Respiratory hyperreactivity was examined in cases of so-called Kawasaki-asthma, which is thought to be induced and aggravated by air pollution.
Stepwise increased concentrations of methacholine were inhaled by patients and respiratory resistance was measured continuously.
The threshold concentration of methacholine which provoked elevation of respiratory resistance indicating respiratory constriction was 2, 446±5, 990mcg/ml in male cases and 2, 558±5, 803mcg/ml in female cases whereas it was 25, 000±0mcg/ml and 20, 833±5, 893mcg/ml in male and female normal controls, i. e. it was 1/8 1/10 in patients compared to normal controls. From these data, it was concluded that respiratory tract hyperreactivity clearly existed in air pollution-induced bronchial asthma.

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To evaluate performance status (PS) objectively and quantitatively by means of anaerobic threshold (AT), a three-minute incremental exercise test on a bicycle ergometer was performed in 17 preoperative patients with bronchogenic carcinoma, who were categorized into three groups according to the Hugh-Jones (H-J) classification: Six patients each belonged to H-J 1 and H-J 2, and the other five patients to H-J 3. However AT determined by visual inspection of abrupt increase in arterial blood lactate could not be detected in some patients because the arterial blood lactate increased smoothly.
In order to obtain blood lactate level at which PS is able to be evaluated, an oxgen consumption/body surface area (VO₂/BSA) was calculated by interpolation of the arterial blood lactate levels ranging from 11 to 30mg/dl and comparing each lactate level between the three groups. VO₂/BSA differed significantly (p<0.05) between the three groups at lactate levels from 16 to 20mg/dl and 24mg/dl. At a lactate level of 20mg/dl, which was about twice the value at rest and which all patients were able to tolerate, VO₂/BSA levels were 574±92ml/min/m² in H-J 1, 445±70ml/min/m² in H-J 2 and 313±47ml/min/m² in H-J 3.
We concluded that VO₂/BSA at an arterial blood lactate level of 20mg/dl during a three-minute incremental exercise test was a useful parameter to evaluate the performance status of patients with bronchogenic carcinoma objectively and quantitatively.

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We previously applied a Pseudomonas aeruginosa multicomponent vaccine consisting of common protective antigen (OEP) of P. aeruginosa with toxoids of protease, elastase and exotoxin of the bacillus for treatment of 38 patients with intractable lower respiratory tract infection from 1970 to 1984. In this study, the Pseudomonas aeruginosa vaccine was evaluated in 22 patients with diffuse panbronchiolitis (DPB) vaccinated every 2 or 4 weeks for more than 3 months. A serum antibody titer was measured by passive haemagglutinin reaction or ELISA. Before vaccination, antibody titers to OEP and exotoxin were already significantly higher in patients with P. aeruginosa infection than in those without it, but the titers to protease or elastase did not show any differences. These 22 patients were divided into the following 3 groups according to the presense of P. aerginosa infection: group I without P. aeruginosa infection before and after vaccination (n=11), group II-P. aeruginosa infection developed after vaccination (n=6), group III-with P. aeruginosa infection before and after vaccination (n=5). After the vaccination, antibody titers to OEP in group I (p<0.005), those to protease in group I (p<0.002) and group III (p<0.005), and those to exotoxin in group I (p<0.005) and group II (p<0.01) elevated significantly. There were no significant differences in the average age of the onset of DPB or the duration from onset to the initial vaccination between group I and group II. Among 22 vaccinated DPB patients, two have already died during the course and their mean survival from P. aeruginosa infection was 5.5 years. Although it was 3.0 years in 23 fatal non-vaccinated control DPB patients, there was no significant difference between them. A survival from the onset in the vaccinated DPB patients failed to show any significant prolongation compared with 72 non-vaccinated control DPB patients by generalized Wilcoxon test. Minor local reactions or low grade fever occured in 3 cases each, but there were no serious reactions. Because some clinical effectiveness of the Pseudomonas aeruginosa multicomponent vaccine has been suggested in the patients with the preventative and therapeutic points of view, long term continuity of the vaccination and its evaluation are necessary in future.

