Nineteen families (108 family members) including patients with bronchial asthma were studied in terms of HLA genotype, serum IgE level, skin tests and RASTs. The results of skin test and RASTs were varied in decades of age, and the highest percent positive of the tests as well as serum IgE level were observed in the 20's. From these results, we considered that the analysis of the results of skin test, RAST and serum IgE level should be performed in HLA identical siblings close in age. The following results were obtained:
1) Significant correlation of serum IgE level between younger and older HLA identical siblings was not obtained.
2) Significant correlations between HLA genotype and skin reactivities to house dust, mite, Candida, as well as between HLA genotypes and RAST were not observed.
3) The skin test results of house dust and mite were markedly correlated to the serum IgE level (P<<0.001 in both) except Candida, however they did not correlate to HLA genotype.
4) In the case of genetical analysis of skin test and RAST results in patients with allergies, the age of subjects should be considered.

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Long endurance training for 10 weeks was performed with female Wistar rats employing a treadmill. A difference in the mean body weight was found between the control and the training group. The histochemical profile, the capillary supply and the energy metabolism of the respiratory muscles (the diaphragm, the external intercoastal muscle and the internal intercostal muscle) were analysed. The respiratory muscles could be classified into four types by myosin ATPase staining. These are type 1 fiber (slow twitch oxidative or slow fatigue resistant fiber), type 2A fiber (fast twitch exidative glycolytic or fast fatigue resistant fiber), type 2B fiber (fast twitch glycolytic or fatigable fiber) and type 2C fiber (primitive fiber).
Although the percentage of the number and the relative area of type 1 fiber and type 2C fiber increased after training, those of type 2A fiber were apparently decreased in the diaphragm, in contrast with the intercostal muscles. It was speculated that type 2A fiber were transformed to type 1 fiber via type 2C fiber as the result of endurance training.
Capillary density and the capillary-to-fiber ratio (C/F ratio) of the diaphragm were higher than that of the intercostal muscles. After the training, C/F ratio was increased in the diaphragm, but not in the intercostal muscles.
Lipoprotein lipase (LPL) activity in the diaphragm was higher than in the intercostal muscles even in the control. Moreover, training caused further elavation in the LPL activity in the diaphragm, but no change in the intercostal muscles.
The diaphragm responded to long endurance training with significant increase in the oxidative capacity, capillary-to-fiber ratio and LPL activity and adapted to become resistant to fatigue. These findings also support the proposal that the availability of metabolic energy differs between the diaphragm and the intercostal muscles.

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We measured α-hANP concentration in peripheral venous blood (V-ANP), systemic arterial blood (F-ANP), and pulmonary arterial blood (P-ANP) and also investigated the relationships between P-ANP and pulmonary hemodynamics and arterial blood gas data in 15 patients with chronic respiratory failure. V-ANP was 31.4±14.4pg/ml, and apparently greater than the values obtained in 10 normal subjects (<10pg/ml). P-ANP (91.4±70.6pg/ml)was approximately three times of V-ANP and almost the same as F-ANP (89.4±74.0pg/ml). P-ANP correlated well with mean right atrial pressure, mean pulmonary arterial pressure, and total pulmonary vascular resistance, but not with cardiac output and arterial blood gas data. P-ANP tended to be higher in patients with congestive heart failure(CHF)than in those without CHF. These results suggest that α-hANP may be closely related to pulmonary hemodynamics and therefore may be very useful for the noninvasive evaluation of pulmonary hemodynamics and right-sided heart failure in patients with chronic respiratory failure.

