岡山医学会 Acta Medica Okayama 0030-1558 136 3 2024 高齢者慢性呼吸器疾患に対する温泉療法 100 106 EN Fumihiro Mitsunobu Department of Longevity and Social Medicine (Geriatrics), Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Association between Radon Hot Spring Bathing and Health Conditions: A Cross-Sectional Study in Misasa, Japan 387 394 EN Takahiro Kataoka Department of Radiological Technology, Okayama University Graduate School of Health Sciences Hiroshi Habu Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ayumi Tanaka Department of Radiological Technology, Okayama University Graduate School of Health Sciences Shota Naoe Department of Radiological Technology, Okayama University Graduate School of Health Sciences Kaito Murakami Department of Radiological Technology, Okayama University Graduate School of Health Sciences Yuki Fujimoto Department of Radiological Technology, Okayama University Graduate School of Health Sciences Ryohei Yukimine Department of Radiological Technology, Okayama University Graduate School of Health Sciences Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumihiro Mitsunobu Department of Longevity and Social Medicine (Geriatrics), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kiyonori Yamaoka Department of Radiological Technology, Okayama University Graduate School of Health Sciences Original Article 10.18926/AMO/65749 No epidemiological studies have examined the health effects of daily bathing in radon hot springs. In this cross-sectional study, we investigated the associations between radon hot spring bathing and health conditions. The target population was 5,250 adults ≥ 20 years old in the town of Misasa, Japan. We collected information about the participants’ bathing habits and alleviation of a variety of disease symptoms, and their self-rated health (SRH). Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated. In both the adjusted and unadjusted models of hypertension, significant associations between the > 1×/week hot spring bathing and the alleviation of hypertension symptoms were observed compared to the group whose hot spring bathing was <1×/week: adjusted model, OR 5.40 (95%CI: 1.98-14.74); unadjusted model, 3.67 (1.50-8.99) and for gastroenteritis: adjusted model, 9.18 (1.15-72.96); unadjusted model, 7.62 (1.59-36.49). Compared to the no-bathing group, higher SRH was significantly associated with both bathing < 1×/week: unadjusted model, 2.27 (1.53-3.37) and > 1×/week: adjusted model, 1.91 (1.15-3.19). These findings suggest that bathing in radon hot springs is associated with higher SRH and the alleviation of hypertension and gastroenteritis. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 135 1 2023 フレイルとサルコペニア 43 48 EN Fumihiro Mitsunobu Department of Longevity and Social Medicine (Geriatrics), Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University No potential conflict of interest relevant to this article was reported.

Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology. Acta Medica Okayama 0449-3060 2022 Potential inhibitory effects of low-dose thoron inhalation and ascorbic acid administration on alcohol-induced hepatopathy in mice EN Takahiro Kataoka Graduate School of Health Sciences, Okayama University Tsuyoshi Ishida Graduate School of Health Sciences, Okayama University Shota Naoe Graduate School of Health Sciences, Okayama University Norie Kanzaki Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Akihiro Sakoda Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Hiroshi Tanaka Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Fumihiro Mitsunobu Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University Kiyonori Yamaoka Graduate School of Health Sciences, Okayama University Although thoron inhalation exerts antioxidative effects in several organs, there are no reports on whether it inhibits oxidative stress-induced damage. In this study, we examined the combined effects of thoron inhalation and ascorbic acid (AA) administration on alcohol-induced liver damage. Mice were subjected to thoron inhalation at 500 or 2000 Bq/m(3) and were administered 50% ethanol (alcohol) and 300 mg/kg AA. Results showed that although alcohol administration increased the levels of glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) in the serum, the combination of thoron inhalation (500 Bq/m(3)) and AA administration 24 h after alcohol administration effectively inhibited alcohol-induced liver damage. The combination of thoron inhalation (500 Bq/m(3)) and AA administration 24 h after alcohol administration increased catalase (CAT) activity. Alcohol administration significantly decreased glutathione (GSH) levels in the liver. The GSH content in the liver after 2000 Bq/m(3) thoron inhalation was lower than that after 500 Bq/m(3) thoron inhalation. These findings suggest that the combination of thoron inhalation at 500 Bq/m(3) and AA administration has positive effects on the recovery from alcohol-induced liver damage. The results also suggested that thoron inhalation at 500 Bq/m(3) was more effective than that at 2000 Bq/m(3), possibly because of the decrease in GSH content in the liver. In conclusion, the combination of thoron inhalation at 500 Bq/m(3) and AA administration promoted an early recovery from alcohol-induced liver damage. No potential conflict of interest relevant to this article was reported.

The Society for Free Radical Research Japan Acta Medica Okayama 0912-0009 70 2 2022 Mechanisms of action of radon therapy on cytokine levels in normal mice and rheumatoid arthritis mouse model 154 159 EN Takahiro Kataoka Graduate School of Health Sciences, Okayama University Shota Naoe Graduate School of Health Sciences, Okayama University Kaito Murakami Graduate School of Health Sciences, Okayama University Ryohei Yukimine Graduate School of Health Sciences, Okayama University Yuki Fujimoto Graduate School of Health Sciences, Okayama University Norie Kanzaki Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Akihiro Sakoda Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Fumihiro Mitsunobu Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University Kiyonori Yamaoka Graduate School of Health Sciences, Okayama University The typical indication of radon therapy is rheumatoid arthritis. Although there are several reports that radon therapy has regulation effects on Th17 cells, there has been no study reporting that radon inhalation affects the immune balance among Th1, Th2, and Th17. The purpose of this study is to examine the cytokine changes after radon inhalation. BALB/c mice inhaled radon at 2,000 Bq/m3 for 2 or 4 weeks. SKG/Jcl mice inhaled radon at 2,000 Bq/m3 for 4 weeks after zymosan administration. The results showed that radon inhalation for 4 weeks activated the immune response of Th1, Th2, and Th17. Moreover, the balance among them was not lost by radon inhalation. Radon inhalation for 4 weeks decreased superoxide dismutase activity and increased catalase activity in spleen. These findings suggest that an imbalance of oxidative stress may contribute to activate the immune response. Although zymosan administration activated Th17 immune response and decreased Th1 and Th2 immune response in SKG/Jcl mice, most cytokines related to Th1, Th2, and Th17 approached the normal level by radon inhalation. These findings suggested that radon inhalation has a different action between SKG/Jcl mice and normal BABL/c mice. This may indicate that radon inhalation has an immunomodulation function. No potential conflict of interest relevant to this article was reported.

Oxford University Press Acta Medica Okayama 0449-3060 62 5 2021 Radon inhalation decreases DNA damage induced by oxidative stress in mouse organs via the activation of antioxidative functions 861 867 EN Takahiro Kataoka Graduate School of Health Sciences, Okayama University Hina Shuto Graduate School of Health Sciences, Okayama University Shota Naoe Graduate School of Health Sciences, Okayama University Junki Yano Graduate School of Health Sciences, Okayama University Norie Kanzaki Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Akihiro Sakoda Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Hiroshi Tanaka Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Katsumi Hanamoto Graduate School of Health Sciences, Okayama University Fumihiro Mitsunobu Graduate School ofMedicine Dentistry and Pharmaceutical Sciences, Okayama University Hiroaki Terato Advanced Science Research Center Okayama University Kiyonori Yamaoka Graduate School of Health Sciences, Okayama University Radon inhalation decreases the level of lipid peroxide (LPO); this is attributed to the activation of antioxidative functions. This activation contributes to the beneficial effects of radon therapy, but there are no studies on the risks of radon therapy, such as DNA damage. We evaluated the effect of radon inhalation on DNA damage caused by oxidative stress and explored the underlying mechanisms. Mice were exposed to radon inhalation at concentrations of 2 or 20 kBq/m(3) (for one, three, or 10 days). The 8-hydroxy-2 '-deoxyguanosine (8-OHdG) levels decreased in the brains of mice that inhaled 20 kBq/m(3) radon for three days and in the kidneys of mice that inhaled 2 or 20 kBq/m(3) radon for one, three or 10 days. The 8-OHdG levels in the small intestine decreased by approximately 20-40% (2 kBq/m(3) for three days or 20 kBq/m(3) for one, three or 10 days), but there were no significant differences in the 8-OHdG levels between mice that inhaled a sham treatment and those that inhaled radon. There was no significant change in the levels of 8-oxoguanine DNA glycosylase, which plays an important role in DNA repair. However, the level of Mn-superoxide dismutase (SOD) increased by 15-60% and 15-45% in the small intestine and kidney, respectively, following radon inhalation. These results suggest that Mn-SOD probably plays an important role in the inhibition of oxidative DNA damage. No potential conflict of interest relevant to this article was reported.

Oxford Univ Press Acta Medica Okayama 0449-3060 62 3 2021 Evaluation of the redox state in mouse organs following radon inhalation 390 400 EN Takahiro Kataoka Graduate School of Health Sciences, Okayama University Norie Kanzaki Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Akihiro Sakoda Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Hina Shuto Graduate School of Health Sciences, Okayama University Junki Yano Graduate School of Health Sciences, Okayama University Shota Naoe Graduate School of Health Sciences, Okayama University Hiroshi Tanaka Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Katsumi Hanamoto Graduate School of Health Sciences, Okayama University Hiroaki Terato Advanced Science Research Center, Okayama University Fumihiro Mitsunobu Graduate School ofMedicine Dentistry and Pharmaceutical Sciences, Okayama University Kiyonori Yamaoka Graduate School of Health Sciences, Okayama University Radon inhalation activates antioxidative functions in mouse organs, thereby contributing to inhibition of oxidative stress-induced damage. However, the specific redox state of each organ after radon inhalation has not been reported. Therefore, in this study, we evaluated the redox state of various organs in mice following radon inhalation at concentrations of 2 or 20 kBq/m(3) for 1, 3 or 10 days. Scatter plots were used to evaluate the relationship between antioxidative function and oxidative stress by principal component analysis (PCA) of data from control mice subjected to sham inhalation. The results of principal component (PC) 1 showed that the liver and kidney had high antioxidant capacity; the results of PC2 showed that the brain, pancreas and stomach had low antioxidant capacities and low lipid peroxide (LPO) content, whereas the lungs, heart, small intestine and large intestine had high LPO content but low antioxidant capacities. Furthermore, using the PCA of each obtained cluster, we observed altered correlation coefficients related to glutathione, hydrogen peroxide and LPO for all groups following radon inhalation. Correlation coefficients related to superoxide dismutase in organs with a low antioxidant capacity were also changed. These findings suggested that radon inhalation could alter the redox state in organs; however, its characteristics were dependent on the total antioxidant capacity of the organs as well as the radon concentration and inhalation time. The insights obtained from this study could be useful for developing therapeutic strategies targeting individual organs. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 0301634X 59 3 2020 Comparison of antioxidative effects between radon and thoron inhalation in mouse organs EN Yusuke Kobashi Graduate School of Health Sciences, Okayama University Takahiro Kataoka Graduate School of Health Sciences, Okayama University Norie Kanzaki Graduate School of Health Sciences, Okayama University Tsuyoshi Ishida Graduate School of Health Sciences, Okayama University Akihiro Sakoda Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Hiroshi Tanaka Ningyo-toge Environmental Engineering Center, Japan Atomic Energy Agency Yuu Ishimori Prototype Fast Breeder Reactor Monju, Japan Atomic Energy Agency Fumihiro Mitsunobu Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University Kiyonori Yamaoka Graduate School of Health Sciences, Okayama University Radon therapy has been traditionally performed globally for oxidative stress-related diseases. Many researchers have studied the beneficial effects of radon exposure in living organisms. However, the effects of thoron, a radioisotope of radon, have not been fully examined. In this study, we aimed to compare the biological effects of radon and thoron inhalation on mouse organs with a focus on oxidative stress. Male BALB/c mice were randomly divided into 15 groups: sham inhalation, radon inhalation at a dose of 500 Bq/m3 or 2000 Bq/m3, and thoron inhalation at a dose of 500 Bq/m3 or 2000 Bq/m3 were carried out. Immediately after inhalation, mouse tissues were excised for biochemical assays. The results showed a significant increase in superoxide dismutase and total glutathione, and a significant decrease in lipid peroxide following thoron inhalation under several conditions. Additionally, similar effects were observed for different doses and inhalation times between radon and thoron. Our results suggest that thoron inhalation also exerts antioxidative effects against oxidative stress in organs. However, the inhalation conditions should be carefully analyzed because of the differences in physical characteristics between radon and thoron. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 131 3 2019 第84回日本温泉気候物理医学会総会・学術集会報告 171 172 EN Department of Geriatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences No potential conflict of interest relevant to this article was reported.

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.

Journal of Radiation Research Editorial Committee Acta Medica Okayama 0449-3060 46 1 2005 The Elevation of p53 Protein Level and SOD Activity in the Resident Blood of the Misasa Radon Hot Spring District 21 24 EN Kiyonori Yamaoka Fumihiro Mitsunobu Shuji Kojima Misako Shibakura Takahiro Kataoka Katsumi Hanamoto Yoshiro Tanizaki To clarify the mechanism by which radon hot springs prevent cancer or not, in this study, blood was collected from residents in the Misasa hot spring district and in a control district. The level of a representative cancer-suppressive gene, p53, and the activity of a representative antioxidant enzyme, superoxide dismutase (SOD), were analyzed as indices. The level of serum p53 protein in the males in the Misasa hot spring district was found to be 2-fold higher than that in the control district, which is a significant difference. In the females in the Misasa hot spring district, SOD activity was approximately 15% higher than that in the control district, which is also statistically significant, and exceeded the reference range of SOD activity despite advanced age. These results suggested that routine exposure of the residents in the Misasa hot spring district to radon at a concentration about 3 times higher than the national mean induces trace active oxygen in vivo, potentiating products of cancer-suppressive gene and antioxidant function. As the p53 protein level was high in the residents in the Misasa hot spring district, apoptosis of cancer cells may readily occur. No potential conflict of interest relevant to this article was reported.

