Hemoptysis is often a presenting complaint in an otherwise asymptomatic patient, and the patient is alarmed and regards this finding as indicative of serious disease. Bronchiectasis associated with inactive lung tuberculosis, chronic bronchitis and chronic sinusitis the most common cause of hemoptysis.
In the present investigation we successfully treated 14 patients with chronic bronchitis and bronchiectasis (9 males and 5 females) whose chief complaint was hemoptysis, by instilling thrombin solution into the affected bronchus via a polyethylene tube inserted through the fiberoptic bronchoscope.
1) In all of 14 patients hemoptysis disappeared immediately after the instillation of thrombin solution.
2) In 13 of 14 patients recurrence was not observed for at least 6 months.
3) Bronchography was performed after the thrombin instillation therapy and revealed bronchiectasis in the affected bronchus.
4) A tendency to bleed was confirmed in 2 of 14 patients, but there was no significant correlation between the volume of hemoptysis and the bleeding tendency.
Above results suggest that this therapeutic procedure might be useful for the treatment of patients with hemoptysis.

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Seven cases of Legionnaires disease (59 to 85yr, three pneumonic, four non-pneumonic type) were observed in an outbreak at a hospital (300 beds) in Fukuoka City during August-September, 1980. The diagnosis of these cases was confirmed serologically.
Serial radiologic examinations were carried out in three pneumonia cases. The findings of the initial chest radiograph obtained on the third to seventh day of illness were diffuse alveolar infiltration of the entire right lobe, of the left middle lobe and thick, well-marginated consolidation of the lower left lobe respectively.
The abnormal shadow present in one case disappeared completely 25 days after administration of CER (2.0g/day for 15days) and AMPC (1.0g/day for 14 days). In two other cases, radiological abnormalities almost disappeared within 40 days after treatment with CER (2.0g/day for 15 days), AMPC (1.0g/day for 10 days) and with Minocyclin (200mg/day for 14 days).
In regard to the efficacy of the antibiotics used, the Legionella pneumophila (serotype 4) isolated from cooling towers in the hospital showed sensitivity to CER (3⁺). Pleural effusion and cavitation were not observed at any time during the course of illness.

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Bronchoactive agents can exert their effects locally on the smooth muscle of the terminal bronchioles and alveolar ducts as well as reflexively on the trachea. Nevertheless, most studies involving the action of drugs on respiratory smooth muscle utilize the isolated mammalian trachea as the test organ. Thus, unless large and small airways of the tracheobronchial tree are pharmacologically identical, results obtained with this tissue might be misleading.
The present investigation was conducted to compare the effects of various bronchoactive agents in guinea pig tracheal, 1st order bronchial and 2nd order bronchial strips. Male Hartley strain guinea pigs, weighing 250-300g, were sacrificed. Guinea pig tracheal, 1st bronchial and 2nd bronchial strips were suspended in bioassay glass jackets and superfused with Krebs-Henseleit solution at 37°C, saturated with oxygen and carbon dioxide (95:5, v/v). Contraction of tissues was detected by an isotonic transducer and displayed on a polyrecorder.
1) The ED₅₀ of acetylcholine was markedly low in trachea compared with 1st and 2nd bronchis, suggesting that the trachea is most responsive to acetylcholine.
2) The ED₅₀ of neostigmine bromide, serotonin and histamine were lowest in trachea, although were low in 1st and 2nd bronchis, suggesting that all of the trachea, 1st and 2nd bronchus are responsive to these agents.
3) The ED₅₀ of prostaglandin F_2α was lower in the trachea compared to 1st and 2nd bronchis, suggesting that trachea is most responsive to RGF_2α.
4) The ED₅₀ of thromboxane B₂ was lowest in trachea, although all of ED₅₀ in trachea, 1st and 2nd bronchis were higher compared to those of others, suggesting that trachea, 1st and 2nd bronchis are less responsive to thromboxane B₂.