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To determine the change of ventilation, alveolar gas exchange and metabolic rate during sleep, we measured minute ventilation (VE), O₂ consumption (V_O2), CO₂ production (V_CO2), respiratory exchange ratio (R) during sleep in healthy human.
Eight normal male subjects (ages 21-24, mean 22.2) were studied during two nights of sleep (for 5-7 hours) by polysomnography (EEG, EOG, and EMG). With sampling the expired gases from tight fitted face masks connected to mass spectrometer, VE, V_O2, V_CO2, and R were calculated breath by breath. Sleep was scored in a standard manner by 20 seconds. We chose all parts in which one sleep stage continued stably, and all breaths of that part were analyzed. We excluded any part of body movements in one successive sleep stage.
1. VE decreased in NREM and REM sleep compared with stage wake (SW).
2. Frequency (f) decreased in NREM sleep compared with SW.
3. V_O2 and V_CO2 decreased in NREM sleep compared with SW.
4. R decreased in REM sleep compared with SW and NREM sleep.
5. V_O2 and V_CO2 correlated closely with VE during all stages of sleep (SW, stage 2, stage REM).
Tidal volume decreased during REM sleep. We suggest that reduction of R in REM sleep is mainly caused by decrement of tidal volume, but alteration in the distribution of ventilation-perfusion matching and change of metabolism during REM sleep may be contributed in normal humans.

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Hypersensitivity pneumonitis (HP) has been presumed to be induced by immunological mechanisms, in which lymphocytes play the most important role. In contrast, the significance of neutrophils in the pathogenesis of HP remains controversial. The current study was undertaken to explore the possible role of chemotactic activity for neutrophils in the pathogenesis by an analysis of the cells and chemotactic activity in the fluids obtained by bronchoalveolar lavage (BAL).
Three patients with summer type HP were lavaged at both the acute and the non-acute stage. The acute stage examination was performed within several hours of cessation of exposure to the presumptive causative agent.
The results indicate that: 1) The percentage of Polymorphonuclear cells (PMNs) in BAL fluids obtained within several hours of avoidance of exposure increased up to 15%, while the percentage of both macrophages and lymphocytes decreased. However, the number of both macrophages and lymphocytes showed inconsistent changes depending upon the individuals. 2) Chemotactic activity for normal peripheral PMNs in BAL fluids recovered within a short period after the last antigen exposure was more active than in the non-acute stage. 3) The percentage of PMNs in BAL fluids increased in proportion to chemotactic activity for PMNs in BAL fluids showing a significant correlation. 4) Chemotactic activity for post-challenge mononuclear cells in BAL fluids varied considerably from patient to patient.
These results suggest that chemotactic activity for PMNs plays a significant role in the early stage of HP.

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Arterial blood gas tensions and pH changes at the start of exercise were studied in ten patients with chronic obstructive pulmonary disease (COPD) and compared with those in five normal men. Ventilatory and gas exchange kinetics during the unsteady state of the same exercise were measured by the breath-by-breath method, and their influence on the arterial blood gas tensions were also studied.
Exercise on a bicycle ergometer were performed with two-step work loads (OW & 25W for the COPD group, 25W & 158±14.5W for the normal group).
1) The COPD group showed the lowest decrease in PaO₂(14.0±7.6Torr) from rest value at the 2nd min of 25W work and this PaO₂ fall continued to the 5th min, while the normal group showed the lowest fall in PaO₂ (16.9+9.2Torr) at the lst min of 158W work, but its PaO₂ fall recovered to the rest value at the 3rd min.
2) Increase in PaCO₂ and decrease in pH at the 1st min of 25W work continued to the 5th min in the COPD group, and transient increase in PaCO₂ at 1.5min of 158W work and continuous decrease in pH from the 1st min of the same work were observed in the normal group.
3) No changes in arterial blood gas tensions and pH were observed during 0W work in the COPD group and 25W in the normal group.
4) VE kinetics were significantly slower than VO₂ kinetics during 25W work in the COPD group and 158W work in the normal group. This VE kinetics dissociation from VO₂ kinetics were considered to cause the transient fall in PaO₂.
5) The fall in PaO₂ and increase in PaCO₂ continuing to a steady state of 25W work in the COPD group seemed to occur due to the disturbance of pulmonary gas exchange related to the abnormal VD/VT and AaDo₂ at its steady state.

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Investigations consisting mainly of analyzing questionaires were performed to evaluate the exact prevalence rate of bronchial asthma in adult inhabitants of Fujieda City. The subjects analyzed totalled 12, 562, and it was found that the rate of prevalence was 3.14%. There was no difference in this respect between males and females, and the rate was relatively high both in people aged 15-29 and elderly people. The rate of prevalence was higher in the area close to trunk roads, and correlated well with the concentrations of falling particulates.