Journal of Radiation Research Editorial Committee Acta Medica Okayama 0449-3060 52 6 2011 Study of the Response of Superoxide Dismutase in Mouse Organs to Radon Using a New Large-scale Facility for Exposing Small Animals to Radon 775 781 EN Takahiro Kataoka Akihiro Sakoda Yuu Ishimori Teruaki Toyota Yuichi Nishiyama Hiroshi Tanaka Fumihiro Mitsunobu Kiyonori Yamaoka We examined dose–dependent or dose rate–dependent changes of superoxide dismutase (SOD) activity using a new large-scale facility for exposing small animals to radon. Mice were exposed to radon at a concentration of 250, 500, 1000, 2000, or 4000 Bq/m³ for 0.5, 1, 2, 4, or 8 days. When mice were exposed to radon at 2000 day•Bq/m³, activation of SOD activities in plasma, liver, pancreas, heart, thymus, and kidney showed dose–rate effects. Our results also suggested that continuous exposure to radon increased SOD activity, but SOD activity transiently returned to normal levels at around 2 days. Moreover, we classified the organs into four groups (1. plasma, brain, lung; 2. heart, liver, pancreas, small intestine; 3. kidney, thymus; 4. stomach) based on changes in SOD activity. Thymus had the highest responsiveness and stomach had lowest. These data provide useful baseline measurements for future studies on radon effects. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 46 3 1992 Spa therapy improves ventilatory function in the small airways of patients with steroid-dependent intractable asthma (SDIA). 175 178 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Koji Ochi Hideo Harada Ikuro Kimura Article 10.18926/AMO/32675 The improvement of ventilatory function by spa therapy was examined in 37 patients with steroid-dependent intractable asthma (SDIA) in relation to clinical asthma types. All subjects had been on long-term corticosteroid therapy before spa therapy. Spa therapy was found to improve the values of ventilatory parameters. The percent improvement in all subjects was +4.1% in %FVC, +8.9% in FEV1.0%, +9.8% in %PEFR, +22.0% in %MMF, +19.7% in %V50 and +28.2% in %V25, respectively. Relating to clinical asthma types, moderate improvement in %MMF and %V25 from 16.7% to 16.9% was observed in type Ia cases, and marked increase in %MMF, %V50 and %V25 was observed from 42.2% to 43.2% in type Ib cases. However, no significant increase was found in these parameters of types Ia or Ib after spa therapy. In patients with type II, a significant increase was shown in %V50 (p less than 0.05) and %V25 (p less than 0.01) after spa therapy. The results show that spa therapy improves the condition of small airways disorder in patients with SDIA. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 46 5 1992 Asthma classification by pathophysiology and IgE-mediated allergic reaction: new concepts for classification of asthma. 381 387 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Naoko Honke Yasuharu Kusaura Ikuro Kimura Article 10.18926/AMO/32659 <p>Bronchial asthma was classified by the pathophysiology and by the mechanism of onset of the disease. Forty asthmatics who had serum IgE levels lower than 200 IU/ml were evaluated by two classification methods. 1. In asthma classified by a score based on clinical findings and examinations, the characteristics of the findings and examination results were compared among three asthma types, i.e., Ia. simple broncho-constriction type, Ib. bronchoconstriction+hypersecretion type, and II. bronchiolar obstruction type. Type Ib patients, in addition to manifesting hypersecretion, had a significantly higher proportion of eosinophils in the bronchoalveolar lavage (BAL) fluid compared to other asthma types. Significantly decreased values for ventilatory parameters and an increased proportion of BAL neutrophils were found in type II compared with other asthma types. 2. In a new classification by mechanism of onset, asthma was classified into three types according to the degree of participation of IgE-mediated reactions associated with specific IgE antibodies and serum levels of total IgE: asthma induced by definite IgE-mediated reaction (atopic asthma), possible IgE-mediated reactions (asthma), and asthma induced by non-IgE-mediated reaction (asthma syndrome).</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 46 4 1992 Asthma classification by a score calculated from clinical findings and examinations in subjects sensitive to inhalant allergens. 295 301 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuharu Kusaura Koji Ochi Hideo Harada Ryo Soda Kiyoshi Takahashi Ikuro Kimura Article 10.18926/AMO/32622 Twenty-one patients with atopic asthma were classified into three types according to their symptoms (clinical diagnosis): Ia, simple bronchoconstriction; Ib, bronchoconstriction + hypersecretion; and II, bronchiolar obstruction, and this classification was compared with a classification made according to clinical findings and examinations (score diagnosis). Type Ib asthma was characterized by the increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF), while type II was characterized by ventilatory dysfunction in small airways and the increased incidence of neutrophils in BALF. Four patients, whose expectoration was between 50 and 99ml/day, of the 12 with type Ia assessed by clinical diagnosis were evaluated as type Ib by score diagnosis. One patient with type II by clinical diagnosis was assessed as questionable type II by score diagnosis. In the other 16 patients, the clinical and score diagnoses were the same. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 45 4 1991 Specific IgE, IgG and IgG4 antibodies against house dust mite in patients with bronchial asthma. 267 273 EN Morihiro Okazaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Noboru Asaumi Yoshiro Tanizaki Hideo Harada Kiyoshi Takahashi Ikuro Kimura Article 10.18926/AMO/32167 <p>Serum levels of total IgE, specific IgE, IgG and IgG4 against house dust mite were measured in mite-sensitive asthma patients receiving immunotherapy with house dust. Serum levels of total IgE, mite specific IgE and IgG did not significantly change during the course of hyposensitization. Increased levels of mite specific IgG4 were observed in patients during immunotherapy. The increase in specific IgG4 was dependent on the total dose of house dust administered in both children (r = 0.636, p less than 0.001) and adults (r = 0.629, p less than 0.01). However, the increase of specific IgG4 in adults was not as apparent as in children. These results might suggest that mite specific IgG4 is a useful immunological marker in the immunotherapy for allergic asthma, and that IgG4 antibody acts as a blocking antibody in atopic bronchial asthma.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 47 5 1993 IgE-mediated allergic reaction in drug-induced asthma. 317 321 EN Hikaru Kitani Kazuhiro Kajimoto Keisuke Sugimoto Takashi Mifune Fumihiro Mitsunobu Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Yoshiro Tanizaki Article 10.18926/AMO/31587 <p>Immunoallergological studies were carried out to clarify the differences between 24 patients with drug-induced asthma (DIA) and 240 with non-drug-induced asthma (non-DIA). The mean values of age, skin reaction to Candida albicans (C. albicans), serum IgE levels, specific IgE antibodies to house dust (HD) and C. albicans, bronchial sensitivity and leukotriene B4 (LTB4) synthesis from peripheral venous blood in patients with DIA were not significantly different from those in patients with non-DIA. In contrast, the frequency of positive skin reaction to HD and histamine release from peripheral basophils by anti-IgE were significantly lower in DIA than in non-DIA. These results agree with the reports that DIA was often observed in non-atopic asthma. But, the mean value of serum IgE was very high in DIA as well as in non-DIA. This result suggests that IgE mediated reaction in DIA is important. Furthermore, the proportion of neutrophils in bronchoalveolar lavage fluid (BALF) was significantly lower in DIA than in non-DIA. Our findings suggest that a decrease of intrapulmonary neutrophils might play an important role in the pathophysiology of DIA.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 47 5 1993 Chemical mediator and cellular reaction in the bronchoalveolar lavage fluid of patients with steroid-dependent intractable asthma (SDIA). 323 328 EN Takashi Mifune Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Fumihiro Mitsunobu Kazuhiro Kajimoto Ikuro Kimura Article 10.18926/AMO/31578 <p>The effects of long-term glucocorticoid therapy on chemical mediator and cellular reaction in the airways were examined in 69 patients with bronchial asthma. The histamine release induced by Ca ionophore A23187 from cells in the bronchoalveolar lavage (BAL) fluid of atopic asthmatics was significantly lower in the subgroup with steroid-dependent intractable asthma (SDIA) than in non-SDIA patients (p &#60; 0.05). In contrast, histamine release in nonatopic SDIA patients did not differ from nonatopic non-SDIA patients. The release of leukotriene C4 (LTC4) was significantly lower in atopic patients with SDIA (p &#60; 0.02). However, there was no significant difference in LTC4 release between nonatopic patients with SDIA and without SDIA. The proportion of BAL lymphocytes was significantly lower in atopic patients with SDIA than in those without it (p &#60; 0.05), although there was no significant difference between the nonatopic patients with and without SDIA. These results show that glucocorticoids affect humoral and cellular events in the airways of atopic asthmatics more than in those of nonatopic asthmatics.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 47 4 1993 Cell-mediated immunity in bronchial asthma evaluated by purified protein derivative- and Candida albicans-skin reaction. 229 232 EN Fumihiro Mitsunobu Hikaru Kitani Morihiro Okazaki Takashi Mifune Tomoharu Okano Naoko Honke Yoshiro Tanizaki Article 10.18926/AMO/31550 <p>Cell-mediated immunity was examined in 45 patients with bronchial asthma by observing the delayed cutaneous reaction to purified protein derivative (PPD) and Candida albicans (C. albicans). The delayed skin reaction to PPD showed a decrease with age starting between 50 and 59 years old. The delayed reaction to PPD decreased more prominently with aging, being significantly depressed in the patients aged over 70 years than in those aged between 30 and 49 years (induration, p &#60; 0.02; flare, p &#60; 0.01). The C. albicans-induced skin reaction was significantly lower in the patients aged over 70 years than in those between 60 and 69 years old (induration, p &#60; 0.01; flare, p &#60; 0.05). The delayed skin reaction to PPD and C. albicans was significantly depressed in the patients with a serum IgE level over 1001 IU/ml. Delayed skin reaction to PPD and C. albicans was more depressed with aging and an elevated serum IgE, and the age (50-59 years) at the initiation of depression in the PPD-induced delayed skin reaction was younger than that (over 70 years) in the C. albicans-induced reaction.</p> No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 100 5-6 1988 組換えプロウイルスLTRの遺伝子転写プロモーター活性 507 517 EN Fumihiro Mitsunobu The transcriptional promoter activity of the proviral long terminal repeat (LTR) of a retrovirus produced in a human lymphoblastoid cell line was studied in a variety of cell types, in comparison with that of the simian virus 40 (SV40) early promoter and Rous sarcoma virus (RSV) LTR. Recombinant plasmids containing these promoter sequences linked to the chloramphenicol acetyltransferase (CAT) gene were constructed and tested in a transient assay system to measure relative rates of transcriptional activites in different cell types, including human lymphoblastoid cell lines. The transcriptional activity of this proviral LTR was much higher than that of the SV40 early promoter and RSV LTR in various cell types, especially in human lymphoblastoid cell lines. This result is consistent with the fact that this retrovirus is a lymphotropic virus. This proviral LTR could be useful for the analyses of the expression and biological activity of various genes in human lymphoblastoid cell lines. 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 65 1994 重症難治性喘息に対する温泉療法の臨床的意義 119 127 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Ichiro Takata 10.18926/15518 気管支喘息のなかでも,副腎皮質ホルモン依存性の喘息は,もっとも重症難治性であり,薬物療法のみでコントロールすることは極めて困難である｡著者らの現在までの成績では,このようなステロイド依存性重症難治性喘息に対して,温泉療法は有効であった｡このことは,喘息の治療,とりわけ重症難治例の治療には温泉療法が必要不可欠であることを示している｡今回は,その臨床的有用性および機序について,若干の考察を加えた｡1.臨床病型では,Ib型やII型に重症難治症例が多く,温泉療法はこれらの病型に対して有効であった｡