To investigate the localization and the possible role of the nonadrenergic inhibitory nervous system in airway hyperreactivity of the feline airway, we have measured the change of R_L and C_L during vagal stimulation in anesthetized artificially ventilated animals during the infusion of serotonin sulfate (20mcg/kg/min), pretreated with atropine sulfate (0.5mg/kg) and propranolol hydrochloride (0.5mg/kg). The dose-response relationship of serotonin was investigated in animals pretreated with atropine and propranolol, during electrical stimulation of cervical vagus nerve and after treatment with hexamethonium bromide (2mg/kg). The following results were obtained.
1) The nonadrenergic inhibitory nervous system innervates the feline airway through the central to the peripheral airways.
2) The activity of the nonadrenergic inhibitory nerve was not apparent under the normal airway tone, but became obvious under increased airway tone.
3) The nonadrenergic inhibitory nerve is supplied by preganglionic fibers in the cervical vagus nerves.
4) The electrical stimulation of the nonadrenergic inhibitory nerve decreased the airway responsiveness to serotonin. The inhibition of the nonadrenergic inhibitory nerve with hexamethonium increased airway responsiveness to serotonin.
These results clarified the innervation of nonadrenergic inhibitory nervous system in the feline airway through the central to the peripheral airways, and suggested that a defect of this nervous system might provide an explanation for airway hyperreactivity.

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Scintigraphy with ²⁰¹TlCl and ¹⁹⁷HgCl₂ was performed in 323 patients with various respiratory diseases. Diffuse, marked bilateral lung uptake of ²⁰¹Tl or ¹⁹⁷Hg was demonstrated in 2 of 3 cases with hypersensitivity pneumonitis, 26 of 29 cases with silicosis and 28 of 29 cases with diffuse interstitial pneumonia, but in diffuse panbronchiolitis, chronic bronchitis and pulmonary emphysema, only slight lung uptake or negative results were obtained in most cases. In diffuse interstitial pneumonia, no close correlation was observed between the grade of the lung uptake and the various clinical findings such as fever, cough, rales, ESR, S-LDH, α₁-globulin, %VC, PaO₂ and so on. With regard to roentgenological findings, marked lung uptake was observed in cases not only with reticulonodular shadows but also those with ring shadows and those without any shadows. Concerning the microscopic findings of lung biopsy specimens, marked uptake was observed in cases with slight interstitial fibrosis as well as infiltration of mononuclear cells. The right ventricle was visualized in 13 of 19 cases (68.4%) with diffuse interstitial pneumonia. Lung scintigraphy with ²⁰¹Tl chloride is non-invasive and seems a more sensitive indicator of diffuse intersitial changes such as inflammatory disorders than the clinical findings, chest X-ray and so on.

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Plasma theophylline disposition after a single intravenous 10-min infusion of aminophylline was examined in 66 patients: 10 with heart failure, 13 with liver dysfunction, 11 with respiratory failure, 6 with renal insufficiency and 26 controls. Plasma theophylline concentration was determined by high-pressure liquid chromatography. One-compartment open system pharmacokinetic analysis provided parameters as follows:
1) The apparent distribution volume of theophylline was 0.49+0.081/kg (Mean+S. D.) and was not affected by age, Rohler's index, serum protein, serum albumin or hematocrit.
2) The plasma elimination rate of theophylline was affected by some disease status. It was smaller in the heart failure group (0.066±0.022hr^-1) and in the liver dysfunction group (0.069±0.021hr^-1) than that in the control group (0.094±0.020hr^-1) (p<0.005).
In the control group, smokers had a larger elimination rate than non-smokers (p<0.2) and elimination rate was independent of age.
The elimination rate was found to be correlated to the plasma retention of indocyanine green at 15 minutes (ICG Ret₁₅). When ICG Ret₁₅ was 8% and below, it was 0.100±0.010hr^-1 (n=10). When over 8%, the following equation was observed;
Elimination rate=-0.0347 In (ICG Ret₁₅)+0.170hr^-1 (n=33, r=-0.84, p<0.001)
Using these parameters, a new type “dose-concentration nomogram” for intravenous theophylline therapy was proposed. By means of this nomogram, an appropriate dose for expected plasma theophylline level could be derived immediately, and reversely, plasma theophylline concentration at any time could be estimated easily from his previous theophylline dosing.
Comparing the calculated value (Y) based on this nomogram with the observed value (X) of plasma theophylline concentration, the following relationship was found;
Y=0.75X+1.46 (n=202, r=0.93, p<0.001) This equation showed the high reliability of this nomogram.
For wider application, the patients were divided into three groups on the basis of their general condition and the mean elimination rate for each group was added to this nomogram. Therefore according to the general condition of the subject this nomogram was available by selecting a suitable elimination rate even when his ICG Ret₁₅ was unknown.