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For many years, inspiratory short musical sounds, called squawks, squeaks, or short wheezes, have been described. However the acoustic charateristics have not yet been fully studied. We have studied the acoustic characteristics of squawks and compared than with wheezes and rhonchi. Squawks were recorded in 29 patients. They were divided into two groups. The first group consisted of interstial lung diseases including 7 asbestosis, 3 rheumatoid arthritis, 2 hypersensitivity pneumonia, 2 progressive systemic sclerosis, 1 systemic lupus erythematosus, and 1 idiopathic interstitial pneumonia. The second group consisted of other lung diseases, including 5 pulmonary tuberculosis. 4 bronchiectasis, 3 diffuse panbronchiolitis, and 1 pneumonia.
Squawks were picked up at the chest wall where squawks were best heard, using an electrect condenser microphone. Squawks and air flow at the mouth were recorded simultaneously with a two-channel tape recorder. We analyzed the duration, phase in inspiration number of overtones and rise time of the envelope of squawks, using a sound spectrograph and a high-speed meter.
Results were as follows;
1) Squawks were auscultated not only in interstitial lung diseases but also in other lung diseases.
2) Squawks were auscultated in inspiratory phase and associated with coarse of fine creakles.
3) The phase in inspiration of squawks was mid or late inspiratory. In interstitial lung diseases, the phase was 66±15% of inspiration, (mean±S. D.), in other lung diseases, the phase was 50±22% of inspiration. The phase was significantly later in interstitial lung diseases than in other lung diseases.
4) The duration of squawks was 67.5±40.4msec, shorter than wheezes. The pitch of squawks was 530±256Hz, higher than wheezes and rhonchi.
5) The number of overtones of squawks was 3.5±2.3. This value was significantly larger than that of wheezes and rhonchi.
6) The rise time of envelope of 29 squawks was 8.3±5.2msec and this value was considered to be shorter than that of wheezes.
Therefore, we can conclude that squawks fall into a different cathegory of musical sounds from wheezes or rhonchi, and the mechanism of production may be nearly equal to that of discontinuous adventitious lung sounds rather than that of continuous advantitious lung sounds.

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We evaluated high resolution CT in 60 patients with histologically diagnosed pulmonary sarcoidosis and, also, studied the relationship between CT and findings in open lung biopsy specimens in 2 cases. The CT findings were as follows: (1) thickening of bronchial wall shadows (27 out of 60 cases, 45.0%), (2) irregular enlargement of pulmonary vascular shadows (39 cases, 65.0%), (3) small or large nodular shadows (24 cases, 40.0%), (4) local volume loss (14 cases, 23.3%), (5) slightly increased density of localized lung field areas (24 cases, 40.0%), (6) pleural or subpleural involvement (27 cases, 45.0%), (7) lymph node enlargement (59 cases, 98.3%). X-ray CT in 7 patients revealed no evidence of lung field involvement in patients with histologicall confirmed epithelioid cell granuloma in transbronchial lung biopsy specimens.
Lesions located within vessels or in the vascular wall, perivascular sheath or alveoli surrounding blood vessels might cause pulmonary vascular shadows to appear swollen on CT. In a comparative study, we found irregular dilatation of pulmonary vascular shadows corresponding to granulomas in the connective tissue sheath of blood vessels. Also, thickening of bronchial wall shadows corresponded to granulomas in and around the bronchial wall. From the point of histopathological view epithelioid cell granulomas in the bronchovascular sheath were most marked in sarcoidosis, and they apperaed on CT as an irregular enlargement of pulmonary vascular shadows and thickening of the bronchial wall.
On the other hand, we reported that collapse of alveoli and fibrosis surrounding blood vessels could cause irregular enlargement of pulmonary vascular shadows on CT in idiopathic pulmonary fibrosis (IPF). Such shadows were seen on CT in both sarcoidosis and IPF but the mechanism of their appearance differed.
We found that small or large nodular shadows corresponded to conglomerated granulomas in bronchovascular sheaths or alveolar septa. The boundary of nodular lesions on CT appeared as fine projections because granulomatous lesions were noted on the edge along blood vessels.
We distinguished the increased density of localized lung filed areas from nodular shadows as representing inner vascular shadows. Such a finding could be caused by the summation of many epithelioid cell granulomas formed in the interstitium of peripheral lung tissue, such as in alveolar septa and around small blood vessels and bronchioles. There were frequent granulomatous lesions in the pleura or adjacent to the pleura which appeared on CT as pleural or subpleural involvement.
We concluded that high resolution X-ray CT is a valuable technique for detecting pulmonary lesions in patients with sarcoidosis.

