Nine patients with, chronic obstructive pulmonary disease (COPD) were studied to determine the effect of chlormadinone acetate (CMA), a potent synthetic progesterone, on cardiorespiratory responses during exercise.
One week of CMA administration caused a significant increase in minute ventilation (V_E) both at rest and during exercise, but no significant change was found in oxygen consumption (V_O2). Therefore these changes resulted in the decrease of oxygen removal (V_O2/V_E) both at rest and during exercise. On the other hand no significant change was observed in heart rate and oxygen pulse by CMA administration when we evaluated these parameters as the index of cardiac response. In addition, when ventilatory and occlusion pressure responses to CO₂ were measured at rest, CMA administration decreased the ratio of the ventilatory response (Δ_I/ΔP_CO2) to occlusion pressure response (ΔP_0.2/Δ_CO2). These results may partially explain the increased dyspnea found in some patients during CMA administration.

View full abstract

Absorbent atelectasis of the right inferior lobe of the lung was experimentally induced in 20 mongrel adult dogs under thoracotomy to determine the blood flow volume before and after inducement of atelectasis. The composition of the inhaled air was changed in the order of (1) 100% O₂, (2) room air, (3) 12% O₂ and (4) 5% CO₂. The results were:
1) Regardless of the type of inhaled air, the blood flow volume in atelecetasis was less that during bilateral pulmonary ventilation.
2) When the concentration of oxygen for ventilation of the contralateral lung was low, the blood flow volume in atelectasis was increased.
3) There was a negative correlation between the ratio of the blood flow volume in atelectasis to the total pulmonary blood flow volume (%Qr) and the amount of oxygen in the pulmonary arterial blood (CvO₂).
4) There was no difference in the blood flow volume in atelectasis during inhalation of 5% CO₂ and that during inhalation of room air.
The above results revealed that the blood flow volume of the lung with atelectasis was decreased by the presence of atelectasis and that the degree of decrease was not constant; it changed with the composition of the air inhaled into the contralateral lung and the blood flow volume was significantly decreased when the concentration of the inhaled oxygen was high. In discussing changes in the blood flow volume in unilateral atelectasis, it is also necessary to consider conditions for ventilation of the contralateral lung and the blood flow volume of the contralateral lung.

View full abstract

To date there has been no report on the pattern of arrangement of secondary pulmonary lobules in the lung, which were established as an anatomico-functional unit of the lung by the study of Miller in 1947. In order to study this problem we performed geometrical analysis on the lobular polyhedra and proposed a new structural model (lobular model) to explain various mechano-rheological properties of the lung instead of the usual alveolo-bronchial model.
The tracing of the network of the connective tissue on the surface and cut surface of the full inflated lung clarified the appearance of lobule which was present in various shapes and sizes. When this network was looked on as the set of corners, sides and faces, from geometrical analysis on this network of two inflated human lungs (right upper love of a 76 year-old female and left upper lobe of a 38 year-old male) the following properties of a lobular polyhedron emerged; (1) the vertices of the lobular polyhedron were generally tetrahedral, (2) the number of sides of faces on lobular polyhedron varied from 3 to 9 with many pentagonal faces (about 34%), (3) the lobular polyhedra were packed uniformly in all direction. These properties suit partitions of space into polyhedral cells by “random close-packing” of bodies such as aggregates of soap bubbles.
Since by the Voronoi transformation method produces an amorphous lattice of randomly close-packed polyhedra, it was possible to look at the lobular polyhedron as a Voronoi polyhedron. This arrangement of bronchovascular branches on the edges of the Voronoi polyhdron we named the “lobular model”. According to Suwa's theorem (equilibrium space division, 1981) some rheological properties of the pulmonary arterial tree could be explained based on our lobular model.
Although the lobular model remains to be applied to solve the problem of discrepancies between the lung structure and its function in normal and/or diseased states, this model may be more realistic than the usual alveolo-bronchial model.

