Acta Medica Okayama 1176-9106 9 2013 Effect of repeated Waon therapy on exercise tolerance and pulmonary function in patients with chronic obstructive pulmonary disease: a pilot controlled clinical trial 9 15 EN Hiroshi Kikuchi Nobuyoshi Shiozawa Shingo Takata Kozo Ashida Fumihiro Mitsunobu Purpose: Controlled clinical trials evaluating the efficacy of repeated Waon therapy for patients with chronic obstructive pulmonary disease (COPD) have yet to be conducted. The purpose of the present study was to evaluate whether repeated Waon therapy exhibits an adjuvant effect on conventional therapy for COPD patients. Patients and methods: This prospective trial comprised 20 consecutive COPD patients who satisfied the criteria of the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines, stages 1–4. They were assigned to either a Waon or control group. The patients in the Waon group received both repeated Waon therapy and conventional therapy, including medications, such as long-acting inhaled β2 agonists, long-acting anticholinergics and xanthine derivatives, and pulmonary rehabilitation. The Waon therapy consisted of sitting in a 60°C sauna room for 15 minutes, followed by 30 minutes of being warmed with blankets once a day, 5 days a week, for a total of 20 times. The patients in the control group received only conventional therapy. Pulmonary function and the 6-minute walk test were assessed before and at 4 weeks after the program. Results: The change in vital capacity (0.30 ± 0.4 L) and in peak expiratory flow (0.48 ± 0.79 L/s) in the Waon group was larger than the change in the vital capacity (0.02 ± 0.21 L) (P=0.077) and peak expiratory flow (−0.11 ± 0.72 L/s) (P=0.095) in the control group. The change in forced expiratory flow after 50% of expired forced vital capacity in the Waon group, 0.08 (0.01–0.212 L/s), was larger than that in the control group, −0.01 (−0.075–0.04 L/s) (P=0.019). Significant differences were not observed in the change in any parameters in the 6-minute walk test. Data are presented as means ± standard deviation or median (25th–75th percentile). Conclusion: The addition of repeated Waon therapy to conventional therapy for COPD patients can possibly improve airway obstruction. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Action mechanisms of complex spa therapy on bronchial asthma. 3. Relationship to airway inflammation 99 106 EN Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15096 The degree and characteristic of airway inflammation were evaluated by the proportions of bronchoalveolar lavage (BAL) cells. Clinical asthma types such as Ia. simple bronchoconstriction, Ib. bronchoconstriction + hypersecretion, and �U. bronchiolar obstruction correlate with airway inflammation. The increased proportion BAL　neutrophils is characteristic of type �U asthma, and increase in BAL eosinophil count is often observed in type Ib asthma. Bronchial hyperresponsiveness also correlates with airway inflammation. Action of spa therapy has been speculated to be related to airway inflammation, since the therapy has no action inhibiting IgE-mediated allergic reaction. In fact, spa therapy is more effective in patients with type Ib and type �U than in those with type Ia showing slight degree of airway inflammation. Bronchial hyperresponsiveness is also improved by spa therapy. From a point of view, the direct action of spa therapy may be to clean airways and improve damaged mucous membrane of the airways, leading to suppression of airway inflammation. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Action mechanisms of complex spa therapy on bronchial asthma. 2. Effects on endocrine-autonomic nerve system and psychological factors 92 98 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Katsuyoshi Saito 10.18926/15094 Actions of spa therapy on endocrine-autonomic nerve system and psychological factors were analyzed in patients with bronchial asthma. In endocrine function, serum levels of cortisol and ACTH tended to increase after spa therapy. In autonomic nerve system, decrease in concentrations of serum adrenalin and noradrenalin was observed after spa therapy, and the difference between the initial levels before spa therapy and the levels after the therapy was significant in serum levels of adrenalin. However, serum levels of substance P and Bradykinin were not affected by spa therapy. To evaluate the action of spa therapy on mental condition in patients with asthma, four kinds of psychological tests, CMI, SDS, CAl and SD, were carried out. Improvement of mental disorders in patients with asthma is observed after spa therapy in all psychological tests. These results suggest that spa therapy acts effectively on endocrine-autonomic nerve system and improve psychological conditions. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Action mechanisms of complex spa therapy on bronchial asthma. 1. Relationship to evaluation of spa therapy 85 91 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15093 Action mechanisms of complex spa therapy (swimming training in a hot spring pool, inhalation with iodine salt solution, and fango therapy) were studied in relation to patient age, clinical asthma type, and airway inflammation. Actions of spa therapy were observed by two clinical effects : direct and indirect effects. Improvement of subjective symptoms, ventilatory function, and bronchial hyperresponsiveness was observed as direct effects of spa therapy, and improvement of suppressed function of adrenocortical glands as indirect effects of the therapy. The clinical effects of spa therapy were higher in patients over the age of 40. Regarding clinical asthma type, the effects were larger in patients with type Ib and type II asthma than in those with type Ia. The efficacy of spa therapy was closely related with airway inflammation in patients with type Ib and type II asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 気管支喘息における温泉療法と薬物療法 107 114 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kouzou Ashida Satoshi Yokota Kazuaki Takeuchi Yuichiro Nawa 10.18926/15092 気管支喘息は,その臨床病態より,Ia.単純性気管支攣縮型,Ib.気管支痙攣縮+過分泌型,�U.細気管支閉塞型の3つの基本病型に分けることができる｡また,発症病態からは,アトピー型と非アトピー型に分けられる｡気管支喘息に対する温泉療法や薬物療法の際には,これらの臨床病態や発症病態を十分把握した上で最も適切な治療法を選ぶ必要がある｡気管支喘息に対する薬物療法では,気管支拡張薬,去痰薬,抗アレルギー薬,副腎皮質ホルモンなどがその主たるものであるが,特に薬物療法では気管支拡張作用と抗炎症作用が重要である｡一方,温泉療法では,気道の浄化作用や気管支粘膜の正常化作用などが得られ,臨床病型では,過分泌型や細気管支閉塞型に対してより効果的である｡また,発症病態からすれば,アトピー型ではヒスタミンとロイコトリエンが,非アトピー型ではロイコトリエンがより優勢な化学伝達物質であり,このような発症病態を十分把握した上で,適切な抗アレルギー薬を選ぶ必要が ある｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Type �U (bronchiolar obstruction) asthma and number of neutrophils in bronchoalveolar lavage (BAL) fluid 79 84 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15091 Bronchial asthma is classified into three types ; type Ia (Ia-1 and Ia-2), type Ib, and type �U, by clinical symptoms (clinical diagnosis). Asthma is also classified by clinical findings and examinations (score diagnosis). Both classification systems show that markedly increased proportion of BAL neutrophils and marked decrease in % V25 value are characteristic of type �U, bronchiolar　obstruction, asthma. However, there are some type �U asthma patients without BAL neutrophilia. In these patients, age is higher compared to those with BAL enutrophlia. Decrease in FEV1.0% value and decrease in the proportion of BAL lympocytes and serum IgG level, are not so remarkable as decrease in those with BAL neutrophilia. It has been suggested that type �U asthma with BAL neutrophilia correlates with suppression of humoral and cellular immunity, and same type of astma without BAL neutrophilia is in part caused by aging. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Evaluation of Body Surface Temperature by Thermography 63 70 EN Yasuhiro Hosaki Yuichiro Nawa Kazuaki Takeuchi Hirofumi Tsugeno Kozo Ashida Satoshi Yokota Fumihiro Mitsunobu Takashi Mifune Yoshiro Tanizaki Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15088 Body Surface Temperature was observed by thermography. The surface temperature of a healthy person's lower limbs, after being cooled in a water bath, increased in parallel with time. Patients with Diabetes Mellitus had different patterns in the rate of increase of the surface temperature. After cold loading, one patient had a 99% recovery ratio of surface temperature, the same level as healthy volunteers (83%, and 88%), as calculated by a picture processing program with the computerized thermotracer. However, the recovery ratio of other patients was poorer, ranging from 56% to under 6% recovery. This measurement of elevation of body temperature is useful for the estimation of peripheral blood flow in patients with lower limbcirculation failure. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Intranasal glucocorticoid therapy in asthmatic patients with mucosal abnormalities of sinonasal cavity 57 62 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15087 Bronchial asthma is often accompanied with allergic rhinitis or chronic sinusitis. Mucosal abnormalities of sinonasal cavity may influence lower respiratory responses in patients with asthma. We experienced a case of 72-year-old woman with asthma, who had dyspnea on exertion and a large volume of expectoration of more than 100mℓ a day. Furthermore she had nasal symptoms (nasal obstruction and rhinorrea) with prominent post-nasal discharge. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa. Although her asthma symptoms such as wheezing and dyspnea improved by administration of bronchodialators, antiallergic agent, and beclomethason di isocyanate (BDI) accompanied with spa therapy after admission, the volume of expectoration revealed no decrease and her peak expiratory flow (PEF) didn't increase. The volume of expectoration and the PEF showed marked improvement after starting of intranasal glucocorticoid therapy. It is suggested from her clinical course that treatment with intranasal glucocorticoids is very important in asthmatic patients with mucosal abnormalities of sinonasal cavity. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Age-related changes of IgE-mediated allergic reaction in patients with late onset asthma. 50 56 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Satoshi Yokota Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15008 Age-related changes in IgE-mediated allergic reaction were examined in patients with late onset asthma, whose asthma occured over the age at onset of 40. 1. The number of patients with a high serum IgE level over 3001U/mℓ was larger in those between the ages at onset of 40 and 49 and over age at onset 60 than in those between the ages at onset 50 and 59. 2. A positive RAST score to Hdm and cockroach allergens was more frequently found in patients between 40 and 49 and over age 60 at onset compared to those between 50 and 59 at onset. In contrast, the number of patients with a positive RAST to Candida was larger in those between 50 and 59 at onset than in those of between 40 and 49 and over 60 at onset. 3. Severe asthma was more frequently and slight asthma was less frequently observed in patients between 50 and 59 at onset than in those of the other age at onset groups. These results suggest that IgE-mediated allergic reaction in patients between the ages at onset of 50 and 59 is different from that in those with early onset asthma, and that the reaction in patients between the ages at onset 40 and 49 and over 60 resembles to the reaction in those with early onset asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Improvement of psychological disorders by spa therapy in patients with asthma 43 49 EN Satoshi Yokota Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/15007 To evaluate improvement of mental disorders by spa therapy for 1-2 months, three kinds of psychological examinations, CMI (Cornel Medical Index), SDS (Selfrating Depression Scale) and CAI (Comprehensive Asthma Inventory) tests, were performed in 37 patients with asthma before and after spa therapy. 1. In CMI test, the scores of physical symptoms, respiratory symptoms, and CIJ symptoms significantly decreased after spa therapy. The score of psychical symptoms tended to decrease after the therapy, however, this was not significant. 2. The mean score of the subjects over 40 points in SDS test significantly decreased from 45.7 points before spa therapy to 37.5 after the therapy. 3. Mental disorders evaluated by various categories in CAI test were significantly improved after spa therapy. The average score in CAI test significantly decreased from 37.1 to 27.8 after the therapy. These results demonstrate that psychological disorders in patients with asthma are improved by spa therapy. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Dietary supplementation with n-3 fatty acids in bronchial asthma correlated with the generation of LTB4 and LTC4 35 42 EN Kozo Ashida Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Satoshi Yokota Hirofumi Tsugeno Yoshiro Tanizaki Junko Yamamoto Takao Tsuji 10.18926/15006 In recent years, it has been noted that there is a close correlation between leukotrienes and late asthmatic reaction (LAR). In this study, effects of dietary supplementation with perilla seed oil rich in alpha-linolenic acid, which is speculated to affect the generation of leukotrienes through metabolism of arachidonic acid (AA), were evaluated in 6 patients with asthma. The symptoms and ventilatory function were improved after 2-week dietary supplementation with perilla seed oil. The generation of LTB4 and LTC4 by peripheral leucocytes stimulated with Ca ionophore A23187 was significantly suppressed by the dietary supplementation (LTB4 and LTC4 ; p<0.05). Regarding the composition of fatty acids in serum phospholipids, the concentrations of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and AA tended to increase after the supplementation, accompanied with an increase in the ratio of EPA to AA. These results suggest that dietary supplementation with perilla seed oil brings beneficial effects in the treatment of asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Bronchial hyperresponsiveness in type Ia (simple bronchoconstriction) asthma Relationship to patient age and the proportions of bronchoalveolar cells 28 34 EN Kozo Ashida Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15002 Bronchial hyperresponsiveness was examined in relation to age, ventilatory function, and the proportion of bronchoalveolar lavage (BAL) cells in 39 patients with type Ia asthma (simple bronchoconstriction) (25 with type Ia-1 and 14 with type Ia-2), classified by clinical symptoms. 1. The proportion of BAL eosinophils was significantly higher in type Ia-2 than that in type Ia-1 asthma patients. 2. Bronchial reactivity to methacholine was not different between type Ia-1 and type Ia-2 asthma patients. 3. Bronchial hyperreactivity tended to decrease as patient age was higher in both types of asthma. Neither ventilatory function (FEV1.0%) nor the proportions of BAL lymphocytes and neutrophils was not correlated with bronchial hyperresponsiveness in both types of asthma. 4. Bronchial reactivity to methacholine more dereased with the increase in the proportion of BAL eosinophils in both type Ia-1 and Ia-2 asthma patients. The results show that bronchial hyperresponsiveness in patients with type Ia asthma is correlated to patients age and the proportion of BAL eosinophils. