Computed tomographic study on 50 asbestos exposed workers who have some of the roentgenographic changes caused by asbestos exposure on the chest was made. After that study, 236 asbestos exposed workers of a certain Japanese National Railways (JNR) repair facility were taken chest roentgenograms of PA projection, right oblique projection and left oblique projection at an angle of 30°.
Computed tomographic examination of the chest of the asbestos exposed workers showed pleural plaques in all areas of the chest wall, but the distribution was unbalance. There were few plaques in costal cartilage area, and there were many plaques in paravertebral area.
On the other hand, there were no plaque in costal cartilage area, anterior area and lateral area of the chest wall in contorols. The types of plaques were Ia except for 3 cases suspected Ib.
Paravertebral area was very difficult to assess on routine chest radiographs and there were no cases of detection of pleural plaques.
Thirty cases (83%) out of 36 cases of pleural plaques in anterior area and posterior area of the chest wall were detected on the routine fronal view of the chest. In order to detect the plaques in anterior area and posterior area of the chest wall, the most suitable oblique angles which were calculated using computed tomography were between 20° and 45° in right and left oblique projection.

View full abstract

Sinobronchial syndrome (S. B. S.) is a clinical entity which exhibits a combination of chronic paranasal sinusitis in the upper respiratory tract and chronic pulmonary inflammation in the lower respiratory tract. There is approximately 70-80% of diffuse panbronchiolitis (D. P. B.) cases are complicated by chronic paranasal sinusitis, therefore DPB might be a part of SBS. It has been reported that the prevalence of HLA-Bw54 is correlated well with SBS disease, including DPB.
In 31 DPB patients, 39 SBS patients not included in the DPB category and 30 non-SBS patients with chronic lung disease. laboratory data including γ-gloculin, complement, rheumatoid factors, cold hemagglutinin (CHA) and HLA system were measured and analyzed statistically. IgG titers above the normal range were found in both the above patient groups. IgA, latex agglutination test and CHA titers were significantly higher in the first group containing DPB patients than in the other 2 groups. In the first group, IgG, IgA, latex agglutination test and CHA titers did not differ between the Bw54 positive cases and the negative cases. In the second group, containing SBS patients not included in the DPB category, titers of IgG, IgA, latex agglutination test, and CHA also did not differ between the Bw54 positive and negative cases. However, application of Hayashi's second method of quantification to all SBS patients produced results indicating that correlations between IgG and Bw54, IgA and DPB, latex agglutination test and DPB, CHA and DPB were all significant.

View full abstract

We studied the effect of ketotifen on human lymphocyte β-adrenergic receptors. Ketotifen (1mg×2/day) was administered orally to 10 normal male volunteers for 4 weeks and 60ml of blood was drawn before, 1 week after and 4 weeks after. At each time, lymphocyte β-receptor density, plasma cyclic AMP and lymphocyte intracellular cyclic AMP response to isoproterenol were measured and compared.
1) Ketotifen increased lymphocyte β-receptor density significantly (p<0.05) while lowering the affinity of ¹²⁵I-HYP, a potent β-antagonist, at 1 week after oral administration and also increased lymphocyte β-receptor density significantly (p<0.001) by 47% without altering the affinity after 4 weeks of oral administration.
2) Plasma cyclic AMP and intracellular cyclic AMP response to isoproterenol were not significantly different from control values.
3) It was estimated that ketotifen might increase human lung β-receptors because of the fact that ketotifen also increased guineapig lung β-receptor density by exactly the same mode of change observed in these human lymphocyte β-receptor changes.

