Fc-receptor activity of pulmonary alveolar macrophages (PAM) was measured in 27 patients with sarcoidosis, 8 patients with farmer's lung, 7 patients with interstitial pneumonia and 18 normal control subjects.
There was significant negative correlation between Fc-receptor activity of PAM and age in normal control subjects. The Fc-receptor activity of PAM was significantly increased in sarcoid patients compared to normal control subjets, but not in patients with interstitial pneumonia. The Fc-receptor activity of PAM tended to correlate well with chest X-ray findings, serum ACE levels and BAL-Ly (%) in the clinical courses of sarcoid patients.

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Computed tomographic studies were made on asbestos-related pleural plaques in 12 cases whose PA chest films revealed marked pleural plaques and 9 controls whose PA chest films showed no pleural abnormalities.
1. CT findings of the controls
The inner surface of the chest wall was smoothly lined and nothing was found between the chest wall and pulmonary parenchymal area. The intercostal space showed a gentle concavity against the outer surface of the thorax. The analyses of the CT numbers indicating the density of the picture showed a layer of negative density-numbers separating the pulmonary parenchyma from the inner surface of the thorax. No pleural images were visible on the CT in these controls.
2. CT findings of those with pleural plaques on PA chest films
1) Locations of pleural plaque: Pleural plaques were widely distributed in the anterior, lateral and posterior chest walls without any tendeney according to site for the occurrence of the plaque. Pleural thickening along vertebral bodies was often recognized. The frequency of the locations of what was thought to be calcification was not different among the anterior, lateral and posterior chest wall areas.
2) Shape of pleural plaque: There were two types of plaque; localized and diffuse. The former mainly showed gentle undulatios, but sometimes showed nodular protrusions, while the latter had flat elevations.
3) Density of pleural thickening: There were two types of densities; homogeneous and heterogeneous density. The area with high densities suggesting calcification existed far from the inner surgace of the chest wall.
4) Width of pleural thickening: The size of CT was displayed 1:0.24 as compared with that of routine chest PA films. The width of pleural thickening was about 1mm in CT, but the maximum width reached 2mm. As our fundamental experiment using a phantom showed the intrathoracic substance reduced from 1/4 to 1/5, the true width was calculated.
5) CT number of the pleural thickening: CT numbers of every pleural thickening had muscle density or more. The area where the average of “pixel” assembly exceeded muscle density was suggested to be calcification.
6) The difference in the frequency of abnormal pleural thickening between chest PA film and CT: Some of the cases whose PA film showed only lateral pleural finding showed pleural thickening in more extensive areas on CT.
The high density area suggesting calcification on CT had calcified findings on PA films as well. However, there were cases in which we observed findings suggesting calcification on CT in spite of negatative findings for calcification on chest PA film.
In conclusion, pleural thickenign could be found more on CT than on chest PA film. Based on this new information, the pleural plaques on PA films should be carefully reinvestigated even though CT is not available for all cases.

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We examined 35 cases of IP. Of these of 25IIP cases and 10IP cases with collagen diseases were examined by direct immunofluorescene microscopy.
Immunoglobulin lining alveolar walls and capillaries in a granular pattern was demonstrated in 7 of 25IIP patients, but complement components were all negative. All 10 patients of IP with collagen diseases had immunoglobulin deposition and 5 demonstrated complement. Circulating immune complexes were present in 6 out of 7 cases. According to these results, circulating immune complexes may play a role in the pathogenesis of IP with collagen diseases.
The immunofluorescence-positive IIP cases showed a high frequency in young women compared with the immunofluorescent negative ones. Extrapulmonary symptoms were noticed more frequently. Serum immunoglobulin level and a positive rate of autoantibosies were higher, but no difference were seen in pulmonary function between two groups. Above all in bronchoalveolar lavage there was a trend towards increased numbers of lymphocytes and a complementary fall in the percentages of macrophages. From the results these cases seem to be similar to IP with collagen diseases. They might be classified in a subgroup located between IIP and IP with collagen diseases. On the other hand, the duration from the onset to biopsy or autopsy were shorter in the immunofluorescent positive cases than in the immunofluorescent negative. Type I findings on chest X ray film were more frequent and Ga accumulation on scintigrams was observed in the former group. Slight fibrosis and moderate or severe cellular thickening of alveolar walls, were also observed more frequently. These results may be evidence of a difference in stage or activity of the same disease. Steroid responders were also seen more frequently in the former group, therefore, immunofluorescence microscopy of the lung might give some information on steroid effects.

