日本胸部疾患学会雑誌
Online ISSN : 1883-471X
Print ISSN : 0301-1542
ISSN-L : 0301-1542
20 巻, 5 号
選択された号の論文の19件中1~19を表示しています
  • 今野 淳
    1982 年 20 巻 5 号 p. 499-500
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
  • 中俣 正美, 五十嵐 英夫, 斉藤 元, 来生 哲, 長井 靖仁, 近藤 有好, 荒川 正昭, 平沢 由平
    1982 年 20 巻 5 号 p. 501-507
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Pulmonary function tests such as spirogram, lung volumes, DLco (S. B.), closing volume, V-V curve, He-O2 V-V curve and respiratory impedance were performed before and after hemodialysis in 14 patients receiving chronic hemodialysis. Blood gas analyses, measurements of VE (BTPS), Vo2 (STPD), Vco2 (STPD) and R (respiratory quotient), and blood cell counts were also studied in 15 patients undergoing hemodialysis.
    The patients consisted of 7 males and 8 females, aged from 22 to 58 years. They were all well controlled and did not show respiratory or cardiovascular signs. Hemodialysis was maintained for 5 hours, 3 times per week with a coil dialyser using a cuprophane membrane. Acetate buffer was available for dialysate.
    The results were as follows:
    1) Before hemodialysis, restrictive impairment was observed in only one patient whereas abnormalities in airway function were shown in FEV1(2 patients), CV% (2), CC% (6), ΔN2 (2), V50 (3), V25 (3) and Visov, (6) respectively.
    2) After hemodialysis, VC, TLC, RV and FRC were unchanged. On the other hand, FEV1, CC%, V25, V50/V25, Visov and FRC-CC improved significantly. It was thought to be due to removal of edema surrounding small airways by hemodialysis.
    3) In 10 out of 14 patients, DLco and DLco/VA were decreased before hemodialysis. They showed low values even after hemodialysis. Low hemoglobin concentration may be one of the causes of decreased DLco, but other factors might be considered.
    4) Pao2 decreased during hemodialysis. The changes in Pao2 and VE correlated significantly. This suggested that hypoventilation was one of the causes of the Pao2 drop during hemodialysis. However A-aDo2 decreased in the early stage of hemodialysis and worsened later. Furthermore, some patients showed low Pao2 after hemodialysis in spite of improvement in small airway function. Improvement in small airway function and disturbance in pulmonary blood flow, such as low cardiac output, pulmonary microembolism and/or leucostasis may cause worsening of VE/Q ratio unevenness. This factor was considered another cause of decreased Pao2 resulting from hemodialysis.
  • 原 洋
    1982 年 20 巻 5 号 p. 508-516
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The aim of this study is to analyze pleural fluid turnover with changes of blood flow distribution in the tissues surrounding the pleural space with noradrenaline instillation into the space. Experimental animals were divided into four groups; namely, (1) normal dogs with artificial pleural fluid (normal group, 5 dogs), (2) normal dogs with artificial pleural fluid containing 4mg of noradrenaline (NAd group, 6 dogs), (3) dogs with tetracycline-induced pleuritis with artificial pleural fluid (Tc-Pl group, 4 dogs) and (4) dogs with tetracycline-induced pleuritis with artificial pleural fluid containing 4mg of noradrenaline (Tc-Pl+NAd group, 4 dogs). Artificial pleural fluid consisted of 250ml of saline containing indocyanine green (ICG) 1mg/dl and para-amino hippurate (PAH) 20mg/dl as markers. The experiment started with instillation of artificial pleural fluid under air-tight conditions into the left pleural space. In the case of the pleuritis group, the artificial pleural fluid was instilled into the space 3 hours after injection of tetracycline into the left pleural space, completely evacuating inflammatory exudate due to pleuritis. The concentrations of respective markers were measured at regular interval and PAH clearance, lymphatic flow and extralymphatic flow were calculated.
    In the normal group, the concentration of PAH decreased rapidly with a half-life of 154.0±8.0 (S. E.) min, while the concentration of ICG remained unchanged. The PAH clearance of this group was 5.27±0.18ml/hr/kg, the extralymphatic flow was 0.02±0.15ml/hr/kg and the lymphatic flow was 2.03±0.28ml/hr/kg.
    In the Tc-Pl group, PAH clearance was double that of the normal group, the extralymphatic flow was 1.30±0.22ml/hr/kg and the lymphatic flow was 1.96±0.16ml/hr/kg. In the Tc-Pl+NAd group, the dynamics of pleural fluid were almost same as in the normal group.
