Factors in the fermentation inhibition test for the measurement of growth inhibiting antibody of serum to M. pneumoniae were examined and the following results were obtained:
1) Serial ten-fold dilutions of the broth culture of M. pneumoniae were inoculated into cups of a microtiter plate and the color change of the medium to yellow with the growth of M. pneumoniae was observed. The cup inoculated with the 10^-1 dilution (about 10⁷ CFU/ml) changed the color to yellow after 3 days' incubation, then the color change proceeded with the increase of dilutions, and the cup inoculated with the 10^-6 dilution (about 10² CFU/ml) changed the color on the 14th day, disclosing that the cup inoculated with 1 to 10 CFU changed the color on the 14th day.
2) When the reading in the fermentation inhibition test was made on the day when the color of the control cup without serum changed to yellow, the growth inhibiting antibody titer was shown to be constant among the inoculations of 10^-2 to 10^-5 dilutions (about 10⁶ to 10³ CFU/ml) of the broth culture. Thus it was concluded that the use of 10^-3 to 10^-5 dilutions (10⁵ to 10³ CFU/ml) was adequate for the inoculation in the fermentation inhibition test, because the one day delay in reading in the 10^-2 dilution resulted in a significant decrease in the titer.
3) Heat inactivation of the serum at 56°C for 30 minutes had no significant effect on the growth inhibition titer. Heated sera tended to show more constant titers among varied dilutions of the broth culture.
4) The growth inhibiting antibody was shown to be detectable in this test, when the growth of M. pneumoniae was suppressed to 1/100 or less as compared with the control without serum.
5) The growth inhibiting antibody titer was determined in sera from children who had not been given any antibiotics. Sera with complement fixing antibodytiter of<1:4 to M. pneumoniae showed the growdth inhibiting antibody titer of<1:4, and the course of the growth inhibiting antibody titer of serial sera obtained from 7 patients with M. pneumoniae pneumonia was parallel to that of the complement fixing antibody titer. In two patients, the growth inhibiting antibody titer rose later as compared with the complement fixing antibody titer.
6) It can be concluded that the fermentation inhibition test is a simple and reliable method for the measurement of the growth inhibiting antibody of serum to M. pneumoniae.
7) It was suggested that, when an erythromycin sensitive strain of M. pneumoniae is used in the test, the growth inhibition titer obtained does not always indicate the real growth inhibiting antibody titer in sera from patients under erythromycin-administration.

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The following observations were conducted on 141 patients with chronic pulmonary diseases, including 52 cases of chronic pulmonary emphysema, 38 of bronchial asthma, 13 of chronic bronchitis, 8 of bronchiectasis, 8 of pulmonary fibrosis, 6 of pulmonary tuberculosis, 6 of pulmonary tumor, 5 of chronic pleurisy and 5 of pneumoconiosis, and the relationship between findings in pulmonary function tests and clinical biochemical findings were investigated.
The pulmonary arterial mean pressure (PAm), the right ventricular end-diastolic pressure (RVd), the arterial oxygen saturation (Sa_O2) and arterial carbon dioxide tension (Pa_CO2) were compared with the clinical biochemical findings in order to see if there were any special relationship between them as to those who under-went right heart catheterization and arterial blood analysis.
As a result, it was found that among patients with chronic pulmonary diseases, there existed quite many patients with decreased total serum protein and/or liver and kidney dysfunctions according to the Progression of there diseases.
Total serum protein, chiefly serum albumin, was observed to be on the decline, and serum globulin, chiefly α₂-globulin, on the increase in proportion to the decrease of %VC and %FEV_1.0. And as for patients with pulmonary hypertension of PAm over 17mmHg, distinct decline of albumin/globulin ratio was noted.
Cases of abnormal alkaline-phosphatase activity (over 4u.) were found more frequently among patients with PAm over 17mmHg than among patients with PAm under 16mmHg. Cases of cholinesterase activity of under 0.75 ΔpH were observed more frequently among patients with %VC under 79% and %FEV_1.0 under 69% than among patients with normal pulmonary function. Cases of abnormal CCFT (+-+++) were quite frequently found among patients with deteriorated respiratory function, hypoxia or hypercapnia.
The influence of chronic pulmonary diseases on the renal function was most conspicuously and frequently observed. NPN was found to increase in proportion to the decline in %FEV_1.0 of the patients. And PSP-15min, renal blood flow and glomerular filtration rate were observed to be on the decline in proportion to the increase of RVd.

