日本胸部疾患学会雑誌
Online ISSN : 1883-471X
Print ISSN : 0301-1542
ISSN-L : 0301-1542
21 巻, 8 号
選択された号の論文の13件中1~13を表示しています
  • 中森 祥隆, 中谷 龍王, 蝶名林 直彦, 立花 昭夫, 中田 紘一郎, 岡野 弘, 谷本 普一
    1983 年 21 巻 8 号 p. 693-698
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    Antibiotic therapy of respiratory infections in diffuse panbronchiolitis was evaluated. Our study consisted of 126 infections in 64 patients (mean age 54.9 years old, 39 males and 25 females). The causative organisms in the respiratory infections were as follows: 1) Haemophilus influenzae (H), 33 cases (26%) (group I), 2) mixed infections of Pseudomonas aeruginosa (P) and either H or Streptococcus pneumoniae (S); 10 cases (8%) (group II), 3) P without prior antibiotic therapy; 22cases (18%) (group III), 4) P with prior antibiotic therapy; 61 cases (48%) (group IV).
    Efficacy of antibiotic therapy was noted in 98% of group I, 90% of group II, 59.4% of group III and 49.2% of group IV.
    Average FEV1% or %VC prior to the development of the respiratoty infections were 56.7% or 87.9% in group I, 48.4% or 72.4% in group II, 51.9% or 79.7% in group III, 45.4% or 72.1% in group IV, respectively. Our study indicates that when P. Infections do not respond to antibiotic therapy, the possibility of mixed infections of P and either H or S should be considered, because the respiratory infections may improve considerable with the treatment of H or S.
  • 岩本 恵子, 郷力 和明, 河野 修興, 生田 隆穂, 頼岡 徳在, 稲水 惇, 大成 浄志, 山木戸 道郎, 西本 幸男, 妹尾 紀具, ...
    1983 年 21 巻 8 号 p. 699-708
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    More than several hundred cases of Kartagener's syndrome (situs inversus, bronchiectasis and sinusitis) have been reported since Kartagener's original report. Although congenital genetical factors were emphasized in the development of the disease, no clear explanation on its pathogenesis has been made.
    We were able to examine two siblings with this triad. Their parents were half-cousins and some family members suffer from sinusitis or chronic obstructive lung disease. Genetic and biochemical studies were performed on the patients, their parents and seven other relatives.
    HLA typing, chromosomal analysis, measurement of activities of red blood cell enzymes and serum protein levels including immunoglobulins, determination of the phenotypes of red blood cell enzymes and serum proteins by electrophoresis were performed.
    Serum IgA levels were within normal limits and phenotyping of α1-antitrypsin showed M1M1 in all eleven subjects studied. Analysis of sweat electrolytes of the patients were abnormal and revealed marked elevation of both sodium and chloride. We must rule out complication of cystic fibrosis in our cases, and both of them had no evidence of pancreatic disorders.
    However there are many cases of cystic fibrosis showing no pancreatic insufficiency, and on the other hand, chronic sinusitis and nasal polyps are ofter seen in patient with cystic fibrosis. In addition, several cases were reported suffering from both Kartagener's syndrome and cystic fibrosis.
    Our results suggest the possibility that the pathogenesis of both diseases may involve a common mechanism.
  • 藤井 英樹, 仲田 裕行, 宮武 博明, 加堂 哲治, 福崎 恒
    1983 年 21 巻 8 号 p. 709-716
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    Ten patients with chronic obstructive lung disease, five patients with restrictive lung disease and five normal healthy volunteers were studied to assess the kinetics of oxygen consumption (VO2) at the start of mild exercise by a treadmill.
    The VO2 during the steady state period showed no significant differences, but the continuous time of the initial period was longer and the amount of increase in VO2 per second (ΔVO2) was smaller in patients than in normal healthy subjects. The continuous time of the initial period was longer and ΔVO2 was smaller in patients whose arterial oxygen tension (PaO2) decreased during exercise than those with almost no change in PaO2 during exercise. Moreover, ΔVO2 at the start of exercise was smaller in patients whose %VC was less than 80% and FEV1.0% was less than 70%.
