The fundamental importance of the lung in providing oxygen and eliminating carbon dioxide is well known. However the lung has another important role, that is the metabolism of vasoactive substances. In the present investigation we tried to establish pulmonary metabolic function tests.
Thirty mongel dogs were anesthetized with sodium pentobarbital. The responses and metabolism of various vasoactive substances in the lung were investigated injecting them into the right ventricle (RV) and the left ventricle (LV) monitoring tracheal pressure (Ptr), pulmonary arterial pressure (Ppa), systemic arterial pressure (Psyst) and cardiac output (Qaorta). The percent inactivation of various vasoactive substance was calculated from the difference of systemic pressure responses by injecting them into LV and RV.
1) Ptr decreased dose-dependently by injection of PG E₁ or PG E₂ into RV and LV, while it increased dose-dependently by injection of PG F_2α, acetylcholine, histamine or serotonin.
2) Ppa decreased dose-dependently by injection of PG E₁ into RV and LV, while it increased dose-dependently by injection of PG E₂, PG F_2α, acetylcholine, histamine or serotonin. There were significant differences in responses between RV and LV injection of PG E₁, PG E₁, PG F_2α and serotonin.
3) Psyst decreased dose-dependently by injection of PG E₁, PG E₂, acetylcholine, histamine or serotonin into RV and LV, while it increased dose-dependently by injection of PG F_2α. The extent of increase and decrease of Psyst by injection of drugs into LV was bigger by injection into RV.
4) Qaorta increased dose-dependently by an injection of PG E₁ or PG E₂ into RV and LV, while it decreased dose-dependently by an injection of PG F_2α, acetylcholine, histamine or serotonin.
5) The percent inactivations of 0.25μg/kg of PG E₁, PG E₂, PG F_2α and serotonin in the lung were 72.0%, 70.2%, 91.8% and 62.6%, respectively, and they decreased dose-dependently.
6) The percent inactivations of PG E₁, PG E₂, PG F_2α and serotonin in the lung decreased significantly in hypoxic conditions.

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Miliary tuberculosis or tuberculous pneumonia is an unusual cause of acute, catastrophic pulmonary failure. In this report, we described six patients with miliary tuberculosis and two patients with tuberculous pneumonia who developed severe respiratory distress.
All patients had symptoms suggesting a chronic or subacute illness such as fever, cough, general fatigue, loss of appetite for 2 to 10 weeks. However the condition of all eight patients deteriorated rapidly, within two to four days and respiratory distress developed. In patients with miliary tuberculosis, the chest X-ray films on admission showed diffuse reticulonodular or miliary patterns with or without a partially confluent pattern in 4 patients and diffuse bilateral alveolar infiltrates in two. Initial smears of sputum for tubercle bacilli were negative in 4 of 8 patients. Cutaneous tests with PPD were negative in seven patients tested. Repeated smears of transbronchial secretions and transbronchial lung biopsy were necessary for early diagnosis.
All eight patients were complicated with disseminated intravascular coagulation. Despite antituberculosis therapy and other appropriate therapy, six patients died, and two patients survived.
Milary tuberculosis or tuberculous pneumonia may be one cause of acute respiratory failure. Experience with these cases serves to emphasize that there is a necessity for a careful and extensive evaluation in all patients with acute respiratory failure for treatable precipitating disorders including tuberculosis.

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Ventilatory change of antero-posterior diameter of the inferior vena cava (IVC) was studied by ultrasonography, simultaneously with measurement of central venous pressure (CVP). In normal subjects, the lumen of IVC started to collapse in the late inspiratory phase, reached a minimum diameter at the end of inspiration, and then distending during expiration. IVC lost this physiological dimensional change and was fully distended through the entire course of ventilation when CVP was elevated, with an increase of intrathoracic pressure, as during mechanical ventilation and Valsalva manuever and with right heart failure and pericarditis. From these results, the correlation between Collapsibility Index ([maximal width on expiration-width in maximal collapse on inspiration]/maximal width on expiration) and CVP was studied. Through accumulated results obtained from various respiratory and circulatory patients, the following regression equation was derived. Y=1.043-0.067X+0.001X², in which n was 48, r=0.73, and p<0.001. In this equation, Y is Collapsibility Index and X is CVP. When CVP is less than 25cm H₂O, Collapsibility Index inversely correlates with CVP and is almost zero when CVP is more than 25cm H₂O which means that IVC is kept in a fully distended state through entire course of ventilation.
From this relationship, it is possible to estimate CVP in various clinical conditions and its alterlation corresponding to reasonable and non-invasive treatment. The clinical significance and its mechanism of the configurational change of IVC are also discussed based on the results obtained through a model experiment designed with a collapsible tube.

