We studied the bronchial reactivity of six adult healthy male volunteers to inhaled acetylcholine (Ach) aerosol after 2-hour exposure to 0.3ppm ozone (O₃) and 0.3ppm sulfur dioxide (SO₂) alone and in combination. Three of the subjects showed small but significant decrease of specific airway conductance (Gaw/Vtg) after either of these exposures in comparison with control measurements. The bronchial response to inhalation of one of four concentrations of Ach aerosol immediately after exposure to these gases was significantly greater than the response in controls, among four of the subjects in O₃ exposure, two of the subjects in SO₂ exposure, and three of the subjects in the O₃+SO₂ mixture exposure. The degree of the response was relatively great after O₃ exposure, but was decreased rather than enhanced by exposure to the O₃+SO₂ mixture. The mechanism of the decreased reactivity to inhaled Ach aerosol after exposure to the O₃+SO₂ mixture was not clear, although the enhanced effect on pulmonary function was usually predictably greater after exposure to the O₃+SO₂ mixture in comparison with the exposure to each gas alone.

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For the measurement and monitoring of ventilation in cases of severe respiratory failure, it is not only frequently impossible to equip patients with a mouthpiece or face mask for long duration but is also often uncomfortable.
The capacitance pneumograph is a noninvasive device to measure the ventilation by means of electrical detection of capacitane change between the body surface and the fixed electrode during respiration. Changes in capacitance during respiratory movement are detected by the balance change in the capacitance bridge. The capacitance bridge is constructed with three fixed capacitors (each 500 PF) and one variable capacitor between the fixed electrode and the body surface. The capacitance bridge circuit is applied with 5KHz, 30VP-P sin wave. Changes in amplitude of sin wave due to the respiration are amplified and then recorded after the low pass filter.
Theoretical valuea of capacitance change with ventilation calculated from the simple corrected parallel plate model is about 24% below that of directly measured capacitance.
The comparison between the output of a Benedict Roth spirometer and that of the capacitance pneumograph demonstrates fairly good linear correlation (γ>0.98) when electrode distances of 25, 35, 40 and 50cm.
Long duration respiratory monitoring with the capacitance pneumograph is also possible by equipping the expiratory level fixing amplifier.
The problem of this type of equipment for respirometry is the possible misreading of the volume below FRC in some patients which can be caused partially by bending the body toward the fixed electrode at expiration below FRC.
The calibration protocol is also a problem. Therefore, the capacitance output has to be calibrated with a conventional respirometory method at the beginning of the measurement for each subject.
At present, however, the capacitance pneumograph is a usefull device for respiratory monitoring of patients under respiratory care and also for spirometry with patients who cannot be equipped with the mouthpiece or the face mask.

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As a pathogenic microorganism of respiratory infection Serratia has become important in recent years. In this report the clinical significance of Serratia isolation from supta of the patients with respiratory diseases in Tokyo Teishin Hospital was described.
1) During the five years from January, 1974 to December, 1978 a total of 69 isolates of Serratia were obtained from 28 patients with respiratory diseases. In the last two years the incidence of Serratia isolation particulary increased.
2) As underlying diseases, chronic obstructive pulmonary disease was recognized most frequently, followed by lung cancer, pneumonia and bronchiectasis.
3) Aggravation of roentgenological and laboratory findings of inflammation were noted in 7 patients.
4) Six patients showed clinical superinfection. All of them had severe underlying diseases and impaired host resistance.
5) Prominant antibiotics administered before the isolation of Serratia were cephalosporin and broad spectrum penicillin.
6) Half of the 28 patients had received medical treatment like nebulization, bronchoscopy, bronchography, endotracheal anesthesia, tracheotomy. It is important to keep in mind that usage of medical instrumentation in respiratory care has been responsible for the nosocomial infection.

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Immunofluorescent studies were performed using rabbit immunoglobulins for Pseudomonas aeruginosa (Toshiba, Japan) and fluorescein-conjugated anti-rabbit immunoglobulins of sheep origin (Wellcome, England).
Thirty-seven patients with clinical signs and symptoms of terminal pneumonia were studied. Pseudomonas aeruginosa (Ps. aeruginosa) had been isolated from the lung or cardiac blood of all patients at autopsy.
Twenty-four of the 37 cases were diagnosed as pathological pneumonia based on inflammatory cell infiltration in the alveolar spaces of the lung. Of these 24 patients, Ps. aeruginosa was detected in the lung tissue by the immunofluorescent antibody technique in 15.
These latter cases fulfilling both the conditions of having pathological pneumonia and positive signs of Ps. aeruginosa in the lung tissue are referred to as “Pseudomonal pneumonia” in this paper.
Ps. aeruginosa was also detected in three cases which did not have pathological pneumonia. In these cases, peripheral lymphocyte and neutrocyte counts at the terminal stage of the disease were extremely low, indicating that pathological pneumonia was not present.
In the 18 cases in which Ps. aeruginosa was detected in the lung, there was a high incidence of pathological findings including bronchiolitis (50.0%), alveolar septum destruction (66.7%), vascular changes (61.1%), angitis (11.1%) and bleeding (44.4%) in comparison to the remaining 19 cases.
There were 7 cases in which Ps. aeruginosa was isolated from both lung and cardiac blood at autopsy, and in 6 out of these 7 cases, Ps. aeruginosa was detected in the lung tissue by the immunofluorescent antibody techniq ue. It is therefore necessary to examine both to order to confirm the bacteriological diagnosis at autopsy.
Experimental pneumonia was studied following different challenge doses of Ps. aeruginosa in rats and rabbits. Large challenge doses (8×10⁹/ml) of Ps. aeruginosa administered by transbronchial inoculation in rats produced pathological findings very similar to those observed clinically. The increase in the number of Ps. aeruginosa in the lung was proportional to the changes in pathological findings.
The detection of Ps. aeruginosa around the vessels was obtained soon after challenge (6 hours later), and bleeding was observed after 9 hours.
Small challenge doses (6×10⁷/ml) of Ps. aeruginosa in rabbits produced delayed pathological changes in the lung and curing stage could be observed.
In spite of the decreasing number of Ps. aeruginosa in the lung, pathological findings such as alveolar septum destruction, angitis or inflammatory cell infiltration in the alveolar spaces were severe. The occurence of bleeding might be induced by the direct vascular infiltration of Ps. aeruginosa.
Endotoxin titer was also tested and increased in spite of the decreasing numbers of Ps. aeruginosa in the lung.
Based on these results, it can be assumed the pathological features, due to Ps. aeruginosa except for bleeding, were caused by the presence of endotoxins and other elements.

