Rabbits were injected intravenously with a suspension of autologous fat cells to induce pulmonary fat embolism and, eventually, lung edema. Pathological changes of the ultrastructures of the lung were then followed up though the healing process. Concurrently, the pulmonary extravascular water content was measured. Some animals were given an injection of oleic acid or an injection of autologous fat cells combined with a hypovolemic shock.
The lung damage caused by 0.05ml or 0.10ml/kg body weight of the fat-cell suspension was comparatively mild (fat-cell group): 4 hours after injection, changes such as the formation of subendothelial blebs, increase of pinocytotic vesicles, and aggregation of neutrophils and platelets were recognized, but the alveolar-capillary barrier remained relatively intact and the animals were free from alveolar ulcer and destructive changes of the endothelial cell and interstitium as observed in rabbits with lung edema induced by oleic acid (oleic acid group).
In the fat-cell group, the changes described above were still observed 96 hours after injection, but improved 216 hours after injection. In the animals given fat cells plus a hypovolemic shock (combined group), severe changes such as the aggregation of platelets and leucocytes, bleeding into the alveolar space, and transudation of fibrin were noticed 3 hours after blood reinfusion.
The pulmonary extravascular water content 24 hours after injection was 4.59±0.34 (mean±S. D.) g/g of bloodless dry lung in the fat-cell (0.10mg/kg) group and 6.54±1.12 in the combined group. Both values were significantly greater than the control value (3.66±0.20) (p<0.001).
The neutral fat infused into the pulmonary artery in the form of fat cells primarily caused extensive mechanical obstruction of the arterioles and capillaries of the pulmonary vascular bed and relatively mild edema involving mainly the thick portion. Secondarily, lung edema was exacerbated with advancing time probably due to various factors including the increase of free fatty acid derived from sources other than embolic fat and the aggregation of platelets and leucocytes.
The above observations in experimental animals resembled those in clinical cases of relatively mild posttraumatic adult respiratory distress syndrome.

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Aspirin-induced asthma (AIA) is sensitive to many non-steroidal anti-inflamatory drugs. Therefore, the queustion of which drugs are safe and effective for AIA from the point of view of climination of fever and pain is extremely inportant. “Jiryu” (earthworm, Lumbricus spencer) has been used as an antipyretic drug in Chinese and Japanese folk medicine. The effect of “Jiryu” on AIA was investigated.
1) 500mg of “Jiryu” was given to five cases of AIA with no significant difference in asthmatic symptoms or respiratory functions.
2) 1500mg of “Jiryu” was given for three or seven days. There were no significant changes in asthmatic symptoms or PEFR after administration.
3) One case of AIA with fever was given 500mg of “Jiryu”, and antypyretic effects were ovserved with no exacerbation of asthmatic symptoms.
These results suggest that “Jiryu” is a useful antipyretic drug in AIA. Although the antipyretic components of “Jiryu” have been considered to be arachidonic acid and eicosapentaenoic acid, no clear explanation has been given about the precise mechanism of the antipyretic activity of these two components. Because abnormal arachidonic metabolisms have been proposed as one of the mechanisms of AIA, it is of interest that “Jiryu” contains arachidonic acids.

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α₁-Antitrypsin, a major proteinase inhibitor in human blood, was found to have an inhibitory effect on the IgE or, Ca²⁺ionophore A23187-mediated histamine release from human peripheral leukocytes in a dose-response manner within the range of its physiological concentration in plasma (IC₅₀: IgE-mediated 2.0mg/ml, A23187-mediated 3.0mg/ml). α₁-Antitrypsin affected histamine release immediately, even after one minute's preincubation with cells before anti-human IgE antibody challenge, and the effect was almost irreversible up to 4 hours incubation after washing out α₁-antitrypsin. The inhibitory effect of α₁-antitrypsin was reversed by adding trypsin. So, it is conceivable that the inhibitory effect of α₁-antitrypsin on histamine release was specific to its proteinase-inhibitor function. α₁-Antitrypsin was found to affect the first Ca²⁺-independent step in histamine release and not to affect the second Ca²⁺-dependent step. As plasma normally contains 2-3mg/ml of α₁-antitrypsin, we tried to investigate the effect of plasma on Ca²⁺-ionophore A23187-mediated histamine release from human leukocytes. But normal human plasma was found to have no effect or did not reverse the inhibitory effect of α₁-antitrypsin added to plasma. It seemed that the effect of α₁-antitrypsin on histamine release was counterated by proteinases in normal human blood. However it is conceivable that in a situation such as inflammation or severe attacks of bronchial asthma, which raise α₁-antitrypsin levels in blood, or in a local lesion, α₁-antitrypsin could affect histamine release from stimulated human basophils or mast cells.

