Diffuse panbronchiolitis (D.P.B.) is a chronic obstructive lung disease, to which much attention has been paid because of its characteristic clinical features. Recently, it has been suggested that this disease is related to some immunological disorders or predisposition. In this respect, the elevation of cold hemagglutinin titer, chronic sinusitis, and HLA-antigen BW54 were found in many patients with this disease. Also, there were some reports of sibling cases.
We investigated the subsets of peripheral lymphocyte in patients with D.P.B., in order to determine whether immunological disorders exist at the lymphocyte level.
Analyses of subsets were performed using Leu-series monoclonal antibodies, Leu-1, Leu-2a, Leu-3a, Leu-4, Leu-7, Leu-10, and Leu-HLA-DR, by flow cytometry (FACS-440).
1) There was no change in the percentage of Leu-1, Leu-4, Leu-7, Leu-10, and Leu-HLA-DR positive lymphocytes.
2) As compared with healthy controls, in D.P.B. cases the percentage of Leu-2a positive cells decreased significantly (p<0.001) and Leu-3a/Leu-2a (Th/Ts) ratio increased significantly (p<0.001).
3) The lymphocyte subsets of D.P.B. cases tended to return to normal following Erythromycin therapy, running parallel with the clinical improvement. It is therefore possible that these changes in the lymphocyte subsets may be due to co-existing chronic bacterial infection.

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Twenty-nine adult healthy volunteers, 26 men and 3 women, were requested to become experimental subjects. Men were requested to smoke 5 cigarettes and women 3 cigarettes within 10 minutes. Before, immediately after and 20min after cigarettes smoking, peripheral venous blood was collected for the assay of 6-keto PGF_1α, thromboxane B₂ lipoperoxide.
1) There were no significant correlations between blood levels of 6-keto PGF_1α, TxB₂ and lipoperoxide and the number of cigarettes smoked in a day.
2) Serum levels of lipoperoxide showed a tendency to increase in 11 of 10 smoking subjects, while no definite tendency was observed in non-smoking subjects.
3) Plasma levels of 6-keto PGF_1α showed a marked increase in all except one of the non-smoking subjects after cigarette smoking, while no definite tendecy was observed in smoking subjects.
4) Plasma levels of TxB₂ showed a marked increase in all non-smoking subjects after cigarette smoking, an increase in 8 of 9 “shallow” smoking subjects, and showed a marked decrease in “deep” smoking subjects.
5) Plasma levels of TxB₂ before cigarette smoking showed significantly higher levels in “deep” smoking subjects than those in “shallow” smoking subjects.
The above results suggest that acute effects of cigarette smoking may cause a change of humoral factors such as TxB₂, 6-keto PGF_1α and lipoperoxide.

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Magnified peripheral pulmonary wedge angiography was performed in 92 patients with chronic pulmonary disease. A 7F balloon catheter was wedged into the pulmonary artery and 6ml 76% Urografin was injected automatically. The projection was magnified about 2.4 times. We classified wedge angiography into types I-IV in terms of changes in capillary background (CBG) findings. Each type was compared with the clinical diagnosis, blood gases, pulmonary arterial mean pressure and pulmonary function tests.
Results were as follows;
1) Type III showed a tendency of more frequent chronic pulmonary emphysema more than other chronic pulmonary diseases. Type IV showed a tendency of more frequent pulmonary fibrosis more than others.
2) The pulmonary arterial mean pressure of type III was significantly higher than that of type I. The PaO₂ of type II and type III was significantly lower than that of the type I. There was no significant difference between type II and type III.
3) Type II showed a tendency to increase in mixed type in the pulmonary function tests.
These results suggest that classifying wedge angiography into four types may show specificity for each chronic pulmonary disease in some degree, and it may be possible to evaluate the severity of chronic pulmonary diseases using this classification.