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Difference in the onset mechansisms of attacks between atopic and nonatopic asthma. A role of leukotriene C4 21 27 EN Kozo Ashida Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Satoshi Yokota Hirofumi Tsugeno Yoshiro Tanizaki 10.18926/15001 Concentrations of main bronchoconstricting chemical mediators, histamine and leukotriene C4 (LTC4), were measured in bronchoalveolar lavage (BAL) fluid, and when cells (peripheral leukocytes and BAL cells) were stimulated by Ca ionophore A23187, in 7 atopic and 7 nonatopic asthma patients. 1. The proportion of basophilic cells was significantly larger in atopic than in nonatopic asthma (p<0.05), however no significant difference was present in the other BAL cells between the two asthma types. 2. Concentration of histamine in BAL fluid was significantly higher in atopic than that in nonatopic asthma, however, difference in that of LTC4 was not found between them. 4. The release of LTC 4 from BAL cells was higher in nonatopic than that in atopic asthma, but this was not significant. In contrast, the release of histamine was significantly higher in atopic compared to that in nonatopic asthma (p<0.001) when the cells were stimulated by Ca ionophore A23187. These results suggest that both histamine and LTC4 participate in the onset mechanism of atopic asthma, and only LTC4 in that of nonatopic asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Difference in small airway inflammation between type �U (bronchiolar obstruction) asthma and obstructive bronchiolitis 14 20 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/15000 Ventilatory function and inflammatory cells in airways were compared between patients with type �U (bronchiolar obstruction) asthma and those with obstructive bronchiolitis. 1. Age and age at onset were higher in patients with type �U asthma than in those with obstructive bronchiolitis. IgE-mediated allergic reaction was observed in patients with type �U asthma, but not in those with obstructive bronchiolitis. 2. In ventilatory function tests, all ventilatory parameters examined were lower in patients with type �U asthma compared to those with obstructive bronchiolitis, and the differences were significant in FEV1.0% (p<0.001), % MMF (p<0.02), and V50 (p<0.01). 3. The proportion of BAL neutrophils was very high in type �U asthma (55.7%) and obstructive bronchiolitis (74.4%), however, this was not significant. 4. Absolute numbers/BAL fluid of total cells, BAL macrophages and BAL neutrophils were significantly higher in patients with obstructive bronchiolitis than in those with type �U asthma. 5. The results on absolute number/mℓ of BAL cells demonstrated that number of BAL neutrophils markedly larger in patients with obstructive bronchiolitis compared to those with type �U asthma. These results show that high proportion of BAL neutrophils was observed in the two respiratory diseases, however, the degree of inflammation in airways was markedly greater in obstructive bronchiolitis. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Clinical features of asthma patients with a low % FVC. In relation to clinical asthma type and disease severity. 8 13 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Yuichiro Nawa Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/14999 Clinical features of asthma patients with a low % FVC (<75%) were studied in relation to clinical asthma type and disease severity. 1. The value of % FVC was not related to patient age. 2. A significant association between % FVC value and clinical asthma type was found. The value of % FVC was significantly lower in subjects with type �U asthma (bronchiolar obstruction) than in those with type Ia-1 and type Ia-2 (simple bronchoconstriction) (p<0.001). 3. % FVC value significantly correlated with disease severity. The value in the subjects tended to decrease as their asthma conditions were more severe. 4. The % FVC value in the subjects was improved after treatment (complex spa therapy). These results demonstrate that a significant correlation is present between low % FVC and disease severity in asthma patients with a low % FVC. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 67 1996 Clinical features of type �U asthma (bronchiolar obstruction) without bronchoalveolar neutrophilia 1 7 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Kazuaki Takeuchi Takao Tsuji 10.18926/14998 Clinical features of asthma patients with bronchiolar obstruction (type �U asthma) were studied in relation to the proportion of neutrophils in bronchoalveolar lavage (BAL) fluid. Of 13 subjects studied, 7 were accompanied with BAL neutrophilia (53.5%) (BALn(+)) and 6 were without BAL neutrophilia (3.5%) (BALn(-)). 1. The mean age was higher in BALn(-) (66.0 years) than in BALn(+) patients (55.0 years). 2. Bronchial reactivity to methacholine was slightly higher in BALn(-) patients than in those with BALn(+). 3. The value of FEV1.0% was significantly lower in BALn(+) patints than in those with BALn(-) (p<0.01). 4. The proportion of BAL lymphocytes was signicantly more decreased in BALn(+) patients compared to the proportion in those with BALn(-) (p<0.001). 5. the values of serum IgG, IgA, and IgM were not significantly different between BALn(+) and BALn(-) patients, however, the value of IgG was more decreased in BALn(+) patients than in those with BALn(-). These results suggest that two kinds of type �U asthma ; one is with BAL neutrophilia related to suppressed immunity, and another is without BAL neutrophilia in part due to aging. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 慢性関節リウマチに胆道系悪性腫瘍を合併した3例 107 114 EN Naofumi Iwagaki Hirofumi Tsugeno Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Makoto Okamoto Yoshiro Tanizaki 10.18926/14994 一般的に,慢性関節リウマチには悪性腫瘍の合併は少ないと言われている｡特に,消化器系あるいは胆道系悪性腫瘍を合併したという報告は極めて少ない｡我々は慢性関節リウマチの経過中,胆道系悪性腫瘍を合併した3例を経験した｡3症例はそれぞれ胆嚢癌,肝内胆管癌,乳頭部癌を合併していた｡非常に稀な症例であり,文献的考案を含め報告する｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 n-3系脂肪酸を強化した食事療法が有効と考えられた肺気腫の一例 99 106 EN Hirofumi Tsugeno Kozo Ashida Fumihiro Mitsunobu Takashi Mifune Makoto Okamoto Naofumi Iwagaki Yasuhiro Hosaki Takao Tsuji Yoshiro Tanizaki 10.18926/14993 症例は67歳,男性｡主訴は労作時呼吸困難｡【第一回目入院】平成7年9月から12月まで入院し,薬物療法,複合温泉療法を行なった｡自覚症状はやや改善がみられたが,呼吸機能検査所見の改善は得られなかった｡【第二回目入院】平成8年8月から12月まで入院｡n-3系脂肪酸強化食事療法も併用した｡自覚症状および,呼吸機能検査上,FVC,FEV(1.0),PEFなどに改善を認めた｡n-3系脂肪酸はアラキドン酸代謝を通してロイコトリエン合成に関与すると推定されるが,経過中に白血球のLTB(4)産生能の減少を認めた。この症例は肺気腫に対するn-3系脂肪酸強化食事療法の有用性が示唆され,病態を考える上でも興味深いと考えられたので報告する。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 Rehabilitation for patients with respiratory disease. Spa efficacy in relation to pathophysiological characteristics of bronchial asthma. 80 93 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Naofumi Iwagaki Kazuhiko Yamamoto 10.18926/14991 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 腰痛症に対する温泉療法の効果 51 58 EN Makoto Okamoto Kozo Ashida Kazuhiko Yamamoto Naofumi Iwagaki Hirofumi Tsugeno Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/14987 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｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 Determinants of trabecular bone mineral density of the lumber spines and vertebral fracture in patients with bronchial asthma 45 50 EN Hirofumi Tsugeno Mutsuro Nakai Makoto Okamoto Takashi Mifune Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Tsuneo Akiyama Takao Tsuji Yoshiro Tanizaki 10.18926/14986 Clinical risk factors associated with the development of osteoporosis and vertebral fractures were evaluated in patients with asthma in relation to sex, age, and dose of glucocorticoids (GC). In 75 asthmatic patients including 44 steroid-dependent asthma, the bone mineral density (BMD) of the lumber spines was measured by quantitative computed tomography (QCT). Thirty five patients of them were followed up with radiographs over a period of 0.5 to 4 years (average: 2.6±1.3 years). The BMD was significantly lower in older (p<O.01) or female (p<0.05) patients. All the five patients developing vertebral compression fractures were female and more than 64 y.o., and received systemic glucocorticoid (GC) therapy for more than 3 years with a lot of cumulative gramdosage of GC. No significant correlation was demonstrated between the BMD and the dose of systemic GC per day, but multiple regression analysis demonstrated a significant relationship (p<O.o1) between the BMD and lifetime cumulative gramdosage of GC. Multiple regression analysis also demonstrated significant relationships (p<O.01) between the BMD and clinical factors such as age and sex. These results indicates that the bone loss and vertebral fractures of patients with asthma are influenced by the patient's age, sex, and the lifetime cumulative GC dose. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 気管支喘息に対する食事療法｡N-3系脂肪酸(エゴマ油)によるロイコトリエン産生抑制 41 44 EN Kozo Ashida Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Naofumi Iwagaki Yoshiro Tanizaki Takao Tsuji Junko Yamamoto Misako Okita 10.18926/14985 N-3系脂肪酸の気管支喘息に対する有用性が示唆されているが,その評価は定まっていない｡今回,5人の気管支喘息患者に対しN-3系脂肪酸であるαリノレン酸を豊富に含有するエゴマ油を用いた食事療法を行い,臨床症状,ピークフロー値,末梢白血球からのロイコトリエン産生能,血漿リン脂質中の脂肪酸組成につき検討を行った｡2週間の食事療法の前後でピークフロー値は有意な改善を示し(p<0.05),カルシウムイオノファー刺激によるロイコトリエン(LT)産生能は治療前後でLTB4が77.6ng/5×106cellsから41.6ng/5×10(6)cells(p<0.05)に,LTC4は64.0ng/5×10(6)cellsから38･8ng/5×10(6)cells(p<0.05)とともに有意な改善を認めた。また血漿リン脂質中のN-3系脂肪酸(αリノレン酸,エイコサペンタエン酸,ドコサヘキサエン酸)も有意な上昇を認めた。以上よりN-3系脂肪酸(エゴマ油)を用いた食事療法の有用性が示唆された｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 Correlation between clinical features of asthma and computed tomographic findings of nose and maxillary sinus 34 40 EN Takashi Mifune Kazuhiko Yamamoto Naofumi Iwagaki Makoto Okamoto Hirofumi Tsugeno Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/14979 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 ピークフローから見た気管支喘息に対する温泉療法の効果 28 33 EN Takashi Mifune Kazuhiko Yamamoto Naofumi Iwagaki Makoto Okamoto Hirofumi Tsugeno Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/14978 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。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 Correlation between low attenuation area (LAA) of the lungs in high-resolution computed tomography (HRCT) and mean CT number in bronchial asthma 15 21 EN Fumihiro Mitsunobu Kozo Ashida Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Naofumi Iwagaki Kazuhiko Yamamoto Yoshiro Tanizaki Mutsuo Nakai Tsuneo Akiyama Harumi Hasegawa 10.18926/14975 The maximal percent low attenuation area < -950 HU (% LAA) among three anatomic lung levels on high resolution computed tomography (HRCT) was examined in patients with asthma, classified by the degree of % LAA, in relation to the mean CT number, % FVC of the predicted value, and FEV 1/FVC (FEV1%). 1 . The mean CT number was closely related to the degree of % LAA of the lungs. The mean CT number was significantly lower in patients with high % LAA (mean CT number-915.3HU, % LAA 37.6%) than in those with low % LAA (-852.9HU, 4.7%). 2. The FEV1% value was significantly lower in patients with high % LAA (47.8%) than in those with low % LAA (62.2%)(p<0.05). The % FVC value was also significantly lower in patients with high % LAA (77.1%) compared to the value in those with low % LAA (101.2%). The results suggest that a large volume of LAA<-950HU of the lungs can be observed in patients with asthma, and the % LAA is closely correlated with mean CT number and the values of FEV1% and % FVC. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 Low attenuation area on computed tomography in asthma. Comparison between smoking and nonsmoking subjects. 8 14 EN Yoshiro Tanizaki Fumihiro Mitsunobu Kozo Ashida Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Naofumi Iwagaki Kazuhiko Yamamoto Mutsuo Nakai Tsuneo Akiyama 10.18926/14974 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 慢性閉塞性呼吸器疾患の治療における温泉療法の位置づけ.最近5年間の入院症例520例を対象に 1 7 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Naofumi Iwagaki Kazuhiko Yamamoto 10.18926/14973 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｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 68 1997 IgE antibodies against pollinosis-inducing allergens in asthma patients with and without allergic rhinitis 22 27 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Naofumi Iwagaki Kazuhiko Yamamoto Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/14972 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 アトピー性皮膚炎に対する新しい治療の試み〜エゴマ軟膏の効果〜 76 81 EN Miyuki Miyamoto Chiaki Akiyama Michiyo Noumi Junko Takata Nobuko Nisimura Sumie Nakamura Yasuhiro Kawakami Makoto Okamoto Kozo Ashida Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14964 近年アトピー性皮膚炎が増加しており,工ゴマ油を使った食事療法がアレルギー抑制に有用であることが報告されている｡そこで今回,エゴマ油を外用剤として使用するため,亜鉛華単軟膏を基剤とした工コマ軟膏を作製し,アトピー性皮膚炎患者3例を対象にその臨床応用を試みた｡その結果,掻痒感の軽減に効果がみられ,また皮膚症状では,丘疹.表皮剥離,苔癬化,落屑などの所見が改善される傾向が見られた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Evaluation of Body Surface Temperature by Thermography 2. Effect of Pre-loading with Hot Water 68 75 EN Yasuhiro Hosaki Shingo Takata Fumihiro Mitsunobu Takashi Mifune Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Yoshiro Tanizaki Koji Ochi Hideo Harada Takao Tsuji 10.18926/14963 The body surface temperature of 41 patients suffering coldness, numbness or pain in their feet was examined using thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as: Recovery ratio =[Total counts of thermography (Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). Three different baseline temperatures, 26℃. 27℃ and 28℃, were used in processing the thermographic results into pictures. The recovery ratio was susceptible to temperature, and we recommend a baseline temperature limitation of 27℃ for clinical study. A bi-modal distribution of recovery ratio was observed in 18 patients with diabetes mellitus. One group (6 subjects) had high recovery ratio between 80%-100%, and another group (10 subjects) had a low recovery ratio between 0%-19%. The results of thermography were also influenced by weather. To reduce the effect of outside temperature, we used pre-loading with hot water at 36℃ for 5 min (hot loading).　A large difference in　recovery ratio between presence and absence of hot loading was observed in 6 of the 30 subjects. The difference was over-estimated in more than 20% of recovery ratio without hot loading as compared with hot loading in these 6 subjects. The effect of drugs on peripheral circulation, such as beraprost sodium and sarpogrelate hydrochloride, was clear and quantified using thermography under these conditions of hot loading. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Abnormalities of gastric mucous membrane in patients with steroid-dependent intractable asthma 63 67 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Seishi Harada Makoto Okamoto Eiichirou Yumoto Shingo Takata Yoshiro Tanizaki 10.18926/14962 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Long-term administration of Clarithromycin for an asthmatic patient with mucosal abnormalities of sinonasal cavity 57 62 EN Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Seishi Harada Makoto Okamoto Eiichirou Yumoto Shingo Takata Yoshiro Tanizaki 10.18926/14961 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 A patient with pulmonary emphysema treated by diet therapy with α-linolenic acid-enriched perilla seed oil. 49 56 EN Hirofumi Tsugeno Kozo Ashida Fumihiro Mitsunobu Takashi Mifune Makoto Okamoto Yasuhiro Hosaki Yoshiro Tanizaki Takao Tsuji 10.18926/14960 An effective treatment for the advanced stages of chronic obstructive pulmonary disease (COPD) has not been established yet. We report our recent experience of one patient with pulmonary emphysema treated by dietary supplementation of n-3 fatty acid for two months. He presented improvements in clinical symptoms and pulmonary function, and suppression of leukotriene B(4) generation by peripheral leukocytes. We consequently suppose that dietary treatment with n-3 fatty acids (perilla seed oil) may offer benefits for the treatment of pulmonary emphysema by competitively inhiabiting the conversion of arachidonicacid to leukotrienes and prostanoids. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 The clinical effects of dietary supplementation with n-3 fatty acids in bronchial asthma compared with n-6 fatty acids. 40 48 EN Makoto Okamoto Kozo Ashida Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Seishi Harada Eiichiro Yumoto Shingo Takata Yoshiro Tanizaki Mikio Kataoka Mine Harada 10.18926/14959 N-3 fatty acids, such as fish oil, have been reported to have some beneficial effects in patients with bronchial asthma by suppressing leukocyte function, followed by reduction of the need for pharmacologic agents. To examine the effects of dietary supplementation with perilla seed oil rich in α-linolenic acid (ALA), 23 patients with　asthma took corn oil rich in linoleic acid (LA) for the former two weeks, perilla seed oil for the later two weeks. The asthmatic patients were classified into two groups by the changes of the generation of leukotrienes B4 (LTB4), C4 (LTC4), and B5 (LTB5) during the two courses of dietary modification: one was sensitive to dietary modification, and the other was insensitive to dietary supplementation. We compared the two groups in clinical characteristics. Significant differences were observed in peak flow (PEF), forced expiratory volume in one second (FEV1.0), IgE, sex, obesity index (OI), concentration of serum total cholesterol, albumin, low density lipoprotein {LDL)-cholesterol, β-lipoprotein and phospholipids between two groups. This study indicated that these factors influence the generation of LTB4, C4 and B5 of asthmatic patients in dietary supplementation. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Correlation between decrease in % FVC and airway inflammation in patients with asthma, classified by clinical symptoms 28 34 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Satoshi Yokota Hirofumi Tsugeno Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/14955 Clinical features of asthmatics with a low % FVC (<80%) were studied in relation to airway inflammation and clinical asthma types. 1. Twenty four (75.0%) of the 32 subjects with a low % FVC had steroid-dependent intractable asthma. 2. A significant association between % FVC value and clinical asthma type was found. The value of % FVC was significantly lower in subjects with type II asthma (bronchiolar obstruction), in which significantly decreased proportion of lymphocytes,and significantly increased proportion of neutrophils in bronchoalveolar lavage (BAL) fluid were observed, than in those with type la-1 (simple bronchoconstriction) with (P<0.001) and without glucocorticoid therapy (P<0.02). 3. The % FVC value was significantly improved after treatment in type lb (hypersecretion) with BAL eosinophilia, but not in those with type II with BAL neutrophilia. These results demonstrate that marked decrease of % FVC in patients with asthma correlated with airway inflammation, and that airway reversibility by medication is very low in patients with type II asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 IgE antibodies against inhalant allergens in patients with pulmonary emphysema 21 27 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Eiichiro Yumoto Shingo Takata Yoshiro Tanizaki Koji Ochi Hideo Harada Harumi Hasegawa 10.18926/14954 To analyze the pathophysiological changes ot the airways in emphysema, bronchial responsiveness and the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by peripheral leucocytes were examined in 22 patients with emphysema. The subjects were divided into two groups according to the presence or absence of IgE antibodies against inhalant allergens; RAST positive group and RAST negative group. 1. Smoking history, mean CT number and mean maximum % low attenuation area (% LAA) <-950HU of the lung on high resolution computed tomography (HRCT), and DLco value suggested that there were emphysematous changes of the lung in all subjects. However, these findings were not different between the two groups. 2. The level of serum IgE was significantly higher in RAST positive group than in RAST negative group. 3. The mean % increase in FEV1.0 after inhalation of β-agonists was higher in RAST positive group than in RAST negative group. The % increase more than 15% was found in 4 of the 9 subjects (44.4%) in RAST positive group and 2 of the 12 (16.7%) in RAST negative group. 4. The generation of LTC4 by leucocytes was significantly higher in RAST positive group than in RAST negative group (p<0.01). The generation of LTB4 was not significantly different between the two groups. The results suggest that IgE-mediated allergy participates in the bronchial responsiveness of patients with emphysema. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Association of the mean CT number by high resolution computed tomography (HRCT) with generation of leukotrienes B4 (LTB4) and C4 (LTC4) in patients with pulmonary emphysema 15 20 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Eiichiro Yumoto Shingo Takata Koji Ochi Hideo Harada Harumi Hasegawa 10.18926/14953 The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by peripheral leukocytes stimulated with Ca ionophore A23187 was examined in 17 patients with pulmonary emphysema. They were divided into three groups according to the mean CT number; A (<-940 HU), B (-940 ≦, <-930 HU), and C (-930 HU ≦ ).1. The values of FVC (% predicted), FEV1.0% and DLco (% predicted) showed a tendency to decrease as the mean CT number was smaller. The value of % FVC was significantly lower in patients with group A than in those with group C (p<0.05). 2. The generation of both LTB4 and LTC4 was significantly higher in patients with emphysema compared to the generation in healthy subjects (LTB4;p<0.05, LTC4;P<0.05). 3. The generation of LTB4 and LTC4 in patients with emphysema was higher as the mean CT number was larger (severity of the disease become less). The LTC4 production was significantly higher in patients with group C(mild or moderate type of emphysema) than in those with group A(advanced type of emphysema). These results suggest that the generation of LTB4 and LTC4 is higher in patients with mild or moderate type of emphysema than in those with advanced type of the disease. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 Leukotrienes B4 and C4 generation by peripheral leucocytes in patients with asthma 9 14 EN Yoshiro Tanizaki Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Eiichiro Yumoto Shingo Takata Koji Ochi Hideo Harada 10.18926/14951 The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 16 patients with asthma (8 with atopic and 8 with nonatopic asthma) and 12 healthy controls. 1. The LT84 generation by leucocytes was not significantly different between patients with asthma and healthy controls. The generation of LTC4 was significantly larger in patients with asthma than in healthy controls. The LTC4 generation was also significantly larger in patients with attacks (58.4 ± 38.5 ng/5x10(6) cells) than in those without attacks (23.3 ± 25.9 ng/5x10(6) cells)(p<0.05). 2.ln atopic asthma, the LTC4 production was significantly larger in patients with attacks (84.7 ± 35.4 ng/5x10(6) cells) compared to the production in those without attacks (40.4 ± 27.2 ng/5x10(6) cells)(p<0.02). However, the production of LTB4 was not significantly different between attack and attack-free stages. 3. In nonatopic asthma, the LTC4 production was also significantly higher in patients with attacks (32.2 ± 26.3 ng/5x10(6) cells) than in those without attacks (12.2 ± 3.5 ng/5x10(6) cells)(p<0.05). However, the LTB4 production was not significantly different between attack and nonattack stages. 4. The LTC4 production was significantly larger in atopic asthmatics compared to the production in nonatopic subjects both in attack and nonattack stages. These results suggest that the generation of LTC4 by leucocytes of patients with asthma is closely related to IgE-mediated reaction and asthma attacks. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 69 1998 慢性閉塞性呼吸器疾患に対する温泉療法の臨床的評価.最近5年間(1993年- 1997年)の入院症例511例を対象に 1 8 EN Yoshiro Tanizaki Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Eiichiro Yumoto Shingo Takata Koji Ochi Hideo Harada 10.18926/14950 1993年1月より1997年12月までの5ヵ年間に当院へ入院した慢性閉塞性呼吸器疾患511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594例で,このうち,慢性閉塞性呼吸器疾患患者は511例(86.0%)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416例(81.4%)と最も多く,その他.慢性気管支炎20例,閉塞性細気管支炎27例,肺気腫48例であった｡2.慢性閉塞性呼吸器疾患のなかでは,肺気腫の症例が増加する傾向が見られた｡3.慢性閉塞性呼吸器疾患の年齢別検討では,鳥取県内では,70才以上の症例が,また遠隔地(鳥取県外)では60-69才の症例の頻度が高い傾向が見られた｡4.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)からの入院患者が比較的多く,その比率は1997年度で48.4%であった｡また,その分布別検討では,岡山県,兵庫県,大阪府,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｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Churg-Strauss症候群の再燃を来した気管支喘息症例 61 66 EN Seishi Harada Hirofumi Tsugeno Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Makoto Okamoto Shingo Takata Toshio Yamamoto Yoshiro Tanizaki 10.18926/14935 入院中にChurg-Strauss症候群の再燃を来した症例を報告した｡症例は気管支喘息を有する73歳の女性で,持続する両下肢の知覚障害を主訴に当院に入院した｡入院2週頃より微熱,下腹部不快感が続き右下肢のdrop foot,下血を呈した｡末梢血では著明な好酸球増多を認め,内視鏡検査で直腸潰瘍を認めた。3年前の両下肢の知覚障害出現時にも同様の症状を経験しており,Churg-Strauss症候群の再燃と診断し,ステロイド治療を開始することにより新たな後遺症を残すことなく寛解に至った｡Churg-Strauss症候群の発症･再燃の機序を考える上で貴重な症例と考え,文献的考察を加え報告する｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Cortical bone porosity in patients with asthma 53 60 EN Hirofumi Tsugeno Mutsuro Nakai Makoto Okamoto Seishi Harada Shingo Takata Takashi Mifune Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Tsuneo Akiyama Takao Tsuji Yoshiro Tanizaki 10.18926/14934 In previous studies, we have demonstrated that chronic administration of systemic glucocorticoids decreases cortical bone mineral density (BMD), cortical bone volume, bone strength, and induces development of pathologic fractures in asthmatic patients. We have also demonstrated that glucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites in postmenopausal asthmatic patients. There is a difference of gonadal hormones between male and female. To investigate the influence of hormonal difference on glucocorticoid-induced cortical bone porosity, we studied cortical bone volume and BMD in both male and female patients with asthma in this report. A total of 99 asthmatic patients (male 26 cases, female 73 cases) were enrolled in the study. Peripheral quantitative computed tomography (pQCT) was used to measure cortical BMD and relative cortical volume. The cortical volume-density relationship appeared to remain constant regardless of the level of systemic glucocorticoid administration, age or sex, suggesting cortical bone porosity causes similar and simultaneous decreases in cortical bone volume and density. In conclusion, glucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites despite the gonadal hormonal differences. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Factors influencing the effects of dietary supplementation　with PUFAs on leukotriene generation by leucocytes in　patients with asthma 43 52 EN Makoto Okamoto Fumihiro Mitsunobu Kozo Ashida Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Seishi Harada Shingo Takada Yoshiro Tanizaki Mikio Kataoka Kenji Niiya Mine Harada 10.18926/14933 Dietary supplementation with perilla seed oil, a vegetable oil rich in α -lin- olenic acid, inhibits the generation of leukotrienes(LTs) by leucocytes in patients with bronchial asthma. We examined the factors that affect the suppression of LT generation by leucocytes with perilla seed oil-rich supplementation in patients with asthma, by comparing the clinical features of patients with asthma, whose generation of leukotriene (LT) C4 was suppressed by dietary supplementation with perilla seed oil (n-3 fatty acids) (group A), with those of patients who showed no suppression of LTC4 generation (group B). Group A showed a significant increase in the generation of LTB4 and L TC4 by leucocytes after corn oil-rich supplementation (n-6 fatty acids), and a significant decrease in the generation of LTB4 and LTC4 after perilla seed oil-rich supplementation (n-3 fatty acid). However, this was not observed in group B. The level of serum IgE and peak expiratory flow (PEF) in group A were significantly higher than in group B. Furthermore, the serum levels of LDL-cholesterol, β-lipoprotein and　phospholipid were significantly lower in group A than in group B. These results suggest that the clinical features differ between these two asthmatic populations with respect to suppression of LTB4 and LTC4 generation by n-3 fatty acids in perilla seed oil-rich supplementation. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Evaluation of Body Surface Temperature by Thermography 3. Correlation between the peripheral circulation estimatedby Laser-Doppler blood flowmetry and thermography. 36 42 EN Yasuhiro Hosaki Shingo Takata Fumihiro Mitsunobu Takashi Mifune Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Yoshiro Tanizaki Koji Ochi Takao Tsuji 10.18926/14927 The body surface peripheral circulation in 12 cases,　including 9 patients with　diabetes mellitus who were suffering coldness, numbness or pain in their feet, and 3 healthy volunteers was examined using Laser-Doppler blood flowmetry. At the same time, the body surface temperature was estimated by thermography. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio = [Total counts of thermography(Pixels) over temperature (T) after cold loading] ÷ [Initial counts over T before cold loading] x 100(%). The recovery ratio and the blood flow were correlated, r=0.68, p<O.01. The peripheral circulation of 16 patients with diabetes mellitus was observed at three different conditions including, l)placed at room temperature at 20℃for 15 min, 2) submerged and warmed for 5 min in a hot bath at 36℃(i.e. hot loading), and 3) submerged and cooled for 5 min in a water bath at 20℃ (i.e. cold loading). Three different baseline temperatures, 26℃, 27℃ and 28 ℃, were used in processing the　thermographic results into pictures. The highest correlation (r=0.59, p=0.0002) was obtained under the condition of cold loading using a baseline temperature limitation of27℃.The difference ratio (%) of blood flow was calculated as the blood flow at cold loading divided by the blood flow at hot loading in these 16 patients. The difference　ratio of the blood flow and the recovery ratio of thermography were correlated, r=0.46, p<O.OOO1. We found a strong correlation between the results of Laser-Doppler blood flowmetry and one of thermographic methods used to monitor peripheral circulation in patients with diabetes mellitus. Cold loading using a baseline temperature limitation of 27℃ were recommended for further examinations. Patients with low blood flow as well as　with large differences in their peripheral circulation between cold loading and hot　loading had severe coldness in their body surface temperature. We showed the usefulness of the results of thermography, when quantified by picture processing using computer software, in relation with the results of Laser-Doppler blood flowmetry. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Relationship between bronchial hyperresponsivenessand nasosinus lesions in patients with bronchial asthma 28 35 EN Takashi Mifune Shingo Takata Makoto Okamoto Hirofumi Tsugeno Kozo Ashida Seishi Harada Fumihiro Mitsunobu Yasuhiro Hosaki Yoshiro Tanizaki Mine Harada 10.18926/14926 Pathological changes of nasosinus occur often in subjects with bronchial asthma. Coexisting nasosinus lesion may affect pathophysiology of lower respiratory tract in asthmatics. The extent of nasal and sinus lesion was quantified in 17 patients with bronchial asthma, and their relationships to atopic status, asthma severity and bronchial hyperresponsiveness were evaluated in this study. Opacification degree of maxillary sinuses and nasal mucosa thickening were quantified using CT scans. The opacification degree was evaluated as (total opacification area)/(total maxillary sinus area). Although the opacification degree of maxillary sinuses in atopic patients showed no significant difference compared with that in non-atopic patients, maximum nasal mucosa thickening in atopic patients had a significant difference compared with that in non-atopic patients (p=0.028). In severe asthmatics, the opacification degree of maxillary sinuses was significantly more prominent compared with those in moderate and mild asthmatics (p=0.0005, p=0.036, respectively). Significantly marked nasal mucosa thickening was recognized in mild asthmatics compared with that in moderate asthmatics (p=0.0462). Regarding bronchial hyperresponsiveness, a significant correlation between Dmin and the opacification degree of maxillary sinuses was observed (rs= -0.551, p=0.0276). Nasal mucosa thickening had no correlation with bronchial hyperresponsiveness. The results suggest that sinusitis may affect bronchial hyperresponsiveness and asthma severity. Treatment of sinusitis may lead to improvement of asthma symptoms. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 Evaluation of low attenliation area (LAA) of the lungs in patients with reversible airway obstruction by high resolution computed tomography (HRCT). 17 27 EN Fumihiro Mitsunobu Takashi Mifune Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Seishi Harada Mutsuo Nakai Yoshiro Tanizaki 10.18926/14925 The significance of the low attenuation area (LAA) of the lungs on high resolution computed tomography (HRCT) has not been determined in patients with asthma. We examined the relationship between the percentage of lung area with CT numbers lower than -950HU (% LAA) and the mean CT number in 81 patients with reversible airway obstruction (asthma) and in 22 healthy subjects, as well as the relationship between maximal % LAA and various parameters of pulmonary function, smoking history, disease severity and allergic type in the asthmatic subjects. The mean CT number was obtained by scans at three anatomic levels, and maximal % LAA was the % LAA which had the largest value of those measured at the three anatomic levels of the lung. We found that: 1. The mean CT number was closely related to the maximal % LAA of the lungs in all subjects studied (r= -0.916, p<O.OOO1). 2. The maximal % LAA in asthmatics with a previous smoking history (median: 20.1) was significantly larger than that in asthmatics without a smoking history (median: 10.8), and that in healthy subjects with (median: 8.8) and without a history of smoking (median: 10.4). 3. The maximal % LAA was significantly correlated with FEV1/FVC (r=-0.611, p<O.OOO1) and TLC (r=0.391, p=0.0068) in the asthmatic subjects. 4. The maximal % LAA was significantly correlated with the severity of asthma (p<O.01), but not with the etiology of asthma. This study suggests that the maximal % LAA is influenced by disease severity in patients with asthma, and that a smoking history has a more significant effect on the pulmonary function of asthmatics than healthy individuals. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 IgE-mediated allergy enhances and glucocorticoids inhibit the generation of leukotrienes B4 and C4 by peripheral leucocytes in patients with asthma 9 16 EN Yoshiro Tanizaki Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Shingo Takata Koji Ochi Norio Koide 10.18926/14922 The generation. of leukotrienes 84 (LT84) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 71 patients with asthma (42 with atopic and 29 with nonatopic asthma) and 23 healthy controls. Of these patients,22 had SDIA (steroid-dependent intractable asthma). 1. The generation of LT84 and LTC4 by leucocytes was significantly more enhanced in patients with atopic, non-SOIA asthma than in healthy subjects, but not in patients with nonatopic asthma. The generation of LT84 and LTC4 in atopic asthma was significantly more decreased in patients with SOIA than in those with non-SOIA. 2. The LTC4 generation was significantly larger in attack stage than in attack-free stage of patients with atopic and nonatopic asthma when they had not SOIA. However, no significant difference was found in LT84 generation between attack and nonattack stages in these patients. 3. In patients with SOIA, no significant differences were observed in the generation of LT84 and LTC4 between attack and nonattack stages. The results suggest that IgE-mediated allergy and asthma attacks enhance and glucocorticoids inhibit the generation of LT84 and LTC4 by leucocytes. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 70 1999 気管支喘息に対する温泉療法.最近5年間(1994年-1998年)の入院症例437例を対象に 1 8 EN Yoshiro Tanizaki Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Seishi Harada Shingo Takata Koji Ochi 10.18926/14921 1994年1月より1998年12月までの5年間に当院へ入院した呼吸器疾患のなかで気管支喘息を対象に,年齢,地域分布などの経年変化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664例で,このうち,気管支喘息は437例(65.8% )であった｡呼吸器疾患のなかで気管支喘息に占める割合の経年変化では,1995年度が最も高く(74.4% ),1997,1998年度にはやや低下(ともに60.7% )の傾向が見られた｡2.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)からの入院患者が比較的多く,いずれの年度においても50% 以上(平均57.3% )であった｡また,岡山,大阪,兵庫,広島,山口,愛媛県などからの入院症例が多い傾向か見られた。3.年齢別検討では,いずれの地域においても,高齢者の入院症例か多く,鳥取県内では70才以上の症例の頻度(平均35.1% )が,また遠隔地(鳥取県外)では60-69才の症例の頻度(平均37.7% )が高い傾向か見られた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 4年間無治療にて経過を観察した高齢発症原発性胆汁性肝硬変症の一例 73 75 EN Kozo Ashida Hirofumi Tsugeno Yasuhiro Hosaki Fumihiro Mitsunobu Takashi Mifune Norikazu Nishida Makoto Okamoto Shingo Takata Yoshiro Tanizaki Takao Tsuji 10.18926/14912 症例は80才，女性。76才時［平成7年11月］より肝機能異常［アルカリフォスファターゼ高値］を認め，肝機能異常出現1年7ケ月後，血清学的検索で原発性胆汁性肝硬変症が疑われたが，無治療にて外来で経過を観察を行った。アルカリフォスファターゼ値は漸増傾向を示し，トランスアミナーゼ値の異常も伴ってきたため，平成12年11月精査目的で入院。組織検査等で無症候性原発性胆汁性肝硬変症［PBC］と診断した。PBCは中年・女性に好発する疾患で，高齢【特に後期高齢者］での発症は極めて稀である。4年間の自然経過も含め，興味深いと考えられたので報告する。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Glucocorticoid-induced cortical bone porosity in postmenopausal patients with asthma 59 67 EN Hirofumi Tsugeno Bunrei Goto Mutsuro Nakai Makoto Okamoto Singo Takata Takashi Mifune Yasuhiro Hosaki Fumihiro Mitsunobu Kozo Ashida Tsuneo Akiyama Takao Tsuji Yoshiro Tanizaki 10.18926/14910 In a previous study, we demonstrated that chronic administration of systemic glucocorticoids decreases cortical bone mineral density (BMD) and induces development of pathologic fractures in asthmatic patients. To investigate cortical bone porosity due to glucocorticoids, we studied cortical bone volume, BMD, bone strength, and fractures in patients with asthma in this report. A total of 82 postmenopausal asthmatic patients were enrolled in the study. Vertebral fractures were diagnosed via plain spinal radiograms. Peripheral quantitative computed tomography (pQCT) was used to measure cortical BMD, relative cortical volume, and Strength Strain Index (SSI). Multiple regression analysis, Student's t test, and other statistical analyses were performed. Patients with systemic glucocorticoids therapy had lower cortical BMD, relative cortical volume, SSI, and more number of vertebral fractures than patients without it. Lifetime cumulative dose of glucocorticoids was related to cortical BMD, relative cortical volume, SSI, and the number of vertebral fractures. The cortical volumedensity relationship appeared to remain constant regardless of systemic glucocorticoid administration. The number of vertebral fractures correlated highly with cortical BMD, relative cortical volume, and SSI at the radius. In conclusion, systemic glucocorticoid administration decreases cortical bone density, cortical bone volume, and bone strength. G lucocorticoid administration appears to be responsible for the process of cortical bone porosity at both endosteal and intracortical sites. Given that both cortical bone density and volume provide bone strength, cortical bone porosity was seen to contribute to glucocorticoid - induced bone strength loss and fractures. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Effects of dietary supplementation with n−3 fatty acidson bronchial asthma associated with changes in lipids．−Comparison with n−6 fatty acids− 50 58 EN Makoto Okamoto Fumihiro Mitsunobu Kozo Ashida Takashi Mifune Yasuhiro Hosaki Hirofumi Tsugeno Shingo Takata Yoshiro Tanizaki Mine Harada 10.18926/14909 N-3 fatty acids have been reported to be effective for asthma. In the present study, the effects of perilla seed oil (n-3 fatty acids) on asthma were compared with the effects of corn oil (n-6 fatty acids) in terms of pulmonary function, lipometabolism and the generation of leukotriene C4 (LTC4) by leucocytes. A total of 28 asthmatic patients were randomly divided into two groups : Group A patients (15 subjects) consumed perilla seed oil-rich supplementation, while Group B patients (13 subjects) consumed corn oil-rich supplementation for 4 weeks. Generation of LTC4 by leucocytes, respiratory function and the serum levels of lipids were compared between the two groups. The generation of LTC4 by leucocytes decreased significantly in Group A subjects following perilla seed oil-rich supplementation for 2(P < 0.05) and 4 weeks(P < 0.01). A significant difference in the generation of LTC4 was observed between the two groups after different dietary supplementations for 4 weeks (P < 0.05). Significantly increased values for PEF (P < 0.01), FVC (P < 0.05) and FEV1.0 (P < 0.05) were found in Group A subjects following perilla seed oil supplementation for 4 weeks, compared with the initial value prior to supplementation. A significant decrease in the serum level of total cholesterol, LDL-cholesterol and phospholipid was detected in Group A subjects following perilla seed oil supplementation for 4 weeks. The present results suggest that peril la seed oil-rich supplementation is effective in the treatment of asthma in terms of its ability to suppress LTC4 generat ion by leucocytes, and in inducing an improvement in pulmonary function associated with changes in the serum level of lipids. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Effect of partial cold-loading on peripheral circulation 42 49 EN Yasuhiro Hosaki Fumihiro Mitsunobu Takashi Mifune Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Shingo Takata Tadashi Yokoi Yoshiro Tanizaki Koji Ochi Takao Tsuji 10.18926/14908 The purpose of this study is the effect of partial cold-loading on whole body peripheral circulation. The body surface peripheral circulation in 24 cases (25 years old to 86 years old, the average was 64.3 years) who were suffering coldness, numbness or pain in their feet was examined using Laser-Doppler blood flowmetry. The peripheral circulation at the base of the 2nd toe of the right foot was estimated after the foot was submerged and cooled for 5 min in a water bath at 20°C (i. e. cold-loading). At the same time, the distant body surface peripheral circulation was estimated at the base of the 2nd finger of the right hand. Simultaneous observations were made of blood flow, blood mass and blood velocity. The peripheral blood flow of the upper limbs at a room temperature of 20°C (pre-loading) was 5.00 ml/min 100 9 tissue on average. The average blood rnass was 287 and the average blood velocity was 0.516. On the other hand, the average peripheral blood flow of the lower limbs was 2.23, the average blood mass was 149 and the average blood velocity was 0.574. This result shows that the blood flow and blood mass of the upper limbs were more than in the lower limbs. The average blood flow at the upper limbs decreased to 3.69 from 5.00 (or at 26.2% ) when the lower limbs were submerged and cooled for 5 min in a water bath at 20°C (i. e. cold-loading). On the other hand, blood flow of the lower limb was 1.51 m l under a condition of cold-loading, and decreased 32.3% from 2.23. Blood mass of the upper limb was 241 on average and decreased 16.0% from 287. Blood mass of the lower limb was 113 on average and decreased 24.2% from 149. There was no difference between blood velocity of the upper limb under the conditions of room temperature at 20°C (0.516) and cold-loading (0.501). However, blood velocity of the lower limb increased to 0.642 from 0.574. After the end of cold loading, there was some tendency for blood flow, blood rnass and blood velocity to return to the amount at pre-loading. Twenty minutes after the end of cold-loading, blood flow increased to 5.74 (14.8% ) compared with pre-loading (5.00). However, blood flow of the lower limb remained at only 83.9% (1.87) of the amount at pre-loading (2.23). These results show that partial cold-loading of the lower limb had a quantitative effect on the distant peripheral circulation. The speculated mechanism of this phenomenon is that it to protects against loosing body heat from the body surface under the conditions of local cold-loading. Our body has defense mechanisms to decrease whole body peripheral circulation to protect against loosing body heat. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Correlation between efficacy of Pranlukast and LTC4 generation by peripheral leukocytes 36 41 EN Takashi Mifune Shingo Takada Makoto Okamoto Hirofumi Tsugeno Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Yoshiro Tanizaki Mine Harada 10.18926/14907 The correlation between the efficacy of 4-weeks administration with pranlukast, leukotriene receptor antagonist, and LTs generation by peripheral leukocytes were evaluated in 18 patients with mild-persistent asthma. The efficacy of pranlukast administration was assessed by symptom, morning PEF and pulmonary function. Pranlukast were effective in 12/18(67%) patients. In those patients, LTC4 generation before pranlukast administration was significantly high, compared with that in pranlukast-ineffective patients. LTC4 generation decreased after 4-weeks administration with pranlukast in effective patients. In ineffective patients, however, LTC4 generation increased after 4-weeks administration. LTB4 had shown no significant difference between effective and ineffective patients before administration, and LTB4 decreased after 4-weeks in both groups. Proport ion of peripheral eosinophi Is in effective patients were higher than that in ineffective patients, however not significant. After 4-weeks, proportion of eosinophi Is was decreased in effective patients and increased in ineffective patients. These findings suggest that pranlukast is effective for patients with high LTC4 generation and has the effect to suppress the accumulation of eosinophils in such patients. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Correlation between pulmonary function and low attenuation area (LAA) on HRCT III patients with asthma in relation to smoking 29 35 EN Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Shingo Takada Tadashi Yokoi Yoshiro Tanizaki 10.18926/14906 The influence of smoking on pulmonary function and emphysematous changes of the lung (percentage of attenuation area < -950 HU (% LAA) on high resolution computed tomography (HRCT) was examined in 49 patients with bronchial asthma. 1. In patients with asthma, the % residual volume (RV) in many nonsmokers was less than 129%, in contrast, the % RV in many smokers was between 130% and 189% , which was higher than that in nonsmokers. 2. Significant correlations between % RV and 96LAA value, and between % RV and CT number were observed both in nonsmokers and smokers with asthma, in which as % RV more increased, % LAA value was larger, and CT number was lower. 3. % DLco value was lower in smoking patients with asthma, whose % RV was between 130% and 189% and larger than 190% , however, the % DLco value did not change in nonsmoking patients despite of higher valure in % RV. 4. A significant correlation was also observed between % FEV1.0 value and % RV both in smoking and nonsmoking patients with asthma; as % RV value more increased, % FEV1.0 value was lower. 5. Any correlation between % FVC value and % RV was not observed. These results suggest that smoking affects the % LAA of the lung on HRCT and % DLco in patients with asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Quantitative evaluation by high resolution computed tomography (HRCT) of patients with asthma and emphysema 19 28 EN Fumihiro Mitsunobu Takashi Mifune Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Seishi Harada Mutsuo Nakai Yoshiro Tanizaki 10.18926/14905 Background: Assessment of low attenuation areas and lung densitometry on high resolution computed tomography (HRCT) have been reported in studies of patients with chronic obstructive pulmonary disease. Objective : The purpose of this study was to examine if HRCT could separate asthmatic patients from normal control subjects and patients with emphysema. Methods : Subjects were divided into three groups : 24 patients with bronchial asthma, 23 patients with pulmonary emphysema and 15 normal controls. HRCT scans of the lung were performed at three different levels at both end inspiration and expiration in all patients and control subjects. Results : The mean CT number of three slices was significantly lower in asthmatic subjects compared with normal individuals at both end inspiration (p < 0.05) and expiration (p < 0.01). The relative area of the lung with an attenuation value lower than -950 HU (% LAA) for three slices was significantly higher in asthmatic subjects than in normal individuals at end inspiration (p < 0.05), but there was no significant difference at end expiration. The mean CT number and % LAA obtained from studies that were performed at three cm above the top of the diaphragm provided the best separation among three anatomic levels. In comparison between asthmatic and emphysema patients, both parameters were significantly different in asthmatic subjects than in those with emphysema at both end inspiration and expiration on each scan and in the total scans (p < 0.001). Conclusions : HRCT is a useful method to separate asthmatic subjects from patients with emphysema and normal subjects. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 Spa therapy and bronchial hyperresponsiveness in elderly patients with asthma 10 18 EN Yoshiro Tanizaki Fumihiro Mitsunobu Takashi Mifune Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Shingo Takata Koji Ochi 10.18926/14904 Clinical effects of spa therapy were examined in 150 patients with asthma in relation tobronchial hyperresponsiveness and patient age. 1. The efficacy rate of spa therapy was larger as the patient age was higher: the rate was 73.3% in patients under age 49, 81.8% in those between the ages of 50 and 59, 86.4% in those between the ages of 60 and 69, and 90.6% in those over age 70. The mean of efficacy rates was 83.3% in all subjects. 2. The bronchial hyperresponsiveness (BH) was lower as patient age was higher: the BH in patients between the ages of 60 and 69 and in those over age 70 was significantly lower compared to the BH in those under age 49 (p < O.OOl). 3. Clinical effects of spa therapy tended to be lower in patients with increased bronchial hyperresponsiveness. The bronchial hyperresponsiveness showed a tendency to decrease after spa therapy in whom the therapy was effective, however, the BH did not change in patients with slight or no efficacy during spa therapy. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 71 2001 呼吸器疾患に対する温泉療法.　最近7年間(1993年-1999年)の入院症例999例を対象に 1 9 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Shingo Takata Koji Ochi 10.18926/14903 1993年1月より1999年12月までの7年間に当院へ入院した呼吸器疾患999例のうち閉塞性換気障害を示す829例(気管支慌息BA+COPD)を対象に,年齢,地域分布などの経年変化について検討を加えた｡ 1.最近7年間に当院へ入院した閉塞性呼吸器疾患患者829例のうち, 気管支喘息は636例(76.7% )であった｡閉塞性呼吸器疾患のなかで気管支喘息の占める割合の経年変化では,1996年度が最も高く(84.5% )その後徐々に低下する傾向か見られ1999年度では65.5% であった｡一方′肺気腫は近年増加の傾向を示し,19993年度では5.6% であったが.1999年度では25.6% であった｡　 2.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)からの入院患者が比較的多く,この7年間の鳥取県外(遠隔地)からの入院患者は829例中433例(52.2% )であった｡また,岡山,大阪,兵庫,広島,山口,愛媛,東京,神奈川などからの入院症例か多い傾向が見られた｡　 3.年齢別検討では,いずれの地域においても,高齢者の入院症例が多く,鳥取県内,県外を問わず,70才以上の症例の頻度が明らかに高い傾向か見られた.そして,50才以上の症例の全症例に対する頻度は,鳥取県内では80.9% ,県外では96.7% であり,県内ではその多くが,また県外ではそのほとんどが50才以上の症例であった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 A case with persistent asthma symptoms despite fluticasone treatment in which concomitant treatment with montelukast and perilla seed oil-rich supplementation significantly improved asthma control 53 59 EN Shingo Takata Kozo Ashida Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Hiroshi Kikuchi Fumihiro Mitsunobu 10.18926/14900 A 25-year-old woman had the chief complaint of recurrent episodes of dyspnea and wheeze. Asthma had been diagnosed at infant years and sometimes experienced asthma attacks. She graduated senior high school and entered technical school in Tokyo. She received fluticasone (400μg daily) but exacerbation continued after she became an office clerk. She returned Kurashiki in October 2001 but had wheeze and asthma exacerbations. She was admitted to our hospital for evaluation and treatment of bronchial asthma on August 2, 2002. After admission, her symptoms subsided within some days. She was treated with montelukast and perilla seed oil-rich supplementation . The number of eosinophils decreased, decrease was observed in leukotriene (LT) B4 generation and in LTC4 generation, and pulmonary function improved following montelukast and perilla seed oil-rich supplementation for 4 weeks. The patient had no exacerbation under treatment and was discharged from the hospital on September 2, 2002. For some patients with persistent asthma, inhaled corticosteroids may fail to achieve adequate control possibly because corticosteroids do not completely inhibit the synthesis and release of cysteinyl leukotrienes (cysLTs) in the lung. Montelukast blocks the interaction of cysLTs with their receptor and resulting downstream events and perilla seed oil-rich diet suppresses LT generation. Combination therapy with montelukast and perilla seed oil-rich diet is more effective than montelukast or perilla seed oil-rich diet alone because of additive effects of montelukast with perilla seed oil-rich diet. We suggest that montelukast and perilla seed oil-rich supplementation are effective options when bronchial asthma patients receive inhaled corticosteroid but exacerbation continues. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 肝細胞癌の経過中に肝原発腺扁平上皮癌を合併した１例 41 48 EN Shingo Takata Kozo Ashida Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Hiroshi Kikuchi Fumihiro Mitsunobu 10.18926/14898 症例は74歳男性｡慢性Ｃ型肝炎にて当院外来通院中であった｡肝細胞癌を指摘され1998年7月腹部血管造影, 経皮エタノール注入療法施行した｡以後当院外来加療中であったが, 腹部超音波上肝Ｓ５に低エコー域を認め, 1999年10月27日精査加療目的で入院となった｡入院 後肝Ｓ６にも低エコー域を認めた｡超音波ガイド下経皮的針生検施行し, Ｓ５では中から低分化の腺癌に加え, 部分的に扁平上皮癌が認められ, 腺扁平上皮癌と診断された｡Ｓ６では中分化, 一部高分化の肝細胞癌を認めた｡転移性肝癌の可能性を考え全身検査を行なったが,他臓器に原発病巣は発見されず, 肝細胞癌に肝原発扁平上皮癌を合併したと考えた｡経皮的エタノール注入療法施行し12月28日退院となった｡その後も外来にて加療されていたが, 2000年３月肝Ｓ４を中心に再発し, ９月９日死亡した｡肝細胞癌に合併した肝原発腺扁平上皮癌は稀であり, 若干の文献的考察を加えて報告する｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 ケトプロフェン湿布剤により全身性麻疹様紅斑を来した１例 35 40 EN Shingo Takata Kozo Ashida Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Hiroshi Kikuchi Fumihiro Mitsunobu 10.18926/14897 症例は74歳男性｡慢性Ｃ型肝炎にて当院外来通院中であった｡肝細胞癌を指摘され1998年7月腹部血管造影, 経皮エタノール注入療法施行した｡以後当院外来加療中であったが, 腹部超音波上肝Ｓ５に低エコー域を認め, 1999年10月27日精査加療目的で入院となった｡入院 後肝Ｓ６にも低エコー域を認めた｡超音波ガイド下経皮的針生検施行し, Ｓ５では中から低分化の腺癌に加え, 部分的に扁平上皮癌が認められ, 腺扁平上皮癌と診断された｡Ｓ６では中分化, 一部高分化の肝細胞癌を認めた｡転移性肝癌の可能性を考え全身検査を行なったが,他臓器に原発病巣は発見されず, 肝細胞癌に肝原発扁平上皮癌を合併したと考えた｡経皮的エタノール注入療法施行し12月28日退院となった｡その後も外来にて加療されていたが, 2000年３月肝Ｓ４を中心に再発し, ９月９日死亡した｡肝細胞癌に合併した肝原発腺扁平上皮癌は稀であり, 若干の文献的考察を加えて報告する｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 帯状疱疹後神経痛に対する温泉を利用したリハビリテーションの経験 31 34 EN Masanori Hamada Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Shingo Takata Hiroshi Kikuchi 10.18926/14896 帯状疱疹後神経痛に対して, 温泉療法を行い, 良好な結果が得られた症例について報告する｡72才, 女性. 右下肢の皮疹にて帯状疱疹を発症した｡皮疹が治癒した後も疼痛が強かった｡発症半年後, 温泉を利用したリハビリテーション目的にて, 当院に入院した｡右下肢にはアロディニアがあり､温度覚過敏があった｡微温浴を中心とした温熱療法と右下肢の自動介助運動を中心とした運動療法を行った. 温泉療法により疼痛軽減し､杖歩行が可能となった｡温泉療法は副作用も少なく帯状疱疹後神経痛の治療の選択肢の一つになると考える｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 Effects of spa therapy on the six-minute walk test in patients with chronic obstructive pulmonary disease 24 30 EN Shingo Takata Kozo Ashida Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Hiroshi Kikuchi Fumihiro Mitsunobu 10.18926/14895 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 慢性閉塞性肺疾患患者の運動耐容能・肺機能に対する温熱療法の有効性についての検討　−pilot study− 18 23 EN Hiroshi Kikuchi Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Shingo Takata Fumihiro Mitsunobu 10.18926/14894 我々は現在まで, 慢性閉塞性肺疾患(COPD；chronic obstructive pulmonary disease)患者に対する複合温泉療法(温泉プール運動浴, 鉱泥湿布療法, ヨード吸入) の有効性を報告してきた｡今回, 温熱療法の有効性を明らかにすることを目的として, 温熱療法を 従来の治療に併用し, 運動耐容能および肺機能に対する効果を検討した｡Ａ群７例(68〜79歳・男性６例, 女性１例) およびＢ群７例(63〜81歳・全例男性), 計14例のCOPD患者を対象とした｡Ａ群については, 薬物・肺理学療法の他に, 温熱療法を週５回で４週間施行した｡ 温熱療法として, 乾式遠赤外線式サウナを用いた60℃, 15分間のサウナ浴(座位) を施行した後, 臥位で30分間全身を毛布で包んで安静保温した｡Ｂ群は, 薬物・肺理学療法のみ４週 続けた｡治療前後で肺機能および６分間歩行試験を施行し比較検討した｡両群とも, 治療開始４週後には６分間歩行での歩行距離, 酸素飽和度(ＳpO2), 修正Borg scaleにて改善を認め, 肺機能においても肺活量(VC；vital capacity), 一秒量(FEV1.0；forced expiratory volume in one second) は上昇した｡両群間の比較では, ６分間歩行試験で上記３項目の改善率はいずれもＡ群はＢ群を凌駕し, Ａ群が優位に運動耐容能の向上を認めた｡Ａ群で修正 Borg scaleの治療４週間後の改善率は有意差(p＜0.01) を認めた｡また肺機能では, ４週間後でVC上昇率はほぼ不変であったがFEV1.0ではＡ群が優位に上昇した｡以上の結果より温熱療法がCOPD治療に有効である可能性が示唆された｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 2002−2007年における当院市中肺炎入院症例の臨床的研究 12 17 EN Shingo Takata Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Hiroshi Kikuchi Fumihiro Mitsunobu 10.18926/14893 当院に入院した市中肺炎症例の臨床像を明らかにし, 日本呼吸器学会2007年成人市中肺炎診療ガイドラインによる市中肺炎の重症度分類の妥当性を検討した｡2002年４月から2007年３月までの過去５年間に当院に入院した, 30歳から95歳までの市中肺炎109名142例 (男性72名102例, 女性37名40例) を対象に, その臨床像を検討した｡平均年齢は74.8歳で,65歳未満26例, 65歳以上75歳未満の前期高齢者30例, 75歳以上の後期高齢者86例であった｡ 肺炎重症度は軽症21例, 中等症99例, 重症17例, 超重症５例であった｡抗菌薬の選択に関して軽症では21例中18例, 中等症では99例中92例, 重症では17例中16例がガイドラインに準じていたが, 超重症では全例でガイドラインに準じていなかった｡平均入院日数は軽症28.4日,中等症39.9日, 重症48.5日, 超重症45.2日であった｡死亡例は, 軽症では無く, 中等症群７例, 重症群４例, 超重症群３例の計14例で, 死亡例の平均年齢は81.8歳であった｡重症度が悪化するにつれ, 高齢, BUN高値, 低酸素血症, 意識障害, 低血圧の頻度は増加傾向にあった｡79例で慢性呼吸器疾患を合併し, 慢性呼吸器疾患合併群では有意に呼吸器関連死亡が多かった｡日本呼吸器学会2007年成人市中肺炎診療ガイドラインは, 本邦の肺炎の重症度別症 例解析に適していると考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 76 2008 呼吸器疾患の温泉療法−25年間の入院症例2762例を対象に− 1 11 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Shingo Takata Hiroshi Kikuchi Masanori Hamada 10.18926/14892 1982年から2006年までの25年間に当医療センターで入院加療した2762例を対象に５年毎にその年次推移を検討した｡その内訳は,気管支喘息1578例(57.1％),COPD652例(23.6％),その他532例(19.3％) 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93.0例／年と初期と比べ8.1倍の増加がみられた｡また, 第５期 (2002−2006年) では70.4例／年と6.2倍であった｡その内のステロイド依存性重症難治性喘息(SDIA；steroid-dependent intractable asthma)の頻度は初期の68.4％から第４期では29.0％,第５期24.1％にまで低下する傾向を示した｡２.COPD症例は, 第１期では平均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47.4例／年へと9.1倍の増加がみられた｡また, その中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78.9％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％, そして第5期では85.1％と, 年々その頻度は高くなっていく傾向が見られた｡ 即ち, 最近25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, そしてその年齢は年々高くなる傾向にあることが示唆された｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 高齢者気管支喘息の病態におよぼす加齢および喫煙の影響について 74 79 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Tadashi Yokoi Shingo Takata Yoshiro Tanizaki 10.18926/14886 高齢者喘息の病態に対する加齢および喫煙の影響について,若干の検討を加えた｡高齢者喘息,特に70才以上の喘息では,HRCT上の1950HU以下の肺のlow attenuation area(LAA)は,苦青年者喘息と比べ有意に増加していた.また,同時にこの年齢層では残気量の有意の増加,拡散能の有意の低下が見られた.% LAAと% 1秒量との間には,喘息の非喫煙例,喫煙例,肺気腫(全例喫煙例),いずれにおいても相関が見られた｡しかし,% LAAと拡散能との間には,喘息の喫煙例および肺気腫では相関が見られたが,非喫煙例では有意の相関は見られなかった｡これは,喫煙の拡散能におよぽす影響が大きいことを示唆しているものと考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 RA患者のQOL ―　SF-36を用いて　― 71 73 EN Tadashi Yokoi Masuo Senda Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Norikazu Nishida Hirofumi Tsugeno Makoto Okamoto Shingo Takata Yoshiro Tanizaki Hajime Inoue 10.18926/14885 近年QOLが重視されるようになってきている｡MOS short form 36 health survey (以下SF-36と略す)は,国際的レベルでの基準とされるべく開発された非疾患特異的HRQOL尺度である｡今回我々は当院でリハビリテーションをうけているRA患者を対象にSF-36を用いてQOL評価を行った｡SFl36の8項目をそれぞれ算出し,国民標準値との比較を行った. すべての項目において標準値を下回っていたが,特に,日常役割機能(身体),日常役割機能(精神),身体の痛み,身体横能において大きな開きを認めた｡また,PCSは平均35.8であり,MCSは平均49.1であった｡以上より,RA患者は身体に強い痛みを伴っているため精神健康面より身体横能面において制限を有していることが分かった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 腰痛症患者における腰椎MRI画像所見の検討 66 70 EN Shingo Takata Tadashi Yokoi Norikazu Nishida Makoto Okamoto Hirofumi Tsugeno Kozo Ashida Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki Kenji Niiya Mitsune Tanimoto 10.18926/14842 (目的) MRlは腰痛をきたす疾患の診断に必須な検査法である｡腰痛と腰椎MRl所見との関係を明らかにすることを目的として検討した｡(対象と方法)腰痛を訴えた30例を対象とし､腰椎MRl所見の頻度を調査した｡全例に温泉療法を施行した｡　 (結果)全症例において腰椎MRl上異常所見を認めた｡少なくとも1つ以上の椎間板の変性病変をもつ症例は30例中27例(90% )で､椎間板変性はL4/5levelで最も多く認められた(30例中18例)｡椎間板ヘルニア を示す症例は30例中10例(33.3% )であった｡神経根圧迫を持つ症例は30例中8例(26.7% )であった｡腰椎圧迫骨折を持つ症例は30例中6例(20% )であった｡温泉療法により腰痛が改善した症例は30例中17例(56.7% )であった｡　 (結論)腰痛症患者は腰椎MR止異常所見を有した｡温泉療法により腰痛の改善を認めたので､MRL上で認めた形態学的異常は必ずしも機能的異常や症状に直結しないと思われた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 男性ステロイド依存性喘息患者に対する4年間のエチドロネート投与の経験 62 65 EN Hirofumi Tsugeno Makoto Okamoto Singo Takata Tadashi Yokoi Kazunori Nishida Kozo Ashida Yasuhiro Hosaki Fumihiro Mitsunobu Yoshiro Tanizaki Mutsuo Nakai Tsuneo Akiyama Hisakazu Hasegawa Takao Tsuji 10.18926/14841 男性のステロイド依存性気管支喘息患者にエチドロネートを4年間の長期間にわたり投与した経験を得たので報告する｡症例は,男性のステロイド依存性気管支喘息で,エチドロネート200mg/日･14日間投与を4ケ月おきに4年間にわたり反復投与し,活性型ビタミンD製剤 (VD)投与と併用した2例と,活性型VD製剤を単独授与した2例｡椎体圧迫骨折数,境骨耗骨密度,海綿骨骨密度,皮質骨骨密度について,椎体X線像,PQCT(Stratec XCT960)を用いて4ケ月毎に測定し,48ケ月後の効果を検討した｡エチドロネートを投与した症例1では,総骨密度と海綿骨はやや増加を認め皮質骨密度は減少していた｡エチドロネートを授与した症例2では,総骨密度,海綿骨,皮質骨密度はいずれも減少を認めたが,VD単独投与した2例よりもやや減少が抑制されていたようであった｡VD単独投与した2例ではいずれの項目も減少を認めた｡これらの症例からは,エチドロネートは男性のステロイドによる骨傷害にも有効と考えられたが,現在投与継続途中であり,今後さらに検討を続ける必要がある｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 解離性大動脈瘤と冠動脈狭窄病変のマルチスライス(多列検出器型高速)CT画像診断(解離性上行大動脈瘤と狭心症を合併した一患者の診断と考察を元に) 55 61 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Shingo Takata Tadashi Yokoi Mutsuo Nakai Hirofumi Makino Yoshiro Tanizaki 10.18926/14840 2000年になり多列検出器高速CT (Multi-detector CT,以下MDCT)が出現し,大動脈疾患や心電図同期での冠動脈狭窄病変診断への臨床応用が開始された.