2.年齢別検討では,発症年齢では30才以上,また現年齢では40才以上の症例に対して温泉療法は有効であった｡3.温泉療法による換気機能の改善では,小ないし細気管支領域の閉塞の改善がより高度であった｡4.温泉療法により,気道過敏性が低下することが観察された｡5.温泉療法により,高度に低下した副腎皮質機能の改善が見られた｡5.ヨードゾル吸入,鉱泥湿布療法,温泉プール水泳ないし歩行訓練などが,喘息の治療に適した温泉療法と判断された。 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 0913-3771 63 1992 Effect of aging on onset mechanism of bronchial asthma 142 147 EN Fumihiro Mitsunobu Hikaru Kitani Morihiro Okazaki Takashi Mifune Yoshiro Tanizaki 10.18926/15345 Skin tests, serum total IgE levels, specific IgE antibodies against each allergen, bronchial reactions provoked by allergens and histamine release from basophils are well known as prameters of immediate allergic reactions. The incidence of positive immediate skin reaction to allergens such as house dust, ragweed, Aspergillus Alternaria, Cladosporium and Broncasma decreased with aging. On the other hand, the incidence of positive skin reaction to Candida albicans was higher in cases between the age of 41 and 50 and cases over the age of 61 compared to that in the other groups classified by age. Serum IgE levels was highest in cases aged between 0 and 30. The levels of serum IgE decreased with aging. The incidence of positive RAST scores (more than 2+) and positive bronchial reaction to house dust were highest in cases between 0 and 30, and decreased with aging. However, the positive ratio of these tests against C. albicans were highest in cases between 41 and 50. The degree of histamine release from basophils of asthmatics induced by anti-IgE was consistently high without any correlation to aging when their serum IgE levels were more than 501 IU/ml. In the cases with serum IgE levels of less than 300 IU/ml, basophil reactivity to anti-IgE decreasd with aging. Basophil reactivity to house dust was generally dependent on the levels of specific IgE antibodies against the allergen. Although basophil reactivity to C. albicans was also high in cases with positive RAST scores, some cases with a RAST score of 0+ or 1+ showed high or moderate basophil reactivity. Moderate or high reactivity of basophils was frequently observed in cases between 41 and 50 and cases over age 61. 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 0913-3771 63 1992 Basophil response to antigen and anti-IgE 3. Ca(2+) influx and histamine release 134 141 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Ikuro Kimura 10.18926/15343 The release mechanism of chemical mediators from basophils and mast cells was discussed when these cells were stimulated by different antigens and anti-IgE. 1. Ca(2+) influx into mast cells increased after stimulation by antigen. The increased Ca(2+) uptake by mast cells was inhibited by antiallergic agents, disodium cromoglycate (DSCG) and tranilast, and calcium antagonists, nifedipine and nicardipine. 2. The dose-response curve of histamine release by antigen was different from that by anti-IgE. The maximum release of histamine by house dust was, however, similar to that by anti-IgE. House dust- and anti-IgE-induced release of histamine increased with higher- serum IgE levels. On the contrary, the release of histamine by Candida albicans was not releated to serum IgE levels, and the release by C. albicans did not parallel therelease by anti-IgE. 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 0913-3771 63 1992 ダニ喘息患者の免疫療法 117 122 EN Morihiro Okazaki Hikaru Kitani Takasi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honnke Yasuhiro Kusaura Yoshiro Tanizaki 10.18926/15338 ダニ喘息はアトピー型喘息の典型であるが,これに対する根本療法としてアレルゲンであるハウスダストを皮下注射する免疫療法が臨床でおこなわれている。70-80%の有効性が報告されているが,その作用機序はいまだ不明である｡この稿においては特異的IgE抗体,特異的IgG抗体,特異的lgG4抗体,抗イディオタイプ抗体,肥満細胞の反応性,リンパ球の役割について総説する｡また新たな試みとしてのallergen antibody complexを使った免疫療法,ペプタイドを使用する治療の可能性についても言及する｡ 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 64 1993 気管支喘息におけるカンジダ特異的IgGおよびIgG(4)抗体の病因的意義について 116 124 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto 10.18926/15337 カレジダ特異的IgG及びIgG(4)抗体が,気管支喘息の発症病態に関与しているかどうかについて検討を加えた。カンジダ特異的IgGおよびIgG(4)抗体は, 0-30才の年齢層の症例ではアトピー性素因の強い症例で,また,31-60才の年齢層の症例ではストロイド依存性重症難治性喘息症例で,さらに61才以上の高年令の症例で,その産生亢進が観察される｡これらの症例におけるIgG及びIgG(4)抗体産生は,0-30才の年齢ではアトピーとの関連で,また31-60才の年齢では副腎皮質ホルモンの長期投与と関連して,さらに61才以上の症例では加齢と関連して,細胞性免疫能が低下し,そのためカンジダの発育が促進され,その結果として,IgG及びIgG(4)抗体の産生亢進が見られることが明らかにされている｡すなわち,気管支喘息におけるカンジダに対するIgG系抗体の産生亢進は,cell-mediated immunityの低下と言う共通の基盤を有しており,病因的意義とは必ずしも関連していないことを述べた。 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 64 1993 Association of increased number of bronchoalveolar lymphocytes with patient age and IgE-mediated allergic reaction 97 104 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Ikuro Kimura 10.18926/15332 The proportion and number of lymphocytes in the airways were analyzed in 15 patients with a high proportion of lymphocytes in bronchoalveolar lavage (BAL) fluid (more than 30%) and in 17 patients with less than 20% of BAL lymphocytes. 1. Both atopic and nonatopic asthma patients with a high proportion of BAL lymphocytes were aged more than 50 years. In contrast, the age of patients with less than 20% of BAL lymphocytes ranged widely, from 29 to 63 years, in the two asthma types. 2. Age at onset of the disease, serum IgE levels, and ventilatory function test were not related to the proportion of BAL lymphocytes. 3. In patients with a high proportion of BAL lymphocytes, the mean proportion of these cells was 47.3% in atopic patients and 36.4% in non-atopic patients, i. e., there was no significant difference between the two asthma types. The absolute number of BAL lymphocytes in these patients was significantly higher in atopic (5.62×10(6)) than in nonatopic asthma (0.77×10(6)) (p<0.01). These findings show that an increased number of lymphocytes in the airways is clearly related to patient age and IgE-mediated allergic reaction. 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 0913-3771 63 1992 furosemide添加による末梢血好塩基球からのヒスタミン遊離抑制作用について 95 98 EN Hikaru Kitani Yasuhiro Kusaura Naoko Honke Masakuni Tanimizu Fumihiro Mitsunobu Takashi Mifune Morihiro Okazaki Yoshiro Tanizaki 10.18926/15327 furosemideは利尿剤として知られているが,吸入することにより気道収縮に対して抑制的に作用することが近年報告されている｡その抑制作用の機序を明らかにする目的で,furosemide添加による末梢血好塩基球からのヒスタミン遊離に対する抑制効果を検討した｡健常人4例,アトピー型気管支喘息患者8例を対象として全血法で抗ヒトIgE刺激によるヒスタミン遊離を観察した｡なお,furosemideの最終濃度は0,1,10,100μg/mlに調整して添加実験を行った｡健常人,気管支喘息いずれにおいても,furosemide添加による末梢血好塩基球からのヒスタミン遊離に対する抑制効果はみられなかった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 63 1992 電子内視鏡ファイリングシステムSDF-3の使用経験 74 78 EN Koji Ochi Hirofumi Miyake Shuji Matsumoto Toshinobu Seno Juntaro Tanaka Hideo Harada Fumihiro Mitsunobu Yosiro Tanizaki 10.18926/15326 光ディスクとパーソナルコンピュータを組み合わせた内視鏡画像ファイリングシステムは電子内視鏡の画像の保存･管理,検索･再生などに威力を発揮する｡今回,われわれはオリンパス社製内視鏡ファイリングシステムSDF-3を使用する機会を得たので,その有用性や問題点の検討を行った｡有用性としては,�@内視鏡画像を検査終了後直ちに再生し,再検討できる,�A多数の項目についての検索や統計処理が可能である,�B限られたスペース内で大量の画像データの一括保存･管理が可能であるなどが挙げられる｡一方,問題点としては,�@内視鏡再生画像は画質が劣化する,�A検索機能を十分に活用するにはかなり煩雑な人力操作を必要とする,�B光ディスクの清掃が必要であるなどがあげられる｡本内視鏡ファイリングシステムに今後必要な改良点やその展望についても合わせて考案を加えた。 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 0913-3771 63 1992 Cell-mediated immunity in bronchial asthma. Depressed response towards Candida albicans 69 73 EN Yosiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Hideo Harada Koji Ochi Ikuro Kimura 10.18926/15325 Delayed cutaneous hypersensitivity towards Candida albicans was examined　in 200 patients with bronchial asthma in relation to patient age and the level of　total IgE. 1. Delayed skin reactivity towards C.albicans was depressed in the patients between the ages of 10 and 20 and in those over the age of 61. A significant difference was present in delayed skin reactivity between the groups of 10-20 and 41-50 years old. 2. The frequency of the patients with positive delayed skin reactivity towards C.albicans was the highest in those with low levels of total IgE (0 -100 IU/ml) and the low est in those with high levels of total IgE (over than 1001 IU/ml). The results suggest that cell-mediated immunity towards C.albicans is depressed re lating to atopics in the patients between 10 and 20 and to aging in the patients over 61. 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 0913-3771 63 1992 Characteristics of asthma classified by a score relating to clinical findings and examinations 63 68 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Akimasa Takatori Hiroyuki Okuda Ikuro Kimura 10.18926/15324 Twenty six patients with bronchial asthma was classified by clinical symptoms and singns (clinical diagnosis), and the classification by clinical diagnosis was compared with the classification by a score calculated from clinical findings and examinations (score diagnosis). 1. Of 12 subjects with type Ia classified by clinical diagnosis, 8 cases with 0 to 49 ml/day of expectoration were evaluated as type Ia by score diagnosis. While four type Ia cases with 50 to 99ml/day of expectoration were calssified as type Ib by score diagnosis. The increased incidence of eosinophils in bronchoalveolar lavage fluid (BALF) of these four cases was similar to the incidence in type Ib cases with hypersecretion. 2. All of 6 subjects with type Ib by clinical diagnosis were estimated as type Ib by score diagnosis. 3. Of 8 cases with type II by clinical diagnosis, 7 cases were assessed as type II by score diagnosis. One case with type II by clinical diagnosis and with the score of 10 points was evaluated as questionable type II by score diagnosis. 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 0913-3771 63 1992 Difference in specific IgG and IgG(4) antibodies against Candida aibicans between healthy and asthmatic subjects in the elderly 58 62 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Naoki Kotoh Shinya Tada Ikuro Kimura 10.18926/15322 Specific IgG and IgG(4) antibodies against Canadida albicans were exmined in 48 healthy and 69 asthmatic subjects to analyze the mechanism causing an increased production of these immunoglobulins. 1. The level of C.albicans-specific IgG and IgG(4) antibodies was higher, not significantly in IgG(4), in asthmatics under 30 years of age, compared with healthy subjects of the same age group. 2. Specific IgG and IgG(4) antibody levels in both healthy and asthmatic subjects showed a tendency to increase with aging, and significant difference was present between cases under 30 years and cases over 70 years of age. 3. Any difference in the production of specific IgG and IgG(4) was not observed in elderly cases older than 60 years between healthy and asthmatic 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 64 1993 Effects of aging on responsiveness and inflammation in the airways of patients with bronchial asthma 89 96 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Hideo Harada Ikuro Kimura 10.18926/15320 Ventilatory function, cellular composition in bronchoalveolar lavage (BAL) fluid and release of chemical mediators from leucocytes were examined in 25 older asthmatics (mean age 66.7 years) and 25 younger asthmatics (mean age 45.1 years) in relation to clinical asthma types. 1. Ventilatory function tests showed that the values of ventilatory parameters such as % MMF, % V(50) and % V(25) were lower in older subjects than in younger subjects, and a significant difference was found in the % V(50) value between the two age groups. Regarding clinical asthma types, the values of % MMF, % V(50), and V(25) were significantly lower in both younger and older subjects with type II. 2. In analysis of cellular composition in BAL fluid, the proportion of BAL lymphocytes was significantly lower in type II older subjects than in younger subjects with the same type. A significantly increased proportion of BAL neutrophils was observed in both younger and older subjects with type II. 3. The release of leukotriene C(4) (LTC(4)) from leucocytes was significantly lower in type II older subjects than in younger subjects with the same type, and LTC(4) release in patients with type II was also significantly lower than that in those with other asthma types in both younger and older subjects. The release of histamine and leukotriene B(4) (LTB(4)) from leucocytes was not significantly different between the two age groups. These results demonstrate that ventilatory function, cellular composition in BAL fluid, and the release of chemical mediators from leucocytes are affected by aging and clinical asthma types. 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 64 1993 QCTによる骨塩量測定とその経時的変化による骨粗鬆症の治療効果判定 71 74 EN Junnichi Hiramatsu Masashi Kawaraya Satoshi Yokota Keisuke Sugimoto Fumihiro Mitsunobu Takashi Mifune Kazuhiro Kajimoto Hikaru Kitani Yoshiro Tanizaki Mutsuro Nakai Tsuneo Akiyama 10.18926/15319 40才〜84才(平均64.1才)の患者38例における骨塩量を,ある期間(1〜15カ月,平均8.2カ月)をおいて2回,定量的QCT(quantitative computed tomography)法を用いて測定し,その経時的変化によって,骨粗鬆症に対する治療法の効果判定を試みた｡