The acute hemodynamic effect of low-flow oxygen (1-3L/min) and sublingual administration of 10mg nifedipine was investigated in 10 patients with chronic respiratory failure and secondary pulmonary hypertension (chronic pulmonary emphysema (CPE): n=5, chronic lung tuberculosis (TB): n=5). All patients showed hypoxemia with arterial oxygen tension of about 60torr (room air) and pulmonary hypertension (mean pulmonary arterial pressure >20torr).
Oxygen significantly reduced the mean pulmonary arterial pressure and pulmonary vascular resistance index in both groups without change of other hemodynamic parameters, but the degree tended to be greater in the CPE group than in the TB group.
Nifedipine significantly reduced the pulmonary and systemic vascular resistance index, and lowered mean arterial pressure. Cardiac output and the coefficient of oxygen delivery increased significantly, but mean pulmonary arterial pressure, heart rate and oxygen consumption apparently did not change. Although these responses were common in both groups, the additional administration of oxygen significantly reduced the mean pulmonary arterial pressure in the CPE group, in contrast to no change in the TB group. Furthermore, the relationship between pulmonary driving pressure and cardiac index in nifedipine-plus-oxygen shifted to a right lower position in the CPE group, and a right upper position in the TB group.
These differences between the two groups are considered to be based on the difference in the mechanism of development of pulmonary hypertension and the duration of the course of the disease. In the TB group, the reduction of the pulmonary vascular bed to respond to vasodilators and/or the decrease of reactivity to vasodilating agents should be considered.
We conclude that the hemodynamic responses to oxygen and nifedipine in secondary pulmonary hypertension may represent the diference in the mechanism of development of pulmonary hypertension.

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We have tried the production of a monoclonal antibody against human alveolar macrophages. It was derived from the fusion of the NS-1 plasmacytoma cell line with spleen cells from a BALB/c mouse immunized with human bronchoalveolar lavage (BAL) cells. The binding characteristics of the monoclonal antibody, called AMH-1, was analyzed by cellular radioimmunoassay, flow cytometry and immunohistochemistry.
AMH-1 antibody reacted strongly with some lung macrophages in alveolar spaces and in BAL fluid, but did not react with mononuclear cells in peripheral blood, including monocytes, lymphocytes and granulocytes. Furthermore, neither peritoneal exudate cells obtained from a patient with liver cirrhosis nor BAL-cells from rats were reactive with AMH-1. The comparative study with OKM 1 revealed that macrophage surface antigen molecules recognized by AMH-1 differ from those of OKM 1. Immunoglobulin subclass of AMH-1 was IgM, lambda.
AMH-1 thus may define a tissue specific differentiating antigens on alveolar macrophages differing from common antigens of the macrophage population. This anitbody is characterized as recognizing a discrete molecule specific to lung macrophages, and further could help closely the differentiation and maturation process of lung macrophages.

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Natural killer (NK) cell activity and its mechanism, using K562 cells as target cells by ⁵¹Cr release assay, and by analysis of Leu-7 positive (Leu-7⁺) cells and Leu-11 positive (Leu-11⁺) cells of mononuclear cells using monoclonal antibody (Leu-7, Leu-11) by Ortho Spectrum III, were examined in patients with diffuse panbronchiolitis (DPB), in patients with pulmonary emphysema (PE) and in healthy controls.
Results were as follows:
1. In the control group, NK cell activity did not correlate with the donor's age.
2. NK cell activity in patients with DPB was significantly lower (p<0.05) than that in the control group (E/T=10). NK cell activity in patients with PE was significantly higher (p<0.05) than that in the control group (E/T=10).
3. The percentage of Leu-7⁺ cells and Leu-11⁺ cells in patients with DPB revealed no change, but in patients with PE such percentages were significantly higher (p<0.05) than that of the control group.
4. The percentage of Leu-7⁺ cells and Leu-11⁺ cells did not correlate with NK cell activity in patients with DPB, in patients with PE or in healthy controls.
5. Augmentation of NK cell activity by α-IFN, γ-IFN and IL-2 was observed in patients with DPB, in patients with PE as well as in healthy controls.
6. Production of γ-IFN in patients with DPB was lower than that of the control group, but did not change in patients with PE. On the other hand, production of IL-2 in patients with DPB and in patients with PE was observed, as well as in healthy controls.
These results suggest that the reason for low NK cell activity in patients with DPB possibly results from a reduction of γ-IFN production in the peripheral blood lymphocytes.