当院でも2001年7月からMDCTが稼動し,日常臨床診療に貢献している. 今回,解離性上行大動脈瘤(DeBakeyII)(以下DAA)と冠動脈疾患(LAD# 7の閉塞)を合併した患者を診療した.MDCTによるCT - Angiography (以下CTA)が両者の診断に非常に有用であった.患者の負担は100mlの末梢静脈内への造影剤の投与と約数十秒間の呼吸停止だけで,解離性大動脈瘤並びに冠動脈狭窄病変の診断にそれぞれ非常に有用であった.三次元診断の鮮明な画像が得られ,かつ低侵襲度のMDCT並びにCTAは,今後益々臨床の場で血管造影検査の強力なファーストチョイスの診療手段になると考える. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 Effects of alpha -linolenic acid-rich supplementationon leukotriene generation by leucocytes in patientswith asthma associated with lipometabolism 45 54 EN Makoto Okamoto Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Norikazu Nishida Tadashi Yokoi Shingo Takata Yoshiro Tanizaki Mitsune Tanimoto 10.18926/14839 Dietary sources of a -linolenic acid, such as perilla seed oil, may have the capacity to inhibit the generation of leukotrienes (LTs) by leucocytes in patients with asthma, as has been reported with the consumption of other long - chain n- 3 fatty a-cids. The factors affecting the suppression of leukotriene (LT) C4 generation by leucocytes were examined by comparing the clinical features of patients with asthma who had been given dietary perilla seed oil (n - 3 fatty acids). Group A consisted of patients in whom the leucocyte generation of dietary perilla seed oil LTC4 was suppressed by this procedure. Group B consisted of those in whom LTC4 generation was not suppressed. LTC4 generation by leucocytes significantly decreased in group A for two (P<0.05) and four weeks (P<O. OS), conversely, significantly increased in group B for four weeks (p<O. OS). The two study groups differed significantly in LTC4 generation by leucocytes after four weeks of dietary supplementation (P<0.05). Ventilatory parameters such as peak expiratory flow (PEF) , forced vital capacity (FVC) and forced expiratory volume in one second (FEV(1.O)) increased significantly after four weeks of dietary supplementation in group A (P<0.05). Values of PEF, FVC, FEV(1.O) and V(25) between groups A and B significantly differed prior to dietary supplementation. Serum levels of total cholesterol, LDL- cholesterol and phospholipid were significantly decreased by dietary supplementation in group A after four weeks. Serum levels of total-choles terol, triglyceride, HDL-Cholesterol, LDL-Cholesterol and phospholipid values between the two study groups differed significantly prior to dietary supplementation. Serum levels of triglyceride and LDL- cholesterol differed significantly between the two study groups after four weeks of dietary supplementation. The effects of dietary supplementation with perilla seed oil to patients with asthma by suppressing the generation of LTC4 is associated with clinical features such as respiratory function and lipometabolism. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 The generation of leukobienes B4 (LTB4) and C4 (LTC4) and bronchial hyperresponsiveness in patients with asthma and spa therapy 38 44 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14838 Changes in the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes after spa therapy were examined in 30 patients with asthma. 1. The efficacy of spa therapy was marked in 8 (26.7%), and moderate in 16 (53.3%) of 30 patients with asthma, and slight or no efficacy of the therapy was observed in the residual 6 patients (20.0%). 2. Bronchial reactivity to methacholine was the highest in patients with slight or no efficacy of spa therapy, however. there were no significant differences among the three groups classified by clinical efficacy. 3. The generation of LTC4 was significantly higher in patients with slight or no efficacy compared with the generation in those with marked (p<O. 01) and moderate efficacy (p<O. 001). However, there were no signifcant differences in the generation of LTB4 among them. 4. The generation of LTC4 signifcantly decreased in patients with marked and moderate efficacy after spa therapy. but not in those with slight or no efficacy. The generation of LTB4 was not significantly different before and after spa therapy among patients with marked, moderate, and slight or no efficacy. These results show that the efficacy of spa therapy for patients with asthma is closely related to the generation of LTC4 by leucocytes. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 Non-invasive study for peripheral circulation in patients with diabetes mellitus 31 37 EN Yasuhiro Hosaki Fumihiro Mitsunobu Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi Yoshiro Tanizaki Koji Ochi Takao Tsuji 10.18926/14837 The purpose of this study is to establish a new, non - invasive diagnostic technique for peripheral circulation in patients with diabetes mellitus in the early stage of arteriosclerosis obliterans (ASO) as one of the complications of diabetes mellitus. We observed peripheral circulation quantitatively by thermography and Laser- Doppler blood flowmetry. The body surface peripheral circulation in 27 patients with diabetes mellitus, including 14 males and 13 females with a mean age of 67.4 years (range from 51-82 years), and with a mean hemoglobin A1C (HbA1C) 019.5% (range from 6.8%-13.0%), and who were suffering coldness, numbness or pain in their feet, was examined using thermography and Laser- Doppler blood flowmetry. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio= [Total counts of thermography (Pixels) over temperature (T) after cold -loading] + [Initial counts over T after hot-loading] Xl00 (%). Results of recovery ratios for 27 cases were 0% - 93.5%, and the average was 34.0%. At the same time, the blood flow after cold -loading was 0.91 - 5. 36ml/min/lOOg tissue and the average was 2.04ml/min/l00g tissue. We found that the recovery ratio and the blood flow were correlated (r=O. 634, p<O. 0001). The recovery ratio for males was 28.4% and that of females was 39.9%, and there was a tendency for the recovery ratio of females to be higher than males, however, this was not statistically significant. There was a correlation between the recovery ratio and age (r=O.187, p < 0.0001), although, the correlation was low. There was also a slight correlation between the recovery ratio and HbA1C (r=0.041, p<O.OOl). On the other hand, the blood flow of males was 2. 03ml/min/lOOg tissue and that of females was 2.05. There was a tendency for the recovery ratio of females to be higher than males. however. the correlation was not significant. There was a correlation between blood flow and age (r=O. 110, p<0 . 0001) , however, the correlation was low. There was also a slight negative correlation between blood flow and HbA1C (r=-0.179, p<O.OOOl). The ratio of the blood flow after cold -loading at 20t divided by the blood flow after hot -loading at 36 C was 38.1 %-122%, and the average was 80.6%. There was correlation between this ratio and the recovery ratio (r=0.502, p<O.OOOl). The case of the peripheral blood flow recovered immediately to the amount of the hot-loading or access amount of hot-loading after cold-loading, and had a high recovery ratio of thermography. This might mean that the cooled body surface was warmed by overcirculation of blood flow to keep body temperature at 30C in the mean of homeostasis. We showed that thermography and Laser- Doppler blood flowmetry were useful for non - invasive study to separate patients with poor peripheral circulation. We recommend that these methods for evaluation of further treatment, such as with Prostaglandin E1, on peripheral circulation in patients with diabetes mellitus and ASO. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 The role of leukotrienes B4 (LTB4) and C4 (LTC4) in pathophysiology of asthma in the elderly. Relationship to bronchial hyperresponsiveness and FEV1.O% 23 30 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14836 The generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes stimulated with Ca ionophore A23187 was examined in 67 patients with asthma. 1. The generation of leukotriene B4 (LTB4) by leucocytes was significantly more increased in patients with asthma than in those with pulmonary emphysema (PE) and healthy subjects. The generation of leukotriene C4 (LTC4) was also signficantly more increased in patients with asthma compared to the generation in those with PE and healthy subjects. The generation of both LTB4 and LTC4 was significantly more increased in patients with PE than in healthy subjects. 2. The generation of both LTB4 and LTC4 was larger in patients with asthma over age 70 than in those of other age groups, however, the difference was not significant. 3. The generation of LTC4 was significantly higher in attack stage than in non-attack stage in all age groups of patients with asthma, however, the generation of LTB4 was not significantly different between the two stages. 4. Bronchial hyperresponsiveness to methacholine in patients with asthma tended to decrease with aging, and the bronchial hyperresponsiveness was to a certain extent correlated with the generation of LTB4, but not LTC4. 5. The generation of LTC4 was correlated with value of FEV1.0%. These results may suggest that both LTB4 and LTC4 participate in the pathophysiology of asthma in the elderly. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 Effects of aging on bronchoalveolar lavage (BAL) cells in patients with asthma 16 22 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14835 Effects of aging and glucocorticoid therapy on bronchoalveolar lavage (BAL) cells, particularly lymphocytes, neutrophils and eosinophils, were examined in 81 patients with asthma. 1. The proportion of BAL lymphocytes tended to increase with aging in asthmatics under age 69 years, and the proportion was significantly higher in patients with asthma between the ages of 60 and 69 than in those under age 39 and between the ages of 40 and 49. 2. The proportions of BAL neutrophils and eosinophils were not related to aging. 3. The proportion of BAL lymphocytes was higher in patients without glucocorticoid therapy than in those with steroid-dependent intractable asthma (SOIA) in those under age 69 years. In patients between the ages of 50 and 59, the proportion of BAL lymphocytes was significantly higher in patients without glucocorticoids than in those with SOIA. 4. The proportion of BAL neutrophils was higher in patients without glucocorticoid therapy than in those with SOIA, and the difference was significant in patients between the ages of 60 and 69. 5. The proportion of BAL eosinophils was not related to glucocorticoid therapy. These results suggest that the proportion of BAL lymphocytes and neutrophils is affected by aging and glucocorticoid therapy, but not BAL eosinophils. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 % Low attenuation area (% LAA) of the lungs on high resolution computed tomography (HRCT), associated with pulmonary function in elderly patients with asthma 9 15 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi Mutsuo Nakai Yoshiro Tanizaki 10.18926/14834 The clinical significance of low attenuation area <-950 HU of the lungs on high - resolution computed tomography (HRCT) was evaluated in 80 patients with asthma in relation to patient age, CT number, pulmonary function including % residusal volume (% RV) and % DLco, and generation of leukotrienes B4 and C4 by leucocytes. 1. The % LAA (<- 950 HU) of the lungs showed a tendency to increase significantly with aging; the % LAA was significantly larger in elderly patients over the age of 60 years than in those under the age of 49 years. The CT number was also significantlyincreased with aging. 2. The values of % FVC, % FEV1.0, and FEV1.0% were significantly decreased in elderly patients over age 70 compared with the values in those under age 49. 3. The value of % residual volume (% RV) tended to increase significantly with aging; the value in patients over the age of 70 years was significantly larger in those between the ages of 50 and 59 (p<O.OOl). and under the age of 49 years (p<O.OOl). 4. The % DLco value significantly decreased with aging; the value in patients over age 70 was significantly lower than the value in those between the ages of 50 and 59 (p<O.Ol) and under age 49 (p<O.OOl). 5. A significant correlation was observed between % LAA of the lungs and % RV (r=O. 67, p<0.001), however. any significant correlations were not observed between % LAA and the values of % FVC, % FEV1.0, and FEV1.0% . 6. The generation of LTB4 and LTC4 by leucocytes was not significantly related with patient age. The results suggested that % LAA of the lungs on HRCT tended to increse with aging, accompanied with a significant increase in % RV. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 0918-7839 72 2002 呼吸器疾患に対する温泉療法　―最近20年間の入院症例1934例を対象に― 1 8 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Shingo Takata Tadashi Yokoi 10.18926/14822 1982年1月より2001年12月までの20年間に当院へ入院した呼吸器疾患患者1934例のうち閉塞性換気障害を示す肺疾患1641例(気管支喘息BA+慢性閉塞性呼吸器疾患COPD)を対象に,5年間ごとに年齢,地域分布などの経年変化について検討を加えた｡　 1.最近20年間に当院へ入院した閉塞性換気障害を示す呼吸器疾患1641例のうち,気管支喘息は1226例(74.7%)であった｡閉塞性呼吸器疾患のなかで気管支喘息の占める割合は,最初の5年間では106例中 57例(53.8%),1987年からの5年間では71.7% (271/378),1992年からの5年間では73.6% (433/588)で,最近の5年間では53.9% (465/862)と最近ではその割合がやや低下する傾向が見られた｡　 2.全ての気管支喘息のなかでステロイド依存性重症難治性喘息(SDIA)の割合は,最初の5年間をのぞけばほぼ横ばいで最近の5年間では35.3%であった｡COPDのなかでの肺気腫の割合は,近年増加の傾向を示し,最初の5年間の4.7% (5/106)に対して最近の5年間では20.2% (174/862)であった｡　 3.年齢別検討では,閉塞性換気障害を示す全ての症例のうち60才以上の症例の割合は,最初の5年間では30.1%であったが,その後増加の傾向を示し,最近の5年間では68.0%であった｡　 4.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)からの入院患者が比較的多く,この20年間の鳥取県外(遠隔地)からの入院患者は1641例中853例(52.0%)であった｡また,岡山,大阪,広 島,兵庫,東京,愛媛,山口,京都などからの入院症例が多い傾向が見られた｡なお,入院患者の出身県は,35都道府県に及んでいた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 高齢者喘息における気腫化傾向 - 加齢変化と病的変化（肺気腫）の相違点 62 67 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14811 高齢者喘息の病態的特徴を臨床的に観察した。その結果は以下のごとくであった。 1．血清IgE値や抗原に対するIgE抗体の陽性率は一般的に低いが，しかしアレルギー疾患の家族歴を有する症例の頻度は高く，アトピー性の素因を有する症例の頻度がかなり高いこと，そして，このような症例ではIgE系反応の関与が示唆された。　 2．気道過敏性は加齢とともに低下する傾向が見られた。　 3．換気機能，ガス交換能は加齢とともに低下し，特に70才以上 の症例では若青年者喘息と比べ有意の低下が見られた。　 4．肺容積は，加齢とともに増大し，70才以上の症例では有意の増大傾向が見られた。また，この肺容積の増大は，HRCT上の−950HU以下の肺% UIAと有意の相関が見られ，肺の過膨張の状態が存在することが示唆された。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 温泉療法が腰痛症患者のQOLに及ぼす効果 48 50 EN Tadashi Yokoi Masuo Senda Masanori Hamada Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Yoshiro Tanizaki Hajime Inoue 10.18926/14800 近年QOLが重視されるようになってきている。MOS short form 36 health survey（以下SF-36と略す）は，国際的レベルでの基準とされるべく開発された非疾患特異的HRQOL尺度である。今回，我々は当院でリハビリテーションをうけている腰痛症患者を対象に温泉療法のQOLに対する効果をSF−36を用いて調べた。SFL36の8項目をそれぞれ算出し，温泉療法前後での比較を行った。PCSは41.1から43.6へ, MCSは49.1から5l.0へ上昇したことより，身体・精神面ともに効果があると考えられた。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 IgE-mediated allergy and cigarette smoking enhancethe generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leucocytes and bronchial hyperresponsiveness in patients with atopic asthma 42 47 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14789 Influences of IgE-mediated allergy and cigarette smoking on pathophysiology, evaluated by bronchial hyperresponsiveness and the generation of LTB4 and LTC4, of asthma were examined in 69 patients with asthma sensitive to inhalant allergens such as house dust mite and Candida albicans. 1 . Bronchial byperresponsiveness was significantly higher in previous and current smokers of asthmatics than in never-smokers. 