Pulmonary gas exchange during ergometer exerise was studied in 14 healthy subjects and 12 patients with idiopathic interstitial pneumonia (IIP). The baseline pulmonary functions in these patients showed slightly restrictive impairments and a decrease in single-breath pulmonary diffusing capacity (DLCO). However, the baseline of the arterial oxygen tension (PaO₂) in patients was within the normal range. During steady-state exercise an increase in per minute ventilation, tidal volume and breathing frequency was shown in patients as well as in healthy subjects. The dead space (V_D) in patients increased significantly in comparison with V_D in healthy subjects. V_D/V_T in patients did not decrease with increase in V_O2, while in healthy subjects V_D/V_T decreased with increase in V_O2.
An increase was seen in alveolar-arterial oxygen gradient (A-aDO₂) and a decrease in PaO₂ during exercise in IIP patients, while both parameters did not change on exercise in healthy subjects. The single breath DLCO of the IIP patients increased significantly during exercise, however the level was lower than that of healthy subjects. Therefore, the reserve capacity of the pulmonary capillary bed might decrease in IIP.
The present study suggests that the measurements of PaO₂, A-aDO₂ and DLCO during mild exercise would be useful to detect the capacity of gas exchange in patients with mild IIP.

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Thirty-two patients with interstitial pneumonia (IIP), 22 with idiopathic interstitial pneumonia and 10 with progressive systemic sclerosis (PSS), were examined physiologically to evaluate pulmonary diffusing capacity and small airway dynamics.
In IIP a decrease in pulmonary diffusing capacity (DLCO) (21/22), an increase in esophageal pressure on maximal inspiration (9/10) and a decrease in static compliance (6/9) were noticed.
However, loss of lung volume was not seen in 10 patients and only 3 patients showed hypoxemia at rest. DLCO was correlated with TLC (r=-0.556 p<0.01), therefore, it might be thought that decreased DLCO was due to loss of lung volume in IIP.
Small airway dysfunction was noticed in few IIP patients and was seen more freguently in smokers than in non-smokers. Physiologic monitoring of small airways did not correlate with loss of lung volume therefore it might be partially due to smoking.
Non-smoker IIP patients, whose clinical manifestations were similar to those of collagen disease, revealed the same lung dysfunction as that of PSS patients associated with interstitial pneumonia.

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IAP (immunosuppressive acidic protein), isolated from cancer ascitic fluids by Ishida, is found in large quantities in the serum of cancer patients and in only small amounts in the serum of benign cases. This protein possesses strong immuno-suppressive activity.
The aim of this study was to determine the value of the serum IAP levels for the assessment of disease activity in sarcoidosis, and the correlation between serum IAP levels and depression of cell-mediated immunologic tests in sarcoidosis.
In 40 patients with sarcoidosis proven histologically and clinically, the serum levels of IAP was measured by the single radial immnuodiffusion method. The serum levels of IAP was significantly increased in all sarcoidosis patients (472±132μg/ml) compared to healthy controls (391±75) (p<0.001). In sarcoidosis patients not receiving corticosteroid therapy, the mean level of serum IAP was 563±124 in 8 active patients, 442±123 in 17 inactive patients and 340±80 in 6 resolved patients. In active cases, it was significantly increased in comparison to both controls and inactive cases (p<0.001, p<0.05). Furthermore in inactive cases, it was significantly higher than in controls (p<0.02). However, there was no significant difference between resolved cases and controls.
The levels of IAP correlated significantly with serum lysozyme activity (r=0.597, p<0.01) or serum angiotensin converting enzyme activity (r=0.397, p<0.05) in sarcoidosis patients not under treatment. There was, however, no correlation between the serum IAP levels and PPD-skin reaction, nor several functions of peripheral monocyte including chemotaxis, phagocytosis and beta-galactosidase activity.
The serum IAP levels may be another useful determinant of disease activity and may be used to supplement other clinical laboratory indices of activity.

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It has been reported that drug such as steroid hormones or anticancer agents show suppressive effects on lung defenses in which alveolar macrophages (AM) play an important role. In this study, five drugs which are frequently used for the treatment of respiratory diseases were investigated as to whether they affect the AM function.
When the drugs were added in vitro to monolayers of the AM obtained from normal rabbit lungs, epinephrine and tyloxapol increased NBT reduction by AM. On the other hand, orciprenaline, bromhexine and aminophylline suppressed NBT reduction by AM as compared to controls.
Inhalation experiments with these drugs in vivo revealed that in the presence of normal pulmonary washings (PW), AM obtained from bromhexine-inhaled rabbits showed more enhanced NBT reduction than did AM obtained from saline-inhaled rabbits.
The discrepancy between in vitro and in vivo effects of bromhexine on AM function is probably due to the influences of alveolar lining materials, because the AM which were stimulated by the PW from bromhexine-inhaled rabbits produced more superoxide than did the AM stimulated by the PW from saline-inhaling rabbits.
These results suggest that some inhalants affect the AM function directly or indirectly, resulting in the alterations of lung defenses.