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There is scarcely any organ or tissue which has not been reported to have been involved in sarcoidosis, with the exception of the adrenals. Although the thymus is closely related to the lymphoid tissue, which is most liable to sarcoidosis lesions, there has been no report on its involvement to date. As sarcoidosis is usually found among adults or older children and rare among younger ones, there is the possibility that involvement of the remaining thymus tissue might have been overlooked. We have observed two sarcoidosis cases, aged 15 and 13, with mediastinal shadows indicating an enlarged thymus on chest radiographs with pneumomediastinum.
Case 1. A boy, aged 15, developed uveitis with granuloma in the iris of the left eye. He had generalized enlargement of lymph-nodes, affecting the occipital, retroauricular, cervical, axillary, cubital, inguinal, femoral and popliteal nodes. Biopsy of a femoral lymph-node showed epithelioid cell tubercles with scanty necrosis (Fig. 4). The tuberculin reaction, positive before 6 months, was negative to 5 TU. A chest radiograph showed bilateral hilar lymph-node enlargement (BHL), with faint mottling in both lungs. The mediastinal shadow was markedly enlarged with bilateral straight borders (Fig. 1). On tomographs this shadow was bestdefined just behind the sternum (Fig. 3, 5). A lateral radiograph showed a tumorous mass in the upper portion of the anteior mediastinum, suggestive of an enlarged thymus (Fig. 2). Prednisolone, to a total dose of 850mg, was administered for 52 days. The broad mediastinal shadow and BHL regressed rapidly and subsided almost completely after 1 month (Fig. 6), and no relapse was observed after corticosteroids were discontinued. The enlarged superficial lymph-nodes were reduced in size during the corticosteroid treatment, but enlarged again after the withdrawal. The uveitis deteriorated in spite of the repeated administration of corticosteroid, and the left eye lost its vision due to cataract formation after 11/2 years.
Case 2. A girl, aged 13, was found to have BHL on a routine chest radiograph. The right inguinal lymphnodes were enlarged. Biopsy of one of them showed noncaseating epithelioid cell tubercles with giant cells (Fig. 9). A tuberculin reaction, previously positive for 7 years, was negative to 5 TU. Chest radiographs showed enlargement of the mediastinal shadow with BHL (Fig. 7), and a tumorous mass in the upper portion of the anterior mediastinum in lateral view (Fig. 8). Tomographs with pneumomediastinum demonstrated this mass more clearly, suggesting enlargement of the thymus (Fig. 10, 11). Prednisolone, to a total dose of 1, 225mg, was administered for 75 days. The tumorous mediastinal shadow and BHL regressed rapidly and subsided almost completely within 3 months. Inguinal lymph-nodes were also markedly reduced in size. Pneumomediastinum showed no tumorous mass in the anterior mediastinum 21/2 months after discontinuance of the corticosteroid (Fig. 13, 14). At that time the tuberculin reaction converted to positive. The Kveim reaction with the antigen prepared from patient's own inguinal lymph-node was negative after corticosteroid treatment.
Two cases of sarcoidosis with tumorous mediastinal shadows indicative of an enlarged thymus are presented. Both had enlarged superficial lymph-nodes besides BHL. These mediastinal shadows regressed rapidly on the administration of corticosteroid. Whether this means thymus sarcoidosis or not, remains to be proven by biopsy on other patients.

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