It is believed that immunological competence of cellular and humoral immunity declines by aging. This is because the histological changes and atrophy of the various organs of the body, involution of thymus and resultant hypofunction of T-cells and abnormality of the immunoglobulin from the group of B-cells lead to the onset of the diseases in the elderly people.
In the present paper, the pathology of the immunodeficiency occurring in the aged is described, with detailed description of senile pneumonia, megaloblastic anemia, multiple myeloma, leukemia and other autoimmune diseases, all of which are common in the general clinics for the elderly patients.

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Infections due to Mycobacterium kansasii are usually pulmonary infections. This is the most common disease among nontuberculous mycobacterioses in the United States and Europe, but it is secondly common in this country and takes less than 20% of all nontuberculous mycobacterioses. However, the incidence of the disease has increased from 7% in 1977 to 19% in 1981. Many patients with this disease have chronic obstructive lung disease. The age of patients ranges from 40 to 50 in the United States and Europe. The age of Japanese patients is in the same range or over 50 years. The majority is male. Rifampicin, ethambutol, ethionamide and cycloserine are effective agents.

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Specific features useful for identifying M. xenopi have been shown (Tabel 1), and literatures on infections due to this organism have been reviewed (Table 2).

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In 16 patients with tuberculous pleurisy and 23 patients with carcinomatous pleurisy associated with bronchogenic carcinoma, immuno-biochemical studies were performed on both serum and pleural effusion.
The serum concentrations of IgA, α₁-Antitrypsin, Haptoglobin, and Adenosine deaminase (ADA) activity were clearly higher in tuberculosis than in bronchogenic carcinoma, whereas LDH activity was significantly higher in bronchogenic carcinoma than in tuberculosis. Pleural fluid concentrations of LAP, IgA and ADA were significantly higher in tuberculosis than in bronchogenic carcinoma, whereas the concentration of glucose was lower in tuberculosis than in bronchogenic carcinoma. It is considered that measurement of these substances is useful in differentiating tuberculous pleurisy from carcinomatous pleurisy.
The concentration ratios of pleural fluid to serum for most substances examined were similar between tuberculosis and carcinoma. However, the concentration ratios of LAP and ADA were significantly higher in tuberculosis than those in bronchogenic carcinoma. The ratios of GOT, LDH and ADA were greater than 1.0 in both disease. These findings suggest that the elevation of these substances in pleural fluid is attributed to the local production from pleural cavity as the inflammation site. The isoenzyme pattern of GOT and LDH was also analyzed, but there were no differences between tuberculosis and bronchogenic carcinoma.
The concentration ratios of other substances were less than 1.0 and inversely related to their molecular weights. It is suggested that the transfer of substances without local production into pleural fluid from serum was dependent of the size of the molecule.

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The diagnosis of asbestosis is usually made by occupational history, clinical symptoms, chest x-ray findings and the results of pulmonary function tests. It is not usually diagnosed by the detection of asbestos bodies or asbestos fibers. In order to find a more reliable diagnostic indicator of asbestosis, therefore, we performed the bronchoalveolar lavage in 14 asbestos workers and 20 patients with other pulmonary diseases. BAL fluid was analyzed for its asbestos bodies content as well as lavage cells and humoral components. In the asbestos workers, the relationship between the number of asbestos bodies in the fluid and clinical symptoms, radiological findings and the results of pulmonary function tests were also examined.
The following results were obtained.
1) Asbestos bodies and asbestos fibers were found in the BAL fluids of all asbestos workers, but they were not detected in the control patients.
2) Both basilar fine crackles and abnormal chest x-ray shadows were observed in the cases of more than 7-8 asbestos bodies per 1, 000 AMo.
3) Changes in %DLco and DLco/VA were highly correlated with changes in the number of asbestos bodies in the fluids (p<0.01, p<0.02, respectively). When the number of asbestos bodies was higher than 4-5 per 1, 000 AMo, %DLco was decreased in most of the cases.
Quantitative analysis of asbestos bodies in BAL fluid, therefore, appeared to be avery useful method for the dianosis of parenchyma) asbestosis.

