Twenty-six patients with sarcoidosis were followed up for 3 years, and the relation between clinical features and angiotensin j converting enzyme (ACE) activities in plasma were analyzed.
High level of ACE activity over 30 u (normal=22±6 u) was observed in 72% (13/18) of the patients, and its activity decreased as abnormal shadow or hilar lymph node enlargement on chest roentgenogram diminished.
The clinical state of sarcoidosis generally improves during pregnancy, and deteriorates after delivery. ACE activity in pregnant patients correlated well with the clinical courses, suggesting that ACE might be a good indicator to demonstrate the prognosis of pregnant patient.
Inh one case, hypertension was associated with sarcoidosis, and its severity was correlated wit that of sarcoidosis. In the other case, renal insufficiency occurred. ACE in these patients also correlated well with the severity of the complications. These results suggested that ACE measurement in patients with sarcoidosis might help in the diagnosis of the disease and ACE activity might be a good indicator of the clinical course of sarcoidosis, although the change of ACE activity was not specific for sarcoidosis.

View full abstract

The present paper describes our concept of lung cancer in relation to immunity and immunotherapy based on our data and historical views including immunological surveillance theory by Burnet as well as immunological stimulation theory by Prehn.
Skin reaction to PHA and PPD, total number of lymphocytcs and T cells and PHA reaction in vitro were usually decreased in patients with lung cancer but were not closely related with their stages.
We believe that local immune function of thymus derived from lymphocytes in regional lymphnodes serves as a more important parameter than the function of peripheral blood lymphocytes in the cancer patient, since 3-year-survival rate is directly correlated with the amount of small and large lymphocytes and lymphoid follicles with active germinal centers in patients with lung cancer.
Finally, we referred to the problems and the future of immunotherapy in cancer patients.

View full abstract

Leukocyte migration inhibition test (LMIT) was performed in 46 patients with primary lung cancer. The three kinds of antigens were allogeneic 3 M KCl extracts of lung cancer tissues obtained from the patients with adenocarcinoma, squamous cell carcinoma and small cell carcinoma. Nine of 46 patients (19%) were positive in LMIT with adenocarcinoma antigen, seven patients (15%) with squamous cell carcinoma antigen and 11 patients (24%) with small cell carcinoma antigen. Ten patients with benign lung disease, ten patients with non-pulmonary cancer and 12 healthy controls were all negative. These results suggest that some patients with lung cancer had cell-mediated immunity against a common lung tumor-associated antigen. Further study on the relationEhip between LMIT and clinical stage of lung cancer revealed that the percentage of positive LMIT in patients with localized disease was higher than that of patients in extensive disease. Serial determination of migration index was correlated with the clinical course. Analysis of survival according to LMIT response showed that the positive group had a longer survival than the negative group. Thus, LMIT may be a useful parameter to monitor the clinical course in patients with lung cancer.

View full abstract

Our questionnaire was directed toward the national medical institutes to investigate the present circumstances and problems with respect to the cytodiagnosis being performed there and responses were obtained from 60 national hospitals (61%) and 85 national sanatoriums (56%). The institutes where screening and diagnosis were performed by the hospital personnels were 44 national hospitals (73%) and 35 sanatoriums (41%); the institutes which employ their own screening technicians were 22 national hospitals (37%) and 17 sanatoriums (20%); and the institutes being attended by guiding physicians were 8 national hospitals and 2 sanatoriums. With respect to the number of cases in which the institutes performed cytodiagnosis, there were many institutes that dealt with the diagnosis of more than 1, 000 cases per year, and particularly as many as 5 sanatoriums performed the more than 3, 000 cases of diagnosis regarding only respiratory organs. Of the cases reported in the questionnaires, 163 patients were early lung cancer at the hilus and one-third of these patients revealed negative X-ray findings with positive cytology. The technique of bronchial brushing under bronchoscopy has been recently employed in many hospitals, and the successful diagnosis of peripheral pulmonary carcinoma is increasing.
Next, the data regarding cytodiagnosis from our hospital was analyzed. The cases undergoing the diagnosis are increasing annually and the number exceeded 4, 000 in 1980. The cases of pulmonary carcinoma diagnosed by cytodiagnosis have reached 91%, and recently percutaneous needle aspiration biopsy has been performed in cases with negative cytology in both sputum and brushing in an attempt to improve the diagnosis of pulmonary carcinoma. These results suggested that cytodiagnosis will remain important as a means for the diagnosis of lung cancer.
However, the analysis by questionnaire in the present study also demonstrated complaints from many institutes against shortage of screening technicians. It is required that not only these institutes would exert their efforts but the government would take appropriate measures for establishing cytodiagnostic systems and particularly for the education of screening technicians.

