[in Japanese]

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Thirty patients (16 male, 14 female) with Mycoplasma pneumoniae pneumonia have been encountered in the past 2 years. Fifteen cases (7 male, 8 female) diagnosed as severe were treated by hydrocortisone (5mg/kg, for 5-7 days) combined with EM or DOXY.
This treatment brought about the rapid disappearance of fever, coughing attacks and abnormal shadow on chest x-ray. Immunosuppressed animals infected with Mycoplasma reportedly showed a much less severe reaction reaction than immunologically normal animal. We consider severe Mycoplasma pneumoniae pneumonia to be caused by immunological hyperreaction in the host with Mycoplasma pneumoniae infection.
Therefore, concomitant administration of hydrocortisone for severe Mycoplasma pneumoniae pneumonia appears to be very effective in improving the condition of local immunological hypersensitivity.

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Nonspecific bronchial responsiveness to methacholine chloride was assessed by an astograph in 20 non-smoking, non-atopic and non-steroid-treated patients with sarcoidosis, 43 asthmatics and 20 normal subjects. Before the study, baseline pulmonary function tests and serum angiotensin-converting enzyme level were measured.
1) In patients with sarcoidosis, Dmin (bronchial sensitivity) was significantly reduced compared to normal subjects (p<0.01), and bronchial hyperresponsiveness to methacholine was observed.
2) No significant correlation was observed between Dmin and duration of disease, and no significant difference in Dmin was observed between chest X-ray type 1 and chest X-ray types II and III.
3) No significant correlations were observed between Dmin and baseline pulmonary function tests (%VC, FEV_1.0%, %MMF, %V₅₀, %V₂₅, %ΔV₅₀, %ΔV₂₅, %Visv) in patients with sarcoidosis.
4) Significant correlation was observed between Dmin and serum angiotensin-converting enzyme levels in patients with sarcoidosis (p<0.02).
5) Bronchofiberscopic findings of inflammation (capillary dilatation and/or redness of bronchial mucosa) were more frequent in responders (Dmin<50unit) than nonresponders (Dmin≥50 unit) in patients with sarcoidosis.
These results suggest that bronchial hyperresponsiveness to methacholine in patients with sarcoidosis is related to bronchial mucosal inflammatory changes with active sarcoidosis lesions.

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Lung cancer was found in 10 (15%) of 67 patients with idiopathic interstitial pneumonia (IIP). In a retrospective study, 10 patients with IIP in chest roentgenograms were found among 440 patients with primary lung cancer. Of these 20 patients (10 IIP patients with lung cancer and 10 lung cancer patients with IIP findings), the average age 66 years, 15 (75%) were atypical cases previously proposed by us, and 19 (95%) were men. All these 20 patients smoked. In these patients, %VC, %TLC, %FRC and %RV were within normal range, but FEV_1.0% was low while it was not low in the IIP patients without lung cancer. %DL_CO/V_A was lower than the IIP patients without lung cancer. IIP-associated lung cancer was seen in the lower lobe in 12 (60%) patients. Histologically, 11 out of 20 (55%) were adenocarcinoma. Metastasis to other organs by lung cancer was observed in 10 (50%) even on the occasion of the first hospitalization. Thus, a close relation of IIP to lung cancer was suggested.

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Through a questionnaire, we examined the major onset time of asthmatic attack worsening at night (so-called nocturnal asthma (NA)) in 34 allergic asthmatic children in our hospital. All of them had been shown to have frequent episodes of NA before admission. As a result, it was shown that NA frequently developed early in the evening (5-8pm)in the majority of study subjects (56%). In these children, it was suggested that asthmatic attacks in the evening, or in other words, worsened lung function in the evening might be one of the causes for the development of NA. It was thus considered that it would be important for the treatment of NA to study exacerbating factors on lung function at the time in these children.
To study the relationship between exacerbation of lung function in the evening and the degree of cholinergic tone at the time, eight NA children with such characteristics were examined by beat-to-beat variation of the heart rate (BVHR) at 9am, 2pm, and 7pm. The PEFR at 7pm was shown to be significantly lower than at 9am and 2pm in these children. BVHR was quantitatively measured as a coefficient of variation of the R-R interval (CVR-R, see ref 14). As a result, CVR-R in these children was significantly increased at 7pm, while it was not in those of asthmatic children who did not have any diurnal variation in PEFR between the period examined and in nonallergic disease controls. On the other hand, ipratropium bromide was effective for the improvement of PEFR at 7pm in six of eight study subjects. Moreover, there was significant relation between the levels of PEFR in the evening and the occurence of NA in two subjects with frequent NA even after admission.
It was, therefore, suggested that the cholinergic system might be one of the factors for the exacerbation of PEFR at evening, and anticholinergic drugs might be useful for the patients whose NA frequently developed early in the evening.

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Clinical studies of eleven cases with primary pulmonary cryptococcosis, during the past ten years from 1977 to 1986, were performed mainly with respect to medical treatment.
All cases were diagnosed by transbronchial lung biopsy (TBLB) and percutaneous lung biopsy. Symptoms and laboratory data were non-specific, and the roentgenographic appearances were varied and gave no clue to the diagnosis. Immunological examination showed depressed cellular immunity in eight of eleven cases at the time of admission.
Ten cases were treated with antifungal agents, such as 5-fluorocytosine, Amphotericin B, Miconazole and Ketoconazole. Of these ten, five cases were treated with 5-fluorocytosine alone for six to nine months. In these five cases, the chest abnormal shadows had 50 to 75% improvement within two or three months as in cases treated with other combination therapy of antifungal agents. One of them treated with 5-fluorocytosine for only 1.5 months, showed remarkable improvement and no relapse.

