岡山医学会Acta Medica Okayama0030-1558963-41984肩関節石灰沈着性腱板炎の病態に関する研究 ―特に石灰化結晶の微細構造について―435448ENMasashiIshikawaCalcified substances from lesions of calcified tendinitis of the shoulder (CTS) were studied by scanning electron microscopy (SEM) and polarized light microscopy. The substances were also analysed by infra-red spectrography. The rotator cuffs of the shoulder in 9 cadavers were observed by light microscopy. In the histological study of the rotator cuffs, various degenerative changes, such as separation and irregular arrangement of the collagen bundles and hyalinization at the attachment of the rotator cuff tendon to the bone were found. Calcification at the tendon insertion was also detected at the blue line area, which was stained with hematoxylin, while the musculo-tendinous juntion was intact. Scanning electron micrographs showed that calcified deposits in the CTS lesions were made up of granular crystals (0.1-0.2μ in diameter) accumulating into round particles (3-10μ in diameter). Infra-red spectrography demonstrated that the deposits were similar to commercially available hydroxyapatite. Calcification can be induced by aging and mechanical stresses which proceed degenerative changes and circulatory disturbances at the tendon insertion. The calcified crystals, composed of hydroxyapatite, can push into the subacromial bursa and cause crystal-induced synovitis.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984酵素抗体法による胃癌組織内collagenaseの検索421433ENYasutaTsutsui胃癌が発育進展するとき,あるいは潰瘍が進行,治癒するときには病巣及び病巣周囲の間質結合織はそれに伴い崩壊する一方,増生もしてくる.この間質の変化は,結合織崩壊に働く因子と増生に働く因子の均衡によっている.結合織崩壊の因子の中で最も重要なものの一つとして,生理的条件下でcollagen分子を特異的に分解するcollagenaseがあげられる.浸潤しつつある癌の先進部では,癌細胞より分泌されたcollagenaseを主とする蛋白分解酵素が間質を破壊し,その間隙を癌細胞が拡がって行くと考えるのが妥当であろう.すでに胃癌浸潤とcollagenaseの関連について,胃癌組織各部のcollagenase活性を計測し,癌先進部で最も活性が高く,胃癌の進展にcollagenaseが関与しているとの報告がある.しかし,そのcollagenaseが胃癌細胞から分泌されているのかという最も興味ある疑問に答えることはできていない.著者はcollagenase抗体を作製し,免疫組織学的方法(酵素抗体法)を用いて,胃癌組織内におけるcollagenaseの局在を検索した.その結果collagenaseは間質側に多く存在するが,癌細胞内にも存在することを確認した.また胃癌を組織型別,深達度別,浸潤様式別等に分類し,各組織でのcollagenaseの局在を検索し,これらの結果や他の報告をも含めて,胃癌の進展にcollagenaseがどのように関与しているのか考察した.更には対照組織として正常ヒト皮膚,胃潰瘍,大腸癌を検討し,各組織におけるcollagenaseの局在と免疫学的組織特異性の有無も検討した.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984小児のTRH負荷試験におけるthyroid stimulating hormoneの分泌動態の解析411420ENKumikoArakiJoujiHiguchiSusumuKanzakiMasahiroKatayamaYuusukeHimotoYoshiyukiUchidaTakeoOguraChiharuFujitaHiroshiKimotoIn order to establish the quantitative parameters indicating serum thyrotropin dynamics after TRH stimulation, we measured the maximum incremants in TSH above the baseline level (max. 儺SH), the percentage ratio of the TSH level at 30 min to that at 15 min (R 30/15) and the percentage ratio of the TSH level at 120 min to that at 30 min (R 120/30) in 145 normal children. The geometric means (-2SD and+2SD) of max. 儺SH, R 30/15 and R 120/30 were 11.2% (3.9 to 32.5) uU/ml, 101.1% (75.9 to 134.7) and 38.9% (25.8 to 58.5), respectively. The values were compared with those of variables computed from the mathema-
tical model of Okuno et al. (1977), i.e., C=(a/(β-α))•(Q(0)/V)(e(-αt)-e(-βt)＋Coe(-βt)where α=the rate constant for TSH release, β=the rate constant for TSH elimination, and Q(0)/V=the serum TSH releasing value per minute. Highly significant correlations were found between max. 儺SH and Q(0)/V (p<0.001), between R 30/15 and α (p<0.001) and between R 120/30 and β (p<0.001). The values of max. 儺SH also correlated well with the integrated secretion of TSH (p<0.001). These results suggest that our three parameters are more practical and useful indicators of serum TSH dynamics after TRH stimulation than the cumbersome mathematical model of Okuno et al. (1977), facilitating the detection of mild delayed TSH response.