    Regarding the cause of the VO2 kinetics at the start of exercise, it seems possible that the cardiorespiratory response at the start of exercise is slower in patients with impaired pulmonary function than in normal healthy subjects and patients with normal pulmonary function.
    In conclusion, these findings suggest that the studies of the initial period of the exercise load test are useful in assessing the severity and the work capacity in patients with chronic lung disease.
  • 白日 高歩, 松葉 健一, 栗田 幸男, 重松 信昭
    1983 年 21 巻 8 号 p. 717-721
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    Oncocytes of bronchial secretory glands were investigated in 50 operated cases with pulmonary diseases. In 28 cases (56%) oncocytes were found in the main bronchial wall or lobar bronchial wall. They were observed more commonly with increasing age.
    On light microscopy oncocytic glands were divided into 3 types, i.e. type I gland full of oncocytes, type III gland with few oncocytes and type II which showed intermediate amounts of oncocytes.
    Ultrastructurally we found normal oncocytes which were fully packed with hyperplastic mitochondrias and incomplete oncocytes, derived from serous gland cell, in which the cytoplsm was filled with a large amount of mitochondrias.
  • 神島 薫
    1983 年 21 巻 8 号 p. 722-729
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    It has been reported that nonsmoking monozygotic twins have fairly similar bronchial mucociliary clearance. It is not clear, however, whether this similarity is affected by smoking. The author attempted to ascertain the genetic contribution to variation of smoking effect on bronchial mucociliary clearance and to demonstrate the regional difference of smoking effect within the lungs.
    Forty-five healthy persons and 24 pairs of monozygotic twins were studied. Albumin aerosols (MMAD 4.2μ) labelled with 99mTc (20mCi/2ml) were inhaled during rapid, shallow breathing (panting) with tidal volumes of approximately 100ml to enhance bronchial deposition. Clearance of deposited aerosols was quantified as a function of time (1.5 hours) using a gamma camera and computer system. The results were analyzed both for the whole right lung and for 3 concentric areas representing central, mid, and peripheral regions of the right lung.
    Analysis of the intra-pair variances for total and peripheral clearance showed that the discordant smoking twins of 6 pairs differed from the concordant nonsmokers (5 pairs) and the concordant smokers (8 pairs), and that the intra-pair variances of the concordant nonsmokers and concordant smokers did not differ. In non-concordant smoking twins, smokers had a significantly faster clearance for the total lung and the peripheral region than the co-twin nonsmokers (p<0.01). Seven male heavy smokers (Brinkman index 664±176) had a significantly lower clearance in the central region than 8 male nonsmokers (p<0.05), while smokers had a significantly faster clearance in the peripheral region than nonsmokers (p<0.02). The ratios of activity within lung regions of the smokers and nonsmokers were compared using the linitial gamma camera image. There was no significant difference in indices of deposition pattern.
    These results suggest that genetic factors play some roles in determining bronchial susceptibility to cigarette smoke with regard to bronchial mucociliary clearance and that smoking per se or factor (s) associated with smoking habits decelerates central mucociliary clearance while peripheral clearance is accelerated.
  • 細川 芳文, 松浦 真理子, 長尾 光修, 堀江 孝至
    1983 年 21 巻 8 号 p. 730-737
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    Several factors affecting the volume of trapped gas (VTG) were examined in excised rat lungs. After degassing, five successive cycles were made at 30°C in plethysmograph between pre-set inflation and deflation pressure limits at a controlled flow rate (V). The transpulmonary pressure and lung volume were recorded directly on an X-Y plotter. When V varied between 1ml/min to 243ml/min, VTG was found to be most dependent on the inflow rate, especially at V below 9ml/min. However, VTG also depends critically on low end-expiratory pressure (EEP). Minimum trapping occurs when EEP is greater than 4cmH2O. It appears that trapping depends on airway menisci formed at low EEP, and that the production of obstructing foam depends on advancing menisci into terminal units by a very slow flow rate.