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Clinical investigations were conducted to compare the bronchial hypersensitivity of normal volunteers and asthmatic patients after administering prostaglandin F_2α (PGF_2α) and acetylcholine by inhalation.
1) The mean threshold value of PGF_2α was 2550.5ng/ml in asthmatic patients and 500μg/ml or more in normal volunteers, and there was a highly significant difference.
2) There was no correlation between the threshold values of acetylcholine and PGF_2α in the same patients.
3) There was a tendency for the threshold value of PGF_2α tobe high in mild cases and low in moderate cases.
4) There was neither correlation between the threshold values of PGF_2α and the duration of asthmatic attacks, nor between those and the duration of desensitization therapy.
5) The percent recovery of R.R., FEV_1.0, P.F., V₂₅ and V₅₀ 20 minutes after the inhalation of threshold doses of PGF_2α were 31.0% 60.3%, 44.7%, 40.7% and 43.7%, respectively.
6) In normal volunteers the plasma level of cAMP showed transient increase 5 minutes after the in-halation of PGF_2α, while that of cGMP did not show any significant change.
7) In asthmatic patients the plasma level of both cAMP and cGMP showed gradual increase for 20 minutes after the inhalation of PGF_2α.
8) The above results may suggest that the PGF_2α provocation test is useful for the diagnosis of bronchal asthma.

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In recent years, secondary pulmonary cryptococcosis has not only developed in immunosuppressive conditions, but also primary case have been increasingly reported. During the past two years we experienced two cases of primary pulmonary cryptococcosis which were diagnosed by transbronchial lung biopsy.
A 73-year-old female, farmer, was admitted to our department because of abnormal shadows on chest roentgenogram without any subjective symptom on January 1977. Chest roentgenogram taken on admission revealed a solitary dense mass, 3.5×4.5cm in size with a slightly irregular margin in the right upper lung field. Air-bronchograms were seen in the tomograms. On February 1977, surgical resection was carried out after confirmation of diagnosis of cryptococcosis by transbronchial biopsy.
An 18-year-old male student was referred to our department because of an abnormal shadow on chest roentgenogram taken in a routine medical examination on university entrance in May 1979. He was asymptomatic. Chest roentgenogram on admission showed an infiltrative lesion, about 5cm in diameter with cavitation accompanied by slightly irregular walls. Diagnosis was made by transbronchial biopsy from the right B⁹a. He was given 600mg miconazole per day intravenously for 17 days, then 6 grams 5-FC orally per day until the present. The pulmonary lesion has become smaller.
It seems very important to immediately obtain material from the affected area transbronchially without hesitation for the early diagnosis of cryptococcosis because of the difficulty in treating this disease.

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A case of lung cancer with prolonged pleural effusion after pneumonectomy was presented. He was found to have a shadow 3×4cm. in size in the left lung field. Left pneumonectomy was performed on June 2, 1972, because of many swollen lymph nodes in the mediastinum. About 500ml. of bloody pleural effusion was removed once after a few months by means of thoracentesis after surgery, but a large amount of pleural effusion has remained for the past seven years. The reason why the pleural effusion did not disappear was not clear.
Pathological examination of hilar lymph nodes revealed non-caseating epithelioid cell granuloma without metastasis. However, clinical examination did not reveal evidence of generalized sarcoidosis, and the Kveim test was also negative.
Sarcoid-like lesions had been observed within malignant tumors and in the related regional lymphatics draining the primary neoplasm. Sarcoid-like lesion may be a type of tissue response indicating resistance of the body, and in this case, resistance to malignant tumors.

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A 45 year-old male who had had recurrent epigastralgia and hemoptysis suddenly expectorated biliary fluid. He had suffered from right hypochondralgia at age 5, had cholecystectomy at 29 and papilloplasty at 31.
On Nov. 11, 1978, thoraco-abdominal exploration was performed. The base of the left lung was completely adherent to the diaphragm and here there was an abscess cavity which contained gallstones and bile. It was found that the subphrenic abscess which communicated with the dilated hepatic duct of the left lobe of the liver had broken through the diaphragm into the left lower lobe bronchus. Partial resection of the lung tissue and Roux-en-Y hepato-jejunostomy with T-tube decompression were carried out. 1 month later choledochotomy was performed and intrahepatic gallstones were removed. Thereafter he had an uneventful recovery.

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