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984気管支喘息に対する温泉療法の臨床効果 ―過去2年間の入院症例を対象に―405410ENYoshiroTanizakiHarukiKomagoeMichiyasuSudoJitsuoNakagoHiroshiMorinagaJunOhtaniShinyaTadaKiyoshiTakahashiIkuroKimuraSeventeen inpatients with bronchial asthma, including 15 steroid-dependent intractable asthmatics, received spa therapy (swimmimg tratning in a hot spring pool) for 3 months at Okayama University Medical School, Misasa Branch Hospital. Clinical effects of spa therapy on these patients were evaluated regarding patient age, age at onset of disease and each asthma type classified by clinical symptom. Spa therapy was markedly effective in 5 cases (29.4%), moderately so in 7 cases (41.2%) and slightly so in 4 cases (23.5%). Reduction of the corticosteroid dose was made possible in 12 patients (80%) out of the 15 steroid-dependent asthmatics. Spa therapy was more effective in patients over 41 years old and in patients whose age at onset was 21 years or over. Clinical symptoms were improved more in the asthmatic group with bronchiolar obstruction and with bronchospasm-hypersecretion than in cases showing only bronchospasm.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984肺葉Sleeve切除術後の長期生存犬における気管支・肺の形態学的研究391403ENShinMatsumotoMorphological changes of the bronchus and lung tissue of ten adult dogs were examined at various intervals after sleeve resection of the left upper lobe was performed in combination with bronchoplasty and pulmonary artery angioplasty. Postoperative changes in the bronchus and pulmonary artery were investigated by bronchoscopy and pulmonary angiography 8 months to 14 months after the operation. The dogs were sacrificed 9 months to 32 months after the operation, and the bronchus and lung tissue were submitted for microscopic and scanning electromicroscopic investigation. The bronchial mucosa at the anastomosis showed irregular height of the mucosal epithelial cells, the continuity of which was smooth with normal cilial appearance. The peripheral lung tissue showed no obvious difference between the operated lobe and the non-operated one. Dilatation of the internal diameter of the bronchial anastomosis was seen in 3 dogs in which the bronchial cartilage showed a degenerative change at the anastomosis. These changes were thought to be related to the anastomosis method and suture tension. Therefore it was suggested that much attention was paid to the bronchial anastomosis. Absorbable suture material, Dexon, was well absorbed and showed no foreign-body or inflammatory reaction. Based upon these results, excellent healing can be expected after sleeve resection despite some degenerative changes, and the clinical application of this procedure seems acceptable.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984電子レンジによるおしぼり付着菌の殺菌効果385389ENIzumiKoujimaHiroshiYamamotoMarilia AkemiYamamotoTomoakiNakamuraEikoNagamachiMasakoTerasakaYasuhiroKanemasa電子レンジによるおしぼり付着菌の殺菌効果について検討した.菌付着おしぼりを1本ずつ照射する実験ではE. coli, S. aureus, P. aeruginosaの細菌類は2分間程度のマイクロ波照射で殺菌された.真菌類のC. albicansも3分で殺菌された.しかしB. subtilisの芽胞は5分間のマイクロ波照射でも10%の生残が認められた.実際面を考慮しておしぼり10本程度を同時に行なう場合は,効率的にやや長時間を要するが,芽胞以外のものを対照にする限り5分照射で充分である.電子レンジによるおしぼりの殺菌は手軽に短時間にしかも効果的になされることが判明し,自家処理おしぼりの殺菌にはもちろんのこと業処理おしぼりの追加殺菌にも有用であると考えられる.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984腸球菌および糞便性大腸菌の水質汚染指標性に関する検討377384ENIzumiKoujimaTomohisaKanataniAkiraKumodeYasukoNodaAkihiroFukuharaNorikoMoriYasuhiroKanemasa腸球菌および糞便性大腸菌の水質汚染指標性の検討を行ない次のようなことが判明した.○人糞便中に腸球菌は糞便性大腸菌の約10倍多く存在していた.○糞便水を25℃におくと糞便性大腸菌は増殖したが,腸球菌は増殖しなかった.○メンブランフィルター濾過滅菌河川水中でE. coliは微小濃度の栄養源を利用しているものと考えられる増殖を示した.一方,消化器系 病原菌(Sal. typhi, Sh. sonnei)は4日程度ですみやかに死滅するが,腸球菌はそれよりやや遅く死滅する良好な生残性を示した.○野外調査を行ない河川水から腸球菌・糞便性大腸菌の検出を行なった結果, 50例による両者の相関係数は+0.71で糞便汚染指標菌として相関性があることが示され,量的には腸球菌が糞便性大腸菌の2.3倍多く検出された.○検査における手技の簡便性を考察すると糞便性大腸菌の検出は培養温度(44.5℃)の管理がわずらわしく,ルチンとしては不向きであると考えられた.以上のことから腸球菌は糞便性大腸菌よりも公共用水の汚染指標として有用であると結論された.