There are numerous reports showing the depressed immune functions in lung cancer patients using in vivo and in vitro testings. We, in this paper, described the physical and biologic properties of a naturally occurring immunosuppressive factors in serum of human both normal person and patients with a wide variety of diseases, and that those factors played an immunoinhibitory or immunoregulatory role in immune responses. However, the precise role, properties and active substances of those factors still remain to be fully determined.
We also described a possible correlation between depressed immune function in lung cancer and immunosuppressive factors occurring in serum of lung cancer patients. The immunosuppression in lung cancer may be partly due to those factors.
The biological characteristic of immunosuppressive factors in serum of lung cancer in our laboratories previously reported is long acting in mode of action in immunosuppression.
An attempt was made to try Serum Immunosuppression test using the nature of those factors. In vivo transfer experiment of immunosuppressive activity indicated that immunosuppression in this test was due to suppressor cell induced through serum factor and cell interaction in animal.
The further isolation and purification of these factors will be most important in future.
We believe it may be expected that these factors become useful for not only as an immunoregulatory factor but also cancer immunotherapy, immunodiagnosis of cancer and an immunosuppressive agents.

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Fibrillatory waves of 500 patients were analysed according to the method described by Peter.
In the majority of patients (73%) with rheumatic valvular disease, the amplitude of f-waves was 2.0 mm or more, whereas, in the majority of patients (84%) with non-rheu-matic heart disease, it was less than 2.0 mm.
When the patients recovered from congestive heart failure, f-waves tended to be smaller than before.
In serious rheumatic patients with high mean pulmonary cabillary pressure, f-waves were rather small although certain numbers of exceptions were present.
After cardiac surgery, the amplitude of f-waves was much decreased. When observed more than ten years, the amplitude of f-waves changed from time to time and tended to be smaller after certain period of time. The majority of patients with very fine f-waves were those of chronically ill serious condition with massive cardiomegaly.
It should be noted that large f-waves were occasionally seen in non-rheumatic patients.
Histological findings of the left atrium of chronically ill grave patients with rheumatic valvular disease were muscular hypertrophy and degeneration, interstitial fibrosis and endocardial thickening in high degree, whereas, in patients with less severe degree, the abnormalities were relatively mild. In arteriosclerotic patients, capillary sclerosis was the prominent feature and the above-mentioned findings were mild.
In conclusion, it is suggested that the atrial wave size is determined by pathological abnormalities of the atrial tissue and influenced by circulatory pathophysiological conditions of the patients, especially, strain or tension of the atrium.

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A study of the therapeutic effect of chemotherapy on recurrent breast carcinoma seen during the period from December 1973 to April 1978 at 14 National Institutes had been done with random selection method.
The chemotherapy regimen was as follows;
Group A: 5-Fu d. s. 5 mg/kg and Endoxan (tablet) 1 mg/kg
Group B: Endoxan (tablet) 2 mg/kg
Patients were assessed at the end of a six week period after being given chemotherapy every day, using UICC criteria for therapeutic effect. 73 examples of breast cancer in each group of regimen were treated.
Results: Partial remission (P. R.) was found on 7 of 12 metastasized lymph nodes (58.3%) and on 14 of 27 metastasized foci of chest wall and soft tissue (51.4%) in Group A.
Comparison of the effective rate for 21/39 (53.8%) in Group A and for 6/36 foci (16.7%) in Group B indicated statistically significant differences (0.05<P<0.10). There were also significant differences 25/73 (34.2%) in Group A from 12/73 (16.4%) in Group B on entire foci involved. Statistic evaluation could not be documented on a few cases with bone, lung and liver metastasis.
Chemotherapy regimen was changed to the following drugs from May 1978.
Group A: Adriamycin 1 mg/m² and Endoxan 70 mg/m² i. v.; 5 to 8 times every one to 2 weeks
Group B: 5-Fu 350 mg/m² and Methotrexate 17 mg/m² i. v.; 5 to 8 times every one to 2 weeks and Endoxan (tablet) 70 mg/m²; everyday
Results: Partial remission was gained on 9/24 cases reported. These foci included 2 of lung and pleural cavity, 2 of bone and 5 of chest wall and soft tissue metastasized.
Statistic evaluation could not be reached because of shortage of cases. These results, however, suggest that the effect on further metastasis was noticed rather in this regimen than in previous regimen of only peroral drugs.

