Steroid withdrawal methods with beclomethasone dipropionate inhaler (BDI) from maintenance systemic corticosteroids in steroid-dependent asthmatics were studied based on the results of a BDI questionnaire survey, copies of which were sent to 19 institutions studying asthma in various parts of Japan.
1) Steroid withdrawal was easier in moderate patients than in severe patients. When the daily maintenace dosage was 10mg or less of prednisolone or 1.0mg or less of betamethasone, many cases could reduce to less than a half of the initial daily dosage, then some of them could withdraw completely after administration of BDI for more than one year.
2) Steroid withdrawal is difficult in severe patients. Many patients whose maintenance daily dosage was 5mg or less of prednisolone could reduce to less than a half of the initial daily dosage within five months and moreover could withdraw within one year. Extension of triamcinolone acetonide (TA) injection periods could be observed in many patients treated with TA.
On the other hand, when their maintenace daily dosage was been between 5, 10mg of prednisolone, the reduction rate after one and a half years BDI treatment was about 50% on average. In the patients whose maintenance daily dosage was more than 10mg of prednisolone, the average reduction rate was between 60% and 70% after long-term BDI administration, but further reduction after reduction to around 5mg/day was not so easy. The reduction rate in patients treated with betamethasone was approximately 50% the initial daily dosage after one year of BDI administration.
3) Effects of transfer from systemic corticosteroids to BDI differed according to the kind of systemic corticosteroids. The ratio of steroid reduction effect between prednisolone and betamethasone with BDI was 1:18-1:35, approximately the same as the ratio of adrenal function supressing effect.
4) Reduction of BDI dosage could be seen at five to six months of BDI administration in cases in which BDI was effective moreover in excellent cases BDI daily dosage was 2 to 4 puffs at 10 months to 1 year.
5) Discontinuance of BDI administration in BDI non-response patients should be judged carefully.

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It has been well documented that slow reacting substance of anaphylaxis (SRS-A) belongs to a group of compounds named leukotriene C₄ (LTC₄), LTD₄ and LTE₄. It was also suggested that these LTs play very important roles in the pathophysiology of bronchial asthma and anaphylactic shock. In the present investigation we detected, identified and measured various LTs in sensitized guinea pig lung perfusate after antigen challenge by HPLC and by tissue bioassay method using guinea pig ileum.
1) Eluted solution from a peak portion of LT-like substance detected by HPLC in lung perfusate from actively sensitized guinea pig lung lobes after the antigen challenge showed LT-like biological activity by tissue bioassay method using guinea pig ileum.
2) The amount and the ratios of various LTs released from actively sensitized guinea pig lung lobes differed in individual guinea pigs.
3) The amount of LTC₄ released from sensitized perfused guinea pig lung lobes was greater than that of LTD₄ and LTE₄.
4) The amount of LTC₄ released from sensitized perfused guinea pig lung lobes after the antigen challenge was significantly decreased by pretreatment with AA-861, the specific 5-lipoxygenase inhibitor.
5) The recovery rates of synthetic LTs added to whole human blood were 80-90% by this HPLC assay method.

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Fifteen patients with normal chest roentgenograms who had complaints of persistant cough but had no history of attacks of dyspnea or wheezing were investigated by allergological tests, pulmonary function tests, acetylcholine inhalation tests and follow-up study.
Data suggested that they can be categorized into 3 groups, i. e. Group I: latent asthma or “pre-asthmatic stage”, Group II: allergic bronchitis, Group III: non-allergic acute or chronic bronchitis.
The peripheral blood of many patients in both Group I and II was eosinophilic and there was eosinophilic infiltration in bronchial mucosa but good therapeutic responses to corticosteroids and/or β-stimulants were obtained. Group I differed from Group II in terms of the presence of bronchial hypersensitivity. Seven of 10 patients in Group III in whom histological examinations were performed showed lymphocytic infiltration in bronchial mucosa but no eosinophilic infiltration.
From these results, we conclude that allergological tests, acetylcholine inhalation test and bronchofiberscopy are extremely useful to find cases of latent asthma and allergic bronchitis among patients with persistent cough.

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Bronchoscopy was performed in 23 cases with untreated sarcoidosis. Non-specific findings such as reddening, edema, etc. were the most common and were observed in 19 cases (83%). Among the abnormalities considered specific to sarcoidosis, retinalization of vessels of the bronchial mucosa was noted in 15 cases (65%), granular appearance in 8 cases (35%), and nodular formation in 6 cases (26%).
Severe stenosis was not observed. Retinalization of vessels was pronounced around the cartilaginous rings of main bronchus and the orifice of the upper lobe branch, and was also observed in cases without BHL. Blood vessels networks resembled those of the retina, and such areas could be distinguished clearly from uniform reddening of the mucosa observed in cases of inflammation due to other causes. Retinal vasculitis was observed in 16 cases (69%). Among 15 cases showing vascular mucosal changes, 14 cases (93%) had retinal vasculitis, while among 8 cases showing no vascular changes of the bronchial mucosa, only 2 cases (25%) had retinal vasculitis, and it has been suggested that there is a close relation between retinalization seen in the bronchial mucosa and retinal vasculitis.