その結果,(1)全体として骨塩量に有意の増加は認められなかった｡(2)骨強化剤使用例についても骨塩量に有意の増加は認められなかった｡(3)運動療法施行者においても骨塩量に有意の増加は認められなかった｡以上のことから骨粗鬆症の治療においては,約1年弱の経過では著明な反応は得られにくいものと思われた｡ただし,一部の運動療法施行者,骨強化剤使用者において,骨塩量の著明な上昇が認められており,さらに経時的な観察が必要と思われた。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 63 1992 Bronchial asthma in the elderly. Ventilatory function in each clinical asthma type. 44 49 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Akimasa Takatori Hiroyuki Okuda Ikuro Kimura 10.18926/15318 Ventilatory function was examined in 20 elderly patients with bronchial asthma in relation to clinical asthma types, and the results were compared with those of younger asthmatics. 1. Ventilatory parameters such as FEV(1.0%), % PEFR, % MMF, % V(50) and % V(25), which repressent obstructive ventilatory dysfunction, were in general lower in older asthmatics than in the youger cases. 2. The values of % V(50) and % V(25), representing ventilatory dysfunction in small airways, were significantly lower in the older subjects with type Ib and II compared to the younger cases with same types. 3. Markedly decreased values in ventilatory parameters, particularly in % MMF, % V(50) and　% V(25) were observed in both older and younger subjects with type II. The results suggest that ventilatory function decreases with aging and the decrease is related to the pathophysiological changes in the 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分院 Acta Medica Okayama 0918-7839 64 1993 ERCP後CTによる膵嚢胞性疾患の診断 65 70 EN Koji Ochi Hideo Harada Shuji Matsumoto Tosinobu Seno Juntaro Tanaka Takaaki Mizushima Keisuke Sugimoto Fumihiro Mitsunobu Yoshiro Tanizaki Mutsuo Nakai Tsuneo Akiyama Hideaki Hasuoka 10.18926/15317 ERCP直後にCTを撮影するERCP後CTはERCPの際に膵内に注入された造影剤をCTで検出するため,ERCPでは得られない情報が得られる利点がある｡われわれはERCP後CTが診断や治療方針の決定に有用であった膵嚢胞の4例を経験した｡膵嚢胞では主膵管との連絡,嚢胞の部位,性状診断にERCP後CTは有用な検査法であり,文献的考察を含めて報告した｡ 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 0913-3771 63 1992 Bronchial asthma in the elderly. Relationship to allergic reaction and airway inflammation 39 43 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Koji Ochi Hideo Harada Ikuro Kimura 10.18926/15316 Clinical features of bronchial asthma in the elderly were analyzed by observlng IgE-mediated allerglc reactions evaluated by immediate skin reaction and specific IgE antibodies to allergens, ventilatory function and cellular composition in bronchoalveolar lavage (BAL) fluid. 1. The frequency of positive immediate skin reaction and positive RAST score to allergens was in general low in the elderly patients over age 70. 2. Ventilatory function was widely variegated, and fifteen cases (60%) of the 25 Subjects showed considerably high values of FEV(l.0%), % PEFR, % MMF, % V(50) and % V(25), and the mean value of FEV(1.0%) in these cases was 71.3%. 3. The decreased value of % V(25) was related to BAL neutrophilia in 2 cases, but any correlation was not found between BAL neutrophilia and decreased value of % V(25) in 9 csese of the eleven subjects who had the BAL examination. The results show that in asthma of elderly patients, IgE-mediated allergic reactions are weak, and that a decreased value of % V(25) can be observed without BAL neutrophilia. 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 64 1993 Transient bronchoalveolar neutrophilia in a patient with atopic asthma 52 59 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Yoshiyasu Nakagiri Shinya Tada Ikuro Kimura 10.18926/15314 Clinical course of one asthma patient (64 years old, female), who had an increased proportion of neutrophils in bronchoalveolar lavage (BAL) fluid, was observed in relation to the proportion of BAL cells and ventilatory function. The patient had large asthma attacks two times during her clinical course for 15 months observed. 1. An increased proportion of BAL neutrophils and suppression of ventilatory function were found after her first large asthma attacks. The increased proportion of BAL neutrophils continued for more than 5 months. A reduction in the proportion of BAL neutrophils was found 3 months after her second large asthma attack, accompanied by improvement of clinical symptoms and ventilatory function. The numbers of total cells and neutrophils in BAL fluid were also reduced. Transient increase in number of BAL lymphocytes was found 13 months after the first large attack when the number of BAL neutrophils was markedly decreased. The number of BAL eosinophils did not change during her clinical course. 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 0913-3771 63 1992 Total IgE, IgG and IgG(4) levels in sera of patients with bronchial asthma. Changes of serum concentrations in the elderly 34 38 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Ikuro Kimura 10.18926/15313 The serum levels of total IgE, IgG and IgG(4) were compared among five age groups of patients with bronchial asthma. 1. The level of serum IgE was significantly higher in the patients before the age of 29 than in those between the ages of 30 and 49 (p < 0.02), between 50 and 59 (p < 0.01) and between 60 and 69 (p < 0.01). The serum IgE level tended to increase in the patients over age 70. 2. The serum level of total IgG was significantly higher in the patients over age 70 compared with the level in the 30-49 (p < 0.05) and the 60-69 year old groups (p < 0.05). 3. The serum IgG(4) level was increased with aging, although no significant difference was found among the five age groups. 4. The IgG(4) level correlated to a certain extent with the level of serum IgE. The results reveal that the levels of total IgE, IgG and IgG(4) are increased in the elderly patients over age 70, and that there is a relationship between serum levels of total IgE and IgG(4). 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 64 1993 Airway inflammation in elderly patients with bronchial asthma. Different airway inflammatory cell response related to disease severity. 83 88 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Yoshiyasu Nakagiri Hideo Harada Ikuro Kimura 10.18926/15312 Cellular composition of bronchoalveolar lavage (BAL) fluid was examined in 11 elderly asthmatics over the age of 70, and the results were compared with those of 11 younger asthmatics under the age of 50. In the subjects with mild asthma, the proportion of BAL cells in the elderly subjects was 86.2% macrophages, 11.0% lymphocytes, 1.9% neutrophils, 0.9% eosinophils and 0.08% basophilic cells. The proportion of neutrophils and eosinophils in the BAL fluid was slightly higher in younger subjects with mild asthma compared with that in elderly subjects, although no significant difference was found between the two groups. In subjects with severe asthma, the proportions of lymphocytes, neutrophils, eosinophils and basophilic cells were more increased in both younger and older patients compared to those with mild asthma, and a significant increase in the number of BAL eosinophils was found in younger subjects with severe asthma compared to those with mild asthma (p < 0.05). However, no significant difference was present in the proportion of BAL cells between younger and older patients with severe asthma. The results reveal that BAL cells are more increased in subjects with suvere asthma than in those with mild asthma in both younger and older subjects, and show the possibility that this increase is more predominant in neutrophils in older subjects and in eosinophils in younger 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 64 1993 Difference in motility of basophilic, granulocytes from atopic subjects following antigen- and Ca inophore A23187-stimulation 43 51 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Koji Ochi Hideo Harada Saburo Nakagawa Ryo Soda Kiyoshi Takahashi Ikuro Kimura 10.18926/15311 We examined histamine release and morphological changes in basophilic granulocytes from atopic subjects, in response to stimulation with antigen and Ca ionophore A23187. 1. Histamine release and a reduction in the rumber of basophils were more rapid and greater in extent at an early stage of antigen stimulation compared with Ca ionophore A23187 stimulation. 2. Morphological changes in basophils, represented by increased motility, in terms of an increased ratio of short to long axis diameter (L/S ratio), as well as the increased frequency of basophils with localized granules and those with pseudopods, were more often observed antigen stimulation than with Ca ionophore A23187 stimulation. In contrast, morphogical changes in which basophils appeared swollen, showing an increased mean cell diameter and an increased frequency of cells with 5 vacuoles or more were more predominant with Ca ionophore A23187 than with antigen stimulation. The results obtained here show that bridging of IgE receptors is essential to activate basophils and induce increased motility in these cells. 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 64 1993 Characteristics of humoral and cellular factors participating in onset mechanism of asthma in　relation to clinical types classified by symptoms. 36 42 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Yoshiyasu Nakagiri Shinya Tada Ikuro Kimura 10.18926/15310 Characteristics of each asthma type classified by clinical symptoms and　findings were studied in 72 patients with bronchial asthma. 1. Ventilatory function tests showed that the values of % MMF, % V(50) and % V(25) were significantly lower in patients with bronchiolar obstruction (type II) compared to the values of those with simple bronchoconstriction type (type Ia) and those with bronchoconstriction + hypersecretion (type Ib). 2. The proportion of neutrophils in bronchoalveolar lavage (BAL) fluid was significantly higher in type II than in type Ia and type Ib. Several　patients with type Ib showed higher proportion of BAL eosinophils. 3. The release of LTC(4) from leucocytes was significantly lower in type II compared with type Ia and type Ib. There was no significant difference in the release of histamine and LTB(4) among the three asthma types. 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 0913-3771 63 1992 QCTによる骨塩量測定と骨粗鬆症のリスクファクター 30 33 EN Naoko Honke Yasuhiro Kusaura Masakuni Tanimizu Fumihiro Mitsunobu Takashi Mifune Morihiro Okazaki Hikaru Kitani Yoshiro Tanizaki Akimasa Takatori Hiroyuki Okuda Mutsuro Nakai Tsuneo Akiyama 10.18926/15309 27〜85才の女性143例における骨塩量を,定量的QCT法 (quantitative computed tomography)を用いて測定し,年令,身長,体重及び原疾患(慢性関節リウマチ),使用薬剤(ステロイド･骨強化剤)の因子の骨塩量に及ぼす影響について検討した｡その結果,1)加令とともに骨塩量は低下するが,特に40才代後半から60才代にかけての低下が顕著であり,また, 他因子の影響を受けやすい｡2)体型的因子としては.痩せ型で低身長の人に低値の傾向がある｡3)ステロイド使用の有無における検討において,特に50才代で使用群が著明に低値であることが明らかとなった｡また,薬剤の因子の考察に関しては,さらに経時的検討か必要であると思われた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 64 1993 Humoral and cellular immune response in elderly patients with bronchial asthma 75 82 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Koji Ochi Hideo Harada Shinya Tada Ikuro Kimura 10.18926/15308 Humoral and cellular immune responses in bronchial asthma were examined by comparing the results of older asthmatics (group OA) with those of older healthy subjects (group OH) and of younger asthmatics (group YA). In humoral immune response, IgE-mediated immune system expressed by elevated serum IgE levels and IgE antibodies for house dust mite (HDm) and/or Candida albicans was clearly found in older asthmatics, while there was no finding showing the presence of IgE-mediated immune response in older healthy subjects. There was no significant difference in levels of serum IgG and IgA among the three groups. However, the serum IgM level was significantly lower in older asthmatics than in younger asthmatics. IgE antibodies to HDm and/or Candida albicans were more frequently found in older asthmatics compared with older healthy subjects. In contrast, IgG(4) antibodies to HDm were not different among the three groups. IgG(4) antibodies to Candida albicans were significantly higher in both older groups than in younger group. However, there was no significant difference between asthmatic and healthy subjects in the elderly. Delayed skin reaction to PPD was significantly more decreased in older asthmatics. These results show that bronchial asthma in the elderly is characterized by the presence of IgE-mediated immune response and by the changes of immune response with 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 64 1993 House dust mite allergy in patients with　bronchial asthma. Serum IgE levels and IgE antibody values in relation to patient age. 31 35 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Koji Ochi Hideo Harada Shinya Tada Ikuro Kimura 10.18926/15307 Serum IgE levels and IgE antibody values in relation to patient age were examined in 50 patients with house dust mite (HDm) sensitive asthma, 1. IgE antibody values to HDm were highest in patients between the ages of 10 and 19, and the　values generally low in those over the age of 40. 