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The specific IgG antibodies to Thermoactinomyces vulgaris and Micropolyspora faeni associated with farmer's lung disease were detected by an ELISA and compared with the standard double immunodiffusion assay. In the farmer's lung group, all sera were precipitin positive against Thermoactinomyces vulgaris and/or Micropolyspora faeni, and revealed significantly high levels of IgG antibody activities against these antigens. We found 18 asymptomatics in a medical examination survey carried out on the dairy farming population of the northern area of Iwate prefecture. Although their sera were precipitin-positive against some antigens involving Thermoactinomyces vulgaris and/or Micropolyspora faeni, IgG antibody activities to these antigens as a group were significantly more reduced than the symptomatic farmer's lung group. Dairy farming controls and normal controls revealed low antibody activities. From these studies, we concluded that the assay of specific IgG antibody activities to thermophilic actinomycetes by ELISA was a useful test for the diagnosis and screening of farmer's lung disease.

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Open lung biopsy specimens obtained from patients with sarcoidosis (Sar, n=17), chronic beryllium disease (CBD, n=6) and hypersensitivity pneumonitis (HP, n=5) were studied histopathologically. In HP thoracotomy was performed between 1.5 to 3 months from the onset of symptoms without previous steroid treatment.
Histological findings were as follows:
1) Non-necrotizing epithelioid cell granulomas were seen in 15 patients (88%) of Sar, 6 patients (100%) of CBD and 5 patients (100%) of HP.
2) Major pulmonary lesions of Sar and CBD were interstitially distributed non-necrotizing epithelioid cell granulomas, whereas those of HP were predominantly centrilobular lesions composed of bronchiolitis and mural and luminal alveolitis.
3) In HP, the granulomas were non-necrotic. In Sar, a few granulomas showed minimal necrosis. Generally the granulomas in Sar and HP measured up to 300 microns in diameter. In 4 patients with CBD, some granulomas measured up to 1.5mm in diameter with central hyalinization and necrosis.
4) In Sar, epithelioid cell granulomas were seen in the visceral pleura in 5 patients (29.4%) and in the interlobular connective tissue in 3 patients (17.6%). Two patients (33%) with CBD showed epithelioid cell granulomas in the interlobular connective tissue. By contrast, no patients with HP showed granulomas in the visceral pleura or in the interlobular connective tissue.
5) Granulomatous involvements of the vascular wall (granulomatous angiitis) were seen in 9 patients (53%) with Sar (4 with only PV involvement, 3 with PV and PA involvement and 2 with only PA involvement), whereas no patients with HP showed such lesions (p<0.05). In CBD, 3 patients (50%) showed granulomatous angiitis (2 with only PV involvement and 1 with PV and PA involvement).
6) Bronchiolar lesions of Sar were narrowing of the lumen or disruption of the basement membrane due to the presence of granulomas in the subepithelial layer, while those of CBD were less extensive than in Sar. In HP bronchiolar lesions were marked with intraluminal cellular infiltration and, in 3 patients (60%), intrabronchiolar polypoid organizing exudates.
7) Masson bodies were seen in 5 patients (100%) with HP, whereas they were not found in Sar or CBD (p<0.01). One patient with HP showed epithelioid cell granulomas embedded in two Masson bodies.
8) Mural and luminal alveolitis mainly composed of lymphocytes and macrophages were most marked in HP. In 5 patients (29%) with Sar, 4 patients (67%) with CBD and 4 patients (80%) with HP, there were epithelioid cell granulomas in alveolar spaces. In 3 patients with HP there were numerous macrophages with prickly cytoplasmic processes (prickly alveolar macrophages) in alveoli adjacent to centrilobular lesions. In 3 patients (60%) with HP, there were foamy cells in alveoli adjacent to bronchioles.
From the pathological viewpoint of the open lung biopsy specimens HP could be differentiated from the pulmonary pathology of Sar or CBD. Pulmonary pathology and possibly pathological processes of Sar were considered to be similar to those of CBD rather than those of HP.