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Recent studies suggest that initiation of bacterial respiratory tract infections is mediated by adherence to pharyngeal epithelial cells. In order to investigate the pathogenesis of Branhamella catarrhalis and Neisseria sp. from the view point of adherence activity, we studied the adherence of these bacteria to human pharyngeal cells. Sixty pharyngeal cell samples were collected from 25 patients with chronic respiratory infections and 9 samples from 8 healthy adult controls.
B. catarrhalis was isolated from the sputum of the patients with acute symptoms, whereas Neisseria sp. was isolated from patients without symptoms.
B. catarrhalis attached to pharyngeal cells of the patients in greater number (p<0.001) than Neisseria sp. In contrast Neisseria sp. attached equally to the human pharyngeal cells of the patients and healthy adult controls. Compared with the acute phase and remittent phase, there was no significant difference in attachment of B. catarrhalis to pharyngeal cells of the patients. B. catarrhalis exhibited increased attachment in the patients who had episodes of B. catarrhalis infections (p<0.01) compared with those without episodes. Attachment of beta-lactamase producing B. catarrhalis (2 strains) differed from the non-beta-lactamase producing strain (1 strain) (p<0.05).

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Recent studies have demonstrated oxygen desaturation during sleep in some patients with chronic obstructive pulmonary disease (COPD). In the present study, we examined what cases exhibited nocturnal oxygen desaturation, and what degree of oxygen desaturation during sleep was found in patients with COPD. Furthermore, we studied the relationship between the magnitude of desaturation, and chemical control of breathing or mean pulmonary arterial pressure (PA mean) during wakefulness. Twenty four cases with COPD were divided into two groups, 8 patients with predominantly Type B and 16 patients with primarily Type A.
1. Maximal change in arterial oxygen saturation (Sa_O2) was greater in Type B than in Type A during REM sleep, whereas there was no difference between the two groups during NREM sleep.
2. 90% of hypoxemic episodes with 4% or more desaturation were found in REM sleep, and this occurrence was more frequent in Type B than in Type A.
3. Two cases with Type A and one case with Type B showed no hypoxemic episode.
4. Hypoxic ventilatory response expressed as ΔV_I/ΔSa_O2 was lower in Type B, except for one case with no hypoxemic episode, than in Type A.
5. Most common breathing patterns accompanying hypoxemic episodes were irregular and paradoxical breathing in REM sleep, while sleep apnea or hypopnea occurred in NREM sleep.
6. All hypoxemic episodes with 10% or more desaturation were found in REM sleep, and more frequently in Type B than Type A.
7. Patients with more hypoxemic episodes in Type A showed lower arterial P_O2 and hypercapnic ventilatory response, and higher mean PA.
8. There was significant correlation between maximal change in Sa_O2 during REM sleep and mean pulmonary arterial pressure during wakefulness.
These results suggest that repeated severe episodes of nocturnal hypoxemia have relevance to attenuated chemoreceptor function and pulmonary hypertension.

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Recently, various tumor markers were investigated for the diagnosis and the assessment of therapy in patients with malignant diseases. In a previous study we measured CEA values in peripheral venous blood, pleural fluid and BALF (broncho-alveolar lavage fluid) from patients with various lung diseases.
In the present investigation we measured and compared TPA (tissue polypeptide antigen) values in serum and BALF obtained from patients with lung cancer and other respiratory diseases.
Fifty-six men and 31 women, averaging 56 years old, were measured simultaneously.
1) In healthy volunteers TPA values in BALF was higher than those in serum.
2) In patients with primary lung cancer and other inflammatory respiratory diseases TPA values in BALF showed a tendency to increase.
3) There was no significant correlation between TPA and CEA values in BALF from patients with primary lung cancer.
4) TPA values in BALF from affected bronchi were higher than those from normal bronchi.
The above results suggest that the measurement of TPA in BALF might be useful to determine the location of bronchial carcinoma.