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Anti-adult T cell leukemia antigen (ATLA) antibody and its related reactions were examined in 12 patients with diffuse panbronchiolitis (DPB), because we initially found in 1978 that the disease was sometimes followed by ATL. As a result, three of 12 DPB patients were positive for anti-ATLA antibody showing a positive granular pattern in MT-1 cells and also a positive diffuse pattern in MT-2 cells, and were diagnosed as adult T cell leukemia because of the appearance of leukemic cells in peripheral blood and bone marrow. Anti-ATLA like antibody with diffuse patterns in both MT-1 and MT-2 cells was detected in 5 of 12 sera in patients with DPB. A diffuse pattern only in MT-2 cells was found in 2 cases of 12 diffuse panbronchiolitis. A positive diffuse pattern in MT-2 cells was shown in 10 of 12DPB patients in total. On the other hand, 12 cases of bronchial asthma, 21 cases of sarcoidosis and 20 healthy controls were all negative for anti-ATLA antibody and its related reactions except for only one case of sarcoidosis which showed a positive MT-2 diffuse pattern.
These findings suggest that there is a close relationship between DPB and adult T cell leukemia, and that ATLA-related reactions, including anti-ATLA like antibody, may be useful in the diagnosis of DPB. The onset of adult T cell leukemia is not clear, though the leukemic cells seems to appear after the respiratory symptom.

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Anti-adult T cell leukemia antigen (ATLA) antibody and its related reaction were examined in 12 patients with idiopathic interstitial pneumonia in a tumor related virus study, concerning the high incidence of lung cancer in case with this disease. At first, tests for anti-ATLA antibody, expressed by a granular pattern in MT-1 cells, were all negative in sera of patients with the disease. However, anti-ATLA like antibody in ATLA-related reactions, showing diffuse pattern in both MT-1 and MT-2 cells, was observed in 5 of 12 idiopathic interstitial pneumonia patients. The ATLA-related reaction, showing a diffuse pattern in only MT-2 cells, was also observed in 3 of 12 patients with the disease. In total, ATLA related reaction in MT-2 cells with a diffuse pattern was observed in 8 of 12 patients with idiopathic interstitial pneumonia. On the other hand twenty-one cases of sarcoidosis, 12 cases of bronchial asthma and 20 healthy controls were all negative in anti-ATLA antibody and its related reaction except for only one case of sarcoidosis that showed a positive MT-2 diffuse pattern. Therefore, the ATLA related reaction might be useful in the diagnosis of idiopathic interstitial pneumonia as well as diffuse panbronchiolitis.
Adult T cell leukemia like cells appeared in 5 of 7 patients with positive MT-2 diffuse patterns in idiopathic interstitial pneumonia, showing a correlationship between the incidence of the cell and serum titer of the reaction. It is suggested that there is a close relationship between idiopathic interstitial pneumonia and adult T cell leukemia, although the nature of the ATLA-related reaction is still unknown.

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A 42-year-old woman with liver cirrhosis and Sheehan's syndrome was admitted because of severe hypoxemia. Mild increase of cardiac output was detected by right heart catheterization, which also excluded a L-to-R shunt and pulmonary hypertension. Pulmonary artery angiography revealed no abnormal circulation or vessels except a dilatation of the portal vein. Very low diffusing capacity and small airway obstruction were detected by pulmonary function tests. The shunt ratio calculated after administration of 100% oxygen for 30 minutes was 16.3%. A perfusion lung scan using ^99mTc macroaggregated albumin (^99mTc-MAA) demonstrated that 77.3% of injected ^99mTc-MAA passed through the lung and visualized capillary beds in end organs. Microscopic examination of lung tissue obtained by transbronchial lung biopsy showed no remarkable changes in the interstitial area.
These findings suggested that severe hypoxemia in this case was caused by a shunt-like effect due to pulmonary microcirculatory dilatation, which reduced pulmonary diffusing capacity and increased ventilation-perfusion ratio inequality.

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A 73-year-old male case of primary lung cancer with high alpha-fetoprotein (AFP) level is reported. The patient complained of cough and sputum. On chest X-ray, an abnormal shadow in the right lung field was seen. Serum AFP level was as high as 4590ng/ml. Primary hepatoma, gastrointestinal tumors and mediastinal tumors were ruled out by echogram, scintigram, GIS and CT.
Right upper lobectomy was done on 9 August, 1983. Histopathological finding of the specimen was adenocarcinoma of the lung. Immunohistochemically, AFP was localized only in the well differentiated tubular component with eosinophilic cytoplasm, but not in the moderately differentiated adenocarcinoma with small clear cytoplasm. These findings are in agreement with previously reported immunohistochemical analyses on these cases.
In this case, urinary and bronchoalveolar fluid AFP level was also high.

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A 42 year-old female was hospitalized because of dyspnea and anemia. The diagnosis of SLE was made based upon the findings of polyarthritis, proteinuria, and the presence of ANF and anti-DNA antibody. After admission, she became acutely dyspneic and anemic. Chest roentgenogram showed diffuse alveolar infiltrates. Bronchoscopy was preformed and the diagnosis of alveolar hemorrhage was made because of the bloody bronchoalveolar lavage fluid. The patient was intubated and pulse therapy was initiated. The abnormal opacification in the chest roentgenogram was resolved within a week and no more hemorrhage was observed after four series of pulse therapy.

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