In order to clarify the correlation between morphological features and functions of human pulmonary alveolar macrophage (PAM), we investigated surface structure by scanning electron microscopy, and biochemical functions such as NBT reduction and superoxide anion (O₂^-) release.
Human PAMs were obtained from 18 normal volunteers aged 21 to 33 years (NV group, consisting of 11 nonsmokers and 7 smokers), and 16 patients with a localized pulmonary lesion with a mean age of 55.1 years (P group, all smokers), by segmental bronchoalveolar lavage (BAL). In the P group, BAL was performed in lesion-free regions.
The following results were obtained.
I. Morphological study.
When human PAMs were incubated in vitro for 1 hour, it was shown that they have numerous ruffles on their cell surfaces, and were attached to the cover glass by lamellipodia and filopodia. PAMs were morphologically classified into spreading cells and round cells.
The spread of cells and formation of ruffles, lamellipodia and filopodia on the cell surface were more marked in the PAMs from smokers of both the NV and P group than in those from nonsmokers of the NV group. Therefore it is considered that these morphological features become marked in PAMs by smoking.
It was shown that the cell form and surface structure of human PAMs change with incubation time in vitro. During incubation for 48 to 72 hours, the PAMs from smokers showed a markedly different morphological change compared with those from nonsmokers. This result indicates that the morphological changes of PAMs may reflect their functional states.
II. NBT reduction and O₂^- release by PAMs.
There was no significant difference bwtween either NBT reduction or O₂^- release by the PAMs from nonsmokers and smokers in the NV group. However NBT reduction and O₂^- release by PAMs from smokers of the P group were significantly higher than those by PAMs from nonsmokers of the NV group. These results indicate that NBT reduction and O₂^- release by human PAMs are increased by smoking, and that the degree of the increase depends on smoking history.
The present results indicate that the function of human PAMs is generally increased by smoking and the increase depends on smoking history, and that cell spreading, and formation of ruffles, lamellipodia and filopodia on cell surfaces are morphological features closely related with increased function of the PAMs.

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Using our excised canine lung lobe perfusion system with a constant pulsatile pump and an air-chamber, differences of the flow amplitude change at the inflow site of the lobe was observed on 5HT and histamine administration. After 5HT injection, the flow amplitude markedly decreased with inflow pressure elevation, on the other hand after histamine injection, there was no remarkable change regardless of the same grade pressure elevation.
To interpret these results, we represented the lobar vascular bed by two series of compliance (air-chamber)-resistance (rubber tube) circuit resembling arterial and venous side component of the lobe. With this model, only decrease of the compliance of “arterial side” exhibited the same phenomenon as 5HT, and changes of the other compliance and resistances had no effect on the flow amplitudes. These results could explain the general features of flow amplitude changes and allow for evaluation of lobar vasomotor reactivity.
Therefore we conclude that vasoconstriction occurs predominantly in arteries after 5HT injection and exclusively in veins after histamine injection, and this perfusion system is useful for detecting the sites of vasomotor reactivity on pulmonary circulation.

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The authors reviewed 135 patients with pneumoconiosis who died during the 9-year period from 1975 to 1983. Of these 31 cases (23.0%) suffered pneumothorax, and 15 cases (48.4%) had repeated episodes. All was male and the age distribution ranged from 46 to 84 years, with a mean of 57.8. The chest roentgenograms of 29 cases (93.5%) were categorized as Type 4 according to the standard category of pneumoconiosis issued by the Ministry of Labor, Japan, and emphysematous bullae were seen around large opacities. Therefore it has been suggested that the rupture of emphysematous bullae is the main etiological factor of pneumothorax. The majority of patients showed under 30% pneumothorax, chiefly with collapse of an upper lobe.
However, respiratory distress was severe because of advanced pneumoconiosis and 10 cases (32.3%) died due to pneumothorax. In cured cases the reexpansion period averaged 36 days.

