The purpose of the present study is to evaluate the clinical usefulness of a newly developed P_O2 intravascular electrode and a computerized system measuring breath-by-breath V_O2 and V_CO2. Arterial, mixed venous P_O2, V_O2 and V_CO2 were continuously monitored on anesthetized dog under the following experimental conditions. 1) hyperpnea and hypopnea 2) hyperoxia and hypoxia 3) rebreathing 4) added extra-dead space 5) increased expiratory resistance 6) administration of respiratory stimulant 7) inhalation of histamine 8) pulmonary emboli 9) administration of sodium bicarbonate 10) bleeding followed by transfusion. The results indicate that both electrode and V_O2-V_CO2 system are stable and accurate up to 8 hours and sensitive enough to respond well to the above experimental procedures. However, the exact role of these monitoring system in RCU practice has yet to be determined.

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We have carried out rehabilitation for an average of 7.5 weeks on 1272 patients with chronic lung disease since 1967. The modality of rehabilitation used was diaphragmatic breathing exercises, postural drainage and walking training.
Though standard pulmonary function tests were unchanged following rehabilitation, almost all patients demonstrated marked subjective and objective improvement in exercise tolerance. The short term effects of diaphragmatic breathing were a reduction in minute ventilation, V_O2/V_A, respiratory rate and V_D/V_T, whereas the tidal volume was increased in 16 emphysema patients.
Postural drainage was very useful in cases of bronchiectasis and diffuse panbronchiolitis with >30ml of sputum. It is possible that administration of oxygen is useful during rehabilitative walking training programs in chronic lung disease patients who demonstrate a marked decrease in arterial oxygen tension during exercise while breathing air. Home oxygen was useful in 23 patients.
After rehabilitation, the patients were able to increase the amount of tolerated exercise and the O₂ debt was significantly decreased by exercise testing. Rehabilitation is a very important therapy in cases of chronic lung disease.

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Three types of aerosol nebulizers used in clinical practice, a jet type (JT), and IPPB (Bennett PR-2) and an ultrasonic nebulizer (Mistogen EN 142) (US) were studied regarding aerosol size distribution, efficiency in aerosol output, efficiency in lung deposition and deposition patterns in the lungs. The JT was operated both manually and mechanically. Tc-99m-albumin solution was the agent for aerosol generation. Aerosol size was measured by a cascade impactor, efficiency by measuring radioactivity in the lungs and nebulizers and deposition patterns by visual comparison. Mass median diameter (MMD) was the largest (4.18μ) with its geometric standard deviation of 1.76 with the US, and the other nebulizers showed smaller MMD (2.00-2.35μ) and broader geometric standard deviations. Aerosol output was 4 times more efficient with the US than with the others. Lung deposition was 8 times more efficient with the US, 7 times with the mechanically operated JT, and 6 times with the IPPB than the manually operated JT. Overall aerosol deposition in the lungs was the most efficient with the US, but the IPPB showed better penetration in normal subjects and patients with the least obstructive disturbance. Manually operated JT tended to produce the so-called central deposition pattern even in normal subjects. In conclusion, of the three nebulizers tested, the MMD of aerosol generated was the largest with the US, and the US was the most efficient in aerosol output and lung deposition.

