Recently, A-aD_O2 has generally been used to assess the pulmonary gas exchange clinically. A-aD_O2, however, represents mainly low V_A/Q space because the ideal alveolar point is calculated from an alveolar air equation by assuming no arterial-alveolar CO₂ tension difference. Precise analysis of the pulmonary gas exchange in particular diseases among cardiopulmonary disorders must be done by evaluating high V_A/Q space as well as low V_A/Q space. On theoretical grounds a-AD_CO2 is most suitable to estimate high V_A/Q space. Mean expired alveolar CO₂ tension (P_ACO2) might be difficult to be measured accurately in clinical patients, even when complicated procedures were employed. P_ETCO2 is known to be practically identical to P_ACO2 in normal individuals.
Clinical significance of measuring arterial to end-tidal CO₂ tension difference (a-ETD_CO2) was studied in 25 normal subjects and in 172 patients including 14 with pulmonary thromboembolism (PTE), 91 with chronic obstructive lung disease (COLD) and 67 with valvular heart disease (VHD).
a-ETD_CO2 was increased in patients with COLD (5.4±2.5 TORR, 1SD) and in patients with VHD (1.7±1.9 TORR, 1SD) compared with that in normal subjects (0.1±1.5 TORR, 1SD). But it was especially high in patients with PTE (9.5±2.1 TORR, 1SD). A-aDO₂ was significantly high in patients with PTE (52.7±13.5 TORR, 1SD). In patients with COLD (29.7±8.4 TORR, 1SD) and VHD (25.7±8.6 TORR, 1SD), A-aD_O2 was increased compared with that in normal subjects (13.3±1.6 TORR, 1SD).
The correlation between a-ETD_CO2 and A-aD_O2 was not statistically significant in patients with COLD, which was thought to be a representive of disorders with impaired pulmonary gas exchange. Patients with high a-ETD_CO2 values did not necessarily have high A-aD_O2 values, and vise versa. A-ETD_CO2 and A-aD_O2 were independent of each other. This means that assessment of pulmonary gas exchange cannot be done by only A-aD_O2.
We emphasized the significance of a-ETD_CO2 as an index of high V_A/Q space as well as A-aD_O2 as an index of low V_A/Q space in the assessment of pulmonary gas exchange.

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Nonspecific esterases of epithelioid granulomas were studied histochemically in developing and healing lesions produced in rabbit lung by BCG or Freund's complete adjuvant. Nonspecific esterases were assayed with the following substrates: acid α-naphthyl acetate (acid α-N), α-naphthyl acetate (α-N), naphthol AS-D chloroacetate (AS-D Chl), naphthol AS acetate (AS), and naphthol AS-D acetate (AS-D).
The nonspecific esterases in the epithelioid cells of two types of granulomas could be classified into two groups on account of the chronologic change of enzyme activity. In the first group including acid α-N esterase, the activities were prominent through all stages of the granuloma. On the other hand, in the second group including AS-D Chl, AS and AS-D esterase, the activities were increased prominently only in the healing stage.
These results suggest that the esterases of the second group, especially AS and AS-D esterase are enzymes which participate in the healing of pulmonary granulomatous lesions.

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A study was made of the pathological findings of 14 cases of acute or subacute farmer's lung by transbronchial lung biopsy (TBLB). The conclusions were as follows:
1. Alveolitis were found in all patients. Two of the 14 patients had severe alveolitis, 7 moderate and 5 patients slight alveolitis.
2. Granuloma and Masson bodies were found in 4 patients, granuloma alone in 5 patients and Masson bodies in 2 patients.
3. Four patients were biopsied within one month after the onset of symptoms. All disclosed the findings of alveolitis and three of them had no graonuloma. All of them were also bipsied on 1.5 to 6 months after the onset of symptoms and showed granuloma and/or Masson bodies.
4. In 4 patients treated with steroids, severe alveolitis was not found, but granuloma and/or Masson bodies were observed. The pathological findings of 3 patients on the second biopsy after the steroid therapy showed improvement or some resolution.

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A human mediastinal tumor in a 19-year-old male containing the elements of embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma, was successfully transplanted into nude mice. The transplanted tumor was transferred to tissue culture and a cell line, designated as HMT cells, was established. The morphology of HMT cells showed various cell types; mainly flat epithelial cells, piled-up colonies of cells, polygonal cells and teratoid elements. The chromosomes of HMT cells were heteroploid and were distributed from 48 to 66 on the 30th day in culture. The HMT cells produced AFP in cultured medium and had characteristics of embryonal carcinoma cell in high-level alkaline phosphatase. The histology of the tumor obtained by retransplantation of HMT cells into nude mice was mainly that of embryonal carcinoma with few teratoid elements. In long term culture HMT cells changed to less-differentiated cells.