    In the NAd group, PAH clearance and lymphatic flow decreased to half that of the normal group. Extralymphatic flow was 0.09±0.05ml/hr/kg.
    These results suggest that vascular constriction in surrounding tissues of the pleural space suppresses the turnover rate of pleural fluid, and supports our thesis that the contact surface around pleural fluid affects pleural fluid turnover anatomically and physiologically.
  • 許 榮宏, 和泉 孝志, 北村 諭, 小坂 樹徳
    1982 年 20 巻 5 号 p. 517-524
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The effect of histamine, acetylcholine, serotonin and prostaglandin F on the tracheobronchial tree, pulmonary circulation and systemic circulation before and after ligation of bronchial arteries was studied to examine the mechanism and site of action of these vasoactive substances in anesthetized dogs.
    The left hemithorax was opened under artificial ventilation, bronchial arteries with their parent intercostal arteries were carefully dissected. Drugs were injected through catheters inserted into the right and left ventricle, respectively. The same injection was repeated after ligation of bronchial arteries. The data of intratracheal pressure (Ptr), pulmonary artery pressure (Ppa) and systemic arterial blood pressure (Psyst) before and after ligation of bronchial arteries were compared by Student's paired-t test.
    1) The percent increase of Ptr after left ventricular injection of acetylcholine (200μg), serotonin (200μg) and prostaglandin F (100μg), except histamine (200μg), was significantly attenuated by ligation of bronchial arteries.
    2) The percent increase of Ptr after right ventricular injection of serotonin and prostaglandin F, except acetylcholine and histamine, was attenuated significantly by ligation of bronchial arteries.
    3) The influence of bronchial arteries ligation on increase of PPA was observed following histamine injection only.
    4) Ligation of bronchial arteries has no influence on the change of Psyst induced by these vasoactive substances.
    The above results may suggest that acetylcholine, serotonin and prostaglandin F act on relatively proximal portions of the airway, while histamine acts on relatively peripheral airway portions.
  • 堀尾 直, 安藤 正幸, 杉本 峯晴, 徳臣 晴比古
    1982 年 20 巻 5 号 p. 525-530
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The relationship between the morphology and the function of alveolar macrophages (AM) in healthy rabbit lungs and pulmonary macrophages (PM) in rabbit lungs with inflammation was studied. The effects of alveolar lining materials obtained from these lungs on the morphology and the function of these cells were also studied.
    The BCG-induced granulomatous rabbit lungs were used as a model of the inflammed lungs. A granulomatous response in the lungs was produced in BCG-vaccinated rabbits by intravenous injection of heat-killed BCG. Five days after a granulomatous response, pulmonary macrophages (PM) and lung lavage fluids (immune PW) were harvested from the lungs by bronchial lavage with sterile physiological saline solution.
    The normal alveolar macrophages (AM), lung lavage fluids (normal PW) and homologous serum were harvested from normal rabbits as well as those in which a granulomatous response was obtained.
    1) The normal AM exposed to normal PW showed activated surface morphology such as microvilli, filopodia, and lamellipodia and functionally enhanced NBT reduction.
    2) The normal AM exposed to immune PW or homologous serum exhibited veil-like membranous folds and wave-like lamellipodia morphologically. These macrophages reduced more NBT than the normal AM exposed to normal PW functionally.
    3) The pulmonary macrophages (PM) are not exactly comparable to the AM exposed to immune PW or homologous serum, because these PM from the BCG-induced granulomatous lungs are different from the AM from the normal lungs in cell population and in degree of activation. Nonetheless, such PM exhibited veil-like membranous folds and wave-like lamellipodia similar to those of the AM exposed to homologous serum.
    4) The PM exposed to immune PW or homologous serum reduced more NBT than those exposed to saline or normal PW functionally.
    From the results presented here, we may conclude that alveolar lining materials and exuded serum play an important role to the activation of the AM in the healthy lungs and the PM in the inflammed lungs, and that there is a strong relationship between the morphology and the function of the AM and the PM.
  • 吉川 隆志, 山本 宏司, 西村 正治, 浅沼 義英, 川上 義和, 村尾 誠
    1982 年 20 巻 5 号 p. 531-539
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    We developed an automated system which measures responses to hypoxia and hypercapnia both in terms of ventilation and P0.1, and timing components of ventilation in terms of the rate of inspiratory to total respiratory cycle duration (Ti/Ttot). The system is composed of a dual control system of arterial blood gases (Pao2, Paco2), a system that measures ventilation, P0.1, Ti and Te, and a microcomputer.
    The system was applied in 13 normal subjects (mean age=35.9 years) and 8 patients with chronic pulmonary emphysema (mean age=67.9 years).