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The clinical effect of intra-arterial infusion of anti-cancer drugs (ADM alone, or ADM and 5-Fu) were studied on 26 patients with locally advanced breast cancer.
In the cases treated with intermittent infusion of ADM alone, we could increase not only each ADM dosage per infusion, but also total amount of ADM.
The intermittent infusion of ADM alone showed a high response rate (CR+PR) of 62.5%, compared to that of continuous infusion of 5-Fu with intermittent shot of ADM (21.4%).
These response rate, moreover, was closely related with the ADM dosage.: High response rate was observed especially in the patient treated with over 30 mg of ADM in each infusion, and also up to 150 mg of total dosage.
The side effects frequently observed in the patients treated with ADM alone were alopetia (87.5%), gastro-intestinal disorders (62.5%) and leucopenia (62.5%).
Follow up informations were obtained in all cases. 14 of 23 patients with currative operation had clinical evidences of recurrence elsewhere in the body, only in one of them was observed regional lymph node metastasis.
In conclusion, intra-arterial infusion of ADM was a effective treatment for locally advanced breast cancer as a part of multi-discriplinary treatment.

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The hormonal and immunological environment in pregnancy differs from that in the non-pregnant state, and it seems that this factor plays an important role in the growth of cancer during pregnancy. Therefore, we have reviewed breast cancer in three cases of coincident pregnancy and 34 non-pregnant cases, all under 39-years-old, seen at the Sagamihara National Hospital during the period between 1971 and 1980.
Our conclusions are as follows:
The duration of complaints was longer and the tumors were larger in cancer of the breast during pregnancy. In such cases, metastasis to the axillary lymph nodes is common. However, the prognosis is not so poor. Breast cancer in pregnancy should be treated by termination of the pregnancy, and further pregnancies should be avoided. The effect of abortion is not only change of the hormonal environment, but of the immunological environment as well.

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Between January, 1966 and June, 1981, 89 patients underwent thoracoscopy at Nakano National Chest Hospital. Biopsy specimens were obtained during this examination in 27 patients who had pleural effusion of unknown origin. Consequently, 3 tuberculous pleuritis, 17 carcinomatous pleuritis, one mesothelioma, one pleural effusion associated with pulmonary hemoangioendothelioma and one metastatic pleuritis with malignant thymoma were diagnosed. Thoracoscopy is a useful examination for diagnosis of pleural effusion of unknown origin.

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Recent prolongation of human age has led to a remarkable increase of the chronic obstructive pulmonary disease (C. O. P. D.). Such patients are accompanied with more or less respiratory insufficiency, the degree of which is clinically important to be grasped. Further, whether they have been fallen into hypercapnia cver moderate degree or not, is a matter of significance for their prognostic judgement. For that, needless to say, it is best to make a frequent arterial blood gas analysis, which, however cannot be entirely non-invasive, so that a simpler method would have a clear advantage. From this point of view EKG findings key to the diagnosis of hypercapnia were energetically searched for by comparative study between arterial blood gas analytical values and EKG findings obtained in 41 cases of chronic obstructive pulmonary disease. In such disease patients without primary heart disease, changes in EKG pattern were caused by the pulmonary hypertension due to hypoxia accompanying an alteration in the right ventricular hemodynamics, and their EKG findings were variable with considerable reversibility. That is to say:
1) In the C. O. P. D., patients the negativeness of T wave in V₁ lead was suggestive of a hypercapnic condition while in normal subjects it was positive in principle.
2) As the hypoxemia and hypercapnia were enhanced, the incidence of pulmonary P became higher, but it was difficult to judge the point of time at which a transition has been made to hypercapnia by referring to pulmonal P.
3) In the C. O. P. D. patients, both the pulmonary P and negativeness of T wave in V₁ lead were presumedly attributed mainly to a pulmonary hypertension due to alveolar hypoxic vascular contraction, the changes in T wave being reversible in many cases. Irreversible change in T wave coincided with that in right ventricle with severe respiratory insufficiency.
4) Seeing that in the C. O. P. D., while EKG was presenting reversible changes, arterial blood gas analytical findings and T wave in V₁ lead varied with a comparatively good relationship, so that EKG findings can make it possible to judge, to some extent, the degree of possible respiratory insufficiency and especially the point of time at which a transition has been made from the respiratory insufficiency to hypercapnia.

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We made a clinico-pathological study on 8 cases with pulmonary hamartoma which were operated between 1973 and 1981. The age of the patients ranged from 32 to 62 years with peak incidence in third decade. The sex ratio was 5 males and 3 females. 3 of them had symptoms such as hemoptysis and chest pain. 7 of them were intrapulmonary hamartoma and only one was endobronchial hamartoma. Roentgenographically, in intrapulmonary hamartoma, all of them showed well defined margins. 4 cases had lobulated out-lines and 3 had smooth. Grossly, 5 of 8 tumors were round and lobulated with sharply circumscribed borders. 7 of these tumors were located in the right lung with a predominant for the lower lobe. 4 of 8 tumors were located in the subpleural region, 3 in the deep parenchyma and one in the endobronchial area. Histologically, 7 of the patients showed chondromatous hamartoma and one non-chondromatous hamartoma. 3 casesof the patients, giant hamartoma, endobronchial hamartoma and pediculate hamartoma were presented.

