In an attempt to establish the screening criteria of tracheobronchomalacia, we examined the average diameter of the tracheal air column of healthy Japanese individuals.
We report here the results along with their correlation with age and height. The frontal diameter of the intrathoracic trachea was found to have a good correlation with height. There is also a good correlation with age under twenty years where developmental growth is still continuous. When we examined the relationship between the saggital and frontal diameters of the intratoracic trachea, the increase with age of the former was greater than the latter. In addition, the increase of the frontal diameters of the intrathoracic trachea was less than those of the extrathoracic one. These results suggest a disporportional development of the trachea in specific directions.

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The observation of fibronectin in the basement membranes of bronchial mucosa in 43 specimens biopsied bronchoscopically from patients with bronchial asthma (18 cases), chronic bronchitis (4 cases), lung cancer (11 cases), lung tuberculosis (one case), lung fibrosis (2 cases) and control subjects (7 cases) was done by the direct immunofluorescence staining method.
The results were as follows.
1) Fibronectin staining was observed in the bronchial basement membranes of twelve of the 18 patients with bronchial asthma and of two of the four patients with chronic bronchitis, but only two of the 14 patients with other bronchopulmonary diseases and the seven control subjects.
2) In bronchial asthma, there was no correlation of clinical type (atopic, infectious, and mixed) and fibronectin staining in the bronchial basement membranes.
3) Fibronectin staining in the bronchial basement membrane was observed in nine of the 13 cases whose biopsied bronchial tissues showed the thickening of basement membrane, but in only two of the 17 cases whose bronchial tissues showed no thickening of basement membranes.
4) Fibronectin staining in the bronchial basement membrane was observed in ten of the 15 cases whose biopsied bronchial specimens revealed fibrinogen staining in the basement membrane, but in five of the 26 cases whose bronchial specimens revealed no fibrinogen staining.
From these results it was suggested that increase in fibronectin in the bronchial basement membranes correlated to thickening of the basement membranes and deposition of fibrin, and that fibronectin in the bronchial basement membranes may be involved in repeated destruction and repair of bronchial mucous tissues.

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The purpose of this study was to examine the kinetics of myocardial energy metabolism and cardiac function in cor pulmonale. In order to achieve these ends, the author made comparative studies of the myocardial energy transport system in humans and hamsters with elastase-induced emphysema. In addition the effects of digoxin and furosemide on the cardiac metabolism was pursued.
Emphysema in hamsters was induced by 24 unit elasterase injections into the trachea. The heart was followed up more than a year, both histologically, and enzymologically. Pyruvatekinase, a key enzyme of glycolysis, was measured by the method of Bücher.
The main enzymes of the electron transport system (succinic-cytochrome C reductase, NADH-cytochrome C reductase, and cytochrome C oxidade) were measured by the modified method of Tsoo, using a multiconvertible spectrophotometer. The P/O ratios were measured polarographically at 20°C with an oxygen electrode.
In the hypertrophic phase, the activities of pyruvate kinase, NADH-cytochrome C redutase, succinic-cytochrome C reductase, and cytochrome C oxidase were increased in the right ventricle. Inversely, the activities of these enzymes in the left and right ventricular myocardia were decreased in the congestive phase. The P/O ratio was also decreased only in the congestive phase in the ventricular myocardium.
Likewise, the activities of the human myocardial enzymes were increased in the hypertrophic phase and decreased in the congestive phase.
Digoxin and furosemide appered to exert a small stimulatory effect only in the congestive phase.

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A case of supposed pulmonary metastasis from uterine leiomyosarocma was reported. The case was a 59 year-old female, who showed multiple round shadows on chest X-ray. Historectomy was performed 23 years ago due to a uterine tumor diagnosed as a polyp. Open lung biopsy revealed a cystic nodule composed of smooth muscles and collagenous tissue containing entrapped glandular elements and cystic space covered by flat epithelium. Postoperative course is uneventful and no new nodule appeared. Previously these cases were considered to be multiple hamartomas of the lung in Japan, so this case is the first case diagnosed as pulmonary metastasis from apparently benign leiomosarcoma of the uterus. Sixteen supposed cases of lung metastasis from uterine leiomyosarcoma reported in Japan were reviewed.