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The effect of oleic acid injection (0.1ml/kg) on pulmonary vascular permeability was examined in 5 anesthetized dogs. In addition to lung water content and histological examination, we studied lung lymph flow, lymph to plasma protein ratio and lymph protein clearance as sensitive indicators of transvascular fluid filtration and protein permeability. Furthermore, we compared lymph protein clearance between oleic acid studies and increased pressure studies in order to clarify pulmonary vascular permeability.
1) Lung water content increased by 35% in comparison to controls and intraalveolar and interstitial pulmonary edema were demonstrated histologically on the postmortem examination after oleic acid injection.
2) Oleic acid injection caused significant increases in lung lymph flow with no changes in lymph to plasma protein ratio. In contrast, left atrial hypertension resulted in increases of lung lymph flow that were associated with a decreasing lymph to plasma protein ratio.
3) Oleic acid significantly increased lymph protein clearance with an increasing lymph flow, indicating an increase in protein permeability. When we compared lymph protein clearance for a given increase in lymph flow between oleic acid and the increased pressure groups, oleic acid produced a greater increase in protein clearance than that seen after increased pressure.
These findings indicate that oleic acid caused an increase in pulmonary vascular permeability, probably due to pulmonary endothelial injuries.

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The prevalence of pleural thickenings among in three groups of different grades of asbestos exposure was investigated by the method of case-control study. For 130 cases of workers manufacturing asbestos products, two kinds of controls with matched age and sex were selected from drivers or road staff working in a transportation company and residents in the rural district. Blind readings of postero-anterior chest X-ray films were made independently by three trained chest physicians following the criteria for classifying pleural thickening and ILO international classification of parenchymal abnormalities.
In analysing the prevalence of noncalcified pleural thickenings in the chest lateral on the X-ray films by two-way experimental lay out, the variation between populations was statistically significant, and the prevalence reflected the different grade of asbestos exposure in the three groups. The variation between readers was statistically significant, too.
The same analysis was carried out for “Pi” cases of suspected thickened interlobar fissures in the right lung. The variation between groups was statistically significant, and the prevalence reflected the different grade of asbestos exposure in the three groups. However the variation between readers was not statistically significant. The shadow of “Flange” representing a hyaline plaque along the rib flange was investigated by the same analysis but the prevalence did not necessarily reflect the grade of asbestos exposure. The prevalence of irregular opacities was significantly different between groups reflecting the grade of asbestos exposure. Furthermore persons with pleural thickening showed significantly higher prevalence of irregular opacities than those without pleural thickening.

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32 patients with adult leukemia were referred to our hospital during a 12 month period from October 1980 to October 1981. P. carinii pneumonia was a complication in 4 cases of leukemia following remission induction therapy. Some factors seemed to be associated with a high risk of P. carinii pneumonia: aging, long treatment with corticosteroids, beds next to those of patient with P. carinii pneumonia etc. Transbronchial lung biopsy was utilized in these 4 cases with P. carinii pneumonia and definitive diagnoses were obtained in 3 cases. The complications attributable to TBLB were 1 pneumothorax and 1 bleeding. Massive platelet transfusion administered just before the procedure was effective prophylactic measures for patients with bleeding tendency due to thrombocytopenia. All these 4 cases were treated by co-trimoxazole and 2 responsed. However the other 2 did not and in one case, evidence of P. carinii pneumonia was found at autopsy. Because therapeutic use of co-trimoxazole was not sufficiently effective, prophylactic use of it may be better in all high risks patients.

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Using a new preparation for perfusing the bronchial artery in the dog, the bronchomotor and vasomotor activities in the bronchial circulation system of several physiologically active amines were investigated. The right bronchial artery was cannulated and perfused with the dog's own blood delivered from the femoral artery in the anesthetized and immobilized dog. The bronchomotor and vasomotor tones were measured continuously. Drugs were injected into the perfused bronchial artery. Acetylcholine, pilocarpine, histamine, serotonin and nicotine caused bronchoconstriction, the duration being within one minute for ACh and nicotine, several minutes for histamine and serotonin, and 10 to 20 minutes for pilocarpine. The order of bronchoconstrictor activity was as follows: Serotonin>histamine>ACh>pilocarpine>nicotine. The amines produced a vasodilatation of the bronchial vascular bed, except that serotonin evoked either vasodilatation or vasoconstriction. Pretreatment with atropine (0.5mg/kg i.v.) completely abolished the bronchomotor and vasomotor responses to ACh, pilocarpine and nicotine, and inhibited the increase in overflow produced by histamine by 47%. The responses to serotonin were not altered by atropine pretreatment. In this study, the bronchomotor and vasomotor responses in the bronchial circulation system to the physiologically active amines were clarified, and were discussed on the basis of the physiological and pathological roles of the amines and, also in terms of differences between the in vivo and in vitro responses to the amines.