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To examine the relative importance of genetics and environments in determiing chemical and mechanical control of breathing, an age-, body size-, and sex ratio-matched study was conducted in 62 twins (mean age=16.4 years, 20 pairs of monozygotes (MZ) and 11 pairs of dizygotes (DZ) for ventilatory responses to hypoxia (A) and hypercapnia (S) along with thresholds for perception of added inspiratory resistance (0.38-5.11cmH₂O/1/sec measured at 0.51/sec 7ow rate). Both A and S were determined by a dual control system developed to automatically attain normocapnic hypoxia and normoxic hypercapnia.
The variable A was assessed by the hyperbolic equation:
V_E=V_O+A/(P^e_AO2-32)
Where, V_E: minute ventilation in 1/min, V_O: asymptote for ventilation obtained by extrapolation, P^e_AO2: endtidal P_O2 in mmHg and 32: P^e_AO2 at which the slope of the V_E-P^e_AO2 curve approaches an infinite.
The variable S was assessed by the equation:
V_E=S(P^e_ACO2-B)
Where, P^e_ACO2: endtidal P_CO2 in mmHg and B: extrapolated intercept on the abscissa (P^e_ACO2).
A and S were standardized by body surface area (BSA). The thresholds for inspiratory resistance was assessed by resistance value (ΔR) detected on 50% occasions and the mouth pressure (P) in which the subjects could detect the load. ΔR was analysed as Weber fraction (ΔR/Ro: Ro=airway resistance plus apparatus resistance). Since ΔR/Ro and P were distributed in lognormal fashion, In(ΔR/Ro) and lnP were used for the analysis. To examine the similarity between pairs, intrapair variance ratio (F₂=M_WDZ/M_WMZ) was used.
A/BSA and S/BSA averaged 97.5±64.2 (mean±SD) 1·mmHg/min/m² and 0.65±0.19 1/min/mmHg/m², respectively in MZ. They averaged 79.5±53.6 1·mmHg/min/m², respectively in DZ. There were no significant differences in these variables between MZ and DZ. In (ΔR/Ro) and lnP averaged -1.001±0.738 and -0.993±0.660, respectively in MZ. They averaged -0.826±0.705 and -1.005±0.736, respectively in DZ. There were no significant differences in these variables between MZ and DZ.
In contrast, intrapair variance for A/BSA and S/BSA were significantly smaller in MZ than in DZ (p<0.005 for A/BSA and S/BSA). Intrapair variance for lnP was significantly smaller in MZ than in DZ (0.01<p<0.025). There were no significant relationships between A/BSA, S/BSA, in (Δ[/Ro) and lnP.
These results indicate that 1) genetic influence on chemosensitivity to hypoxia and hypercapnia and mechanosensitivity to added inspiratory resistance is more evident than environmental influence in young healthy twins, and 2) perception of added inspiratory resistance is not directly related to chemical control of breathing.

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The effect of variable conditions of the reaction on phagocytosis and rosette formation of sensitized SRBC (EA) by rabbit pulmonary alveolar macrophages (PAMs) was studied in order to establish a method for assaying IgG Fc-receptor activity of PAMs by using SRBC coated with anti-SRBC antibody (IgG). Dynamics of Fc-receptor activity of PAMs in sarcoidosis was investigated by the method reported herein.
A) EA phagocytosis by PAMs inhibited EA rosette formation of PAMs. EA phagocytosis was observed in 3-5% of FCA activated PAMs after incubation at 22°C for 1hr. However this phenomenon was not observed under the condition of 4°C for 20hrs. Fc-mediated phagocytic potential was remarkably elevated in FCA activated PAMs, but there was no difference in EA rosette forming ability between FCA activated PAMs and normal PAMs. This observation indicates that Fc-mediated phagocytic potentil is influenced by nonspecific phagocytic potential of PAMs. It is suggested that Fc-receptor activity should be expressed by EA rosette forming activity of PAMs measured under the condition of 4°C for 20hrs where phagocytosis is minimal.
B) Fc-receptor activity of PAMs was measured in 7 patients with sarcoidosis and 8 non-sarcoid patients. Fc-receptor activity was significantly increased in sarcoid patients compared to non-sarcoid patients. Fc-receptor activity of PAMs correlated well with serum ACE level in sarcoidosis, and was remarkably increased in sarcoid patients whose chest X-P findings were progressing compared to those improving. Thus, the dynamics of Fc-receptor activity of PAMs might reflect the change of activity of sarcoidosis.