2. High IgE antibody values to HDm　were accompanied by high serum IgE levels in patients between 10 and 19. IgE antibody values and serum IgE levels were in general low in patients over age 40. In patient under　age 9, serum IgE levels were less than 500 IU/ml in 5 of the 10 subjects despite an increased value of IgE antibodies to HDm. These results suggest that an increased　production of IgE antibodies to HDm is usually accompanied by an increased production of total IgE in younger subjects. However, an increase in production of IgE antibodies is not always related to an increase in production of total IgE in patients under age 9. The results also show that production of IgE antibodies to HDm and total IgE is in general low in older patients despite the hyperreactivity to HDm. 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 0913-3771 63 1992 Neutrophils in the airways of patients with bronchial asthma. Relationship to ventilatory function 25 29 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuharu Kusaura Ikuro Kimura 10.18926/15306 Ventilatory function was compared between two age-matched asthma groups : group A (study group) consists of 8 patients with bronchial asthma with marked neutrophilia (20% or more) in the BAL fluid and group B (control group) of 8 patients with neutrophils (less than 5% of total BAL cells). The values of six ventilatory parameters were lower in group A than in group B, and a significant difference was found in FEV(1.0%), % MMF, % V(50) and % V(25) between groups A and B. Of these parameters, the value of % V(25) was markedly decreased in group A compared with group B. The results show that ventilatory dysfunction in airways, especially in small airways, is closely correlated to increased number of neutrophils in BAL fluid. 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 64 1993 Clinical significance of airway inflammation in bronchcial asthma. Comparison with chronic obstructive bronchiolitis. 24 30 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Koji Ochi Hideo Harada Shinya Tada Ikuro Kimura 10.18926/15305 Clinical significanoce of airway inflammation was assessed in 28 patients with bronchial asthma, and the results were compared with those in 9 patients with chronic obstructive bronchiolitis (COB). 1. Total cell number in bronchoalveolar lavage(BAL) fluid was markedly increased in patients with COB (51.0×10(6)), which was significantly greater than that in those with bronchial asthma (9.6×10(6) ). 2. The proportion of BAL macrophages was significantly higher in patients with bronchial asthma than in those with COB. However, the, absolute number of BAL macrophages was not significantly different between them. 3. The proportion of BAL lymphocytes was higher in patients with bronchial asthma than in those with COB, but this difference was not signifcant. In contrast, the absolute number of BAL lymphocytes was significantly greater in patients with COB than in those with bronchial asthma. 4. The proportion and the number of BAL neutrophils were markedly increased in patients with COB compared to those with bronchial asthma. 5. The proportion and the number of BAL eosinophils were higher in patients with bronchial asthma than in those with COB, although these defferences were not significant. The results suggest that airway inflammation in bronchial asthma is not so intensive as that in COB. 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 0913-3771 63 1992 Role of eosinophils in the airways of patients with atopic asthma. Relationship to mucus hypersecretion 14 18 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Ikuro Kimura 10.18926/15304 A correlation between the proportion of eosinophils in bronochoalveolar lavage (BAL) fluid and amount of expectoration was examined in patients with atopic asthma. The subjects were divided into two groups : cases with high proportion (20% of more) (group A) and low proportion (less than 5%) (group B) of eosinophils in the BAL fluid. Any significant difference was not paesent in the value of each ventilatory parameter between the two groups. The amount of expectoration/day was significantly higher in group A compared with group B (p<0.001). These results suggest that eosinophilia in BAL fluid correlates to mucus hypersecretion in the airways of 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分院 Acta Medica Okayama 0918-7839 64 1993 Activated blood T cells in patients with bronchial asthma. Relationship to asthmatic cycle. 11 16 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Hideo Harada Shinya Tada Ikuro Kimura 10.18926/15303 The number of CD4(+) T-Iymphocytes, CD4/CD8 ratio, and the number of IL2R(+) T-Iymphocytes (CD25) were examined in 14 patients with bronchial asthma, and the results were compared in three different asthma stages : symptom-free stage, wheeze stage, and attack stage. 1. The proportion of blood CD4(+) T-lymphocytes was more decreased in patients with asthma attacks than in those without symptoms. The CD4/CD8 ratio was also more　decreased in patients with attacks than in those without symptoms. However, these differences were not significant. 2. The proportion of blood activated T cells (IL2R(+) cells, CD25) was significantly increased in patients with attacks than in those without symptoms. The proportion of activated T cells in 5 asthma patients was 2.9±0.8% in　symptom-free stage and 6.6±1.1% in attack stage(p<0.001). These findings show that numbers of activated T-lymphocytes in peripheral blood were increased during asthma attacks, and this increase suggests the participation of　activated T cells in the pathogenesis 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 0913-3771 63 1992 Lymphocytes in the airways of patients with bronchial asthma. Is there any relationship to IgE-mediated allergic reaction. 19 24 EN Yosihiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Masakuni Tanimizu Naoko Honke Yasuhiro Kusaura Ikuro Kimura 10.18926/15302 Relationship of the proportion of lymphocytes in　bronchoalveolar lavage (BAL) fiutd to IgE-mediated reactions and to ventilatory function was studied in two age-matched asthma groups : group A of 11 subjects with BAL lymphocytes over 30% and group B of 11 subjects with BAL leyphocytes less than 10%. Of the eleven subjects in group A, 3 (27.3%) were atopic and 4 (36.4%) were non-atopic. The proportion of BAL lymphocytes in subjects with serum IgE level more than 300 IU/ml, who were all older than 50 years, was significantly higher than that in subjects with serum IgE less than 100 IU/ml in group A (p<0.05). While of the eleven subjects of group B, 5 (45.5%) were atopic and 4 (36.4%) were non-atopic. The value of % V(25) was significantly higher in the atopics compared with the non-atopics in group A (p<0.05), although no significant difference was found in the value of % V(25) between the two asthma types in group B. The results show that an increased number of lymphocytes in BAL fluid may be enhanced by IgE-mediated allergic reactions in the elderly, and that the decreased value of % V(25) may be associated withan increased number of lymphocytes in BAL fluid in non-atopics. 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 64 1993 Immunosuppression by glucocorticoids leads to bronchoalveolar neutrophilia in patients with bronchial asthma 17 23 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Hideo Harada Ikuro Kimura 10.18926/15301 Cellular composition of bronchoalveolar lavage (BAL) fluid was compared　between two age-matched steroid-dependent　intractable asthma (SDIA) groups : 17 group A patients (serum IgG level < 1000mg/dℓ) whose immunity was regarded as being　suppressed by long-term glucocorticoid therapy and 17 group B patients (serum IgG level > 1200mg/dℓ). 1. The levels of serum IgA and IgM were significantly decreased in group A compared to the levels in group B patients. 2. The number of blood lymphocytes was also significantly lower in group A than in group B patients. However, the number of blood neutrophils was not different between the two asthma groups. 3.The number of BAL lymphocytes was significantly lower in group A than in group B patients. 4. BAL neutrophilia (more than 1.5×10 (4)/mℓ) was observed in 6 of the 17(35.3%) patients in group A, but not observed in any patients in group B. The number of BAL neutrophils was significantly greater in group A than in group B　patients. These results suggest that there is a correlation between immunosuppression by glucocorticoids and BAL neutrophilia in patients with bronchial 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 0913-3771 63 1992 気管支喘息における温泉療法の臨床効果とその特徴 7 13 EN Takashi Mifune Yasuhiro Kusaura Naoko Honke Masahiro Tanimizu Fumihiro Mitunobu Morihiro Okazaki Hikaru Kitani Yoshiro Tanizaki 10.18926/15300 ステロイド依存性重症難治性喘息を中心に,喘息に対する温泉療法の臨床効果を,症例の背景因子に基づいて検討した｡1.現年令あるいは発症年令が高い症例でより有効であった｡2.非アトピー性の症例において有効率が高率であった｡3.臨床病型別では,細気管支閉塞型において最も有効率が高く,17例中16例(94.1%)が有効であった｡4.ステロイド減量効果は.71症例中43例(60.6%)で認められた｡細気管支閉塞型の症例でステロイド減量不能の症例を多く認めた｡ 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 64 1993 Spa therapy is very important for the treatment of steroid-dependent intractable asthma (SDIA). Analysis of 181 patients with SDIA. 1 10 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Keisuke Sugimoto Satoshi Yokota Junichi Hiramatsu Masashi Kawaraya Koji Ochi Hideo Harada Shinya Tada Ikuro Kimura 10.18926/15299 Characteristics of 181 patients with steroid-dependent intractable asthma (SDIA) who were admitted to our hospital and had spa therapy for last 10 years were examined in relation to the methods of spa therapy. For last 10 years, three kinds ofspa therapies were administered: spa therapy A (swimming training in a hot spring pool) in the first atage (1982-1985), spa therapy B (swimming training + inhalation of iodine salt solution) in the middle stage (1986 -1989), and spa therapy C (swimming training + inhalation of iodine salt solution + fango therapy) in the last stage (1990-1991) of this study. 1. The number of patients with SDIA who were admitted to our hospital and had spa therapy tended to increase from 2 in 1986 to 35 in 1991. 2. The number of SDIA patients over the age of 60 or over the age at onset of 40 tended to increase from the first stage to the last stage. 3. The proportion of patients from distant areas (prefectures other than Tottori) was decreasing for the last stage, although the number of these patients was increasing in recent years. 4. The proportions of patients divided by serum IgE levels and by clinical asthma types did not change for last 10 years. 5. The proportion of type Ib and type II asthma was considerably high in patients with SDIA for last 10 years. 6. Clinical effects of spa therapy were observed in 21 of the 30 (70.0%)patients with SDIA in the first stage (1982-1985) with spa therapy A, 68 of the 83 (74.7%) patients with SDIA in the middle stage (1986-1989) with spa therapy B, and 61 of the 68 (89.7%) patients with SDIA in the last stage (1990-1991) with spa therapy C. 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 0913-3771 63 1992 Action mechanisms of complex spa therapy on steroid-dependent asthma 1 6 EN Yoshiro Tanizaki Hikaru Kitani Morihiro Okazaki Takashi Mifune Fumihiro Mitsunobu Akimasa Takatori Hiroyuki Okuda Koji Ochi Hideo Harada Ikuro Kimura 10.18926/15298 Effects of complex spa therapy, which comprises swimming training in a hot spring pool, inhalation of iodine salt solution and fango therapy, were analyzed in patients with steroid-dependent intractable asthma (SDIA) by comparison between the subjects with and without efficacy of the therapy. 1. The complex spa therapy was effective in the patients with lower levels of FEV(1.0%) and % PEFR. 2. The complex spa therapy was not always effective in the patients with a low value of % V(25), which represents depressed airflow in the small airways. 3. The efficacy of the complex spa therapy was found in the patients showing a low value of % V(25) accompanied by BAL neutrophilia, but not found in those without increased proportion (more than 10% ) of neutrophils in BAL fluid. The results reveal that the complex spa therapy is effective in patients with SDIA showing low values of FEV(1.0%) and % PEFR, and in those with a low value of % V(25) and BAL neutrophilia. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 62 1991 経過中に低蛋白血症をきたし抗リウマチ剤の関与が疑われた慢性関節リウマチの1症例 80 83 EN Hikaru Kitani Fumihiro Mitsunobu Takashi Mifune Morihiro Okazaki Yoshiro Tanizaki 10.18926/15167 症例は52歳女性で，慢性関節リウマチ（RA）はclassical，stageIV，　class 2であった。症状は進行性で加療を行うも改善がみられなかった。平成元年11月RA症状の増悪のための再入院後，Penicillamine 100〜200　mg，Sulfasalazine 500mgを合せて投与を行ったところ，血沈，CRP等の検査所見は改善傾向を示したが入院時には正常値であった血清蛋白量がその後5.1g／dlまで低下し，下肢浮腫が出現，その後さらに血清蛋白量は4.1g／dlにまで減少した。治療により蛋白量は5.8g／dlにまで回復したが，低蛋白血症の原因としてはD−Penicillamineの関与が疑われた。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 椎体変形と腰椎海綿骨骨塩量の関連-360症例の検討 115 118 EN Mutsuo Nakai Tsuneo Akiyama Kazuhiro Kajimoto Fumihiro Mitsunobu Takashi Mifune Yoshiro Tanizaki 10.18926/15163 QCTによる腰椎海綿骨骨塩量と,圧迫骨折を含む,椎体(第11胸椎〜第4腰椎)の変形率の関係を検討した｡椎体変形率と腰椎QCT値の間の強い相関関係が確認され,椎体変形者全体の50%はQCT値70mg/cm(3)以下に分布し,90%は125mg/cm(3)以下に分布した｡さらに,この70mg/cm(3)付近での椎体変形者の割合は50%であり,125mg/cm(3)付近での椎体変形の割合は10%であった｡QCTによる腰椎海綿骨骨塩量測定値は,腰椎の変形および骨折の危険性を予 測する良好な指標であることが確認できた｡ 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 65 1994 新型DR装置･高精細CCDカメラ�]線テレビ装置の使用経験 107 114 EN Tsuneo Akiyama Mutsuo Nakai Kazuhiro Kajimoto Fumihiro Mitsunobu Takashi Mifune Yoshiro Tanizaki Koji Ochi Chowdhury Riaz Masataka Satou Hiroe Ukon 10.18926/15162 画像の入力部に世界初100万画素の多画素･高精細のCCD(電荷結合素子)を用いたテレビカメラを搭載したX線テレビ装置とDigital・Radiography装置を導入し,主に消化管検査を中心に多目的に任用した｡このシステムは従来のscreen/filmシステムの持つ膨大な情報量を確保しながらCCDカメラのメリットを最大限に生かしており,DRシステムの特長であるリアルタイムのCRT撮影画像表示,透視像のFREEZE確認,動態解析,画像処理等を導入することにより診断能の向上がはかれた｡更に,従来X線フィルム･撮像管に比較して被曝量の大幅な低減が期待できた｡また,デジタルであるため撮影像をHDに保管すると共にMODにも記録･再生が可能である｡今後,PACSやフイルムレス電子媒体保管への展開の可能性についても確認できた｡ 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 65 1994 当院における大腸ポリープの臨床的検討 101 106 EN Ichiro Takata Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Tadashi Matsumura Satoshi Yokota Yoshiro Tanizaki Koji Ochi Hideo Harada Tsuneo Akiyama Mutsuo Nakai 10.18926/15161 1990年4月より1994年3月末までの間に岡山大学医学部附属病院三朝分院で経験した早期大腸癌を含む大腸ポリープ88例を対象に,病理組織診断,性別,年齢構成,存在部位,精査動機について検討を行い,以下の成績を得た｡(1)ポリープの69.2%は腺腫,13.2%は腺癌(早期癌)であった｡(2)男女とも加齢による大腸ポリープ及び大腸癌の頻度の増加がみられた｡(3)50歳未満の若年者では右側結腸にポリープが発見されることは稀であったが50歳以上では6.5%に認められ,高齢者における積極的なtotal colonoscopyによる観葉が重要であることが再確認された｡(4)精査動機では便潜血陽性が最多を占め,便潜血は大腸ポリープのスクリーニングにおいて有用であることが示された｡またフォローアップ目的に大腸ファイバーを施行しポリープや早期癌を発見した例も多く,フォローアップ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分院 Acta Medica Okayama 0918-7839 65 1994 混合性結合組織病(MCTD)の1症例 96 100 EN Ichiro Takata Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Tadashi Matsumura Satoshi Yokota Yoshiro Tanizaki 10.18926/15160 症例は50歳女性で,1991年頃より両肘関節の疼痛とレイノー現象を自覚するようになり前医にて慢性関節リウマチ(Rheumatoid arthritis, 以下RAと略)との診断を受け加療受けるも症状の改善なく,当科を受診した｡典型的な慢性関節リウマチの症状に乏しく,他の膠原病の存在を疑って検索したところ,抗RNP抗体陽性等の所見から,混合性結合組織病(mixed connective tissue disease, 以下MCTDと略)と診断した｡MCTDは初診時に慢性関節リウマチと誤診される例が多く,慢性関節リウマチに非典型的な症状を伴う場合は,MCTDが鑑別診断として重要と考えられた。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 気管支喘息および慢性関節リウマチにおける気道抵抗(sRaw)および気道コンダクタンス(sGaw)に対するサルブタモールまたはクロモリン吸入の影響 87 95 EN Satoshi Yokota Hikaru Kitani Takashi Mifune Kazuhiro Kajimoto Fumihiro Mitsunobu Itiro Takata Yoshiro Tanizaki Shinya Tada Mine Harada 10.18926/15159 サルブタモールまたはdisodium cromoglycate(クロモリン)吸入液を,気管支喘息(以下BA)6例,慢性関節リウマチ(以下RA)7例,正常対照5例に吸入させ,吸入前および吸入後約30分に,気道抵抗(sRaw)と気道コンダクタンス(sGaw)を,定容積型体プレチスモグラフ(Sensor Medics Corporation, Anaheim, California, made in U.S.A.)を用いて測定した｡吸入前の値をsGawで比較すると,BAはRAや正常対照に比べ有意に閉塞の程度が強く,RAと正常対照の間では有意な差はなかった｡サルブタモール吸入の場合,BAでは吸入後にsRawおよびsGawの有意な改善(P<0.01)がみられ,それらの改善率(%)は,RAや正常対照と比べて有意に高く(P<0.01),RAと正常対照の間では改善率の有意な差は認めなかった｡クロモリン吸入の場合,いずれの群においても,sRawおよびsGawの吸入後の変化に有意差はみられなかったが,BAにおいて,sRawの改善率(%)はRAと正常対照に対して,またsGawの改善率(%)は正常対照に対して有意に高く(P<0.05),RAと正常対照の間では,sRaw,sGaw共に改善率(%)の明らかな差はみられなかった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 QCTによる経時的3回の骨塩量測定と骨粗髭症治療についての検討 69 76 EN Kazuhiro Kajimoto Ichiro Takata Satoshi Yokota Fumihiro Mitsunobu Takashi Mifune Hikaru Kitani Yoshiro Tanizaki Yasuaki Kobayashi Yoshiyasu Nakagiri Mutsuro Nakai Tsuneo Akiyama 10.18926/15156 当院通院あるいは入院中の女性患者54例を対象に骨塩量を経時的に3回測定し検討を行った。54例の骨塩量の平均は3回とも有意差はなく,年次骨塩変化量は-3.1±14.6mg/cm(3)/yearであった｡平均骨塩量の年齢別比較では40才台,50才台,60才台の順に有意な減少がみられ,60才台と70才以上との間には差は認めなかった｡また50才台及び70才以上の年代で1年当たりの骨塩量の減少が大きい傾向が窺われた｡身長と骨塩量との間に有意の正の相関を認めたが,体重との間には有意の相関を認めなかった｡血清中Ca,P及びALPと骨塩量との検討ではいずれも有意の相関を認めなかった｡骨塩変化量減少群と増加群との比較では,平均骨塩量及び背景因子の間に差を認めなかった｡女性,特にステロイド療法を必要とする患者については閉経の時期にあたる40〜50才台より積極的に骨粗髭症対策を考える必要性があると考えられた｡また運動療法については温泉プール療法自体を再検討するとともに,骨粗髭症に特異的な運動療法の確立が必要と思われた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 Clinical evaluation of MAST system in the measurement of specific IgE antibodies in patients with bronchial asthma 62 68 EN Fumihiro Mitsunobu Hikaru Kitani Takashi Mifune Kazuhiro Kajimoto Satoshi Yokota Ichiro Takada Yoshiro Tanizaki 10.18926/15155 The serum levels of specific IgE antibodies to food allergens and inhalant allergens were evaluated in ninety five patients with bronchial asthma using the MAST system, which can measure specific IgE antibodies against sixteen different allergens with a single sample. 1. Higher positivities of specific IgE antibodies were found in inhaled allergens than in food allergens. Specific IgE antibodies against several allergens were detected in individuals more frequently in inhaled allergens than in food allergens. 2. Positivities of specific IgE antibodies against food allergens did not correlate to patients' age and patients' age at onset. In inhaled allergens, positive results in MAST system were frequently observed in patients under age of 50 and under age at onset of 60. 3. In subjects with high serum IgE levels, high positivities of specific IgE antibodies against inhaled allergens and food allergen were found. 4. The MAST system is suggested to be clinically more useful than RAST. 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 65 1994 Serum immunoglobulin levels and peripheral lymphocyte count related to changes in cellular composition of bronchoalveolar lavage fluid in patients with bronchial asthma 55 61 EN Fumihiro Mitsunobu Hikaru Kitani Takashi Mifune Kazuhiro Kajimoto Satoshi Yokota Ichiro Takata Yoshiro Tanizaki Koji Ochi Hideo Harada Shinya Tada Mine Harada 10.18926/15154 Changes in airway inflammation by glucocorticoids were examined in 26 patients with bronchial asthma, divided into two age groups ; 20-59 and 60+ years, in relation to serum immunoglobulin levels and peripheral lymphocyte count. 1. The levels of IgG, IgA and IgM were significantly lower in patients with steroid-dependent intractable asthma (SDIA) of age over 60 years than in those with non-SDIA of the same age group. In patients between the ages of 20 and 59, only serum IgG level was significantly lower in SDIA than in non-SDIA patients. 2. Peripheral lymphocyte count was significantly decreased in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. 3. Number of lymphocytes in bronchoalveolar lavage (BAL) fluid was significantly lower and number of BAL neutrophils was significantly higher in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. These results suggest that levels of IgG, IgA and IgM, and peripheral lymphocyte count were significantly suppressed in SDIA patients of age over 60, accompanied with decrease of BAL lymphocytes and increase of BAL neutrophils. 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 65 1994 年令から見た気管支喘息症例の臨床的特徴 48 54 EN Takashi Mifune Ichiro Takata Satoshi Yokota Kazuhiro Kajimoto Fumihiro Mitsunobu Hikaru Kitani Yoshiro Tanizaki 10.18926/15153 高齢気管支喘息症例の病態を解明するために30才以降の気管支喘息症例について年齢層別に臨床的特徴を検討した｡1)60才以上の高齢気管支喘息症例は全体の41.1%を占めており,年齢層別では50-59才,60-69才の症例が多く認められた｡2)ほとんどの症例が成人発症喘息であり,高齢気管支喘息では92.3%が中高年発症型気管支喘息であった｡3)加齢に伴って細気管支閉塞型気管支喘息の増加か認められた｡4)血清IgE値は50-59才で再増加し,histamine release,LTC(4)産生は40149才で高値であった｡5)40-69才の年齢層でステロイド依存性難治性喘息が多く認められた｡以上高齢気管支喘息症例は中高年発症型喘息の病態の特徴を有しており,中高年発症型気管支喘息の病態の解明が必要と考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 Characteristics of airway response in patients with steroid-dependent intractable asthma (SDIA) 40 47 EN Takashi Mifune Hikaru Kitani Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Ichiro Takata Yoshiro Tanizaki Koji Ochi Hideo Harada Shinya Tada Mine Harada 10.18926/15152 Characteristics of airway response in steroid-dependent intractable asthma (SDIA) were examined in 86 asthma patients (43 with SDIA and 43 with non-SDIA) divided into three age groups: 20-39, 40-59 and 60+ years, by observing cellular composition of bronchoalveolar lavage (BAL) fluid and ventilatory function. 1. The level of serum cortisol was significantly lower in patients with SDIA than in those with non-SDIA in all age groups. 2. The proportion of lymphocytes in BAL fluid was significantly decreased in patients with SDIA compared to results in non-SDIA patients in the age between 40-59, and over 60+ years, While BAL neutrophils were significantly increased in SDIA patients compared to results in non-SDIA patients in the age group over 60 years. 3. Of ventilatory parameters, the values of % FVC, FEV(1.0%), % MMF and % V(25) were significantly lower in SDIA patients over the age of 60 compared with non-SDIA subjects of the same age group. These results show that in SDIA patients the proportion of BAL lymphocytes decreases and the proportion of BAL neutrophils increases with aging, and that ventilatory function in SDIA patients also decreases with aging compared to non-SDIA 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 65 1994 Sodium picosulfate,PEG腸管洗浄液併用によるTotal colonoscopyの前処置法に関する検討 22 26 EN Koji Ochi Hideo Harada Riaz Chowdhury Juntaro Tanaka Shuji Matsumoto Toshinobu Seno Takaaki Mizushima Fumihiro Mitsunobu Yoshiro Tanizaki Tsuneo Akiyama Mutsuo Nakai Hideaki Hasuoka Tadahiro Kato 10.18926/15150 Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用で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分院 Acta Medica Okayama 0918-7839 65 1994 重症ブユアレルギーの1症例 17 21 EN Hikaru Kitani Ichiro Takata Satoshi Yokota Kazuhiro Kajimoto Fumihiro Mitsunobu Takashi Mifune Yoshiro Tanizaki 10.18926/15149 多数のブユに刺されたのを契機に重症反応を呈するようになった29歳男性例について,アレルギー学的検討を行った。血清IgE値が高値(4591U/ml)であったが,免疫グロブリン,抗核抗体,血清補体価,CD4,CD8陽性リンパ球出現頻度などいずれも正常であり,またハウスダスト,カンジダその他16種類の吸入性抗原,ミツバチ,スズメバチ,アシナガバチ,ゴキブリ,ヤブカ,ユスリカなどの昆虫抗原に対する特異的IgE抗体はいずれも陰性であった｡一方ニッポンヤマブユ抗原による好塩基球からのヒスタミン遊離は陰性であったが,皮膚反応,IgE抗体は陽性を示したことから,本症例における重症化因子としてIgE系反応の関与が示唆された｡なおEBウイルス抗体価の検討では,EBV-EADR抗体はすべて陰性,EBNA-EIA抗体はIgG抗体のみ陽性であり,EBウイルスの既感染状態と判断されたが,病因との関連は明らかではなかった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 65 1994 Release of histamine and leukotrienes C(4) and B(4) from peripheral leucocytes and bronchoalveolar cells and bronchial hyperresponsiveness in patients with asthma 9 16 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Ichiro Takata Koji Ochi Hideo Harada Shinya Tada Mine Harada 10.18926/15148 The proportions of cells in bronchoalveolar lavage (BAL) fluid, the release of histamine, leukotrienes C(4) and B(4) from leucocytes and BAL cells, and bronchial reactivity to methacholine were examined in 40 patients with asthma in relation to patient age. 1. The proportions of lymphocytes and neutrophils in BAL fluid were higher in older patients over age 60 than in younger patients between 20 and 49. The proportions of eosinophils and basophilic cells in BAL fluid were higher in younger patients than in older patients, and the difference in the proportion of BAL basophilic cells was significant between the two groups (p<0.05). 2. The release of histamine from BAL cells was significantly higher in younger patients than in older patients (p<0.001). The release of LTC(4) from BAL cells was higher in older patients compared to younger patients. 3. Bronchial reactivity to methacholine was higher in younger patients than in older patients. The number of patients reactive to low concentration of methacholine (390μg/mℓ or less) was larger in younger patients (12/16 ; 75.0%) than in older patients (5/14 ; 35.7%). These results suggest that bronchial hyperresponsiveness changes with aging, accompanied by changes in the release of chemical mediators from BAL cells and in the proportion of BAL cells. 