- 著者
- Takashi Ohrui
- 出版者
- Tohoku University Medical Press
- 雑誌
- The Tohoku Journal of Experimental Medicine (ISSN:00408727)
- 巻号頁・発行日
- vol.207, no.1, pp.3-12, 2005 (Released:2005-08-04)
- 参考文献数
- 87
- 被引用文献数
- 42 44
Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., related to cerebrovascular disease, increase the risk of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. Since both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, can improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine can reduce the incidence of pneumonia. Furthermore, since mortality from infections correlates with cutaneous anergy, interventions that reverse these age-associated changes in the immune system are also effective. The main theme of this review is to discuss how pneumonia develops in disabled older people and to suggest preventive strategies that may reduce the incidence of pneumonia among these subjects.
- 著者
- Katsutoshi Nakayama Mitsutoshi Shinkawa Takashi Ohrui Hisao Hirai Hidetada Sasaki
- 出版者
- Elsevier
- 雑誌
- The Lancet (ISSN:01406736)
- 巻号頁・発行日
- vol.360, no.9342, pp.1335, 2002-10-26
- 被引用文献数
- 6
- 著者
- Takashi Ohrui Hidenori Takahashi Satoru Ebihara Toshifumi Matsui Katsutoshi Nakayama Hidetada Sasaki
- 出版者
- Tohoku University Medical Press
- 雑誌
- The Tohoku Journal of Experimental Medicine (ISSN:00408727)
- 巻号頁・発行日
- vol.192, no.1, pp.81-86, 2000 (Released:2005-04-21)
- 参考文献数
- 11
- 被引用文献数
- 16 16
This report presents the cases of two patients with rapidly progressive hypoxemia associated with influenza A(H3N2) virus infection, who were diagnosed with influenza related acute pulmonary microthromboembolism by serum D-dimer, lung perfusion and ventilation scans and computed-tomography scan of the chest, and were successfully treated by anti-coagulant therapy. The present cases suggest that acute onset pulmonary microthromboembolism should be considered in some patients with sudden, unexplained dyspnea during an outbreak of influenza infection and prompt diagnosis is essential to save the patient from acute death associated with influenza.
- 著者
- Hiroyuki Arai Mutsuo Yamaya Takashi Ohrui Satoru Ebihara Takae Ebihara Kazushi Nakajo Hidetada Sasaki
- 出版者
- The Japan Society of Logopedics and Phoniatrics
- 雑誌
- The Japan Journal of Logopedics and Phoniatrics (ISSN:00302813)
- 巻号頁・発行日
- vol.43, no.4, pp.467-472, 2002-10-20 (Released:2010-06-22)
- 参考文献数
- 19
- 被引用文献数
- 1 2
誤嚥性肺炎を発症する高齢者では, 高率に脳血管障害, 特に大脳基底核領域に脳梗塞が見出される.この場合の脳梗塞は, 新しいものであっても陳旧性のものであっても, また症候性であっても無症候性であっても構わない.このような患者では, 嚥下反射と咳反射の両者の低下により, 誤嚥特に夜間の不顕性誤嚥により肺炎の成立にいたると考えられる.嚥下反射と咳反射は, 少なくとも2つの神経伝達物質, すなわちドーパミンとサブスタンス-Pによって支えられている.進行したアルツハイマー病患者も大脳基底核障害などにより誤嚥性肺炎を発症する.進行したアルツハイマー病患者において, major tranquilizerの使用と無症候性脳梗塞の合併は誤嚥性肺炎を誘発する危険因子であるため問題行動に対するmajor tranquilizerの使用には細心の注意が要求される.塩酸アマンタジン, ACE阻害薬, 抗血小板剤の使用また歯ブラシなどによる簡便な口腔ケアは肺炎の予防に役立つばかりでなく高齢者医療費削減にも貢献すると思われる.