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To investigate the effects of pulmonary congestion (and/or edema) and the increase of pulmonary blood flow on intrapulmonary gas distribution, multiple-breath nitrogen washout tests were performed on patients with heart diseases; 22 patients with mitral stenosis, 8 patients with aortic regurgitation and 10 patients with left-to-right shunts. They were compared to the results from 20 healthy adults. The distributions of inspired gas and lung volume were derived from a nitrogen washout curve analysis which was based on a multiple compartment model of the lung which is composed of 50 compartments using the computer technique reported by Koga et al. Each compartment was characterized by its own ventilation/volume ratio (specific tidal ventilation) ranging equally on a log scale between 0.005 and 10.0.
1) In mitral stenosis, the amount of poorly ventilated compartments increased even in patients whose pulmonary pressure was normal or slightly elevated. This finding was more dominant in a case with higher pulmonary arterial mean pressure and the disbribution patterns of lung volume and inspired gas were broad forming a multimodal shape in the case with a higher degree of pulmonary hypertension.
2) In aortic regurgitation, the increase of the poorly ventilated compartment was found only in cases accompanied by congestive heart failure.
3) In left-to-right shunts, abnormal distribution patterns were found in a few cases with atrial septal defects with large shunt ratios and pulmonary hypertension and one patient with endocardial cushion defect. Three patients with ventricular septal defect including one patient with Eisenmenger syndrome showed almost normal dibribution patterns.
In conclusion, pulmonary congestion and/or edema is a more important factor causing intrapulmonary gas distribution abnormality than increase of pulmonary blood flow in heart disease. It is considered that pathophysiological changes including decrease of lung compliance, narrowing of peripheral airways and increased gas trapping are important factors concerning the uneveness of intrapulmonary disbribution of inspired gas in patients with heart diseases.

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In this study, we investigated the activity of alveolar macrophages (AM) obtained from bronchoalveolar lavage (BAL) fluid in terms of their immunological (IgG-Fc receptor activity) aspects in various diffuse pulmonary diseases (i. e., hypersensitivity pneumonitis, sarcoidosis, chronic beryllium disease, pulmonary fibrosis, including collagen vascular disease, and normal control subjects). Results are as follows 1) Rosette forming activity of AM with oxEAEA-IgG were significantly increased in epithelioid cell granulomatous pulmonary disease (i. e., hypersensitivity pneumonitis, sarcoidosis and chronic beryllium disease), while, in contrast, no difference was observed between pulmonary fibrosis and normal control subjects. 2) IgG-Fc receptor-mediated phagocytic activity of AM also showed an increase in epithelioid cell granulomatous pulmonary diseases as compared to pulmonary fibrosis and normal control subjects. 3) The percentages of rosette-forming AM using low sensitized erythrocytes (oxEAEA-IgG × 10^-1) were very low in all pulmonary diseases tested, but the percentage in hypersensitivity pneumonitis showed a relative increase. 4) Almost all alveolar macrophages seem to have a IgG-Fc receptor, as seen from the fact that the percentages of rosette-forming alveolar macrophages using high sensitized erythrocytes (oxEA-IgG × 10) were nearly 100%.
We can thus conclude from BAL cell findings that alveolar macrophages are activated in epithelioid cell granulomatous pulmonary diseases. Therefore, activated alveolar macrophages play some role in epithelioid cell granulomatous pulmonary diseases.
On the other hand, the activity of alveolar macrophages in pulmonary fibrosis shows no difference with that of normal control subjects.

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In order to investigate the mechanism of the development of allergic bronchopulmonary aspergillosis (ABPA), mononuclear cells with receptors to Fc portion of IgE (FcεR (+) cells) were counted and ratios to total number of mononuclear cells were calculated. Human leucocyte antigens (HLA) were also analysed in six patients for the same reason. The conclusions are as follows.
1) The ratios of FcεR (+)-non-T cells (mainly B cells) in ABPA patients were not different from those in normal individuals. FcεR (+)-T cells were not detected in either ABPA patients or normal individuals. All ABPA patients were receiving steroid therapy. In one patient the ratio of FcεR (+)-T cells increased at exacerbation.
2) No specific HLA type increased in patients with ABPA.
3) In patients with atopic asthma, the ratios of FcεR (+)-non T cells increased in comparison with normal individuals, especially when serum IgE levels of the patients were over than 10, 000U/ml. The ratios in patients correlated well with IgE levels (r=0.79, p<0.001). FcεR (+)-T cells were almost undetectable in asthmatic patients.

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The patient, a 34 year-old housewife was admitted with complaints of the slowly increasing cough and dyspnea on exertion. Chest roentgenograms showed bilateral diffuse micronodular shadows, predominantly in the lower lung fields. Respiratory function studies revealed a normal ventilatory pattern but low CO diffusing capacity. Arterial blood gas analysis was normal at rest. TBLB specimens showed interstitial infiltration of polymorphous mononuclear cells, predominantly lymphocytes. Some lymphocytes showed mitotic figures. Plasma cells were relatively few. Lymphoid interstitial pneumonia (LIP), a lymphoproliferative disorder, was confirmed through the open lung biopsy. Cellular infiltration was predominant in the centrilobular area and in the lower lobe. Hilar lymph nodes were not involved. Infiltrating cells in the interstitium consisted mainly of lymphocytes, with some histiocytes and few plasma cells. Scattered mitotic figures were recongnized. We consider that this case might be in premalignant stage of LIP and needs a careful follow up study.
We revieved 19 cases of LIP reported in Japan, including the present case. We discussed their clinical features especially extrapulmonary lesions. Of these 3 showed Sjögren's syndrome; 7 hepatosplenomegaly; 3 skin lesions; 6 superficial lymphadenopathy and, 16 dysproteinemia, respectively. These results revealed that LIP might be a pulmonary lesion of a systemic disorder.

