The acute effects of intravenously administered sodium hydrocortisone succinate was estimated primarily by respiratory resistance as an indicative parameter, and in addition comparison among different dosages and different administration techniques were examined in adult asthmatics with middle-grade acute attacks. Twenty three patients were randomly selected, and they were divided into three groups.
The first group received a rapid bolus injection of 100mg prior to receiving 300mg in 500ml fluid over 3hrs. The second group was given only a rapid bolus injection of 300mg. The third group received a rapid bolus injection of 300mg prior to receibing 900mg in 500ml fluid over 3hrs. Each group was observed for symptoms andphysical findings, which included the time course of respiratory resistance, plasma 11-OHCS levels and arterial blood gas analysis until 6hrs after administration of the drug.
A slight fall in respiratory resistance and temporary subjective improvement were observed as the acute effects of intravenously infusing sodium hydrocortisone succinate. Except for blood gas level definite beneficialeffects, however, appeared approximately 1hr after in almost every case.

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Two autopsy cases of fatal myocardial sarcoidosis with endocardial pacing were presented
Case 1: A 51-year-old female was admitted to hospital because of complete A-V block in November, 1966, and she received isoproterenol therapy. In 1970, she had an attack of Adams-Stokes syndrome and underwent implantation of a pacemaker. The patient did well until December, 1972, but died suddenly while doing house work. At autopsy sarcoid granulomas were found in the walls of the left and right ventricles, atrial and ventricular septum, lymph nodes (hilar, tracheobronchial, paratracheal, left anterior mediastinal and retroperitoneal), lungs, spleen and liver. Adherence of an endocardial pacemaker lead to the tricuspid valve followed by tricuspid insufficiency was noted. The tricuspid valve was not involved by sarcoid granulomas.
Case 2: A 52-year-old female was admitted to hospital because of complete A-V block in May, 1976. She underwent implantation of a pacemaker the next month. Kveim reaction was positive. In April, 1980, congestive heart failure grew more serious and a fluid wave was present indicative of ascites. The patient died of ventricular fibrillation in June, 1980. At autopsy, sarcoid granulomas were found in the walls of the left and right ventricles, ventricular septum, lungs, lymph nodes (hilar, tracheo-bronchial and paratracheal) and spleen. The activities of enzymes such as acid phosphatase (AcP), alkaline phosphatase (AlP), β-gluculonidase (β-G) and adenosine triphosphatase (ATPase) in sarcoid granulomas were studied histochemically. AcP and ATPase showed activities in both the epithelioid and multinucleated giant cells. β-G activity was shown only in giant cells. AlP activity was not revealed in either type of cell.

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Cytological studies on broncoalveolar lavaged macrophages and lymphocytes obtained in the fiberoptic bronchoscope were performed in 24 patients with lung cancer, eleven patients with lung tuberculosis, seven patients with chronic bronchitis and 19 control subjects.
The results were as follows:
1) The proportion of alveolar macrophages in the lung cancer and lung tuberculosis groups showed no significant difference compared with that of the control group. In the lung cancer group, a significant decrease in the proportion of lavage lymphocytes was observed compared with the control group, and a decrease in the percentage of lavaged T-lymphocytes forming rosettes with sheep erythrocytes was found.
2) The alveolar macrophages were all shown to be positive for acid alpha-naphthyl acetate esterase (ANAE) staining, and to differ in ANAE staining patterns. However there was no recognizable difference in the distribution of ANAE staining cell patterns of each disease group and the control group.
3) Lavaged lymphocytes appeared as 61.0% single or scattered spotted ANAE staining positive cells and 38. 8% ANAE negative cells in the control group. In the lung cancer group, the proportion of ANAE positive cells was lower than in the control group. The proportion of lavaged ANAE positive lymphocytes correlated well with the percentage of lavaged T-lymphocytes.

