activity, and disorder of urinary bladder, and total score calculated from each score were compared before and after spa therapy. A significant improvement of subjective symptoms, daily life activity, and total score was observed after spa therapy. However objective symptom was not significantly improved. The effects of spa therapy was larger in patients under age of 65, and in those who had long-term spa therapy more than 80 days during their admission. The results suggest that spa therapy IS effective for patients with lumbargo

Effect of spa therapy on peak expiratory flow in patients with bronchial asthma

気管支喘息に対する温泉療法の効果をピークフローメーターを用いて継時的(第1週,第5過,第9週)に検討した｡1.軽症･中等症では,第5週で有意にピークフロー (PEF)値は上昇した.重症気管支喘息例では第9週に有意な改善を認めた｡2.20%以上のPEF値の改善を認めた症例の割合は第5週では,軽症･中等症･重症群で40～50%であったが,第9週では軽症群で80%,重症群で54.5%に増加していた｡中等症群では第5週と同等であった｡3.第1週のPEFが200(L/m)以下の症例では第5週,第9過とPEFの有意な改善を示したが,200<PEF≦300の症例,300<PEFの症例では有意な改善は認められなかった｡4.PEF≦200(L/m)の症例群において,20%以上のPEFの改善を示す症例は,第5週で57%,第9週で69%と高率であった｡200<PEF≦300の症群,300PEFの症例群では第9週で40%以上の症例が20%以上のPEFの改善を示した。The aim of this study was to investigate effects of spa therapy on peak expiratory flow (PEF) in patients with bronchial asthma. Morning PEF metry was studied in fifty asthmatics who had spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution and fango therapy) for 5 - 9 weeks. Mean values of morning PEF at the initial stage, 5 and 9 weeks after spa therapy were assessed. In mild and moderate asthmatics, PEF significantly improved 5 weeks after spa therapy. In severe asthmatics, PEF showed significant increase 9 week. The number of subjects with PEF improvement more over 20%, compared with the intial value of PEF, were 50% at 5 weeks and 80% at 9 weeks after spa therapy in mild asthmatics. In moderate asthmatics, however, the number little changed between 5 (39.3%) and 9 weeks (38.9%) after the therapy. In severe asthmatics, 57.1% at 5 and 68.8% at 9 weeks. In asthmatics with the initial value of PEF<200L/m (low PEF group), the value showed significant increase 5 and 9 weeks after the therapy compared with the initial value. In asthmatics with the initial values of 200≦PEF<300 (middle PEF group) and　300≦PEF (high PEF group), the values showed no significant increase. The number of subjects with PEF improvement more than 20% showed a tendency to increase 9 weeks in low, middle and high PEF group, compared to the value after spa therapy (57.1% to 68.8%, 21.4% to 50% and 35.7% to 42.9%, respectively )