To evaluate the left heart function in patients with chromic obstructive pulmonary disease (COPD), measurements of the left ventricular systolic time intervals with noninvasive technique were performed in 23 patients with moderate COPD, but without right heart failure (58 year sold), 9 healthy adults (25 years old) and 25 middle and old age healthy subjects (65 years old). The effects of isometric hand grip exercise (50%MVC, 1.5min.) and bicycle ergometer exercise (300KPM, 3min.) on the systolic time intervals were studied.
There was a significant increment in heart rate at lest in the patients with COPD as compared with that in the normal groups. The pre-ejection period (PEP) and the ejection time corrected for the heart rate (ETc) in the patients were longer than those in the control groups. The significant prolongation in the total systole corrected for the heart rate (QS_2c) and the increment in PEP/ET were observed in the patients as compared with those in the normal groups. These systolic time intervals, PEP, ETc, PEP/ET, had significant inverse relationships with arterial oxgen tension. (correlation coefficients; -0.42, -0.37, -0.54).
Isometric hand grip exercise produced lengthening of QS_2c, and ETc, shortening of PEP and decrease of PEP/ET. Consequently, there was significant prolongation in ETc in the patients after exercise, as compared with that in the normal groups. The bicycle ergometer exercise produced slight shortening in QS_2c and ETc, significant shortening in PEP and moderate decrease in PEP/ET. Therefore, QS_2c in the patients was longer and PEP/ET in the patients was larger than those in the normal groups.
There was no apparent evidence of the typical left heart failure in the patients with moderate COPD but the lung disease itself had affected the hemodynamics and the left ventricular function in the patients.

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The relationship between deficient pheno-types of α₁-antitrypsin (α₁-AT, Pi system) and the chronic obstructive pulmonary disease (COPD), especially the familiar emphysema, has recently been recognized in Europe and U. S. A. As the distribution of genetic markers differs among races, we examined wheather or not the Pi phenotypes in the Japanese patients have the similar role in pathogenesis of COPD.
This study was carried out on 183 patients with respiratory diseases (106 males and 77 females) concerning the phenotypes and serum levels of α₁-AT. The serum levels, the mean values and the influence of age, sex and race were also studied in 655 healthy indivisuals (515 males and 240 females).
Genetic vs. quantitative analysis of α₁-AT was studied in addition.
The results were as follows.
(1) Mean value of serum α₁-AT in the healthy Japanese indivisuals is 234±65mg/dl; male 234±69mg/dl and female 234±56mg/dl.
(2) The serum level has no correlation with sex, age, or race (Japanese, White and Negro).
(3) Low serum level does not always indicate the genotype “Z” or “S”.
(4) No specific distribution of variant Pi types is seen in any respiratory disease studied. So it was felt that “Pi types” have only minor role in pathogenesis of COPD in the Japanese.
(5) Extremely high incidence of the Pi type “MM” is found in the patients as in the healthy indivisuals.
(6) Generally high serum level is seen in respiratory diseases, highest in malignancy. The level is usually within normal limit in bronchial asthma during remission, however.

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In this report, a resuscitated case of 54 year old female who developed the pneumothorax following the asthmatic attack and led to acute asphyxic state was described in detail.
At first, the dangerous course to acute asphyxic death resulted in regarding the psychosomatic factors seriously and the withdrawal of steroid hormone. The general conservative treatment for the attack of serious bronchial asthma was done. But this attack became very serious because of the rupture of the alveolar wall caused by the increase of intrapulmonary pressure. In this circumstance, it is an only lifesaving method to do the controlled ventilation and bronchopulmonary lavage under the intratracheal intubation as the limit to conservative treatment. Therefore the prolonged respiratory management in ICU is needed to release the airway resistance rised. In this case, the control of the continuous oxygen humidification therapy, the maintenance of acid-base balance and the administration of some neuromuscular blocking agent and sedativa during mechanical ventilation were required. In addition, the importance of nutrition must be emphasized during the management of long time intensive respiratory therapy. The patient was succeeded in lifesaving after prolonged respiratory management such as controlled respiration for six days and assisted respiration continuously under the tracheotomy done in the third day, though the movement of extremities were disturbed. And her consciousness was recovered in half a month. It is known that the sitting position are more comfortable to patient than supine in asthmatic attack. This fact was confirmed in this case by the data of both the respiratory and circulatory functions.

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A case of primary diffuse tracheobronchial amyloidosis which is a rare variant of amyloidosis, is reported. A 51-year-old male whose occupation was a factory manager had cough and wheezing at night. Bronchoscopy revealed diffuse thickening and irregular bosselation at the wall of the lower part of the trachea and of the main bronchi of the both sides, especially at the cartilagous part. The orifice of the left upper lobe bronchus narrowed extremely owing to these changes. Microscopic examination of the tracheal fragments biopsied from the area of the carina showed diffuse depposition of amorphous mass which gave positive staining reactions for amyloid in the submucosa. Electron microscopic findings were those of “pen-collagen amyloidosis.” This patient had never been suffered from any long-standing suppurative or inflammatory diseases. His serum protein fractions were normal, and rectal biopsy did not yield positive staining reactions for amyloid. From these findings the case was diagnosed as primary diffuse tracheobronchial amyloidosis.

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最近まで人体寄生が知られていなかった宮崎肺吸虫の人体寄生の1例を経験した. 本症例の診断は免疫血清学的方法によっておこなった. 本症例では, 胸部X線上, 両側胸水貯留のほかに, これまで宮崎肺吸虫症で報告のない結節状陰影が認められ, 経皮肺生検の結果, 軽度の好酸球浸潤を含む肉芽腫であった. この陰影は bithionol 治療により消退した.

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