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A 74 year-old patient was under observation for two years and nine months. During the period of observation he suffered twice from so-called “intra-alveolar edema” of ipsilateral lung first in one lung, then the other. On the first occasion edema improved after open lung biopsy and that on the second time by diuretics. The shape of the edematous findings was markedly dependent on the posture—on standing multiple unclear niveaux over the diaphragm changed to acinar shadows of the lung involved when supine. This phenomenon suggests that there were collateral pathways of Kohn's pore, Lambert's channels and/or possible other channels in the human lungs.

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In order to clarify the role of pulmonary alveolar macrophages (PAM) as a host defence mechanism for respiratory bacterial infection, particulary pseudomonas infection, we investigated the antibody-dependent phagocytic activity of PAM against slime-rich or slime-poor Pseudomonas aeruginosa (P. aeruginosa) which were obtained by different culture conditions.
Slime-rich P. aeruginosa was obtained under static culture with brain heart infusion at 37°C for 20 hours. To the contrary, slime-poor P. aeruginosa was obtained under continuous rotation using the same medium. The difference on slime production around the organism was confirmed by electron microscopic observations as well as partial isolation of slime with SDS and ethanol. The phagocytic activity of P. aeruginosa by PAM was investigated by measuring the uptake of 2-³H adenine-labelled organisms. The phagocytic activity of PAM was enhanced significantly by addition to anti-P. aeruginosa LPS IgG (Pseudomonabulin^T.M.). It was noteworthy that slime-rich P. aeruginosa was resistant to phagocytosis by PAMs which were pre-opsonised with antibody to P. aeruginosa. These results indicated that production of slime by P. aeruginosa and resistance to phagocytosis by PAM were major reasons for the persistance of this organism in the respiratory tract under certain pulmonary disease conditions.

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Total gas pressure in the pleural space is more subatmospheric than that in the alveolar cavity by approximately -50mmHg.
This pressure difference referred to as pleural stress pressure in this paper, may act between visceral and parietal pleura so as to make the lung and chest wall contact together. Furthermore, pleural stress pressure may act to control the accumulation of pleural liquid in the chest cavity. In this study, the relationship between pleural stress pressure and the accumulation of pleural liquid was investigated.
Adult dogs were set in a box, in which a subatmospheric pressure of about -30cmH₂O was maintained by suction, and breathed atmospheric air through a tracheal tube. After 4 hours under these conditions, liquid volumes in the pleural space were measured under thoracotomies.
In the normal group of dogs, volumes of pleural liquid were within normal limits, approximately 2.0ml. But in the pneumothorax-induced group with 50ml air in pleural space, liquids increased significantly in all cases, to approximately 12ml mean value. In both groups, arterial blood pressure and pulmonary artery pressure decreased about 30% in the box under negative pressure. However there was no difference between the two groups of dogs in terms of blood pressures.
Under subatmospheric condition of -20∼-30cmH₂O pleural pressure, exudation pressure from the pleural membrane is estimated to be more dominant than the absorption pressure by the calculation induced from the Starling equation, that was indicated by the result in the macroscopic accumulation of pleural liquid in the pneumothorax dog group, in which pleural stress pressure became minimum due to a small amount of air injected in the pleural space.
However, in the normal group, there was no accumulation of liquid and also no loosening of contact between both sides of the pleurae. As a cause, it is assumed that the contacting faces between the pleurae are hardly separated, even under the condition of marked increase of the transpulmonary pressure under subatmospheric pressure in the box, because of a dominant stressing force by pleural stress pressure against the elastic recoil of both sides of the pleural membranes, resulting in no spaces for the accumulation of pleural liquid.
These facts indicate a significant effective force to hold the lung against the chest wall is pleural stress pressure elicited from gas pressure difference between alveolar and pleural spaces.