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In order to establish the dose of theophylline as a bronchodilator, plasma theophylline levels and respiratory impedance were monitored serially after the intravenous administration of theophylline in 14 patients with bronchial asthma.
Although the bronchodilator effect of theophylline was amply documented, most of the previous reports simply demonstrated the improvement of pulmonary-function at a plasma theophylline concentration plateau. It should be pointed out that miscellaneous factors other than drug effects might interfere with observation when forced expiration is repeated and it took a long time to attain and keep a certain plasma level. In addition, it should be remembered that the bronchodilator effect could be observed only in the bronchoconstrictive state. In the present study the plasma theophylline level changed more rapidly, and the observation was made only in those patients who had kept bronchoconstrictive tendency and returned to an asthmatic state in association with the elimination of theophylline.
Two different procedures were employed. In procedure (A), 250mg of aminophylline (equivalent to 200mg of theophylline) was infused intravenously into each of the 7 subjects for ten minutes, and in procedure (B), into each of the other 7 subjects for 120 minutes. The plasma theophylline concentrations were determined by cation-exchange high-pressure liquid chromatography, and the respiratory impedance was measured by the air oscillation method (MZR-4000, Nihonkohden Ltd.).
The following results were obtained:
1) The increase in the plasma concentration of theophylline after 250mg of intravenous aminophylline administration was 14.7±3.7mcg/ml in procedure (A), and 8.7±1.5mcg/ml in procedure (B) respectively (Mean±S.D.). There were rough inverse correlations between the increase of plasma theophylline level and body weight and body surface area.
2) In procedure (A), the respiratory impedance was reduced to approximately 50% of the previous value at 30min after infusion when the plasma theophylline concentration was 9.1±2.9mcg/ml. In procedure (B), a similar reduction was observed at 120min after the start of infusion, when the concentration was 10.2±2.6mcg/ml. These effects were unchanged at 240min in both procedures.
3) There was a dose-response relationship between the plasma theophylline level and the respiratory impedance during the whole course in procedure (B) or at 30min and later in procedure (A).
4) During the course of plasma theophylline degradation, the respiratory impedance was reduced or unchanged when the plasma theophylline level exceeded 8mcg/ml but it was variable, ranging from 6 to 8mcg/ml. It was not reduced at below 6mcg/ml.
5) The respiratory impedance was not reduced to lower than 70% of the previous value until the plasma theophylline level exceeded 8mcg/ml.

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The effect of pulmonary emphysema on the flow volume curve was evaluated based on the flow volume curve during forced deflation and the static pressure volume relation in excised lobes from 6 normal dogs and 11 dogs exposed to an aerosol of papain.
The degree of destruction of alveoli on microscopy was evaluated by calculation of S/V value (alveolar surface area/unit lung volume). The static pressure volume relation can be represented by the approximation V=Vo(l-e^-KP) with K as an index of distensibility of the lung.
The peak flow, V₅₀, and V₂₅ were measured from the flow volume curve, and moment analysis and instantaneous time constant analysis were performed. The peak flow and V₅₀ and V₂₅ in the lobes exposed to papain decreased significantly. A significant correlation was found between the S/V and the peak flow, V₂₅, and values from moment analysis as well as the mean of instantaneous time constant in the range of the lower half of vital capacity.
Also there was a significant correlation between K and V₂₅, V₅₀ as well as peak flow. However there was no correlation between K and the value from moment analysis or instantaneous time constant analysis. This result suggested that the decrease of Vmax at low lung volume was related to compliance at the same lung volume. However compliance cannot be defined by K alone, because the compliance changes in relation to both K and lung volume. Moreover, irregular changes of time constant due to airway collapse and sequential emptying may affect the shape of the flow volume curve.
Analysis of Vmax in the low lung volume range, especially V₂₅, is useful for the detection of the presence of mild emphysema, because the change of the flow volume curve in papain-induced mild emphysema is reflected by a decrease of Vmax in this range alone.