View full abstract

A total of 200 patients with lung cancer treated in our Surgical Department during the past 10 years were retrospectively assessed for their clinical courses. The sex ratio of these patients was 2.8: 1 (male: female) and the squamous cell carcinoma occurred in approximately 60% of the patients. Recently, the incidence of lung cancer in male elderly patients over 70 years old h s rapidly increased, suggesting its close relationship to cigarette smoking.
The 5-year-survival rate was evaluated in 151 cases and it was 18.9%. As for the prognosis, there was no significant difference between patients with squamous cell carcinoma and patients with adenocarcinoma, but a significantly unfavorable prognosis was encountered in cases of small-cell carcinoma. The clinical stage thus seemed to be closely related to the prognosis. Furthermore, the prognosis was considered to be greatly influenced by resectability and radical cure rate because resected cases showed a more favorable prognosis than those without resection as a whole; and even in non-curative cases, this tendency was also noted. However, operable cases in Stages I and II were encounterd only in 27.5% of all patients examined, therefore, it is required in the future to make every effort for improving the rate of early detection and the rate of curative operation in this field.

View full abstract

The hospital death in Miyazaki-Byoin National Sanatorium during past 15 years was analyzed. The number of death from pulmonary tuberculosis decreased year by year, and in 1982 that of non tuberculous pulmonary disease increased by the three times that of 1973. The increase in non-tuberculous pulmonary disease, including lung cancer, and the elderly patients suffering from pulmonary tuberculosis caused an increase in the number the patients resulting in respiratory failure.
Treatment and prophylaxis against respiratory failure were discussed, and the significance of control of infection, prevention of heart failure, and maintenance of good nutritional condition were emphasized.

View full abstract

In the caeseous lesions and the cavities of pulmonary tuberculosis under chemotherapy, the periodic acid-carbol pararosanilin and periodic acid-methenamine silver stains reveals large number of bacilli where carbol fuchsin shows few or none.
This is due to one of the features of the mycobacteria being metabolically active acid-fast at one time and inactive chromophobic at another time.
The chromophobic bacilli are characterized by a negative staining of carbol fuchsin and by a positive staining of the periodic acid-carbol pararosanilin and periodic acid-methena-mine silver stains with normal roded morphology.
The mycobacteria do not die and disappear in the caeseous lesions as generally supported, but survive as chromophobic bacilli. The chromophobic bacilli may be a source of endogenous infection after years of clinical healing.
In tuberculosis, the tubercle bacilli survive in the outside of macrophages similarly as in vitro, whereas the leprosy bacilli survive within macrophages and Schwann cells.

View full abstract

In human tuberculosis, cavities are commonly seen in the lungs and this phenomenon is a special feature of this disease and quite different from other infections. Why is the cavity so easily and f requntly formed in tuberculosis? Yamamura and coworkers' experiments demonstrated that a tuberculous cavity formation in the lungs was related to the cellular immune reaction between host and tubercle bacilli. The process of the cavity formation will be considered as follows. When tubercle bacilli are inhaled into the lungs, they are phagocytized and processed by macrophages (Mcb) and the antigenic information is transfered to T-lymphocytes (T-cell) and then many sensitized T-cells are formed with the aid of the adjuvanticity of these microorganisms. The number of T-cells begin to increase and when they contact with the mycobacteria or tuberculin-like substances, they release lmyphokine (LK). With the action of LK, many Mφ and monocytes accumulate to the lesion, are activated and phagocytize the bacteria vigorously. Having a difficulty in digesting mycobacteria, Mφ are injured and release the lysosomal enzymes, because the cell wall of mycobacteria is composed of mycolic acid-arabinogalactan-mucopeptide complex and Mφ has no enzyme to disintegrate the mycolic acid. The released lysosomal enzymes damage the adjacent lung tissue and cause necrosis, softening and liquefaction followed by the elimination through the drainage bronchus, thus the cavity is produced. Based on this theoretical consideration the present experiment was done to determine the roles of lymphokine and mycobacterial cell wall in the process of the cavity formation.
Methods and Results. Rabbits were injected into the lungs through the chest wall with the mixture of LK and BCG-cell wall skeleton (CWS). The LK was used to accumulate Mφ to the injection site and to let them activate and phagocytize CWS synchro-nously. The CWS or LK alone was also injected into the lungs as controls. After 7 days the animals were sacrificed and the lesions of the lungs were examined, The histo-logical findings showed that the lesions injected with CWS+LK had necrosis surrounded by mononuclear cells. On the other hand, no necrosis was detected in the lesions injected with CWS or LK alone.
In the mean time, those rabbits received an intradermal injection of both CWS and LK, or CWS, LK, killed M. tuberculosis, H37Rv alone. After six days, the injection sites were surgically removed under anesthesia and the dermal lesions were examined macro-scopically and histologically. With the injection of LK+CWS, necrosis and distinct tissue defects were found in the skin. With the injection of CWS or killed M. tuberc. alone, slight necrosis were detected, but most of the lesions were granulomatous. With the LK-injection, the accumulation of Mφ was observed and no necrosis was found. It seems likely that since CWS or killed mycobacteria alone did not induce the immune reaction in the host by day 6 and were gradually phagocytized by Mφ without LK, the release of the lysosomal enzymes from Mφ would have been insufficient to cause necrosis in the lung tissue.
Conclusion. From these results, it is concluded that the mechanism of tuberculous cavity formation is related to the cellular immune reaction between host and parasites in which the special structure of the cell wall of mycobacteria plays an important role.

