Ninety five cases of hypersensitivity pneumonitis were studied and almost 70% of them were classified as summer-type hypersensitivity pneumonitis which has not been reported in countries other than Japan. Cases of summer-type hypersensitivity pneumonitis reveal the following unique characteristics; 1) occurrence in the summer season. 2) reccurrent episodes in the same summer season for several years (35.9% of cases). 3) provocation of symptoms when returning home (27.5% of cases). 4) familial occurrence (26.2% in this study). 5) a triad of clinical symptoms consisting of coughs, dyspnea and fever. 6) diffuse scattered nodular shadows on chest X-ray. 7) elevation of erythrocyte sedimentation rate and leukocytosis with neutrophilia. 8) decreased %VC, DL_CO and PaO₂ in pulmonary functions. 9) negative inversion of skin reactivity to PPD. 10) granulomata in the lung (found in 63% of biopsied cases).
Although biological air pollution such as ubiquitous fungus spores has been suggested as the offending antigen of summer-type hypersensitivity pneumonitis, but the causative antigen has not been defined yet.
Bronchoalveolar lavage of a case of summer-type hypersensitivity pneumonitis resulted in 25% alveolar macrophages and 75% lymphocytes, all of which were T-cells. Accumulation of T-cells to the inflammatory lesions in the lung, which means participation of cellular immunity in this disease process, may explain the negative conversion of PPD skin reactivity.

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Small pieces of normal lung tissue were obtained from autopsy or surgical specimens (32 to 87 years of age) and immersed in 0.1N NaOH for 5 to 44 days. Tissue elements such as various cells and ground substances of interstitial connective tissue seen in alveolar walls were gradually dissolved away and finally networks of connective tissue fibers appeared: these were then observed by a scanning electron microscope. Collagen bundles which were distributed densely in the alveolar wall were also on part of the destructive process by NaOH. The whole aspect of alveolar elastic networks could be observed after a full NaOH treatment. Thick elastic fibers were seen along the edges of alveolar orifices and several thick projecting branches were distributed in the walls of alveoli. Networks of thin elastic fibers forming fine meshes were seen in a space between thick fibers. However, some of the fine fibers were difficult to distinguish from remaining collagen fibers by scanning electron microscopy. No obvious difference was found between the networks from old subjects and those from the younger ones. The specimens which were made in the usual way without NaOH-treatment showed many linear elevations on the internal surface of alveolar walls of old subjects. Observations of NaOH-treated specimens indicated that thick elastic fibers lying underneath the epithelium formed these linear elevations. In addition, it was suggested that ground substance around the fibers was apt to decrease in aging process.

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Exercise is often limited by dyspnea during relatively mild exertion in patients with respiratory diseases in comparison with normal subjects. Therefore normal subjects and patients with respiratory diseases were examined by an exercise test for the purpose of elucidating what was the exercise limiting factor in their cases.
Subjects performed maximal exercise test at 10 watts, being increased every 3 minutes, using a bicycle ergometer. During increasing work rate test, expiratory gas was analysed continuously, and the respiratory curve and ECG were recorded. Before and after the exercise test pyruvate, lactate and arterial blood gases were analysed.
1. With increasing degrees of ventilatory disturvance, patients required more VE, heart rates, V_O2 and lactate concentration for the same work rate in comparison with normal subjects.
2. The more the degree of ventilatory disturbance deteriorated, the lower were V_O2 and lactate concentrations at the maximum of exercise.
3. Normal subjects and patients reached the limit of exercise tolerance when the ratio of tidal volume during exercise to vital capacity (V_T/VC ratio) approached 50 per cent.
4. With the advance of ventilatory disturbance degree, physiological strain showed high values.
5. In normal subjects the shortening of expiratory time was more than that of inspiratory time during exercise. But with the advance of ventilatory disturbance degree, it became difficult to shorten expiratory time.
6. After exercise test blood gases and pH showed lactic acidosis. As the degree of ventilatory disturbance deteriorated, patients reached the limits of exercise tolerance at an early stage when lactic acidosis was mild.
7. After exercise test Pa_O2 increased and Pa_CO2 decreased in normal subjects and patients.

