We studied blood coagulability of 31 patients with chronic respiratory failure (CRF) in the compensated period and of 13 patients with CRF in the decompensated period by measuring coagulation-fibrinolytic factors. Fibrinogen half-life was also determined in 9 compensated CRF patients as well as in 6 controls by monitoring the survival of ¹²⁵I-labeled fibrinogen.
1. In compensated CRF patients, although platelet counts and fibrinogen increased, we found prolongation of prothrombin time and activated partial thromboplastin time, and decrease of factor VII, factor X, plasminogen, antithrombin III and fibronectin. The above abnormalities were associated with increase of fibrinogen/fibrin degradation products plus high molecular weight fibrinogen complexes.
2. The fibrinogen half-life was significantly shorter in compensated CRF patients than in controls.
3. The abnormalities of coagulation-fibrinolytic parameters of decompensated CRF patients were patently more evident than those of compensated CRF patients mentioned above.
4. These findings suggest that in CRF, there may be subclinical intravascular formation of fibrin monomer complex in the compensated period and we found that with exacerbation, hypercoagulability becomes evident and in some patients, ultimately may result in disseminated intravascular coagulation.

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Diffuse interstitial lung disease (DILD) is a heterogeneous group of disorders, in pathophysiology and pathogenesis of which, certain immunological processes are highly suggested. To determine which immunological reaction is mainly concerned, activated T and B cells in peripheral blood and in BALF were evaluated for various types of DILD: sarcoidosis (SAR), chronic beryllium disease (CBD) hypersensitivity pneumonitis (HP), idiopathic interstitial pneumonia (TIP), and interstitial pneumonitis associated with collagen-vascular disorder (IP-CVD).
Activated T cells were calculated by counting the number of lymphocytes which formed stable rosettes with non-neuraminidase treated SRBC at 37°C (E 37°C), and activated B cells by counting the spontaneous immunoglobulin secreting cells (IgSC) detected by reverse hemolytic assay.
Activated T cell levels were significantly higher in SAR, CBD, and HP, with moderate increase in IgSC. While activated T cells also increased in TIP and IP-CVD, the increase in IgSC, i.e., activated B cells was even more marked in these diseases. Activated lymphocyte levels were always higher in BALF than in the blood.
These findings suggest that DILD might more effectively be classified into two groups, i.e., T Lymphocyte Alveolitis: sarcoidosis, chronic beryllium disease, and hypersensitivity pneumonitis, and B Lymphocyte Alveolitis: idiopathic interstitial pneumonia and interstitial pneumonitis associated with collagen-vascular disorder.

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Tγ cell percentages in peripheral blood of patients with sarcoidosis and other pulmonary diseases were compared. In active stage sarcoidosis, an increase in Tγ cell percentage was detected as compared to inactive stage sarcoidosis. However, this increase in Tγ cells was detected in other diseases, such as pulmonary tuberculosis and lung cancer. A marker study using monoclonal antibodies was performed, but no relationship was determined between Tγ cells and the OKT antibodies.

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In order to determine causative organisms in terminal pneumonia in the aged, 90 autopsies were made during the period from July 1979 to September 1982. The results of routine bacteriological cultures from the lung were analyzed with respect to the correlation between bacteriologic and histologic findings. The following results were obtained.
1) One hundred and twenty strains were isolated from 54 culture positive cases. K. pneumoniae, S. faecalis, E. coli and P. aeruginosa were the more frequently isolated strains of bacteria. Gram-negative bacilli were apparent in 63% of 120 strains.
2) It was very difficult to assess causative organisms of terminal pneumonia from the bacteria isolated in antemortem sputum.
3) The cases showing bacterial amounts of (+) or more isolated from the postmortem lung have greater likelihood of pneumonia as a cause of death.
4) Forty-eight strains were isolated from 30 terminal pneumonia cases. In terms of bacterial amount, K. pneumoniae, glucose non-fermentative gram-negative bacilli, S. aureus, and E. coli were most frequently isolated.
5) The incidence of positive cultures in alveolar pneumonia was significantly higher than that of mixed-type pneumonia.

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Occupational challenges were used to investigate respiratory hypersensitivity in 3 patients with farmer's lung. Challenge exposures were carried out in the patients' cowshed for 10-30 minutes. Vital signs, blood counts, blood chemistry, respiratory function and chest X-ray were monitored for 2-6 days after exposure.
In case 1, leucocytosis, observed at 6 hours after exposure, improved within 24 hours. In case 2, no significant changes were observed. In case 3, leucocytosis was observed at 7 hours after exposure and improved within 24 hours. Fever, cough and also a decrease in FVC and PaO₂ presented changes with two peaks, at 7 hours and 3-6 days after the exposure. A continued decrease in DLco was observed throughout the course. Granular shadows appeared on the chest XP in the late phase of the course.
It is likely that response patterns suggest the immunologic processes in vivo. The provocation test is a clue to the estimation of extrinsic antigens and is of use to explain an importance of environmental factors in the daily life of patients.

