Cases which have cough and sputum continuing one to three months for two years or more and have no specific disease, were divided into two groups, one which shows diffuse small-nodular shadows on chest radiogram and others which do not. The former was defined as diffuse panbronchiolitis (DPB) and the latter, “chronic bronchitis (CB)”. Clinical and pathological findings were compared between these two groups.
1) Clinical symptoms were more severe, lung function was more deteriorated, prognosis was poorer and the coincidence rate of chronic sinusitis was higher in the DPB group than in the CB group.
2) X-ray findings showed the above-mentioned specific pattern in the DPB group, while the CP group showed increased lung markings, asymmetricall distributed fibrous shadows or pleural adhesion.
3) Grossly, the DPB group showed diffusely disseminated yellowishh patchy lesions and bronchioloectasis, while the CB group demonstrated fibrous thickening of peribronchial connective tissue, interlobular septum or interlobar pleura as well as bullae or emphysema in vasying degrees.
4) Hypertrophy of bronchial glands, estimated by Reid's index, was similarly prominent in both groups.
5) Cellular infiltration in the bronchial wall (2nd order) as well as in the bronchiolar one were more prominent in the DPB group than in the CB group and there was peribronchiolar intraalveolar cell infitration in the former which was not seen in the latter.
6) Fibrous thickening of the peribronchiloar connective tissue, alveolar septal fibrosis, lymphoid tissue formation and emphysema were minimal in the DPB group, while these are frequently seen in vasying degrees in the CB group. Though theses observations were limited to autopsy cases showing advanced and complicated findings, it seems that there is no quantative difference in histopathological findings between these two groups. Whereas the DPB group showed more severe and active inflammatory changes and the CB group showed slighter and more chronic reparative processes, both groups appear to fall in the same disease categoryffecting from the nasal cavity to respiratory bronchioles. Qualitative difference causing some characteristic clinical and pathological findings of DPB may be based on the especially low resistance of airways to the infection. Further studies are required on the exogenous factors acting at the onset of disease, pathological findings of the early stage and on the factors prolonging the bronchial infection.

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Heparin and dextran sulfate (D. S) are known to accelerate fibrinolytic activity and the recent increasing evidence of the inhibitory effect of D. S. on fibrosis suggests the possibility of this drug being useful for prevention of radiation fibrosis of the lung. To evaluate this we undertook both clinical and experimental studies and obtained the following results:
1) Pulmonary radiation injuries were less severe in degree and more delayed in onset in D. S. treated cases. Preventive effects of D. S. were most prominent in small radiation fields. There was no significant difference among the various radiation doses.
2) Experimentally, pulmonary radiation injuries were observed in 94% of X-irradiated mice. (unilateral lung field, 3000R, once a week, 3 weeks). Histological evaluation revealed no significant difference in pulmonary injury between the D. S.-treated group and control.

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In order to investigate the diagnostic significance of CEA in lung cancer, plasma CEA levels were determined on 56 cases of primary lung cancer, 16 cases of metastatic lung cancer, 8 cases of other organ cancers, 12 cases of leukemia, 124 cases of benign disease including pulmonary tuberculosis and 56 healthy persons. PHA skin reaction was also tested in totally 74 cases of various diseases concerning primary lung cancer and affiliated patients. Testing was performed in the following methods in CEA by Roche kit and in PHA skin reaction by Difco's Bacto-PHA-P. The results obtained were as follows:
1) CEA positivity was defined as ≥5.1ng/ml. Positive rate in primary lung cancer was 71.4%, metastatic lung cancer 56.3%, cancer in other organs 50%, contrariwise in leukemia wholly negative in 12 cases. However, pulmonary tuberculosis was 2.1%, other pulmonary diseases 13.9%, other benign diseases 9.5% and 5.5% in healthy persons.
2. In different histological types of primary lung cancer, 84% was positive in adenocarcinoma, 80% in small cell carcinoma and 55.6% in epidermoid carcinoma.
3. On classification of UICC stage, positivity in stage I 20% and stage II 22.2% were rather low, but elevated in stage III 88.1%.
4. Referring to improved cases the CEA levels declined low mostly, whereas in progressive cases the CEA rose high generally.
5. In cancerous pleural effusion fluid 80% were CEA positive but all non-cancerous cases were negative.
6. In primary lung cancer, PHA skin reaction was weak compared with non-cancerous ones and healthy persons, and in most cases it whoed below 20mm average diameter of erythema, and in accordance with the progrese of disease, the reactivity decreased.
7. CEA was not always useful for screening test of lung cancer, but it was available for differentiation between lung cancer and benign pulmonary diseases and estimation of progress of lung cancer.
8. PHA skin test was a simple test of the cellular immunity of cancer patients Combination of CEA test and PHA skin test was better for the diagnosis of lung cancer than the CEA test alone.