View full abstract

Respiratory failure accompanied by voluminous bronchial pulmonary secretions is dangerous. This can also be the cause of dyspnea attack every morning. To solve this problem daily patterns of bronchial pulmonary secretion were studied. A total of 21 cases were composed of 11 men and 10 women, with an average age of 56.6 (ranging from 32 to 76). There were 8 cases of sinobronchitis, 4 cases of diffuse panbronchiolitis, 3 cases of interstitial pneumonia and one case of bronchial asthma. Sixteen of the 21 cases (76%) had respiratory failure.
They were under close observation for an average of 172.2 days (from 5 days to 420 days). The conclusions were as follows;
1) The daily patterns of bronchopulmonary secretion were classified into 5 types, i. e. i) early morning type, ii) afternoon type, iii) continuous type, iv) diphasic type, v) nocturnal type.
2) The daily bronchial pulmonary secretion patterns were constant according to the individual not according to the disease.
3) The bronchial pulmonary secretion pattern remained constant despite changes in volume.
4) Steroid therapy induced a decrease of secretions in 50% of all cases but did not alter daily patterns.

View full abstract

Cold-reactive lymphocytotoxin (CLT) was studied in 40 patients (active sarcoidosis 34 cases, resolved sarcoidosis 6 cases) and 12 patients with systemic lupus erythematosus (SLE). In this paper we discussed (i) the difference in the incidence, (ii) the difference of the cytotoxic cellular specificities and (iii) the immunological and in vivo significance of CLT between sarcoidosis and SLE. In addition we tried to purify the CLT from the sera of patients with sarcoidosis and SLE by applying fractionation and chromatography.
Peripheralblood lymphocytes (PBL) obtained from normal healthy volunteers were isolated by centrifugation on a Ficoll-Paque gradient. E-rosette forming cells were used as enriched T-lymphocytes. Cells which did not form E-rosettes after two attempts were used as enriched B-lymphocytes. By the methods of salt fractionation, Sephadex G-200gel filtration, DEAE-cellulose chromatography and IgM-affinity chromatography lymphocytotoxin in the sarcoidosis sera were purified. The lymphocytotoxicity was investigated by a complement-dependent ⁵¹Cr-release cytotoxicity assay according to the method of Brünner et al. Lymphocytotoxic activity was expressed as a percentage by the formula
experimental ⁵¹Cr release-spontaneous release/maximal release-spontaneous release ×100
CLT activity was present in 19 out of 34 active sarcoidosis patients (55%) and in 12 out of 12 SLE patients (100%), but was absent in all 6 resolved sarcoidosis patients and in 19 out of 20 healthy control subjects (5%). In sarcoidosis, CLT activity did not correlate with age or sex, degree of lymphopenia, presence of anergy, or with other clinical parameters, but was correlated with the activity of the disease. In addition, CLT activity was greater at 15°C and negligible at 4°C and 37°C. To clarify the cellular specificity of CLT to T- and B-lymphocyte subpopulation, the sera from 10 sarcoidosis patients, 3 SLE patients and 4 healthy control subjects were examined. All sera from sarcoidosis were cytotoxic to B-lymphocytes, although there were certain sera that were reactive to B-lymphocytes and to a minor proportion of T-lymphocytes. All sera from SLE were cytotoxic to both T- and B-lymphocytes, but these sera had higher reactivity to T-lymphocytes than to B-lymphocytes. None of the sera from healthy control subjects were reactive to either T- or B-lymphocytes. The CLT purified from pooled sarcoidosis sera (10 patients with high CLT activity) by applying salt fractionation, Sephadex G-200gel filtration, DEAE-cellulose chromatography and IgM-affinity chromatography was identical with the antibody of IgM class and was distinct from IgG molecules. These purified fractions were cytotoxic to B-lymphocytes but not cytotoxic to T-lymphocytes. The CLT purified from pooled SLE sera (10 patients with high CLT activity) by applying Sephadex G-200 gel filtration and DEAE-cellulose chromatography was IgM antibody and had higher reactivity of T-lymphocytes than to B-lymphocytes.