    1. In both groups, there were no significant differences of ventilatory and P0.1 responses to hypoxia. Patients had significantly lower ventilatory responses to hypercapnia than normal subjects (0.001<P<0.01), but P0.1 responses were the same.
    2. When the hypoxic stimulus was chemically denervated, patients showed significantly greater VE and P0.1 and lower Ti/Ttot than normal subjects (VE, P0.1, Ti/Ttot: 0.02<P<0.05). Hypoxia led to a significant increase of P0.1 and f (P0.1:0.001<P<0.01, f:0.02<P<0.05), but VE and VT were not altered. Hypercapnia evoked different changes in the respiratory cycle: VE and VT increased significantly (VE:0.02<P<0.05, VT:0.01<P<0.02) and f was unchanged.
    3. In normal subjects, hyperventilation during hypoxia induced a decrease in the ratio of P0.1 to VT/Ti, probably reflecting effective impedance of the respiratory system, but remained unchanged in patients.
  • とくに肺血管内静水圧の影響について
    原 信之, 古川 次男, 吉田 猛朗, 井口 潔
    1982 年 20 巻 5 号 p. 540-546
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    In 5 anesthetized dogs, we measured lung lymph flow and lymph and plasma protein concentrations during a steady-state elevation of pulmonary microvascular pressure (Pmv). Lung water content was also measured at the end of experiments. Lung lymph flow increased and lymph protein concentration decreased approximately linearly whenever pulmonary vascular pressure rose. The increase in lymph protein flow was small, indicating no or little increase of protein permeability in pulmonary vascular endothelial membrane. The difference in plasma to lymph protein osmotic pressure increased as Pmv increased.
    This induced a negative feedback inhibition of Pmv by plasma protein osmotic pressure and reduced transvascular fluid filtration in the lung. Lung water content, measured post-mortem, did not increase until a Pmv of more than 30cm H2O, indicating a strong safety factor that protects the lung against fluid accumulation.
  • 森 成元, 関根 球一郎, 吉岡 一郎, 田中 元一
    1982 年 20 巻 5 号 p. 547-552
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    High speed cinebronchographic studies were performed on ten patients complaining of cough. Five patients showed no or mild abnormalities on their bronchograms and others suffered from chronic obstructive lung diseases. Motion pictures were taken at a speed of a hundred frames per second. A frame-by-frame measurement was made of the transverse diameter of airways during three voluntary coughs in each patient, and the average value of the three was taken as his value.
    Airway narrowing of trachea and large bronchi during coughing occurred extremely rapidly, usually in less than thirty milliseconds. This rapid narrowing tendency of large airways did not depend on the severity of disease. Maximum reduction in the diameter of trachea and main bronchus was 33.7±4.8% and 28.6±7.1%, respectively. Changes in the main bronchus and segmental bronchi during cough were parallel (r=0.73), while the relation between changes of main bronchus and those of subsegmental bronchi was more variable (r=0.47).
  • 大崎 饒, 阿部 庄作, 木村 清延, 常田 育宏, 三上 洋, 村尾 誠
    1982 年 20 巻 5 号 p. 553-559
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    A tram-line shadow located immediately anterior to the tumor shadow in the right lower lung field was observed in a patient with adenocarcinoma of the lung. The extripated lung specimen revealed that the right lower bronchus was compressed anteriorly by tumor formation and there was no thickening of the bronchial wall. Superimposition effect of water dense materials, on the one hand by tumor shadow, and the other hand by bronchial wall, was considered to explain the mechanism of the appearance of the tram-line shadow.
    This reasoning was tested by a model experiment using ham and straws. Frequency of tram-line shadows was tested in cases with non-diffuse lung diseases in which the right lower lung field was free of pathological changes. In 100 such cases, tram-line shadows in the right lower lung field were observed in 31 cases and most of the shadow was made by superimposition of the bronchus upon pulmonary vascular shadows.
    These findings clearly show that tram-line shadows observed in the lung field doe not necessarily indicate abnormal conditions, such as bronchial wall thickening mentioned heretofore, but can reveal radiographic findings observed in normal condition due to superimposition of water dense materials, namely the bronchial wall and pulmonary vasculature.
  • 工藤 英俊, 桑原 博一, 鷲崎 誠, 稲冨 恵子, 本間 日臣, 望月 博之
    1982 年 20 巻 5 号 p. 560-564
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Eleven cases with idiopathic benign bronchial ulcer or erosion studied by the fiberoptic bronchoscope were reported. The patients consisted of ten males and one female of ages ranging from 21 to 68 year old, the majority being men in their thirties. These lesions were located in the main bronchus and/or in the segmental bronchi and more commonly in the right bronchi. Over half the cases had several lesions and the rest had a solitary lesion. These lesions of unknown etiology are considered to be of benign nature, because all seven patients followed up have been doing well without recurrence or any severe complication.