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The mechanism of phases III and IV in a single breath nitrogen washout was studied from the regional distribution of inspired gas in the lungs using Kr-81m. Experiments were performed on five men who consisted of four healthy subjects and one subject with the history of bronchial asthma in his childhood.
A 20-ml bolus of air containing 5-8mCi of Kr-81m was rapidly injected into the mouthpiece stepwise at different lung volumes between RV and FRC+1500ml. The subjects were instructed to inhale a bolus of Kr-81m from different lung volumes in a sitting position or a right lateral position. Radioactive count rate was always measured at the same lung volume (FRC+2000ml) with a scinticamera. Each lung was divided into 6 regions horizontally at FRC+2000ml from dependent lung regions to upper lung regions in a sitting position as well as in a right lateral position.
The divided coefficient of Kr-81m was expressed as a percentage ratio of the regional count rate over the total count rate of Kr-81m. The regional lung volumes at FRC+2000ml and RV were obtained after the equilibrium was achieved in a closed circuit, using Xe-133. The relationship between regional volume and total lung volume was calculated from the divided coefficient of Kr-81m in different lung volumes.
As a result, when a bolus of Kr-81m was inhaled from RV in the sitting position, activity of Kr-81m was relatively greater in the upper than in dependent lung regions. When a bolus of Kr-81m was inhaled from RV in the right lateral position, activity of Kr-81m was relatively greater in the upper regions of the left lung than in the lower regions of the right lung. These data suggested that topographical distribution of inspired gas was gravity dependent. In the sitting position, the divided coefficient of Kr-81m per unit lung volume became smaller in upper lung regions and became larger in lower lung regions as the total lung volume increased from RV to CV. At CV those curves crossed. In the right lateral position, CV was not equal to the lung volume at which the curves obtained from divided coefficient of upper and lower regions in different lung volumes crossed. Therefore the mechanism of phase IV in the right lateral position would be different from that in the sitting position. From RV to CV changes in regional lung volumes were relatively greater in the upper than in the lower lung regions and regional subdivisions of lung volume against total lung volume were expressed as curvilinear. From CV to TLC these curves became linear. Phases III and IV in a single breath nitrogen washout were well simulated by the data obtained by radioisotopes.

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Cutaneous delayed hypersensitivity to DNCB is easily induced in healthy people: However, the sensitization rate is lower in cancer patients. Newly recognized aromatic sensitizers, methyl heptine carbonate (MHC) and Costus root oil (CRO), were compared for their primary sensitizing ability with DNCB in order to diagnose immunodeficiency. After a preliminary study on sensitization and challenge condition, 30% MHC+3% LAS (linear alkylbenzene sulfonate) in hydrophilic ointment, 20% CRO+3% LAS in petrolatum and 5% DNCB+3% LAS in petrolatum, were simultaneously patch tested for 48 hours on 135 chest disease patients, mainly lung cancer, pulmonary tuberculosis and bronchopneumonia. Two to three weeks later, they were challenged with 3% and 1% MHC, 3%, 1% and 0.1% CRO, and 0.5% DNCB in petrolatum, and also with 0.1% DNCB in ethanol. Hypersensitivity reactions were obtained by 3% MHC, 3% CRO, both in pertrolatum and 0.10% DNCB in ethanol.
Eighty-one patients were sensitized with all three primary sensitizers simultaneously, and 38 patients were not sensitized with any of the three. Reactions by MHC, CRO and DNCB were consistent in 119 of 135 patients (88.1%) simultaneously. There were 16 inconsistent cases which were sensitized with only one or two of the three sensitizers. These 16 patients were again sensitized with the sensitizers which showed negative results on the first challenge, and all of them were found to be sensitized on the second trial. Consequently, all of the 97 patients who were sensitized with DNCB were, without exception, sensitized with CRO and MHC. All of the 38, who were not sensitized with DNCB, were not sensitized with either CRO or MHC.
This study shows that we can use MHC and CRO in diagnosing immunodeficiency as well as DNCB. In order to sequentially evaluate the sensitizing ability in lung cancer patients who have been already sensitized to DNCB, the use of newly recognized primary sensitizers, MHC and CRO may be helpful.

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Three strains of mediastinal teratoid tumors transplanted in nude mice were studied with regard to foetal protein production and changes in histological features following transplantation.
The original tumor in case 1 contained elements of choriocarcinoma, embryonal carcinoma and teratoma. In the course of serial transplantation in nude mice, the teratomatous element increased and the other elements disappeared from the first to the third generation transplants. In one nude mouse with second generation transplant, the tumor showed only mature teratoma. But after the fourth generation, the tumor cells remained an undifferentiated solid type of embryonal carcinoma. Production of AFP and HCG by the transplanted tumor gradually decreased in accordance with the changes of histological picture that appeared in the course of serial transplantation.
In cases 2 and 3, which showed findings of embryonal carcinoma with differentiation to yolk sac tumor, the histological picture and ability to produce AFP did not change throughout the experiment.
These findings seem to support the unitarian theory of teratoid tumors, and suggest that human embryonal carcinoma stem cells may differentiate into mature teratoma in vivo.

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A 87 year-old male was admitted complaining of right chest pain, cough with purulent sputam, high fever and weight loss. Chest X-ray film showed right plearal effusion. Thoracocentesis yielded foul smelling yellow pus which, on Gram staining, showed many Gram positive filamentous branching rods identified as A. israelii on anaerobic culture. Following drainage by thoracocentesis and antibiotic therapy the patient recovered gradually. Roentgenographic examination showed remarkable improvement with minimal residual pleuhal thickenng.

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The patient, a 45-year-old male, was admitted with cough and sputum. Chest X-ray film on admission revealed three mass shadows with air bronchogram and small cavities in both lower lung fields. As it was not confirmed by transbronchial examination, open lung biopsy was performed, and primary pulmonary cryptococcosis was diagnosed.
The symptoms disappeared and chest X-ray findings significantly improved after administration of 5-Fluorocytosine.

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