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A biological and biochemical study was undertaken to clarify the nature of smooth muscle contracting substance released by alveolar macrophage (AM) in rats. AMs released smooth muscle contracting substance with properties of a slow reacting substance (SRS) in the culture media only when they were stimulated with zymosan for 1 hr to 24 hrs. AMs were stimulated by zymosan, opsonized zymosan, sheep red blood cells (SRBC) and opsonized SRBC. The amount of smooth muscle contracting subsance released from AM stimulated by zymosan was similar to that from AM stimulated by opsonized zymosan. However, the amount of smooth muscle contracting substance released from AM stimulated by SRBC was lower than that from AM stimulated by opsonized SRBC.
Next, we examined the characteristics of the smooth muscle contracting substance released from AM stimulated by zymosan. It was shown that the contracting substance has a molecular weight of less than 1000, and it was resistant to heat treatment (56°C, 30min, 100°C, 10min) and extracted into ethanol. In vitro production of this substance by AM was not inhibited by indomethacin (an inhibitor of cyclo-oxygenase of arachidonate metabolism) but was completely inhibited by nordihydroguiaretic acid (an inhibitor of lipoxygenase of arachidonate metabolism) and AA-861 (an inhibitor of 5-lipoxygenase of arachidonate metabolism). Analysis of the smooth muscle contracting substance using high performance liquid chromatography indicates that it corresponds to an arachidonate lipoxygenase product, especially LTC.
These results indicate that the smooth muscle contracting substance released by zymosan stimulated rat AM is an arachidonate lipoxygenase product, such as LTC, and that release of the substance by AMs is enhanced by phagocytosis of a stimulus.

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Five cases of Dionosil pneumonia were reported here. Macroscopically, these lesions were 1 to 10mm in size, poorly defined, whitish or yellowish consolidated foci. Location and density of the lesions were various, from lobar, confluent lesions to segmental, scattered lesions.
Histologically, the lesions showed basically acinar distribution. In the peripheral airway, amorphous eosinophilic substance originating from contrast material, filled the alveolar and ductal lumina, and was associated with histiocytic and foreign body type giant cell reaction. Non-specific reaction was seen in the outer zone. Vascular involvement with marked infiltration of lymphocytes, eosinophils, and plasma cells, resulting in obstruction of the vascular lumina were noted.
The pathological diagnosis was necrotizing, granulomatous pneumonia with vasculitis due to Dionosil in all. Dionosil pneumonia may develop when contrast matrial entered into the peripheral airway, thus indicating the necessity of careful consideration of this side effect.

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Clinical characteristics of 17 patients with farmer's lung disease were investigated. All patients were engaged in dairy farming and the average history of dairy labor was 12.6 years. The onset of symptoms was concentrated in winter when they fed stored hay to their cattle. Precipitating antibodies were positive against Micropolyspora faeni in 11 patients and positive against Themoactinomyces vulgaris in 8 patients. Five patients had precipitating antibodies against both of these antigens. Physiologic function studies showed tendencies towards hypoxemia, decreased vital capacity and decreased diffusing capacity. It was suggested that these respiratory function disturbances were based on pulmonary interstitial disorders. Chest X-ray films revealed fine and small granular shadows scattered in both lung fields. Transbronchial lung biopsies were performed in all cases and specimens revealed features of interstitial pneumonitis with granuloma formation. An increased number of cells recovered from the lung and an increased T-cell ratio were observed in cases in which bronchoalveolar lavage was performed.
Epidemiological studies concerning farmer's lung disease were investigated in the dairy farming population at the northern part of Iwate prefecture. The prevalence of antibodies to farmer's lung antigens was 3.5% and the most prevalent antibody type was against Micropolyspora faeni. Precipitin-positive farmers had greater numbers of cattle than did precipitin-negative farmers.

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A total of 64 mild cases of bronchial asthma patients were studied and classified into two groups according to the presence of atopic predisposition, based on a discriminate analysis of the conditions of baseline airway caliber and bronchial hyperreactivity measured by by astograph method. Differences between the two types of bronchial asthma were studied. At the same time, a study of the site of airway response to the bronchial hyperreactivity test, by combined astograph and transcutaneous blood gas monitoring was carried out on 20 of the 64 patients.
As a result, no difference was observed in baseline airway caliber or bronchial hyperreactivity between the two groups. The site of airway response to the bronchial hyperreactivity test was not affected by atopic predisposition, but rather by the size of the baseline airway caliber. The boundary figures that determine whether the site of the airway contraction was a large airway or small airway were: 85.7-87.5% at (%) FEV_1.0 (ratio to the estimated normal value), 75.8-79.4% at (%) Grs. cont, 27.0-31.9% at (%) V₂₅.

