The effect of oxygen inhalation on mixed venous and arterial oxygenation was studied by right cardiac catheterization in patients with respiratory failure due to chronic obstructive pulmonary disease. Data on the relationship between avPO₂ and PaO₂ in 50 patients while breathing air suggested control mechanism (s) minimizing the effect of aVPO₂ approaching to zero. Cardiac output, arterial lactate concentration, PaO₂ and PvO₂ were measured before, and 1 hour after, breathing 100% oxygen in 23 patients. Marked rise in PvO₂ and significant decrease in arterial lactate were observed after oxygen administration in more hypoxic (PaO₂<60mmHg while breathing air) patients, while no significant difference was seen in PaO₂ and cardiac output between more hypoxic and less hypoxic (PaO₂≥60mmHg) patients. Theoretically increase in PvO₂ after oxygen administration was mainly due to decrease in tissue oxygen consumption in more hypoxic patients.
These results suggest that oxygen administration is indicated to relieve tissue hypoxia in patients with PaO₂ less than 60mmHg.

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Five probable cases of myocardial sarcoidosis were reported. The clinical features, especially in the electrocardiographic findings which improved with steroid treatment, were presented and discussed.
Case Reports:
Case 1. A 63 year-old man was diagnosed as a case of ocular sarcoidosis. He had bilateral hilar lymphadenopathy and pulmonary lesion, and histological examination by scalene node biopsy showed typical sarcoid granuloma. Seven months later he was found to have supraventricular premature beats and first degree heart block. At that time he was treated with betamethasone and abnormalities in electrocardiogram, ocular lesion, and pulmonary lesion improved.
Case 2. A 23 year-old man was found to have bilateral hilar lymphadenopathy, and histological skin biopsy showed silica granuloma. Three months later an electrocardiogram showed sinus arrhythmia and ST-T change, and two months later it showed sinus arrest. At that time he was treated with betamethasone, and sinus arrest and bilateral hilar lymphadenopathy were improved.
Case 3. A 63 year-old woman was found to have a facial skin lesion for four years. Skin biopsy revealed sarcoid granuloma. Bilateral hilar lymphadenopathy was also diagnosed. Five months later an electrocardiogram showed ventricular premature beats and incomplete right bundle branch block, and two months later ventricular premature beats and complete right bundle branch block were found. Prednisolone was administered every other day, and the abnormal electrocardiogram findings and skin lesion improved but the chest X-ray findings were unchanged.
Case 4. A 48 year-old woman, who had previously been healthy, was diagnosed as having complete heart block after the onset of severe breathlessness on effort. She had a positive Kveim's test, bilateral hilar lymphadenopathy, and also had a skin lesion. A pacemaker was implanted, but three months later she was readmitted for ventricular tachycardia. At that time prednisolone therapy was begun and ventricular tachycardia was disappeared, but bilateral hilar lymphadenopathy was unchanged.
Case 5. A 19 year-old woman, who had previously been healthy, was diagnosed as having bilateral hilar lymphadenopathy. She was hospitalized for suspected sarcoidosis. Biopsy specimens of cervical lymphnodes and liver exhibited epitheloid cell granuloma. She was assymptomatic but an electrocardiogram showed first degree heart block. After treatment of heart block with betamethasone, bilateral hilar lymphadenopathy and hepato megaly were improved.

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Chest roentgenograms and laboratory findings of 50 patients with pneumonia admitted to our hospital within the past three years were reviewed. 20 of 50 cases were found in elderly patients over 65 years of age. Almost all pneumonia in elderly patients were bacterial, while most cases in younger patients were viral or myconlasmal in origin. In patients over 65 years of age, 13 of 20 patients had reticular-like shadows, with or without homogeneous and/or patchy consolidation. Most elderly patients with reticular-like consolidation had pneumonia caused by gram-negative bacilli, and had reduced FEV_1.0% and increased RV/TLC% in lung function tests. We speculate two pathological changes for the appearance of the reticular-like shadows in chest roentgenograms, that is the dilated air spaces and reduced exudation around those regions.
Recognition of such reticular-like shadows in the chest roentgenograms is considered important to detect pneumonia in the elderly patients. On the other hand, reticular-like consolidation may indicate the possibility of emphysematous changes in pneumonia patients.