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Recently the analysis of breathing during sleep has attracted increasing attention. Disordered breathing and oxygen desaturation are recognized in patients with chronic obstructive lung disease as well as in patients with sleep apnea syndrome. Previous studies by several investigators have demonstrated a close correlationship between alveolar hypoxia and elevated pulmonary artery pressure. Continuous measurement of arterial oxygen tension is necessary to analyse the effects of nocturnal hypoxia on pulmonary hemodynamics. We measured trans-cutaneous oxygen tension continuously by a heated electrode and studied the effects of nocturnal hypoxia on pulmonary hemodynamics.
Ten patients including 5 with old pulmonary tuberculosis with thoracoplasty (Thoracoplasty), 3 with chronic pulmonary emphysema (CPE), 1 with COLD with bronchial asthma (BA) and 1 with pulmonary fibrosis were studied using right side cardiac catheterization. Trans-cutaneous oxygen tension (P_TCO₂) was measured by a heated electrode (Trasoxode, Hellige) on the anterior chest wall. Pulmonary artery pressure by a Swann-Ganz catheter placed in the pulmonary trunk, tidal volume by impedance pneumography and P_TCO₂ were simultaneously recorded all night in these 10 patients.
A preliminary study concerning the trans-cutaneous electrode showed that the correlation between P_TCO₂ and PaO₂ was statistically significant (P_TCO₂=0.8×PaO₂+7.6, N=40, r=0.95, p<0.001). During exercise, the change of P_TCO₂ followed that of PaO₂ with some delay. These results proved the usefullness of P_TCO₂ for continuous analysis of PaO₂.
In 6 patients, including 4 with Thoracoplasty, 1 with CPE and 1 with BA, decreased P_TCO₂ corresponded to the decrease of ventilation. Furthermore the fall of P_TCO₂ accompanied the elevation of pulmonary artery pressure in all 6 patients (P_TCO₂: from 60.7±6.5 TORR to 34.7±4.2 TORR, PAm: from 21.0±5.0mmHg to 58.7±6.5mmHg). The change of P_TCO₂ was mirror image of the change of PAm and they moved reciprocally. Cardiac output measured in 2 patients during hypoxemia increased slightly compared with the elevation of PAm. The elevation of pulmonary artery pressure was considered to be hypoxic pulmonary vasoconstriction. Cardiopulmonary functions were compared between the 6 patients with nocturnal hypoxemia (NH(+)) and the 4 patients without nocturnal hypoxemia (NH(-)). The differences in %VC and FEV1% between 2 groups were not statistically significant, but %VC in NH(+) was lower. Patients with small VC might have poor ventilatory reserve and may be greatly influenced by depressed activity of the respiratory center during sleep. PaCO₂ was significantly higher in NH(+). It was thought to be due to low responsiveness of the respiratory center to CO₂ in these patients. PaO₂ in NH(+) was significantly lower compared with NH(-). Though the difference of PAm between NH(+) and NH(-) was not significant, the cardiac index was lower in NH(+). Pulmonary artery mean pressure during nocturnal hypoxia was higher than during sub-maximal excrcise in 5 patients studied.
We concluded that nocturnal hypoxia had significant effects on the pulmonary vasopressor response, which might contribute to the establishment of chronic cor pulmonale.

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In 1964, Liebow and Carrington advocated a new classification of interstitial pneumonia they called lymphocytic interstitial pneumonia. this disease entity is characterized as benign deposition of mature and plasma cells into lung interstitium.
A 67-year old woman was admitted to our hospital on January, 1981 because of exertional dyspnea. She had acceleratde erythrocyte sedimentation rate, polyclonal hypergamma-globulinemia, generalized superficial lymph adenopathy, hepatosplenomegaly, and skin eruption for about ten years. Biopsy specimens of skin and lymph nodes revealed infiltration of mature lymphocytes and plasma cells. Her chest X-ray films showed bilateral diffuse reticular shadow. Transbronchial biopsy specimens of the lung showed same findings; infiltration of mature lymphocytes and plasma cells into the interstitium. The number of suppressor and killer T-cells in peripheral blood showed a relative increase. The patient was treated with predonisolone but no improvement was observed. We believe that LIP. might be a partial phenomenon of systemic benign proliferative disorder of lymphocytes and plasma cells rather than a specific lung disease.

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Plasma cell granuloma has been reported under several synonyms since the first report by Brunn in 1939.
It is a rather rare disease, but the number of reported cases in Japan has been increasing in recent years.
Differential diagnosis from malignant neoplasm on the basis of clinical and radiological finding is difficult and diagnosis was established after surgical procedures in all cases.
Two cases of post-inflammatory pseudotumor, one case of plasma cell granuloma, and another of histiocytoma, are reported here with the histopathological and immunocyte-chemical findings. Fifty five reported cases in the world literature were reviewed, with special reference to their clinical and histopathological findings.