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We evaluated changes in β-adrenergic receptor levels in lung homogenates, β-aderenergic response and response to histamine in resected tracheal muscle, and plasma catecholamine levels in guinea pigs following sensitization and repeated induction of anaphylaxis by inhalation of α-amylase from Bacillus subtilis.
1) β-receptors in lung homogenates were studied by radioreceptor assay with ³H-dihydroalprenolol. The β-receptor level in sensitized guinea pigs (Bmax, 721±195fmol/mg protein) differed slightly from that in untreated controls (776±148fmol/mg protein). However, it was significantly lower in animals in which anaphylaxis wasrepeatedly elicited following sensitization (608±125fmol/mg protein) in comparison to the untreated control group, the group undergoing only sensitization, or the group inhaling physiological saline (734±119fmol/mg protein) (p<0.02). No difference was found in Kd among all groups.
2) The dose-response curve of the resected tracheal muscle to histamine did not change by sensitization or repeated induction of anaphylaxis.
3) The dose-response curve of the resected tracheal muscle to isoproterenol shifted significantly to the right (p<0.05) in the group with repeated induction of airway anaphylaxis.
4) Epinephrine and norepinephrine levels were markedly elevated in the group in which airway anaphylaxis was repeatedly elicited.
These findings indicate that airway anaphylaxis (asthma attack) elevates catecholamine levels, and that prolongation of the condition leads to a decrease in β-receptors (down regulation), which in turn causes a decrease in the β-adrenergic response of the tracheal muscle. However, no change was noted in the responsiveness of this muscle to histamine in vitro. The possibility that β-receptors may decrease also in human bronchial asthma by the same mechanism is suggested.

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A 23 year-old male was diagnosed as having sarcoidosis with multiple manifestations associated with endocrinological disturbances of the hypothalamus-hypothysis system.
At the onset of disease, Heerfordt syndrome was present, appetite loss, low grade fever and systemic superficial lymphadenopathy, and then symptoms of diabetes insipidus appeared. Chest roentogenogram showed bilateral hilar node and reticular shadows in the right upper zone. Ocular lesions included typical chorioretinitis, periphlebitis and uveitis.
Laboratory examinations revelaed panhypopituitarism to the exclusion of prolactin, and brain CT showed a suprascleral mass. Other tests suggested that liver, spleen, bone and heart were involved.
Treatment by corticosteroids resulted in inprovement of symptoms other than D. I. Chest X-ray and brain CT revealed that the abnormal shadows disappeared and laboratory examinations showed that the endocrinological disturbances gradually improved. Diabetes insipidus was well controlled by replacement therapy with vasopressin by nasal spray.

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A 56 year-old male case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with superior vena cava syndrome (SVCS) was presented. The SVCS was caused by mediastinal tumor metastatic from pancreatic cancer. This case had the following interesting features:
1) Although the water load test disclosed marked antidiuretic status in this patient, the same test employing 500mg of Diphenylhydantoin intravenously showed slight production of free water.
2) Hyponatremia was corrected by oral administration of 200 to 400mg/day of Diphenylhydantoin for one month.
3) Autopsy revealed bilateral involvement of the vagal nerves by the metastatic mediastinal tumor, and no evidence of intracranial metastasis.
4) No ADH activity was detected in two autopsy tissue specimens from the tumors of the mediastinum and pancreas.
The pathophysiological mechanism of SIADH in this case was reviewed, and it was concluded that the inappropriate secretion of ADH in this case was not from the tumor, but depended on the result of the vagal block which disturbed the afferent impulses from the baroreceptor of the left atrium.

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A 53-year-old man who had no symptoms, presenting with BHL and cervical lymph nodes enlargement with demonstration with amyloid is reported.
The BHL was confirmed to exist 5 years previously by retrospective exermmation of chest roentgenograms. There was no hepatosplenomegaly by computed tomography. Soft tissue scan with %Kg 400μ Ci Tc-99m-EHDP (ethylene-hydroxy-diphosphate) 5hr after intravenous injection demonstrated increased uptake in cervical and mediastinal lymph nodes.
Amyloid deposition was found in cervical and inguinal lymph nodes, rectum and stomach biopsy specimens. A bone marrow examination was normal. Immunohistochemical typing was Aλ, but there was no increase in plasma cells.

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