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984生体中のマンガン,鉄,亜鉛,銅,鉛,水銀,カドミウムなどの濃度分布359376ENKeijiroMoritaMasanaOgataThis paper deals with the levels and distribution of manganese (Mn), zinc (Zn), iron (Fe), copper (Cu), lead (Pb), marcury (Hg), cadmium (Cd) and other trace metals in 3 kinds of biological samples relevant to the food chain. Eightly-eight human whole blood samples were taken from 20-59 year old normal adult subjects (57 males and 31 females) in Okayama Prefecture, and the heavy metal concentrations were mesured with a flame or flameless atomic absorption spectrophotometer. The order by level of heavy metals in the whole blood was Fe, Mg, Ca, Zn, Cu, Pb, Mn and Cd. The analytical values of each metal approximated a log-normal distribution. The levels of Fe, Mg and Zn were higher in males than in females, while that of Cu was higher in females high correlation coefficients were obtained between Pd-Cd, Pb-Cd, Cd-Mn and Cd-Fe. The levels of Fe and Zn in males had a negative correlation with thier age. On the other hand, that of Ca and Mg in females had a positive correlation. The heavy metal levels in the fethers of crows were examined as a biological index of heavy metal contamination. The order of heavy metals in feathers was: Zn, Fe, Mn, Pb, Hg and Cd. The concentrations of Pb and Mn were from 3 to 10 times higher in the feathers of crows than in human hair. The concentraiton levels of Cd and Cu were higher in the southern part than in the northern part of Okayama Prefecture. There were significant regional differences in the levels of Pb, Cd and Cu. The order of heavy metals in oyster was Zn, Cu, Mn, As, Ni, Cd, Pb, Se and Hg. The concentration of Zn and Cu had a significant correlation with the size of the oyster. The order of biological concentration was; Zn (22.3×10), Se, Cu, Mn, As, Ni and Pb (7.75×10(3)-0.22×10(3))No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984マンガンの生体影響に関する研究 第4編 マンガン及びバナジウムのラット肝ミトコンドリアの酸化的リン酸化反応に及ぼす複合作用353358ENKeijiroMoritaCooperative effects of Mn(2+) and V(5+) on the energy transfer reaction of rat liver mitochondria were investigated. Mn(2+) (0.10-0.05mM) increased State 4 resperation and decreased State 3 respiration, indicating an uncoupling action on the mitochondria. V(5+) alone at the concentration of 0.1-0.8 mM had no noticeable effect on mitochondrial respiration. In the presence of V(5+), Mn decreased both State 3 and State 4 respiration. The degree of the inhibition was extreme in State 3 respiration at a low concentration of Mn. The change from the accelation of State 4 respiration by Mn(2+) alone to its inhibition by Mn(2+) and V(5+) suggests an incease of cleteriovation in mitochondrial function by the cooperative action of Mn(2+) and V(5+). Cooperative effects of Mn(2+) and Mg(2+) on the energy transfer reaction have been described. In the presence of Mg(2+), the uncoupling action of Mn(2+) was not observed, suggesting that the injurious effect of Mn(2+) on mitochondrial membrane was depressed by Mg(2+). However, phosphorylation activity was more strongly inhibited with Mn(2+) and Mg(2+) together than with Mn(2+) alone.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984マンガンの生体影響に関する研究 第2編 マンガンヒュームの性状と吸入動物による運命及び血清酵素の変動341351ENKeijiroMoritaThe present study was designed to examine the physicochemical properties and effect of generated with an manganese fumes atomic absorption buner. Mice were exposed to approximately 9.5mg/m for 1, 3, 5, and 8 hours. Manganese levels in the lung, liver, kidney and brain were measured 1, 3, 5, 10 and 15 days after the inhalation. The chemical from of Mn in the fumes was wore matallic than oxide. Observation though the electron microscope showed the presence of fine particles (0.02-0.1μm) in the Mn fumes. Manganese fumes rapidly accumulated in the lungs and subsequently moved into various organs through the blood. The biological half life (BHL) of manganese in the lungs was calculated to be 0.82 days and 75.26 days and in the brain 12.76 days and 58.59 days. Manganese content in the brain was significant, but only half that of the other organs.