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One thousand three hundred and fourty-five cases of pneumoconiosis, 264 autopsy cases of pneumoconiosis, 37 cases of pneumoconiosis combined with lung cancer and 314 cases of primary lung cancer were examined statistically on sex, age, amount of smoking (Brinkman Index), types of pneumoconiosis on X-ray findings (pR 1, 2, 3, and 4) and histological findings of cancers.
Summary of the study: (1) autopsy cases of pneumoconiosis were elderly, more amounts in pR4 in type and no causative relationship was found between the death and smoking amounts.(2) the type of pneumoconiosis combined with lung cancer were more pR3 in amounts.(3) male patients of primary lung cancer and pneumoconiosis combined with lung cancer were significantly heavy smokers and no difference of their histological findings was noted between two groups.(4) on the primary lung cancer cases: 60% and more of them were over sixth decade; male to female ratio were 3.8: 1.0; squamous cell carcinoma were found more in male and adenocarcinoma were more in female, and among heavy smokers we found more frequently anaplastic cell carcinoma and next squamous cell carcinoma, but adenocarcinoma has no relationship with smoking amounts.(5) from these studies and literatures on some industrial dusts we had expected the danger grades to lung cancer with ages, histological findings and the locations of tumors in lungs, i. e. the younger, the more dangerous, anaplastic and squamous cell carcinoma worse than adenocarcinoma, the central locations of tumors in lungs worse than peripheral ones.(6) smoking amounts were not related with the frequencies of chronic bronchitis in pneumoconiotic patients.

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We resected a strange intracardiac tumor under open heart, that was diagnosed preoperatively by UCG tomography executed for a 56-years-old woman whose chief complaint was palpitation and breathlessness in exercise.
This strange shaped tumor consisted of ovoid cyst-like mass and 4 strings of chopsticks to finger in breadth like foot of an octopus. One of these strings and the cyst-like mass came from the inferior vena cava and this cyst-like mass sitted down on the tricuspid valve. Moreover three other strings came out from this cyst-like mass, one of which extended from the right atrium through the right ventricle to the pulmonary artery.
Pathological diagnosis was leiomyoma.
The uterus or the inferior vena cava is thought as the organ of this tumor origin, but we can not decide about this origin.
The tumor of this kind is so rare that only about 130 cases are reported in the world and only two cases are reported in Japan.

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We report a following rare case of endocarditis caused by Haemophilus parainfluenzae which we came across.
The patient was a 31-years-old female, who was an office girl of an electrical engineering company. As a result of rheumatic fever at age of 10, she has had heart disease. She had not experienced pregnancy.
The patient began to have remittent fever above 39°C associated with general fatigue from mid-December in 1979, and experienced a weight loss of 4 kgm in 3 months. The patient was admitted on February 18, 1980, on suspicion of endocarditis. Her temperature was 37.2°C, blood pressure of the right and left arms were different, and a high-pitched pansystolic murmur was heard from the third intercostal space of the left side of the sternum to the apex of the heart. Neither sign of heart failure nor swelling of the liver and spleen were found. Retinal hemorrhage in the right fundus was observed.
Because that H. parainfluenzae was found in cultures of arterial and venous blood on three occasions, we began to give CET 12gm/day from the 8th hospital day with due regard to MIC. H. parainfluenzae and other bacteria, that were detected in cultures from the amygdaloid fossa and pharynx, but not from germi-culture of cerumen of the left chronic tympanitis. We observed that the fever went down after 5 days.
Though members of the Haemophilus genus are resident bacteria in the upper airway and can cause inflammation primarily or secondarily in other organs, endocarditis caused by the Haemophilus genus is rare and occurs in only 0.5 to 1% of cases of bacterial endocarditis. Only 7 cases of H. aphrophilus, one case of H. influenzae and one case of H. parainfluenzae have been reported in Japan.
We report here a case of bacterial endocarditis caused by H, parainfluenzae complicated with mitral regurgitation.

