Air pollution has been considered to be one of the inducing and aggravating factors of bronchial asthma. Kawasaki-asthma, which was named for the bronchial asthma seen in the residents of heavily air-polluted Kawasaki City, a heavy industry area located on the seaside just between Tokyo and Yokohama.
Patients of Kawasaki-asthma were compared to those seen at Keio University Hospital which is located in a commercial/residential area in Tokyo which is far less polluted.
Characteristic features of Kawasaki-asthma are: 1. Onset of asthma in later age adults. 2. Low incidence of complicated allergic disorders. 3. Two peaks of attacks in the autumn and winter. 4. Frequent attacks and longer duration. 5. Low incidence of skin hypersensitivity against inhaled allergens. 6. Low incidence of eosinophilia. 7. Low incidence of elevated serum IgE.
From these distinct clinical data on Kawasaki-asthma, it was concluded that air pollution induced and aggravated bronchial asthma in the non-allergic population.

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In an attempt to evaluate male-female difference in the effect of deep inspiration (DI) on bronchomotor tone, spirogram, partial and maximum expiratory flow-volume curve and 3Hz respiratory impedance (Zrs) were measured before and after inhalation of an anticholinergic agent, ipratropium bromide (Sch 1000), in 9 young males (18 to 24y.o.) and 9 young females (20 to 21y.o.).
In females, maximum expiratory flow (Vmax) at 25% VC after DI (MEF₂₅) was significantly greater than that after tidal inspiration (PEF₂₅). In contrast, DI caused no consistent change in Vmax at 25% VC in males. When PEF₂₅-MEF₂₅/PEF₂₅ was calculated as index of DI effect on Vmax (DI index), the value was -0.13±0.13 (mean±standard deviation) in females and -0.02±0.09 in males, the difference of which was significant (p<0.05).
After inhalation of Sch 1000, MEF₂₅ became significantly lower than PEF₂₅ both in females (p<0.05) and in males (p<0.01). DI index was +0.14±0.11 in females and +0.15±0.07 in males, which were not different.
These findings indicate that: 1) the effect of DI on bronchomotor tone is different in males and females; 2) the difference is partly due to the quantitative difference in the vagal nervous system contributing to DI effect.

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The use of diesel engines has increased greatly in recent years. Diesel engines provide the power for most large trucks, trains, and construction and farm machinery. This has led to concern about the contribution of diesel engine exhaust gas to the air pollution. Although many of the pollutants emitted by diesel engines have been studied, the toxicological effects of complete exhaust gas have not yet been elucidated.
In the present investigation we tried to elucidate the chronic effect of diesel-engine exhaust gas on metabolic functions in rat lungs. Rats were exposed to diesel-engine exhaust gas for periods of from 1 week to 6 months. Fifty percent effective doses of acetylcholine in isolated rat tracheal strips, conversion or inactivation of vasoactive substances through isolated perfused rat lung lobes and change of plasma levels of serotonin and histamine were examined. Rats were classified into 3 groups, i.e. control group, filtered exhaust gas (F.E.G.) group and exhaust gas (E.G.) group.
1. Fifty percent effective doses of acetylcholine in F.E.G. and E.G. rat (3-6 months) tracheal strips showed a significant decrease compared with that of control rats.
2. Inactivation of serotonin through isolated perfused lung lobes in E.G. and F.E.G. groups exposed for 6 months showed a decrease compared with that in the control group.
3. Inactivation of prostaglandin E₂ and F_2α through isolated perfused lung lobes in E.G. and F.E.G. groups (exposed for 1 week to 6 months) showed a decrease compared with that in the control group.
4. Conversion of angiotensin I to angiotensin II through isolated perfused lung lobes in E.G. and F.E.G. groups (exposed for 6 months) showed an increase comparing with that in the control group.
5. Plasma level of serotonin did not show any significant differences among these three groups, while the plasma level of histamine in E.G. and F.E.G. group (exposed for 6 months) showed a significant increase compared with that in the control group.
The above results suggest that long term exposure of diesel-engine exhaust gas may affect pulmonary metabolic functions.

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We had 30 cases with pleural effusion (20 males and 10 females) over the past three years. We studied carcinoembryonic antigen (CEA) levels in serum and pleural fluid in these cases. They were classified into three groups: Group I; seven cases of adenocarcinoma, Grouo II; 12 cases of other malignancies, Group III; 11 cases of nonmalignant diseases. Groups I and II showed higher levels of CEA in pleural fluid than those of Group III. Group III showed normal CEA levels (less than 5ng/ml) in pleural fluid and in serum.
In Groups I and II, correlation between pleural fluid and serum levels of CEA were significant. Usually CEA levels in pleural effusion change if the stage of the disease changes. Measuring the CEA levels in pleural fluid and in serum is very useful for determining stage and for evaluating the effects of anticancer therapy.

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To investigate the difference in the cell kinetics of mesothelial cells in malignant and non-malignant pleural effusion, Feulgen-DNA cytophotometry and the autoradiographic method with ³H-thymidine were carried out on 40 pleural fluids (malignant: 16, non-malignant: 24). Consequently, it was proved that mesothelial cells possessing triploid DNA content and belonging to the DNA synthetic (S) phase are much more frequent in malignant effusion; the generation time of free-froating mesothelial cells in malignant effusion is shorter than that of cells in non-malignant effusion. Probably the difference is due to numerous and mechanical exfoliation of the immature surface mesothelial cells following the pleural neoplastic infiltration and secondary pleural reactions. Mesothelial predominance commonly observed in the malignant pleural fluid and sometimes in benign pleural fluid, was discussed from the point of view of mesothelial cell kinetics.