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A 70-year-old female was admitted because of appetite loss, rapidly progressive glaucoma, transient erythema nodosum, peripheral right facial nerve palsy and bilateral hilar lymphadenopathy with right diaphragm palsy on chest x-ray film. Moreover she suffered left vocal cord palsy and numbness of the right forearm after admission. Findings of BAL examination and ⁶⁷Ga scintigram did not conflict with a diagnosis of sarcoidosis. Upper gastrointestinal tract examination was done because of positive fecal occult blood, and a gastric submucosal tumor was found. After subtotal gastrectomy pathological diagnosis of localized gastric leiomyosarcoma was made, but resected regional lymph nodes were occupied with obvious sarcoid granulomas which might be due to sarcoidosis rather than sarcoid reaction. Surprisingly, soon after the operation obstinate glaucoma, diaphragm paralysis, vocal cord palsy and numbness of the right forearm disappeared promptly. After about two months, mild glaucoma and numbness of forearms reappeared. These symptoms continued, but she remained well without relapse of the tumor for about two years.
It was interesting that her various symptoms which had rapidly progressed disappeared transiently soon after the resection of gastric leiomyosarcoma, and reappeared to a mild degree. We thought that in this case the activity of sarcoidosis might be enhanced by the tumor itself or its relationships and reduced by immunological suppression due to a large operation such as gastrectomy.

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A 20-year-old man was admitted for evaluation of dyspnea on exertion and an abnormal shadow on a chest roentgenogram. The chest roentgenogram showed attenuation of pulmonary vessels on both sides, dilatation of the main branches of pulmonary artery and a thin-walled small cavity in the left lower lobe. Laboratory data showed hypercoagulation and hypoxemia. Ventilation and perfusion lung scintigram showed normal ventilation with multiple perfusion defects, particularly in the left lower field. Digital subtraction angiograms showed obstruction of the left lower lobe, lingular and left basilar divisions of the left pulmonary artery. The mean pulmonary artery pressure was 45mmHg. We diagnosed this case as chronic pulmonary thromboembolism. The specimen cultures taken from the thin-walled cavity lesion were reported positive for M. intracellulare. In spite of medical therapy, he died of relapse of pulmonary thrombosis after 9 months.
At autopsy, we identified thrombosis of the trunk and main branches of pulmonary artery, and a small scar lesion in lower lobe of left lung.
The present case of pulmonary atypical mycobacteriosis complicated with disease of pulmonary vessels is very rare. We think compromised local defence mechanism of the lung can be one of prdisposing factors for M. intracellulare infection. Treatment of thrombosis occuring in the main trunk of pulmonary artery is difficult, but embolectomy should be performed, if indicated.

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We report here a case of small intestinal intussusception due to an intestinal metastatic tumor from lung cancer, with a review of literature.
Lung cancer metastasizes to a wide variety of organs. However, the incidence of metastasis to the small intestine is low. Furthermore, it is rare that the metastatic lesion causes abdominal symptoms leading to operation. Our review of the literature disclosed only 15 reported cases in Japan.
The present case was considered to be an intestinal metastatic lesion from lung cancer because of the following reasons.
1) The pathological findings of the removed specimen of the intestinal tumor were the same as those of the biopsied specimen from lung cancer.
2) Metastatic tumors are far more frequent than primary tumors in the small intestine.
3) We could not find a single case report of double lung and small intestinal cancers.
The possibility of metastasis must be considered when abdominal symptoms occur in a patient with lung cancer.