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Fifty-five patients in the 6-year period 1975 to 1981 who underwent chest surgery were studied to evaluate preventive measures for postoperative pulmonary complications. They included 39 patients in a prone position during the operation and 16 cases with postoperative tracheostomy. The evaluation of these procedures was carried out using such parameters as the results of preoperative lung function, morbidity and mortality after the operation, and results of pre- and postoperative bacteriologic examinations of sputum.
Onset of postoperative pulmonary complications was determined by postoperative serial chest X-ray films showing newly developed atelectasis, pneumonia, pneumothorax, pleural effusion and wet lung. The latter three findings were observed in the contralateral lung field.
Results obtained were:
1) The majority of patients were bronchogenic carcinoma cases.
2) The majority of patients in this series had chronic inflammatory changes in the lung such as chronic bronchitis and pneumonitis.
3) They had similar or poorer lung function compared to patients who showed postoperative pulmonary complications after chest surgery in a lateral position during operation.
4) There were quite few fatal cases after chest surgery in a prone position and/or postoperative tracheostomy patients, who died of postoperative pulmonary complications.
5) It is postulated that the indications of chest surgery or thoracotomy for the patient with poorer preoperative lung function have been increased by the application of these preventive procedures described in this series.

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Prostacyclin and prostaglandin E induce relaxation in tracheal smooth muscle and in blood vessels. In addition, prostacyclin has a powerful anticoagulant effect. Although its half life is about five minutes and is metabolized by 15-hydroxy prostaglandin dehydrogenase or in a non-enzymatic process, 6-keto prostaglandin F_1α (6-keto PGF_1α) is a stable metabolite of prostacyclin, and its concentration is higher than that of prostacyclin in circulating blood. The effects of 6-keto PGF_1α on the action of various bronchoconstrictor and bronchodilator agents were examined in guinea pig tracheal strips.
Male Hartley strain guinea pigs, weighing 150-200g, were sacrificed. Their tracheal strips were suspended in bioassay glass chambers and superfused with Krebs-Henseleit solution, PH 7.4, at 37°C saturated with oxygen and carbon dioxide (95/5, v/v). Contraction of tissues was detected by an isotonic transducer and displayed on a polyrecorder and the grade of contraction was expressed as the contraction index that is the area (cm²) enclosed by the response curve and the base line measured with a planimeter. Upward deflection from the base line, i. e. contraction, is shown with a plus sign and downward deflection, i. e, relaxation, is shown with a minus sign.
1) The relaxation responses of 6-keto PGF_1α were weaker than that of isoproterenol (about 1/100) with continuous infusion of neostigmine bromide.
2) Serotonin-, prostaglandin F_2α-, acetylcholine-, histamine- and bradykinin-induced contractile responses were markedly attenuated with continuous infusion of low doses of 6-keto PGF_1α.
3) Isoproterenol-, prostaglandin E₂- and salbutamol-induced relaxation responses were potentiated with continuous infusion of low doses of 6-keto PGF_1α.
These results suggest that 6-keto PGF_1α, a stable metabolite of prostacyclin, has not only a bronchodilating effect by itself, but also has an attenuating effect on the action of bronchoconstrictors and a potentiating effect on the action of bronchodilators.

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Aspiration pneumonias, resulting from aspiration of vomitus or upper respiratory tract secretions, commonly follow prolonged periods of unconsciousness. Head injuries, alcoholism, cerebral vascular accidents and barbiturate poisoning may be complicated within a few days by a severe pulmonary infection apparently caused by organisms aspirated from the nose, throat and mouth.
The present investigation was conducted to clarify the pathophysiology of aspiration pneumonia in anesthetized mongrel dogs. Physiological and biochemical responses were investigated by the instillation of saline, hydrochloric acid (pH 2.0) and gastric contents containing food particles (pH 4.0) into the right main bronchus in anesthetized dogs.
1) Immediately after the instillation, marked hypoxemia and hypoxic acidosis were observed in all three groups. Recovery from hypoxemia was observed in the saline instillation group, although hypercapnea was observed in the gastric contents instillation group.
2) Immediately after the instillation, the tracheal pressure showed marked increase in all of three groups and it remained high in the hydrochloric acid and gastric contents instillation groups. Pulmonary arterial pressure and ascending aorta blood flow showed decreases, while the left lower lobe arterial blood flow showed significant increase 30 minutes after the instillation.
3) Plasma histamine level showed significant increase in the hydrocholoric acid instillation group, and a decrease in the gastric contents instillation group after the instillation.
4) Plasma serotonin level and angiotensin converting enzyme activity showed no significant change after the instillation in all three groups.