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Effects of deep inspiration were evaluated in 117 normal controls and 32 patients with bronchial asthma. These subjects expired with effort from a tidal inspiratory level to RV (partial expiratory flow-volume curve), inhaled to TLC, and immediately expired to RV forcedly (maximum expiratory flow-volume curve). V₂₅ on maximum expiratory flow-volume curve (MEF₂₅) and V at the same lung volume on partial expiratory flow-volume curve (PEF₂₅) were obtained and (PEF₂₅-MEF₂₅)/PEF₂₅ was calculated as the deep inspiration (DI) index.
In normal young subjects, the DI indices were lower than 0 and bronchodilation following deep inspiration was observed. The DI index increased with age and reached to a value above 0 in subjects over 50 years old, therefore it was evident that the bronchodilatory effect of deep inspiration decreased with age. After inhalation of an anticholinergic drug, ipratropium bromide (40μg), DI indices increased significantly exceeding 0 and the difference in DI index related to age disappeared. Although the variation of the DI index was larger in patients with bronchial asthma, the DI index in cases younger than age 40 with %FEV₁≥70% was below 0 and exceeded 0 after inhalation of ipratropium.
We conclude that: 1) in normal young people, the airway is constricted by vagal tone and deep inspiration induces bronchodilation via the vagal reflex; 2) this effect of deep inspiration decreases with age; 3) in young asthmatic patients without bronchospasms, bronchodilation similar to that in normal young subjects is induced by deep inspiration.

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A total of 244 respiratory diseases were studied. In 51 cases with interstitial lung diseases including 19 cases with idiopathic interstitial pneumonitis (IIP), superoxide production (SOP) by neutrophils was examined by cytochrome C reduction.
The following results were obtained.
1) In patients with IIP, SOP by neutrophils was higher compared with control and other lung diseases.
2) The group of interstitial lung diseases which were considered as indications of steroid had significantly higher SOP (p<0.01) than the group of untreated cases.
3) A significant correlation were observed between SOP and PaO₂ (R=-0.496, p<0.01), and SOP and A-aDO₂ (R=-0.603, p<0.01) in patients with interstitial lung diseases.
4) The marked increase of SOP was found in patients developing radiation pneumonitis on chest X-ray film.
5) In relapsing cases under steroid therapy, re-increase of SOP was observed.
The present results indicate that measurement of SOP by neutrophils in patients with interstitial lung diseases is not only instructive to determine the application of steroid therapy, but also may be a good parameter for reducing the dose of steroid. Furthermore measurement of SOP is very useful to descriminate between radiation pneumonitis and other pneumonia in patients of primary lung cancer received irradiation therapy.

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High concentrations of oxygen were administered to patients with chronic lung disease and the changes in the regional distribution of ventilation-perfusion in the lung and right ventricular ejection fraction were measured using radioisotope methods.
Ventilation-perfusion imaging of the lung and right ventriculography were performed while breathing room air and 90% oxygen inhalation in 8 patients with chronic obstructive lung disease and 3 patients with both restrictive and obstructive disorders due to old lung tuberculosis. The ventilation scan was performed by inhalation of 10mCi of Xe-133 gas. Single breath, rebreathing and washout images were obtained in the anterior projection. The perfusion images were made in the same projection during 10 to 20 seconds breath-holding with continuous infusion of Kr-81m glucose solution. Tc-99m-MAA perfusion images were also obtained for comparison with the Kr-81m perfusion images. During continuous infusion of Kr-81m glucose solution, the ECG-gated right ventriculography in the right anterior oblique view was performed and the radionuclide right ventricular ejection fraction was determined by the first pass technique. A region of normal ventilation and perfusion and regions of abnormal ventilation and/or perfusion were selected to compare regional ventilation and perfusion and their changes with oxygen inhalation.
There was excellent agreement in the estimation of regional distribution of lung perfusion by Kr-81m and Tc-99-MAA perfusion lung scan.
The results suggested that the regional distribution of perfusion increased in abnormal areas and decreased in normal areas during 90% oxygen inhalation. No significant change in the distribution of ventilation in both regions suggests the alteration of ventilation versus perfusion relationships due to oxygen inhalation. These findings suggest that high concentrations of oxygen cause vasodilatation in abnormal areas which then draws blood away from normal areas. Then the ventilation-perfusion ratio may decrease in abnormal areas and increase in normal areas.
Decrease of heart rate without significant change of right ventricular ejection fraction was observed, resulting in decrease of right ventricular cardiac output. The decrease of right ventricular cardiac output induced decrease of the blood flow and increase of ventilation-perfusion ratio in normal areas. These findings indicated that an increase of dead space took place in normal areas.