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Numerical changes and beta-galactosidase activity of blood monocytes were examined in 171 asthmatic subjects in relation to their asthmatic cycle.
1. The number of blood monocytes in non-attack stages of bronchial asthma was similar to that of healthy subjects. It increased in pre-attack stages and increased further in attack stages.
2. Numerical changes of blood monocytes in relation to asthma attack provoked by allergen inhalation showed almost the same tendency as spontaneous asthma attacks. The monocyte numerical changes in allergen-induced attacks were later than those of basophils and eosinophils.
3. Beta-galactosidase activity of blood monocytes was generally higher than that of healthy subjects. The activity increased in pre-attack stages and increased further in attack stages of bronchial asthma.
4. There was no significant difference in beta-galactosidase activity of monocytes in atopic and non-atopic types of bronchial asthma.

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Pulmonary involvement with mucormycosis is quite uncommon, but the incidence has been increasingly recognized, especially in patients with leukemia or lymphoma. We report three autopsied cases of generalized mucormycosis (phycomycosis) in patients with non-Hodgkin's lymphoma, acute exacerbation of chronic myelogenous leukemia, and acute myelogenous leukemia. All patients had abnormal lung shadows and high fever unresponsive to broad-spectrum antibiotics and trimethoprim-sulfamethoxazole.
Their chest X-ray findings were as follows;
Cases 1: Diffuse ground glass appearance with nodular density at the right hulim suggesting hemorrhagic infarction.
Cases 2: Diffuse ground glass appearance.
Cases 3: Several patchy infiltrates in the right lung and a large nodular density with cavities in the left lung field.
In two of three cases, flucytosine was administered without any remarkable effect. Histological examination revealed multiple infarction and thrombosis in various parts of pulmonary arteries in which broad and nonseptate hyphae were found. Sputum cultures were performed in all cases white they were alive, but no pathognomonic organism was found. Premortal diagnosis of mucormycosis is extremely difficult, but one possible way of diagnosis might be by lung perfusion scanning using ¹³¹I-MAA.

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A 45-year-old man complained of fever, bloody sputa and left chest pain. X-ray film of the chest revealed an abnormal mass shadow in the left lower lung field. Cytological examination of sputum and the bronchial brushing specimen showed adenocarcinoma.
Although it was found that serum α-fetoprotein (α-FP) level was increased to 15, 000ng/ml (RIA), liver function tests, ^99mTc liver scintigram, CT scan of the abdomen and abdominal ultrasonography showed no abnormality. The maximal value of serum α-FP during the course was 102, 000ng/ml. He died 8 months after his first symptoms.
The autopsy revealed a huge mucinous tumor which destroyed the entire left lung. The microscopic examination showed poorly differentiated adenocarcinoma with a mixed tubular and medullary pattern. There was a single walnut-sized, well circumscribed tumor in the liver consistent with metastasis. There were also metastases to the right lung, the right kidney and the spleen.
The immunoenzyme labelling technique using PAP (Peroxidase-antiperoxidase) method showed α-FP in the lung cancer cells. The α-FP in the cancer tissue homogenate was 66, 400ng/ml/0.15g. These findings show this is a case of a lung cancer producing α-FP.
The carbohydrate moiety of α-FP in this case was studied by Concanavalin A (Con A) affinity chromatography, and almost all parts of α-FP were of the Con A-binding variety; similar to fetal liver and hepatocellular carcinoma.
Although it is not known whether fetal lungs produce α-FP, a lung cancer may well be able to produce α-FP, because the lung originates from the foregut, as do stomach and gallbladder.

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In a 50-year-old female, who had a history of shistosomiasis at age ten, a mass shadow happened to be detected in the right upper lung field and disseminated small nodular shadows throughout bilateral lung fields. Transbronchial lung biopsy showed adenocarcinoma. She succumbed about four months later.
Autopsy revealed typical bronchiolo-alveolar cell carcinoma, spreading throughout both lungs. Many eggs of shistosoma japonicum were found in the lung involved by the carcinoma. The relation of shistosomiasis and carcinoma was discussed.

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A 60 year-old male patient with asbestosis was admitted to our hospital complaining of pleuritic chest pain and general malaise. Urinalysis revealed proteinuria and microscopic hematuria. The renal function was within normal range on admission. A chest roentogenogram showed irregular opacities in both lower lung fields and the left pleural effusion. Pleural tap and pleural biopsy revealed nonspecific pleurisy. Thereafter he complained of increasing malaise and transient hemosputum. Renal function deteriorated rapidly. A chest roentogenogram showed a nodular shadow in the left middle lung field. Renal biopsy was performed. On light microscopy moderate mesangial proliferative glomerulonephritis with crescents was revealed. An immunofluorescent study showed a linear deposition of IgG along the glomerular basement membrane, which suggested anti-glomerular basement membrane antibody mediated glomerulonephritis. On the other hand the episode of hemosputum suggested Goodpasture's syndrome. Transbronchial lung biopsy was performed, but immunofluorescent studies could not reveal any significant deposition of immunoglobulin.
After renal biopsy corticosteroid and fibrinolytic agent were administered. Renal function improved markedly with this regimen. A chest roentogenogram showed the disappearance of pleural effusion and nodular shadow.
It is well documented that exposure to asbestos induces various immunological abnormalities. Therefore we suggest that the glomerulonephritis is related with asbestos in this patient.

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31歳, 男性胸部X線上, 左第II弓第III弓の突出陰影を認めた. 肺動脈造影の静脈相で陰影に一致して, 左心房, 左心耳が造影され, 胸部エンハンスCTスキャンにても, これを裏付ける所見が認められた. 心外膜欠損症を疑い診断的人工気胸術施行, 左胸腔内と心嚢腔内の空気の交通を認め, 左心外膜部分欠損症と診断した.

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