Continuous multistage treadmill exercise tests were performed in 35 COPD patients to evaluate anaerobic threshold (A.T.) Minute ventilation (V_E), V_O2, V_CO2, arterial blood gases and pH in addition to blood lactate were measured at each work load.
Twenty-four patients were considered to have reached an anaerobic threshold (A.T.), whereas eleven patients did not. The mean value of V_O2 max of the former group was 1.141·min^-1, which was significantly greater than that of the latter group, 0.71·min^-1. This difference was mainly attributed to that of ventilatory function.
It was found that the A.T. was difficult to determine from the changes of gas exchange ratio or V_E in patients who developed CO₂ retention during exercise.
The mean oxygen uptake at A.T. in 24 patients was 0.908±0.215 (0.596-1.481)1·min^-1, which was slightly lower than that in healthy subjects of comparable age. It can be said that the cardiovascular response to exercise in these patients were not so disturbed as compared to cardiac patients.
The decrease of PaO₂ during exercise was not necessarily associated with the increase of blood lactate, suggesting the presence of a compensatory mechanism for oxygen transport.

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Experimental and clinical studies on bronchopulmonary absorption of antibiotics with hydrocortisone and salbutamol hemisulfate were performed. Antibiotics (gentamicin, cefazolin and ampicillin) with hydrocortisone were injected into the patients' lower segmental bronchi through a bronchial catheter (16 Fr.) and serum concentrations of the antibiotics were measured by means of a bioassay. Serum levels of intrabronchial gentamicin and cefazolin with hydrocortisone were higher than those of gentamicin and cefazolin only. However serum levels of intrabronchial ampicillin with hydrocortisone were almost equal to those of ampicillin alone.
Antibiotics (gentamicin, cefazolin and ampicillin) with hydrocortisone and salbutamol hemisulfate were injected into rabbit trachea through a teflon tube (70mm in length, 18 gauge). Serum levels of intratracheal gentamicin and cefazolin with hydrocortisone and salbutamol hemisulfate were higher than those of gentamicin and cefazolin only. But serum levels of intratracheal ampicillin with hydrocortisone and salbutamol hemisulfate were almost equal to those of amplicillin alone.
Our findings were as follows. Intrabronchial gentamicin and cefazolin induced bronchospasm, so that bronchopulmonary absorption of these antibiotics was low without hydrocortisone and salbutamol hemisulfate. On the other hand, intratracheobronchial amplicillin did not induce bronchospasm, so that bronchopulmonary absorption of amplicilli was the same with or without hydrocortisone and salbutamol hemisulfate.

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The relationship between the intensity of Gallium-67 scintigraphy, lymphocyte counts in bronchoalveolar lavage and pathologic changes was studied in 18 patients with untreated pulmonary sarcoidosis.
1. Noncaseating granulomas were recognized with significantly greater frequency in radiographic stage II (100 percent, 6/6 cases) than in stage I (36 percent, 4/11 cases). Alveolitis showed little relation to the radiographic stage.
2. There was strong correlation between the intensity of Gallium-67 accumulation in the lung parenchyma and the incidence of noncaseating granulomas. However, alveolitis was not statistically significant.
3. A highly significant correlation was revealed between the counts of lymphocytes in bronchoalveolar lavage and alveolitis in sarcoid patients. In contrast, no relationship existed between the lymphocytic counts in bronchoalveolar lavage and intensity of the Gallium-67 accumulation.
4. These observation suggest that the Gallium-67 scintigraphy probably reflects the noncaseating granulomas and the lymphocytic counts in bronchoalveolar lavage reflect the alveolitis in pulmonary sarcoidosis.