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Pulmonary function of 23 patients with hypersensitivity pneumonitis was investigated. Spirometry, subdivisions of the lung volume, 3Hz impedance, pulmonary diffusing capacity, arterial blood gas analysis etc. were carried out before and after therapy. Changes of parameters during physical exercise were also studied.
Restrictive ventilatory disturbance, decrease of pulmonary diffusing capacity, hypoxemia, increase of A-aD_O2 and decreasing tendency of static compliance were characteristic of this disease. Increase of closing volume, increase of volume of isoflow and decrease of flow at the low lung volume in maximal expiration were also observed. These suggested there were changes at the small airway level following lesions of alveoli in patients with hypersensitivity pneumonitis.
In two cases whose pulmonary diffusing capacity was investigated from the aspects of membrane diffusing capacity (D_M) and pulmonary capillary blood volume (V_C), decrease of D_M and V_C at rest were observed. During physical exercise, poor increase of V_C compared with a slightly increase of D_M were pointed out. After treatment, the improvement of the restrictive ventilatory disturbance seemed to occur earlier than that of the diffusing capacity.

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The acoustic features of wheezes in asthmatic patients was investigated in relation to the respiratory phase and the transmission of sounds. We analyzed wheezes simultaneously recorded at three different locations, i.e. on the left and right sides of the chest and on the neck over the trachea, by a new phonopneumographic method using a sound-spectrograph.
1) Wheezes were revealed as continuous sounds with overtones which are integral multiples of the fundamental frequency.
We regarded wheezes with similar fundamental frequencies and timing as the same wheeze transmitted from the same area.
We could fine a total of 84 wheezes in one respiratory cycle among 20 patients (an average of 4.2 wheezes).
2) The highest prevalence of wheezes among the three different pick-up points was on the neck over the trachea. 90% of 84 wheezes were recorded over the trachea, and 89% of wheezes recorded on the chest were also simultaneously detected over the trachea. We conclude that the tracheal region is a very important location for auscultating or monitoring asthma patients.
3) According to the results of the prevalence of the same wheezes in different locations, wheezes are more strongly transmitted to the trachea than to the other side of the chest.
We could distinguish the sound properties of wheezes detected at all of the three locations and those only over the trachea from those of all wheezes, but the clinical evaluation is unclear.

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A 39-year-old female patient, a housewife, with multiple myeloma (IgG, lambda type) succumbed due to massive accumulation of malignant pleural effusion in the right hemithorax. At autopsy, the right pleural cavity was observed to be filled with numerous metastatic myeloma nodules and myeloma cells were demonstrated in the pleural effusion.
Cytophotometric DNA measurement of myeloma cells in the pleural effusion was performed. Almost all myeloma cells showed DNA amounts much higher than tetraploid value and two definite distributional modes indicated populations of stemline cells in the higher polyploid DNA range on the DNA frequency-distribution histogram. The cytological pathogenesis was discussed in relation to the appearance of myeloma cells with such polyploid DNA amounts in the pleural effusion.

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We presented two cases of pulmonary eosinophilic granuloma diagnosed histologically by open lung biopsies.
Case 1. A 24-year-old man was completely asymptomatic and the disease was detected on a routine chest X-ray film which revealed diffuse micronodular, reticular and small cystic shadows throughout both lungs. There were no complications. Therapy by corticosteroids and immunosuppressants was not effective.
Case 2. A 34-year-old man complained of toothache and weight loss. Chest roentgenogram revealed diffuse reticular shadows throughout both lungs and linear patterns in the right upper lung field. Complications were gingival lesions and bilateral exophthalmos. Corticosteroid therapy was not effective.
Forty cases including the present 2 cases have been reported in the Japanese literature.

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A 14 year-old male, junior high school student with cough and right anterior chest pain was admitted as the diagnosis of right side spontaneous pneumothorax with infectious bulla. Aspirated specimen from the cystic lesion and pleural cavity disclosed bloody effusion and hemopneumothorax was most suspected. Two months later, the patient died of massive bleeding in the opposite side neck, mediastinum and pleural cavity due to so-called campus violence, so the first episode of cystic lesion having bleeding was most seemly to be the blunt traumatic pneumatocele caused by violence. This case is the first report of traumatic pneumatocele related to so-colled campus violence in Japan.

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