Pulmonary hemodynamics were examined in 11 patients with chronic obstructive pulmonary disease (COPD) at rest and during mild single stage exercise on a supine cycle ergometer. In addition, these patients underwent a second exercise test while breathing 30% oxygen and a third exercise test after sublingual administration of 0.3mg nitroglycerin (NTG).
The mean pulmonary arterial pressure (PPA) and right ventricular stroke work index (RVSWI) increased disproportionally to an increase in cardiac output during control exercise in all patients.
Oxygen breathing suppressed the elevation of PPA and RVSWI during exercise. For these parameters, NTG was more effective in all patients. These reductions were caused by the suppression of pulmonary vascular resistance and cardiac output during exercise under both breathing oxygen and sublingual NTG.
These results suggest that in patients with COPD, both breathing oxygen and the administration of a vasodilater, NTG, are of clinical use for preventing the development of pulmonary hypertension.

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Pleural effusion levels of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), adenosine deaminase (ADA), ferritin, β2 microglobulin and sialic acid were measured in 56 cases of primary lung cancer, 35 cases of metastatic tumors, 49 cases of tuberculous pleurisy and 62 cases of miscellaneous pleural diseases.
The investigations attempted to discriminate between carcinomatous and tuberculous pleurisies.
Carcinomatous pleural effusions had significantly higher levels of CEA and TPA than tuberculous effusions (p<0.05). On the other hand, ADA and β2MG were significantly higher in tuberculous pleural fluids (p<0.01). The first two markers had high specificity for malignant pleural effusions, while the specificity of the other two markers were high for tuberculous pleurisy and empyema. Ferritin and sialic acid had a higher sensitivity in both groups, but their specificity was low and they appeared to hold little potential for clinical investigations.
Consequently, the study suggests that pleural effusion CEA and TPA assay may be useful in demonstrating malignant pleurisies, while ADA and β2MG in detecting pleural fluids of tuberculous origin.

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Drug-inhalation is one of the important therapeutic methods to control asthmatic patients and the metered-dose inhaler (MDI) has been extensively used because of its convienient, rapid and selective bronchodilating action. However many asthmatics use MDI suboptimally as they sometimes cannot synchronize inhalation with its actuation. To reduce such inhalation errors new MDI delivery devices (spacers) have been developed in Europe and America.
Two types of spacers (tube type; Aerochamber and bag type; Inspirease) were studied to confirm their usefulness in bronchial asthma. Twenty seven adult asthmatics with mild attacks were divided to three groups i. e. tube spacer with MDI, bag spacer with MDI and control (MDI ony). Bronchodilating effect of salbutamol in conventional MDI (100μg/puff×2) with or without a spacer was analyzed by respiratory function (FVC, FEV_1.0, PEFR, V₂₅ and V₅₀) and signs and symptoms for 60 minutes after inhalation. We could not find a difference between the groups with spacers and controls for each parameter. Patients complained of less oropharyngeal irritaion with a spacer than MDI only. These results suggest that when asthmatics use a spacer fitted to an MDI they do not have to synchronize their inspiration with aerosol generation. Using spacers, effective bronchodilating action can be obtained without synchronization.

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We investigated the correlation between CT and pulmonary function test results in five normal controls and ten patients with severe pulmonary emphsema. We used mean lung attenuation values (MLAV) and ΔEMP as the index of emphysematous change in CT. ΔEMP was defined as the ratio of the area (-960 Hounsfield Units- -1024HU) to the area (-774HU--1024HU). MLAV and ΔEMP were measured from histograms of the CT review. Mean MLAV in pulmonary emphysema was -947.1±9.3HU, and that in normal controls was -906.6±23.6HU. Mean ΔEMP in pulmonary emphysema was 50.0±9.9%, and that in normal controls was 18.8±13.0%. The data in pulmonary emphysema cases differed significantly from those in normal controls. Furthermore MLAV and ΔEMP had good correlation to VC, %VC, FEV₁, FEV₁/FVC, RV/TLC, %V₂₅ and Raw. CT is an easier examination than pulmonary function test for patients, and can show the extent and the distribution of emphysematous area. In this study it is suggested that CT is a useful examination in severe pulmonary emphysema.