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Thirty-one young smokers (cigarette consumption; 19.7±6.8 cigarettes/day, years of smoking; 4.8±1.7 years) who were completely asymptomatic and had FEV_1.0% of greater than 80%, were compared with 29 healthy nonsmokers of the same age group, using airway resistance and maximal expiratory flow volume curves breathing air and a helium-oxygen mixture (79% He+21% O₂).
Airway resistance, Vmax and ΔVmax as well as FEV_1.0% and MMF could not distinguish smokers from nonsmokers, but the 2 groups could be distinguished on the basis of the volume of isoflow following one (Visov₁) and three (Visov₃) inhalations of helium-oxygen mixture. Visov₁ was not significantly higher than Visov₃ in nonsmokers, but it was significantly higher in smokers (P<0.02). Furthermore, Visov₁ was abnormal in 55% of smokers, whereas Visov₃ was abnormal in only 42%.
The correlation between Visov₁ and (V₇₅-V₅₀)/(V₅₀-V₂₅) which seems to express uneven distribution of time constant within lung approached statistical significance for only smokers (r=+0.33, 0.05<p<0.10, n=31), while it was significant for all subjects (r=+0.30, p<0.05, n=60). In addition, a significant correlation was found between ΔVisov (=Visov₁-Visov₃) and (V₇₅-V₅₀)/(V₅₀-V₂₅) in smokers except for the subjects whose ΔVisov is negative or zero (r=+0.51, p<0.05).
We conclude that cigarette smoking impairs peripheral airways first and that Visov₁ which reflects the maldistribution of ventilation is a more sensitive test than Visov₃ to distinguish smokers from nonsmokers.

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The quasi-static deflation V/P relationships of intact and excised rabbit lungs were compared. The FRC of intact lungs was measured in a paralyzed condition identical to that for the measurement of V/P curvves. The V/P curve of intact lung above the level of FRC showed no significant difference from the V/P curve of excised lung, although the lung volume of the intact lungs tended to be smaller at high distending pressures than those of the excised lungs. The RV of intact lungs was not significantly different from the minimal volume of excised lungs at a P_L of 0cm H₂O. Results indicating that the deflation V/P curve of intact lung was more influenced by the length of time spent for the deflation than the V/P curve of excised lung were also presented.

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Acid phosphatase and β-glucuronidase activities of T, B, Tγ and Tμ lymphocytes were studied cytochemically in 30 patients with sarcoidosis (23 active and 7 inactive cases) and 28 healthy controls. The results were as follows:
1. The absolute number of T cells in patients with sarcoidosis significantly decreased, whereas that of B cells remained within the normal range. T cells in active cases tended to decrease as compared to those in inactive cases. B cells in inactive cases significantly increased as compared to those in active cases.
2. Acid phosphatase and β-glucuronidase activities of both T and B cells were significantly elevated in patients with sarcoidosis when compared to those of controls. The two enzyme activities of both T and B cells tended to be higher in active cases than in inactive cases.
3. Negative correlations were observed between the two enzyme activities of T cells and the T cell count, and between acid phosphatase activity of B cells and the B cell count.
4. The percentage of Tγ cells significantly increased in patients with sarcoidosis, whereas that of Tμ cells remained within the normal range. The percentage of both Tγ and Tμ cells in active cases did not differ from that in inactive cases.
5. Acid phosphatase and β-glucuronidase activities of Tμ cells were significantly elevated in patients with sarcoidosis, whereas those of Tγ cells remained within the normal range. The two enzyme activities of Tμ cells in active cases tended to be higher than in inactive cases, whereas those of Tγ cells in active cases were approximately at the same levels as in inactive cases.
The elevation of acid phosphatase and β-glucuronidase activities of T cells seemed to be influenced by the elevation of these enzyme activities of Tμ cells. Tμ cells are considered to be helper cells. The marked enzyme activities of Tμ cells suggest the hyperfunction of helper cells. Moreover, the increased enzyme activities of B cells and elevated serum immunoglobulin levels which represent B cell hyperfunction may reflect the stimulated function of helper cells.
The present study suggests that the quantity of the lymphocyte subpopulations varies associated with the disease activity of sarcoidosis, and that acid phosphatase and β-glucuronidase activities of T, B, Tγ and Tμ lymphocytes correlate with lymphocyte function in humoral and cellular immunity in sarcoidosis.