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The necessity for world-wide standardization of the method to clinically record lung sounds has been recognized. Previous recording systems using an A-D to D-A converting computer system or copy techinque embloying two to three data recorders had some limitations as follows:
1) The recording length of the waves was too short because of the capacity of the computer memory, 2) Real time recording was impossible. Therefore, these systems were inadequate for analysis and inconvenient for clinical use. Such conditions might well have obstructed the standardization of the method.
According to these considerations, we constructed a new phonopneumograph. We adopted a thermal printer system which had minimal damping for wave recording. Moreover, a recording system of respiratory flow rate or volume using a Fleisch type pneumotachograph was combined with the device.
As a result, real time and non-time-limited recording with simultaneous information on respiratory flow rate or volume has become possible. After several tests, accuracy of waveform recorded was considered highly acceptable even at the maximum speed of 750mm/sec. The device is relatively small and light, and is portable. After actual clinical use, it was suggested that we could easily define rales such as crackles, bubbling or friction rub by analysing the characteristics of waveform and recognition of the respiratory phase where the rales appeared.

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The purpose of the present study is to clarify the histopathological changes of the lung in 33 autopsy cases of rheumatoid arthritis, and to discuss the relationship between the pulmonary manifestations and clinical course. The results were summarized as follows:
1. Pleuritis, the most common pleuro-pulmonary lesion of patients with rheumatoid arthritis, was observed in 25 cases (78%). Twenty-two cases were associated with pleural effusion during the clinical course, but subpleural rheumatoid nodule was absent in the 33 cases.
2. Interstitial pneumonitis and diffuse interstitial fibrosis were observed in 9 cases (27.3%).
3. Granulomatous bronchitis or bronchiolitis was less frequent than diffuse interstitial fibrosis, but was considered to be important as a cause of respiratory symptoms.
4. Systemic angiitis was observed in 9 cases (27.3%), and in the lung in 5 cases. Angiitis of classical PN type was found only in the bronchial artery.
5. Pulmonary infections, such as bronchopneumonia, cytomegalic inclusion disease, pulmonary pneumocystosis, tuberculosis and so on, were observed in 13 cases. They seem to be important as one of factor determining the prognosis of patients with rheumatoid arthritis.
6. In the cases of interstitial pneumonitis and diffuse interstitial fibrosis, respiratory symptoms did not precede those of arthritis.
7. Pulmonary infections were frequently observed in cases with short clinical courses from the onset of respiratory symptoms to death, and diffuse interstitial fibrosis was found in cases with long clinical course over 9 months.
8. Caplan's syndrome and lung cancer was not found in the present study.

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Lung functions of 50 patients with sarcoidosis (stage O; 11, stage I; 33, stage II; 6, ) were studied. All cases were considered to be mild because of their clinical findings.
The results were obtained as follows:
1) Abnormalities of DLco and Pao₂ were significantly frequent in stage II.
2) Small airway dysfunction was frequently detected in the cases, also in non smokers. However, decrease in VC and Cst was not observed, and decrease in DLco was found in only 4 cases (8%). Therefore, small airway dysfunction may be the most characteristic finding in mild cases of sarcoidosis.
3) Small airway dysfunction was suggested to be mainly due to increase in resistance of airways narrowed by sarcoid granuloma or peribronchial fibrosis. The loss of elastic recoil at 60% TLC was observed in only one case, so it might not be a main factor of small airway dysfunction.