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The cellular profile and fibronectin (FN) levels by enzyme-linked immunosorbent assay (EIA) in the bronchoalveolar lavage fluid (BALF) obtained from 11 patients with idiopathic interstitial pneumnia (IIP) were evaluated. A immunohistochemical study of FN in a patient with IIP was also performed. The levels of the FN albumin ratio in BALF from IIP patients were significantly higher (p<0.05) than those from normal volunteers. Furthermore, increases of lymphocyte percentges were observed in BALF from IIP patients. A histological study (H. E. stain and EIA stain of FN) in the post-mortem lung of a typical patient with IIP showed infiltration of numerous mononuclear cells in the interstitum and the deposition FN in a similar pattern.
These results suggest that FN and lymphocytes in the lower respiratory tract may play an important role in the mechanism of fibrosis in IIP.

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The effects of vasodilators on right ventricular performance were studied at rest and during exercise in 32 patients with clinically stable chronic respiratory failure.
1) Intravenous isosorbide dinitrate (ISDN) (1γ/kg/min, 11 patients) induced a significant decrease in right atrial pressure (RAP), pulmonary arterial mean pressure (PAMP) and cardiac index (CI), however no change in total pulmonary vascular resistance (TPVR). Right ventricular work index (RVWI) was reduced significantly by ISDN during exercise. CI was reduced by ISDN, however PvO₂, which indicates tissue oxygenation, showed no change.
ISDN reduced the right ventricular preload by means of venodilation and reduced right ventricular work.
2) Sublingual nifedipine (10 mg, 11 patients) induced a significant increase in CI and O₂-transport, but a decrease in PAMP and TPVR. Systemic arterial pressure decreased and heart rate increased significantly after nifedipine administration.
Nifedipine reduced the right ventricular afterload by means of active vasodilation of the pulmonary vascular beds, and increased CI and O₂-transport.
3) Captopril (25mg, 10 patients), an oral angiotensin converting-enzyme inhibitor, acted as a vasodilator, with arterial and venous effects. The hemodynamic response to captopril was similar to the combination administration of intravenous ISDN and sublingual nifedipine. Captopril reduced the increase in CI and O₂-transport, but decreased the PAMP and TPVR, as was ISDN. Heart rates remained unchanged and failed to increase reflexly following reduction in blood pressure, as was observed with other vasodilators. By reducing angiotensin II, a factor in the enhanced systemic vascular resistance, captopril might be useful as adjunctive therapy to counteract vasoconstrictive effects, which was the homeostatic mechanism of chronic vasodilator therapy.
Further long-term studies are necessary to establish therapeutic efficacies of these agents.

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A case of pulmonary alveolar proteinosis with chief complaints of dry cough and exertional dyspnea was reported. The patient was a 53 year-old woman. Her chest X-ray disclosed small patchy infiltrates in the lower lung fields. The serum lactic dehydrogenase (LDH) concentration was increased to 265IU/l. This case was complicated with type IIa hyperlipidemia. Pulmonary function studies were normal except for slight depression of the arterial PO₂. The histologic diagnosis was made by transbronchial lung biopsy.
Bronchopulmonary lavage was performed with the fiberoptic bronchoscope 9 times, during a period of effeminately a month. A total of 3200ml of saline solution was lavaged. Although patient's complaints were relieved, there was no marked imporvement of test data and chest X-ray findings.
During the period of lavage, the serum cholesterol concentration returned to normal and the serum LDH concentration also decreased. However, after the series of lavages, concentrations of both increased again. The scavenger pathway of cholesterol transport was thought to have some relationship to these related decreases.

