Elastin metabolism in lung during elastase induced emphysema was investigated.
Emphysema was developed in mature male hamsters by a single intratracheal injection of 25 Units of porcine pancreatic elastase. Incorporation of proline-¹⁴C into lung elastin and lysine-¹⁴C into lung desmosines, dilution of pre-labeled lung elastin in which hamsters were pre-labeled by proline-³H by cold newly synthesized elastin and content of elastin were studied in elastase-treated hamsters. These experiments were compared with control (saline injected) hamsters.
The incorporation of radioactive amino acids into elastin and desmosines increased markedly during the 30 days, especially at 18 days after the elastase injection. The content of elastin per lung shortly decreased on the 3rd day and then increased in the 18th day after the elastase injury.
Mature elastin has been considered a biologically stable and metabolically inert substance. However, after the injection of elastase, the synthesis of elastin was accelerated, at least for the 30 days observed.
Finally, discussions of the relationship between lung elastin metabolism and morphological and functional changes in emphysematous lung are presented.

抄録全体を表示

Sixteen cases, considered to be diffuse interstitial pneumonia or fibrosis, were examined. Nine were male and seven were female. The patient's ages ranged from 12 to 75 years. Autopsies were carried out in 12 cases, open lung biopsy in 6 cases, including 3 cases of both biopsy and autopsy, and lobectomy in 1 case. Ferruginous bodies wewe examined, using Smith's method in the lungs of 13 cases.
Pathological findings in relation to radiological findings were classified into the following 6 types.
1. Usual interstitial pneumonia (4 cases). Diffuse cellulo-fibrous thickening of alveolar walls with final honeycomb appearance, representing diffuse reticulo-nodular shadows and decreased lung volume on chest X-ray. Progressive course observed all cases.
2. Desquamative interstitial pneumonia (1 case). Prominent intra-alveolar accumulation of PAS positive large mononuclear cells, a small amount of interstitial and intra-alveolar eosinophilic leukocytes and various amounts of fibrosis of alveolar walls, for former correlating with characteristic, slowly progressive, X-ray shadow.
3. Peribronchiolar interstitial type (1 case). Peribronchiolar interstitial fibrosis and organization of intra-alveolar exudation. Patchy or miliary shadows without decreased of lung volume on chest X-ray, showing no progression during 8 years.
4. Multiple focal fibrosis type (2 cases). Fairly well circumscribed fibrosis resulted from diffuse thickning of alveolar walls as well as organization of intra-alveolar hyalinous exudate. Disseminated patchy or miliary shadows with slight or no decrease of lung volume, slowly progressive.
5. Type accompanied by emphysematous changes (5 cases). Emphysematous or atypical honeycombing, showing larger air spaces and thinner walls than ordinary honeycombing, resulted from peribronchiolar alveolar fibrosis and probaly obstructive change. Ring shadows without decrease of lung volume on chest X-ray, seen. Rather static in the clinical course. 6. Mixed type (3 cases). Mixed findings of types 3 and 5. It was a remarkable that lung cancer was present in 3 of 5 cases of type 5, while no lung cancer was found in other types, and cases other than UIP constituted the majority of interstitial fibrosis cases. Ferruginous bodies were found in 2 of 5 cases in type 5, 1 of 3 cases in type 6 but none in other types.
Although intra-alveolar exudation and organization were ordinary phenomena in type 3, 4, 5 and 6, the amounts, nature and consequences of these exudatcs differed from those of chronic bacterial pneumonia, thus justifying these types to be classified as interstitial pneumonia or fibrosis.

