It has been generally considered that the ultrasonic examination is inadequate for investigating the chest diseases because of pulmonary air volume. We performed 369 ultrasonic examinations in 177 patients with diseases of the chest from April, 1976 through September, 1979 and have concluded that ultrasonography is a powerful new diagnostic tool in certain situations.
Ultrasonic examinations are particularly effective in situations where the site of the lesion is in contact with the thoracic wall or when the tissue between the thoracic wall and the lesion has low gas content.
The echogenic images differ from those of other imaging techniques, e.g. roentgenography. Ultrasonic examinations were especially useful investigating the following diseases: neoplastic and non-neoplastic pleuritis, pyothorax, primary and metastatic lung cancer, inflammatory lung tumors including tuberculoma, mediastinal tumors, pericarditis and pericardial cyst.
Ultrasonic detection of the presence of effusion, thickened pleura and collapsed lung was simple. Even small amounts of pleural effusion less than 50ml and slightly thickened pleura less than 1cm were clearly confirmed by this method. Fibrously thickened pleura showed abnormal consistency with fine to gross echoes and distally increased attenuation.
Even in intrapulmonary tumors, if they were in contact with the thoracic wall, ultrasound examination was very effective. And malignant tumors showed different ultrasonic images according to their character. We are sure that ultrasonogram reflects the histological type of lung cancer.
We performed 122 ultrasonically guided puncture in 89 patients and obtained good results. It was superior to roentgenologically guided puncture in clarifying the existence of pleural effusions (100%) and the character of the intrapulmonary malignant tumors (88.9%, 16/18 patients) with less complications, e.g. pneumothorax, when the lesions were in contact with the thoracic wall.

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We compared series distribution of airway collapsibilities in situ in dogs. Four major segments were compared: trachea, extrapulmonary bronchi, intrapulmonary main lobar bronchi and intrapulmonary small bronchi. The pressure-volume relations of the isolated trachea and extrapulmonary bronchi in the closed chest of 6 dogs were measured by glued beads of 6-22mm OD with the cannulation to provide airflow routes to the lobes. The pressure-volume relations of the isolated intrapulmonary large and small bronchi of 9.66 and 3.11mm OD (mean) at P_L 30cmH₂O, respectively, were measured from tantalum dust bronchograms in 6 lobes of excised dog lungs. The isolated intrapulmonary large bronchi were made by glued 10-15 beads of 2-9mmOD as described previously by Takishima et al. The isolated intrapulmonary small bronchi were made by 50-60 glued beads of 1mmOD. Twenty retrograde catheters were inserted into the lobe arround the perimeter and the lobe was inflated by positive pressure through the retrograde catheters. Airway collapsibilities were compared under the constant lung volumes at P_L 30, 10 and 5cmH₂O. At P_L 30cmH₂O, the extrapulmonary bronchi were more collapsible than the intrapulmonary large bronchi and trachea. At P_L 10 and 5cmH₂O, the intrapulmonary small bronchi were more collapsible than the other airways, and the peripheral airways were more collapsible than the large airways. It was concluded that during the maximum expiration as the most collapsible segment moved into the peripheral airway at low lung volumes, it might be possible that the flow limiting segment moved from the trachea towards the peripheral airway during maximum expiratory flow volume maneuvers.

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To investigate the characteristics of respiratory physiology of aged asthmatics, forced expiratory spirogram, MEFV curve breathing air and 80%-20% helium-oxygen mixture, subdivisions of lung volume, diffusing capacity by single breath method, specific airway conductance, static compliance, closing volumes by N₂ resident method and frequency dependence of dynamic compliance were performed in 7 young asthmatics and 6 aged asthmatics under the best clinical conditions. Lung subdivisions, airway conductance and compliance were measured by flow type bodyplethysmograph.
The results were as follows:
1) In FVC, FEV_1.0, VC, RV, FRC, SG_aw, C_st and DL_coSB, which were calculated as percent predicted normal, no significant difference was seen between aged asthmatics and young asthmatics.
2) Aged asthmatics showed significantly lower results in MMF on spirograms and in PEF, particularly in V₅₀ and V₂₅ on MEFV curve tests, but greater TLC than those of the young group.
3) On incidence of abnormal findings in CV/VC% and C_dyn60 %C_st, no significant differences were seen between the young and the aged group.
4) In constrast to young asthmatics, the aged group showed more frequent “abnormalities” in CC/TLC% (p<0.05) and Visov/VC% (P<0.05), and more “non-responders” in percent increase of V₅₀ with He/O₂. (p<0.05).
The above results suggest that even in the best clinical conditions, aged asthmatics have mild obstructive changes in their ventilation, especially in the peripheral portions as compared with young asthmatics who showed almost normal ventilatory functions.