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The authors have developed a new special needle for transbronchofiberscopic aspiration biopsy in cases of lesions growing extrabronchially, especially in the hilum. The entire catheter with the needle extended is 111, 05cm in length, and the needle is 0.8cm in length with a width of 0.6mm and the angle of the needle tip bevel was set at 15°. When the bronchofiberscope reaches the target the catheter is inserted through the instrument channel of the Olympus BF-B2 or BF-B3 bronchofiberscope, and the needle is projected from the tip of the fiberscope and inserted into the lesion through the bronchial wall. In three cases of pulmonary disease which were not diagnosed by ordinary bronchofiberscopic procedures, transbronchofiberscopic needle aspiration biopsy was performed and yielded difinitive diagnosis in each case. Lung cancer and tuberculosis of the broncho-pulmonary lymph node were diagnosed in two cases which showed a well-defined nodule in the hilar region, and another case of lung cancer in right S2 was also diagnosed by this method.

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We operated on 3 cases of broncholithiasis and present the results herein. All of them manifested recurrent massive hemoptysis and underwent lobectomy. One of them needed transfusion before operation because of severe anemia due to hemoptysis.
One originated from calcified lymphnodes which travelled into the bronchus. The second one was from ossified bronchial cartilage and the last one was born in the sea of pooled secretion in the cystic bronchial space.
Broncholithiasis is generally beliveed to be a rare disease but if we condiser this diasese as a possibility in cases of recurrent massive hemoptysis, it can be found more frequently.

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A 29-year-old female was admitted to our hospital with a skin eruption on January, 1977. She had had several hospital admissions for systemic lupus erythematodes and had been managed on a maintenance dose of prednisolone (20mg/day) since 1974. On this admission, a diagnosis of Psoriasis pustulosa was made with regard to the skin eruption and she was given methotrexate intramuscularly 5mg twice per week for the next two months, resulting in gradual disappearance of the skin eruption. In the middle of May, 1977, she developed a nonproductive cough, fatigue, temperature of 39°C and dyspnea. A chest roentgenogram revealed diffuse micronodular infiltrates bilaterally.
The arterial oxygen tension while breathing ambient air was found to be 35.9mmHg. The white blood cell count was 21000 with a normal differential count. Repeated sputum cultures were negative for bacteria and fungi. She became gradually more dyspneic and a chest roentgenogram showed an increase in the amount of infiltrates. As the possibility of methotrexate induced pneumonitis was considered highly probable, the methotrexate therapy was discontinued. The total dose of methotrexate received was 100mg. The prednisolone was increased to a dose of 80mg/day, followed by symptomatic improvement within ten days. Thereafter serial chest roentgenogram and blood gases improved and returned to normal after two months. An attempt was made to reduce the dose of prednisolone without exacerbation of symptoms and after 4 months the prednisolone was maintained at a dose of 20mg/day for systemic lupus erythematodes.

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This is a report of a 62-year-old farmer with a history of asthmatic attack following therapy for bronchial asthma with Hydrocortone Phosphate Injection. It contains hydrocortisone disodium phosphate and diluents.
He has had episodes of dyspnea since 1974, and has been treated with oral bronchodilaters and intermittent corticosteroids (dexamethasone). In 1976, he was treated with triamcinolone acetonide and hydrocortisone sodium hemisuccinate (Solu-Cortef or Saxison). Skin test to 20 antigens were negative. In 1976, he was admitted to Haramachi Red Cross Hospital for treatment of acute bronchial asthma. On August 1st, he was orthopnoeic and slightly cyanosed, so he was given 200mg of Hydrocortone Phosphate Injection intravenously. About 5 minutes after administration, a severe asthamtic attack occurred. To confirm the suspected relationship between the drugs and asthmatic attack, provocation challenge tests with Hydrocortone Phosphate Injection and other corticosteroid products. were made Intravenous challenge with 100mg of Hydrocortone Phosphate Injection produced dramatic confirmation of his history. But intravenous challenge with 100mg of Solu-Cortef, 6mg of dexamethasone disodium phosphate (Decadron Injection), 30mg of prednisolone disodium phosphate (Betnesol Injection) and 30mg of prednisolone sodium hemisuccinate (Predonine Soluble) and oral challenge test with 100mg of hydrocortisone (Hydrocortone Tablet) and 28mg methylprednisolone (Medrol Medulus) produced no adverse reactions. Skin tests using crude hydrocortisone disodium phosphate was negative and skin tests using its diluent were idiosyncratically positive. But on passive cutaneous anaphylaxy test using the skin of Japanese monkey, hydrocortisone disodium phosphate is positive and the diluent is negative. This type of adverse reaction of hydrocortisone administration is very important to clinical allergists, although the mechanism of this asthmatic attack was not clarified.

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73才男性. 徐々に進行する呼吸困難と経過中に出現した胸部常異影を主訴として入院, 呼吸困難以外自覚症状はなかったが, 血液ガス, 心電図. 胸部X線所見から本症を疑い, 肺血流および吸入シンチグラム, 肺血管造影にて多発性肺塞栓症と診断した. 本例の原因は不明であるが, 肺血管内血栓が疑われた.

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