View full abstract

The effects of age and smoking on the pulmonary surfactant content were examined by measuring the disaturated phosophatidylcholine (DSPC) content of the 27, 000×g precipitate of bronchoalveolar lavage fluid (BALF) obtained from 64 normal men aged 20 to 26 years old and 152 male patients aged 30 to 78 years old who had a localized lung disease.
The DSPC content of BALF was almost the same in nonsmokers aged 20-69 years old, but tended to decrease with aging in smokers of 20-78 years old. A negative correlation between age and DSPC content of BALF was found only in the smokers (r, -0.648). There was no significant difference betwen the DSPC content of nonsmokers and smokers aged between 20 and 49 years old, but that of smokers was significantly lower than that of nonsmokers in the 50-60 age group. The DSPC content of nonsmokers aged 70-78 years old was about half of that of nonsmokers aged 20-26 years old, and not significantly different from that of smokers of the same age. The decrease of DSPC content was found only in subjects with a significant decrease in V25/Ht.
It is concluded that the pulmonary surfactant content of BALF is influenced by both smoking and aging but influenced more by smoking than by aging, and its decrease in smokers is closely related to the length of their smoking history. It is suggested that the decrease becomes detectable in subjects with prominent pathologic changes in the lung by smoking and aging.

View full abstract

The localization of proteoheparan sulfate was examined in normal human lung using immunoelectron microscopy. Proteoheparan sulfate was present not only in endothelial, alveolar epithelial and bronchial epithelial basal laminae, but also in basal laminae of fibroblasts and smooth muscle cells. The pleural basal laminae were not stained by the antibody against proteoheparan sulfate. Proteoheparan sulfates were seen as fine granules, 30-100nm in diameter on the basement membrane.

View full abstract

We studied the effects of local therapy on carcinomatous pericarditis in 30 lung cancer patients. There were 16 males and 14 females and the average age was 53.3 years. They consisted of 13 adenocarcinomas, 8 squamous carcinomas, 4 small cell carcinomas, 4 large cell carcinomas. We divided them into two groups from the view point of the pattern of the local therapy.
Ten out of 30 patients (group A) received treatment by only removal of pericardial effusion and the remaining 20 patients (Group B) had local instillation of antineoplastic agents after drainage.
The median survival time was 5 weeks in the group A and 10 weeks in the group B, and there was no statistically significant difference. However in group B, there was no death within 1 week after the local therapy and 6 long-time-survivors (surviving for more than 15 weeks) were observed. It was suggested that local instillation of antineoplastic agents after the removal of the pericardial fluid was more effective than the removal of the effusion alone.
In autopsy findings of the pericardium and epicardium of 17 cases, there were no marked differences between the cases of each group. However some differences in the pattern of metastasis were observed between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). The metastatic nodules of SCLC were larger and the tumor cells infiltrated more vigorously into the myocardium than those of NSCLS and myocardial fibers surrounded by them were atrophic.
Because of the special sensitivity of SCLC to irradiation, the addition of radiotherapy after the removal of effusion may be effective to control carcinomatous pericarditis.

View full abstract

Recently, the number of patients with malignant mesothelioma has increasd in Kure Kyosai Hospital. We investigated the relation between malignant mesothelioma and asbestos exposure in 8 pleural malignant mesothelioma cases after autopsy. The occupational history, indicated that 7 out of 8 patients had worked in the Japan Naval dockyard before and during World War II. The other case had a definite history of asbestos exposure. Mesotheliomas came out after 25 to more than 40 years of the first asbestos exposure.
When we lysed the autopsy lung tissue not involving tumor site by using sodium hypochrolite, we detected many asbestos bodies (from 522 to 149, 160) per 5g of lung tissue. These numbers are significantly (p<0.01) higher than those of non-cancer patients. Patients with more than 30, 000 asbestos bodies had pleural plaques with calcification revealed in their chest X-ray. On the other hand, we analysed these asbestos bodies with a scanning electron-microscope and X-ray analyser. Most of these were composed of crocidolite or amosite, and some were chrysotile.
Thus, we determined that all of these 8 patients with pleural malignant mesothelioma had been induced by asbestos exposure, especially crocidolite or amosite.