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A case of interstitial pneumonitis due to occupational exposure to hard metal dusts is reported. A 34 year-old male with atopic disposition had been exposed to hard metal dust including tungsten, chromium and cobalt for about 16 years in a factory producing hard metal. The patient complained of persistent non-productive cough and dyspnea on exertion (H.-J. 3rd grade) since he had been highly exposed to these dusts for about two year's employment at the factory's laboratory.
The chest X-ray film showed elevation of bilateral diaphragms and diffuse irregular opacities combined with small rounded opacities mainly in both middle and lower lung fields. Severe restrictive ventilatory impairment, leukocytosis and aggravation of blood sedimentation rate was also found. Abnormal immunological findings were not detected.
Specimens obtained by transbronchial lung biopsy revealed interstitial pneumonitis and in these specimens tungsten and chromium were detected by means of X-ray diffraction analysis. Based on these findings, this case was diagnosed as interstitial pneumonitis due to hard metal dust.
By administration of corticosteroid hormone and a change of working place, the respiratory symptoms decreased gradually, and the diffuse shadow on the chest x-ray film has improved. Pulmonary function tests and routine blood studies have showed improvement. This case is still under periodical follow-up.
Periodic medical examinations including chest X-ray and tests of exhaustive ventilation function should be carried out for the workers in such hazardous environments. Early detection of any pulmonary disorder, removal from exposure, and early appropriate treatment should be performed.

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We present two cases of pulmonary pseudolymphoma.
Case 1. A 51-year-old female was admitted because of abnormal findings on chest roentgenogram, which had been found eight years previously. She was asymptomatic and her chest roentgenogram showed tumor shadow in the left lower lung field and an infiltrative shadow in the right middle lung field. Laboratory findings included slight elevation of serum IgM (260mg/dl). At left thoracotomy, the mass was found in the lingular division of the left upper lobe and lingulectomy was performed. The macroscopic appearance showed that the entire lingular division was involved. Histological examination revealed the infiltration of mature lymphocytes, other inflammatory cells and lymphoid follicles with germinal centers. The regional lymph nodes showed no evidence of lymphomatous change.
The pathological diagnosis was primary pulmonary pseudolymphoma.
Case 2. A 77-year-old female was admitted because of the tumor shadow in the right upper lobe, which had increased in size and density during the past two years. She was febrile about one and half year ago. Immunoelectrophoresis showed IgM monoclonal gammopathy (IgM; 700mg/dl). Right upper lobectomy was performed. The macroscopic appearance of the cut-surface showed a well-defined and firm rubbery mass. Histological examination revealed findings similar to case 1. The tumor was diagnosed as primary pulmonary pseudolymphoma.
Thirty cases including the present two cases have been reported in the Japanese literature since 1971. The clinicapathological features and histogenesis of pulmonary pseudolymphoma and LIP are discussd.

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A fatal case of severe pulmonary fibrosis associated with progressive sarcoidosis was reported. In this case, severe chronic respiratory failure secondary to pulmonary fibrosis was one unusual finding, and vanishing lung with multiple emphsematous bullae and pneumothorax on the chest X-ray film was an other. Conditions suggesting poor prognosis in this case were considered to be as follows.
1. Diffuse nodular infiltrates without bilateral hilar lymphadenopathy on initial X-ray film.
2. Fibrotic changes revealed on initial X-ray film, and progressed despite steroid therapy.
3. No steroid therapy in the early stage.
The above finding are consistent with the progressing factors of sarcoidosis reported by Japan Sarcoidosis Committee.

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Diffuse malignant pleural mesothelioma was diagnosed in 54-year-old female case who had no history of asbestos exposure. The tissue specimens obtained at autopsy disclosed follicular thyroid carcinoma and the tubulopapillary type of diffuse malignant mesothelioma histologically. There was no metastatic lesion of thyroid carcinoma, but tumor invasion and metastases of pleural mesothelioma to the distant visceral organs were noted.
The glycosaminoglycans (GAGs) isolated from the tissue of pleural mesothelioma as well as pleural effusion were measured by enzymatic analysis. The total amount of GAGs (46.98μmol uronic acid/g dry weight) in the tumor tissue consisting of 85.8% hyaluronic acid, 10.8% chondroitin sulfate, 2.4% dermatan sulfate and 1.0% heparan sulfate increased markedly. Also in the pleural effusion, the total amount of GAGs (2.07μmol uronic acid/ml) increased markedly, consisting of 95.5% hyaluronic acid 3.3% chondroitin sulfate, 0.9% dermatan sulfate, and 0.3% heparan sulfate.

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41歳, 男性. 10年前交通事故で全身打撲, 数日間の意識消失, 左第7肋骨骨折, 左血胸あり. 開放性外傷なし. その後自覚症なく, 今回肝炎で加療中胸写で左下肺野に手挙大の腫瘍陰影を発見. 胸腹部CT, 肝シンチ, 腹腔動脈造影で左横隔膜破裂, 胸腔内脾と診断した.

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