  • α, β受容体遮断剤投与の影響について
    和泉 孝志, 北村 諭, 小坂 樹徳
    1982 年 20 巻 5 号 p. 565-569
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The lung is one of the organs that possess abundant β-adrenergic receptors. Direct radiologic binding methods for studying β-adrenergic receptors have been developed recently. These methods can provide new insights into the molecular characteristics and regulatory properties of β-adrenergic receptors in the lung.
    Recently, α-adrenergic receptor blockers have been used for the therapy of brochial asthma and some good theraeputic effects have been reported. However the mechanisms have not been elucidated yet.
    β-adrenergic receptor blockers are widely used for patients with hypertension or ischemic heart diseases, and sometimes the use of β-adrenergic receptor blockers elicits asthmatic attacks in patients with bronchial asthma. But actually the incidence of such attacks is not so high as could be expected.
    In the present investigation we determined the number of β-adrenergic receptors in the lung membrane of guinea-pigs, weighing 150-280g. by direct methods using [3H]-(-)-dihydroalprenolol ([3H]-DHA). Effects of phentolamine and propranolol on the β-adrenergic receptors in the lung were also investigated.
    1) The mean values and standard deviation of the number of β-adrenergic receptors (the concentration of [3H]-DHA binding sites) and the dissociation constant (Kd) were 789±121f mol/mg protein and 1.14±0.22nM, respectively (n=10).
    2) The treatment of guinea-pigs with phentolamine (1mg/kg, subcutaneously, for 6 days) induced a significant increase in the number of lung β-adrenergic receptors, 971±149fmol/mg protein (n=8, p<0.02), while Kd did not show any significant change. This increase in the number of lung β-adrenergic receptors might be one of the mechanisms of α- adrenergic receptor blockers in bronchial asthma.
    3) The treatment of guinea-pigs with propranolol (1mg/kg, subcutaneously, for 6 days) induced a significant increase in the number of lung β-adrenergic receptors, 931±141fmol/mg protein (n=8, p<0.05), while Kd did not show any significant change. This increase in the number of lung β-adrenergic receptors might be one of the reasons why the incidence of asthmatic attacks is not so high in spite of the widespread use of β-adrenergic receptor blockers.
  • 泉孝 英, 藤村 直樹, 長井 苑子
    1982 年 20 巻 5 号 p. 570-576
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Sarcoidosis patients were divided into three groups by serum level of ACE and LZM, respectively. The relationship between serum levels of ACE and LZM and the clinical course of sarcoidosis were investigated and the following results were obtained.
    1. The levels of ACE and LZM are not indicators of spontaneous reduction speed as judged by chest X-ray changes. Levels of ACE and LZM were determined in 47 untreated patients divided into three groups. At three, six, twelve, eighteen, and twenty-four months following ACE and LZM determination, X-rays were taken and changes were observed. Groups were compared by spontaneous reduction and disappearance of X-ray shadow. No relationship was observed between serum levels and spontaneous reduction.
    2. Sarcoidosis patients with elevated levels of ACE and LZM showed a high response to steroid treatment.
    Steroid treatment was performed in 26 patients who had been categorized into three groups according to levels of ACE and LZM. Prednisolone in doses of 60mg was administered on alternate days for three months and patient response to steroids was evaluated by observation of changes in X-ray findings. Patients with highly elevated levels of ACE and LZM showed high or medium response and most patients with normal levels showed low or no response to steroid.
  • 和穎 房代, 木下 美登里, 白木 るい子, 渡辺 晴雄, 北村 諭
    1982 年 20 巻 5 号 p. 577-580
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 75-year-old man complained of cough, worsening for one year, and loss of appetite on admission on Oct. 3, 1980.
    Chest X-ray film showed a right hilar mass and multiple small cavities in both lungs. Chest tomograms revealed 17 nodular lesions and 22 cavitary lesions in both lungs. He succumbed about 2 months after admission.
    Autopsy revealed multiple lesions with cavities in both lungs metastatic from primary squamous cell lung cancer.
  • レシャード カレッド, 水野 浩, 竹内 吉喜, 池 修, 藤尾 彰, 北野 司久, 種田 和清, 市島 国雄, 小橋 陽一郎, 西和 田誠
    1982 年 20 巻 5 号 p. 581-585
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    An abnormal shadow superimposed on the aorta was pointed out on the chest X-ray of an asymptomatic. His blood pressure and serological examinations were within normal range on admission to our hospital.
