日本胸部疾患学会雑誌
Online ISSN : 1883-471X
Print ISSN : 0301-1542
ISSN-L : 0301-1542
21 巻, 5 号
選択された号の論文の12件中1~12を表示しています
  • 渡辺 昌平
    1983 年 21 巻 5 号 p. 403-412
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Based upon the analysis of lung cancer patients without any anticancer therapy, the present state and problems of the treatment for pulmonary carcinoma were studied. Clinical materials included the cases not only of our department but also from many other hospitals, with collection done by ourselves.
    From the results of analysis of the cases without treatment the survival was in proportion to the grade of clinical stage and performance status. With regard to the histological type the patients with epidermoid cancer survived for the longest period and the cases with small cell cancer the shortest. As for adenocarcinoma two groups can be seen, one was long survival and the other was rapid progression. The survival period is related to the grade of malignancy of adenocarcinoma. The median survival time of the no treatment group was less than six months. In the progression curve in stage to death, the slopes from stage I to III were gentle and those from III to death were steep. This can be expressed as the cascade of lung cancer progression.
    The five year survival rate of surgically resected cases was about 20%. The frequency of metastasis was 62% in the patients who underwent surgical resection for primary tumor and died within one month after the operation. This suggests that some adjuvant therapy should be added to the surgery. In our surgical department surgery and adjuvant chemotherapy for the patients with relative curative resection had positive effects on survival, but this was a historical study. The evaluation for adjuvant chemotherapy is not established because some randomized clinical trials had positive results while others had negative results. Recently surgery with adjuvant immunotherapy is being studied by a randomized controlled trial.
    Comparison between no treatment and non-surgical treatment groups was carried out using same background factors. Even if the patients were above seventy years old, in poor performance status and in advanced stage, the survival period of the non-surgical treatment group was lengthened. Although the survival period of the no treatment group with small cell cancer was shorter than the group with non-small cell cancer, when non-surgical treatment was given to small cell cancer patients, they survived as long as non-small cell cancer patients. Concerning small cell cancer the responders to therapy survived longer than non-responders. Recently there are many reports showing that chemotherapy of small cell cancer produces good results.
    There are many factors contributing to death of patients, for example pleural carcinomatosis, stenosis of large airway and pulmonary infection. It has become possible to manage malignant pleural effusion by tube drainage with intracavitary injection of immunoactivating drugs. The Nd-YAG Laser surgery is being tried for the improvement of large airway stenosis by intracanal tumor. The early detection and treatment for the respiratory tract infection of the cancer patients contribute to the survival.
    In conclusion, at present lung cancer treatment should be based on the concept of multidiciplinary therapy using combinations of the treatments mentioned above.
  • 寺松 孝, 本間 日臣
    1983 年 21 巻 5 号 p. 413-454
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
  • 武田 純三, 関口 弘昌, 長野 政雄
    1983 年 21 巻 5 号 p. 455-460
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Instantaneous pulmonary capillary blood flow in 14 patients was evaluated by a new device measuring direct intratracheal flow which measured the flow change due to the uptake of N20 by the pulmonary capillary blood by connecting a highly sensitive flow meter directly to the endotracheal tube, instead of using body plethysmograph technique. This method did not need specific training to stop respiration and maintain the glottis open. Instantaneous pulmonary capillary blood flow by this method was found to be bimodal and pulsatile, as described by previous reports.
    Indices of “pulsatility” which were Qcmax/Qc, 2.15±0.47, and Qcmax/SV, 212±55, indicated no differences between males and females Qcmax and SV were significantly larger in males than in females and Qc tended to be large in males. Because these two ratios were relative to each other but not to HR, Qc and SV, they were useful indices to estimate the pulsatility of pulmonary capillary blood flow. As this method is simple, it is considered to be a clinically useful technique with wide applications to estimate pulmonary capillary blood flow, particularly during anesthesia and respiratory care.
  • 石原 陽子, 北村 諭, 高久 史麿
    1983 年 21 巻 5 号 p. 461-465
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The use of diesel engines has increased greatly in recent years. Diesel engines provide the power for most large trucks, trains and construction and farm machinery. Due to the greater efficiency of fuel utilization of diesel powered vehicles, this trend will probably continue. Although many of the pollutants emitted by diesel engines have been studied, the toxicological effects of complete exhaust have not been elucidated yet.
    In the present investigation we tried to elucidate the acute effect of diesel-engine exhaust gas on pulmonary metabolic functions in rats. Rats were exposed to diesel-engine exhaust gas for 96-120 hours, and ED50 of acetylcholine in isolated tracheal strips, activation or inactivation of vasoactive substances through isolated perfused lung lobes and change of plasma levels of serotonin, histamine and thromboxane B2 (TXB2) were examined. Rats were classified into three groups, i.e. control group, filtered exhaust gas (F.E.G.) group and exhaust gas (E.G.) group.
    1) Fifty percent effective doses of acetylcholine in rat tracheal strips did not show any significant differences among these three groups.
    2) Percent inactivation of prostaglandin F (PGF) and PGE2 through isolated perfused lung lobes in E.G. and F.E.G. groups showed a significant decrease compared with that of control group.