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To investigate the clinical course and the prognosis of carcinomatous pleuritis following local therapy, we studied 101 CT films of 53 cases of carcinomatous pleuritis complicated with primary lung cancer. The histological types of the 53 cases included 43 adenocarcinomas, 4 squamous cell carcinomas, 4 small cell carcinomas and 2 large cell carcinomas. The median survival time was 6 months after the initial i. p. instillation. The mean number of i. p. instillations was 6.1 times, median was 3. Instillated drugs were adriamycin, OK-432, ACNU, Mitomycin, aclacinorubicin or others.
In the cases failed in pleurodesis, thickening of the pleura, reaccumulation of the pleural effusion and the loculated pleural space were observed at CT examination.
The loculated pleural space was observed in 21 cases (39.6%), and the loculation of 13 cases developed within 1 month after the initiation of the local therapy or with less than 3 times i. p. instillation. In 12 out of 13 cases, malignant cells remained or reappeared in pleural effusion in spite of local treatment after the loculation. There was no statistical significance between the mean survival time of cases with loculated pleural space (4 months) and that of cases without loculation (8 months).
The i. p. instillation of sclerosing agents are accepted to be rational and useful in the treatment of malignant pleural effusion. On the other hand, the drug instillation seems to have the disadvantage of the development of the loculated pleural space in the early stage of the local therapy. The loculation of the pleural space not only made it difficult to remove the pleural effusion and to reexpand the lung, but also was one of the causes of refractry pleuritis.
So, to minimize the development of loculation, it is suggested that local therapy should be begun as soon as possible after the detection of the pleural effusion with the aim of complete reinflation of the atelectatic lung and complete closure of the pleural space (pleurodesis).

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At present no definite agreement regarding the concept or the diagnostic criteria of bronchiolitis has yet been established, and many pathophysiological points remain unsolved. In the present study bronchiolitis was examined from the endoscopic point of view by means of an endoscope allowing observation and photography of peripheral airways smaller than 2mm in diameter. The following findings were obtained:
1) Endoscopic findings frequently observed in the peripheral airways were redness, occlusion, narrowing and hypersecretion. Bronchiolitis was considered liable to induce occlusion and narrowing.
2) Although selective alveolobronchography can be used for determining the entire features of the peripheral airways, redness and irregular surface of the mucosa of the bronchioli, occlusion and narrowing were detected more easily by endoscopy than by selective alveolobronchography.
3) For the accurate examination of bronchiolitis it was necessary to simultaneously use endoscopic examination and selective alveolobronchography.
Endoscopic examination facilitating observation of the mucosa of bronchioli under direct vision seems to be a basic method for analyzing the pathogenic conditions of bronchiolitis and providing the basis of a new viewpoint.

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Precipitating antibodies (precipitins) against 12 species of fungi were determined by gel diffusion in sera from 36 patients with PIE syndrome of unknown cause, and clinical and laboratory findings were compared between precipitin-positive and precipitin-negative groups of the PIE to see whether any fungal antigens may play a role in the pathogenesis.
Eighteen (50%) of 36 patients with PIE syndrome of unknown cause had at least one of the 12 fungal precipituns. The fungi against which the precipituns were positive consisted exclusively of Aspergillus fumigatus, Aspergillus oryzae, and/or Cladosporium cladosporoides.
In contrast to the precipitin-negative group, the precipitin-positive patients with PIE of unknown cause had such characteristics that their incidence by season was autumn, when allergic bronchopulmonary fungal diseases were frequently found, most of them consisted of the prolonged type of PIE according to Crofton's classification, and they showed a tendency to severer symptoms, more accelerated erythrocyte sedimentation rate, higher rate of positive CRP, and lower serum IgE levels.
Thus, the fungal precipitin-positive PIE, but of unknown cause in appearance, was considered to be an independent type of PIE, suggesting fungal sensittization of the patients as a pathogenetic factor.

