Coagulation and fibrinolysis display important roles in various physiologic and pathologic conditions linked closely with kallikrein-kinin and complement systems and also with prostaglandin metabolism.
In this report, much emphasis is given to the pathophysiological significance and contributions of this system to the pathogenesis of pulmonary thromboembolism, disseminated intravascular coagulation syndrome, generalized Shwartzman reaction, experimental pneumonitis induced by anti-lung antibody, monocrotalin induced pulmonary hypertension, lung edema due to endotoxin and metastasis of lung cancer.
Recently, the frequent occurence of pulmonary thromboembolism has been widely recognized and we observed thrombi or thromboemboli in pulmonary arteries in 41.6% among autopsy cases aged 40 years or older. Although the effects of thrombolytic therapy are still controversial, a clear understanding of the thrombolytic process enables the clinicians to use thrombolytic agents more effectively. Using human artificial thrombi by the Chandler loop, we disclosed that urokinase itself activates directly plasminogen to plasmin on the fibrin threads in thrombi, a consequence of which causes thrombolytis. Based on these results, a larger dose of urokinase is recommended for thrombolytic therapy. The important role of plasminogen tissue activator of vascular endothelium is also emphasized.
The etiology of DIC was investigated in terms of the generalized Shwartzman reaction ultrastructually and it was revealed that infiltration and destruction of granulocytes in pulmonary vessels followed by release of procoagulant were the initial events in pulmonary vascular damage.
In experimental pneumonitis induced by anti-rat lung antibody, intravascular coagulation secondary to antigen antibody reaction in pulmonary capillary basement membrane contributes to the initiation of this disease.
Intravascular coagulation also contributes to the development of monocrotalin-induced pulmonary hypertension and pulmonary edema due to endotoxin. Emphasis is given here especially to the action of degradation products of fibrinogen and fibrin. Both fragments D and E are shown to have permeability-increasing activity in the pulmonary vascular bed. Even lower molecular weight degradation products of fibrin have a strong enhancing effect on vascular permeability.
Thromboplastic and fibrinolysic activities of tumor cells themselves are considered to be important factors in hematogenous metastasis. From the experimental observations it was concluded that the inhibition of coagulation and platelet aggregation and enhancement of fibrinolysis are recommended as a useful treatment for prevention of metastasis.
It is hoped that much information will be found in this report to achieve a better appreciation of the recent progress in the field of coagulation and fibrinolysis and of the etiology of various lung diseases so that a better clinical application of anticoagulant and thrombolytic therapy could be accomplished.

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Alveolar macrophages and lung lavage fluids were obtained from adult and neonatal rabbit lungs by tracheo- bronchial lavage. The alveolar macrophages were assayed for nitrobluetetrazolium (NBT) reduction and superoxide production with or without lung lavage fluids which contained alveolar lining materials. When alveolar macrophages were exposed to lung lavage fluids from adult rabbits, enhanced NBT reduction and superoxide production were observed. The amount of NBT reduction and superoxide produced by neonatal alveolar macrophages was, however, less than one-fourth of that produced by adult alveolar macrophages.
The difference of superoxide production between adult and neonatal alveolar macrophages could not be explained only by the difference of IgG receptors on the surface of cells. No difference was found in the NAD (P) H oxidase activity of the postnuclear fractions obtained from adult and neonatal alveolar macrophages. Moreover, the postnuclear fractions from the alveolar macrophages which were stimulated with the adult lung lavage fluids showed the same activity of NAD(P) H oxidase as those of control alveolar macrophages.
Neonatal alveolar macrophages showed decreased activity of lysosomal and mitochondrial enzymes as compared to adult alveolar macrophages.
These results suggest the functional immaturity of neonatal alveolar macrophages.
The lung lavage fluids from neonatal rabbits which contained less IgG and more phospholipids had no effect on the superoxide production by both adult and neonatal alveolar macrophages. Thus, neonates showed immaturity of both alveolar macrophages and alveolar lining materials. These results may explain the frequent and serious infections of the lung in human neonates.

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Percutaneous needle biopsy has been demonstrated to be a useful tool for the diagnosis of lung cancer. Evaluation of this procedure for benign lung diseases was studied.
Fifty-three resected non-cancerous lesions were examined by percutaneous needle biopsy preoperatively. Most of the benign tumors, especially hamartomas and sclerosing hemangiomas, were diagnosed. The cytological criteria of both tumors were discussed. In the case of inflammatory diseases, such as tuberculosis and mycosis, specific organisms and several cytological informations contributed greatly to diagnesis. A few complications, pneumothorax and bloody sputum, were observed but none was serious.

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Change of arterial blood gas on supine (SUP), right lateral decubitus (RLD), and left lateral decubitus (LLD) position was evaluated in 19 normal young volunteers (age, 23.2±1.2) and 91 hospitalized patients with lung disease. According to roentgenographic findings the 91 patients were divided into 3 groups; right-sided disease and left-sided disease groups with disease predominantly confined to one lung or hemithorax, and a bilateral disease group with equal distribution to both lung fields. Arterial blood gas was analyzed 15 minutes after a new position under room air. PaO₂ value was corrected when PaCO₂ value reached 40 torr. In several patients, ventilation was investigated in terms of impedance pneumography and ¹³³Xe inhalation scan, and perfusion by ^99mTc-MAA perfusion scan.
In ipsilateral disease groups, PaO₂ values were significantly different RLD and LLD position. Eventually PaO₂ values improved when the healthy lung was dependent. This is due to decrease of low V_A/Q parts of the sick lung lying on the healthy lung resulting preferential redistribution into healthy lung and reduction in the sick lung, of pulmonary blood flow. When the lesion in ipsilateral disease disappeared, the difference between RLD and LLD position became insignificant. In normal subjects and the bilateral disease group, no significant difference was found.
From these results it is suggested that change of body position is significant to mantain pertinent V_A/Q matching besides expectoration of secretion from airways, and that this is therapeutically helpful to improve low PaO₂ values especially in patients with ipsilateral pulmonary lesions.