抄録全体を表示

Relationships between airway lesions and pulmonary function were examined in forty-three patients with bronchial asthma with or without complications. The figure of airways and alveoli in asthma was examined by selective alveolo-bronchography (SAB). Spastic narrowing and stenosis at bifurcations were characteristic of asthma and these findings were more remarkable in the central airways than in the peripheral airways. Various pulmonary function tests-spirogram, flow-volume curve, closing volume, respiratory resistance-were performed soon after examining SAB. The degree of spastic narrowing and stenosis at bifurcations correlated well with FVC, FEV_1.0 and V₅₀. These three parameters seemed to be useful in deciding the severity of asthma. The value of these parameters were lower in cases complicated with chronic inflammations and pulmonary emphysema.
The degree of these bronchial findings showed a tendency to correlate with MMF and V₂₅. As MMF and V₂₅ values were low in asthmatics with severe lesions in the central airways, these were thought not to reflect the disorder of the peripheral airway alone.
There was no correlation between bronchial changes and CV/VC(%). Closing Volume, however, seemed to be an indicative test. CV/VC(%) value was abnormal and the slope of phase III (alveolar plateau) was slanting in most of the cases.
The respiratory impedance by 3Hz oscillation technique was not correlative with severity of bronchial lesions, but it showed over 3cmH₂O/1tr/sec in most of the cases and this test seemed to be appropriate for screening.

抄録全体を表示

The present study was designed to systematize the patterns of cardio-pulmonary impairment caused by diffuse interstitial fibrosing pneumonitis. Forty mature rabbits were used. Thirty-five rabbits were repeatedly injected with 2mg/kg of body weight of N-methyl-N-nitrosourethane (MNU) for two weeks intravenously. After the administration of MNU several degrees of the interstitial fibrosing pneumonitis were obtained.
The changes in pulmonary ventilation, the impairment of alveolar gas exchange and the hemodynamic findings were investigated comparing with the morphologic findings of the lung.
Conclusions were as follows.
1) Morphologic findings in lungs; Two weeks after the initial injection of MNU the lung-weight of rabbits was increased and the alveolar walls were diffusely thickened by capillary congestion and intraseptal edema with some grades of neutrophilic cell infiltration.
From four weeks after the injection such acute infiltrations were less prominent and the weight of lungs was decreased, but the alveolar walls were slightly and unevenly thickened with some quantity of collagen fibers. After more than twelve weeks the fibrosing on the walls was highly advanced. In several places, alveolar spaces shrunk and were destroyed by the proliferation of the collagen fibers. The weight of lungs increased again but neither necrosis nor significant intraalveolar exudate was seen in any sections. These findings were divided into following three stages.
Stage 1: Acute infiltrative pneumonitis.
Stage 2: Minimal and/or moderately advanced fibrosing pneumonitis. (proliferating of fibrosis)
Stage 3: Far-advanced fibrosing pneumonitis with destroyed alveoli.
2) The values of the lung-compliance were decreased markedly in the stage of acute infiltrative pneumonitis and in the stage of far-advanced fibrosing pneumonitis.
3) The values of arterial P_O2 decreased in relation with increasing the weight of lungs. During inspiration with pure oxygen for thirty minutes, the values of arterial P_O2 in stage minimal or moderately advanced pneumonitis rose to the same level as in normal lungs. In the stages of acute infiltrative pneumonitis and far-advanced fibrosing pneumonitis, however, the values of arterial P_O2 remained less than 350mmHg in spite of inhalation with pure oxygen. From aboves, the impairment of alveolar gas diffusion or the inequality of ventilation-perfusion ratio was suggested the cause of hypoxemia in the former. In the latter the increase in venous-to-arterial true shunt was the most important factor of hypoxemia.
4) In the majority of MNU-treated rabbits the right ventricular systolic pressure increased in relation with the decrease in the values of arterial P_O2. The right ventricular walls were increased in weight, and myocardial fibers on the right side were also thickened with the continuation of higher systolic pressure.