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A 63-year-old patient with chronic obstructive pulmonary disease (COPD) was complicated by C_O2 narcosis and right ventricular failure due to pulmonary infection. Artificial respiration by means of phrenic nerve stimulation resulted in the improvement of clinical status and arterial gas. The pacer acted effectively for at least one month after commencement. However, it was removed because the patient complained of cervical pain during pacing, possibly due to an increase in electrical resistance. Utilization of diaphragm pacing in patients with COPD was suggested.

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In this report we describe six patients with miliary tuberculosis (five males and one female, ranging in age from 35 to 74 years). Initial chest roentgenogram on admission revealed typical miliary shadow only in one of six patients (case 1) and almost no abnormality in two patients (cases 1, 3). However, within two weeks after admission chest X-ray films of all patients showed diffuse nodular shadows. The size of the nodules in these cases variety widely.
Two of six patients developed adult repiratory distress syndrome despite treatment with antibuberculous drugs and disseminated intravascular coagulation developed at the end stage.
Since clinical signs including chest rentogenogram and complications of miliary tuberculosis are multifarious, miliary tuberculosis should be always be taken into consideration in the treatment of patients with fever of unknown origin.

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Systemic-pulmonary venous shunt with SVC syndrome in a 58-year-old male is presented. Two months after resection of a right Pancoast tumor, SVC syndrome was noticed. RI angiography from the right antecubital vein demonstrated systemic-pulmonary venous shunt between the venous plexus of the right thoracic wall and right pulmonary veins. Nonselective PAG confirmed this phenomenon. Perfusion lung scan with ^99mTc-macroaggregated albumin (MAA) from the right antecubital vein showed marked RI accumulation in the kidneys and brain, indicating right to left shunt. The ratio of extrapulmonary activity to whole body activity showing right to left shunt ratio of the right arm venous drainage was 54%. Perfusion lung scan by foot injection showed no activity in the kidneys and brain, thereby excluding intracardiac shunt.
Generally 4 collateral pathways have been described, 1) internal thoracic vein, 2) lateral thoracic vein, 3) azygos vein and 4) vertebral venous plexus. As a 5th pathway, systemic-pulmonary venous shunt must be considered in the case of pleural adhesion. Systemic-pulmonary venous shunt is rare and this case is the third case in the review of international and Japanese literature.

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Five cases of Paragonimiasis westermani with a major sign of pleural effusion were experienced. The first case, a 65-year-old man, had repeated exudative pleurisy and high eosinophilia. Four more cases were observed for one year. There was only pleural effusion without evidence of nodular or ring lesions throughout both lung fields on the chest roentgenogram.
All these cases had a histoly of eating raw fresh Japanese wild boar. The diagnosis of Paragonimiasis westermani was confirmed by immunological studies. After treatment with Bithionol, the titer of the complement fixation test decreased. The route of trasmission and the pathogenesis of Paragonimus westermani are discussed.

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A case of Posthyperventilation apnea provoked by asthmatic attack was reported. A 19-year-old man was admitted because of syncope after asthmatic attack. Physical examination showed dry rales in both lung fields but neurological examination results, ECG, and X-ray films of the chest were all normal. He was given a three-week course of oral bronchodilator and prednisolone treatments and there was a clinical improvement. Subsequently the steroid was tapered off. On the day following of the cessation of prednisolone, the asthmatic attack recurred and about 5min later, prolonged apnea and syncope followed. He was resuscitated by artificial respiration and steroid injection. Neurological examination and EEG during recovery were normal. VE and Po. 1 responses to hypoxia and hypercapnia were all within normal limits. About 2min after voluntary active hyperventilation of 3min duration, ventilation decreased gradually and almost stopped for 30 seconds. This phenomenon was considered to be posthyperventilation apnea.

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42歳, 男性. 胸部X線写真で右肺尖部縦隔側に境界明瞭な円形の腫瘤陰影を認めた. 胸部CT写真では, 腫瘤の内部は均-な low density を示し, その平均CT値は7.5とのう胞性腫瘤が考えられた. 腫瘤摘出術を施行した. 組織学的検査の結果から神経鞘腫と診断された. 内部のほとんどがのう胞化した神経鞘腫は稀である.

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