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β-Adrenergic receptors in lymphocytes are of β₂-type and similar to those of bronchial smooth muscle in pharmacological characteristics. Consequently, lymphocytes may be used as a model for studying β-adrenergic receptors in bronchial smooth muscle, which cannot be directly determined. Thus, a study was conducted to verify the possible relationship between β-adrenergic receptors of lymphocytes and bronchial hyperresponsiveness in patients with asthma.
The β-adrenergic receptors were evaluated by radioreceptor assay using ³H-dihydroalprenolol (³H-DHA). Bronchial hyperresponsiveness was measured by an Astograph (TCK-6100H, CHEST Corp, Tokyo), and bronchial sensitivity (Cmin and Dmin) and bronchial reactivity (SGrs) were determined. In patients with bronchial asthma (n=25), significant positive correlations were observed between the number of β-adrenergic receptors of lymphocytes (³H-DHA binding at 2nM) and Cmin and Dmin (r=0.508, p<0.01, and r=0.438, p<0.05). On the other hand, no correlation was observed between the number of β-adrenergic receptors and SGrs (r=0.095).
Continuous administration of terbutaline sulfate (12mg/day, p.o.) to normal subjects (n=8) for one week, resulted in a significant (p<0.01) reduction in the number of β-adrenergic receptors in lymphocytes from 25.0±10.1fmol/10⁷ cells to 11.7±3.7fmol/10⁷ cells (51.0±21.6%). Therefore, it can be presumed that β-adrenergic receptors in bronchial smooth muscle decrease accordingly. However, almost no change was observed in bronchial sensitivity to inhaled histamine (PD₃₅ Gaw), or Cmin.
From the above it is thought that β-adrenergic receptors can be regarded as one of the determinants in the bronchial sensitivity of patients with asthma. However, in normal subjects, such remarkable bronchial hypersensitivity as observed in patients with asthma could not be caused only by a reduction in β-adrenergic receptors. The results indicate that there is another more important etiologic factor in bronchial hyperresponsiveness other than β-adrenergic receptors.

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Twenty asthmatic patients, averaging 15 years old, were examined for the relationship between bronchial response to acetylcholine (Ach) and lung functions before inhalation of Ach. There were statistically significant relationships between the respiratory threshold of Ach and FEV_1.0, FEV_1.0%, FEV_1.0/pred. VC×100, MVV, MMF, PF, V₇₅, V₅₀, V₂₅, V₁₀, V₇₅/Ht, V₅₀/Ht, V₂₅/Ht, and V₁₀/Ht.
The minimal concentration of Ach which caused an initial decrease of FEV_1.0, V₇₅ and V₅₀ greater than 20% of standard values tended to be larger than those affecting V₂₅ and V₁₀. There was no statistically significant relationship between the respiratory threshold of Ach and FVC, V₅₀/V₂₅ and V₂₅/V₁₀.
These results may support the view that the bronchial response to Ach may be related to airway conditions such as airway obstruction and airway conductance.

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NK cell activity was examined in 40 patients with radiographically defined asbstosis and 54 sex- and age- matched controls in oder to investigate immunological abnormality in asbestosis.
The results were as follows:
1. NK cell activity in healthy controls was 17.4±12.2%. NK cell activity was independent of the donor's sex and age.
2. NK cell activity in asbestosis (32.3±18.2%) was significantly higher (p<0.001) than that in healthy controls.
3. NK cell activity showed a tendency to decrease as asbestosis progressed.
4. NK cell activity in patients exposed to asbestos dust for over 21 years was significantly higher (p<0.01) than in patients exposed for less than 20 years.
5. NK cell activity in patients with pleural thickening was significantly higher (p<0.05) than in patients without pleural thickening.
6. NK cell activity in patients with asbestosis-related lung cancer was significantly lower (p<0.05) than that in patients without lung cancer.
7. An increase in IgG was seen in 35%, in IgA in 30%, in IgM in 10% and in IgE 16%. ANA was detected in one of 11 cases, and rheumatoid factor was detected in 6 out of 11 cases.
The above results suggest that NK cell activity might be an useful immunological parameter in evaluating the development of asbestosis and asbestosis-related lung cancer.