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To identify and rapidly treat pulmonary infiltrates in thirty-four immunocompromised hematologic disorders we performed transbronchial lung biopsy (TBLB), percutaneous lung biopsy, open lung biopsy and bronchoalveolar lavage with pre-platelet transfusion in cases with thrombocytopenia (less than 5.0×10⁴/mm³) and with oxygen inhalation in hypoxemic patients (under 60 torr).
Etiologies established by biopsies coincided with those clinically suspected in 16 out of 34 cases; i.e. P. carinii infection in 4 out of 6, interstitial pneumonia in 11 out of 18. In the cases of interstitial pneumonia, only 4 definite causative agents were identified by TBLB (3 P. carinii and 1 cytomegalovirus). However, cytomegalovirus was isolated from fluids from bronchoalveolar lavage performed concomitantly with TBLB on two occasions. Although we experienced minor bleeding in 3 cases and pneumothorax in 2 cases, there were no life threatening side effects except in one open lung biopsy case.
In consideration of both the risk of the procedures and the benefits of prompt initiation of etiologically-based treatments, we would recommend the active application of lung biopsy in the early phase of pulmonary infiltrates in immunocompromised cases of hematologic disorders.

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A 35 year-old man was referred to our Institute for surgical treatment of bilateral bullous emphysema associated with bilateral pnuemothorax. A simultaneous bilateral operation was carried out through a median sternotomy. At operation a left total pericardial defect was found and the left phrenic nerve was observed in the anterior mediastinum. The bilateral bullous emphysema tous lesions were resected. Surgical treatment for the pericardial defect was not undertaken.

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Pulmonary mucormycosis occurs almost invariably in patients with underlying disease as an opportunistic infection and is rarely diagnosed before death. A successfully treated case of pulmonary mucormycosis with diabetic disease is reported here.
A 51 year-old male with diabetes mellitus was admitted with fever, cough and a homogenous infiltrative shadow in the right middle lung field on chest X-ray film. The patient was treated with antibiotics. Although the symptoms subsided, an X-ray film showed an increase in the infiltrative shadow. Sputum cultures revealed a normal flora and microscopic examination of bronchial brushing smears yielded numerous broad, nonseptate hyphae. Right lower lobectomy was performed under a diagnosis of pulmonary fungous disease. Histological examination revealed characteristic hyphae which invaded pulmonary vessels consistent with pulmonary mucormycosis. The fungi were identified with mucorales by the immunofluorescence method. The patient is doing well without evidence of recurrence.
It was emphasized that microscopic examination of bronchial brushing materials revealed the diagnosis of pulmonary mucormycosis.

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The patient, a 46 year-old man, had worked at an asbestos factory for 12 years between age 20 and 32. A diagnosis of pulmonary asbestosis was established at 30 years of age. He developed left pleuritis at age 42 and right pleuritis at age 43 and succumbed due to empyema thoracis tuberuculosa of the left lung at 45 years of age. The direct cause of death was respiratory failure. Remarkable bilateral pleural thickening, pulmonary fibrosis and empyema thoracis tuberculosa of the left lung were demonstrated by autopsy. This was a specific case in which pleural plaque and bilateral pleural effusion were derived from pulmonary asbestosis with subsequent complication of empyema thoracis tuberculosa, resulting in varied degeneration of the pleura.

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A 39 year-old female was diagnosed as having pulmonary alveolar proteinosis (PAP) associated with pulmonary tuberculosis. It was not until bronchopylmonary lavage (BPL) was performed that tuberculosis was diagnosed. After BPL, the shadow due to PAP improved but tuberculosis was aggravated.
The clinical course of our case and a review of literature suggest that tuberculosis associated with PAP should be treated with BPL and anti-tuberculous drugs.

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A 70 year old man, who had recieved artificial pneumothorax for pulmonary tuberculosis in 1947, was admitted because of high fever and productive cough. Pleural fluid was purulent and gram-negative bacilli were detected in it. After serial cleansing of the infected pleural space, bacteria disappeared, but malignant unclassified cell (PAP IV) was discovered from bloody effusion.
On chest X-ray and CT scan, thickening of parietal pleura increased progressively.
By thoracotomy on October 7, 1982, non-Hodgkin's lymphoma was diagnosed. He was treated with combination chemotherapy (CHOP). Subsequently he showed good response and his status is favorable.

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