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A 49-year-old man, an administrator in a piano manufacturing plant, first started to use a polyurethane paint in 1975 for refitting secondhand pianos as a part-time home job. He had neither a past history nor a family history of allergic diseases. He used a paint containing diphenylmethane diisocyanate (MDI) in hardener once in two months. The painting was carried out indoors while ventilating by fan for two or three hours. He wore a mask during this spray operation.
In August 1979, episodes of recurrent symptoms of nonproductive cough, dyspnea and fever of 39°C began to appear. These symptoms appeared one hour after he finished the paint application. He did not experience wheezing, and the respiratory symptoms subsided in the following day, but he was febrile for a few days. He visited Seirei Hamamatsu Hospital on November 13, 1979, two days after spraying paint. Crepitations were audible in both lower lung fields and chest x-ray film showed a ground glass appearance in the right upper and bilateral lower lung fields with several thick linear shadows just above the diaphragm. When he was admitted on November 16, however, there were none of the above symptoms, crepitations or abnormal shadows on chest x-ray. The lung function tests and arterial blood gas studies revealed diminution of FEV_1.0, D_LCO, PO₂ and PCO₂.
His symptoms always occurred after painting, so hypersensitivity penumonitis due to MDI exposure was suspected. In the clinical provocation test, the temperature elevated with neutrophilia about six hours after beginning painting, then FEV_1.0 D_LCO, PO₂, and PCO₂ decreased as his respiratory symptoms were aggravated from four to eight hours after MDI exposure. The respiratory distress began to alleviate in the next day, but diminution of FEV_1.0 and D_LCO continued for three days. Chest x-ray films taken on the day of the provocation test showed no abnormalities, but on the following day abnormal shadows similar to those found on the initial visit were recognized.
Other approaches such as serological examination or lung biopsy were not undertaken, but this case has many points of resemblance to those cases of hypersensitivity pneumonitis reported by Charles et al. (1976), Fink & Schlueter (1978) and Zeiss et al. (1980). The patient has been free of symptoms ever since by avoiding MDI exposure.

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The patient described here has a unique abnormality of pulmonary vein. His abnormality was first noticed on chest roentogenogram as a serpentine loop like shadow. This was proven to be the right apical pulmonary vein running anteriorly, downward, and then upward to the hilum connecting with the left atrium in a tortuous form. In addition to this anomaly, systemic arterial supply to the right apical pleura and then apical pulmonary vein was also revealed.
An anomalous course of the pulmonary vein is a rare form of pulmonary vasculature anomaly. This anomaly should be differentiated from partial pulmonary venous return, pulmonary venous varices, and arteriovenous shunt by pulmonary and systemic angiographies.
Its origin from an embryological point is also discussed.

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A 58 year-old housewife was admitted complaining of cough and left chest pain. Chest X-ray film showed massive pleural effusion on the left side. The diagnosis of pleuritis carcinomatosa was made by cytology of fluid and histology of pleural biopsy.
Immediately after removal of 2500ml of fluid through a thoracal tube, she showed productive cough and dyspnea. Chest X-ray film showed re-expansion of the left lung and unilateral pulmonary edema; arterial PaO₂ value revealed 52.8 torr. Hydro-cortison and furosemide were injected intravenously. The symptoms almost disappeared on the next day, and unilateral pulmonary edema disappeared 6 days later.

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In sarcoidosis, despite the high frequency of microscopic splenic involvement of epithelioid granulma, patients with giant splenomegaly are rare. This paper presents 2 cases with marked splenomegaly due to sarcoidosis.
Case 1: A 60-year-old man, complaining of high fever, general fatigue, left hypochondralgia, whose diagnosis was not made before splenectomy. Excised spleen was enlarged in 4fb below the left costal margin, weighing 1180g. Roentogenograms of the chest revealed a cotton-like shadow in the right upper lung field, and reticulo-nodular shadow in bilateral lung fields. The level of serum angiotensin-converting enzyme activity was not remarkably high.
Case 2: A 30-year-old man developed exertional dyspnea. His physical examination showed skin eruption, peripheral lymphadenopathy and giant splenomegaly. Many white patiches were observed on the surface of spleen and liver by peritoneoscopy. The chest X-ray film showed a reticulo-nodular pattern in bilateral middle-lower lung fields and bilateral hilar lymphadenopathy. The activity of serum angiotensinconverting enzyme was very high (109 units). A liver biposy showed non-caseous granuloma compatible with sarcoidosis. The giant splenomegaly disappeared one month after prednisolone administration.

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A case of primary macroglobulinemia with pulmonary infiltration was reported. The patient was a 77 year-old woman who had a history of 2 episodes of pneumonia over a period of several years before admission. She was admitted to our hospital because of cough and mild dyspnea. On physical examination, she had mild anemia and was poorly nourished. There were small crepitant rales on auscultation of the chest, but no lymphadenopathy was detected. Her chest roentgenogram showed reicular and small nodular shadows bilaterally in the middle and lower lung fields, particularly in the right middle lobe, consolidation with homogenous shadow where dilatated and cystic bronchi were seen.
Laboratory data showed an increased monoclonal M-band due to IgM-κ type. The transbronchial biopsy (TBLB) of the pulmonary infiltration revealed accumulations of small lymphid cells which obliterated the alveolar structure. These lymphoid cells were stained with antibodies to μ and κ chains by immunofluorescence.
These findings indicated that the pulmonary infiltration of the patient was most likely due to macroglobulinemia both histologically and immunologically.

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44歳男性. 昭和55年9月胸部X線上, 左胸水指摘. 原因不明のため11月25日当院人院. 胸部X線上, 左肺尖部の腫瘤影と左胸水を認めた. 胸水は黄金色に輝き, 多数のコレステロール結晶を認め, CEA高値を 示した. 胸水より結核菌を検出し, 結核性コレステロール胸膜炎と診断. 抗結核剤投与で治癒した.

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