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Prostacyclin (Prostaglandin I₂) is well known as a potent vasodilator and has an antiaggregatory effect. In the present investigation we studied the effects of prostacyclin, carbacyclin and R-59274 on rabbit pulmonary artery, descending aorta and guinea pig tracheal strips, and investigated the effects of these substances on anaphylactic release of chemical mediators from passively sensitized guinea pig lung tissues.
1) Carbacyclin and R-59274 showed marked relaxation responses in rabbit pulmonary artery and descending aorta strips.
2) Prostacyclin, carbacyclin and R-59274 showed relaxation responses in guinea pig tracheal strips with continuous infusion of neostigmine bromide. Relaxation responses of prostacyclin, carbacyclin and R-59274 were almost 1/100 in comparison to those of PGE₂, while 6-keto PGF_1α, a stable metabolite of prostacyclin, showed relaxation responses almost 3 times stronger than those of the three above drugs.
3) Prostacyclin, carbacyclin and R-59274 attenuated the action of various bronchoconstrictors dose-dependently in guinea pig tracheal tissues.
4) Prostacyclin, carbacyclin and R-59274 inhibited the release of chemical mediators such as histamine and SRSA from passively sensitized guinea pig lung tissues.
The above results suggest that endogenous prostacyclin has a bronchodilating effect and an inhibiting effect on chemical mediator release from lung mast cells besides those well known effects such as vasodilation, hypotension and antiaggregation.
The stable derivatives of prostacyclin, carbacyclin and R-59274, might become useful drugs for various pathological conditions.

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Two kinds of lavage for broncho-alveolar system were performed in 8 normal volunteers. In broncho-alveolar lavage (BAL), a segment (B⁴ or B⁵) was lavaged with 50ml of saline 3 times. In bronchial lavage (BL), we inserted a flexible bronchofiberscope into the lower lobe bronchus and infused 25ml of saline into the bronchus without wedging the tip of the bronchofiberscope. Then we aspirated the infused saline. This procedure was repeated 3 times.
Percentage recovery of infused saline in BAL and BL were 65±6 and 30±6%, respectively. Bronchial lavage fluid (BLF) was more turbid than the broncho-alveolar lavage fluid (BALF), and a clear mucus layer was found on top. We compared the cellular components, protein components, and fucose and sialic acid contents of BLF with those of BALF. We measured fucose and sialic acid to evaluate the mucus content.
Both BLF and BALF contained alveolar macrophages, but in differential cell counts the percentage of neutrophils and epithelial cells were higher in BLF than in the BALF. BLF contained much more mucus, IgA, S-IgA and lysozyme than the BALF.
These results indicate that BLF contains many bronchial components besides alveolar components, and that the compositions of cellular and protein components change from the proximal bronchus to the alveolar region.
BLF from 4 patients with chronic bronchitis contained significantly more neutrophils, protein components, and fucose and sialic acid than that from normal volunteers. This result indicates that the present BL technique is useful for quantitative analysis of bronchial components to clarify the pathophysiology of chronic airway disease.

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Paraquat is a bipyridylium compound that is used widely throughout the world as a herbicide. In most species of animals so far examined, the predominant lesion after even a single dose of paraquat was initial hyperemia of the lungs followed by respiratory insufficiency due to pulmonary fibrosis.
In the present investigation rats were given a dose of paraquat intraperitoneally once a week for 7 to 8 weeks. We also investigated the effect of prednisolone and elastase on paraquat-induced pulmonary fibrosis. We classified rats into five groups, i.e. the normal control group which was given no drug, the control group which was given paraquat alone, the elastase group which was given paraquat and elastase, the prednisolone and elastase group which was given paraquat, and the prednisolone and elastase and prednisolone group which was given paraquat and prednisolone.
1) The survival rate of the control group, the prednisolone group, the prednisolone and elastase group and the elastase group were 51.4%, 70.0%, 50.0% and 48.6%, respectively.
2) Five of 18 rats in the control group and 2 of 14 rats in the prednisolone group showed advanced pathological findings (++), while 17 rats in the elastase group and 5 rats in the prednisolone and elastase group did not show (++) pathological findings.
3) In rats which survived for 7 to 8 weeks, pathological examinations of lungs revealed a diffuse thickening of alveolar septa and a collapse of alveoli suggesting future pulmonary fibrosis.
4) There were no significant differences in body weight between the normal control group and other groups. On the other hand lung wet weights of the four groups which were given paraquat were about 2.4 times heavier than those of the normal control group.
5) Hydroxyproline contents of lung tissue in the 4 paraquat groups showed significant higher values compared with the normal control group. But there were no significant differences among these 4 groups.
6) Serum lipoperoxide values did not show any significant differences among the normal control group and the other 4 groups.
7) Plasma 6-keto PGF_1α and thromboxane B₂ values did not show any significant differences among the normal control group and the other 4 groups.
8) The plasma serotonin level of the prednisolone group was significantly lower than those in the other groups including the normal control group.
9) Plasma histamine level did not show any significant differences among the 5 groups.
The above results suggest that elastase and prednislolne might be useful drugs for patients with pulmonary fibrosis.