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 65 1994 Complex spa therapy and airway inflammation in bronchial asthma 1 8 EN Yoshiro Tanizaki Hikaru Kitani Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Ichiro Takata Koji Ochi Hideo Harada Shinya Tada Mine Harada 10.18926/15147 Efficacy of complex spa therapy was studied in 55 patients with bronchial asthma. Complex spa therapy was effective in 47 (85.5%) of the 55 patients with bronchial asthma : marked efficacy was observed in 15 (27.3%), moderate in 32 (58.2%), slight in 6 (10.9%) and no efficacy in 2 patients (3.6%). Improvement of clinical symptoms and findings by complex spa therapy was more clearly observed in patients with an increased proportion of BAL lymphocytes, neutrophils and eosinophils. These findings suggest that complex spa therapy more affects cell infiltration in the airways than bronchoconstriction induced by chemical mediators. Improvement of ventilatory function represented by FEV1.0% value was higher in patients with a low proportion of BAL neutrophils, suggesting that patients with increased number of BAL neutrophils require longer complex spa therapy than those without BAL neutrophilia. 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 66 1995 コラーゲン分解系と疾患 78 84 EN Koji Ochi Hideo Harada Haruhiro Yamashita Mitsuko Ichimura Juntaro Tanaka Toshinobu Seno Shuji Matsumoto Takaaki Mizushima Satoshi Yokota Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/15128 組織のコラーゲン沈着にはコラーゲン合成系と分解系の不均衡によって生ずる｡従来,主としてコラーゲン合成系が注目されていたが,最近の研究の進歩により,コラーゲン分解系が重要な役割を演ずることが明らかになってきた｡コラーゲンの分解系には細胞内と細胞外の二つの経路が存在する｡それぞれcollagenolytic cathepsinおよびmatrix metalloproteinases( MMP)がコラーゲン分解能を有する重要な酵素である｡その調節因子については細胞外の経路についての解明か進んでいる｡MMPの遺伝子の発現にはサイトカインや成長因子が関与し,IL-1やTNF-αは強力な誘導因子である｡一旦,遺伝子か発現すれば,MMPは合成され,細胞外に不活性型(latent form)で分泌される｡不活性型のMMPが活性化する過程にはplasminogen activator inhibitorやtissue inhibitors of metalloproteinases(TIMP)などの阻害因子が存在し,MMP活性を調節する｡TIMPの遺伝子の発現にもサイトカインや成長因子が関与する｡MMPがTIMPを上回るような病態では組織破壊が,逆にTIMPがMMPを上回るような病態では綿維化が生ずる｡コラーゲン分解能の障害が線維化の維持や不可逆性に関与することが推察される。 No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 66 1995 温泉療法と気管支喘息患者のQOL 72 77 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Yasuhiro Hosaki Satoshi Yokota Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15127 気管支喘息のなかでも,ステロイド依存性重症難治性喘息では,気管支拡張薬その他の抗喘息薬のみでは発作のコントロ-ルが極めて困難であり,したがって副腎皮質ホルモンの長期投与を余儀なくされる｡そして,投与薬剤,特に気管支拡張薬の心臓刺激作用や副腎皮質ホルモンの副作用,さらには運動誘発喘息がひき起こされやすいなどの理由により,体動制限が加えられることが多い｡このことが,また精神活動の低下へとつながる｡したがって,重症難治性喘息患者のQuality of life (QOL)を高めるためには,薬剤の副作用をできるだけ低くするための投与薬剤の減量をはかるとともに,十分な運動のもとに治療を行い全身状態の改善,それにともなう精神活動の活性化をはかる必要がある｡かかる観点からすれば,温泉療法は最も理想的な治療法であり,その直接作用(気道への作用:気道浄化作用,気道粘膜正常化作用)により,白,他覚症状の改善,換気機能の改善,気道過敏性の低下などが観察される｡また,間接作用(気道以外への作用)により,全身状態の改善,自律神経系の安定化作用,副腎皮質機能の改善作用などが見られる｡すなわち,重症難治性喘息に対する温泉療法では,十分な運動のもとに,精神活動の活性化をともなった喘息症状の改善がはかられるため,患者のQOLをより一層高めることができると判断される｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 66 1995 慢性呼吸器疾患の温泉療法 ―遠隔地医療の最近の動向― 57 61 EN Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Yoshiro Tanizaki 10.18926/15125 1995年1月から6月までの半年間に当院へ入院し,温泉療法を受けた慢性呼吸器疾患患者77例について,その地域分布を中心に最近の動向を検討した1.77例中鳥取県内から来院した患者は28例(36.4%)であった｡一方,遠隔地(鳥取県外)からの患者は49例(63.6%)であり,遠隔地から入院してくる患者が増加する傾向か見られた｡2.遠隔地からの入院患者では,兵庫県からの12例(15.6%)が最も多く,次で岡山県8例(10.4%),大阪府7例(9.1%),山口 県5例(6.5%)の順であった｡3.入院患者の年齢分布では,鳥取県内の患者では70才以上の症例が最も多く,次で60-69才の年齢層の順であったが,遠隔地からの患者では,60-69才が最も多く,次で50-59才,40-49才の順であり,鳥取県内に比べ年齢層がやや低い傾向か見られた｡4.慢性呼吸器疾患のうちわけは,気管支喘息が62例と最も多く,全体の80.5%を占め,次で慢性閉塞性細気管支炎6例,肺気腫4例,慢性気管支炎3例の順であった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 66 1995 気管支喘息における抗喘息薬吸入効果の体プレチスモグラフによる評価 49 56 EN Satoshi Yokota Takashi Mifune Kazuhiro Kajimoto Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/15124 サルブタモール,クロモグリク酸ナトリウム(クロモリン)吸入液を,気管支喘息(以下BA)11例,肺病変のない対照群9例に吸入させ,吸入前および吸入後30分に,sRaw(specific airway resistance)とsGaw(specific airway conductance)を,定容積型体プレチスモグラフ(Sensor Medics Corporation, Anaheim, California, U.S.A.)を用いて測定した。サルブタモールの場合,BAでは吸入後に有意な改善(p<0.01)を認め,対照群でも有意な変化(p<0.05)があったが,改善率(%)はBA が対照群に比べて有意に高かった(p<0.01)｡クロモリンの場合,吸入前後での比較では有意差は認めなかったが,吸入後にBAでは改善,対照群では悪化する傾向があり,改善率(%)はBA が対照群に比べて有意に高値(p<0.01)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分院 Acta Medica Okayama 0918-7839 66 1995 気管支喘息臨床病型に対するTリンパ球の関与の検討 44 48 EN Takashi Mifune Satoshi Yokota Yasuhiro Hosaki Kazuhiro Kajimoto Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/15123 気管支喘息症例の臨床病型に対するTリンパ球の役割を明らかにするために,気管支肺胞洗浄液中のCD3,CD4,CD8陽性細胞の比率を検討した｡1.Ia気管支攣縮型におけるCD3陽性細胞は75.6±6.52%,Ib:過分泌型では75.4±16.5%,�U:細気管支閉塞型では61.0±12.5%であり,いずれの病型においても有意な差は認められなかった｡2.CD4陽性細胞についてはIa型47.4±6.11%,Ib型39.5±8.70%,�U型46.3±6.91%,CD8陽性細胞についてはIa型28.3±8.77%,Ib型35.5±12.3%,�U型29.4±11.5%と過分泌型 で他の2病型とは違う傾向を示したが,有意ではなかった｡3.活性化を示すHLA-DR陽性細胞はCD4,CD8陽性細胞とも気管支攣縮型で高い傾向が認 められたが有意ではなかった｡以上,今回の検討では各臨床病型間でTリンパ球の関与に明らかな差は見られなかったが,気管支攣縮型に対する活性型Tリンパ球より強い関与の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分院 Acta Medica Okayama 0918-7839 66 1995 QCTにより測定した骨塩量と骨代謝マーカーについての検討 37 43 EN Kazuhiro Kajimoto Fumihiro Mitsunobu Takashi Mifune Satoshi Yokota Yasuhiro Hosaki Yoshiro Tanizaki Mutsuro Nakai Tsuneo Akiyama 10.18926/15122 当院内科に通院または入院中の女性患者24例(57〜89才,平均71.8才)を対象とし,定量的QCT法による骨塩量測定と同時に血中骨代謝マーカーを測定し検討を行った｡年齢についての検討では,カルシウム(Ca)が70才台で60才台に比べ有意に高値であった以外は年代による有意差は認められなかった｡オステオカルシン(OC)とイオン化Ca(Ca(2+))との間にr=-0.50,p<0.01の有意の逆相関を認め,OCとBody mass indexとの間に有意の正の相関(r=0.41,p<0.05)を認めた｡平均骨塩量と各生化学parameterとの間には有意な相関はみられなかった｡副腎皮質ステロイド剤(ステロイド)投与群では非投与群に比べ,投与群でALP骨型アイソザイム(ALP3)高値,OC低値の傾向がみられた｡またステロイド投与症例はすべてOC値が8.4ng/mℓ以下であり,ステロイドによる骨粗鬆症誘発の機序として骨形成の抑制が関与している可能性が考えられた｡今後骨塩量と骨代謝マーカーとの関連について,若年者を含めた検討が必要と考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 66 1995 Serum cortisol levels in patients with bronchial asthma. Relationship to glucocorticoid therapy and patient age. 30 36 EN Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Yoshiro Tanizaki Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15121 Serum cortisol levels were examined in 94 patients with bronchial asthma in relation to dose of glucocorticoids and age. 1. The level of serum cortisol was significantly lower in group A patients, treated with glucocorticoids (prednisolone of 5mg/day or more) for more than 2 years, (2.4±1.2mcg/㎗) than in group B, treated with glucocorticoids (prednisolone of 5mg or less) for less than 2 years, (6.8±3.7mcg/㎗) (p<0.001) and in group C, treated without glucocorticoids, (12.6±3.9mcg/㎗) (p<0.001). The serum cortisol level was also significantly lower in group B than in group C (p<0.001). 2. The level of serum cortisol was significantly lower in patients over the age of 70 compared to that in those aged between 0 and 39 years (p<0.01) and those between 40 and 49 (p<0.05), and those between 50 and 59 (p<0.02). The level was also lower in patients between 60 and 69 compared to that in those between 0 and 39, however, this was not significant. These results demonstrate that the level of serum cortisol decreases by long-term glucocorticoid regimen and with 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 66 1995 Characteristics of ventilatory function in clinical types of bronchial asthma in the elderly 21 29 EN Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Satoshi Yokota Yoshiro Tanizaki Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15120 Ventilatory function was examined in 55 patients with asthma (25 older patients over the age of 60 and 30 younger patients under the age of 59) in relation to four clinical types classified by clinical symptoms and signs. 1. Regarding cellular composition of bronchoalveolar lavage (BAL) fluid, number of BAL neutrophils was significantly increased in type II, bronchiolar obstruction type, of older and younger patients compared to that in type la-1 and type la-2 of same patients. In contrast, BAL eosinophilia was observed in type la-2 of both older and younger patients and in type Ib of younger patients. 2. The values of % FVC, FEV(1.0%) and % PEFR were not significantly different among four clinical types of asthma and between older and younger patients, although the values of these ventilatory parameters in type II asthma showed a tendency to be lower compared to other clinical types. 3. The values of % MMF, % V(50), and % V(25), showing ventilatory dysfunction of small airways, were lowest in type II asthma of both older and younger patients among four clinical types. A significant difference in these ventilatory parameters of type II asthma compared to type la-1 asthma was observed in younger patients, but not in older patients. These results show that ventilatory dysfunction of small airways is related to clinical asthma types in younger patients, and to aging rather than asthma types in older 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 66 1995 Release of histamine and leukotriene C4 from bronchoalveolar cells in patients with bronchial asthma. A role of histamine in atopic asthma. 14 20 EN Fumihiro Mitsunobu Takashi Mifune Kazuhiro Kajimoto Yasuhiro Hosaki Satoshi Yokota Yoshiro Tanizaki Koji Ochi Hideo Harada 10.18926/15119 To clarify the main humoral triggering factor (histamine and/or leukotriene) of the early stage of asthma attacks, the release of histamine and leukotriene C4 (LTC4) from bronchoalveolar lavage (BAL) cells stimulated with Ca ionophore A23187 was examined in 7 patients with atopic asthma, and the results were compared to those in 7 nonatopic asthma patients. 1. The proportion of BAL basophilic cells was significantly higher in atopic patients than in nonatopic patients (p<0.05). 2. The content of histamine in BAL fluid was significantly higher in atopic (2.3mcg/mℓ) comparted to that in nonatopic patients (0mcg/mℓ)(p<0.001). The content of LTC4 was high in nonatopic (2.4ng/mℓ) than in atopic patients (0.5ng/ mℓ), however, this was not significant. 3. The release of histamine from BAL cells was 32.6% in atopic and 0% in nonatopic patients, and this was significant (p<0.001). The release of LTC4 from BAL cells was significantly higher in nonatopic (11.3ng/10(6)cell) than in atopic (3.5ng/10(6)cell)(p<0.02). The results demonstrate that histamine play more important role in atopic patients as a main triggering factor of attacks than LTC4. In contrast, in nonatopic patients, LTC4 is more predominant than histamine during early stage of 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 66 1995 Spa therapy and serum cortisol levels in patients with steroid-dependent intractable asthma (SDIA) 8 13 EN Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Yasuhiro Hosaki Satoshi Yokota Yoshiro Tanizaki 10.18926/15118 Serum cortisol levels before and after spa therapy were compared in 30 patients with steroid-dependent intractable asthma (SDIA) in relation to clinical asthma types. 1. The mean level of serum cortisol in patients with type la-1 asthma was 2.0±0.7mcg/dℓ before spa therapy, and significantly increased to 9.0±3.1mcg/dℓ　(p<0.001). The serum cortisol level of patients with type la-2 also significantly increased from 3.3±1.5mcg/dℓ before spa therapy to 5.9±3.1 mcg/dℓ after the therapy (p<0.05). 2. The level of serum cortisol in patients with type Ib increased from 4.0±1.6mcg/dℓ to 7.8±1.4mcg/ dℓ after spa therapy (p<0.001). In contrast, the serum cortisol levels in patients with type II were not significantly different before (2.7±1.3mcg/dℓ) and after spa therapy (3.5±3.0mcg/dℓ). The results showed that an increase in the levels of serum cortisol by spa therapy was more clearly observed in patients with type la-1 asthma compared to that in type la-2 or type Ib, and that, in contrast, the serum cortisol levels in patients with type II asthma did not significantly increase by spa therapy, since their asthma attacks were always severe and chronic in spite of long-term glucocorticoid regimen. 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 66 1995 Decrease in histamine release from bronchoalveolarcells with aging in patients with atopic asthma sensitive to house dust mite 1 7 EN Yoshiro Tanizaki Takashi Mifune Fumihiro Mitsunobu Kazuhiro Kajimoto Yasuhiro Hosaki Satoshi Yokota Koji Ochi Hideo Harada Satoru Ikeda Kazuhisa Taketa 10.18926/15117 Histamine release from bronchoalveolar cells induced by house dust mite (HDm) was compared in patients with atopic asthma sensitive to HDm in relation to age. 1. Total cell number in bronchoalveolar lavage (BAL) fluid was larger in patients over the age of 40 years (9.10×10(6)) than in those aged between 20 and 39 years (6.25×10(6)), however, this was not significant. 2. Number of BAL eosinophils was not significantly different between the two age groups. 3. Number of BAL basophilic cells was significantly higher in younger patients (20-39 years) (1.85±1.03×10(2)/mℓ) than in older patients (40+ years) (0.39±0.24×10(2)/mℓ) (p<0.001). 4. Histamine release from BAL cells induced by HDm was significantly higher in younger patients (38.1±24.8%) than in older patients (0%) (p<0.001). These results suggest that histamine release from BAL cells in patients with HDm allergy decreases with aging. No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 62 1991 ウイルス感染による発症が考えられた気管支喘息症例 76 79 EN Takashi Mifune Fumihiro Mitunobu Morihiro Okazaki Hikaru Kitani Yoshiro Tanizaki 10.18926/15097 ウイルスなどの気道感染により，気管支喘息症状が発症したり，あるいは増悪したりすることが知られている。