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We studied the role of pulmonary contact pressure experimentally. As a lung-thorax model, an airtight box containing eight balloons which opened to the outside through tubes, was used. One face of the box wall was made with elastic menbrane and was pushed and pulled alternatively to ventilate balloons in the box. Ventilation could be measured from balloons contacting the moving wall regionally, but scarcely from ones far from the elastic walls.
The relationship between pressures acting on the box was showed as follows, P_a=P_st+P_cont+P_b where, P_a is pressure in the balloon, P_st is elastic recoil pressure of balloon, P_b is pressure in the box, P_cont is contact pressure.
When P_b is more than (-P_st), balloons expand fully in the box without free space, just as the lung in the chest cavity. Then, P_cont acts on the contact faces between balloon and box wall. Contact pressure is an important factor in pleural surface pressure and acts regionally and unevenly in the pleural cavity.
Local compression on the chest wall of adult dogs caused alveolar collapse within the area of the compressed wall but this effect decreased with distance from the focus.
Moreover, in adult dogs from which the right VI-VIIIth ribs had been removed, ventilatory volumes from the right upper and lower lobes were measured separately. Tidal volumes of the upper lobe scarcely changed after rib resection but that of the lower lobe decreased 50%.

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Morphological diagnosis of lesions in the peripheral respiratory tract was performed using two selective alveolo-bronchographies with and without magnification radiography.
In order to perform selective alveolo-bronchography (SAB), a red KIFA angiographic catheter, with a 6.6F outside diameter, was inserted from the infusing contract medium channel and prewedged into the site where the contract medium was injected, through which 2-3ml of contract medium was gradually injected under X-ray TV visualization. The patient was placed in a supine position for SAB and 3-4 times magnification was used. Simultaneously, a digestive-tract X-ray apparatus was used for SAB.
Subjects consented of 51 patients in whom lesions were limted to the peripheral respiratory tract. The patients were divided into the following 4 groups according to the results of selective alveolo-bronchography: The group in which the terminal bronchioles were narrowed (I), the group in which the terminal bronchioles were dilated (II), the group in which the alveoles ducts were dilated (III), and the group in which abnormality in the alveoli was observed (IV).

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A case of re-expansion pulmonary edema following the treatment of spontaneous pneumothorax was reported, and in 3 other cases of this disease, perfusion lung scintigraphy with ^99mTc-MAA and myocardial scintigraphy with ²⁰¹TlCl were performed in order to evaluate the regional pulmonary arterial perfusion and lung uptake of ²⁰¹Tl.
The perfusion decrease and the marked uptake of ²⁰¹Tl were observed in the ipsilateral lung of 2 cases. In a previous study, we reported that diffuse bilateral lung uptake of ²⁰¹Tl, which was distributed in more than 90% of the extravascular space of the lung, was observed in various cases with heart disease, diffuse interstitial pneumonia etc.
Therefore, it seems that ipsilateral lung in cases with spontaneous pneumothorax may be accompanied with a subclinical increased vascular permeability and abnormal accumulation of interstitial fluid. Thus patients with spontaneous pneumothorax will be predisposed to re-expansion pulmonary edema.

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A 51 year-old house wife had not noticed pigmentation of her skin and hirstism for many years before her first X-ray check-up at the age of 45. A tumorous abnormal shadow in the right hilum was found and hyper-γ-globulinemia was noticed. Two years later, edema and polyneuropathy occurred, and the biopsy specimen revealed the lesion to be Castleman's lymphoma. Surgery failed to resect the tumor. In addition to endocrine and neurological symptoms, dyspnea occurred. Steroids induced only a slight remission.

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A 15-year old boy was in excellent health until 4 days before admission when he developed a fever of 40°C with a nonproductive cough. A maculopapular rash on the trunk developed on the day of admission. He had been immunized with dead measles virus at the age of 3 years. Chest radiography on admission revealed a poorly defined consolidation in the left upper lung field without hilar adenopathy or pleural effusion. On the third day of admission, neck lymphadenopathy and hepatomegaly developed and the rash extended peripherally. On the seventh day of admission, the rash, lymphadenopathy and hepatomegaly improved. A chest radiography taken 1 month after admission revealed the smaller and more nodulated consolidation. Follow-up chest radiography and tomography taken 7 months after admission revealed that the nodular consolidation had become smaller, but that a cavity had formed in the consolidation.
The diagnosis of atypical measles was confirmed by the results of measles hemaglutination inhibition (HI) antibody test which was 1:8 on the first day of admission and rose to 1:8192 on the tenth day of admission. The measles HI antibody titer decreased to 1:256 at 7 months after admission.
Atypical measles pneumonia is presumed to be a hypersensitivity response in incompletely immunized patients. Atypical measles pneumonia should be considered as a diagnostic possibility in a patient who has a pulmonary nodular lesion with cavity before invasive investigations are performed.