View full abstract

Background factors and clinical manifestations were studied in 10 patients who died due to cor pulmonale caused by lung tuberculosis. The following findings were common in all patients:
1) Mean age, 55.6±10.7 years; 2) more than 10 years from the onset of lung tuberculosis; 3) the extent of disease is more than one half of the lungs; 4) ECG features showing right ventricular hypertrophy; 5) %vital capactiy less than 50%.
The following clinical signs appeared important predicting the death due to cor pulmonale: 1) Pulse rate at rest, continuously higher than 90 per minute; 2) facial edema (not only objective but also subjective edema are important as predictive signs of fatal cor pulmonale).
Three stages of cor pulmonale due to lung tuberculosis have been defined (Table 2).
As shown in Table 1, the pulse rate over 90 per minute at rest preceded facial edema. The patients shown in Table 3 were on digitalis and diuretics at this stage. They survived. (It was noticed that these surviving patients had a low PO₂ but an almost normal PCO₂.) The patients shown in Table 1 were treated by digitalis and diuretics after the appearance of subjective or objective edema.

View full abstract

The effects of swimming on ventilatory functions (spirogram, maximal expiratory flow volume curve) were studied in 25 normal and 49 asthmatic children.
The mean maximum heart rates ranged from 85.2 to 88.3% of the values predicted for their ages.
Exercise-induced bronchospasm (EIB) developed in 40.0% of out-patients and in 57.1% of hospitalized patients. The magnitude and incidence of EIB caused by swimming were minimum on an averge, but these changes could not be ignored clinically in hospitalized patients or severe asthmatics.
We conclude that swimming is an appropriate physical training for asthmatic children, although medical support and well-controlled programme are necessary for severe asthmatics.

View full abstract

A case of 59-year-old male of primary malignant fibrous histiocytoma of the lung is reported. Primary malignant fibrous histiocytoma of the lung is rare, and commonly seen in deep fascia, skeletal muscles of the extremities, mediastinum and in the peritoneum.
The tumor was predominantly fibroblastic, had a characteristic story-form pattern, and consisted of large histiocytes with bizarre nuclei and a vacuolated cytoplasm.
The patient complained of cough, sputum and slight dyspnea. Chest X-ray revealed a mass shadow with atelectasis in the right lower lung field. The right middle and lower lobes were resected. Histologic examination showed features of malignant fibrous histiocytoma, peribronchial lymph nodes were free of disease. Although the patient was treated with chemotherapy postoperatively, he died from massive bleeding due to rupture of metastatic brain tumor about eight months after operation.
This case appears to be the first reported primary malignant fibrous histiocytoma of the lung in Japan and only five cases have been reported in the world literature.

View full abstract

A 44-year-old man who developed scleroderma after 20 years of exposure to silica dust was reported. So far, only several such cases have been reported in Japan. The recent study demonstrated that the presence of HLA DR5 in white and HLA BW61 in Japanese is found in patients with scleroderma. Interestingly, this patient had both antigens. Thus, the case was considered that scleroderma developed through the immunogenetic background (high susceptibility to scleroderma) as well as disordered immune mechanisms by the “adjuvant” effect of the silica dust.