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Arylsulfatases of human lung carcinomas at surgery and transplanted to athymic mice were investigated. The activity levels of the arylsulfatases from these carcinomas of various histological types were markedly elevated as compared to those in normal lung. Increment of the activities was higher in the transplanted carcinoma than in the tumor at surgery, possibly due to a larger population of carcinoma cells in transplanted carcinoma tissue.
When arylsulfatases were fractionated by an anion-exchange chromatography, normal lung revealed a basic arylsulfatase B and an anionic arylsulfatase A, while carcinoma tissue contained another component (B₁) in addition to A and B enzymes. The arylsulfatase B₁ had the same enzymatic properties as arylsulfatase B of normal lung and carcinoma, but differed in its net charge which displayed an anionic shift from the B enzyme. Since sialidase treatment of B₁ enzyme resulted in conversion of B₁ enzyme to B enzyme with respect to net charge. it is most probable that B₁ enzyme is a modified form of B enzyme due to sialidation during the cancerization process. The extent of sialidation modification was much more prominent in transplanted carcinoma that carcinoma at surgery.

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Serum levels of angiotensin-converting enzyme (ACE) and serum lysozyme (LZM) were studied in sarcoidosis, tuberculosis, extrinsic allergic alveolitis, chronic beryllium disease, silicosis, and various other pulmonary diseases including cryptogenic fibrosing alveolitis, collagenic lung, chronic bronchitis, diffuse panbronchiolitis, bronchial asthma, lung cancer or malignant lymphoma.
Serum ACE was assayed spectrophotometrically with hippuryl-L-histidyl-L-leucine as substrate. Serum LZM was assayed by the lyso-plate technique with Micrococcus lysodeikticus.
Both serum ACE and LZM were elevated and correlated well with the extent of the sarcoid lesion. Therefore, both enzymes may be derived from granulomas. Serum ACE correlated with serum LZM in sarcoidosis, However, serum LZM alone was elevated in some active cases, most of which had been suffering for 2 years or more. Thus, it is suspected that serum ACE activity mightmay decrease earlier than serum LZM activity.
In sarcoidosis cases whose serum ACE reduced to normal levels at 1 or 2 years from the onset of the disease, the prognosis was concluded to be favorable. There was significant correlation between serum ACE and tuberculin test in sarcoidosis. A tendency for steroid administration to reduce serum ACE in sarcoidosis was observed.
Both serum ACE and LZM were elevated in chronic beryllium disease and silicosis, in which serum ACE correlated with serum LZM, although serum LZM in silicosis was not as high as in sarcoidosis. Dissociation of the two enzyme activities was observed in tuberculosis: usually serum ACE remained normal, although serum LZM was frequently elevated. Both enzymes were normal in extrinsic allergic alveolitis. Serum ACE was not elevated in various other pulmonary diseases. Thus, it is speculated that these findingsmay reflect the different properties of granulomas in sarcoidosis and other granulomatous diseases.
A simultaneous determination of both serum ACE and LZM in sarcoidosis may be valuable in ditinsguishing sarcoidosis from other diseases except for chronic beryllium disease and silicosis, and in discriminating between stable and progressive conditions of sarcoidosis.

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Cardiac tamponade is an acute, life-threatening complication of malignant pericardial effusions. Traditionally, the approach has been surgical, with establishment of a pericardial window, or conservative, pericardiocentesis with local instillation of chemotherapeutic agents.
A 60-year-old female was admitted with chief complaints of orthopnea and left back pain. Chest roentgenogram, electrocardiogram and echocardiogram confirmed the presence of pericardial effusion. About 300ml of hemorrhagic pericardial effusion was obtained by pericardocentesis and its pathological examination revealed malignant cells. Doxycycline hydrochloride (200mg), dissolved in 10ml of sterile solution, was then instilled intrapericardially through the indwelling pericardial cannula. Six days after the cannulation the catheter was remoued. The patient survived for four months without clinical symptoms or echocardiographic evidence of tamponade.
The effectiveness of doxycycline hydrochloride in causing a nonspecific irritative action resulting in permanent concrescence of the pericardium to the epicardium was shown by no recurrence of effusions or tamponade in this patient.

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Rare cases of idiopathic hemothorax have been reported. A twenty nine year-old male, complaining of left back pain, fell into shock. His chest X-ray film showed opacity in his left lung field and the thoracenteses resulted in removal of 800ml bloody effusion (hematocrit: 34%). One month later his left lung remained collapsed and pleural effusion was still bloody. He was transfered to our hospital for surgical treatment.
On admission, his vital capacity was 2260ml, %FEV_1.0, 77%. Thoracotomy revealed the presence of 600ml bloody pleural effusion and a well encapsulated tumor, spherical, 5×5×5cm, around which thickened parietal and visceral pleura were recognized. The tumor was near the aorta in the fifth intercostal space, and had a stalk which arose from the fifth intercostal nerve. A small amount of bleeding from the stalk, was recognized. We excised the tumor, which weighed 250g, at the stalk and found an artery 1mm in diameter. No other bleeding foci were present in the chest cavity.
Histological examination of the tumor yielded a diagnosis of neurinoma. Extirpation of the tumor and decortication resulted in fairly good re-expansion of the left lung. Thirty days postoperatively the vital capacity, %FEV_1.0 and other lung functions improved.

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26歳男性, 急性リンパ性白血病の再燃中, 急性呼吸不全に陥るも呼吸管理とステロイド療法にて軽快し, その2カ月後同様な呼吸不全にて死亡した, 剖検にて各臓器における白血病細胞浸潤が著明で, 肺は高度の硝子膜形成と間質内への著しい白血病細胞浸潤が認められ, いわゆるUIPの所見を呈していた.

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