Chronic lower respiratory infectious disease including diffuse panbronchiolitis, bronchiectasis, chronic bronchitis, and right middle lobe syndrome etc., when viewed from a longrange viewpoint, is a serious condition as it may cause chronic respiratory failure and chronic pulmonary heart disease (Cor pulmonale). An inflammatory exacerbation of the disease often is a contributing factor to recurrent bacterial infections of the respiratory tract. Against such a background, an attempt was made to evaluate immunotherapy with Broncasma Berna, a polyvalent bacterial antigen preparation containing chief bacterial pathogens responsible for chronic lower respiratory infectious disease, for its effectiveness in a total number of 103 courses, in 50 patients with this particular disease.
The results indicate that Broncasma Berna therapy decreased the frequency of inflammatory flare-ups, reduced antibiotic requirements and resulted in virtual freedom of sputum from significant pathogens in 30 to 86%, 26 to 86% and 21 to 50%, respectively, of the patients treated. Immunological tests demonstrated augmented cellular immunity in 60 to 70% of patients both in vitro and in vivo. Broncasma Berna was thus considered to be effective as a long-term immunoprophylactic agent in the treatment of chronic lower respiratory infections.

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The lungs of 30 autopsy cases of collagen diseases including 6 cases of progressive systemic sclerosis (PSS), 9 cases of systemic lupus erythematosus (SLE), 8 cases of rheumatoid arthritis (RA), 3 cases of dermatomyositis (DM), 2 cases of polyarteritis nodosa (PN), 2 cases of wegener's granulomatosis (WG) and 4 cases of idiopathic interstitial pneumonia (IIP) as controls were examined pathologically.
The results of the study were as follows.
1. Intrapulmonary vascular changes.
Necrotizing angitis was observed in 2 out of 9 cases of SLE, 1 out of 8 cases of RA, both cases of PN and 1 out of 2 cases of WG. In all cases, necrotizing angitis was found in the bronchial arteries. These were considered to be primary vascular changes, because the lesions were equally disseminated in the upper and lower lobes of both lungs without any accompanying pathological changes such as pneumonia. However, in cases of WG, secondary angitis of the pulmonary arteries and veins were found in the necrotizing granulomatous region. In the honeycomb regions of the lungs of these collagen disease cases and IIP, severe intimal thickening of pulmonary arteries was conspicuous. These intimal changes were considered to be secondary due to interstitial fibrosis.
2. Interstitial pneumonia.
Honeycomb lung was confirmed in all cases of PSS, 2 out of 9 cases of SLE, 2 out of 8 cases of RA and 1 out of 2 cases of PN. In cases of IIP, interstitial fibrous changes were localized in the alveolar walls. In cases of collagen diseases, however, such changes appeared not only in the alvelar walls but also in extensive interstitial tissues. In the honeycomb regions of the lungs of collagen disease, apart from PSS, the cystic changes were not uniform in size and their distribution was limited compared with those of IIP and PSS where the cystic changes were more uniform in size and more widely distributed in the lower lobes.

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We have previously reported the first case with primary pulmonary hypertension (Chest 74: 299) responding well to long term administration of oxygen. This case has been doing well for eight years with nocturnal oxygen administration. The following case differed from the previous one because it did not respond to oxygen in the acute stage but benefited by long term oxygen administration.
A 10 year-old boy with primary pulmonary hypertension did not respond to oxygen and administration of phentolamine resulted in abrupt rise of pulmonary arterial pressure by more than 30% during cardiac catheterization. He was subsequently treated with long term administration of oxygen with substantial improvement (NYHA calss IV to II). On physical examination pulmonary arterial thrust and right ventricular lift became faint and right atrial sound disappearred althought serial ECGs and chest X-rays showed no remarkable changes. After five months of stability, the amount of oxygen administered became far less than expected and he deteriorated rapidly after an episode of influenza. The patient died three months later due to intractable right heart failure.
Autopsy revealed typical pathological changes of primary pulmonary hypertension including plexiform pulmonary ateriopathy and severe right ventricular hypertrophy. The left side of the heart was intact without any shunt or valvular disease. Pulmonary parenchyma and airway were intact and there was no bronchiolo-alveolar lesion suggesting oxygen pneumonitis.
We are now treating four cases of primary pulmonary hypertension with home oxygen therapy all are in good physiological condition. Long term oxygen therapy has been shown to be safe and effective without any noticeable deleterious effects such as systemic hypotension or paradoxical increase of pulmonary arterial pressure which may be seen during vasodilator treatment. This is the treatment of choice for primary pulmonary hypertension.