    3) Percent inactivation of serotonin and activation of angiotensin I through isolated perfused lung lobes did not show any significant differences among these three groups.
    4) Plasma levels of serotonin, histamine and TxB2 did not show any significant differences among these three groups.
    The above results suggest that short term exposure to diesel-engine exhaust gas may affect pulmonary metabolic functions.
  • 大谷 理智子, 大河内 寿一, 東野 一彌, 岸本 進, 伊藤 文雄
    1983 年 21 巻 5 号 p. 466-473
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Some lung carcinoma tissues produce unusual alkaline phosphatases (APs), the Regan, Nagao and other on-codevelopmental isoenzymes which are usually absent in normal lung tissue. The aim of this study is to characterize these enzymes in lung carcinoma and to find any relation of the AP isoenzymes to cell types of lung carcinoma.
    The properties of AP isoenzymes of lung carcinoma tissue from 30 cases were examined in comparison to counterparts in 8 normal lungs, and normal liver and placenta.
    The specific activity of AP in the lung carcinoma tissue of case S.M., one of the 30 cases, was about 60 times as high as the average AP activity of the 8 normal lungs. The average specific activity of the remaining 29 cases of lung carcinoma was also significantly higher than that of normal lung AP. Among lung carcinoma, cases, the average specific activity of the adenocarcinoma group was higher than that of squamous cell carcinoma group. However exclusion of case S.M. from the adenocarcinoma group resulted in almost equal specific activity in the two groups. The specific activity of anaplastic carcinoma was the lowest.
    The AP of the case S.M. electrophoresed slightly faster than that of normal lung but slightly slower than liver AP. The AP from 29 carcinomatous tissues showed microheterogenous electrophoretic mobilities with broad bands, ranging from liver AP to bone AP to bone AP band. Treatment of enzyme preparation with neuraminidase made it clear that two out of 29 lung carcinomas had another faster migrating band, identified as Regan isoenzyme. The other 27 cases had an enzyme, “usual lung type AP”, which was indistinguishable in properties from counterparts of normal lung, normal liver, and early placenta. The isoenzyme of lung carcinoma from case S.M., also belonged to the usual lung type AP.
  • 骨折時のウサギ肺における骨髄および脂肪塞栓症特にその初期病変について
    山本 雅博, 坂田 一美, 井口 千春, 永原 貞郎
    1983 年 21 巻 5 号 p. 474-485
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Post-traumatic pulmonary microembolism comprises pulmonary bone marrow and fat embolism and seems to be a major cause of death in patients dying of traumatic bone fracture. The authors examined the morphological changes of 21 rabbit lungs produced 30 minutes to 48 hours after mechanical fracture and discussed the pathogenesis of the initial lesions.
    Thirty minutes after fracture, the embolized bone marrow and thrombi were found in the small arteries and arterioles, measuring 100μ to 500μ in diameter. Fat droplets were also demonstrated in the arteriole and capillary. At the same time, vacuolation of endothelial cells and smooth muscle cells, swelling of the media of small arteries as well as alteration of pneumocytes were observed. At 48 hours, there was a slight degeneration of the hematopoietic cells in the embolized bone marrow, invasion of fibroblastic cells into the thrombi and proliferation of modified smooth muscle cells in the arterial wall.
    As early as 30 minutes, “vascular leukostasis” namely sticking (or plugging) of leukocytes to the endothelium or in the lumen of small artery and capillary was observed. A large proportion of leukocytes were neutrophils and eosinophils. In addition, they gathered in the subendothelial portion of the arterial wall. Ten hours after fracture, the degree of vascular leukostasis reached a maximum and monocytes relatively increased in number. As a result of the endothelial injury of capillary due to the action of neutrophils, vascular leukostasis caused remarkable edema and lymphangiectasia in the perivascular connective tissue.
    From these observations, it seems probable that the complement-induced vascular leukostasis may be of etiologic importance in the pathogenesis of initial lesions of post-traumatic pulmonary microembolism and also in the progression of adult respiratory distress syndrome (ARDS).
  • ラットを用いた実験的研究
    北村 諭, 庄内 香代, 榊原 郁子, 石原 陽子, 高久 史麿, 原沢 道美
    1983 年 21 巻 5 号 p. 486-491
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Age-related fall of the motor function, reproductive function, psychomotor function and respiratory function of the lung are well known. However age-related changes of the metabolic function of the lung are not elucidated yet.
    We tried to elucidate the effect of aging on responsiveness of tracheal strips, on activation and inactivation (or uptake) of various vasoactive substances through isolated perfused lung and on change of plasma levels of thromboxane B2 and 6-keto PGF in male Wistar rats.
    1) The body weight and wet lung weight showed a rapid increase from 1 to 8 weeks, and thereafter the former showed a gradual increase, while the latter reached a plateau.
    2) The ED50 of acetylcholine in rat tracheal strips showed a rapid increase from 1 to 12 weeks, and thereafter it showed a gradual increase.
    3) Percent inactivation of serotonin through an isolated perfused rat lung showed an age-related increase reaching a plateau from 7 to 36 weeks. Thereafter it showed an age-related decrease.