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984マンガンの生体影響に関する研究 第1編 溶接作業場及び居住地域におけるマンガンの性状と気中濃度327339ENKeijiroMoritaIn the present study, the author examined the physicochemical properties and the atomospheric levels of manganese and other heavy metals in the suspended particulate matter of a welding workshop and a residential area neighboring an iron works. α-Fe(2)O(3) and Fe(3)O(4) were the main components of the suspended particulate matter collected in the atomosphere around both areas. The total suspended particulate matter of the welding process (welding TSP) also contained MnFe(2)O(4) formed from Fe(3)O(4) by exchange of Fe with Mn, metalic Mn and an alloy from of Mn-Fe. These findings were obtained by X-ray diffractometry. Observation through the electron microscope showed the presence of fin particles (0.5-1.5μm) in welding TSP, and attention should be given hazards. The concentration of the metals in the welding TSP was about 10 to 30 times higher than that in the covering materials of the welding rods. Exposure levels of manganese in the welding workshop at a breathing zone ranged from 0.4 to 1.0μg/m(3) and the levels were reduced to one tenth by using a welding mask. Levels of manganese have decreased from a maximum median levels of 0.24μg/m(3) in 1971 to 0.15μg/m(3) in 1981. The order of content of the metals in the paticulate matter was: Fe, Cu, Zn, Pb, Mn, V, Ni, and Cd.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984ヒト髄液中のグアニジノ化合物に関する研究 ―特にてんかん患者について313325ENNoboruFujimotoGuanidino compounds in cerebrospinal fluid (CSF) of nonneurological and epileptic patients were investigated. After separating using high performance liquid chromatography, and reacting with phenanthrenequinone, the compounds were analyzed fluorometrically. Arginine (Arg), creatinine (CRN) and homoarginine (HArg) were found in all subjects. Trace amounts of guanidinosuccinic acid (GSA) and guanidinoacetic acid (GAA) were detected in some subjects regardless of disease state. Positive correlations were noted in females between Arg and CRN levels and age. Serum Arg and HArg levels were related to in urine concentrations, but there was no association between CSF guanidino compound levels and serum levels. Guanidinoethanesulfonic acid (GES) was detected in the CSF of some epileptic patients. This was confirmed by high voltage paper electrophoresis. This finding suggests that GES may relate to epileptic seizure mechanism.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984散発性A型肝炎の臨床像 ―その臨床症状,経過と予後について―305312ENTetsuyaFukudaGotaroYamadaHiromichiOgawaHiroakiOkushinIchinosukeHyodoTakashiNishiharaMotowoMizunoYujiSakamotoHideoNagashimaKazuhideYamamotoToshinariKobayashiTomoroYoshidaClinical and laboratory features of 66 patients with sporadic hepatitis A were evaluated from October 1978 to July 1981. Jaundice was reported in 88.6% of the patients, and the frequency of skin rash was 15.7%. Less than 5% atypical lymphocytes were noted in 29.5% of the patients. Proteinuria and hematuria were present in 23.4% and 6.3% of the patients. However, immune complexes were not detected in their sera. One of the patients who had hematuria developed acute renal failure. About 10% of the patients transiently showed both low levels of cholinesterase and cholesterol and prolongation of the prothrombin time. There was no patient with fulminant hepatic failure. Liver function tests returned to normal except for 3 patients within 3 months. For 10 months after the onset, slight elevation of SGPT peristed in the patient with acute renal failure and also in a patients with a previous history of liver disease. One of two patients with acute intrahepatic cholestasis showed protraction of mild hyperbilirubinemia more than 6 months after the onset of acute illness.