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Sixty-nine patients with chronic obstructive lung disease were evaluated morphologically and functionally. They consisted of 28 cases of chronic pulmonary emphysema, 32 cases of chronic bronchitis and 9 cases of diffuse panbronchiolitis. The morphology of airways and alveoli were examined by selective alveolo-bronchography—SAB—. Just before SAB, spirometry and flow-volume curve were performed. Within a few weeks after SAB, intra-cardiac pressure was measured by cardiac catheterization.
Narrowing, irregularity, fringe and dilatation of bronchi were characteristic findings in chronic pulmonary emphysema. It was possible to distinguish panacinar from centrilobular emphysema by SAB. Transverse folding, irregularity, fringe and mucus of bronchi were more remarkable in central airways than in peripheral airways in chronic bronchitis. On the contrary, these findings were more remarkable in peripheral airways than in central airways in diffuse panbronchiolitis. Rounded ending of peripheral airways was observed in all cases of diffuse panbronchiolitis. This finding seemed to be characteristic of diffuse panbronchiolitis.
The values of %FEV_1.0, %MMF, %V₅₀ and were lower in diffuse panbronchiolitis than in chronic pulmonary emphysema and chronic bronchitis. The value of mean pulmonary arterial pressure was higher in airway diseases such as diffuse panbronchiolitis and chronic bronchitis than in pulmonary emphysema.
A negative correlation was recognized between the severity of peripheral airway lesions and the values of %VC and %FEV_1.0 in chronic bronchitis.

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It is well known that cigarette smoking has diverse effects not only on the airway system but also on the pulmonary circulation system. The acute effects of cigarettes are induced mainly by nicotine, the main alkaloid in tobacco. The present investigation was conducted to explore the acute effects of nicotine on canine airway, pulmonary circulation and systemic circulation. We also measured the serum histamine and serotonin levels in order to evaluate the secondary effects of nicotine.
Twelve dogs, weighing between 18 and 25kg, were anesthetized with intravenous administration of 25mg/kg of sodium pentobarbital. The left hemithorax was opened under artificial respiration and tracheal pressure (Ptr) was measured. Catheters were inserted into the pulmonary artery trunk, left atrium and descending aorta. The pulmonary artery pressure (Ppa), left atrium pressure (Pla) and systemic artery pressure (Psyst) were measured. Drugs were injected into the left pulmonary artery through a polyethylene catheter. Ten dogs with closed chest were injected with 1mg of nicotine intravenously, and venous-blood samples were collected once before nicotine injection and 4-5 times after nicotine injection. Serum histamine and serotonin levels were measured, respectively.
1) Ptr increased following injection of nicotine into the left pulmonary artery.
2) Ppa and Psyst increased dose-dependently following injection of nicotine into the left pulmonary artery.
3) Serum histamine level was increased 20 minutes after the intravenous injection of 1mg of nicotine, and remained at a high level for over 60 minutes.
4) Serum serotonin level was decreased significantly 30 seconds and 2 minutes after the intravenous injection of nicotine.

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The relationships between pulmonary function tests and the findings on chest X-P were statistically analyzed in 162 cases of silicosis. The respiratory function tests were spirography (VC, FEV₁), measurements of the lung volumes (TLC, FRC, RV, RV%), CO₂ diffusing capacity by single breath methods (DL_CO, DL_CO/V_A), arterial blood gas analysis (PaO₂, PaCO₂, pH, AaDo₂), and mechanical properties (Pel, Cst, Cdyn/Cst, R_L, R_L). The findings on chest X-ray film in silicosis are divided broadly into three categories: the types and profusion of small opacities and the size of large opacities. The authors observed the statistically significant correlation between the types and profusion (p<0.01), and between the profusion and the size of large opacities (p<0.05). Therefore, taking that correlation into account, the relationships between the function and the roentgenographic findings were investigated by means of multiple regression analysis: the parameters of the function were regarded as criterion variables and the three chest X-ray film categories as predictor variables. The results were as follows: 1) the disturbances of Pel, Cst, lung volumes (VC, TLC, FRC), parameters of obstructive impairment (FFV₁, V50, V25, R_L, R_T, ) and DLCO were in parallel with the grade of profusion of small opacities and the size of large opacities. 2) The parameters correlating with the types of small opacities were merely R_L and R_T. 3) The relation between the parameters and those mentioned above (RV, %RV, V50/V25, Cdyn/Cst, DL_CO/V_A and the blood gas parameters) and the grade of chest X-ray film were not significant.