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Two cases of rare earth pneumoconiosis are reported. Both patients worked for long years in offset printing plants using carbon arc lamps. The first case, a 50-year-old man, had been exposed to smoke emitted from carbon arc lamps for 10 years and developed a productive cough. The second case, a 61-year-old man, also had productive cough and dyspnea after 24 years of exposure to carbon arc lamp fumes. Chest radiographs showed diffuse dense nodular shadows in both cases. Transbronchial lung biopsies were performed and X-ray microanalysis of each specimen revealed cerium and other rare earth metals and in the second case, iron and others also.
The second case had been previously diagnosed as miliary tuberculosis and had T. B. had therapy for it two years. When diffuse pulmonary shadows are seen on radiographs, this disease must be considered if the patient has an occupational history of printing work.

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A 57-year-old female was admitted to our hospital, complaining of hemoptysis. On auscultation, moist rales were audible at the lower portion of left posterior chest. Plain chest roentgenogram showed a round shadow in the left lower lung field. Computed tomography with contrast enhancement revealed an abnormal structure which was contiguous to a strand structure. Dynamic scanning demonstrated opacification of the strand structure and that of the greater part of the abnormal structure during peak opacification of the descending aorta. A part of the abnormal structure was opacified during the same phase as the opacification of the right ventricle and pulmonary artery.
A diagnosis of intralobar pulmonary sequestration associated with pulmonary arterio-venous malformation was confirmed by thoracic aortography and left pulmonary arteriography. The hemoptysis was found to be caused by chronic bronchitis. It was emphasized that dynamic computed tomography is very useful to diagnose intralobar pulmonary sequestration and to assess the presence of pulmonary arterio-venous malformation.
In addition, it is of particular interest that this case cannot be assigned to any category of Pryce's classification although it resembles both type I and IV.

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A 43-year-old woman was refered for evaluation of a mass shadow noted on routine chest roentgenogram. She had no respiratory and circulatory symptoms. There was no critical episode in her past illness nor family history. Also, no abnormality had been pointed out at birth. Physical examination revealed no abnormality except bradycardia of 50/min. The electrocardiogram showed a regular sinus rhythm at a rate of 52/min, which was associated with occasional sinus arrest and junctional escape beats. The P wave was almost normal in shape. These findings suggested a sinus node dysfunction. On the P-A chest film, the azygos arch was dilatated to 2.0cm in transverse diameter at the junction of the trachea and the right main bronchus, along with the mass shadow in the left middle lung field. The CTR was 44%, and the shape of the heart was almost normal. On the lateral view, there was a shadow of a blood vessel between the lower back of the heart and the right diaphragm. Contrast angiogram showed a “candy cane” image due to anastomosis of the inferior vena cava with the superior vena cava through the azygos vein on the lateral view. Backward flow from the right atrium into the hepatic vein revealed a direct connection between them on the frontal view. No other abnormalities were found. The pulmonary mass was surgically removed, and diagnosed as tuberculoma histopathologically. She has been followed up under a diagnosis of interruption of the inferior vena cava with azygos continuation. The pathogenesis of this malformation was discussed.

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A 49 year-old, asymptomatic female patient was admitted to our hospital because of abnormal chest X-ray findings. Her chest X-ray films showed a calcified hilar lymph node and a pneumonia-like shadow in the right upper lung field. Bronchoscopy showed a tumor at the orifice of right B³a. Microscopic findings showed lymphoid granulation tissue with no evidence of malignancy.
A CT scan performed an a suspicion of carcinoma revealed a calcified hilar lymphnode and dense consolidation distal to the calcified lymph node in S³a. These findings strongly suggested broncholithiasis.
Bronchoscopy was performed two months after admission and calcified material was found around the tumor. Therefore we diagnosed this case as broncholithiasis. It was emphasized that the CT scan was a useful procedure in the diagnosis of broncholithiasis as well as bronchoscopy.