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The values of serum type III procollagen N-terminal peptide (PIIIP) were measured in patients with fibrotic lung disease, and compared with serum monoamine oxidase (MAO).
In 95 patients, the following diagnoses were established; pulmonary fibrosis (31 cases), pneumoconiosis (7 cases), radiation pneumonitis (9 cases), sarcoidosis (10 cases), chronic pulmonary emphysema (9 cases) and primary lung cancer (29 cases). Moreover, changes of serum PIIIP and MAO following radiation therapy were investigated in patients with primary lung cancer.
The normal control value of serum PIIIP was 9.82±1.53ng/ml (mean±SD, n=100) and that of serum MAO was 0.700±0.23IU. Upper values higher than the mean+2SD, 12.85ng/ml (PIIIP) and 1.16IU (MAO) were regarded as abnormal values.
The values of serum PIIIP in patients with pulmonary fibrosis were significantly higher than those in control subjects (p<0.01). In cases of pulmonary fibrosis, the values of serum PIIIP in the active stage were significantly higher than those in the inactive stage (p<0.001). Regarding the roentgemographic types of pulmonary fibrosis, the values of serum PIIIP in cases which showed small granular or ring shadows were significantly higher than those which showed a large ring or cystic shadow with loss of pulmonary volume on chest X-ray films.
The values of serum PIIIP in patients with radiation pneumonitis were significantly higher than those in control subjects (p<0.001)and in patients with other disease (p<0.01), except for pulmonary fibrosis. In cases of primary lung cancer treated with radiation, the values of serum PIIIP did not increase in proportion to the irradiation dose, but in 2 cases complicated by radiation pneumonitis, the values of serum PIIIP increased to higher levels than before onset.
These findings indicated that serum PIIIP may be useful for the detection of the activity of pulmonary fibrosis and also be useful for predicting radiation pneumonitis which can develop with radiation therapy.
Although MAO has been useful for fibrotic lung disease, the values of serum MAO did not increase in any pulmonary disease. Serum PIIIP values were not related to serum MAO (r=0.139, p>0.05).

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A 60 year-old woman with awake apnea secondary to Arnold-Chiari malformation was reported. The pattern of apnea was central type. Episodes of apnea increased in frequency and duration under inhalation of oxygen and during non-REM sleep despite relatively good pulmonary function study results. Ventilatory response to carbon dioxide was markedly diminished at first. Not only compression but also edema of the medulla oblongata were suggested as the cause of apnea, because she could spontaneously ventilate fairly well after heart failure with systemic edema disappeared and normalization of the values of arterial blood gas through assisted ventilation for two months.
It was suggested that she would easily develop hypoxia with hypercapnea without mechanical ventilation, so she accepted home care ventilation ten months ago, receiving assisted ventilation at night and for two hours in the afternoon, the values of arterial blood gas measurements indicate that she is well ventilated. We concluded that home care ventilation was useful for this patient with apnea due to Arnold-Chiari malformation.

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This study was undertaken to clarify the function of peripheral blood monocytes in auto-and allo-lung transplantation treated either with azathioprine or without any immunosupressants. The phagocytic acitvity, and the cellular RNA content of monocytes in peripheral blood were evaluated and also expression of Ia antigen was assessed using flow cytometry.
At rejection, phagocytic activity was slightly increased but the cellular RNA content was not remarkedly changed. On the contrary, Ia expression was significantly decreased in rejection. We confirmed that the percentage of Ia expression on monocytes was a useful diagnostic sign of rejection.