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A 32 year-old polyurethane paint sprayer developed dry cough and fever after repeated spray work. The symptoms subsided during a period away from spray work, and developed again after returning to spray work. These episodes was repeated throughout one month and the symptoms became worse with each episode. The spray contained isocyanates. Plain chest x-ray film and computed tomogram of the lung showed a diffuse small nodular shadows in both lung fields. Arterial blood oxygen tension was low and vital capacity was reduced. 83% of the total cells in the broncho-alveolar-lavage fluid were lymphocytes. Lung biospy specimen obtained by transbronchial lung biopsy revealed infiltration of numerous monoclear cells in the interstititum.
From the above findings, this case was diagnosed as hypersensitivity pneumonitis possibly induced by isocyanates. This is the fifth such case reported in Japan.

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From December 1982 to May 1985, 5 patients (2 men and 3 women, aged from 28 to 69) with psittacosis were admitted to out hospital, in most of which the chief complaints were fever and cough. The chest x-ray revealed homogenous infiltrative shadow in the unilateral lung field in 4 patients and in the bilateral lung fields in one patient. At first we treated all cases suspicious of mycoplasma pneumonia or bacterial pneumonia. However, because of the elevated titer of antibody to chlamydia and of the history of contact with birds, we diagnosed psittacosis in all. All patients were treated with tetracycline, lincomycin or macrolides.

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We reported two resected cases of aspergillosis complicated by cancer. Case 1 was a 63 year-old male. His chest roentgenogram revealed a cyst containing a round mass shadow in the cavity. Right upper and middle bilobectomy was performed. Histologically aspergilloma combined with lung cancer forming a cavity was demonstrated. Case 2 was a 54 year-old male in whom an abnormal shadow in chest x-ray film and compression film of the stomach were pointed out. As a result of left upper lobectomy and subtotal gastrectomy, a fungus ball in the left S¹⁺² and early type IIa+IIc gastric cancer were demonstrated.
The incidence of pulmonary aspergillosis complicated with solid tumor is low, and cases with complications prior to cancer treatment are very rare.

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A 29 year-old male case of proximal interruption of the right pulmonary artery was reported.
He was admitted to Tenri Hospital with a complaint of bilateral shoulder pain. Laboratory examinations on admission were normal. The chest roentgenogram showed a large hypertranslucent left lung with displacement of the heart and mediastinum to the right. Vascular markings were seen throughout the right lung, but not in the usual pattern radiating from the hilu. Perfusion scan showed no perfusion of right hemithorax. The pulmonary angiogram showed proximal interruption of the right pulmonary artery. Cardiac catheterization revealed the absence of pulmonary hypertension. No intracardiac malformation was present. Bronchogram of the right lung showed a normal distribution of bronchi to all lobes with no signs of bronchiectasis. Selective alveolobronchogram of the right B₈ showed signs of bronchioloectasis.
Because of the absence of repeated pulmonary infections, life-threatening hemoptysis, and pulmonary hypertension, he was treated conservatively.

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A 32 year-old female patient with bronchial asthma developed an anaphylaxis-like reaction after intravenous injections of Saxizon. Positive inhalation provocation tests were observed with Sulpyrin and Saxizon. Intradermal skin tests revealed positive immediate reactions to Saxizon. Although the Prausnitz-Küstner reaction was positive to Saxizon, RAST was negative.
These results suggest that this patient's immediate hypersensitivity was mediated by IgE antibody against Saxizon.

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A 56 year-old woman was admitted with cough and hemosputa. A chest roentogenogram showed a tumor shadow in the left middle lung field, bilateral hilar lymphadenopathy and fine nodular shadows in both lungs. A diagnosis of lung cancer associated with pulmonary sarcoidosis was made based on transbronchial lung biopsy and mediastinoscope. Left pneumonectomy was performed. The postoperative pathologic examination also disclosed lung adenocarcinoma with sarcoid granuloma. The simultaneous occurence of the two pathologic conditions is unusual and few such cases have been reported. Speculations about the relationship of lung cancer and sarcoidosis have been made, but it is as yet unclear. There is also no evidence of increased frequency of malignant tumor in patients with sarcoidosis.

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