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Nifedipine, one of the potent slow channel inward current inhibiter of calcium, was administered to patients with various valvular heart diseases, and acute hemodynamic effects on the afterload reduction were compared. Materials consisted of 7 with normal control, 12 with mitral regurgitation, 8 with aortic regurgitation, 9 with mitral stenosis and 6 with aortic stenosis. Patients with significant combined lesion were excluded. Before and 30 minutes after administration of the drug, cardiac output by cuvette dye-dilution technique and radial artetial pressure were recorded. While the significant reductions of arterial pressure and peripheral vascular resistance were observed in each group, it was concluded that afterload reduction therapy was essentially beneficial in cases with regurgitant valvular lesions not with stenotic lesions.

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Kanpo therapy, Japanese herbal therapy, was administered to the children with tumorous diseases such as acute lymphocytic leukemia (ALL) and histiocytosis X and congenital heart diseases, such as ventricular septal defect(VSD) and total anomalous pulmonary venous drainage. The cosmopolitan medical treatment was given at the same time. The Kanpo medicines were used according to the Japanese traditional diagnostic method.
Kanpo medicine was given to five ALL patients, two of which died : case H. D. whose onset was at two, and case K. Y. who had had recurrent meningeal infiltration and received Shinbuto, with which the side effect of Vincristine diminished. Other cases of ALL have been well up to present. They all received Saikokeishikankyoto. Case M. S. had had the history of relapse. He had gastro-intestinal disturbance as a side effect of Juzendaihoto and was given Saikokeishikankyoto insted, which brought him good appetite and gaining weight. Case M. M, had the tendency to have cold and complained coldness and was treated by Shinbuto which improved his complaints and increased weight. Case H. M, was a patient with T-cell leukemia. Her weakness by chemotherapy and lineac treatment was improved by Saikokeishikankyoto. Although the case of histiocytosis X has reccurent relapse on bone after Kanpo treatment, his general condition is well.
After administration of Saikokeishikankyoto, the values of immunoglobulin were not too low as before in case Y. K. The values of ESR didn't increase so much in case Y. K. too. Saikokeishikankyoto may have activity to regulate immunomechanism.
In regard to the cases of congenital heart disease, Saikokeishikankyoto revealed to be effective to case N. E. with VSD on her psychomotor development. Case S. S, whose operation of total anomalous pulmonary venous drainage had been refused by his family, couldn't control his own temperature. But it was well controlled by administration of Shinbuto in winter and Seishio-ekkito in summer. His appetite and weight increased and Lasix could be cut.

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T. B. L. B. and brushing by applying the bronchofiberscope were performed in 112 cases since 1978. We studied the evaluation of T. B. L. B. and brushing by applying the broncho-fiberscope in the pulmonary diseases.
1) In the peripheral coin lesions on the chest-X ray, the diagnostic rate of T. B. L. B. was 53% and that of brushing was 83%. Brushing was positive in the peripheral coin lesions greater than 3 cm in diameter but the diagnostic accuracy of brushing is influenced by tumor location in those less than 3 cm in diameter.
2) In squamous cell carcinoma the diagnostic rate of T. B. L. B. was 88% and that of brushing was 100%, which was not influenced by tumor location and diameter.
3) In adenocarcinoma the diagnostic rate of T. B. L. B. was 68% and that of brushing was 96%. Brushing was positive in adenocarcinoma greater than 3 cm in diameter but in which less than 3 cm the diagnostic accuracy of brushing is influenced by tumor location.
4) In alveolar cell carcinoma of the infiltrate type on the chest X-ray the diagnostic rate of T. B. L. B. and brushing were 100%.

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One hundred and three cases of the thoracic injury (Male 84, Female 19) were treated at Iwakuni National Hospital from 1971 to 1980.
The causes of 97 blunt trauma were traffic accident (51%), fall contusion (32%) and working disaster (17%). These cases included rib fracture (18%), pneumothorax (44%), hemothorax (30%) and etc. The cases of 13 deaths revealed that the associated multiple systemic injuries have relation with the prognosis of the thoracic injury.
The degree of the thoracic injury was classified into following four stages.
Stage I: Soft tissue injury on the thoracic wall
Stage II: Bone tissue injury on the thoracic wall
Stage III: Pneumothorax, hemothorax and mild pulmonary contusion
Stage IV: Flail chest, severe pulmonary contusion, bilateral hemopneumothorax, injury of tracheo-bronchus, heart great vessels and so on Frequency of each stage was Stage I 10%, II 36% III 38%, an IV 16% respectively.
The treatment for Stage III is commonly performed continuous thoracic drainage. For Stage IV intensive care for respiration and circulation is necessary. Especially, for frail chest the internal fixation by artificial lung ventilator is more effective than the external fixation by surgical operation. But some cases need emergency operation.

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