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A 50 year-old engineer developed acute respiratory failure, during exposure to nitrous fumes (NO₂) and hydrogen fluoride in a stainless steel tank. His chest roentgenogram revealed marked infiltrates suggesting pulmonary edema.
A few days later, he was admitted to our hospital and his symptoms began to improve without any medication, including steroids. Microscopic examination of lung specimens obtained by TBLB demonstrated respiratory bronchiolitis with cellular infiltration and fibrous exudate. His pulmonary function studies showed only mild obstructive ventilatory disturbance and slight hypoxemia, but no impaired diffusion capacity. A study of bronchoalveolar lavage fluids (BALF) showed an increase in number of cells, almost all of which were macrophages. About 80% of these alveolar macrophages were large in size with cytoplasmic vacuoles.
One year after exposure, he remained symptomless and lung function studies and chest roentgenogram showed no abnormalities. BALF findings were normal except for Leu7-positive cells, which represented natural killer (NK) cells. The relationship between Leu7-positive cells in BALF and the activity of pulmonary diseases, however, is still to be resolved. In chemical pneumonitis, it is important to prevent the progression to bronchiolitis fibrosa obliterans. It is speculated that an autoimmune type of response might be involved in this stage. There were significant changes in the alveolar macrophages in this patient, so they might play some role in this stage of the illness.

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A 54 year-old man was admitted with dry cough and exertional dyspnea. A diagnosis of idiopathic pulmonary fibrosis (IPF) was made based on his past history, chest X-ray, Gallium scintigram, bronchoalveolar lavage and TBLB specimens. Treatment with prednisolone, 80mg daily, was started, and his hypoxia, as well as chest X-ray, improved in response to the treatment. One month later, however, dyspnea suddenly developed and decreased PaO₂ was noted even with 60mg prednisolone treatment daily. Pulse therapy was performed and azatioprine was also administered. Mild increase of PaO₂ was noted, but it again began to decrease after a week. Double filtration plasmaphresis was therefore initiated. Immediately after the first plasmapheresis, PaO₂ rose and has remained at 70torr in room air for the next seven months.
Althought the pathogenesis of IPF is not clearly understood, much evidence suggests that alveolar macrophages, activated by immune complexes (IC), play a major role in IPF. According to this hypothesis, plasmapheresis, which removes IC from plasma, should be a effective treatment for IPF. Our succesful experience supoorts this hypothesis and plasmaperesis should be tried for rapidly progressive IPF with poor prognosis, combined with conventional therapy by corticosteroid and immunosupressive agents.

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A case of benign lung tumor, chondroma, which developed in the left main bronchus is presented, and discussed with reference to the literature on this subject.
The patient was a 27 year-old female who complained of cough and sputum. As an abnormal shadow was recognized on chest X-ray films, she had been treated for pneumonia. However, the incidence of symptoms became frequent and she was admitted to our hospital.
A poorly-defined infiltrative shadow was disclosed in the left upper lung field on chest X-ray films, and bronchography and bronchoscopy revealed stenosis of the left main bronchus due to tumor. Biopsy and cytological examinations, however, did not show any findings suggestive of malignancy. An intrabronchial benign tumor was suspected, and left upper lobe lobectomy with sleeve resection of the left main bronchus was performed.
Histologically, the tumor was diagnosed as chondroma which developed in the lumen of the left main bronchus.
The postoperative course was uneventful and she is in good condition 36 months after surgery.

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A case of polypoid sarcoma of the pulmonary trunk in a 49 year-old woman presenting with a 4 month history of pain in the anterior chest and back with gradually progressive dyspnea is described.
As the clinical history and the findings of CT and pulmonary arteriogram suggested a tumor of the trunk of the pulmonary artery, surgical resection was attempted, but she died one month after the operation because of respiratory insufficiency. Autopsy showed a polypoid tumor arising from the pulmonary trunk. The tumor extended down across the pulmonary valve and up to the trunk of the pulmonary artery and the right main pulmonary artery, and had metastasized to the lung, the pleura and the adrenal glands. Histologically, the tumor was diagnosed as rhabdomyosarcoma by a histochemical study.
This is the first reported in Japan of rhabdomyosarcoma originating from the pulmonary artery and involving the pulmonary valve.
Primary pulmonary artery sarcoma is an extremely rare disorder and can be treated by resection when it is found sufficiently early. Although its prognosis is generally poor, any measure that gives as much information as possible as to its location and/or nature of the tumor would be definitely helpful to improve operability.
In our case, CT proved to be most useful in detecting the tumor involvement of the trunk of the pulmonary artery. It is suggested that nonivasive measures such as CT and ultrasonography are the first methods of choice in evaluating cases of pulmonary artery tumors.

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A 72 year-old man was admitted with a complaint of right back pain. Chest X-ray film and chest CT scan showed multiple tumors of the chest wall. Percutaneous needle biopsy revealed malignant fibrous histiocytoma histologically. ⁶⁷Ga-scintigram and abdominal CT scan showed no other lesions in the body. These findings suggested that the primary lesion was in the clost wall. This patient died of gastrointestinal bleeding 6 months later with no remission after ⁶⁰Co radiotherapy.

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