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We examined the pathogens of 204 patients with acute pneumonia at our hospital between Jan. 1970 and Dec. 1979 to study the changes of the pathogens in community acquired acute pneumonias over a period of 10 years.
The results were as follows:
1) Of 204 cases, bacterial pathogens accounted for 53 cases (26.0%), mycoplasmas pneumoniae 35 cases (11.3%) and viral species 9 cases (4.4%). However, in the remaining 107 cases (52.4%) the pathogens could not be identified.
2) Of bacterial pathogens, Streptococcus pneumoniae was the most frequegt etiologic agent (29.0%), Hemophilus influenzae was the second (22.6%), Pseudomonas aeruginosa the third (17.7%) and the majority of the pathogens were gram negative bacilli including E. coli, Klebsiella aerogenes and Serratia marcescens. Although lung abscess and empyema were included in this series, Staphylococcus aureus was the pathogen in only 3 cases.
3) The study of the yearly incidence of each pathogen demonstrated that pneumonias due to Hemophilus influenzae increased since 1974, but the those of undetermined pathogens decreased.
4) To study the relationship between the pneumonias and the underlying deseases, the pneumonias due to S. pneumoniae and H. influenzae occurred both in previously healthy patients and in those with underlying diseases. The pneumonias due to gram negative bacilli occurred in patients with underlying diseases, while mycoplasmal pneumonias primarily occurred in previously healthy patients.
5) The age of the patients with bacterial pneumonias increased in recent years, however, the majority of mycoplasmal pneumonias still occurred in young or middle aged people.
6) We have often used the transtracheal aspiration (TTA) technique to determine the pathogens of the pneumonias when the pathogens are not determined from the sputums. In this series, the pathogens were identified in 14 out of 42 cases examined with TTA. However in 12 out of 14 cases the pathogens could not be identified by examining sputums.

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With regard to the pathogenesis of hypersensitivity pneumonitis, cells in lung lavage fluid were studied in rabbits with respect to their functions.
Granulomatous lesions in the lung were produced with transtracheal insufflation of Micropolyspora faeni antigen in rabbits previously sensitized with subcutaneous injection of M. faeni emulsified in complete Freund's adjuvant (group I) and compared with groups of rabbits treated with transtracheal injections of the antigen after subcutaneous sensitization with incomplete Freund's adjuvant (group II) or rabbits treated only with systemic sensitization with M. faeni emulsified in complete Freund's adjuvant (group III).
Total lavaged cells increased in number in group I with mild increase of lymphocytes. The phagocytic rate of lung macrophages studied with Candida yeast phagocytosis was greater in group I (p<0.05). However, the positive response to LPS-activated sera, that was shown in control animals, was diminished or decreased in all animals of group I and some of group II. Migration of cells in lavage fluid was inhibited in the presence of M. faeni antigen most markedly in group I. However, migrating lung macrophages from group I rabbits were found to have aggregated even without antigen.
These changes of the lung macrophages from granulomatous lesions were discussed with relationship to the pathogenesis of the lesions most directly related to type III allergy of Coombs and Gell.

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To calculate the predicted vital capacity (VC-pr), eight standard formulae are used in Japan. It is appropriate to use more than one formula, because the age correlated change of the vital capacity is not monotonic. However more formulae make it more complicated to calculate the VC-pr. From this point of view, the nomogram which can be used in most ages was developed.
The nomogram reported in this report covers the eight standard formulae used in Japan and is applicable in most ages (from 6 to 80 years old) regardless of sex.
The height axis, VC-pr axis and the axis of measured vital capacity are drawn using an equal interval scale. Therefore, interpolation of the scales and enlargement of the ranges of the scales are easy. The scale of age axis expresses the contribution of age to VC-pr variation much more than former nomograms.
The axes are arranged according to the sequence of use, to prevent error.

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Recently, it has become not so difficult to diagnose mediastinal tumor or aneurysm of thoracic aorta, because of the remarkable development of the computed tomography (CT). Nevertheless, it can be rather difficult to differentiate thoracic aortic aneurysm from organized thrombus from the mediastinal tumor.
We presented here a case of thoracic aortic aneurysm with organized thrombus who died from the aneurysm rupture. A 70 year-old man was admitted to our hospital with chief complaints of exertional dyspnea and hoarseness. But, Homer's syndrome was not found. Chest X-ray film, CT scan and angiography suggested an anterior mediastinal tumor. But before surgery he died suddenly. Autopsy revealed the ruptured thoracic aortic aneurysm with the organized thrombus, bleeding into the left pleural cavity.

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27才, 男, 入院1カ月前より胸部牽引痛が出現し胸部X線にて右側大量胸水を認めた. 入院後上腹部痛出現し胸水中 amylase の異常高値を認め, 膵膿瘍の疑いにより開腹, 術中の膵管造影にて膵仮性嚢胞から後縦隔に至る内瘻が認められた. 右胸腔内への内瘻形成は本例が本邦初例である.

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