View full abstract

A 45 year-old man with Shy-Drager syndrome was admitted to Chiba University Hospital for detailed examination of his sleep apnea, because he once had experienced respiratory arrest during sleep. There were no symptoms referrable to the respiratory system. Spirometry showed normal %VC and FEV1.0%. Paco₂ was normal at 38 Torr but there was mild hypoxemia (Pao₂; 72 Torr). Ventilatory responses to either CO₂ or hypoxia were preserved. In addition, the heart rate response to hypoxia was also preserved in this patient in whom autonomic function was impaired. However, the load compensation response to an artificially increased flow resistance was impaired when it was assessed by the ratio of the loaded to unloaded slope in the occlusion pressure response to CO₂.
He underwent overnight polysomnographic study and he exhibited abnormal breathing patterns. These were all found to be obstructive type and were mainly demonstrated to appear in stage 1 to 2 sleep with a periodic pattern of breathing, but they were not accompanied by severe arterial oxygen desaturation. The lowest Sao₂ during sleep was 83%.

View full abstract

A 61 year-old woman was admitted to National Yamanaka Hospital on June, 15, 1985 with fever, cough, mucoid sputum and general malaise for a month. There was no history of smoking or exposure to toxic gas. Physical examination revealed goiter and early inspiratory crackle in her right lower lung field. There was no cyanosis or clubbed fingers. The chest X-ray film showed diffuse peripheral infiltrative shadow on the right side. The diagnosis on admission was bacterial pneumonia. The patient was treated with antibiotics, but in vain. She was transferred to Kanazawa Medical University Hospital on July, 26, 1985. The antibiotic therapy was halted and open lung biopsy was done on Aug., 10, 1985. The pathological diagnosis was bronchiolitis obliterans organizing pneumonia (BOOP). She was treated with steroid therapy (prednisolone 40mg orally per day) on August, 10, 1985. There was a good response to steroid therapy. In this case, the etiologic facter was unknown. Some relationship was suggested between the chronic thyroiditis and BOOP. During the course, the specimens of TBLB which had been performed two times in the previous hospital, were not contributory to definitive diagnosis. A final diagnosis was made on the pathological basis of the open lung biopsy specimen.

View full abstract

Eosinophilia (about 27, 000/mm³) was pointed out in a 53 year-old woman in July 1980 and PIE syndrome was diagnosed in November of the following year. On September 1983, she was admitted with complaints of general fatigue, vertigo, hyperesthesia and myoclonus of the left lower extremities and thirst.
Bone marrow examination revealed eosinophilia but no increase of blast cells or abnormal immature cells. The chest roentgenogram showed small nodular shadows in both lower lung fields. After admission, Jacksonian type convulsion appeared. Subsequently, swelling, pain and local heat sensation in both lower extremities were observed. These findings, such as thrombophlebitis, were not improved by antibiotics or heparin, which improved by steroid therapy.
In June 1983, as peritonitis and ileus developed, laparotomy was performed. In the abdomen, partial necrotic change of the ileum and numerous thromboses in mesenteric vessels were found. Microscopically, eosinophilic infiltration was marked in the areas surrounding arteries and veins in the ileum and mesenterium. The wall of veins was degenerated with fibrinoid necrosis. Subsequently, GI bleeding and DIC occurred and she died of multiple organ involvement.
The case was diagnosed as hypereosinophilic syndrome based on the findings such as remarkable persistent increase of eosinophils in peripheral blood and bone marrow and eosinophilic infiltration in lung, muscle, ileum and mesenterium, while no other cause of eosinophilia was found.