  • 中田 安成, 小林 洋三, 岸 俊行, 大田原 保幸, 近藤 昭, 江尻 東伍, 大熨 泰亮, 木村 郁郎, 田仲 俊雄, 真田 浩
    1983 年 21 巻 8 号 p. 738-744
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    We have investigated the presence of epithelioid granuloma in the bone marrow of patients with sarcoidosis to evaluate the correlation of the granuloma with hematologic abnormality.
    The bone marrow of 22 patients with sarcoidosis, consisting of 7, 13 and 2 patients in stages I, II and III, respectively, was studied. Fourteen of these 22 patients had been treated with corticosteroid at the time of bone marrow examination. Sarcoidosis was diagnosed according to clinical and biopsy findings. Clinically, the three patients with bone marrow involvement had pulmonary fibrosis, extrapulmonary involvement, splenomegaly and prolonged illness.
    Nineteen patients underwent bone marrow aspiration and biopsy through the posterior iliac crest; a Jamshidi needle was used for the biopsy. Three patients had only aspiration through the sternum. In three of 19 patients (16%) non-caseating epithelioid granuloma were observed in the biopsied specimens; two of the three patients also showed the granuloma in bone marrow aspirates. Myelogram demonstrated a decrease in nucleated cell counts in 5 patients (23%), decreased neutrophilic series in 4 (18%), an increase in eosinophilic series in 4 (18%), and increased monocytic series in 2 (9%). Peripheral blood showed anemia in 1 patient (5%), neutropenia in 5 (23%), lymphopenia in 6 (27%), monocytosis in 5 (23%) and eosinophilia in 4 (18%). The culture of aspirated bone marrow produced a growth of Propionibacterium acnes in 4 of 17 patients (23%) with sarcoidosis as opposed to 5 of 20 controls (25%) including lung cancer and malignant lymphoma.
    In summary, i) granuloma formation in the bone marrow and hematologic abnormality showed no correlation to sarcoidosis; ii) myelograms and the peripheral blood picture did not show a specificity for sarcoidosis; and iii) growth of Propionibacterium acnes in the bone marrow was not significantly related to sarcoidosis.
  • 肺アスペルギローマ症例におけるゲル内沈降反応との対比
    檀原 高
    1983 年 21 巻 8 号 p. 745-752
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    Although the gel precipitation method is valuable in the diagnosis of patients with aspergillosis, it is not infrequently negative in a certain number of cases of histologically and bacteriologically confirmed pulmonary aspergilloma. This is probably due to insufficient sensitivity. Because of these reasons, we developed a new paper disc solid phase immunoradiometric assay (IgG-IRA) to detect IgG type antibody specifically against Aspergillus fumigatus in sera with reasonable sensitivity.
    New procedures which we developed were as follows; purification of anti-human IgG heavy chain antibody from goat labelled with 125I with an affinity chromatography on Sepharose 4B column conjugated with human IgG, and a surface treatment of paper discs conjugated with Aspergillus fumigatus antigen with goat gammaglobulin. These procedures are essential to reduce background due to nonspecific binding of antibody. As a comparative study, we simultaneously carried out gel precipitation tests with double diffusion method and immunoelectrophoresis using same sera.
    These studies were carried out in 101 subjects composed of 33 pulmonary aspergilloma patients, 36 non-aspergillosis patients with various respiratory diseases and 32 normal adults. In all pulmonary aspergilloma patients, %cpm of IgG-IRA were significantly greater than in the other two groups (p<0.001). In normal subjects and non-aspergillosis patients, %cpm of IgG-IRA were low and there was no significantly statistical difference between the two. Mean %cpm of IgG-IRA of pulmonary aspergilloma patients with positive gel precipitation tests was significantly greater than those of aspergilloma patients with negative gel precipitation tests (p<0.001). The sensitivity and the specificity of IgG-IRA were both 100% in pulmonary aspergilloma patients and control groups. On the other hand, the sensitivity and the specificity of gel precipitation tests were 76% and 100% respectively.