View full abstract

We studied the intrapulmonary affinity of aerozolized antibiotics in mice using an aerosol exposure apparatus. Serum and lung concentrations were measured in mice treated with 1.6g aerosolized cefazolin. The peak serum concentration was 17.8μg/ml, and the peak lung concentration was 194μg/ml. Serum and lung concentrations were measured in mice treated with 400mg aerosolized gentamicin. The peak serum concentration was 14.3μg/ml, and the peak lung concentration was 18.7μg/ml.
We produced experimental pneumonia by air-borne infection using the aerosol exposure apparatus Klebsiella pneumoniae. The MIC vaule of cefazolin against K. pneumoniae was 1.56μg/ml, and that of gentamicin was 0.39μg/ml. The K. pneumoniae pneumonia in mice was treated with aerosols of 1.6g cefazolin and 400mg gentamicin. The therapeutic dose of 1.6g cefazolin was not curative dose. But the 400mg gentamicin was tremely effective.
On the basis of these experiments it is suggested that aerosol administration of cefazolin causes it to attach for bronchi easily, so that the lung concentration of cefazolin is higher than that of gentamicin and that the aerosol therapy of cefazolin for K. pneumoniae in mice is not effective.

View full abstract

The activation of complement components during the complement cascade, plays an important role in self defense and pathophysiology following anaphylaxisis, infection and massive tissue damage. Two anaphylatoxins are derived from complement 3 and 5 of the cascade and are called C3a and C5a, respectively.
In the present investigation we measured plasma C3a and C5a in patients with various lung diseases and rabbits with endotoxin shock by the radioimmunoassay method.
1) Mean values and standard deviation (SD) of plasma C3a in healthy volunteers were 86.6±38.1ng/ml.
2) Mean values and SD in patients with primary lung cancer, hypoxemia induced by nonrespiratory diseases, chronic bronchitis, pulmonary tuberculosis and interstitial pneumonia were 426.0±469.5, 421.0±283.3, 130.6±66.3, 181.3±49.7 and 340.0±367.7ng/ml, respectively.
3) Mean values and SD of plasma C5a in healthy volunteers, patients with lung cancer, hypoxemia, chronic bronchitis, pulmonary tuberculosis and interstitial pneumonia were 4.2±0.6, 35.6±45.0, 10.4±11.3, 9.7±5.0, 8.5±4.4 and 12.2±0.3ng/ml, respectively.
4) Plasma C3a level in rabbits showed a marked increase after the intravenous administration of 3.3 mg/kg of endotoxin, but almost no change following i. v. administration of 3.3mg/kg of endotoxin.
5) Plasma C5a level in rabbits showed a marked increase after the i. v. administration of 3.3mg/kg of endotoxin, but almost no change by i. v. administration of 1mg/kg of endotoxin.

View full abstract

Specific IgE and IgG antibodies and basophil response to Candida albicans were examined in 115 patients with bronchial asthma and compared to responses to house dust antigen.
1. The incidence of patients with specific IgE antibodies to Candida albicans was highest in cases aged between 41 and 50 years, and high in cases aged between 31 and 40 years and between 51 and 60 years. The incidence was also high in cases with the age at onset of the disease between 21 and 30 years and between 41 and 50 years, and in cases with serum IgE levels between 101 and 200IU/ml and more than 1001IU/ml. On the other hand, specific IgE antibodies to house dust were more frequently observed with younger patient age and age at onset of the disease, and higher serum IgE levels.
2. The concentrations of specific IgG antibodies to Candida albicans increased as patient age was higher.
3. A ratio of histamine release induced by Candida against anti-IgE-induced release was lower in cases aged between 0 and 40 years, and higher in cases aged between 41 and 50 years, while the ratio of housedust-induced release against the release by anti-IgE was lower as patient age became greater.