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A case of hypersensitivity pneumonitis with repeated episodes every summer during the past three years was reported.
In Ouchterlony Gel immunodiffusion method, a precipitin band between the patients' serum and Micropolyspora faeni was detected. Furthermore, the provocation test with Micropolyspora faeni caused decreases in the VC, FEV_1.0 and PaO₂ of the patient and an increase in temperature after 4 hours.
These results suggested that frequent insufflation of Micropolyspora faeni caused the hypersensitivity pneumonitis in this patient. Moreover, pulmonary function test and chest X-ray findings suggested irreversible restrictive changes in this patients' lung during the past three years.

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A 41 year-old male case with immotile cilia syndrome is presented. The patient had a long history of chronic respiratory infection and sinusitis since early childhood and was found to have situs inversus at the age of eighteen years.
His sperm were immotile and sperm tails lacked dynein arms. The inhaled aerosol of albumin microspheres labeled with ^99mTc demonstrated the lack of mucociliary clearance from the airway in which cilia also lacked dynein arms.

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A 57 year-old man was admitted to our hospital with complaints of cough and dyspnea. He had asthma in his childhood. About 50 years after the last attack of asthma, he had an attack immediately after he handled bovine bone powder which was to be used as a fertilizer in his garden.
Examinations revealed that there were diffuse infiltrations in his lungs, peripheral eosinophilia and a high level of serum IgE. Reactions were observved by intradermal injections of antigens from aspergillus, candida, cladosporium and penicillium. Precipitins to these antigens were detected in the serum. From these results, the case was diagnosed as allergic bronchopulmonary aspergillosis. Probably the bone powder contained the causative antigens. Mold antigens other than aspergillus might be also causative antigens. Steroid therapy was very effective in this patient.

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A 32-year-old housewife presented with cough and fever. The postero-anterior chest X-ray film on admission showed a left hilar mass with an infiltrative shadow in the left lower lung field. Bronchograms and tomograms revealed the mass occupying the anterior mediastinum or the left lower lobe.
On left thoracotomy a thick-walled cystic tumor measuring 3×3×3.5cm was found in the anterior mediastinum adhering to the upper lobe of the left lung. On cut sections, the cystic lumen was seen to possess two protrusions covered by epidermis with a few hairs and to form bronchial fistulas communicating to B₄ and B₅ of the left lung.
Histologically, the wall of the cyst consisted of alimentary epithelium, respiratory epithelium and stratified squamous epithelium with sweat glands, sebaceous glands and hair follicles. A distinct feature of the present case was the presence of abundant pancreatic tissue containing both exocrine and endocrine elements. Cartilage, smooth muscle, adipose tissue and lymphoid tissue were also found as mesodermal elements. Residual thymic tissue was also found. There were no signs of malignancy.
It is therefore very possible that enzymes from the above alimentary tissue, especially from the pancreatic tissue, caused inflammatory granulation tissue resulting in destruction of cystic walls and bronchial fistulas.
In a review of the Japanese literature, forty-one cases of benign mediastinal teratoma were presented. Twenty-one cases penetrated into lung. On the pathological findings, twenty-eight cases were cystic and two cases were parenchymatous.
Examining the structural components of all cases, urinary epithelium was found in only one case. Four cases contained nervous tissue. Hematopoietic tissue and bone were seen in three cases each. Pancreatic tissue was found in twelve cases, and residual thymic tissue in fourteen cases. There was no skeletal muscle, thyroid gland, hepatic tissue or nephrotic tissue. These findings may be ascribed to the pathogenesis of teratoma as described in the literature.

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43才男性, 咳嗽, 喀痰を訴えて受診した. 胸部X線写真正面像で Scimitar sign と心右方転位がみられた. 一部右肺静脈は右房直前の下大静脈に還流していた. 右上葉の無形成に伴う右肺動脈, 右気管支の分岐異常, 腹部大動脈から右下肺への動脈進入を伴い, ASDを合併した典型的な Scimitar syndrome を呈示した.

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