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In order to differentiate between mycobacterial species, thin-layer chromatography of petroleum ether-soluble lipids was carried out, using solvent system consisting of petroleum ether: diethyl ether: acetic acid (90:10:1, involume). Wet weight of 100 mg of test organism was extracted twice with 2.0 ml of petroleum ether, and the extracts were combined and dried. The dried material was dissolved in 0.1 ml of petroleum ether and placed on a thin-layer of Silica Gel H (Merck, Darmstadt, Germany; 20 by 20 cm, 0.25 mm thick). After development, the lipid spots were visualized by spraying a 5% phosphorus molybdatemethanol solution and by heating them at 90°C for 10 minutes. The lipids appeared as brown or green spots.
The following slowly-growing-mycobacteria were differentiated from each other, showing a pattern specific for the species: Mycobacterium bovis; M, kansasii; M. marinum; M. avium; M. scrofulaceum. In contrast, M. nonchromogenicum, M. gordonae and M. intracellular (3 strains) showed the same pattern and were not differentiated from each other by this method.
The following rapidly-growing-mycobacteria were differentiated from each other, showing a pattern specific for the species: Mycobacterium fortuitum; M, chelonei subsp. chelonei; M. chitae; M, smegmatis; M. parafortuitum; M, thermoresistibile. In contrast, M. phlei and M. flavescens, and M. vaccae and M. aurum showed similar patterns respectively. Three species of the genus Rhodococcus showed the same pattern as shown by M. vaccae and M. aurum.

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In the initial intensive chemotherapy for primary pulmonary tuberculosis, there are very few cases whose tubercle bacilli in sputum did not disappear.
The purpose of this study was to analyze the causes of failure and relapse treated with SHR or HER regimens in original cases.
The 50 patients (33 cases of bacteriological failure during chemotherapy and 17 cases of relapse after stopping) were analysed. On the retreatment of the relapses, it is well known that the same regimens as initials were available and a high level of success was again achieved, because nearly all the patients who relapsed did so with the strain fully sensitive to H and R.
But in our research some patients acquired the resistance to both drugs during chemotherapy and after stopping. One of the causes of failure was the drug-resistance acquired in the early stage of chemotherapy. Some medical complications (diabetes mellitus, pneumoconiosis, chronic hepatitis and asthma etc.) and some accident (hemoptysis, stress and disorder of daily life etc.) were also the causes of increasing failure and relapse.
In retreated-cases and previously treated cases, we had the same results as in primary treated cases.

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A 50-year-old man, a wood worker, had been suffering from dyspnea with stridor after work for the past 9 years. He was admitted to our hospital. An antigen was extracted from the sawdust of “Boxwood”. The intracutaneous test with this antigen showed immediate wheal and flare reactions. Bronchial inhalation induction test with the antigen showed typical asthmatic attack of immediate type. This was a case of occupational asthma and the allergen was the sawdust of “Boxwood”, which had not been previously reported in any literature.

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Recently we had a case of sarcoidosis starting with pleural effusion.
The case was a 47-year-old female, and was admitted to our clinic because of exertional dyspnea and tumor in the right parotid region. Chest x-ray at the time of admission showed diffuse small nodular shadows in both lung fields, lymphadenopathv in the mediastinum and both hili as well asleft pleural effusion. The tumor in the right parotid region was 3×2 cm in diameter, had hard elasticity, immovable and showed no tenderness. Erythrocyte sedimentation rate was accelerated to 28 mm for an hour, CRP was (+), peripheral blood picture showed no abnormalities, PPD was negative, and ACE was 84 U. The examination of pleural effusion showed pale yellow turbid exudative fluid, and no malignant cell, tubercle bacilli or fungi could be detected.
The biopsy of the right parotid tumor and lymphnode in the right anterior scalenus muscle revealed tuberous proliferation of epitheloid cells and the appearance of Langhans' giant cells, and the diagnosis of sarcoidosis was made.
Prednisolone of 40 mg/day was started, and the shadow in the lung fields and the hili as well as effusion disappeared after 4 weeks, and simultaneously no tumor could be palpated in the right palotid region.
Generally pleural effusion is rarely seen in patients with sarcoidosis. Possible etiology in this case may be the extention of sarcoid lesion to the pleura or the circulatory disturbances due to swelling of the lymphnode in the hilus. In this case the former was considered to be the cause.

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We have experienced a case of ectopic ACTH syndrome due to thymic carcinoid, which is the fifth case reported in Japan. The case is a 23-year-old male, who presented the high blood pressure of 180-140 mmHg, moon face, suggillation, acne, hirsutism and a striae cutis. On laboratory findings there were hypokalemia and hyperglycemia with fasting blood sugar of 170 mg/dl, for which insulin therapy was started. The levels of urine 17-OHCS, 17-KS and plasma cortisol, ACTH, 11-OHCS, were also abnormally high, and these high hormone levels could not be inhibited even with administration of 8 mg/day of dexamethasone. Operation was performed under the diagnosis of thymoma and a mass weighing approximately 160 g was excised, but total excision was not possible because of tumor invasion to pleula and superior vena cava. However, the operation resulted in remarkable improvement of clinical symptoms and laboratory findings. That is, fasting blood sugar decreased to 72 mg/dl so that insulin was no longer necessary, blood pressure became normal and hormone levels also became normal. Histological diagnosis was thymic carcinoid, and ACTH-like immunoreactivity in the tissue showed the remarkably high value of 12000 ng/g tissue.