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We present two cases of allergic bronchopulmonary aspergillosis. The first case was a 23 year-old female with bronchial asthma. Chest roentgenogram showed a mass shadow in the right upper lung field. After corticosteroid administration for status asthmaticus, the shadow almost dissapeared. Bronchography showed bronchiectasis which was coincident with the mass shadow. Two years later, she was admitted again with an abnormal chest shadow. Bronchoscopy showed mucoid impaction of the lingula bronchus. Sputum cultures were positive for Aspergillus, but precipitating antibodies against Aspergillus were negative. Total serum IgE was more than 4000IU/ml.
The second was a 53 year-old female also with bronchial asthma. The chest roentgenogram showed atelectasis of the right upper lobe. Bronchoscopy showed mucoid impaction of the right upper lobe. Sputum cultures and precipitating antibodies were positive for Aspergillus. Total serum IgE was more than 400IU/ml.
In both cases, mucoid impaction is considered to play an important role in ABPA.

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A 46 year-old male was admitted because of recurrent right spontaneous pneumothorax after an interval of 8 years. He had multiple cutaneous neurofibromas and cafe-au-lait spots, and a diagnosis of Recklinghausen's disease was made. Chest X-ray film showed collapse of the right lung. Contrast thoracography revealed some thumb sized cysts in the lung apex, and cobblestone appearance on the lung surface. At thoracoscopy numerous cysts were seen all over the lung. Open lung biopsy and resection of large cysts was performed. Microscopically the cysts were bullae and there were emphysematous changes arround them, therefore the pathological diagnosis was emphysematous bullae. Six months after operation, chest CT revealed multiple peripheral lung cysts bilaterally, but respiratory function tests showed no abnormality.
Although Recklinghausen's disease associated with multiple lung cysts is rare in Japan, some cases were reported in international journals. Many of them had interstitial pneumonitis and it has been considered that alveoli were destroyed by fibrosis and accumulated to form bullae. However in our case, emphysematous changes with neither interstitial pneumonitis nor airway obstruction were seen. Therefore we consider that these findings are very interesting and may have some relation to Recklinghausen's disease.

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Suspected case of malignant lymphoma (small cell type) of the lung is reported. A coin lesion in the right upper lobe of an asymptomatic 31 year-old male was detected in a mass survey. Partial resection of the right upper lobe was carried out under a diagnosis of pseudolymphoma of the lung based on the transbronchial lung biopsy finding. Histologically the mass was composed of small lymphocytes and small numbers of another inflammarory cells. Though tumor cells were mainly small lymphocytes, rather monotonous and homogenous infiltration and location of the tumor cells around the mass were consistent with malignant lymphoma (small cell type). Immunohistochemical staining of tumor cells was not successful. We collected primary lymphoproliferative disorders of the lung reported in Japan, such as pseudolymphoma, lymphid interstitial pneumonia and primary malignant lymphoma (small cell type), including primary pulmonary macroglobulinemia (lympho-plasma cell type). Differentiation between benign and malignant cases based on the criteria of Colby is discussed.

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A 61 year-old male patient with pulmonary emphysema underwent selective alveolobronchography (SAB) with Dionosil Aqueous contrast medium in order to confirm the destruction of alveoli.
Six days after SAB, the patient complained of fever, general malaise, dyspnea, cough and sputum. His chest X-ray film revealed pulmonary infiltration around the retained contrast medium. Further additional findings of peripheral blood and sputum eosinophilia suggested a diagnosis of asthmatic pulmonary eosinophilia caused by contrast medium retained in the pulmonary region.
This diagnosis was supported by evidence that Dionosil Aqueous acts as a chemotactic substance for eosinophils, as shown by the skin window method.
However, another truly allergic mechanism was suspected due to elevated serum IgE levels, and the detection of both IgE and precipitating antibody against Cladosporium. Further, computed tomography finding 1 year later revealed bronchiectasis at the region where the contrast medium had been retained. Thus, almost all of the criteria for the diagnosis of Cladosporium-induced allergic bronchopulmonary fungal disease (a type of asthmatic pulmonary eosinophilia) were fulfilled.
It was suspected that the antigen of Cladosporium might have been accidentally concomitantly retained with the contrast medium resulting in long-term sensitization of the patient. Under such circumstances, it is also be possible to speculate that Dionosil Aqueous contrast medium might have played a role as an adjuvant for the production of IgE and precipitating antibodies against Cladosporium and as a chemotactic substance for eosinophils.