    Urine VMA and catecholamine reactions were positive. As the result of CT scan, aortography, serological and urine examinations, an intrathoracic pheochromocytoma was suspected before surgery.
    At thoracotomy a brownish, 4×3cm mass was recognized at the paravertebral area, related to the 5th intercostal nerve.
    A hypertensive attack was evoked during decollement of the tumor.
    Histological examination of the surgical specimen showed that it was a pheochromocytoma, and neurogenic secretory granules were found on electron microscopic examinations of the specimen. Postoperatively, urine VMA and catecholamine reduced to a normal range, and the patient is still asymptomatic, with a normal blood pressure.
  • 礒田 幸太郎, 傍島 徹, 安田 正幸, 濱本 祐二
    1982 年 20 巻 5 号 p. 586-589
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 43-year-old male patient with esophageal cancer was given preoperative treatment with irradiation and bleomycin. Soon after the esophageal resection, the patient showed hypercalcemia and developed progressive fatal respiratory failure.
    Autopsy revealed bleomycin-induced pneumonitis with severe exudation and hyaline membranous deposition of calcium in the alveoli. Calcium deposits were also found in the kidney and gastric membrane. Therefore, it was suggested that the mechanism of alveolar calcification in the present case was due to dystrophic as well as metastatic calcification.
  • 富岡 元明, 佐藤 茂, 菊地 亮, 前田 真作, 青木 徹, 永岡 百合子, 志村 早苗, 滝島 任
    1982 年 20 巻 5 号 p. 590-596
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Three female patients (M. O. age 60; N. S. age 46; K. H. age 57) with rheumatoid arthritis developed dry cough and shortness of breath, associated with pulmonary infiltration during gold therapy (Sodium thiomalate). One patient (K. H.) also developed skin rashes. The absolute white blood cell count in all three patients was within normal limits but M. O. had mild eosinophilia. No pathogens were evident in smear or culture of sputum in all three patients. The radiological appearances of the chest were similar in all three patients with bilateral coarse linear and reticular shadows predominant in middle to upper lung fields. As the possibility of gold-induced pneumonitis was considered highly probable, gold therapy was discontinued. The total dose of gold received before the development of the respiratory symptoms was 560, 605 and 200mg respectively. A transbronchial lung biopsy in M. O. showed typical interstitial pneumonia and electron microscopic examination did not disclose gold particles in the lung tissue. Pulmonary function tests showed changes consistent with restrictive lung disease. When the pulmonary function data of the three patients above was compared with that of 14 patients with cryptogenic fibrosing alveolitis, they were similar except for the fact that the maximum inspiratory esophageal pressure was less negative and the permeability, DLCO/VA, was normal in the three patients. Two to five months after the discontinuation of the gold therapy and steroid treatment, respiratory symptoms subsided but there was little change in radiological findings.
  • 檀原 高, 松岡 緑郎, 貫和 敏博, 名取 博, 荒井 達夫, 吉良 枝郎
    1982 年 20 巻 5 号 p. 597-603
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 60 year-old man and his two daughters, aged 29 and 26, were hospitalized due to dyspnea and productive cough which had been observed for several years. The diffuse disseminated small nodular shadows on chest X-ray film, obstructive disturbance in pulmonary function studies, hypoxemic respiratory failure and chronic sinusitis observed in these patients were clinically compatible with signs of diffuse panbronchiolitis. Diagnosis was confirmed histologically in the father and his elder daughter by transbronchial lung biopsy (TBLB). They live in small rural town with no special environmental or occupational hazard. These cases may be of some significance in relation to genetical or hereditary analyses of etiological factors of diffuse panbronchiolitis.
    Additionally, abnormally high titers of cold agglutinin (more than ×1024) were observed in all these cases. Based on these results, we carried out a retrospective survey for this agglutinin in various lung diseases. While is true that patients of this disease frequently showed abnormally high cold agglutinin test titers is not specific for diffuse panbronchiolitis.
  • 三上 洋, 鈴木 潤一, 木村 清延, 阿部 庄作, 大崎 饒, 村尾 誠, 中村 恭二
    1982 年 20 巻 5 号 p. 605-609
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    43才, 女性, 主婦. 胸部異常陰影精査のため入院. 右S4に円形の孤立性陰影を認め, 確定診断のため右中葉切除術を施行. 組織学的検索により, 軟骨組織のみからなる良性腫瘍で, 過誤腫の性格を有しないことから, きわめて稀な気管支軟骨腫と診断した.
  • 1982 年 20 巻 5 号 p. 610-617
    発行日: 1982/05/25
    公開日: 2010/02/23
    ジャーナル フリー
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