パラコート(PQ)の腸管収縮に対する影響を,モルモット摘出腸管標本を用いて検討した。PQ前処置は,アセチルコリン(ACh)による腸管収縮反応の発現を濃度依存性に抑制したが,ヒスタミン(Hist), KClによる収縮の発現には影響を与えなかった。また,あらかじめACh, Hist, KClによって収縮させた標本に対しPQを加えたところ,どの標本においても弛緩反応が観察された。さらに,PQはβ-escinによるスキンド標本において,細胞内カルシウム濃度を一定に保った条件下でも,いったん収縮した標本を弛緩させるうえ,GTPγS投与によるGタンパクの活性化を介したカルシウム感受性増加も抑制した。これらの結果から,PQは腸管平滑筋収縮抑制作用をもち,その機序には少なくとも,1) AChレセプターに対する阻害,2) 細胞内Ca²⁺レベルの低下,3) Ca²⁺利用以降の情報伝達系の阻害が関与していることが示唆された。

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破裂性腹部大動脈瘤では治療開始前に死亡する症例も多く,救命率の向上のためには手術例を対象とした検討では不十分である。そこで開設以来10年間に当センターに来院した破裂性腹部大動脈瘤例50例のうち,来院時心肺停止例(CPAOA) 9例(男7例,女2例,平均年齢は76歳)を中心に治療成績や問題点について検討した。全50例の死亡率は46%であったが,非shock例(17例)では6%, shock例(21例)では53%,他院での心肺蘇生後症例(3例)では67%, CPAOA例(9例)では89%であった。CPAOA例は病院からの搬送例7例,救急隊からの直接搬送2例で,すべて救急車内での心肺停止であった。心拍再開は8例(89%),蘇生(入院)は7例(67%)であった。手術は5例に行い,術中死亡は2例,人工血管置換術を施行しえたのは3例であった。このうち1例は術後脳死となったが,2例では術後に意識が回復し,このうち1例は多臓器不全で死亡したが,1例(11%)が完全社会復帰した。CPAOA例における既往歴は高血圧が5例,高脂血症,狭心症,心筋梗塞,胃潰瘍,糖尿病が各1例で,腹部大動脈瘤をすでに指摘されていた症例が3例あった。病院からの搬送7例で前医での初期診断は原因不明の腹痛3例,尿管結石2例,急性腹症として開腹術を受けたもの1例で,破裂性腹部大動脈瘤と的確に診断されたものは1例のみであった。CPAOA例では初期診断が的確でない症例が多く,deep shockや腹部膨満が著明となって初めて診断がなされていた。初期診断の遅れが心肺停止を招き,発症から心肺停止までの時間は30分から3日,平均12.8時間であった。破裂性腹部大動脈瘤の治療成績向上のためには第一線の医療機関での迅速かつ的確な初期診断が重要であり,そのためには腹痛,shock,拍動性腹部腫瘤の3徴や既往歴の聴取が重要である。

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Acute occlusion of the descending thoracic aorta causes many clinical problems, although it is rare. A 59-year-old man had sudden onset of coldness in his legs. On a CT scan, a thoracic aortic aneurysm with a mural thrombus was detected. After 4 hours, pulsations in the lower extremities reappeared. However, he died three days after onset. In the pathological findings, all visceral organs were necrosed. The second patient, a 74-year-old woman, had sudden onset of back pain. Both femoral pulses were impalpable. On a CT scan, a dissecting aortic aneurysm (DeBakey I type) was detected. After 4 hours, a right axillo-bifemoral bypass was performed. However, she died on the 8th postoperative day. In the pathological findings, all visceral organs were necrosed. When we detect an acute occlusion of the descending thoracic aorta, some immediately examinations for ischemic injury of visceral organs are very important for diagnosis and treatment.

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We report a case of severe airway sequelae following inhalation injury. A 52 years old male was transferred to our hospital because of severe inhalation injury. Acute respiratory failure was treated by frequent tracheobronchial lavage using bronchofiberscope (BFS) under Pressure Support Ventilation with PEEP and superimposed high frequency jet ventilation. Severe tracheal stenosis and endobronchial multiple granuloma (polyposis) developed after one month. Life-threatening tracheal stenosis was treated by Nd-YAG Laser coagulation, and a silicone stent was inserted against recurrent stenosis up to the 693rd day. Endobronchial multiple granuloma subsided spontaneously following cicatrizational stenosis. After about one year from his admission, an ectatic change gradually developed in the peripheral bronchus and pulmonary fibrosis. The etiology of these airway sequelae were considered to be related to the destroyed basal membrane of the airways, and to the prolonged accompanying inflammation. The frequency of the sequelaelike cicatrizaional stenosis, inflammatory granuloma, peripheral bronchoectasia, pulmonary fibrosis will increase, as treatment in the acute phase improves. In cases of severe inhalation injury, it is important to investigate airway sequelae over a long follow-up period, and BFS is the most valuable means not only for treatment but also for investigation.

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On 15th June 1995, an accidental explosion in a chemical plant in Aizu where benzyl chloroformate was synthesized from phosgen and benzyl alcohol killed one man and injured 35 others. The plant was destroyed, and benzyl chloroformate designated sprayed out of it. The dead man was designated DNR (do not resuscitate), because of the blast injury. In two men the chemical compound poured all over the body and they were diagnosed as having respiratory distress and chemical burns. Another mildly affected patient suffered from mucosal membrane irritative symptoms. From this experience, it was realized that gas masks are necessary as an immediate response, so 10 masks were provided. And we mailed a questionnaire on chemical compounds used by the chemical plants around the area. Very few traumatic centers have paid attention to the possibility of having to cope with such a crisis.

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