In the past two years, it has been established that the activity of the slow reacting substance of anaphylaxis (SRS-A) is almost entirely attributable to leukotrienes C₄, D₄, and E₄. It is well known that SRS-A is released from mast cells in anaphylactic shock. Several compounds have been reported to inhibit biosynthesis of leukotrienes. It is also reported that quinone derivatives with modified polyprenyl side chains have inhibitory effects on the antigen-induced SRS-A release.
In the present investigation, we studied the effect of coenzyme Q₁₀ (E-0216) on histamine or SRS-A release from passively sensitized guinea pig lung tissues and on the actions of various bronchoactive-agents in isolated perfused guinea pig tracheal strips.
1. The amount of histamine released from passively sensitized guinea pig lung tissues by antigen challenge showed a marked decrease by preincubation with E-216. The percent inhibition of histamine was greatest at a concentration of 10μg/ml of E-0216.
2. The amount of SRS-A released from passively sensitized guinea pig lung tissues by antigen challenge showed a marked decrease by preincubation with E-0216. The percent inhibition of SRS-A was greatest at a concentration of 10μg/ml of E-0216.
3. Prostaglandin F_2α^-, acetylcholine-, serotonin- and bradykinin-induced contractile responses in guinea pig tracheal strips did not show any significant increase by continuous ifusion of E-0216 (0.05-5.0μg/ml). On the other hand, histamine-induced contractile responses showed a significant increase by continuous infusion of 0.5μg/ml of E-0216.
4. Isoproterenol- and salbutamol-induced relaxation responses in guinea pig tracheal strips did not show any significant decrease by continuous infusion of E-0216 (0.05-5.0μg/ml). On the other hand, prostaglandin E₂-induced relaxation responses showed a significant decrease by continuous infusion of 0.05-5.0μg/ml of E-0216.

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Localization of angiotensin-converting enzyme (ACE) and its activity in sarcoid granuloma were studied by ACE substrate film prepared from hippuryl-L-histidyl-L-leucine and purified calfskin gelatin. ACE activity in sarcoid granulomas was recognized as numerous sharply defined plaques (digestive vaculoes) or poorly stained plaques on the substrate film under epithelioid cells and the sites of sinus histiocytosis. ACE activity was completely inhibited by 10^-1M of captopryl (SQ 14-225) or by 5×10^-2M of EDTA.
Our substrate film method enables localization of ACE and the estimation of ACE activity in sarcoid granuloma.

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In order to investigate factors affecting postmortem lung cultures in the aged, 90 autopsies were made during the period from July 1979 to September 1982. The following results were obtained:
1) Cerebral vascular disease was the most frequent underlying disease, and was present in 50% of 54 culture-positive patients, followed by cancer and cardiac failure (20% each).
2) The elapsed time between death and postmortem examination had no significant effect on the incidence of positive cultures.
3) The incidence of positive cultures in cases with an activities of daily living (ADL) score of 0 to 5 was significantly higher than that of cases with an ADL score of 6 to 15.
4) The incidence of positive cultures in cases of total protein less than 6.0g/dl was significantly higher than that of cases of 6.0g/dl or more total protein.
5) Antibiotic therapy given prior to death influenced both the percentages of cases with positive cultures and the bacterial amount isolated postmortem.
6) The incidence of positive cultures according to the cause of death was 81% in pneumonia, 54% in cancer, 50% in cerebral vascular disease, 29% in cardiac failure, and 50% in others.

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The characteristics of two types of oxygen concentrators, the molecular sieve type (DAM-2 and DAM-4, Osaka Oxygen Industries Ltd.) and the membrane type (TO-40, Teijin Ltd.), were studied and the results in 20 cases of long-term home oxygen therapy (LHOT) with the former are reported. In the molecular sieve type, approximateley 95% oxygen was supplied in quantities of up to 21/min in the DAM-2 and up to 41/min in the DAM-4. In the membrane type, approximateley 35% oxygen was supplied in quantities of up to 6L/min irrespective of flow rate. Although the concentration ratios of argon were the same as oxygen in both types of oxygen concentrators, the concentration was so low that it may be concluded that there is little effect on the human body if given by nasal cannula. Flow rate-Pa_O2 responses to these concentrators were studied in eighteen hospitalized patients with various pulmonary disorders. In the molecular sieve type flow is equivalent to pure oxygen while in the membrane type, 5L/min oxygen-enriched air corresponds to about 1L/min of pure oxygen.
The LHOT subjects consisted of 14 males and 6 females with a mean age of 57±11. They consisted of 13 COLD cases, 4 cases with sequelae of pulmonary tuberculosis, 2 cases of bronchiectasis and 1 case of pulmonary fibrosis. Their mean Pa_O2 when breathing room air was 48.0±7.6Torr and was significantly raised to 64.2±9.8Torr by the administration of oxygen with a nasal cannula at a flow rate from 0.5 to 3L/min (1.3±0.6L/min). No significant changes were found in Pa_CO2. Thirteen recieved continuous oxygen therapy and seven received nocturnal oxygen therapy. All were followed for an average of 13.3 months and the mean period, during which they were able to stay at home, was 11.5 months. In all cases, the oxygen concentrator worked well and, in 10 of them, functioned throughout more than 12 months. This oxygen delivery system proved satisfactory in practice. The introduction of this equipment makes LHOT more practical in terms of oxygen supply in the home because of its simplicity in operation and maintenance.