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The disease entity of idiopathic interstitial pneumonia (IIP) has not been definitely determined, making the clinical features somewhat different from case to case.
Using a statistical technique (Q-mode cluster analysis based on R-mode prinicipal component analysis), 43 IIP patients (mean age=57±SD 10 years) were classified according to 30 clinical parameters (5 for signs and symptoms, 10 for chest radiographic findings, 8 for respiratory functions and 7 for hematological, chemical and immunologic data).
As the first step, the patients were classified into 2 main groups (group I and group II), except for one case that belonged to neither of these 2 groups. Twenty four patients of group I were further divided into 2 subgroups (16 patients of group Ia and 8 patients of group Ib). Group II consisted of 18 patients.
Patients in group I were characterized by exertional dyspnea, Velcro rales, cough, homogeneous nodular or reticulo-nodular shadows distributed predominantly in lower to middle lung fields, diminished lung size, marked reductions in %VC, %TLC, %D_LCO and PaO₂, and increased ESR, WBC and LDH. Females were predominant in this group, the main initial symptom was dyspnea, the mean duration of symptoms or signs prior to hospital admission was relatively short, and steroid treatment was tried upon admission in 71% of patients.
Subgroup Ia patients were characterized by more frequent cough and sputum, nodular shadows, increased RV/TLC and mild reduction in PaO₂. This group showed longer survival rates than group Ib. Most of the clinical course of this group were relatively chronic. Subgroup Ib patients were characterized by less frequent cough and sputum, homogeneous reticulo-nodular shadows, severe reduction in PaO₂ and negative or false positive PPDs reaction. This group showed the shortest survival rates. The clinical course of most of this group was relatively acute.
Group II patients were characterized by frequent cough and sputum, Velcro rales, clubbed fingers, inhomogeneous nodular or reticulo-nodular or ring-shaped shodows distributed in lower to upper lung fields with large regional translucency and no or slight reduction in lung size, %VC, %TLC, and PaO₂, with reduction in %D_LCO, elevated ESR and γ-globulin. Males were predominant in this group, the main initial symptom was cough and/or sputum, the mean duration of symptoms or signs prior to hospital admission was long and steroid was given to only 22% of patients upon admission. This group showed the longest survival rates. Most of these clinical features of this group differ from those of typical IIP and might be called chronic “atypical” IIP.

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A 33 year-old woman was admitted to our hospital because of increasing exertional dyspnea. Chest roentogenogram showed hyperinflation. Pulmonary function tests showed obstructive pattern and a markedly decreased diffusing capacity. Transbronchial lung biopsy specimen revealed pulmonary lymphangiomyomatosis. We treated her with progesterone and oophorectomy and have followed her for about two years. After surgery the progress of the disease halted and her condition improved.

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50-year-old male with Pancoast's syndrome was admitted to our hospital with a diagnosis of lung cancer. he had left pulmonary superior sulcus tumor on his chest X-ray film, persistent pain on left C₈-Th_{1, 2} trunk distribution, wasting of the muslces of his left upper extremity and Horner's syndrome.
Sputum cytology revealed small cell carcinoma. He was irradiated (40Gy) and then treated with Adriamycin, Vincristine, Cyclophosphamide and Methotrexate. Now 5 months after diagnosis, he is alive and being followed as an out-patient.

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Dense fine nodular opacities were seen on chest X-rays of a hard metal worker aged 40. He had been highly exposed to hard metals including tungsten as a shaper for 24 years. The diffuse shadows in the lung appeared to be due to much hard metal accumulated in the lung. The case was diagnosed as pneumoconiosis due to inhalation of hard metal. He also suffered from chronic bronchitis. He died of giant cell carcinoma of the lung.

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The first case, a 62-year-old man was admitted with fever, dyspnea and delirium. Chest X-ray film revealed bilateral pneumonia and laboratory findings disclosed hepatic and muscular injury. Echocardiogram showed pericardial effusion. Three months before admission, the patient purchased parakeets and almost all of them died within a few months. Psittacosis was suspected and doxycycline was administered immediately. However, respiratory failure progressed and mechanical ventilation was instituted. DIC developed but was successfully treated with heparin. Chest X-ray findings improved and weaning from the respirator was successfully done on the 41st hospital day. Psittacosis CF titers increased from 1:64 to 1:256, confirming the diagnosis of psittacosis. The second case, the wife of case 1, 53 years old, had suffered from fever for 10 days when her husband was admitted. Because the same disease was suspected, she was examined carefully and pneumonia was disclosed. Liver function was also impaired. Treatment with doxycycline was successful. Psittacosis CF titers increased from 1:128 to 1:256.

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A thirteen-year-old boy came to our hospital for further evaluation of an egg-sized tumor shadow in his left posterior mediastinum, revealed on routine chest X-ray film. This film also showed calcification in the tumor shadow and concavity of the inferior rim of the third rib above the tumor. Thoracotomy confirmed the diagnosis of osteochondroma originating from the posterior portion of the left fourth rib.

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