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A thirty-one year old male case with exertional dyspnea and dry cough was diagnosed as lymphoid interstitial pneumonia by open lung biopsy. Chest X-ray film and CT scan showed bilateral central consolidations consisting of air bronchogram and a cystic lesion with a sparse margin. Ga citrate scintiscan was positive in the affected areas. Vital capacity (%VC 70.5), residual volume (%RV 45.7), diffusion capacity (%DL_CO 52.6) and arterial oxygen tension (PaO₂ 76) were all decreased. The histology of the biopsy specimen showed marked lymphocytic (partially plasmacytic) infiltration without lymphoid follicles in the alveolar wall, thickening of the alveolar wall and accumulation of macrophages in the alveolar air space. Immunologically, an increase in serum IgA, equivocal decrease in C₄ and CH₅₀, negative PPD and DNCB skin reactions, decrease in the number of T cells in peripheral blood with diminished blastogenesis response to PHA, ConA and PWM were found. Analysis of bronchoalveolar lavage fluid revealed an increased proportion of lymphocytes (mainly null cells). Prednisolone was initiated at a dose of 90mg/day, which was tapered gradually to 45mg/day. Symptomatic improvement, partial clearing of chest roentogenogram and increase in PaO₂ levels were observed but there was no recovery of pulmonary function.

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Transtracheal aspiration was performed in 60 patients who presented with respiratory symptoms and were not yet treated with antibiotics. The transtracheal aspirates were bacteriologically positive in 40 patients. Haemophilus parainfluenzae only was isolated in 5 patients (12.5%). The diagnosis in 5 patients with H. parainfluenzae isolated purely from transtracheal aspirates were pneumonia in 2 cases and lower airway infection in 3 cases. In all patients, response to treatment with penicillin was good.
The antibiotic disc sensitivity studies showed H. parainfluenzae isolated from transtracheal aspirates to be sensitive to penicillins and aminoglycosides and to be resistant to cephalosporins and erythromycin. These results show that the role of H. parainfluenzae in respiratory tract infections is important.

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We present a case of diffuse sino-bronchiectasis associated with the lack of expression of HLA A, B, and C antigens. The case was a 40-year-old male diagnosed in our outpatient clinic as sino-bronchiectasis at about ago 20. In these 20 years, bronchiectasis has progressed gradually. Twenty years ago, bronchiectasis was limited to bilateral middle lobe bronchi, but now it extends to all bronchi.
In this patients, we also found the lack of expression of HLA A, B, and C antigens on his lymphocytes. Concerning other immunological data, his serum IgA, α₁-antitrypsin, and β₂-microglobulin levels were increased, and serum IgG, IgM and complements levels were within normal limits. Lymphocyte stimulation tests using, PHA, PWM, and Con-A show slightly low but positive reactions. Also, in the analysis of lymphocyte subsets the Leu-3aILeu-2a ratio showed a slight increase. It has been suggested that HLA molecules play an important role in immunological cellular interactions, especially between T-lymphocytes and other cells.
Therefore, we suspect that disorders of surface antigens on the lymphocytes of this case could be closely related to the respiratory tract disorders.

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Forty-five subjects with no history of asthma underwent the standard acetylcholine inhalation test. Two women showed a 2, 500μg/ml of respiratory threshold of acetylcholine. This value is within the range of mild bronchial asthma. They subsequently developed symptoms of bronchial asthma 2 months and 7 months after the test. One of them had allergic rhinitis, the other had no atopic background. Though there have been some case reports of atopic patients with brochial hypersensitivity developed asthma, there have been no reports that non-atopic patients with bronchial hypersensitivity developed asthma.
The respiratory threshold to acetylcholine did not diminish after the onset of bronchial asthma. The upper respiratory infection seems to precipitate asthmatic symptoms in latent asthma patients, but it still remains unknown why asthma develops in spite of the same threshold to acetylcholine. Further investigation is required to make it clear. From these cases it can be considered that the acetylcholine inhalation test is very useful in detecting latent bronchial asthma.

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49歳女性. 胸部X線上左上肺野に腫瘤状陰影を指摘され入院した. 肺内腫瘍と診断し, 開胸摘出術を施行した. 腫瘤は左S¹⁺²原発の5×3.5×3cm, 弾性硬, 淡黄色の腫瘍で, 組織学的に長紡錘形・短紡錘形線維芽細胞様細胞が主体で storiform pattern が著明である malignant fibrous histiocytoma と診断された.

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