View full abstract

In the present investigation we measured various physiological parameters and blood levels of histamine and serotonin in anaphylaxis induced by the intravenous infusion of ascaris antigen.
Mongrel dogs, weighing 10-25kg, were anesthetized with intravenous administration of 2mg/kg of sodium pentobarbital. Catheters were inserted into the left femoral artery, bilateral femoral veins, left pulmonary truncus and left atrium. A probe of an electromagnet flow meter was placed around the ascending aorta. We measured tracheal pressure (PTR), pulmonary arterial pressure (PPA), femoral arterial pressure (PFA), left atrial pressure (PLA), and the cardiac output (QAORTA). Incrementally increasing doses of ascaris antigen were injected intravenously, and blood samples for the assay of histamine and serotonin were taken from the catheter inserted into the left femoral vein.
1) By the administration of ascaris antigen PPA, PLA, PFA and QAORTA showed a marked decrease and PTR showed an increase within a minute.
2) Plasma levels of histamine and serotonin showed a significant increase and reached the maximum value within a minute after the antigen challenge.
3) By repeated challenges with the ascaris antigen, late increase of PTR instead of anaphylactic shock was observed repeatedly within a short time.
The above results suggest that ascaris antigen challenge is a useful method to investigate the pathophysiology of anaphylaxis.

View full abstract

The role of the immunological reaction has recently been noticed as the forming mechanism of pneumonia due to Mycoplasma pneumoniae (M. pn.) and the authors analyzed lymphocyte subsets in peripheral blood and bronchoalveolar lavage fluid in 12 pneumomia patients due to M. pn..
The subjects comprised 3 males and 9 females, the youngest patient being 20 and the oldest 54 years old, the age averaging 31.5 years. Peripheral blood and BALF were sampled in the acute stage, when an abnormal chest X-ray shadow was still present, ranging from day 9 to day 71 of the illness (average: day 24).
In the peripheral blood lymphocyte subsets, the OKT 4/8 ratio was significantly lowered (0.97±0.45, p<0.001) compared with that of the control group, and this was due to a decrease of the real number of OKT4⁺. In the BALF cells, the lymphocytes and neutrophils increased, and in the lymphocyte subsets, an increase in the activating T-cells of OKIa 1 positive was suggested, and the OKT 4/8 ratio was elevated to an average of 2.1, contrary to the results in the peripheral blood. Considering these findings, it was inferred that T-cells, which are responsible for immunity, played a certain role in the establishment of pneumonia due to M. pn..

View full abstract

We reported a case of pneumonitis induced by Naproxen. A 69-year-old man was admitted to our hospital because of skin eruptions, dyspnea on exertion, and epigastralgia. He had been treated with Naproxen and Sulindac five weeks prior to the onset of these complaints because of shoulder pain. A chest X-ray on admission revealed bilateral diffuse reticulolinear shadows. On hospitalization, Naproxen and Sulindac treatment was discontinued and the patient showed a resolution of symptoms 20 days after admission. He began to receive prednisolone therapy, 30mg/day 43 days after admission. Fourteen days later he showed a marked improvement in the pulmonary infiltrative shadows on his chest X-ray. The result of a lymphocyte stimulation test of Naproxen was guardedly-positive, with a stimulation index of 188%. We carried out this lymphocyte stimulation test because of a clinical diagnosis of drug allergy. The result of this test supported the clinical diagnosis.
To our knowledge, there has been no previous case of pulmonary hypersensitivity to Naproxen reported in Japan. Clinicians should be alerted to the possibility of the occurrence of such a complication in patients being treated with Naproxen.

View full abstract

Squamous cell carcinoma of the lung was diagnosed in a 77 year-old man with dyspnea at rest, stridor, cough and sputum. Wheezes throughout the lung were distinct “random monophonic wheezes” and not “fixed monophonic wheezes” by a sound spectrogram. Bronchofiberscopy revealed a large, pink polypoid lesion in his right truncus intermedius, accompanied by necrosis. Biopsy showed non-keratonizing squamous cell carcinoma. His wheezes, which were characteristic of bronchial asthma, were remarkedly reduced after resection of the tumor by electrosurgery.