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984慢性関節リウマチにおける全股関節置換術例の臨床的および病理学的研究289304ENMotomasaFujiwaraFrom 1972 to 1981, 75 total hip replacements were performed on 56 patients with rheumatoid arthritis in our department. Eleven patients had definite RA and the other 45 had classical RA, according to the criteria of the American Rheumatism Association. The age at operation was 27 to 68 years (average, 51 years), and the average duration of the disease was 13 years. A Charnley type prosthesis was used in 41 hips and a Charnley-Muller type in 34 hips, including 19 replacements with a cup supporter. Setting the cup in the proper position was very difficult, especially in the cases with protrusio acetabuli (PA). A cup supporter was, therefore, devised in our clinic to get a good cup setting by combining the supporter with the Charnley-Muller type prosthesis. Assessment of the patients' movement was carried out by a method described by Fujibayashi and others. Twenty-three patients improved within 2 years of the operation, but poor results were found in patients with knee destruction and complications such as deep infection (1 case) and prosthesis loosening (1 cases). Destruction of the rheumatoid hip was studied roentgenographically. Pathology of the excised femoral head and synovium was compared with the X-ray findings in relation to drug therapy. Preoperative X-ray examination, according to criteria of Uchida et al. (1978), showed the atrophic type in 44 percent and PA in 38 percent. Incidence of protrusio was significantly high in patients with systemic steroid intake. Adrenal cortical steroids may play an important role in the progress of the protrusion in rheumatoid patients. However, there was shown no correlation among hip destruction and age, duration of RA, the severity of joint inflammation and the use of gold or D-penicillamine.
In a Pathological study of 35 excised femoral heads, cyst formation and periarticular osteophytes in the remaining head contour were found mainly in the protrusio type. Repair of fibrocartilaginous tissue was observed both in the protrusio and collapse type of acetabulum, but clinically, no significant improvement was detected in such cases.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984X線照射によるラット臓器中のメタロチオネインの変動について271287ENYoshihiroTakeda(1)ラット肝Metallothioneinが増加する2000rad, 72時間後にMTの増加が認められるのは,腎臓のみで他の臓器(心臓,肺,脾臓,赤血球,血漿)では認められなかった.(2)肝,腎臓のMTの照射線量に対する増加には差が認められなかった.(3)照射後の経時的変化では,肝臓が6時間からその増加が認められるのに対して,腎臓では, 24時間と大きな違いが認められた.(4)照射後の血清亜鉛量に低下傾向は,認められないが, Sephacryl S-300のゲル濾過の結果では, Albumin分画の亜鉛量に低下傾向が認められ,血清亜鉛に質的変化が生じていることが示唆された.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558963-41984聴器扁平上皮癌の臨床と側頭骨病理組織所見263270ENRyusukeSaitoAkikoFujimotoAkiraFujitaShuichiWatanabeTakaoTomotsuKeizoMisakiYoshioOguraKiyoshiMatsubaraSeven cases of squamous cell carcinoma of the ear encountered at Okayama university hospital between 1972 and 1981 were reviewed, and a histopathological study of the temporal bone of one patient was reported. All cases were in advanced stages, T3 in five cases and T4 in two cases according to the TNM classification of ear cancer after Sakai. The external auditory canal was the primary site in five cases and the middle ear in two cases. Only two patients, whose lesions were localized in the shallow portion of the external auditory canal, had lived for a long period without any recurrence at the time of this study. In contrast, the remaining five patients whose lesions extended into the middle ear and mastoid had died of cancer. Histopathological examination of the temporal bone of one patient revealed that the tumor extended both into the internal acoustic meatus along the facial canal and to the extratemporal bone area via the eustachian tube. Additionally, in spite of extensive osteoradionecrosis over the temporal bone due to a full dose of irradiation, active tumor tissue remained in the petrous apex cells of the temporal bone.From these findings, it was assumed that carcinoma of the ear is the most difficult to treat successfully among head and neck malignancies.No potential conflict of interest relevant to this article was reported.