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A 26-year-old male dentist was referred to our hospital because of suspected pulmonary tuberculosis. The patient complained of nasal discharge, fever and blood-streaked sputum. X-ray films of the chest showed infiltration with cavity of hen's egg size in the right upper lung.
Microscopical examination of repeated smears of sputum revealed no acid-fast bacilli, and cytologic examination of this sputum showed actinomycosis.
We used penicillin-G for two months and the general condition improved.

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Three hundred and forty five patients with lung cancer admitted to Toneyama Byoin National Sanatorium over the 5 years between 1978-1982 were analyzed. As a result, the 67 patients had lung cancer and coexisting non-active pulmonary tuberculosis, and the 5 patients had lung cancer and coexisting active pulmonary tuberculosis. Patients of the latter were three males and two females.
Histological type of the 72 patients with coexistent lung cancer and pulmonary tuberculosis were squamous cell carcinoma in 36, adenocarcinoma in 22, large cell carcinoma in 8 and small cell carcinoma in 6. The proportion of squamous cell carcinoma in the patients with coexistent lung cancer and pulmonary tuberculosis were higher when compared to the proportion seen in the general population of the patients with lung cancer.
In cases of patients with coexisting lung cancer and active pulmonary tuberculosis, the lesions of the diseases were found in the same lung. On the other hand, in cases of patients with coexistent lung cancer and non-active pulmonary tuberculosis, lesions were located in both sides of lungs and thier distributions were non-specific.
The active pulmonary tuberculosis recurred in the patients with coexisting lung cancer and non-active pulmonary tuberculosis who received radiotherapy, but the pulmonary tuberculosis was not aggravated in the patients received radiotherapy if the pulmonary tuberculosis was treated.

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Multiple primary cancers detected after surgical treatment of the primary lung cancer are discussed in this paper. In the past 8 years, double cancer was diagnosed postoperatively in 4 of 128 patients with resected primary lung cancer. All the patients with double cancer were males and heavy cigarette smokers. The first cancer was pulmonary squamous cell carcinoma in all cases, and the second cancer was pulmonary squamous cell carcinoma in two patients, laryngeal squamous cell carcinoma in one and stomach cancer in one. Some of them were early stage cancers. The incidence of double cancer was 3.1%. After treatment of a cancer, careful follow-up studies must be performed to detect any secondary cancers in the early stage.

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A 52 year old woman slowly developed polyarthralgia, myalgia, Raynaud's phenome on, eye lid edema, sausage-like fingers, dry mouth, keratocojunctivitis sicca for the past ten years. Laboratory findings showed elevated ESR, hypergammaglobulinemia, positive ANA (speckled pattern) and high antibody titers of RNase sensitive ENA, and she showed positive findings of Sjögren's syndrome.
During the course of the disease she had pleuritis, pericarditis and disturbances of renal function. High dose corticosteroid hormone was necessary for these lesions. The antibody titers of RNase sensitive ENA decreased concomitant with the improvement of the clinical course.

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Infections are most common and important cause of morbidity and mortality in the children with multiple severe handicaps. Repeated treatment with antibiotics occasionally results in opportunistic infections or bacterial infections resistant to antibiotics. In some patients any antibiotics can not stop the progress of the disease.
To prevent the children hospitalized in our sanatorium from infectious diseases we have tried the treatment with Oriental Herbal Prescriptions Extracts since 1979. Fifteen children hospitalized over four years, were reviewed. Average treatment period per month during which antibiotics were given, were compared. There was no remarkable reduction in average treatment period if the drug was given orally, but there was a marked reduction in average treatment period from 0.7 to 0.3 days if the drug was given parenterally (intravenous drip infusion in most cases).
In this paper we also report the boy with severe pulmonary aspiration. He has repeated respiratory infections. With Oriental Herbal Prescriptions Qing Fei Tang, he keeps a stable condition over ten months. He needed minimal oral but no parenteral administrations of antibiotics for these ten months.
From our results, Oriental Prescriptions seem to be very helpful to have patients recover rapidly and also to avoid deterioration if the proper prescriptions are determined according to the traditional way.

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