抄録全体を表示

In a previous report on the simulation of the Velcro rale using a mathematical model we postulated that stiffening of the lung tissue was closely related to the production of the rale. In this study, the acoustic analysis of the rales heard in 6 patients with cryptogenic fibrosing alveolitis and 7 patients with pulmonary fibrosis due to collagen disease was undertaken using a sound spectrogram.
Each spike wave, components of the rale, was as certained to be composed of several resonant sounds by sound spectrogram. Therefore, a resonator theory similar to that of Helmholtz was applied to calculate each frequency of the resonant sounds in any partial lung volume of certain lung levels, and it was supposed that a wave of 1000-2000Hz, for example, was produced from the lung units of bronchiole to terminal bronchiole level. On the other hand, the so called moist rale heard in pneumonia had explosive sound acoustic characteristics, completely different from the Velcro rale.
After the calculations from postulated size in various elements of the lung, the refractory period of around 0.2-0.3 second seen at the beginning of inspiratory phase was considered to be the time required to fill the first lung unit by air until the wall of the unit reached a certain tension to produce the rale.
The meaning of the spike to spike time observed around 0.02-0.04 second was clarified by mathematical analysis. However, it was seen that inspiratory air flow was relatively related to spike to spike time and the size of spike wave.
As a result, these findings may suggest that the alveolar wall theory is supported, and that Velcro rale is heard not only in cryptogenic fibrosing alveolitis but in certain other pathologic conditions.

抄録全体を表示

Asthma is a clinical syndrome manifested by reversible and intermittent obstruction of the bronchi.
The reported incidence of aspirin-induced asthma varies from 2.3 to 20.0% and is the highest of all drug-induced asthma. Nevertheless the etiology of aspirin-induced asthma is unknown.
We suggested that contractile responses of guinea pig tracheal tissues with histamine, serotonin, prostaglandin F_2α and bradykinin were increased with continuous infusion of aspirin, continuing to increase with larger doses of aspirin.
The present investigation was conducted to explore the effect of aspirin on the relaxation of guinea pig tracheal tissues with various bronchodilators.
Male guinea pigs, weighing 250-300g, were killed. Guinea pig tracheal tissues were removed and suspended in bioassay glass jackets and superfused with Krebs-Henseleit solution at 37°C, saturated with oxygen and carbon dioxide (95:5, v/v).
Relaxation of tissues was detected by an isotonic transducer and displayed on a polyrecorder.
1) Bronchodilating effects of isoproterenol and salbutamol were increased with continuous infusion of aspirin at a dose of 5×10^-8M and decreased dose-dependently with increasing doses of aspirin.
2) Bronchodilating effects of adrenaline, aminophylline and prostaglandin E₂ markedly decreased with continuous infusion of aspirin, and became even smaller by increasing the dose of aspirin.
3) These results suggest that aspirin has an attenuating effect on the actions of bronchodilators, besides a potentiating effect on the action of bronchoconstrictors, and that such a mechanism may play an important role in the pathophysiological aspects of aspirin-induced asthma.

抄録全体を表示

We experienced a thirty year old male with continued cough after cold like symptoms since the end of 1971 and complained of exertional dyspnea after several months and developed pneumothorax after about four years.
On admission to our clinic, chest x-ray showed unusual confluent massive shadows in the bilateral middle lung fields and bronchoscopical investigation showed endobronchial nodular growths, confirmed histologically as sarcoidosis.
Arterial blood gas analysis showed moderate hypoxemia, and lung function study showed moderate restrictive as well as obstructive ventilatory impairment with marked reduction of diffusing capacity.
A few months after corticosteroid therapy, most of the confluent massive shadows were absorbed and replaced by reticulo-nodular shoadows. Accordingly there was moderate improvement of restrictive impairment and hypoxemia as well as of symptoms.
We think, at present, that this case is an unusual roentgenological manifestation of sarcoidosis and that it is necessary to follow his clinical features, including chest x-ray, lung function and results of immunological studies.

抄録全体を表示

65才男. 肺癌―小細胞性未分化癌―の全身転移例で, 入院後より放射線療法および抗癌剤とステロイドを投与し, 続発性免疫不全が考えられたので Levamisole を併用した. 一旦原発巣の縮小が認められたが, 約3カ月後より咳嗽, 微熱が現れ次第に増強し, 誤嚥による窒息が直接死因となった. 剖検により肺癌の全身転移と, 左上葉の Pneumocystis carinii 肺炎を認めた.

抄録全体を表示