    From these results, it may conclude that the newly developed IgG-IRA method is highly sensitive and specific for IgG type antibody to A. fumigatus, and patients with pulmonary aspergilloma respond to aspergillus infection with the production of specific IgG antibody even when it is not detected with gel precipitation tests.
  • 阿児 博文, 龍神 良忠, 西川 潔, 堅田 均, 東口 隆一, 三上 理一郎, 松島 明彦
    1983 年 21 巻 8 号 p. 753-757
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 23-year-old man was admitted to the hospital because of non-productive cough, slight fever and generalized lymphadenopathy. Chest roentgenogram showed bilateral hilar and paratracheal adenopathy, diffuse granular infiltrates and right subpulmonary effusion. Pleural aspiration yielded 180ml of clear yellow fluid with a specific gravity of 1.039 and protein content of 3.83g/dl with 80% lymphocytes. The T cell subsets analysed by FACS using monoclonal antibodies showed significantly greater percentage of Leu 3a cells in pleural fluid (73%) than in peripheral blood (28%). ACE in pleural fluid was also elevated. Smears and cultures for acid-fast bacilli and fungi were negative. A pleural biopsy obtained with a Cope needle showed multiple non-caseating granulomas. Prednisone therapy resulted in rapid disappearance of the pleural effusion, progressive clearing of diffuse granular infiltrates and lymphadenopathy.
  • 冨地 信和, 加藤 良平, 伊藤 俊一, 武内 健一, 高山 和夫, 矢川 寛一, 三田 修, 遠藤 憲幸, 吉田 泰二
    1983 年 21 巻 8 号 p. 758-763
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    The light microscopic and ultrastructural findings of a rare case of benign clear cell tumor of the lung were reported.
    A routine chest X-ray film of an asymptomatic 42-year-old man revealed a coin lesion in the right upper lobe. Macroscopically, the round tumor was 3cm in diameter and was well demarcated from the surrounding pulmonary parenchyma. Microscopically, the tumor cells possessed clear cytoplasm containing large amounts of PAS positive granules (glycogen). Large sinusoidal vessels were observed among the tumor cells. Electron microscopically, the tumor cells showed characteristic cytoplasmic membrane-bound glycogen. Many tumor cells were surrounded by basement membrane-like material and were in contact with capillary walls. Some of the tumor cell had intracytoplasmic filaments. The ultrastructural findings suggested a smooth muscle or pericytic origin.
  • 巽 浩一郎, 井村 价雄, 鈴木 光
    1983 年 21 巻 8 号 p. 764-769
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    A 49-year-old male was admitted with recurrent infected pulmonary cystic lesion. Chest X-ray film showed an infiltrative shadow with an air-fluid level in the right lower lobe and CT-scan showed a polycystic lesion. No arterial abnormality was found on aortography. Right lower lobectomy was carried out and pathologically, the lesion was intralobar sequestration without arterial abnormality.
    This case seems to support the theory that pulmonary sequestration should be considered as a bronchovascular anomaly.
  • 青木 隆幸, 津田 富康, 鬼塚 徹, 水城 まさみ, 吉松 哲之, 岡嶋 透, 葉玉 哲生, 調 亟治
    1983 年 21 巻 8 号 p. 770-774
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
    31歳男. 中国のポーロンリ (7,292m) にアタック中, 高山病を発症. 下山途中 (5,300m), 痙攣ののち四肢麻痺が出現. 下山後 (700m) 左胸痛, 咳嗽, 血痰が出現. 当科入院後左下葉切除を行い, 背側下部の融解壊死, 組織学的には, 無気肺, 肺胞内出血, うっ血, 小肺動脈の血栓形成, 多数の梗塞巣を認めた. 頭部CT写真で両側頭頂部に梗塞巣を認めた.
  • 1983 年 21 巻 8 号 p. 775-789
    発行日: 1983/08/25
    公開日: 2010/02/23
    ジャーナル フリー
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