The effect of mean alveolar pressure (Pal) and pleural pressure (Ppl) on pulmonary hemodynamics were studied in 19 pulmonary patients. The change of pulmonary arterial diastolic pressure (P_PAd) had a linear correlation with those of Pal and Ppl in each patient. In 8 patients with pulmonary hypertension, the values of ΔP_PAd/ΔPal, as well as ΔP_PAd/ΔPpl, were significantly higher than those in 11 patients without pulmonary hypertension. Furthermore, the pulmonary arterial pressure (P_PA) in the group with higher ΔP_PAd/ΔPal (≥0.86) was significantly higher than that in the group with lower ΔP_PAd/ΔPal (<0.86). On the other hand, the pulmonary arterial compliance (C) in the former group was significantly lower than that in the latter group.
These data suggest that the change of P_PAd under the influence of Pal or Ppl relate with the organic change of pulmonary vessels, indicated as P_PA, C.

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We have developed a dual control system which controls Pa_O2 and Pa_CO2 either simultaneously or independently of each other. Since the endtidal to arterial P_O2 ratio (P_ÅO2/Pa_O2) remains almost constant for a wide range of P_IO2 and endtidal P_CO2 (P_ÅCO2) is assumed to be an adequate measure of alveolar P_CO2 (P_ACO2), P_ÅO2 and P_ÅCO2 measured by a mass spectrometer can be used to estimate Pa_O2 and Pa_CO2, respectively. When P_ÅO2 and P_ÅCO2 signals deviated from the preset levels, the control circuit rotated the nozzles of two gas blenders with the pulse motors so as to change P_IO2 and P_ICO2.
In 23 healthy subjects, the system was applied to control their arterial blood gases at preset levels: normoxia (Pa_O2 90mmHg and Pa_CO2 40mmHg), normocapnic hypoxia (Pa_O2 40mmHg and Pa_CO2 40mmHg), and normoxic hypercapnia (Pa_O2 90mmHg and Pa_CO2 55mmHg).
Arterial blood gases attained by the control system were: 91.1±S.D6.5mmHg for Pa_O2 and 41.2±3.2mmHg for Pa_CO2 during normoxia, 40.4±3.9mmHg for Pa_O2 and 38.9±2.5mmHg for Pa_CO2 during normocapnic hypoxia, and 98.1±11.5mmHg for Pa_O2 and 52.8±3.4mmHg for Pa_CO2 during normoxic hypercapnia. The mean difference between target and attained levels were: 1.1mmHg (1.2% of preset level) for Pa_O2 and 1.2mmHg (3.0%) for Pa_CO2 during normoxia, 0.4mmHg (1.0%) for Pa_O2 and 1.1mmHg (2.8%) for Pa_CO2 during normocapnic hypoxia, and 8.1mmHg (9.0%) for Pa_O2 and 2.2mmHg (4.0%) for Pa_CO2 during normoxic hypercapnia. Coefficients of variation around the mean were 7.1 to 11.7% for Pa_O2 and 6.4 to 7.8% for Pa_CO2.
This method is useful in physiology as well as clinical medicine because of its accuracy and noninvasiveness.

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Morphological changes of pulmonary bone marrow embolism were examined in 16 out of 550 autopsy cases in the department in the past 7 years (1971-1978).
1. Pulmonary bone marrow embolism was complicated not only by fracture but also by therapy such as bone surgery and closed heart massage.
2. Bone marrow embolism was seen as microembolisms in the pulmonary small arteries and arterioles measuring mainly 100-500μ in diameter. Pulmonary changes were compatible with those seen in shock lung; vacuole formation in the endothelial cells, microthrombi, perivascular edema in the interstitium, hyaline membrane and hemorrhage in the alveolar space due to disturbance of microcirculation.
3. Post-traumatic bone marrow embolism was frequently accompanied by fat emboli and microthrombi. Therefore, the authors interpreted these findings to mean that bone marrow embolism is important as a cause of death and proposed considering the disease in terms of post-traumatic pulmonary microembolism rather than respiratory distress syndrome of shock and trauma.

