Miyoji Aiba

Respiratory nicotine absorption in non-smoking females during passive smoking

SummaryThe aim of this study was to measure nicotine concentrations in inspired and expired air so as to learn more about respiratory (nasopharyngeal cavity and lung) nicotine absorption from inspired air and to estimate the nicotine intake during passive smoking. A total of 17 young non-smoking women were exposed to experimental passive smoking. Inspired and expired air was sucked at a constant rate into samplers filled with acid-treated diatomite (Uniport-S) to absorb nicotine in the air. Absorbed nicotine was assayed by gas chromatography. The range of nicotine concentration in the inspired air was 40–200 μg/m3. In this setting, 47 samples obtained from the 17 subjects were assayed. Nicotine absorption, which was calculated as [(nicotine concentration in inspired air — nicotine concentration in expired air)/nicotine concentration in inspired air] × 100, remained at 60%–80% (mean ± SD, 71.3% ± 10.2%) without being affected by the nicotine concentration in the inspired air. From this result, it was estimated that the average intake of nicotine was 0.026 mg/h in a group of non-smokers exposed in a room containing a nicotine concentration of 100 μg/m3, which is equivalent to fairly severe involuntary tobacco smoking. This is the first report on the estimation of respiratory nicotine absorption and nicotine intake during passive smoking based on the direct measurement of nicotine concentrations in both inspired and expired air.

Blood culture results in elderly febrile patients

AIM We retrospectively evaluated blood culture results in elderly patients (≥65 years) with a fever due to infection. METHODS We examined the bacteria isolated from blood cultures and compared them to bacteria detected in infected lesions that caused bacteremia. We compared the types of bacteria isolated in the two groups (the community-acquired group and the hospital-acquired group). RESULTS Blood cultures were obtained from 638 patients. Bacteria were detected in 182 patients (28.5%), including 66 (36.3%) patients in the community-acquired group and 116 (63.7%) patients in the hospital-acquired group. There were 259 positive samples (25.1%). In arterial blood specimens, 153 (30.9%) samples were positive, while in venous blood specimens, there were 106 (19.8%) positive samples (P<0.001). In the community-acquired group, the most common bacteria identified were E. coli compared to S. epidermidis in the hospital-acquired group. More than 50% of the bacteria identified in the blood cultures were of the same species identified in the respective urine samples and central venous catheter tips. CONCLUSIONS The bacteria detection rate in this study was 28.5% for blood cultures, which is higher than the 17.5% reported by the Japan Nosocomial Infections Surveillance Program conducted by the Japanese Ministry of Health, Labour and Welfare. These results suggest that in elderly patients from whom an insufficient volume of blood can be drawn from a vein, an arterial sample may increase the detection rate. A high percentage of bacterial species isolated from the blood cultures was also detected in urinary tract infections and central venous catheter-related infections, indicating that a blood culture is useful for detecting various infectious diseases, even in elderly febrile patients.

Does the Diaphragm Act as a Barrier Against Transdiaphragmatic Spread of Carcinomas? Comparison of the Incidence of Carcinomatous Pleuritis and Peritonitis in Various Carcinomas.

1979年から1988年までの10年間に当院に入院した癌症例6,145例を対象に, 原発巣が横隔膜より頭側臓器にある症例 (SD群) と横隔膜より尾側臓器にある症例 (ID群) に分けて, 癌性胸膜炎・癌性腹膜炎の合併頻度をretrospectiveに検討した. SD群では癌性胸膜炎合併は12.3%, ID群の癌性腹膜炎合併は9.9%であった. SD群が腹膜炎を, ID群が胸膜炎を単独で発症する率は各々0.3, 0.7%であった. 両合併例は, SD群1.1%, ID群2.0%で, SD群の胸膜炎合併例中では8.8%, ID群の腹膜炎合併例で20.0%であった. SD群の胸膜炎腹膜炎併発例よりID群の腹膜炎胸膜炎併発例が多かった (P<0.01). 剖検例190例では, SD群の癌性腹膜炎合併例は癌性胸膜炎のみの症例より, またID群の癌性胸膜炎合併例は癌性腹膜炎のみの症例より, おのおの横隔膜の対側へのリンパ行性転移が高頻度にみられた (38.7%vs73.3%: P<0.05, 37.3%vs78.3%: P<0.01). 以上の結果, 横隔膜は胸腔から腹腔へ, 腹腔から胸腔への癌の波及を隔壁として抑制すること, リンパ系の癌の進展でこの抑制は破綻すること, さらに, ID群の頭側への進展は, SD群の尾側への進展に比べれば容易であることが示唆された.

A study of lung cancers with the onset of neurological disorders.

過去8年間の原発性肺癌368例中, 神経症状で発症した肺癌は, 43例 (11.9%) であり, このうち, 組織診のある35例について, 診断, 治療の問題点を検討した.片麻痺で発症する症例が14例と最も多く, その他, 種々の多彩な神経症状を認めた.単発脳転移16例中15例が転移巣摘出術を受け, その後, 4例が原発巣の肺葉切除術を受けた.種々の神経症状で発症する肺癌があることに留意し, その治療には, 開頭手術を含めた集学的治療が必要である.

A case of small cell carcinoma of the lung with neurological symptoms due to intramedullary metastasis.

65才男性.左下肢しびれ感と筋力低下で発症し, 下半身麻痺へと進行した.左中肺野に腫瘤影を認め, 皮下腫瘤の生検で低分化の癌細胞を検出したが, 下半身麻痺との関係は不明であった.剖検では, 左肺S4原発の中間細胞型小細胞癌の腰髄内転移を認めた.脊髄内転移は極めて稀であり, その転移症状が初発症状であったことは興味がある.肺癌に神経症状を伴う時, 脊髄内転移の可能性も念頭に置くべきである.