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We reported two cases of non-Hodgkin lymphoma (NHL) associated with diffuse panbronchiolitis (DPB) during their clinical courses.
Case 1: A 44-year-old female, who had been clinicaly diagnosed as DPB and followed up in our hospital from 1975, was found to have developed bilateral hilar lymph node enlargement on her chest X-ray film, and supraclavicular and axillar lymph node swelling by physical examination as well, approximately ten years after the onset of DPB. Lymph node biopsy revealed diffuse monotonous tumor cell proliferation, which was compatible with non-Hodgkin lymphoma (poorly differentiated). It was also proved to be T cell lymphoma by monoclonal antibodies. She was treated with cyclophosphamide, vincristine, and prednisolone, and she showed good response to this combination chemotherapy. She was discharged in remission.
Case 2: A 47-year-old female came to our hospital complaining of cough and sputum. She was clinically diagnosed as DPB, in 1981. One year later, swelling of inguinal lymph nodes was noticed. A biopsy specimen was interpreted as non-Hodgkin lymphoma (diffuse, histiocytic). She died of lymphoma nine months later non-withstanding treatment. Postmortem examination revealed widespread dissemination of lymphoma cells and respiratory bronchiolitis compatible with DPB.
It is well known that DPB is usually accompanied by some immunological abnormalities, such as a high titer of cold hemagglutinin, increases of serum immunoglobulins (especially IgA), elevation of helper/suppressor T cell ratio in a peripheral blood caused by not only an increase of helper T cells but a decrease of suppressor T cells as well. These abnormalities in T cell subsets are usually observed in some collagen vascular diseases, particularly in Sjögrens syndrome. It is also said that the prevalence of NHL in patients with collagen diseases is higher than that in a normal population. The imbalance of helper versus suppressor T cell activity is considered to be one of the causes of superimposed NHL in such cases. From this point of view, the prevalence of NHL in DPB patients might be higher than that in a normal population. In fact, two out of 120 DPB patients in our hospital had developed NHL during the course of the disease.
We believe this is the first report that refers to the possibility of a high prevalence of NHL in DPB patients, and these examples can provide some cluse to resolve the pathogenisis of DPB which is still under investigation.

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A 54-year-old daughter and her mother both of whom developed idiophathic pulmonary fibrosis were described. Both of them had no history of significant dust exposure. There were no specific characteristics to distinguish the familial form from the usual sporadic form of idiopathic pulmonary fibrosis.

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A 36-year-old female patient developed atelectasis of the right middle and lower lobes for a period of 8 months due to tracheo-barondhial tuberculosis. Resection of the stenotic right main bronchus and truncus intermedius and anastomosis of right upper bronchus and truncus intermedius to the orifice of the right main bronchus were done without lung resection.
We examined pre- and postoperative repiratory function. At 3 months after operation the vital capacity, FEV_1.0 and BGA (room air) showed slight improvement in spite of the restrictive effect of thoracotomy. The ventilation and perfusion lung scan revealed the apparent improvement of ventilation, perfusion and wash-out of the lower field of the right lung. However, the improvement of perfusion was delayed compared with that of ventilation.

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A 74 year-old woman was admitted with dyspnea and right chest pain in November, 1986. A chest X-ray and chest CT scanning showed right pleural thickening and effusion, and left pleural thickening with calcification, but no obvious mass in the lung. Examination of pleural effusion and sputa revealed no malignant cells, and pleural biopsy was non-diagnostic. The patient deteriorated gradually and died on December 23, 1986. At autopsy the right lung was almost coverd by a layer of grey-white tumor, which suggested malignant mesothelioma grossly. However squamous cell carcinoma was diagnosed by histological examination. It is very rarely that squamous cell carcinoma imitates malignant mesothelioma clinically and grossly.

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A 51 year-old male was referred to our department because of an abnormal chest X-ray, obtained during a routine physical examinaiton. The P-A chest film revealed an abnormally prominent right cardiac silhouette. A right decubitus film showed displacement of a portion of the right cardiac silhouette into the right hemithorax. On the basis of these findings, absence of the right pericardium seemed the most likely diagnosis. Non-selective pulmonary angiography demonstrated that the prominent silhouette was formed by the right atrium. This is the second case of pericardial defect on the right side in Japan and the thirteenth case in the world.

