Shinichi Tomioka

Discordant findings between krypton-81m gas and Tc-99m labeled ultrafine aerosol lung ventilation SPECT in two patients with idiopathic pulmonary fibrosis

Technegas, a newly developed ultra-fine dry dispersion of Tc-99m labeled carbon with a particle size of approximately 5 nm to 20 nm, possesses the properties for lung ventilation imaging using SPECT. The authors observed a discrepancy between krypton-81m gas and technegas lung ventilation SPECT in two patients with idiopathic pulmonary fibrosis who demonstrated heterogeneously decreased distribution of technegas without regions of high count density (focal hot spots) of tracer in their lungs in spite of the almost homogenous distribution of krypton-81m gas. This finding could be explained by the duration of radioactive gas inhalation. Technegas lung ventilation SPECT images reflected lung ventilation with tidal breathing. Conversely, Kr-81m gas lung ventilation SPECT images reflected not only lung ventilation, but also lung volumes. These two radioactive agents for lung ventilation SPECT show different findings.

Effect of Nifedipine on Dose-Response Curves to Acetylcholine and Histamine Measured during Quiet Breathing

We have investigated the effect of nifedipine on acetylcholine-induced bronchoconstriction in 8 asthmatics and on histamine-induced bronchoconstriction in another 8 asthmatics on a single-blind basis. Expiratory spirograms were done at the beginning of the examination in all subjects, and repeated after 10 mg of oral nifedipine or a placebo. The change of respiratory resistance during the inhalation of acetylcholine or histamine was recorded continuously by an Astograph. Using this device, we were able to obtain the direct-writing dose-response curve of respiratory resistance measured during quiet breathing. Resting airway tone appeared to be generally unaffected by nifedipine, as there was no significant change in baseline spirograms. Nifedipine increased significantly the threshold of bronchial responsiveness, i.e., the cumulative dose of acetylcholine (Dmin) at which the respiratory resistance started to increase, compared with placebo (p less than 0.02). However, Sd, the slope of the increasing rate of respiratory resistance in the dose-response curve, was not attenuated by nifedipine. In histamine inhalation tests, neither Dmin nor Sd were modified by nifedipine. The discrepancy observed between the effects of nifedipine on acetylcholine- and histamine-induced bronchoconstriction may imply that, in asthmatics, nifedipine exerts its effect mainly by stabilizing mast cells rather than by directly inhibiting bronchial smooth muscle contractility. This hypothesis is based on the fact that mast cells have acetylcholine receptors on their surfaces but no histamine H1-receptors.

A CASE OF WEIL'S DISEASE FOUND IN THE TONE-NUMATA DISTRICT OF GUNMA PREFECTURE

症例は56才,男性.職業は旅館番頭.素足で魚釣,水田作業に従事後,高熱が出現,発熱,筋肉痛,下痢を主訴として入院.入院後,典型的な臨床経過をとり,顕微鏡的凝集反応でL. icterohaemorrhagiae 80倍陽性で, Wei1病と診断された. SM,抗血清療法などの他,腹膜潅流も併用したが,昏睡状態となり,呼吸困難で死亡した.剖検では,著明な黄疸と出血傾向が有り,直接死因は,肺実質内出血であつた.組織学的には,腎で尿細管上皮の変性と間質性腎炎が著明であつた.肝では肝細胞索解離,胆汁うつ滞,有糸分裂縁などが特徴的で, Areanらの記載と一致した.一方,最近7年間の本邦におけるレプトスピラ症の報告例は103例で,死亡例は14例,全てWeil病であつた. Weil病は69例で,うち比較的記載の十分な30例について,治療内容,治療開始病日を検討すると,死亡例12例,生存例18例とも全例SMが使用された.治療開始病日は,死亡例では,平均8.3日であつたが,生存例では,平均5.6日であつた.この数日の遅れが予後に重大な影響を与えていると思われ,自験例でも,こうした治療開始病日の遅れが致命的であつた. Weil病は,現在なお,全国各地で散発的な発生がみられ,急性熱性疾患の診断にあたつては,本症の存在を常に念頭に置く必要性が痛感させられた.

Short-term and long-term effects of a self-managed physical activity program using a pedometer for chronic respiratory disease: a randomized controlled trial

[Purpose] The aim of this study was to evaluate the effects of a self-managed physical activity program using a pedometer and diary on physical function, ADL, and QOL in patients with chronic respiratory disease. [Subjects and Methods] 17 outpatients with chronic respiratory disease were assessed for dyspnea, muscle strength, exercise tolerance, ADL, and QOL at baseline, after 3-, and 6-months after the start of the program. Patients were randomly assigned to “Control” or “Diary” group. In the Diary group, the number of steps was counted with a pedometer and recorded in a diary together with self-evaluation of physical activity, while patients assigned to the Control group did not use a pedometer or keep a diary. [Results] The Diary group showed significant improvement in the daily step count over time. The Diary group showed significant improvement of the dyspnea, muscle strength, and exercise tolerance at 3 months, dyspnea and muscle strength at 6 months. Significant differences found between two groups with regard to the extent of change in the muscle strength, exercise tolerance, and QOL at 3 months. [Conclusion] This study suggests that a self-managed physical activity program using a pedometer and diary can increase the level of physical activity.

A CASE OF HYPERSENSITIVITY PNEUMONITIS CAUSED BY CANDIDA ALBICANS

カンジダに起因すると考えられた過敏性肺炎の1症例を経験したので報告する.症例は25才,女性,教員で昭和47年より毎年5～9月に発熱,乾性咳嗽,食欲不振をくり返し来院した.血沈亢進,白血球増加, CRP(〓), γグロブリン上昇が認められた.肺機能では,拡散機能の低下(% DLco 59.0),胸部X線像では両側下肺野に細網状陰影がみられた.各種アレルゲンを用いた皮内反応では,カンジダと多価細菌ワクチン(ブロンカスマベルナ)にアルサス型,遅延型反応が陽性であつた.また, Ouchterlony法を用いたゲル内沈降反応ではカンジダのみに陽性で,他のM. faeniやT. vularisその他の真菌類では陰性であつた,以上より本例は典型的過敏性肺炎であり,かつその起因抗原としてカンジダが考えられたので,これを用いて吸入誘発試験を施行した.その結果,吸入終了数時間後に咳嗽,発熱,呼吸菌難等の症状が再現され,肺に湿性ラ音も聴取された.また白血球増加,血沈亢進CRPの陽性化(〓)→(〓), %VCの低下を認め,またA-aDO2の上昇も認められた.一方, FEV1.0%は前値に比し不変であつた.吸入3日後にtransbronchial法にて施行した肺生検の組織像では,間質の細胞性肥厚,肺胞内および間質に肉芽腫形成がみられた.アレルギー的発症機序については, III型アレルギーの可能性が示唆されたが,本例はいわゆる夏型過敏性肺炎のアレルゲンとして,カンジダをも考えるべき一つの示唆を与えていると思われる.