View full abstract

A 43 year-old male had suffered from productive cough, fever, night sweating, body weight loss and malaise for two months before admission, when his peripheral blood showed marked eosinophilia and his chest X-ray film revealed “a photographic negative shadow of pulmonary edema” (Carrington et al., 1969). Later, the infiltration on the plain chest X-ray films extended to the central area, although the CT scan revealed that the infiltration on the left side did not involve the central area. Specimens taken by a transbronchial lung biopsy showed alveolar and interstitial eosinophilic infiltration with multinucleated giant cells. A slight degree of angiitis, but no granuloma was found. Results of respiratory function tests were normal except for a low threshold value for methacholine inhalation test (312ug/ml). Prednisolone (40mg per day) was begun and the clinical symptoms improved within a few days. The abnormal shadow on the chest X-ray film disappeared after one and a half months.
No causative drugs were elucidated. Examinations for bacteria, fungi and helminths were negative. As for the differential diagnosis, eosinophilic leukemia was denied by findings on specimens aspirated from the bone marrow. Tuberculosis was unlikely since cultures of the sputa were always negative. Sarcoidosis was denied by absence of hilar lymph node swellings and granuloma and by normal activity of angiotensin I converting enzyme. There were no signs of Hodgkin's disease. His disease was considered to be essentially the same as Carrington's “Chronic Eosinophilic Pneumonia”. The extension of the infiltration on the plain X-ray films to the central area was regarded as a peculiar finding of this case.

View full abstract

A 58 year-old ethnic Korean male was admitted because of persistent cough, sputa, and exertional dyspnea. He had suffered from chronic sinusitis since age 15 and his chest roentgenogram showed diffuse nodular shadow especially in the lower lung fields. His cold hemagglutinin titer was markedly elevated, and obstructive impairment and overinflation were found in his respiratory function tests. According to these data, the case was diagnosed as diffuse panbronchiolitis (DPB).
It is noteworthy that a disease equivalent to DPB has not been reported in America or Europe. Previously, we reported that the frequency of HLA-Bw 54 in patients with DPB was significantly higher (68.4%, relative risk; 16.8) than controls (11.4%). This antigen, Bw 54 is unusual, because only Japanese, Chinese, Koreans and rarely Jews have been shown to possess this antigen. These facts might suggest that the disease-susceptible gene of DPB was inherited, closely associated with Bw 54, and that DPB does not exist in races that do not possess this antigen.

View full abstract

A 55 year-old female was found to have a squamous cell carcinoma in the upper lobe of her left lung. The tumor significantly decreased with chemotherapy and radiation therapy, but after 6 months the patient became exhausted with multiple metastatic lesions in her bilateral lung fields. Then, in spite of only symptomatic treatment, the multiple lesions gradually disappeared during 3 months. During this time lymphocyte stimulation test by various mitogens (PHA, Con A and PWN) and NK cell activity showed normal values. But 5 months later the patient died, with increase in tumor size. At autopsy the microscopic findings showed both nodules composed of squamous cell carcinoma and those composed of necrosis of the carcinoma. The necrotized nodules had no living carcinoma cells and were surrounded by fibrous tissue.

View full abstract

We report two adult cases of primary varicella pneumonia. Case 1 was a 22 year-old female who had a fever and showed a characteristic varicella rash. Her chest X-ray showed diffuse nodular infiltrations and bilateral hilar lymph node swelling. She had only slight symptoms of pneumonia. The infiltrative shadow on X-ray improved in a week. Case 2 was a 24 year-old female. She showed varicella rash after contact with her own child. The chest X-ray showed diffuse nodular infiltrations, thickening of the minor fissure and slight pleural effusion. Her symptoms improved in a week, but the infiltrative shadow on chest X-ray remained for more than two weeks.
From these observations, we should like to emphasize that primary varicella pneumonia is not rare. We may have overlooked many cases of varicella pneumonia, because of its mild symptoms.

View full abstract

A 74-year old female suffering from cough, sputum and fever of 2 months duration was transfered to UOEH pulmonary division, because of failure to various antibiotic or antituberculous treatment. Transbronchial lung biopsy (TBLB) revealed infiltration of lymphocytes and thickening of alveolar interstitium with IgA deposition. Serum immunological examination showed monoclonal IgA κ type hypergammaglobulinemia. There was no evidence of multiple myeloma. Marked clinical and radiological improvement was attained after prednisolone administration. This case provides information concerning the pathogenesis of LIP.

View full abstract