View full abstract

A 71 year-old man had an isolated calcified lesion in the intrathoracic-extrapleural space. Fluoroscopic examinations revealed that this calcified material shifted in the left intrathoracic space, due to the movement of the diaphragm when the patient breathed and coughed. We successfully removed this material using a basket forceps, during flexible thoracoscopy.
The obtained material (15×12×8mm) was very hard, white and glossy at the surface; it weighed 1.1g. Chemical analysis showed that it contained 67% calcium phosphate and 33% calcium carbonate. Histological examination disclosed that it contained some structures that resembled connective tissues, vessels and adipose tissue which occupied a large part of this material, and that it was surrounded by a capsule consisting of fibrous connective tissue.
We speculated that the material originated from a lipoma that had arisen from the chest wall or peripheral region of the lung, and that the lipoma might have degenerated, entering the intrathoracic space and become calcified during this process.
No similar case has been reported in the literature. We decided to coin a name for this case; “thoracolithiasis”.

View full abstract

We experienced 2 cases of Legionnaires' disease. Case 1 was a 70 year-old man whose main complaints were cough and fever. His chest X-ray film showed a ground glass shadow in the lower lung field. Because he developed acute respiratory distress and renal failure soon after hospitalization, hemodialysis and mechanical ventilatory assistance was started. Laboratory findings indicated the presence of multi-system involvement, including renal, hepatic, cardiac and muscle lesions. Legionella pneumophila serogroup 1 was isolated from his endobronchial aspirate. This patient died due to DIC and pseudomonas pneumonia on hospital day 29.
Case 2 was a 60 year-old man with fever, cough and dyspnea. His chest X-ray film indicated a rapid spread of peripheral infiltration into the entire right lung by the presence of ground glass shadow. He exhibited mental confusion and renal and hepatic insufficiencies as well as elevation of CPK. His symptoms were abated by treatment with erythromycin and rifampsin. During this patient's convalescence, a definitive diagnosis of Legionnaires' disease was made by the indirect fluorescent antibody test, in which his serum antibody titer was found to be 1/2048.
As for characteristic phenomena, these 2 cases showed the rapid spread of lobar ground glass shadows on chest X-ray films in addition to multi-systemic disorders including those of renal, hepatic, cardiac, muscle and central nervous systems.

View full abstract

A 23 year-old morbidly obese woman was admitted for evaluation of a 1-year history of exertional dyspnea. At age 9 years, she was admitted-complaining of massive hematemesis. The cause of hematemesis was not clear, but thrombocytopenia, splenomegaly and light liver dysfunction were pointed out at the time. She began to gain weight since age 12 although she was admitted to receive weight reduction therapy at age 16 and 19, when the same abnormal findings were pointed out. During has present admission, right heart catherization test revealed severe pulmonary hypertension (mPAP 65mmHg) and normal wedge pressure (6mmHg). Abdominal angiography demonstrated extrahepatic obstruction of the portal vein with portal-left inferior vein caval shunt. Our data suggested that extrahepatic obstruction of the portal vein already existed since the age of 9, and later developed pulmonary hypertension at age 22.

View full abstract

Pulmonary involvement is an uncommon finding in Epstein-Barr virus (EBV) infection. A case of EBV infection with interstitial pneumonitis was reported. A 25 year-old male was admitted to our hospital with complaints of fever and dry cough. Marked hepatosplenomegaly was noted. A chest radiograph showed multiple nodular shadows in both lung fields, especially in the lower lobes. Arterial blood gas analysis showed hypoxia and pulmonary diffusion capacity was decreased. The white-cell count was 1100/mm³, the platelet count 2.4×10⁴/mm³, the LDH 1107 IU. The bacteriological examinations of blood, sputum and BALF were negative. TBLB revealed an interstitial infiltrate of lymphocytes extending into the interalveolar septa and formation of Masson's bodies. These findings showed an interstitial pneumonitis and alveolitis. Serum antibodies to EVB were examined. The titer of anti VCA-IgG was increased from 640 to 5120, anti VCA-IgA from <10 to 320, anti EAD-IgG from 320 to 5120 and anti EBNA from 40 to 160. The results of BALF supernatants for EBV serological profiles suggest alveolar production of EBV-specific immunoglobulins. This case is of interest because EBV may play a part in the etiology of interstitial pneumonitis.

View full abstract