2 . The generation of leukotrienes 84 (LTB4) and C4 (LTC4) by leucocytes was significantly larger in patients with serum IgE over 350 IU/ml than in those with serum IgE less than 150 IU/ml (LTB4 : p<O. 01 , LTC4 : p<0.05) . 3 . Long term glucocorticoid regimen suppressed the generation of LTC4, but not bronchial hyperresponsiveness and LTB4 generation. 4 . Bronchial hyperresponsiveness was not significantly correlated with patient age in thse patients with atopic asthma. The results demonstrate that IgE-mediated allergy significantly enhances the generation of LTB4 and LRC4 by leucocytes, and cigarette smoking significantly enhances bronchial hyperresponsiveness in patients with atopic asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 Difference in low attenuation area (LAA) of the lungs on high resolution computed tomography (HRCT) between asthma and pulmonary emphysema in relation to cigarette smoking 35 41 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14788 The low attenuation area (LAA) of the lungs on high resolution computed tomography (HRCT) was evaluated in 20 asthmatics (10 ex-smokers and 10 never-smokers) and 10 patients with pulmonary emphysema (all ex-smokers) by ventilatory function, lung volume, DLco, and a ratio of expiratory LAA/inspiratory LAA. 1 . The % LAA of the lungs on HRCT was significantly larger in patients with pulmonary emphysema(PE) than in those with asthma, but there was not significant difference in % LAA between ex-smokers and never-smokers of asthmatics. 2. A ratio of expiratory Winspiratory LAA was significantly higher in patients with PE than in those with asthma , and the ratio was significantly higher in ex-smokers of asthmatics than in never-smokers (p<0.05). 3 . The difference in % residual volume and % DLco was significant between asthma and PE , and between ex - smokers and never-smokers of asthmatics (% RV : p<0.05, DLco : p<0.05) . 4 . The difference in the values of % FVC, % FEV(1) .O, and FEV1.0% was significant between asthma and PE, but not significant between ex-smokers and never- smokers of asthmatics. The results suggest that the difference in a ratio of expiratory W inspiratory LAA, % RV and % DLco was significant between ex - smokers and never - smokers of asthmatics , and cigarette smoking induces more irreversible changes of the lungs. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 Characteristics of the elderly in high - resolution computed tomography lung densitometry 26 34 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14787 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 Cigarette smoking enhances LTB4 generation by leucocytes associated with bronchial hyperresponsiveness in asthma in the elderly 18 25 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14784 Abstract : Influence of cigarette smoking on leukotriene 84 (LTB4) generation by leucocytes associated with bronchial hyperresponsiveness was examined in 110 patients with asthma. l. The frequency of positive RAST score for inhalant allergens and LTB4 generation by leucocytes were significantly larger in previous and current smokers than in nonsmokers. 2. In nonsmokers, bronchial hyperresponsiveness was significantly higher in asthmatics under the age of 49 years compared with that in patients between 50 and 59 years, between 60 and 69 years, and those over age 70 years. In contrast, no significant differences were present between bronchial hyperresponsiveness and patient age in previous and current smokers. 3. In patients over age 60, bronchial hyperresponsiveness was significantly higher in previous and current smokers than in nonsmokers. In these patients, LTB4 generation was significantly more increased in previous and current smokers than in nonsmokers. 4. A significant correlation was observed in asthmatics of nonsmokers between LTB4 generation and bronchial hyperresponsiveness . 5. LTC4 generation was significantly higher in previous and current smokers than in nonsmokers in patients under age 49 years. These results show that in patients over age 60 years, cigarette smoking induces an increase in the generation of LTB4, leading to an increase in bronchial hyperresponsiveness . No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 Clinical effects of long-term spa therapy on pulmonaryemphysema. Evaluation by pulmonary function and pathological changes of terminal airspace of the lung 11 17 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada Yoshiro Tanizaki 10.18926/14783 Clinical effects of long-term spa therapy for 4 years were estimated in 8 patients of pulmonary emphysema (4 with spa therapy and 4 without spa therapy) by pulmonary function and morphological changes of peripheral airspaces of the lung on high - resolution computed tomography (HRCT). 1 . The values of % FVC, % FEV1.0, and FEV 1.0% did not significantly change for 4year observation both in patients with spa therapy and those without spa therapy. 2. The OLco value significantly decreased from 69.9% at the initial level to 48.8% after 4-year observation in patients without spa therapy (p<O.02). However, the DLco value did not significantly decrease in patients with spa therapy. 3. The values of % RV and % LAA of the lung showed a significant increase in patients without spa therapy (% RV: p<O.05, % LAA: p<O.Ol after 4-year observation compared with the initial levels), however, a change in % RV and % LAA was not significant in patients with spa therapy. 4. The CT number also significantly decreased in patients without spa therapy, but not in those with spa therapy. The results suggest that spa therapy improves % DLco, % RV and morphological changes of peripheral airspaces, chiefly overinflation, of the lung in patients with pulmonary emphysema. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 74 2004 呼吸器疾患の温泉療法 -22年間の入院症例2295例を対象に- 1 10 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Takuya Nagata Makoto Fujii Shingo Takata Tadashi Yokoi Masanori Hamada 10.18926/14782 1982年から2003年までの22年間に当医療センターで入院加療した2295例を対象に5年間毎にその年次推移を検討した｡2295例のうちわけは,気管支喘息1400例(61.0%),COPD510例(22.2%),その他385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93例と初期と比べ8.2倍の増加が見られた｡また,第5期(最近の2年間)では87.0例/年であった｡そのなかのSDIA(steroid-dependentintractableasthma)の頻度は初期の68.4%から第4期では29.0%,第5期23.6%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44.6例/年へと8.7倍の,また第5期では47.5例/年へと9.1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%,そして第5期では87.4%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22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が示されている｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 早期診断にて軽快したMPO-ANCA関連血管炎の一例 88 92 EN Hirohisa Ichikawa Kozo Ashida Katsuichiro Ono Shingo Takata Tadashi Yokoi Takuya Nagata Makoto Okamoto Hirohumi Tsugeno Norikazu Nishida Yasuhiro Hosaki Fumihiro Mitsunobu Yoshiro Tanizaki Yoshinori Noguchi Mitsune Tanimoto 10.18926/14775 症例は76歳男性03年前肺気腫と診断された｡今回呼吸器リハビリテーション目的で当院に入院の運びとなった｡入院時より37-38'Cの発熱を認め,下気道感染を疑い抗生剤で加療したが改善しなかった.入院時の検尿検査で蛋白･潜血陽性であり,血清MPO-ANCAが307U/mlと高値を示した｡血清クレアチニン値も徐々に上昇してきたため,MPO-ANCA関連血管炎と診断した.プレドニゾロン投与を開始したところ,症状及び検査所見は速やかに改善した. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Bromocriptineにより白血球減少症及び血小板減少症をきたしたパーキンソン病の1例 84 87 EN Shingo Takata Takashi Mifune Fumihiro Mitsunobu Makoto Okamoto Norikazu Nishida Hirofumi Tsugeno Kozo Ashida Yasuhiro Hosaki Tadashi Yokoi Yoshiro Tanizaki Kenji Niiya Mitsune Tanimoto 10.18926/14774 症例は67歳,女性｡以前からパーキンソン病にて加療されていたが,リハビリテーション目的で当院入院した.入院時白血球数,血小板数正常であったが,bromocriptine投与開始後白血球減少,血小板減少を認めた.薬剤性白血球減少症及び血小板減少症を疑い, bromocriptine投与中止するとともにfilgrastim投与により,白血球減少,血小板減少は改善した。誘発試験施行し白血球減少を認めた｡Bromocriptineによる白血球減少症,血小板減少症の報告は少なく,我々の検索しえた範円内では本症例を含めて2例のみであった。Bromocriptineには安全性や神経保護作用に関して多くのデータの蓄積があるが,安全性に十分な注意が必要であると考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Yawning associated with anterior chest pain in a patient with asthma. 81 83 EN Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Takuya Nagata Shingo Takata Yoshiro Tanizaki 10.18926/14773 We present a case of a patient with asthma who developed yawning associated with anterior chest pain. She was admitted due to severe anterior chest pain, wheezing and dyspnea. Although the frequency of the symptoms decreased, she began to experience frequent episodes of yawning at night accompanied by tears. While she experienced yawning, although PEF (peak expiratory flow) decreased, no asthmatic symptoms, such as wheezing or dyspnea were observed. The yawning was improved markedly by bronchodilators and a leukotriene receptor antagonist, and moderately improved by corticosteroids. We speculated that yawning is a clinical manifestation of asthma that responds to treatment. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 高齢者気管支喘息の病態におよぼす加齢および喫煙の影響について(2) 93 101 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi 10.18926/14772 高齢者気管支喘息について.IgEにmediateされるアレルギー反応の特徴、臨床病態,肺機能(換気機能,ガス交換),気腫化傾向,治療上の問題点などを検討した. 1.高齢者喘息におけるIgE抗体の関与は予想外に多く,しかもアレルギーの家族歴を有する症例で特に高度であった。また,加齢とともに感作される抗原の種類が異なってくることが示唆された。 2.臨床病態では,単純性気管支攣縮型に比べ,気管支攣縮+過分泌型や細気管支閉塞型が増加する傾向が見られた｡ 3.肺機能では,airflow (% FVC,FEV1.0%)ゃlung volume(% RV)をあらわすパラメーターは,いずれも70才以上の症例で若青年者喘息に比べ有意に低下していることが示された｡また,transfer factor(% DLco)も70才以上の症例では有意の低下傾向が見られた。 4.HRCT上の1950HU以下の肺の% UIAは,加齢とともに増加する傾向を示し,% RVの増加と同様肺の気腫化傾向が見られること,しかし,この現象が肺気腫へと移行することはないことが示された. 5.治療上では,薬物療法よりも気道の浄化を促す吸入や水中運動(温泉療法など)が重要であると考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 温泉療法が骨関節症患者のQOLに及ぼす効果 72 74 EN Tadashi Yokoi Masuo Senda Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Norikazu Nishida Hirofumi Tsugeno Makoto Okamoto Takuya Nagata Shingo Takata Yoshiro Tanizaki Hajime Inoue 10.18926/14770 近年QOLが重視されるようになってきている｡MOS short form 36 health survey(以下SF-36と略す)は,国際的レベルでの基準とされるべく開発された非疾患特異的HRQOL尺度である.今回,我々は当院でリハビリテーションをうけているOA患者を対象に温泉療法の効果をSF-36を用いてQOLの変化を調べたoSF-36の8項目をそれぞれ算出し,温泉療法前後でのQOLの比較を行った｡pCSは36.4から37.1へ,MCSは53.0から55.4へ上昇したことより,身体･健東面ともに効果があると考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 BNPの著明な高値が持続した高齢者陳旧性心筋梗塞患者　 (高齢者のBNPについての考察も加えて) 64 71 EN Norikazu Nishida Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Takuya Nagata Tadashi Yokoi Mutsuo Nakai Hirofumi Makino Yoshiro Tanizaki 10.18926/14769 心不全が比較的良好にコントロールされているのにもかかわらず,高齢の陳旧性心筋梗塞後患者等で脳性ナトリウム利尿ペプチド(BNP)の異常高値が持続する場合がある.今回,また超高齢の心不全患者で同所見を認めたので,考察を含めて報告する. 93歳高齢の陳急性心筋梗塞患者で,BNP1600-1200の著明な高値が持続した.主に心尖部と一部の前側壁の陳旧性心筋梗塞症であったが,利尿薬等による治療によって心不全はコントロールできており,救急入院時を除いては,鬱血性心不全の状態ではなかった.心願超音 波検査でも心内圧の上昇や下大静脈の拡張も認めなかった.利尿薬を増量するとむしろ脱水による腎機能障害の増悪を認めていた. 入院中に狭心痛を認めることがあり,心筋逸脱酔素の軽度の上昇を認めた.BNPの著明な高値持続は,陳旧性心筋梗塞後の心臓機能障害や左室肥大,僧帽弁閉頚不全等による慢性心不全･心負荷のための心筋でのBNP合成･分泌元進の他に,新たな小梗塞(非貫壁性心筋梗塞)や持続する無症候性の心筋虚血による心筋でのBNP合成･分泌亢進,高齢によるBNPクリアランスの低下と分泌の持続的亢進,慢性腎機能障害によるBNPクリアランスの低下,心筋障害後の心筋再構築(リモデリング)の訳節と心筋繊維化抑制の為に合成が元進していると考えられる.更に,いわゆる老人肺･慢性呼吸機能低下による右心系の負荷による心室からの分泌元進,ステロイドホルモン内服による鉱井コルチコイド作用,貧血,低栄養状態等の様々な要因が重なっているものと考えられた. 心臓でBNPの産生･分泌が亢進するのは,心不全に伴う全身の体液量バランスや血行動態等の悪化を改善,調節するためだけではなく,心臓自身のリモデリングの調節･抑制,再構築の調薪のため,さらには心臓･心筋の繊維化や拡張障害の増悪を抑制するための自己防衛 機構としても機能している.心臓は,単に循環系のポンプではなく,利尿ペプチドホルモンを分泌する内分泌器官でもある. 一般的に加齢に伴いBNPは上昇してくる.特に70歳以上の高齢者では顕著になる.考察ではその点についても新たな文献的考察も含めて報告し,高齢者のBNPの捉え方と治療についても述べる. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Effects of spa therapy combined with dietary supplementation with alpha -linolenic acids on bronchial asthma 55 63 EN Makoto Okamoto Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Tadashi Yokoi Shingo Takata Yoshiro Tanizaki Mitsune Tnimoto 10.18926/14768 N-3 fatty acids are reportedly effective for asthma. In addition, spa therapy has been reported to be effective for patients with asthma. In the present study, the effects of spa therapy combined with perilla seed oil- rich diet (rich in n-3 fatty acid)were examined on asthma. A total of 14 asthmatic patients had a complex spa therapy and consumed a perilla seed oil- rich diet - rich in a -linolenic acid (alpha-LNA) for 8 weeks. Generation of leukotriene (LT) C4 by leucocytes, respiratory function were analyzed. The generation of LTC4 by leucocytes decreased significantly for 2, 4 and 8 weeks (P<O.05). Peak expiratory flow (PEF) values increased significantly for 2,4, 6 and 8 weeks (P<O.05). The values of ventilatory parameters [forced vital capacity (FVC) , forced expiratory volume in one second (FEV(1)) forced expiratory flow after 25% of expired FVC (FEF(25)), forced expiratory flow after 75% of expired FVC (FEF (75)) • mean expiratory flow during the middle half of the FVC (FEF(25-75)) ] revealed a significant increase after 4 and 8 weeks of the modified diet (P<O.05). The results suggest that spa therapy combined with a perilla seed oil- rich diet are effective in the treatment of asthma in terms of its ability to suppress LTC4 generation by leucocytes, and in inducing an improvement of pulmonary function. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Effects of cigarette smoking on IgE-mediated allergy in elderly patients with asthma 49 54 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14767 The influence of cigarette smoking on the pathophysiology of asthma in the elderly remains controversial. In this study, the inluence of cigarette smoking on IgE - mediated allergy including the generation of leukotrienes B4 (LTB4) and C4 (LTC4) was examined in forty asthmatics over the age of 70 years (20 ex-smokers and 20 never-smokers), and 20 patients with pulmonary emphysema over age 70 (all ex - smokers). The frequency of patients with serum IgE more than 200 IU/ml was significantly larger in smoking asthmatics than in non - smoking asthmatics. The incidence of patients with positive RAST score for inhalant allergens, was also significantly higher in patients with a history of smoking than in those without a smoking history. There were no significant differences in the frequency of patients with positive RAST and those with serum IgE more than 200 IU/ml between non-smoking asthmatics and patients with pulmonary emphysema. The generation of leukotriene B4 (LTB4) by leukocytes was significantly more increased in ex-smokers than in never-smokers in the elderly asthmatics. The results suggest the possibility that cigarette smoking enhances IgE - mediated allergy in elderly patients with asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Airflow, the volume and transfer factor of lungs in elderly asthmatics with long-term cigarette smoking 44 48 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Tadashi Yokoi Shingo Takata Yoshiro Tanizaki 10.18926/14766 The influence of cigarette smoke on pulmonary function, airflow, lung volume, and transfer factor in patients with asthma was examined in 40 subjects over the age of 70 years (20 ever-smokers and 20 never-smokers), and 20 patients with pulmonary emphysema over age 70 (all ex-smokers). The ventilatory parameters showing airflow limitation (% FEV(1) and FEV(1)%) were not significantly different between ever-smokers and never-smokers of elderly asthmatics. In contrast, % FEV(1) and FEV(1) % values were significantly lower in patients with pulmonary emphysema than in those with asthma with or without a history of smoking. The % RV value was significantly larger and % DLco value was significantly more decreased in ever-smokers compared with neversmokers of the elderly asthmatics. However, there were no significant differences in % RV and % DLco values between asthmatics with a history of smoking and patients with pulmonary emphysema. The results show that cigarette smoke inflluences % RV and % DLco, but not % FEV(1) and FEV(1) %, suggesting airflow limitation of large and moderate size airways. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 レーザードプラー血流計による高齢者の末梢循環の数量的解析 39 43 EN Yasuhiro Hosaki Fumihiro Mitsunobu Kozo Ashida Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi Yoshiro Tanizaki Koji Ochi Tetsuya Fukuda Yasushi Shiratori 10.18926/14765 糖尿病や閉塞性動脈硬化症(ASO)の患者に合併する難治性潰瘍や壊疸の予知,予防を目的として高齢者の末梢循環の観察を行った. 下肢に冷え症,しびれ感,神経痛,歩行障害等を有し温泉療法を希望した患者21例(年齢58-78歳,平均年齢71.4歳)について,下肢の末梢循環障害の程度をレーザードプラー血流計を用いて評価した｡測定は20℃冷水負荷後30分後に,末梢皮膚血流量について測定を行った｡ レーザードプラー血流計で得られた結果は左右足趾始起部5カ所,計10カ所の平均値で表した｡7例については1年後に再測定を行った.14例についてはプロスタグランディン製剤(ベラプロスト)を投与し3ケ月後に再測定を行った｡ 1.自然経過群の7例(平均年齢73.0歳)は初回測定時の血流量は1.82±0.98であった｡2回目測定時は1.59±0.40であった｡血流量の低下傾向を認めたが有意差を認めなかった｡ 2.一方,ベラプロスト内服群の14例(平均年齢70.6歳)は初回測定時の血流量は1.27±0.35であった｡2回目測定時には1.62±0.51であった｡血流量の増加を認めた(P<0.0002)。 3.両群について,3ヶ月当たりの変化率で比較したところ自然経過群は3ヶ月当たり-1.7%の低下傾向を示した｡一方,ベラプロスト内服群は+15.4%の増加(p<0.02)を示 した｡ 4.プロスタグランディン製剤の内服中であっても加齢と共に末梢循環血流Iが低下する症例があり温泉療法を含めた集学的治療の必要性が示唆された｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Effects of aging on the pathophysiology of asthma obsetved by IgE-mediated allergy, pulmoanry function, low attenuation area of the lungs on HRCT, and LTB4, LTC4 generation 31 38 EN Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Tadashi Yokoi Shingo Takata Yoshiro Tanizaki 10.18926/14764 The influence of aging on the pathophysiology of asthma in the elderly was examined in 40 patients (20 younger asthmatics under the age of 50 years, mean age 32.5 years and 20 elderly asthmatics over the age of 70 years, mean age 74.3 years), relating to IgE - mediated allergy, pulmonary function, low attenuation area (LAA) of the lungs on HRCT, and the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leukocytes. The frequency of patients with serum IgE of more than 200 IU/ml, and the incidence of those with a positive RAST score for inhalant allergens were significantly higher in younger patients than in elderly subjects. The values of % FVC, % FEV1 and FEV 1% were significantly larger in younger patients compared with elderly subjects. The % RV was significantly larger in elderly patients than in younger patients, however, the difference in % DLco was not significant between the two age groups. The LAA of the lungs on HRCT and the ratio of expiratory LAA (exp LAA) to inspiratory LAA (ins LAA) were also significantly larger in elderly asthmatics than in younger subjects. The generation of LTB4 and LTC4 was larger in younger patients than in elderly subjects, and LTB4 generation was significantly larger in younger subjects compared with elderly subjects. These results suggest that changes in IgE-mediated allergy, airflow and lung volume accompanied with hyperinflation are often observed in elderly asthmatics. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Cigarette smoking and pathophysiology of asthma and pulmonary emphysema 74 87 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata Yoshiro Tanizaki 10.18926/14758 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 呼吸器疾患に対する温泉療法 ―その臨床効果と作用機序― 61 73 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Masanori Hamada Kiyonori Yamaoka Yoshiro Tanizaki 10.18926/14757 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｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 気管支喘息における温泉療法による薬剤費の削減の臨床的検討ー投与方法による検討 53 60 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata Yoshiro Tanizaki 10.18926/14756 気管支喘息27例を対象に, 1年間の治療に要した薬剤費が, 温泉療法を行うことによりどの程度削減されるかについて若干の検討を加えた. 本論文では, 薬剤費を定期処方, 臨時処方に大別し, さらにそれぞれをない内服薬と注射・吸入薬とに分けて検討した. 1. 1年間の総薬剤費では, 温泉療法を受けた21例では23,936点から療法後は16,580点へと29.6% の削減が可能であった. 一方, 温泉療法を受けなかった6症例では, 同時期の比較で18,341点から19,021点へと明らかな減少傾向は見られなかった. 2. 定期処方の内服薬の薬剤費では, 温泉療法を受けた症例の削減率25.6% に対して, 温泉療法を受けなかった症例の削減率は23.6% であり, 両グループ間に明らかな差は見られなかった. 一方,定期処方の注射･吸入薬の薬剤費は,温泉療法を受けた症例では5,505点から,5,468点へと軽度の減少傾向が見られたが(削減率7.6%),温泉療法を受けなかった症例では,同時期の推移は3,252点から5,645点へとむしろ増加する傾向が見られた｡3.臨時処方の内服薬の薬剤費は,温泉療法を受けた症例では,2,528点から194点へと削減率90.0%と著明な減少傾向が見られたが,温泉療法を受けなかった症例では446点から786点へとむしろ増加する傾向が見られた｡4.盛時処方の注射･吸入では,同様に温泉療法を受けた症例では著明な減少傾向を示したが(削減率70.7%),壁 けなかった症例では減少傾向は見られなかった｡以上の結果より,温泉療法を行うことにより,薬剤費の削減が可能となることが示された｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 An increase in bronchial hyperresponsiveness by cigarette smoking in elderly patients with asthma 25 30 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14755 Influence of cigarette smoking on the pathogenesis of asthma in the elderly remains controversial. This study was undertaken to clarify the influence of cigarette smoking on IgE-mediated allergy, bronchial hyperresponsiveness, and the generation of leukotrienes B4 (LTB4) and C4 (LTC4) by leukocytes in 48 elderly patients (25 patients with a history of smoking for more than 20 years and 23 never-smokers) with asthma over the age of 70 years. 1. The incidence of positive IgE antibodies for inhalant allergens was significantly higher in asthmatics with a history of smoking than in never-smokers of asthmatics. 2. In bronchial hyperresponsiveness for methacholine, the Cmin was significantly lower in ever-smokers than in never-smokers of elderly asthmatics. 3. The generation of LB4 was significantly increased in patients with a history of smoking compared with those without a smoking history. However, the difference in LTC4 generation was not significant between ever-smokers and never-smokers of asthmatics. These results suggest that cigarette smoking increases bronchial hyperresponsiceness through IgE-mediated allergy and LTB4 generation. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Effects of spa therapy on reduction of the costs of the drugs used for the treatment of asthma in the elderly in relation to disease severity 45 52 EN Kozo Ashida Fumihiro Mitsunobu Yasuhiro Hosaki Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata Yoshiro Tanizaki 10.18926/14754 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Long-term cigarette smoking influences low attenuation area of the lungs on high-resolution CT in elderly patients with asthma, compared with pulmonary emphysema. 19 24 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Hirofumi Tsugeno Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi Yoshiro Tanizaki 10.18926/14753 The influence of cigarette smoking on the pathophysiology in elderly patients with asthma. Forty asthmatics over the age of 70 years (20 ex-smokers and 20 never-smokers), and 20 patients with pulmonary emphysema over age 70 (all ever-smokers) were studied to determine the influence of cigarette smoke on the low attenuation area (LAA) <-950 HU (RA950) of the lungs on high resolution CT (HRCT) scans, and the ratio of expiratory LAA to inspiratory LAA of the lungs in relation to pulmonary function. The LAA value was significantly higher in patients with pulmonary emphysema compared with ever-smokers of asthmatics. The LAA ratio was significantly higher in ever-smokers than in never-smokers of asthmatics, and the ratio was less than 0.5 in all never-smokers, and the ratio was more than 0.5 in 10 of 20 ever-smokers of asthmatics and in all patients with pulmonary emphysema. The % RV (residual volume) was significaltly larger and % DLco (diffusing capacity for carbon monoxide) was significantly lower in subjects with the ratio more than 0.5 than in those with the ratio less than 0.5. These results suggest that cigarette smoke influences LAA of the lungs in relation to % RV value and % DLco value. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Enhanced leukotriene generation adn bronchial hyperresponsiveness in asthmatics with allergic rhinitis 37 44 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Makoto Fujii Shingo Takata Masanori Hamada Yoshiro Tanizaki 10.18926/14752 Rhinitis frequently precedes asthma, and treating allergic rhinitis has benefi-cial effects on asthma, suggesting upper airway disease ia a risk factor for asthma. The aim of the present study was to investigate the influence of allergic rhinitis on se-rum IgE level, leukotriene generation by peripheral leukocytes, and bronchial hyperresponsiveness (BHR) to methacholine in patients with atopic asthma. Seventy-one asthmatic subjects (mean age, 59.5±12.5, years ; 37 women, 34 men) were recruited, and 48 asthmatics had allergic rhinitis and 23 asthmatics did not have allergic rhinitis. The log10 (Dmin) was significantly lower for those with allergic rhinitis than those with-out allergic rhinitis (P<0.05), implying that those with allergic rhinitis developed BHR to a greater degree than those without allergic rhinitis. LTC4 generation from periph-eral leukocytes was significantly greater for atopic astmatics with allergic rhinitis than those without allergic rhinitis (p<0.05). In contrast, the amount of LTB4 produced from peripheral leukocytes did not significantly differ between asthmatic patients with and without allergic rhinitis. These results suggest that the presence of allergic rhinitis enhances BHR by enhancing LTC4 production. while the presence of allergic rhinitis did not affect LTB4 production in patients with atopic asthma. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Comparison of pathophysiological changes of asthma between younger and older patients with asthma in relation to long-term cigarette smoking 27 36 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata Yoshiro Tanizaki 10.18926/14751 Influence of long-term clgarette smoking on the paphophysiological changes of the disease was compared between younger and older patients with asthma. 1. The frequency of positive RAST score against inhalant allergens was significantly higher in ex-smokers than in never-smokers in older patients with astham, but not in younger subjects. 2. Ventilatory parameters such as % FVC and FEV 1.0% were not sig-nificantly different between ex-smokers and never-smokers either in younger or older patients, although a significant difference in these values was observed between younger and older subjects. 3. The % DLco was significantly lower in ex-smokers than in never-smokers both in yonger and older patients. 4. The parameters associated with hyperinflation asuch as % RV and % LAA of the lungs on HRCT were significantly higher in older patients than in younger subjects, and also significantly larger in ex-smokers than in never-smokers in older patients, but % RV was not different between ex-smokers and never-smokers in young subjects. 5. Bronchial hyperresponsiveness (BH) was significantly more increased in ex-smokers than in never-smokers in older patients, but not in younger subjects. There was a significant difference in BH be-tween younger and older patients. 6. LTB4 generation was significantly larger in ex-smokers than in never-smokers in older patients, and LTC4 generation was more in-creased in ex-smokers both in younger and older subjects. The results show that significant differences between ex-smokers and never-smokers were observed in % DLco, LTC4 generation and % LAA both in younger and older subjects, and in IgE an-tibodies production, % RV, BH and LTB4 generation only in older subjects. In contrast, the values of % FVC and FEV1.0% were not different between ex-smokers and never-smok-ers either in younger or older subjects. A significant difference between younger and older subjects was found in all other parameters except % DLco and LTC4 generation. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 Influence of long-term cigarette smoking on changes of lung density by high-resolution computed tomography in asthmatics--4 years follow-up study 10 18 EN Fumihiro Mitsunobu Kozo Ashida Yasuhiro Hosaki Hirofumi Tsugeno Makoto Okamoto Norikazu Nishida Takuya Nagata Shingo Takata Tadashi Yokoi Mutsuo Nakai Yoshiro Tanizaki Mitsune Tanimoto 10.18926/14750 Background-The influence of cigarette smoking on the pathogenesis of asthma in the elderly remains controversial. This study attempts to estimate longitudinal changes in HRCT (high resolution computed tomography) parameters and pulmonary function parameters obtained for ex-smokers and never-smokers in asthmatics during 4-yr follow-up period. Methods-Fourteen asthmatics (6 ex-smokers and 8 never-smokers) were studied to determine the influence of aging and cigarette smoking on pulmonary function, and mean lung density (MLD) and the relative area of the lung showing attenuation values less than -950 HU (RA950) on HRCT scans. Results-The values of FVC and FEV1, were significantly more decreased in asthmatics without a smoking history during 4-yr follow-up period. The values of FVC, FEV1, FEV1/FVC and DLco/VA were significantly decreased and RV/TLC were significantly increased in asthmatics with a smoking history over 4 years, and annual decline in FEV1 ex-smokers was larger than that in never-smokers. In the upper lung field, inspiratory MLD was observed to shift in a negative direction and inspiratory RA950 was found to increase during 4-yr observation period in ex-smokers, but not in never-smokers. In the middle lung field, inspiratory RA950 was significantly enhanced in both two groups. Although expiratory MLD, expiratory RA950 and exp RA950/ins RA950 were observed to change significantly during the observation period in ex-smokers, no changes were observed in never-smokers. Conclusion-These results suggest that aging augments airspace enlargement predominantly in the middle lung field, while long term cigarette smoking further worsens emphysematous alterations in the upper lung field. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Spa therapy and bronchial hyperresponsiveness associated with cigarette smoking in asthmantics in the elderly 18 26 EN Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Naofumi Iwagaki Makoto Fujii Shingo Takata Masanori Hamada Yoshiro Tanizaki 10.18926/14749 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 Costs of drugd used for the treatment of asthma in relation to disease severity 12 17 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata 10.18926/14748 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. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 73 2003 呼吸器疾患の温泉療法-21年間の入院症例2129例を対象に- 1 9 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Norikazu Nishida Hirofumi Tsugeno Takuya Nagata Tadashi Yokoi Shingo Takata 10.18926/14747 1982年から2002年までの21年間の当医療センターで入院加療した2129例を対象に5年間毎にその年次推移を検討した．2129例のうちわけは，気管支喘息1311例（61.5％），COPD467例（21.9％），その他351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93例と初期と比べ8.1倍の増加が見られた．また，そのなかのSDIA （steroid-dependent intractable asthma）の頻度は初期の68.4％から第4期では28.9％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例へと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いは初期の19.2％から第4期では78.5％と明らかな増加傾向を示した．なお，昨年度の1年間では，第4期の5年間（1997-2001年）とほぼ同様の傾向を示したが，全般的な傾向としては気管支喘息症例がやや減少し，一方肺気腫症例が増加する傾向が見られた．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％だあったが，第4期では68.0％，そして昨年度は85.4％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21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が示された． No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝医療センター Acta Medica Okayama 1348-1258 75 2004 呼吸器疾患の温泉療法ー1982年から2004年までの23年間の入院症例2485例を対象にー 1 11 EN Yoshiro Tanizaki Fumihiro Mitsunobu Yasuhiro Hosaki Kozo Ashida Masanori Hamada Naofumi Iwagaki Makoto Fujii Shingo Takata 10.18926/14746 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. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 1997 Localization of 9'2kd gelatinase (MMP9)gene transcripts in human hepatocellular carcinoma EN No potential conflict of interest relevant to this article was reported.