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Liquid-filled alveolography (LFA) was reported as a routine technique by Hideo Sawada et al. in 1969. This method was designed to investigate the structural changes of the peripheral bronchi, bronchioles and alveoli in cases of diffuse pulmonary diseases by infusing low viscosity contrast medium (60% Urografin) into the subpleural portion of the lung via a flexible bronchocatheter, the FBC-5 (Machida K.K.).
For the last three years we have performed LFA in 29 patients with cryptogenic fibrosing alveolitis. LFA revealed a high frequency of poor alveolar filling (28/29) simultaneously with numerous small cysts (18/29) in the subpleural portion of the lung, especially adjacent to the costophrenic angle. A combination of these findings suggests “honeycomb lung”, which is the only dependable roentgenological sign of “interstitial fibrosis”. Since biopsy techniques including TBLB are not necessarily successful in cryptogenic fibrosing alveolitis, LFA may be very helpful to establish a definitive diagnosis in such cases.

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An animal model of hypersensitivity pneumonitis was developed in order to study the mechanism of early specific allergic response provoked by inhalation provocation test with antigen. Guinea pigs, which were immunized by subcutaneous injection with M. faeni extract antigen emulsified in complete Freund's adjuvant (immunized group) or with only complete Freund's adjuvant (control group), were sacrificed before, and 1, 3, 6, 24, 72 hours and 1 week after an aerosol inhalation challenge with M. faeni extract antigen.
Histopathological findings of the immunized group revealed severe acute bronchiolo-alveolitis consisting of polymorphnuclear cell infiltration, hemorrhage, edema and hyaline membrane degeneration at 6 and 24 hours after the challenge, in contrast to moderate alveolitis with mononuclear cell infiltration observed at 72 hours after the challenge. The number of peripheral blood neutrophils (3hrs: p<0.05, 10 and 24hrs: p<0.01) and serum concentration of immune complexes (24hrs: p<0.05) of immunized group weve significantly increased, and the number of peripheral blood lymphocytes (6hrs: p<0.05, 10 and 24hrs: p<0.01) and serum CH50 (24hrs: p<0.05) of the immunized group were significantly decreased compared with those of the control group. Total cell counts obtained from immunized group by broncho-alveolar lavage (BAL) were strikingly increased at 6-24 hours after the challenge. The analysis of cell populations in BAL fluids of immunized group showed significant increases of the number of neutrophils (6 and 24hrs: p<0.001, 72hrs: p<0.05), alveolar macrophages (72hrs and 1 week: p<0.05) and lymphocytes (72hrs: p<0.01, 1 week: p<0.02) compared with those of the control group. The concentration of IgG/albumin (24hrs: p<0.01, 72hrs: p<0.05) and immune complexes (24hrs: p<0.02) in BAL fluids of immunized group were also significantly elevated compared with those of the control group. Immunofluorecence demonstrated depositions of IgG and/or C₃ in the alveolar walls and along the blood vessels of lung sections from almost all immunized animals at 3, 6, 24 and 72 hours after the challenge. In contrast, lung sections from immunized animals before and at 1 week after the challenge, and those from all control animals demonstrated few these depositions. Elevation of body temperature of immunized animals decomplemented by intraperitoneal injection with cobra venom factor just before the challenge (CVF group) was significantly suppressed at 8 hours after the challenge compared with that of immunized but not decomplemented animals (immunized group) (p<0.02). Histopathological findings of hemorrhage, edema and hyaline membrane degeneration demonstrated in the CVF group at 24 hours after the challenge were also less extensive than those demonstrated in the immunized group.
These data suggest, that Type III allergic reaction plays an important role in the mechanism of early specific allergic response provoked by inhalation provocation test in hypersensitivity pneumonitis, especially at 6-24 hours after antigen exposure. The role of Type IV allergic reaction was also considered in this disease, but it seemed to be important at later than 24 hours after antigen exposure.

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Bronchial mucosa biopsies from nine patients with bronchial asthma were examined by light and electron microscopy after 2 to 6 years of daily therapy with beclomethasone dipropionate by aerosol inhalations. Biopsies revealed no changes referrable to treatment.
Pharyngeal mucosa biopsies from five out of none patients examined by electron microscopy also revealed no changes referrable to treatment. Candida albicans was not detected in sputum cultures performed after the bronchoscopic examinations. This study showed no abnormal findings which appeared to be caused by inhalation of beclomethasone dipropionate.