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One hundred and thirty-one cases of spontaneous pneumothorax from 1972-1979 were evaluated clinically the literature reviewed.
The yearly incidence of spontaneous pneumothorax has been increasing gradually. The highest incidence was in the 20-29 age group, and the overwhelming majority of the cases were males (91.8%). The affected side was the right in 54, left in 59 and bilateral in 24 cases including 9 of simultaneous onset. The initial symptoms were chest pain (70.2%) and dyspnea (38.9%). Physical activity at the time of onset was not characteristic in the history of the condition: at rest (59.0%), during exercise (27.0%), on coughing (6.6%) and unknown (7.4%). Of 131 cases, 72 were initial and 59 were recurrent. The duration to relapse was within a year in 72% of the 59 cases.
In examining the relation between previous treatment and recurrence, there was a remarkably high risk of recurrence (79.6%) if the only treatment had been bed-rest or simple needle aspiration therapy. The recurrence rate was less frequent (27.9%) in tube drainage cases. The lowest recurrence was noted in 74 thoracotomized cases with a recurrence of 1.3%.
Considering the high incidence of recurrence in patients treated with conservative therapies, the importance of a more radical therapy, thoracotomy, should be emphasized as the treatment of choice in the management of spontaneous pneumothorax.

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A forty five year-old man was transferred to our hospital because of persistent high fever and dyspnea. The patient had been on various antibiotics and steroids for the treatment of fever of unknown etiology after nasal polypectomy. The chest X-ray film on admission showed diffuse interstitial infiltration over both lung fields and a thick-walled cavity in the left middle lung field. As laboratory data did not yield a definitive diagnosis, transbronchofiberscopic lung biopsy and tube aspiration of the cavity were performed simultaneously.
Specimens of the biopsied lung revealed interstitial pneumonia and included enlarged cells with characteristic nuclear inclusion bodies, which were determined to be of cytomegalovirus origin by immunofluorescence. Direct staining of the aspirated material showed Gram-positive hyphae with branching characteristic of Nocardia asteroides which was confirmed subsequently by culture.
Treatment with sulfomethoxazole (2.4g/day) and trimetprim (480mg/day) led to disappearance of the cavity in a month.
In most cases of both cytomegalovirus pneumonia and pulmonary nocardiosis infection, definitive diagnosis has been made from postmortem specimens and few cases have been diagnosed before death by lung biopsy or needle aspiration. To the authors' knowledge this is the first report of such a case diagnosed by these procedures in Japan. Appropriate treatment was initiated after the establishment of diagnosis, with a successful outcome.

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A fifty year-old house wife had subacute onset of cough and exertional dyspnea. Her chest X-ray film taken on admission showed ground glass shadows in both lower lung fields. Pulmonary function test revealed reduced diffusing capacity, increased closing volume, abnormal flow volume curve and hypoxemia. Serum precipitating antibody against Aspergillus fumigatus was positive and serum anti-cryptococcal antibody was detected by the indirect fluorescent antibody method.
Open lung biopsy was carried out, and microscopic studies demonstrated alveolitis as well as bronchiolitis accompanied by a small amount of epitheloid cell granulomas. Diffuse deposits of IgG in the alveolar walls were also demonstrated by immunofluorescent studies.
The primary histologic finding of extrinsic allergic alveolitis appeared to be bronchiolo-alveolitis, while epitheloid cell granuloma is thought to be secondary, and the bronchiolar change is a valuable findings for differential diagnosis from cryptogenic fibrosing alveolitis.
Desposits of IgG in alveolar walls demonstrated by immunofluorescent studies would be valid evidence that the pathogenesis of extrinsic allergic alveolitis is related to the type III allergic reaction. Immunofluorescence observation was shown to be an effective diagnostic technique.

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A cloudlike shadow in the right upper lung field of a 60 year-old male was pointed out in a mass survey on April, 1974. He was admitted on August 7 after the appearance of a dry cough, low grade fever, arthralgia and exertional dyspnea. His chest film demonstrated diffuse reticulonodular shadows and ground-glass appearance in both lower lung fields. On August 20, he developed high fever, marked dyspnea at rest and cyanosis, and almostly succumbed. He was treated with a large dosage of corticosteroid (maximum, 425mg equivalent to prednisolone per day). His clinical condition improved dramatically.
The findings of the TBLB specimen were compatible with UIP (Liebow).
The patient was discharged on December 25, 1974, with minimal residual chest X-ray and laboratory data abnormal findings. Thereafter he has experienced no exacerbations for about five years with maintenance therapy (prednisolone, 5mg every other day).

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13才, 女子. 右胸部痛があり, 胸部X線写真にて, 右肺野縦隔側に辺縁不整の淡い腫瘤陰影を認めた. 陰影は淡く, 境界不鮮明で, 辺縁は放射状を呈した. 喀痰細胞診, 気管支造影, 気縦隔造影等の検査にても確定診断が得られず. 試験開胸により組織学的に肺放線菌症と診断され. 術後の抗菌性化学療法にて治癒した.

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