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Leukotrienes (LTs) are thought to be important mediators of IgE-mediated hypersensitivity reaction in lung tissue. But the release of LTs in plasma is hard to detect because of the very low levels. In this study, we have measured LTC₄ and LTD₄ in arterial plasma of 9 atopic asthmatics during wheezing attack and of 4 normal subjects. After extraction using SEP PAK and separation of LTs by HPLC, radioimmunoassay and bioassay were performed. In all 9 asthmatics, LTC₄ was detected by RIA, and LTC₄ in plasma was 520±740pg/ml. In 6 out of 9 asthmatics, LTD₄ was detected by RIA, and LTD₄ in plasma was 500±300pg/ml. In 5 out of 9 asthmatics, LTC₄ was detected by bioassay and LTC₄ in plasma was 1710±1670pg/ml. In 5 out of 9 asthmatics, LTD₄ was detected by bioassy and LTD₄ in plasma was 770±340pg/ml. In 4 normal subjects, any LTs were detected neither by RIA nor bioassay. There was not a significant relationship between LTs levels and IgE levels. Although chemical mediators other than LTs may be concerned, LTs seem to play an important role during wheezing attack in atopic asthmatics. In the text, we clearly discribed our analytical method, and also extensively discussed merits and disadvantages of our method.

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A 67 year-old male complaining of dry cough and dyspnea was hospitalized for the evaluation of mild diffuse pulmonary shadows. Chest X-ray films revealed small nodular opacities in the upper lung field and a reticulonodular pattern in the middle to lower lung field. Bronchoalveolar lavage yielded 63.5% lymphocytes, indicative of the presence of alveolitis. Since he had inhaled dust while working as a boiler scaler 40 years previously, a clinical diagnosis of pneumoconiosis was made at first.
However, the shadows and symptoms were subacutely aggravated during the next six months. Open lung biopsy revealed fibrous nodular lesions with marked deposition of coal-dust chiefly in the upper lobe. Mild mononuclear alveolitis around the nodular lesions was also present. Analytical electron microscope and proton-induced X-ray emission (PIXE) analysis demonstrated a considerably large amount of silica. In the lower lobe, the alveolitis was prominent to an extent uncommon in pneumoconiosis.
Considering the pathological findings described above and his past occupation it was thought that IIP-like lesions had developed in a case of mixed-dust fibrosis.

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A 45 year-old housewife presented with a small coin lesion on her chest X-ray. The lesion was a well defined, homogeneous mass, measuring 13×11 mm, which was located in the right S⁶ region. A transbronchial needle aspiration cytology was performed, because the lesion was too medial to obtain a specimen with ordinary transcutaneous aspiration biopsy. The procedure was done puncturing the wall of a bronchus, through which the needle tip was anticipated to be most accessible to the tumor by a preceding bronchography. The cytology specimen yielded a diagnosis of chondromatous hamartoma. Enucleation of the tumor was undertaken without any complication.

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A 70 year-old woman complained of a low fever, nausea and body weight loss. Chest X-ray film showed no abnormality except for a calcified lesion in the right axilla, in which an old tuberculous lesion was found by biopsy. Fiberoptic bronchoscopy revealed a large polypoid lesion in the membranous portion of the left main bronchus. The biopsy specimens from the lesion showed severe inflammatory edema of the bronchial submucosa with capillary growth and a small amount of cell infiltrates. There was no evidence of tuberculosis in both pathological and bacteriological studies. The bronchial polyp was transbronchially removed without any complication. Inflammatory polyp of the bronchus is very rare. Only six cases of bronchial inflammatory polyps have been reported in Japan.

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A 43 year-old man was admitted due to an abnormal shadow on the chest roentgenogram. For twenty months before admission, his work had been to mix several elements of hard metals including carbon, tungsten and cobalt. Chest X-ray film on admission showed linear and granular shadow in both upper and middle lung fields.
The pulmonary function test on sirogram showed restrictive abnormality and flow volume values were found to be decreased. Transbronchial lung biopsy specimens showed focal interstitial fibrosis and anthracosis. He was maintained on corticosteroid therapy as an outpatient but the abnormal shadows on chest X-ray gradually worsened.
Dry cough and dyspnea on exertion appeared and an open lung biopsy was performed. The specimen showed findings of giant cell interstitial pneumonia. Numerous black granules which were found in alveolar macrophages and giant cells proved to be tungsten by energy dispersion X-ray microanalysis.
Dry cough and dyspnea increased in spite of palliative therapy for about six months. Cardiovascular dysfunction subsequent to pneumothorax appeared leading to his death. On autopsy the lung showed diffuse fibrosis with many bullous lesions. No higher concentration of cobalt than controls was detected in the lung tissue by atomic absorption spectrometry.

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