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Four hundred and twenty patients with lung cancer received lobectomy or bilobectomy in our hospital during the last 10 years (1975-1984). Fifteen of these patients (3.6%) showed characteristic non-specific ipsilateral pulmonary infiltrates 2 or 3 years after the operation. All of these operations were lobectomy or bilobectomy with mediastinal lymph node dissection (R-2). As for the side of resection, 13 cases (86.7%) were right, other 2 cases were left where the mediastinal lymph node dissection were usually incomplete because of the presence of the aotic arch. Such infiltrates did not occur in lobectomy of non-cancerous diseases except in one pulmonary tuberculosis patient who was a miner.
The features on chest x-ray or CT were pleural thickening, reticulonodular, small ring or bullous shadows in the peripheral region of the residual lung on the operated side.
In five cases, fibrosis or emphysema which could not be detected on the preoperative chest X-ray films were found macroscopically in the non-cancerous regions of the resected lung. Seven cases had silicotic nodules microscopically in dissected lymph nodes which reflected the effect of air pollution on the lung.
The clinical symptoms of these patients were not characteristic at the early stage. But two patients died of pneumonia in the contralateral lung in cases in which the ipsilateral lung had been severely infiltrated.
The likely mechanism of the observed postoperative infiltrates is unclear, but in addition to occult pulmonary disease, the anatomical, metabolic and immunological changes after lobectomy with mediastinal lymph node dissection may be the most important factor for such pulmonary complication.

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A 38-year-old woman was admitted with exertional dyspnea. She had a history of familiar tuberous sclerosis, epileptic seizures, and a spontaneous pneumothorax. Roentgenological examination reveraled diffuse reticulonodular shadows predominantly in both lower lung fields on chest X-ray films, subependymal calcifications on a brain CT, and renal angiomyolipoma by a whole body CT and biopsy.
Upon the clinical diagnosis of tuberous sclerosis with pulmonary manifestations, an open lung biopsy was performed. The biopsy specimen revealed pulmonary lymphangiomyomatosis histologically and the cytosolic receptor for the progesterone was determined by the dextran characoal method. Therefore she was treated with the anti-estrogen drug tamoxifen. Her clinical condition has been stable for 17 months since then.

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We reported two cases of hypersensitivity pneumonitis induced by the inhalation of isocyanate (MDI). The patients were 49 and 42 year-old males. They were engaged in casting at the same foundry and were dealing with MDI for two months, when dry cough, fever and exertional dyspnea developed. These symptoms improved while they took leave. Fine crackles were auscultated in both lungs at the inspiratory phase, and restricted pulmonary dysfunction with hypoxemia was noticed. Chest X-ray film revealed diffuse fine granular shadows on both lungs. Alveolitis, epithelioid granulomas and Masson's bodies were demonstrated in transbronchial lung biopsy specimens. Because of positive skin test, positive lymphocyte stimulation test and doubtful precipitation test utilizing isocyanate-human serum albumins, type IV allergy mechanism (Gell-Coombs) might have a significant role in the pathogenesis of this hypersensitivity pneumonitis induced by isocyanate.

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A 64-year-old man was admitted to our division for evaluation of systemic lymph adenopathy and a 3-year history of dry cough and exertional dyspnea in March of 1986. Physical examination on admission revealed bilateral axillary and inguinal lymph adenopathy. Laboratory tests showed an increased erythrocyte sedimentation rate, hypergammaglobulinemia and severe renal dysfunction. Pulmonary function values were within normal limits except for the diffusion capacity of the lung with carbon monoxide. Other laboratory data were within normal limits. A chest roentgenogram revealed bilateral hilar lymph adenopathy with diffuse reticulonodular changes over both lung fields. All biopsy specimens obtained from the lungs, stomach, rectum, kidney, bone marrow and axillary lymph nodes revealed a large number of amyloid deposits. Immunohistochemical typing was AL. A diagnosis of primary amyloidosis was made.

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A 67-year-old woman was admitted to our hospital because of hemoptysis and coughing. Two years previously, chronic renal failure had been diagnosed, and her chest X-ray revealed a giant mass shadow in the right chest. She died of uremia three and a half months after admission.
Autopsy findings showed a bulky, white and brown mass occupying almost the entire right lung, and histological findings showed caseous necrosis encapsulated by thick fibrous tissue.

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