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There have been a number of unsolved problems in lung transplantation with regard to preservation, immunosuppression and pathophysiological alterations, for which much time and effort was, and still is, expended in solving.
The purpose of this paper is to report the results obtained in our serial studies concerning hemodynamic characteristics following bilateral lung auto-and allotransplantation in dogs.
The one-stage bilateral lung autotransplantation employed in our studies showed the critical entity of different degrees of pulmonary edema in both lungs in the early postoperative period.
Some experimental animals with bilateral lung grafts succumbed to respiratory failure showing gradual in PaO₂ caused by pulmonary edema but some other animals recovered from these pathologic states within 10 days postoperatively.
Hemodynamic characteristics of lung transplantation include high pulmonary vascular resistance, in the early postoperative period and returning to near preoperative values in later periods.
There have been few answers to the question concerning how pulmonary vascular beds change with abrupt alteration of pulmonary blood flow in this model. Our approach to this question was to inject plasma expander consecutively via intraatrial catheter in order to increase pulmonary flow and to determine simultaneousl P_PA and cardiac output in the bilaterally transplanted animal.
During the course of increased cardiac output both P_PA and TPVR linearly increased until the lung became edematous, while TPVR decreased despite increase in P_PA in the control animals. It should be results may indicate the change in mechanism of pulmonary circulation in the transplanted lungs, i. e. suggesting the characteristics of lung denervation.
In regard to the ventilatory effects of CO₂ inhalation, it was associated with a similar increase in tilation and tidal volume in both control and bilaterally reimplanted animals. However, the transplanted showed no change in respiratory rate in the control animals.
It is difficult to explain entirely this loss of rate alteration during CO₂ inhalation in the bilaterally transplanted dogs. Previous work has established that the Hering-Breuer reflex is lost for several years after surgery and it seems reasonable to assume that this phenomenon is responsible for the loss of rate alteration with CO₂ inhalation.

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A 65-year-old housewife was admitted to Juntendo Hospital with a complaint of right chest pain and she recieved consecutive chest examinations. In these examinations, pulmonary arteriogram showed an anomalous artery supplying a tumor mass. We diagnosed a benign lung tumor such as hamartoma or sclerosing haemangioma and tumor resection was performed. Pathologically this tumor was typical benign localized pleural mesothelioma.
132 cases including our case were reported in Japanese literature between 1903 and 1977 and they were classified as diffuse and localized mesothelioma. The ratio of diffuse type to localized type was 2:1. Diffuse type was seen mainly over the age of 40 and localized type cases were generally under 40. Clinical manifestations were chiefly chest pain and dyspnea, lacking sputum or hemosputum. Bloody pleural effusion was found in 60% of cases of diffuse type and tumor cells were found in half of these. In some cases treatment was ineffective for the diffuse type, but in localized type cases successfully resection was performed in 58 percent of cases. Metastasis was seen the lungs, lymph nodes and liver. Prognosis was poor in diffuse type and the one year survival rate was 22%.

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A case of liver cirrhosis with cyanosis and fingerclubbing is reported. A sixty-year-old female entered our hospital because of exertional dyspnea and cyanotic lips. She was not in acute distress and not dyspneic at rest. Respiratory rate was 22 per minute. Lips and nail beds were cyanotic and fingers were clubbed. Auscultation revealed no significant rale and no significant cardiac murmurs. The liver was enlarged and hard. There were some vascular spiders on the anterior and posterior chest walls.
Chest X-ray films showed fine reticular shadows in the lower lung fields.
From liver scintigram and liver biopsy, a diagnosis of liver cirrhosis was made.
Arterial blood gas analysis showed marked hypoxemia (P_O2 46.3mmHg and S_O2 84.8%) and alveolar hyperventilation (P_CO2 24.4mmHg).
The cause of cyanosis was investigated in the following way.
1) Intracardiac shunt was denied on the basis of physical examination and indicator dilution studies.
2) Measurement of lung volumes and ventilatory functions, closing volume and flow-volume analysis did not reveal any lesions which might be the cause of cyanosis. Although the diffusing capacity (D_LCO) was moderately decreased to 60% of the predicted value, this decrease was not sufficient to explain the hypoxemia already present at rest.
3) There was no abnormal Hb. 2-3 DPG in RBC was slightly increased. However, comparison of the O₂-Hb saturation values obtained by Van-Slyke manometry and corrected for pH differences with electrochemically measured O₂ tension (four steps) showed no rightward shift of O₂-Hb dissociation curve of the patient's own blood.
4) Pulmonary arteriogram with the injection of contrast material into the right atrium did not demonstrate the presence of arteriovenous fistula and pulmonary perfusion scanning by ^99mTc-MAA did not demonstrate any perfusion defect.
5) After 100% oxygen was administered for 20 minutes through a two-way nonreturn valve, arterial blood was drawn and analysed. From Berggren's standard formula, venous admixture was calculated approximately 22% of the cardiac output.
These results suggest that the cause of cyanosis in this patient is intrapulmonary venous admixture which seems to be related to liver cirrhosis. The intrapulmonary venous admixture was also the cause of cyanosis of other cases reported up to this time.

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A case of indomethacin-induced asthma is reported. A 43-year-old housewife suffered a severe asthmatic attack with cyanosis after administration of an indomethacin suppository for shoulder joint pain.
She had extrinsic asthma, aspirin sensitivity, but no nasal polyp.
The clinical features of indomethacin-induced asthma were summarized from the literature, including this case. The findings were characterized by onset after age 30, concurrence with aspirin sensitivity and nasal polyp. No difference in incidence according to sex was observed. The mechanism of indomethacin-induced asthma was discussed.

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胸部X線写真上, 両側上中肺野に多発性斑状影がみられ, その一部に空洞様陰影を伴なつたもので, 両側の肺門部陰影の腫大も著明で, サルコイドーシスが最も考えられた確定診断のため開胸生検で肺および縦隔リンパ節に定型的類上皮結節がみられた. 数ヵ月後自然治癒がみられた.

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