自験例は65歳の女性で，上気道炎症状に引き続いて，気管支喘息が発症した。臨床症状の軽快とともに気道過敏性・IgE値は低下し，感染による気道過敏性の亢進，IgE型アレルギー反応の機序が関与していると考えられた。これらの結果は喘息患者は気道感染（特にウイルス感染）の予防が必要であり，感染した場合には抗喘息剤とともに抗炎症剤の使用が有用である可能性を示している。 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 膵線維化のメカニズム 115 120 EN Koji Ochi Riaz Chowdhury Mitsuko Ichimura Naoki Matsumura Juntaro Tanaka Takaaki Mizushima Ryoichi Yamamoto Hideo Harada Satoshi Yokota Fumihiro Mitsunobu Yasuhiro Hosaki Yoshiro Tanizaki 10.18926/15095 膵の線維化は慢性膵炎に特徴的な病理組織所見の一つであるが,その発生機序については不明な点か多い｡慢性膵炎はいったん発症すれば,進行性かつ非可逆性であるとされるが,その非可逆性に膵の線維化が関与するとされる｡膵の線維化の発生機序を明らかにし,線維化に対する根本的な治療法の確立が望まれるところである｡そこで,本稿では今後の膵の線維化の研究課題を明らかにする目的で,現在までの膵臓線維化の発生機序に関する知見を整理した｡ 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 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 上腹部不定愁訴患者の胃･胆嚢運動に関する研究 75 78 EN Takaaki Mizushima Ryoichi Yamamoto Naoki Matsumura Riaz Chowdhury Tadahiro Kato Koji Ochi Juntaro Tanaka Hideo Harada Satoshi Yokota Fumihiro Mitsunobu Takashi Mifune Yoshiro Tanizaki 10.18926/15090 現在,上腹部不定愁訴の原因は特定されていない｡その原因を解明するため,上腹部不定愁訴患者8人と健常対照者10人に対して液体食の胃排出能と,食事負荷による胆嚢収縮能を測定した｡胃排出時間,胆嚢収縮能はいずれも両者に有意な差は認められなかった｡健常対照者では胃排出時間と胆嚢収縮時間に有意な相関関係が認められたが,上腹部不定愁訴群では相関関係は認められなかった｡上腹部不定愁訴の原因として胃･胆嚢協調運動障害の存在が示唆 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 67 1996 大腸前処置法の栄養評価としてのレチノール結合蛋白の有用性の検討 71 74 EN Tadahiro Kato Hideaki Hasuoka Koji Ochi Takaaki Mizushima Naoki Matsumura Ryoichi Yamamoto Juntaro Tanaka Hideo Harada Tsuneo Akiyama Satoshi Yokota Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/15089 大腸内視鏡検査の前処置を栄養面から評価する目的で前処置前後にrapid turnover proteinである血中レチノール結合蛋白の変動を検討した｡前日に普通食を用い,当日ニフレックを使用した10例,検査1日前に低残渣食を用いた27例,通常の前処置では良好な腸管洗浄が得られないために検査前2日間低残渣食を用いた27例の3群について,前処置開始前と検査終了後に血中レチノール結合蛋白の変動をみたところ,検査前2日間低残渣食服用群で有意の低下を認めた｡前日普通食群では検査前後で変化を認めず,1日低残渣食服用群では低下傾向を認めたが,有意差は認めなかった｡これまで前処置の成否は腸管洗浄度の面で評価されてきたが,血中レチノール結合蛋白を目標として用いることにより栄養面から評価することができることが考えられた。 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環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 62 1991 JUN遺伝子の生化学的、生物学的活性についての考察 71 75 EN Fumihiro Mitsunobu Hikaru Kitani Morihiro Okazaki Takashi Mifune Noboru Asaumi Yoshiro Tanizaki 10.18926/15065 c-junはニワトリの癌ウイルスから分離された癌遺伝子（v-jun）のproto−oncogeneであり，その遺伝子産物は細胞内転写促進因子AP−1の主成分である。v−jun，c-junのトランスフォーム能を検討するために，我々はv-jun，ニワトリc-jun遺伝子さらにJUN遺伝子の種々の組換え体を複製能を持つレトロウイルスベクター（RCAS）に挿入し，CEF細胞（ニワトリ胎児線維芽細胞）にトランスフェクションした。その結果4か所存在する両者の構造的相違のうち，アミノ末端近くの27アミノ酸の欠損と3' untranslated regionの欠損が十分なトランスフォーム能と転写促進能発現に必須であることが明らかとなった。これらの部分がどのように機能発現に関与しているかは，これからの研究を待たねばならない。 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 慢性膵炎診療における内視鏡的純粋膵液採取法の意義 94 98 EN Koji Ochi Naoki Matsumura Tadahiro Kato Takaaki Mizushima Mitsuko Ichimura Hideo Harada Yoshiro Tanizaki Fumihiro Mitsunobu Hideaki Hasuoka Tetsuya Tsurumi 10.18926/14992 内視鏡的純粋膵液採取法の慢性膵炎診療における意義を検討した｡本法を用い,セクレパン100単位静注後10分間膵液を採取するintaraductal secretin test(IDST,膵管内セクレチン試験)はこれまで膵外分泌機能検査のgold standardである十二指腸液を採取するセクレチン試験に代用ができ,しかも10分間の採取時間で終了する利点を有する｡本法を施行することにより,蛋白栓が除去され,痔痛の消失に有用である｡また,慢性膵炎と鑑別を要する膵癌を除外診断するために,本法によって採取した膵液の細胞診,腫瘍マーカー,癌遺伝子の検出は有用である｡ 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 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 大腸の全周性狭窄を呈した好酸球性胃腸炎の1例 64 70 EN Takaaki Mizushima Koji Ochi Naoki Matsumura Tadahiro Kato Toshinobu Seno Hideo Harada Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14989 大腸に全周性狭窄をきたした好酸球性胃腸炎の1例を報告した｡症例は54才の女性で,腹痛と下痢を主訴に来院した｡上部消化管検査では異常を認めなかったが,下部消化管造影検査と大腸内視鏡検査で横行結腸の全周性狭窄を認め,生検にて大腸粘膜の好酸球浸潤を認めた｡貝料理の摂取にて腹痛発作が出現したが,原因抗原は同定できなかった｡貝類の摂取を避けることにより,症状は消失し,末梢血液中の好酸球増多は消失した｡本邦ではこれまでに124例 の報告があるが,大腸に全周性の狭窄をきたす症例は稀であり,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 68 1997 Studies on whole gut transit in chronic pancreatitis patients 59 63 EN Takaaki Mizushima Koji Ochi Naoki Matsumura Toshinobu Seno Hideo Harada Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14988 Abnormalities of whole gut transit could contribute to the maldigestion and　digestive symptoms of chronic pancreatitis patients. Whole gut transit was measured by radiopaque markers method. Fifteen chronic pancreatitis patients (2 females, 13 males; age range 40-78 years) and 17 controls (4 females, 13 males, 32-73 years) were studied. Additionally, we also looked for evidence of autonomic neuropathy in the chronic pancreatitis patients by using cardiovascular tests. In chronic pancreatitis, whole gut transit was shorter than controls. These abnormalities were not influenced by the degree of autonomic neuropathy. We conclude that whole gut transit is shorter in chronic pancreatitis 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 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 Oncogenes and tumor suppressor genes in pancreatic cancer 82 87 EN Koji Ochi Naoki Matsumura Mitsuko Ichimura Takaaki Mizushima Hideo Harada Hideaki Hasuoka Motohiro Yokoyama Tetsuya Tsurumi Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14965 Recent advances in molecular biology have revealed that a number of oncogenes (K-ras, erbB-2, and Met) and tumor suppressor genes (p53, p16, APC, and DCC) contribute to the development of pancreatic cancer. This paper reviewed the present knowledge of oncogenes and tumor suppressor genes relevant to pancreatic cancer. Further studies on molecular alterations in pancreatic cancer may lead to a better understanding of tumor biology, offering a possibility of development of new diagnostic and therapeutic approaches in the future. 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 A Case of Giant Cell Arteritis Associated with Rheumatoid Arthritis Monitored by Magnetic Resonance Angiography 35 39 EN Seishi Harada Fumihiro Mitsunobu Fumiko Kodama Yasuhiro Hosaki Takashi Mifune Hirofumi Tsugeno Makoto Okamoto Eiichiro Yumoto Shingo Takata Yoshiro Tanizaki 10.18926/14956 We report a patient who developed giant cell (temporal) arteritis during treatment of rheumatoid arthritis. The patient was a 57-year-old Japanese woman and had been well controlled with anti-rheumatic drugs, when she presented to our hospital with severe bitemporal headaches and marked fatigue. An exclusive diagnosis was rapidly made and she was diagnosed as having giant cell arteritis based on the classification criteria by American College of Reumatology. Additionally, magnetic resonance (MR) angiography was performed, from which stenotic change in the bilateral superficial temporal arteries was strongly suspected and then corticosteroid therapy was quickly started. The patient followed an uneventful course without developing any complications such as visual dysfunctions. Therapeutic effect was confirmed by MR-angiographic findings obtained 4 weeks after the initiation of 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 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 膵炎とインターフェロン 84 87 EN Koji Ochi Naoki Matsumura Takaaki Mizushima Hideaki Hasuoka Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14943 インターフェロンは慢性肝炎や悪性腫瘍の治療など,広く臨床の場に用いられるようになった｡その副作用の一つとして,膵炎があり,その多くは急性膵炎である,慢性膵炎の報告もあり,膵炎はインターフェロンを用いる場合に知っておくべき副作用である｡そこで,膵炎とインターフェロンの関係について現在までに知られている知見について概説する｡ 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 Clinical and experimental aspects of free radicals in chronic pancreatitis 79 83 EN Koji Ochi Naoki Matsumura Takaaki Mizushima Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14942 Free radicals have been suspected to play an important role in the pathogenicity of chronic pancreatitis. We reviewed studies on free radicals in chronic pancreatitis in both c1inical and experimental aspects. Many clinical studies have provided circumstantial evidence for the close relation between free radicals and chronic pancreatitis. However, few experimental studies in animals on relation between free radicals and chronic pancreatitis have been reported, because adequate experimental models for elucidating a pathological role of free radicals in chronic pancreatitis have not been established. The research concerning the role of free radicals in chronic pancreatitis is expected to improve our understanding the pathological mechanisms 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 70 1999 The relationship between the magnetic resonance imaging of the lumbar spine and low back pain 67 72 EN Shingo Takata Eiichirou Yumoto Makoto Okamoto Hirofumi Tsugeno Seishi Harada Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki Mine Harada 10.18926/14936 The purpose of this study was to examine the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP). The study group, 19 patients with low back pain (2 subjects aged 32-39 years and 17 aged 59-78), underwent MRI of the lumbar spine. Disc degeneration at L4/5 was the most common finding (68.4%). Overall in present study, all patients with LBP had abnormalities around the lumbar spine (evidence of disc degeneration, deformity of lumbar spine, disc bulging or protrusion, facet hypertrophy, nerve root compression and so on). 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 Matrix metalloproteinases (MMPs) and pancreatic diseases 76 83 EN Motohiro Yokoyama Koji Ochi Takaaki Mizushima Mitsuko Ichimura Tetsuya Tsurumi Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14913 Matrix metalloproteinases (MMPs) is a family of collagenolytic enzymesand are associated with many pathological conditions. Especially, MMPs have a strong relation with tumor progression and invasion. In this review, we focused on association of MMPs and pancreatic diseases, and a potential treatment of MMPs inhibitors for pancreatic cancer. 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 播種性血管内凝固症候群（DIC）を合併した全身性エリテマトーデス（SLE）の1例 68 72 EN Singo Takata Makoto Okamoto Hirofumi Tsugeno Seishi Harada Yasuhiro Hosaki Takashi Mifune Fumihiro Mitsunobu Yoshiro Tanizaki Kenji Niiya Mine Harada 10.18926/14911 播種性血管内凝固症候群（DIC）を合併した全身性エリテマトーデス（SLE）を経験したので報告する。症例は73歳女性。64歳時慢性関節リウマチ（RA）と診断された。1999年1月食欲低下を訴え当科受診した。血小板減少、FDP高値、PT上昇等よりDIC発症を疑った。膠原病では凝固系の異常を認めるが、本症例では凝固系が完進しDICを来したと考えられた。 本症例はリウマチ因子陽性であったが、朝のこわばり等典型的なRAの所見に乏しく他の膠原病の合併を疑い、腎障害、血小板減少、抗Sm抗体、抗核抗体陽性よりSLEと診断した。 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 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 IgG4関連疾患 60 65 EN Kazuhisa Hiramatsu Motoi Asano Koki Matsushita Tomoko Miyoshi Sukio Nakamura Takaaki Mizushima Norio Koide Hitomi Kataoka Koji Ochi Fumihiro Mitsunobu 10.18926/14901 IgG4関連疾患は21世紀になって提唱された新しい疾患である｡組織学的にはIgG4陽性形質細胞やリンパ球浸潤が涙腺, 唾液腺, 後腹膜, 膵臓, 胆管などで起こり, 臨床的にはMikulicz病, 後腹膜線維症, 自己免疫膵炎, 糖尿病, 原発性硬化性胆管炎類似の胆管病変などを呈する全身性疾患であり, ステロイド治療に対する良好な反応性を認める｡その診断基準は確立されておらず, われわれは, �@血清IgG4の高値, �A本疾患に特徴的な臓器の障害(唾液腺,涙腺, 膵臓, 後腹膜), �B組織学的にIgG4陽性形質細胞とリンパ球の浸潤の確認, の３項目のうち２項目以上認めれば, IgG4関連疾患とするという診断基準を提言する｡ 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 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 吸気流量を考慮することにより吸入器具を変更できた一症例 49 52 EN Toshimitsu Konuma Yoichi Kawasaki Risa Katsube Hideki Nawa Fumihiro Mitsunobu 10.18926/14899 気管支喘息や慢性閉塞性肺疾患の治療において､適切に吸入薬を使用することが重要である｡本症例は60歳代女性で､労作時呼吸困難を訴え入院となった｡点滴による治療､内服薬服用と同時に吸入薬の使用開始となったが､呼吸機能検査値が低値であり､製薬企業供与の吸入チェック器具により吸入できていないことが判明した｡そこで､吸入薬を変更し吸入できていることを確認した｡吸気流量が十分得られない場合は積極的にチェック器具により確認を行い､アドヒアランスの改善に努めることが重要である｡ 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 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.

岡山医学会 Acta Medica Okayama 0030-1558 121 1 2009 慢性閉塞性肺疾患における呼吸リハビリテーションとしての温泉療法 9 15 EN Fumihiro Mitsunobu 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 気管支喘息患者におけるモンテルカストの有用性についての検討　−テオフイリンとモンテルカスト併用の影響を中心に− 51 56 EN Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14809 新規ロイコトリエン（LT）受容体桔抗薬であるモンテルカスト服用によるテオフイリン服用患者の処方動向，臨床検査値ならびに患者の服用に対する意識について検討を行った。 その結果，テオフイリン服用患者177名の内，51％がLT受容体抵抗薬を併用しており，併用率はモンテルカストが最も多く，プランルカスとザフィルルカストの順であった。また，プランルカストからモンテルカストに変更された症例が多かった。臨床検査値はモンテルカスト服用により血中好酸球数の減少作用が認められた。肝機能検査値（AST・ALT・ALP）は影響しなかった。テオフイリン服用量はモンテルカスト併用服用により減量され，それに伴い血中濃度も低下した。しかしながら，血中濃度／投与量比は影響しなかったことより，モンテルカストはテオフイリンクリアランスに影響しないと考えられる。モンテルカストヘの変更により，患者の服薬コンプライアンスは良好に維持され，自覚する副作用の発現は認められ なかった。以上の結果，テオフイリン服用患者へのモンテルカスト併用投与は良好な服薬コンプライアンスを維持させ，さらにテオフイリンの体内動態に影響を及ぼすことなく，テオフイリンの投与量を減少させ，患者のQOLの向上につながると考えられる。 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 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 呼吸器疾患症例における温泉療法の効果　-アンケートを利用して- 111 114 EN Fumihiro Mitsunobu Yoshiro Tanizaki 10.18926/14779 呼吸器疾患症例における温泉療法の効果(自覚症状,事物投与量など)早,有効と思われた温泉療法の種類,終了後の経過(1年後)などについて,気管支喘息102例を対象にアンケート調査を行った｡ その結果,温泉療法開始1週間で自覚症状が改善された症例が71.5%,副腎皮質ホルモンの減量が可能であった症例が65.6%,通院後1年間は,入院時に比べ症状が改善されている症例が61.8%,さらに,退院時より改善されている症例が53.9%であった｡ これらのことから,当院の温泉療法により症状が改善したことと,体調コントロールを身につけることにより,退院後1年以上経過しても,体調が良好に維持されてい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 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.