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Comparisons of flow-volume curve (V-V) with spirogram, residual volume, delta N₂ Xe-133 inhalation scintigram and Tc-99m perfusion scintigram were made in 121 patients with pulmonray diseases. We calculated dV/dV of descent of V-V (slope). The curve had good correlation with FEV₁/FVC (FEV₁%). A gradient of less than 1.9 was equivalent to FEV₁% less than 69% and a gradient less than 0.9 was eqivalent to FEV₁% less than 54%. We calculated the descent curvature using the following formula; Curvature (%) is (S′-S) × 100/S′, where S is the area under the descending curve and S′ is the area under a line connecting the peak with endexpiratory position. The descent gradient was classified into 4 patterns; When the slope is less than 0.9, it is classified as flat. A slope over 1.0 and curvature of less than 29% is classified as straight. A slope over 1.0 with a curvature of over 30% and a descent gradient can be approximated to a bent double or triple line is classified as bent. The remainders are curved. As ventilatory disturbances advanced, the shape transformed from straight through bent or curved to flat and the frequency in abnormalities in residual volume and/or delta N₂ increased.
We quantitated abnormalities on the inhalation scintigram and perfusion scintigram dividing the lung field into 6 areas (left or right, upper, middle and lower) and scoring each area as follows; 3 as total regional defect, 2 as patchy defect, 1 as other hypofunctions and 0 as no abnormality. The score increased when the shape transformed from straight through bent or curved to flat. We determined regional mean washout time (MTT) dividing the lung field into 6 areas. Then we calculated the coefficient of variance (CV) of regional MTT as an index for interregional nonhomogenity of ventilation. CV increased as the shape changed from straight through bent to curved. In bent cases, regional MTT could be separated into either normal or delayed. Delayed areas were put together. When we recalculated CV in normal areas and delayed areas respectively, revised CV in both areas were similar to those in strainght. Thus in bent case, poorly ventilated areas were considered to be put together and connected in parallel to well ventilated areas. Meanwhile, curved underventilated areas were patchy but scattered diffusely throughout total lung-field. CV in flat cases was rather small considering their scores. In most flat cases, ventilatory disturbances advanced throughout the lungfield so that interregional nonhomogenity became less remarkable. In rare flat cases, airway obstruction might be restricted merely to the central airway without nonhomogenity of ventilation.
It is concluded that the slope of the descent gradient of flow-volume curve indicates severity of obstruction and the curvature may reflect interregional nonhomogenity of ventilation.

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Atomic absorption spectrophotometry was employed to measure zinc and cooper in serum and zinc in tissue of 81 patients with lung cancer, 4 thymoma patients, and 14 cases of lung metastasis, and results were compared with 21 normal individuals.
1) The value of zinc in serum of normal individuals was 1.33±0.37mcg/ml while that of lung cancer cases was 0.86±0.22mcg/ml, which showed a statistically significant decrease in the latter. In other categories, the value was inclined to be lower than that of normal individuals.
2) There was no correlation between clinical stage and the decrease of serum zinc value.
3) The value of serum zinc was not related to that of serum copper.
4) In lung cancer cases the value of zinc in lung cancer tissue was higher than in normal lung tissue.
From the above-mentioned results, the tranference of serum zinc to cancer tissue was considered to be one reason for the decrease of serum zinc value, thus it may be possible to control tumor development by regulating zinc in serum.

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The causative agents of human paragonimiasis are regarded as Paragonimus westermani and Paragonimus miyazakii in Japan. The patient of paragonimiasis westermani shows a typical ring form or a nodular shadow on the chest X-ray and the detection of eggs from feces or sputum is considered easy. On the other hand, the patient of paragonimiasis miyazakii shows some characteristic symptoms such as exudative pleurisy and/or spontaneous pneumothorax with marked eosinophilia, and the detection of eggs has been impossible except for a few cases. Therefore the latter has to be diagnosed by immunoserological techniques.
Recently we observed four cases of paragonimiasis, who were admitted to Kashiwa National Hospital. These patients manifested pleural effusion, marked eosinophilia and/or spontanous pneumothorax. Two months before admission they ingested uncooked fresh water crabs (Geothelphusa dehaani) captured by themselves in Yorou-Keikoku, Chiba, where no human cases of paragonimiasis have been reported yet. All these patients, experienced high fever, abdominal pain and diarrhea just 1 week after eating the crabs. Then chest symptoms such as cough, sputum and chest pain followed in all cases from 6 to 14 weeks after eating the crabs. All patients were diagnosed as paragonimiasis westermani by immunoserological examinations.
Intradermal test with the antigen extracted from adult worms of Paragnimus has been employed as a screening device for suspected cases of paragonimiasis, however, the exact time course when the reaction turns positive has not been known in human paragonimiasis. We performed intradermal test on all these patients at certain intervals, and clarified that the positive reaction appeared in the 4th month after infection.
The patients were treated with praziquantel for 3 days at a daily dosage of 25-50mg/kg, which has apparently been successfully employed in schistosomiasis. After completion of the therapy, all clinical signs disappeared and the patients seemed to be cured with few side effects.

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This report describes three aspirin-sensitive asthmatic patients who had anaphylactoid reactions to hydrocortison succinate (Saxizon^®).
Case 1 was a 42 year-old male with a history of asthmatic attack following administration of an aspirin preparation, who became uncosciousness immediately after the administration of Saxizon. Case 2, a 30 year-old male and case 3, a 39 year-old male also had histories of aspirin-sensitive asthmatic attacks, and experienced severe asthmatic attacks following intravenous administration of Saxizon.
Inhalation challenge with Sulpyrin and Saxizon were positive in all three patients. Direct skin testings revealed positive immediate reactions to Saxizon in two and in one of them also to Predonisolone. Prausnitz-Küstner reactions were positive to Saxizon in two whereas histamine-release testings were negative in all.
It is suggested that at least two of these three patients had immediate hypersensitivity to Saxizon.

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A 54 year-old male was admitted on April, 1969 with tuberculosis. In the tuberculous cavity, aspergilloma consisting of allergic bronchopulmonary aspergillosis was found to involve the entire right lung. We diagnosed this cases as chronic necrotizing pulmonary aspergillosis. A long-term treatment 5-FC led to destruction of the aspergilloma.

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A 59 year-old woman was admitted to our hospital for the evaluation of her chest X-ray abnormality. Chest X-ray film showed fine granular calcifications diffusely. Transbronchial lung biopsy specimen revealed alveolar microlithiasis. Fuji computed radiogram revealed fine calcifications clearer than conventional roentgenogram.

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