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A 12-year-old schoolboy was admitted with chief complaints of dyspnea and cyanosis up on exertion on June 21, 1979. He had been well until two months before admission and there was no family history of tuberculosis. Cough with low grade fever developed one and half months before admission. Cough continued and he complained of dyspnea and cyanosis up on exertion. On June 14, he was admitted to another hospital and was referred to Gunma University Hospital. On admission, physical examination revealed subcutaneous nodules in the abdominal wall, elbow joint, back of the hand and lower leg. Breath sounds were decreased in the lower field. Moist rales were heart up on inspiration in the left lung field. Chest X-ray films showed right hilar lymphnode enlargement, with many large nodules and alveolar infiltration. PPD skin test and DNCB test were both negative and Kveim-Silzbach skin test was also negative. Biopsied skin nodule showed noncaseating granulomas believed to be compatible with sarcoidosis. The patient was initially given 30mg of prednisolone daily from June 28. Prednisolone was decreased gradually. Twelve days after admission, cranial computed tomography showed intracerebral mass in the left frontal lobe which was enhanced homogeneously. On July 27, chest computed tomography disclosed intrapulmonary masses with cavity. When prednisolone was decreased to 17.5mg a day, cranial computed tomography revealed similar mass in the right frontal lobe.
The patient is still under observation with steroid therapy revealing a marked improvement on the chest X-ray films.

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A 67-year-old male was admitted because of asthmatic attacks. He exhibited eosinophilia, elevated serum IgE levels, and serum precipitin and a dual skin reaction to Aspergillus fumigatus. The chest X-ray film revealed bilateral pulmonary infiltrates and the bronchogram showed proximal bronchiectasis. Specific serum IgE antibodies against Aspergillus antigens measured by radioallergosorbent test were also found. Inhalation challenge provoked immediate asthmatic response. These findings were consistent with the diagnosis of A.B.P.A.
In addition, various immunological examinations were performed serially and the results were compared with the clinical course. The summary is as follows.
1) The total serum IgE and IgG levels were decreased according to clinical improvement.
2) No relationship was found between eosinophil count, total serum IgA and IgM levels and the clinical course.
3) Circulating immune complexes were examined with polyethylene glycol (PEG) method. PEG precipitates indices of IgG and C_3c were significantly higher in active stage and declined when clinical and roentgenologic findings were improved with corticosteroid therapy.
These data suggest that PEG precipitates indices of IgG and C_3c reflect disease activity as evidenced by clinical and roentgenologic findings in A.B.P.A..

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A 20year-old man was wounded in the chest in a car accident. He was admitted to the Nagasaki University Hospital because of hemosputum and mild dyspnea without evidence of shock. About 33 hours after injury he developed acute dyspnea: PaO₂ 42.9mmHg, A-aDO₂ 64mmHg. Chest X-ray films showed alveolar infiltrate in the both lungs. In spite of treatment with CPPV, dyspnea and cyanosis became progressively severe, finally PaO₂ 26.3mmHg, PaCO₂ 61.3mmHg, A-aDO₂ 625mmHg and chest X-ray films showed diffuse dense consolidation of air spaces. He died 75 hours after injury.
The postmortem examination revealed “wet lung”. The lungs were heavy, non-crepitant and deep purple-red in color. Histological findings consisted of interstitial edema and hemorrhage, and the presence of proteinaceous fluid and cellular desquamated debris in the alveoli. Hyaline membranes also were seen lining alveolar ducts and alveoli. Careful pathological examination of the lungs revealed multiple platelet fibrin aggregates occluding small arteries and arterioles.

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A 60 year-old female was admitted to Kanagawa National Hospital with a coin lesion in the right lower lung field. There was no malignant sign in the chest tomography, bronchography and bronchial brush cytology. In bronchial arteriography, we found so-called specific findings of Sclerosing hemangioma.
Right middle lobectomy was performed on November 27, 1980 and we obtained diagnosis of sclerosing hemangioma by pathological findings.

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