View full abstract

A 45-year-old male patient developed left pleural effusion and a tumor shadow was seen in the middle of left lung by chest x-ray examination. The cytodiagnosis of hemorrhagic pleural fluid revealed atypical cells suggesting adenocarcinoma and that of sputum resembled squamous cell carcinoma. These cytologic findings suggested the presence of double lung cancer. Ten months later, the patient died of lung cancer.
At necropsy both squamous cell carcinoma which localized around the left upper bronchus (B₁₊₂), and adenocarcinoma which occupied the apex of the left lung were recognized.
Since the incidence of double lung cancer in autopsy cases is low, it might be very difficult to make a diagnosis of double cancer before the start of treatment. The present case suggests that the cytodiagnostic procedure is useful and valuable for these patients.

View full abstract

This is a case report of an 8-month-female baby. The ultimate cause of her death was respiratory insufficiency. This interesting case was diagnosed by autopsy as severe pneumocystis carinii pneumonia with lack of normal thymus. If this case should be classified as any type of DiGeorge, it might be classified as DiGeorge variant. This syndrome includes many cases which are difficult to be classfied except complete types. There is a possibility that the thymic hypoplasia includes involution of the thymus. Thus the term of thymic hypoplasia seems an inadequate expression. The thymic hypoplasia inevitably includes dysplasia. Nowadays, however, there are no appropriate criteria for deciding what is thymic dysplasia. In order to avoid confusion, advanced studies are required to collect more cases.
This case had microscopic adenoma in the liver. The relation between immunodefficiency and the development of tumors are still unknown. It is of special interest that this case had findings of so-called infantile arterial calcification in the arteries of both the salivary and the thyroid glands. This change may have correlation with thymic hypoplasia. Otherwise, did it appear in relation to maldevelopment of the III rd and the N th pharyngeal pouch? Nevertheless, this case had neither malformation of the heart nor the great vessels. In addition, there were two parathyroid glands found by serial microscopic sections.
There were hypogammaglobulinemia and remarkable eosinophilia in the clinical laboratory findings. There are a few reports describing eosinophilia in cases of DiGeorge syndrome, although its significance is unknown. Pneumocystis carinii pneumonia has been called “interstitial plasma cell pneumonia”. It is interesting whether or not the appearance of plasma cell-like cells in alveolar septa contributes to product globulin.
In this case functions of both cellular and humoral immunity were remarkably suppressed.

View full abstract

Three cases of systemic lupus erythematodes are reported. Case 1 is 54-year-old female. Case 2 is 28-year-old female. Case 3 is 57-year-old female. Common symptoms are as follows: 1) nephropathy, i. e., the decreased renal functions, alubuminuria, abnormalities of urinary sediments, especially hypercellularity of mesangium in case 3, 2) fever, 3) accelerated blood sedimentation rate, 4) positive ANF, 5) hypergamma-globulinemia, 6) neurological signs and 7) pneumonitis.
Furthermore, all three cases have some more various symptoms, i.e., case 1 has Raynaud's phenomenon, leucopenia, and thrombocytopenia, case 2 has psychotic symptoms, and hypocomplementemia, and case 3 has skin rash, leucopenia, psychotic symptoms, and hypocomplementemia.
These findings suggest that pneumonitis serves as a reference to early and suitable administration of glucocorticoid.

View full abstract

A case of pulmonary hypertension of unknown origin (so-called primary pulmonary hypertension) was reported. The case was 47-year-old woman. She had immunological abnormalities such as Raynaud's phenomenon, arthralgia and positive RA-test. Her elder brother also had primary pulmonary hypertension at necrospy. At present her symptoms era improved by the administration of digoxin, diuretics and hydralazine.

View full abstract

The results of monthly sputum examinations were analyzed in patients with pulmonary tuberculosis hospitalized in Minami-Kyoto Byoin National Sanatorium during 5 years from 1977 to 1981. Acid-fast organisms were identified in all patients.
The frequency of cases showing transient discharge of atypical mycobacteria in sputum among patients with M. tuberculosis approximately 10%. The diagnosis of atypical mycobacteriosis was made according to the criteria of Tsukamura (Tsukamura, M.: Kekkaku, 55:513, 1980). Of the patients hospitalized during the period from 1980 to 1981, a total of 13 patients were diagnosed as atypical mycobacteriosis in the lung. All of the cases were classified as group III according to the Runyon's classification. In cases due to isolated acid-fast organisms, we must pay attention to differentiation between M. tuberculosis and atypical mycobacteriosis.

View full abstract