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A 36-year-old female was hospitalized due to hemoptysis and severe respiratory failure with sudden onset. Twenty years prior to admission, systemic lupus erythematosus (SLE) had been diagnosed. Chest X-ray film revealed extensive infiltrates in both lung fields. She was treated with “pulse” methylprednisolone therapy because it was judged that this hemorrhage was complicated with SLE. After a transient remission for a few weeks, she died of recurrent intrapulmonary hemorrhage on the 30th hospital day.
Autopsy findings showed diffuse hemorrhage in the alveolar spaces without alveolitis. Immunofluorescence studies revealed granular deposition of IgG on glomerular capillary of the basement membranes in kidneys, but no immunoglobulin deposition in lungs.

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We report a case of pulmonary parenchymal leiomyoma. The patient was a 50-year-old female, with a tumor in the anterobasal segment of the right lung. Right lower lobectomy was performed. The tumor was 4×2×2cm in size, showing smooth and yellow-white cut sufaces. Specific stainings, including immunostaining and electron microscopy, established a diagnosis of pulmonary leiomyoma.

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A 45 year-old woman was admitted on June 26, 1986 complaining of somnolence and general malaise. Approximately 2 weeks before admission she had noticed dry cough, exertional dyspnea and diarrhea. One week previously she had nausea and vomiting. She could not take any food and was confined to bed. Laboratory data on admission showed hypercalcemia (serum Ca 18.8mg/dl). She received drip infusion of saline solution (2-4l/day), furosemide (20mg/day), calcitonin (40-80u/day) and prednisolone (40mg/day) for 7 days and her serum Ca level decreased within normal limits. Meanwhile, her dyspnea increased and her chest radiograph showed a diffuse ground glass appearance in both lung fields. Bone scintigraph with ^99mTc and ⁶⁷Ga scintigraph showed marked diffuse deposition of radioactivity in both lungs. Transbronchial lung biopsy was done. Microscopic examination revealed pulmonary edema and deposition of fine calcium granules in alveolar walls. Subsequently, 500mg/day methlprednisolone was administered in pulse therapy for 3 days and thereafter 40mg/day of prednisolone was continued. In the middle of August prednisolone was tapered and stopped. Her dyspnea and cough reappeared and her chest radiograph also worsened. Transbronchial lung biopsy was repeated. Microscopically calcium deposit in the alveolar wall aggregated and formed coarse granules. Besides it there was infiltration of mononuclear cells and scattered foreign body giant cells in the alveolar wall.
These findings suggested that active fibrotic reaction to foreign body was in progress in the alveolar wall. Thus 30mg of prednisolone was administered for anoher one and half months. She became free from symptoms and was discharged in November 9. She has been doing well so far. The origin of her hypercalcemia remains unexplained, although we suspect humoral hypercalcemia of malignancy (HHM).

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A 48 year-old male was admitted to Kanazawa Medical University Hospital because of abnormal shadow on chest X-ray film. He had had backpain for 13 years with gradually progressing kyphosis and limitation of spinal movement. He was free from respiratory symptoms until December 1985, when he noticed cough, dyspnea, fever and general malaise. Physical examination revealed marked kyphoscoliosis and limited respiratory movement of the chest. A dull percussion note was present over the right upper lung. There were no joint deformities in the extremities and no clubbing of the fingers. Tissue typing was positive for HLA-B 27. The radiograms of his spine and pelvis showed typical “bamboo spine” and bilateral sacroiliitis. Ankylosing spondylitis was diagnosed.
The radiogram and CT scan of his chest showed pleural thickening, marked pulmonary volume loss, cavitary formation and bronchiectasis. No acid-fast bacilli were found in the sputa, bronchial lavage fluid, gastric juice, urine or cerebrospinal fluid and the tuberculin test was negative. He was treated with antituberculous agents, but did not respond to therapy. Transbronchial biopsy specimens taken from the superior segment of the right lower lobe showed non-specific chronic inflammatory changes of the alveolar septa, i. e., lymphocyte infiltration, fibrosis and no evidence of granulomatous lesions. We conclude from the above-mentioned evidence that the pulmonary involvement in this case is one of the systemic manifestations of ankylosing spondylitis. To our knowledge, such a case with pulmonary involements as described here has not previously been reported in Japan.

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