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Serum angiotensin-converting enzyme activity (SACE) and serum lysozyme activity (SLZM) were measurd in 43 and in 34 cases of lung cancer, respectively. The activity of the former was 22.2±8.0nmol/ml/min 37°C and that of the latter was 19.9±6.6mcg/ml; the former being lower and the latter higher than respective control (p<0.01). According to statistical analysis, these enzymes were considered to be independently related to lung cancer (r=0.149).
34 patients were categorized into 4 groups by analyzing SACE-SLZM values with the cluster-alanysis method; 31 patients in one group (LC-G), one patient each in the remaining groups.
Three of 19 patients in whom these enzymes were measured more than twice showed significant decrease with deterioration of physical state! Since recent studies have shown that SACE and SLZM may be markers of the dynamics of activated monocyte-macrophages series and proliferating T-lymphocytes series, our results suggest that SACE-SLZM maybe useful for evaluation of the dynamics of cell populations and host resistance.

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An unusual case of combined bronchial asthma and hypertrophic cardiomyopathy is described. She complained of precordial oppression, palpitation and dyspnea. These two diseases in this patient presented a paradoxy in terms of β-adrenergic therapy.
β-adrenergic antagonist was indicated for the treatment of hypertrophic cardiomyopathy, but it was contraindicated because of bronchial asthma.
We treated this patient with metroprolol, a recently developed selective β₁-antagonist, for hypertrophic cardiomyopathy and salbutamol, a selective, β₂-agonist, for bronchial asthma. Marked improvement in symptoms of palpitation and precardial oppression, findings of echocardiogram and phonocardiogram were obtained, without inducing asthmatic attacks or deterioration in pulmonary function.
We concluded that selective β₁-antagonist combined with selective β₂-agonist is useful in the treatment of patients with bronchial asthma associated with hypertrophic cardiomyopathy.

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A 37-year-old male presented with a 12-year history of occasional episodes of dry cough. Five years previously, he had been adimtted to hospital because of proteinuria, when an abnormal chest shadow was also pointed out.
In 1982, he was referred to our hospital for further examination of dry cough and diffuse nodular shadows on the chest X-ray film. Epithelioid granulomas were observed in biopsied specimens of lung and bone marrow. A percutaneous renal biopsy, perfomed because of the persistence of proteinuria, showed sclerosing of glomeruli, cellular crescent formation, segmental proliferation and thickened messangium on light microscopy. Immunofluorescence study demonstrated IgA nephropathy with remarkable IgA deposits in the mesangial area.
A review of the Japanese literature revealed 13 reports of cases of sarcoidosis associated with glomerulonephritis. Only two cases of sarcoidois with IgA nephropathy have been reported in Japan, including this case. These data suggest that a causal relationship exits between the two diseases.

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The clinical findings of scimitar syndrome were present in a 40-year-old male case, but the scimitar vein was recognized to terminate in the left atrium. Hypoplasia of the right lung, dextroposition of the heart, and the scimitar sign in the right lower lung field were observed. Pulmonary angiograms showed a right lower pulmonary vein curved toward the diaphragm which is usual in cases of scimitar syndrome, but which then reversed its course to enter the left atrium. Abnormal branchings of the right bronchial tree and right pulmonary artery were recognized. The right bronchial tree had a weeping-willow appearance.

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A 37-year-old Japanese male case of severe multiple bronchial stenosis due to sarcoidosis was reported.
Although he was completely asymptomatic until August, 1981, retrospective examination showed that his chest X-ray film in 1970 had already shown bilateral hilar lymphadenopathy. In 1977, a subcutaneous mass on the right arm was resected, and its histological findings were consistent with sarcoidosis. He was admitted to another hospital in 1979 with a diagnosis of sarcoidosis because of abnormal chest X-ray film findings, and received prednisolone therapy.
He was admitted to our hospital in February, 1982, complaining of dyspena on exertion. Chest X-ray film on admission showed bilateral infiltrative shadows as well as bilateral hilar and mediastinal lymphadenopathy. Respiratory function tests revealed definite obstructive damage (FEV_1.0 1.96L, FEV_1.0% 49.8%).
Bronchoscopic studies showed marked multiple bronchial stenosis as well as yellow white plaques and telangiectasia, especially in the right upper lobe bronchus, and its biopsy specimen revealed non-caseating epithelioid cell granuloma.
Prednisolone was administered 40mg daily and his dyspnea disappeared with improvement of bronchial stenosis. Since then he has been well for one year and a half without any complications.
Although severe bronchial involvement in sarcoidosis is considered to be rare, especially in Japan, its course and prognosis should be carefully evaluated as a possible causative factor of terminal respiratory failure in this disease.

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A 46-year-old man visited the hospital because of fever and a low grade of exertional dyspnea. Chest X-ray film revealed diffuse reticulo-nodular shadows throughout both lung fields. A serological test for toxoplasmosis with indirect hemagglutination (IHA) showed 1:20480 titer on admission. By the positive serological test and clinical manifestations (fever, eruption, lymphadenopathy and pneumonitis), acute acquired toxoplasmosis was diagnosed. The patient was treated with Acetylspiramycin and was radiologically, physiologically and serologically improved.

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