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A plethysmographic system has been described to provide ventilatory functional parameters of anesthetized, tracheotomized rats. They include respiratory mechanics, lung volume, static pressure-volume curve for lung, and flow-volume curve. The dynamic response of the apparatus and basic problems involved in the present techniques were examined. The measurements performed in two groups of Wistar male rats yielded the results exactly predictable from differences in body weights and lung volumes. These results are compared with those published by other investigators for Fisher female rats.

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The correlation between chest X-Ray and pathological findings was studied in 25 cases proven to be lymphangitis carcinomatosis by atuopsy. They included 17 lung cancers, 4 gastric cancers, 1 esophageal cancer, 1 thyroid cancer and 2 cases of unknown primary site. Various findings corresponding to the site of carcinomatous invasion were found.
Stenosis of the bronchial lumen with bronchial wall thickening due to submucosal tumor invasion of the bronchus, thickening of bronchial wall without stenosis of the bronchial lumen due to peribronchial invasion, unclear margin of the vascular shadow due to perivascular invasion and linear shadow due to septal invasion.
The early findings of P-A chest film in this pathological condition were unclear vascular shadow margins especially in the hilar region. It was considered that those radiological findings were due to the thickening of fibrous tissue caused by invasion to interstitial lymphatics.

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The patient was a 82 year-old female, in whom an abnormal lung shadow was noticed by roentgenographic examination. Her chief complaints were cough, sputum and hemosputum, however her general condition was fairly good.
Chest X-ray film taken on her first visit to our hospital showed a large round tumor (6.0cm×6.5cm) in the right lower lobe. Fiberoptic bronchoscopy revealed that the orifice of right B₆ was markedly reddened and swollen. Transbronchial lung biopsy was carried out and a histological diagnosis of moderately differentiated squamous cell carcinoma was made.
In spite of our systemic and local immuno- and chemotherapy, the diameter of the tumor became more than 10cm. She died of lung cancer after a course of about 20 months.

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A case of prune belly syndrome with funnel chest and dextrocardia which we experienced underwent surgical correction (STO-T) of the funnel chest deformity with good results. Reports of female prune belly syndrome with no abnormalities of the genito-urinary system are very rare.
Our concepts in treating the congenital absence of abdominal muscles in prune belly syndrome were discussed.

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A 26 year-old woman with fever and dyspnea due to disseminated Mycobacterium kansasii infection is reported. Mycobacterium kansasii was isolated in sputum, gastric juice and bone marrow cultures. Unlike the fatal termination in other reported cases of this type of disease, our patient responded completely to rifampicin, ethambutol, cycloserinum and ethionamidum therapy. The bacilli showed in vitro sensitivy to these four antibiotics.
Infection with Mycobacterium kansasii is rarely reported compared to other acid-fast organisms in Japan, and this case is the first case of Disseminated Mycobacterium kansasii Infection in our country.

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38歳, 男性, サワガニを生食しその3週間後に咳嗽発作出現し, 両側胸水貯留と著明な好酸球増多を認めたが, 血痰喀出はなく, 胸部X線上肺野に結節性陰影, 輪状陰影は認められなかった. 血清, 胸水の補体結合反応, Ouchterlony 法, 免疫電気泳動法によりウェステルマン肺吸虫症と診断し, Bithionol で治療した.

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