    4) Percent inactivation of prostaglandin E2 through an isolated perfused rat lung showed an age-related increase, reaching a plateau from 7 to 36 weeks. Thereafter it showed an age-related decrease.
    5) Percent inactivation of prostaglandin F through an isolated perfused rat lung showed an age-related increase reaching a plateau from 7 to 24 weeks and showing a maximum value at 36 weeks, followed by an age-related decrease.
    6) Percent activation of angiotensin I through an isolated perfused rat lung showed a maximum value at 1 week. Thereafter it showed an age-related decrease and became stationary from 3 to 24 weeks, following which it again showed an age-related increase.
    7) Plasma levels of 6-keto PGF and thromboxane B2 did not show any age-related change.
    The above results suggest that the percent inactivation of serotonin, prostaglandin E2 and prostaglandin F and the percent activation of angiotensin I may show age-related changes.
  • 津谷 泰夫, 上西 豊基, 藤本 知久, 志波 邦夫, 高木 洋, 大石 光雄, 中島 重徳
    1983 年 21 巻 5 号 p. 492-499
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    The effects and site of action of a-adrenergic blocker (E-643) were studied in patients with bronchial asthma who hardly responded to β2-receptor stimulants and xanthines. Spirometry, air-or He-O2- flow volume curves, respiratory resistance, closing volume and arterial blood gas analysis were examined before and after oral administration of E-643 alone, inhalation of orciprenaline with premedication of E-643 and inhalation of PGF with premedication of E-643, respectively. In our studies, we found that 1) E-643 resulted in decrease of bronchoconstriction moderately but significantly. 2) E-643 increases the bronchodilator effect of orciprenaline. 3) E-643 inhabits the bronchoconstrictor effect of PGF 4) The bronchoditator effect of E-643 acts not only on large airways but peripheral airways.
    We concluded that α1-adrenergic blocker enhances the treatment of bronchial asthma, especially in patients who benifit little from β2-receptor stimulants and xanthines.
  • 鳥井 義夫, 山本 正彦, 杉浦 孝彦, 高田 勝利, 森下 宗彦, 市村 貴美子, 橋上 裕, 吉川 公章, 鈴木 雅之
    1983 年 21 巻 5 号 p. 500-506
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    Two cases of diffuse panbronchiolitis in a family were reported. They had chronic cough productive of a large amount of sputum for more than 10 years. Their clinical pictures, chest X-ray and bronchography demonstrated diffuse panbronchiolitis. Chronic nasal sinusitis was identified. Their tuberculin skin tests were negative and the titers of the cold hemagglutinin test were moderately elevated (X 256). Their serum complement levels (C3) were decreased.
    The first case was a 73-year old mother, who was also diagnosed as having chronic thyroiditis by thyroid scintigram. Her serum T4 level was only 1.6μg/dl, TSH 113.8μU/ml, anti-thyroid antibody 25600x and anti-microsome antibody 6400x.
    The second case was her 49-year old daughter, who was also diagnosed as having selective IgA deficiency. Her serum IgA was below 10mg/dl with increased serum levels of IgG and IgM. IgA were not detected in her saliva and sputum though secretory component was detected in saliva, 12μg/dl.
    Many other members of the family had chronic nasal sinusitis, chronic thyroiditis and rheumatoid arthritis, and had auto-antibosies and abnormal levels in serum immunogolbulins. These two cases suggest that immunologic deficiency might play an important role in the pathogenesis and the mechanisma of the progression of diffuse panbronchiolitis.
  • 澤田 雅光, 坂口 和成, 田中 信之, 仁井 昌彦, 高 光重, 荒木 良彦, 藤田 一誠
    1983 年 21 巻 5 号 p. 507-511
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 50-year-old obese male developed cor pulmonale secondary to repeated obstructive sleep apnea and accompanying marked oxygen desaturation. His ventilatory response to CO2 was depressed in sleep and sleep apnea continued until PaCO2 reached about 60 torr. Huge tonsils also played an important role in obstrucion of his upper airway in sleep apnea. Marked degrees of hypoxemia occurred transiently with each episode of apnea, with SaO2 values falling from 94 to 76%. Bradyarrhythmia (nodal rhythm) appeared and mean pulmonary arterial pressure rose progressively from 15 to 26mmHg with developement of hypoxemia. This pulmonary hypertension was suggested to be a main cause of cor pulmonale in this case.
  • 筒井 秀人, 青沼 和隆, 稲田 美穂恵, 三浦 博太郎, 金山 正明
    1983 年 21 巻 5 号 p. 512-515
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
    54歳男性. 嘔吐に続き動悸・左胸部圧迫感と呼吸困難が出現し来院した. 入院時, 胸部X線像で左水気胸を認め, ショック状態を呈しており, 発症後約19時間で死亡した. 剖検により食道下端から左胸腔に通じる小裂口を認め, Boerhaave 症候群と診断された.
  • 1983 年 21 巻 5 号 p. 516-523
    発行日: 1983/05/25
    公開日: 2010/02/23
    ジャーナル フリー
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