Nobuhiro Sasaki

Exertional rhabdomyolysis as a result of strenuous military training

We reviewed biochemical data from 19 soldiers who marched intermittently over 4 weeks, carrying about 45 kg of kit, with a limited intake of food and water. The mean serum creatine kinase activity was higher after the march (p < 0.01), although the subjects did not develop symptomatic rhabdomyolysis. The mean serum potassium level (p < 0.005) and the mean serum sodium level (p < 0.05) were lower after the march. The level of serum osmolality showed no significant changes. Subclinical rhabdomyolysis was not rare among the soldiers. We also report a case of the soldier with exertional clinical rhabdomyolysis.

Principal component analysis of various respiratory function tests: the relationship between factor score and severity of pulmonary circulatory disorder in chronic obstructive pulmonary disease.

The relationship between pulmonary haemodynamics and values of various respiratory function tests was studied in patients with mild chronic obstructive pulmonary disease (COPD) and the following results were obtained. (1) The value of mean pulmonary artery pressure (mPAP) at rest in COPD patients was slightly elevated to 19.4 mmHg on average compared with our control value of less than 18 mmHg. (2) Analysis of the data of 11 routine respiratory function tests in 88 COPD patients extracted two principal components: an index of the expiratory function and an index for overinflation of the lung. (3) In individual patients, mPAP expressed the severity of pulmonary circulatory disorder roughly inverse to the factor score of the first principal component (index of expiratory function) but not to that of the second principal component (overinflation of the lung). (4) Discriminant analysis was performed in all 88 COPD patients according to data from the 11 respiratory function tests. The probability of mPAP being above or below 18 mmHg was 18.2%. (5) The relationship between the predicted EPOI value and the factor score was similar to that between mPAP and the factor score. EPOI (exercise pulmonary artery pressure-oxygen consumption index) was calculated with the following equation: EPOI = (mPAPex#-mPAPrest)/[VO2ex-VO2rest)/BSA##). On the other hand, EPOIpred was calculated with the prediction equation obtained from multiple linear regression (dependent variable; EPOI, independent variable; respiratory function).

Clinical Features of Female Lung Cancer.

女性肺癌の臨床像について, とくに喫煙歴に注目して男性と比較検討した. 女性の喫煙率は男性の1/3以下, 平均喫煙指数も1/2以下であった. 女性では男性と比較して腺癌, 無自覚症状者, 臨床病期1期, IV期, PS0, 4が有意に多く, 検診発見者が多い傾向にあった. しかし, 喫煙歴別では, 非喫煙女性で非喫煙男性に比較してPS0が有意に多かったほかに男女間に有意差はなかった. また, 喫煙女性は非喫煙女性と比較し自覚症状発見者, 有自覚症状者が有意に多く, IV期, PS4が多い傾向にあった. 予後は, 全症例およびおもな予後因子で層別しても男女間に有意差はなかったが, 腺癌のIV期では女性の予後が有意に良好であった. 女性肺癌の臨床像の特徴は男性と比較して喫煙歴が少ないことによる影響が大きいと考えられた. また, 喫煙歴の有無は男性と比較して女性でより大きく臨床像に影響を与えていた.

A CASE OF PULMONARY ALVEOLAR PROTEINOSIS

症例は, 47才,男性,教員.主訴は,労作時息切れ,咳嗽,喀痰. 28才頃より慢性気管支炎と言われていたが,最近息切れが増強し受診した.理学的所見では,胸部で両下肺野後面に少数の捻髪音が聴かれ,軽度のばち状指趾が認められた.胸部写真では,左右両下肺野に淡い微細粒状影を,呼吸機能検査では,拘束性障害と拡散能力の低下を,動脈血ガス分析では,低酸素血症と過換気の状態を認めた.開胸肺生検により組織学的に肺胞蛋白症と診断された. L-シスチン内服で若干の改善が認められたが, Ramirez-Rらの方法に準じて病変の高度な左肺の肺洗浄を施行し,自覚的および他覚的症状は著明に改善された.肺洗浄液の分析では,蛋白と燐脂質は正常であり,燐脂質ではレシチンとスフィンゴミエリンが主であつた.レシチン画分では,パルミチン酸が高値を示し,洗浄液脂質の主成分はlung surfactantと近似していた.肺胞蛋白症は,血清とII型肺胞上皮細胞に由来する物質が,何らかの原因により肺胞クリアランス機構が障害されるため肺胞内に異常に蓄積し,さらに悪循環を形成するために生ずると考えられる.従来は死亡率がかなり高いとされたが,肺洗浄などの積極的な治療で著明な改善を期待できる疾患であるので,早期発見および治療が重要である.疑わしい症例に対しては,積極的に喀痰の分析,肺生検などの確診の得られる検査を行なう必要がある.