腰椎MRI画像と腰痛の関係

The purpose of this study was to examine the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP). The study group, 19 patients with low back pain (2 subjects aged 32-39 years and 17 aged 59-78), underwent MRI of the lumbar spine. Disc degeneration at L4/5 was the most common finding (68.4%). Overall in present study, all patients with LBP had abnormalities around the lumbar spine (evidence of disc degeneration, deformity of lumbar spine, disc bulging or protrusion, facet hypertrophy, nerve root compression and so on).この研究の目的は腰痛評価におけるMRIの役割を検討することであった｡対象は腰痛を訴え腰椎MRIを受けた19名(32歳から39歳2名,59歳から78歳17名)であった｡椎間板変成はL4/5levelで最も多く認められた(68.4%)｡本研究において腰痛を有する全患者に腰椎の異常(椎間板変性,disc bulging, protrusion, facet hypertrophy,神経根圧迫,腰椎変形など)を認めた

ステロイド依存性重症難治性気管支喘息症例における胃粘膜病変の検討

Recently, we experienced two asthmatic patients with advanced gastric cancer. The two patients had steroid-dependent intractable asthma (SDIA) who had been on administration of corticosteroids for more than 2 years. To determine the influence of pathophysiology of SDIA on stomach mucous lesion, gastroscopic examinations and immunological examinations were performed in eight patients with SDIA, compared with 25 patient with non-SDIA. In patients with SDIA, gastric cancer, its precursor condition and immunosuppressive state were observed. These results suggest that the immunosuppressive state in SDIA induced by the long-term administration of corticosteroids may lead to the risk of gastric cancer development.最近,進行胃癌を合併した気管支喘息症例を2例経験した｡2症例ともにステロイド依存性重症難治性喘息(SDIA)症例であり,SDIAが胃悪性腫瘍に関与している可能性が考えられた｡今回,SDIA症例における胃粘膜病変の臨床像および背景因子を検討する目的で,8例のSDIA症例における胃内視鏡検査,末梢血液分画,免疫グロブリン定量を行い,非SDIA症例と比較検討を行った｡SDIA症例においては胃癌･前癌状態が認められたが,非SDIA例では認められなかった｡SDIA群において,末梢血白血球は有意に増加し,リンパ球分画･IgGは有意に減少していた｡これらの結果より,ステロイド依存性重症難治性気管 支喘息症例においては免疫状態が抑制され,胃悪性腫瘍が発生する危険性があるものと考えられた

鼻腔･副鼻腔疾患を合併する気管支喘息症例に対するクラリスロマイシン投与の効果

We experienced a case of 59-year-old woman with intractable asthma, who had aspirin intolerance. Despite various treatments including systemic corticosteroid administration, she was often admitted due to severe asthma attacks. Furthermore, she had allergic rhinitis and sinusitis. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa and air-fluid level in maxillary sinuses. Although her asthma symptoms such as wheezing and dyspnea were improved by administration of bronchodilator, systemic corticosteroids and beclomethasone diisoccyanate (BDI) accompanied with spa therapy, her peak expiratory flow (PEF) showed no improvement. After readmission due to asthma attacks, clarithromycin (CAM) administration for sinonasal disorders was started. The PEF value showed marked improvement after starting CAM administration, and pulmonary functions and bronchial hyperresponsiveness were also improved. It is suggested from her clinical course that CAM may have beneficial effects in asthmatic patients with sinonasal disorders.気管支喘息にアレルギー性鼻炎や副鼻腔炎を合併する症例は頻回に経験される｡副鼻腔炎症状の増悪が喘息症状の増悪を引き起こす症例も存在し,鼻腔･副鼻腔における炎症が気管支喘息の病態と何らかの関係を持っていることが考えられる｡今回,59才の難治性アスピリン喘息症例を呈示する｡副腎皮質ホルモンの全身投与を含めた様々な治療にも関わらず頻回に重篤な喘息発作を呈し,入退院を繰り返している症例である｡アレルギー性鼻炎も合併し,CTでは著明な鼻粘膜肥厚と上顎洞の鏡面形成が認められた｡入院後の投薬や温泉療法によって呼吸困難は改善したが,ピークフロー値は上昇が認められないまま退院となった｡再入院後,副鼻腔炎に対しクラリスリマイシン投与を開始したところ､ピークフロー値は著明に改善を示し,肺機能･気道過敏性も改善した｡この症例のように,鼻腔･副鼻腔疾患を合併する気管支喘息症例に対しては,クラリスロマイシン投与が有効である可能性が考えられた