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The direction of the initial deflection of the wave-form (DID) of coarse crackles from fifteen patients and fine crackles from ten patients was studied. In coarse crackles, 93.4±4.0% of DID was upward on inspiration and 93.2±10.9% was downward on expiration. In fine crackles, DID was upward in 95.4±3.2%. An experiment simulating coarse crackles proved that their DID should be determined by sudden changes in intrabronchial pressure following the rupture of bubbles in the airways.
In fine crackles, DID is thought to go upward by the compression wave propagated around the fibrous distal airways which suddenly extend in the late phase of inspiration. These characteristic DID distribution patterns in coarse and fine crackles may be a useful clue for classification of rales, and, furthermore, DID analysis will provide us with a new means to study generating mechanisms of discontinuous adventitious lung sounds.

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A 28-year-old female patient with aneurysmal bone cyst of the left 2nd rib extending to the 2nd vertebral body was presented. She complained of back pain and tenderness on the medial portion of the scapula. Chest X-ray examination showed a mass shadow in the left upper lung field that was quite similar to that of peripheral lung cancer. CT scan, bone scan and gallium-67 scan suggested it to be a bone tumor extending from the rib to the vertebral body. Thoracotomy was done to remove the tumor and the histological diagnosis was aneurysmal bone cyst arising from the 2nd rib with extension to the vertebral body. Although bronchoscopic and transthoracic diagnostic approaches were unsuccessful to make a definite diagnosis prior to surgery, multiple diagnostic procedures suggested the etiology. The significance of diagnostic procedures was emphasized.

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A 47 year-old female was admitted to our hospital on May 1st 1979 with dry cough, palpitation and facial edema. A chest roentgenogram revealed extensive diffuse bilateral acinar filling pattern and the patient became progressively dyspneic. Sputum, blood and urine cultures were negative. Physical examination and laboratory studies suggested acute pneumonitis associated with systemic lupus erythematosus. Though treatment was initiated with steroids, the patient died of acute respiratory failure after 9 days. Autopsy histological findings of both upper lobes showed acute alveolar damage with interstitial edema and hyaline membranes. Chest roentgenogram and histological findings of the lung corresponded. A diagnosis of acute lupus pneumonitis was made by clinical and autopsy findings.

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Infantile infections are thought to constitute one of the main bases of the etiology of Swyer-James syndrome. This case seems to support the above theory allowing for the anamnesis of the pleuritis at 2 years of age, bronchographical findings—bilateral but markedly left-sided bud-like bronchiectatic changes— and left pulmonary angiographical findings—simultaneous appearance of pulmonary arteries and veins with scarce capillary image. Concerning the ventilation of this syndrome, ¹³³Xe inhalation test showed a “Pendelluft” phenomenon, shift of ¹³³Xe from the healthy to the affected lung on forced expiration.

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A autopsy case of funnel chest and agenesis of corpus callosum was reported. A one year and ten months old male infant had a severe degree of funnel chest with frequent recurrent respiratory infections after birth and died of respiratory failure. Respiratory paradox movement of the sternum was dominant.
At autopsy was recognized in the right lower lobe and the left lung, and the right middle lobe was overinflated. The trachea was depressed in a posterior direction by the dilatated pulmonary artery due to cor pulmonale in addition to anterior chest wall depression. The heart was prominently deviated to the left side, and showed right ventricular hypertrophy which was consistent with cor pulmonale.
In the brain, there was absence of the corpus callosum, accompanied by marked separation of both lateral ventricles and slight dorsal deviation of the third ventricle. In addition to these anomalies, there were retention testis and anomaly of the kidnly.

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Hypersensitivity pneumonitis due to inhalation of spores of Pholiota nameko (P. nameko) was demonstrated. A 52-year-old male mushroom worker, noticed a dry cough, exertional dyspnea, and high fever several hours after working in the nameko cultivating house in June 1980. These symptoms only developed after working in the cultivating house. He visited our hospital on October 27. His examination revealed a bilateral basilar crepitation sound, diffuse fine granular shadows on chest X-ray, slightly decreased diffusion capacity. Intracutaneous tests using the extract from P. nameko spores were positive both for immediate and late reactions. Precipitins against P. nameko extract were detected by counterimmunoelectrophoresis but not against other molds. Histological findings by TBLB showed granulomatous alveolitis compatible with hypersensitivity pneumonitis. Provocative inhalation test with extract of the antigen showed similar symptoms and signs as in his place of work 8 hours after inhalation. Leucocytosis, positive CRP, shadows suggestive of interstitial change on chest X-ray and decrease of PaO₂ and pulmonary diffusion capacity were also found. It seems to be the first case of hypersensitivity pneumonitis due to Pholiota nameko.

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64歳, 男性. 血疾, 左右の血圧差を主訴とし, 喀痰細胞診で class Vであり, 大動脈造影で, 左鎖骨下動脈の起始部の閉塞, 左椎骨動脈の逆流と, それの左鎖骨下動脈への流入が認められ, 肺癌に併発した subclavian steal syndrome と診断された. その原因は動脈硬化症によるものと考え, 肺癌に対して手術を施行し, 治癒手術があった.

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