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Diffuse interstitial fibrosis of the lung of unknown etiology was studied in cases detected in mass surveys and at autopsiy throughout Japan to clarify the epidemiological features of the disease.
1) Cases showing bilateral diffuse fibrous shadows were selected from 1978 mass survey chest X-ray films, excluding the following cases: Cases suspected to have COPD due to the presence of long-standing sputum and/or abnormal FEV 1.0%, cases with a history of pneumoconiosis and the cases with collagen disease. The remaining cases were considered to haves idiopathic diffuse interstitial fibrosis.
The age and sex distribution of these cases showed high prevalence in the age group older than 50 years, showing a peak in 80 and male incidence was around 10 times that of females (Table 1).
The prevalence was highest in Nagano, Okayama and Ehime prefectures, and it was a striking fact that the highest prevalence was found in rural areas, the lowest incidence was observed in the large cities and other cities showed intermediate values. Significant difference was detected statistically between prevalence in the rural and the combined urban areas (Table 3). The follow up study carried out on 27 cases one year later, revealed increase of the shadow in 5 cases and appearance of lung cancer in 2 cases.
2) Autopsy records collected from throughout Japan during the period from 1975 to 1977 were analyzed. Age and sex distribution of the autopsy cases which were diagnosed as idiopathic diffuse interstitial pneumonia and fibrosis of the lung were somewhat different from those found in mass surveys, showing younger age distribution and more frequent female incidence. This difference was suspected to be partly due to the predominance of young and female cases in the acute and subacute cases which were included in the autopsy series (Table 5). The rate of idiopathic interstitial fibrosis of the lung per 10, 000 autopsies in each district demonstrated higher rates in Hokuriku, Chugoku and Koshinetsu districts, 8.8, 7.5 and 5.7 respectively, than the average rate in Japan, 4.4, and presumed rate of the death per 100, 000 population in each district showed similar tendencies (Table 6). The rate of the disease per 10, 000 autopsy in the 10 largest cities showed 3.7, in the other cities, 4.9 and in the rural area, 5.7, showing significant difference (P<0.05) between the largest cities and rural ares. The rates per 100, 000 population were 1.9, 2.8 and 4.8 respectively (Table 7).
It can be concluded that there are more cases of idiopathic diffuse interstitial fibrosis of the lung in rural than in the urban areas, showing the necessity of further epidemiological studies on this problem.

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It has been reported that diffusing capacity is one of the most useful indices of pulmonary damage in sarcoidosis.
This paper reports sequential changes of diffusing capacity (single breath method) following corticosteroid therapy in sarcoidosis.
1) D_LCO, D_LCO/V_A, TLC, FEV_1.0%, V-V curve, and A-aD_O2 measured in 30 patients before treatment were within normal limits, except A-aD_O2 showed a slight tendency to widen.
2) D_LCO, D_LCO/V_A showed a significant decrement after 2-6 months corticosteroid therapy in 16 patients despite of clinical improvements.
3) On the other hand, other pulmonary function tests did not show significant changes statistically.
4) The decrement of diffusing capacity observed by corticosteroid therapy was due to so-called “permeability disturbance”. The mechanism is discussed.

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This paper presents a rare case of pancreatic cyst with amylase rich left hemothorax which occured subsequently to right hydropneumothorax. After 6 months hospitalization, a 53-year-old male with right hydropneumothorax, probably due to repeated thoracentesis for intractable pleural effusion, was referred to the first Department of Surgery, Teikyo University Hospital. Closed tube drainage was carried out for one week, however lung re-expansion did not seem probable because of thickened pleural peel. In this particular case, therefore, decortication was performed. The postoperative course was uneventful and he was discharged one and a half months after surgery. However, he was hospitalized again about 3.5 months after the initial surgery due to dyspnea. Chest X-ray films and thoracentesis revealed left hemothorax. A pancreaticopleural fistula was strongly suspected because pleural hemorrhagic effusion contained high amylase in comparison to serum amylase level. With repeated cytological studies of pleural effusion, hypotonic duodenography, ERCP, selective angiography and CT scan, the diagnosis of pancreatiocopleural fistula due to carcinoma or cyst of the pancreas was made and the patient consented to undergo a second surgical procedure. No malignant lesion was noted macroscopically. Moreover, a definite sinus tract between pancreas and pleural cavity was obscured, but several-cord like substances were noted between the two. A resection of the tail of the pancreas including the cyst and cord like substances associated with tube drainage for left hemothorax was carried out in the second surgical procedure. The hemothorax findindings rapidly disappeared after surgery and the patient is now leading normal life. Unfortunately, the amylase level of the right thoracic effusion which was seen on the occasion of the first hospitalization was not analyzed, however, it might also be attributable to the pancreaticopleural fistula, from the aspects of clinical course, thoracotomy findings and review of the literature.

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46才男性. 定期健康診断の胸部X線検査で縦隔腫瘍が発見され, 切除標本の病理学的検索により Castleman リンパ腫と診断された. 血中ガンマグロブリン値が上昇しており, 術後1カ月で正常値へと改善した. 免疫蛍光抗体法により, 切除リンパ節の形質細胞中に多量のIgGの存在を確認し, ガンマグロブリンが腫大したリンパ節より血中に分泌されていることが示唆された.

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