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We report three cases of AGA with various manifestations. In the first case, a 19 year-old female first suffered from bronchial asthma and one year later developed systemic vasculitis showing symptoms of asymmetrical paresthesia, paresis in the extremities, skin eruptions and hypereosinophilia. The biopsy of the skin lesion revealed angiitis and extravascular granulomas. She underwent illectomy for multiple intestinal perforations, which were presumably due to angiitis. The second case was a 46 year-old male. Before the onset of vasculitis, attacks of bronchial asthma had recurred for seven years. He had complained of epigastric pain after meals and had lost six kilograms in weight one month before admission. Neurological examination disclosed paresthesia and hypesthesia, suggesting polyneuritis. The skin biopsy of livedo vasculitis revealed angiitis and perivascular eosinophil infiltration. In both cases, treatment by prednisolone produced marked improvement in symptoms without subsequent recurrence of the systemic disease. The third case was a 37 year-old female who had experienced rhinitis and PIE syndrome for a year before the onset of sytemic vasculitis which showed gastrointestinal, renal, dermatological and neulogical symptoms. Although treatment by prednisolone relieved symptoms, bronchial asthma first appeared on reduction of the steroid and vasculitis recurred one year later. Her clinical course was atypical for AGA because of the delayed onset of asthma. In her second attack of vasculitis, severe neurological involvements were manifest, including palsy of extrimities and hoarseness due to recurrent nerve palsy. Dermatologically livedo vasculitis and annular erythema were also salient features. The skin biopsy of livedo vasculitis on a lower limb revealed extravascular granulomas and vasculitis. Although this second attack was resistant to treatment, symptoms were gradually relieved on increase of steroid.
We reviewed 55 cases of AGA in the Japanese literature and summarized them with our three cases. The mean duration of asthma prior to the onset of vasculitis was four years. Initial symptoms involved asthma in most cases. Our third case was the only one reported in which systemic vasculitis preceded the onset of bronchial asthma.

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A 37 year-old nonsmoking man who complained of exertional dyspnea and cough was referred to our hospital by a local physician. Physical examination revealed finger clubbing, inspiratory moist and dry rales and expiratory dry rale in bilateral middle and lower lung fields. Chest radiograph disclosed a hyperlucent lung field with small nodular and linear shadows. Vital capacity (%VC 65.3%), forced expiratory volume in one second (FEV1.0% 30.5%) and arterial oxygen tension (Pao₂ 50torr) were all decreased, conversely, respiratory resistance (Rrs 8.0cmH₂O/L/sec), residual volume (%RV 153.8%) and arterial carbon dioxide tension (Paco₂ 45torr) were all increased. The histology of the open lung biopsy specimen showed chronic bronchobronchiolitis with interstitial pneumonia; infiltration of small round cells into bronchioles and alveolar septa with localized alveolar wall destruction. Immunologically, serum IgG, IgA and IgM were decreased accompanied with a normal cold agglutinin titer and there were decreases in lymphocyte blastogenic response to PHA, ConA and PWM with negative PPD skin reaction. There was also a slight increase in OKT4 and OKT10-positive T cells in peripheral blood.
Based on the data obtained in this case, we discussed the relationship between our case and diffuse panbronchiolitis or common variable hypogammaglobulinemia.

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A 50 year-old woman presented with tumor shadows on her chest X-ray film. The shadows had not been observed on a film taken one year previously, when she had seen her local doctor complaining of chest pain and cough. On admission, her chest X-ray revealed round, well-defined tumors in the lung field and masses in the mediastinum. A CT scan of the chest showed unique fundings of several tumors forming a line like a rosary in the right lung field. The preoperative tentative diagnosis of invasive thymoma with metastasis to the major fissure, was confirmed by posterolateral thoracotomy. All these tumors and thymus were removed combined with adjacent tissues including lung, diaphragm and pericardium. The tumor cells were predominantly the epithelial type and showed increased mitotic activity and prominent nuclei. She was treated postoperatively by chemotherapy with cis-platinum and is alive well 6 month after operation.

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