A method to measure airway resistance was invented by DuBois and his coworkers. With this method, airway resistances are measured during panting respiration. However the measurements are very difficult to make, not only in patients with respiratory diseases, but also in normal subjects. Furthermore, the method has another disadvantage in that the measurements are not obtained during natural breathing. For these reasons we have developed a new plethysmograph with which we are able to measure airway resistance continuously during spontaneous breathing. With the apparatus we measured airway resistances of 7 normal persons and 8 patients with chronic obstrucitve pulmonary disease. We were able to record alveolar pressure curves and airway resistances along with respiratory volume curves. Maximal airway resistances during each inspiration and expiration were measured. Maximal expiratory resistances were higher than inspiratory resistances especially in patients with chronic obstructive pulmonary disease. Airway resistances measured with our plethysmograph correlated well with values obtained with the DuBois' method (r=0.905). We think that this method is a very easy and useful one for measuring airway resistance in patients with respiratory disease.

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Thirty-one patients presenting hemoptysis were treated by transcatheter arterial embolization (TAE) of the bronchial artery and other arteries. Gelfoam particles were used for embolization in all cases with additional use of Ivalon particles, coils and Lipiodol-fibrin adhesive mixture in a small number of cases.
Angiographic evaluation of the bronchial artery anatomy revealed eleven different patterns, with intercostobronchial trunk (ICBT) in 48% and truncus communis in 64% of cases. Peripheral hypervascularity with increased caliber of the bronchial artery (94%) and broncho-pulmonary shunt (68%) were the most common angiographic findings on bronchial arteriography (BAG) in patients with hemoptysis, and these findings were considered to indicate arteries to be embolized.
Systemic feeders other than bronchial artery were found in 52% of 31 patients, especially in cases with pleural thickening and adhesion, and those with widespread bronchiectasis. The role of the esophageal artery in cases with widespread bronchiectasis especially involving the left lower lobe was stressed as a new angiographic finding.
Good control of hemoptysis was achieved in 23 of 26 patients (88%) after TAE. Five patients were excluded from the evaluation of the efficacy of TAE because of intermittent episodes of hemoptysis or possible effective medical control before embolization. Among the patients with effective embolization, 5 cases (21%) recurred within one month after embolization, and 6 out of 18 patients (33%) showed recurrence of hemoptysis during the long-term follow-up ranging from 1-46 months.
The major reasons for recurrence were superimposed infection, the existence of many systemic feeders and recanalization of embolized arteries. Most of these patients were controlled by additional TAE or medical treatment.
Most of the complications related to TAE were mild and insignificant especially in BAE. However, we experienced one case of spinal cord ischemia following embolization of intercostal arteries which was not directly related to the anterior spinal artery.

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Using the enzyme-linked immunosorbent assay (ELISA), we measured IgG antibodies to type I, III and V collagens in sera of 98 patients with idiopathic pulmonary fibrosis (IPF) and 39 normal subjects. Mean levels of types I, III and V collagens-specific antibodies in patients with IPF were significantly higher than those in normal subjects, (p<0.01). Circulating immune complexes (IC) were detected in sera of 26 (35%) out of 74 IPF patients by C₁q solid phase radioimmunoassay. Levels of antibodies to three types of collagens in IC-positive sera were significantly higher than in IC-negative sera (p<0.01 or p<0.05). There were statistically significant correlations among the levels of types I, III and V collagen-specific antibodies (p<0.01). Our data collectively suggest that autoantibodies to collagens, especially to type I collagen, may participate in the pathogenesis of pulmonary fibrosis and may reflect destruction of pulmonary connective tissue.

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We studied the T cell function by investigating IL-2 production and the response to PHA in the cases of pulmonary sarcoidosis, because our previous findings of no significant appearance of IL-2 receptors on lung T cells and lower response of lung T cells to exogenous IL-2 in active sarcoidosis were not coincident with the possibility of lung T cell proliferation.
Some cases with sarcoidosis showed higher levels of IL-2 production in both lung T cells and blood T cells stimulated by 0.1% PHA, in parallel with the T cell response to PHA. The higher response of T cells to PHA in sarcoidosis than in healthy cases were differs from the previous reports.
As to the effect of smoking, enhanced IL-2 levels and enhanced response to PHA were observed in healthy smokers, compared with healthy non-smokers. These effects tended to be decreased in sarcoidosis cases.
The number of blood lymphocytes were significantly lower in sarcoidosis cases than healthy subjects.
These findings indicate that both the blood T cell recruitment to lung and the proliferation of lung T cells result in the significant increase of lung T cells in active sarcoidosis.

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Fibronectin (FN) levels and type III procollagen N-terminal peptide (pIIIp) in the bronchoalveolar lavage fluid (BALF) from patients with idiopathic interstitial pneumonia (IIP), interstitial pneumonitis due to definite causes (IP) and normal volunteers (NV) were evaluated. The levels of FN albumin ratio in BALF from IIP patients were significantly higher than those from normal volunteers, especially in non-smokers. The levels of pIIIp albumin ratio in BALF from IIP patients and IP patients were also significantly higher than those from normal volunteers. However, but there is no correlation between the levels of FN albumin ratio and those of pIIIp albumin ratios in BALF from IIP patients. On the other hand, the localization of pIIIp by immunohistochemical examination (EIA stain) in the post-mortem lung of a patient with IIP concurred with that of FN. From the clinical aspect, the levels of FN albumin ratios in BALF from IIP patients correlate with A-aDO₂ from the analysis of arterial blood gas, and the levels of pIIIp albumin ratio in BALF from IIP negatively correlate with the duration of symptoms. We tentatively conclude that levels of FN albumin ratio in BALF may show the disease activity, and that those of pIIIp albumin ratio may be useful to predict the duration from the onset or the exacerbation of IIP.

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Platelet activating factor (PAF) was first derived from rabbit basophiles that had been sensitized with a specific IgE-antibody. Subsequent studies have shown this compound to have a unique structure, [1-o-alkyl-2-acetyl-sn-glycero-3-phosphocholine]. PAF is a potent mediator of anaphylaxis and inflammation, as well as the ability to aggregate platelets.
The present investigation was conducted to explore the effect of PAF on various drug-induced contractile responses in rabbit pulmonary artery and descending aorta strips.
Seventeen Japanese albino rabbits, weighing about 3kg, were sacrificed. Rabbit pulmonary artery and descending aorta were removed, cut spirally, set up in bioassay glass jackets and superfused with Krebs-Henseleit solution at 37°C, saturated with oxygen and carbon dioxide. Contraction of tissues was detected by an isotonic transducer and displayed on a polyrecorder.
1) Norepinephrine-induced contractile responses in rabbit pulmonary artery and descending aorta strips were potentiated significantly by continuous infusion of PAF at a low concentration (5×10^-5-5×10pg/ml) and the degree of potentiation became more marked by increasing the dose of PAF.
2) Angiotensin II-induced contractile responses in rabbit pulmonary artery and descending aorta strips were potentiated significantly by continuous infusion of PAF at a low concentration (5×10^-5-5×10pg/ml) and the degree of potentiation became more marked by increasing the dose of PAF.
3) Prostaglandin F_2α-induced contractile responses in rabbit pulmonary artery and descending aorta strips were potentiated significantly by continuous infusion of PAF at a low concentration(5×10^-5-5×10pg/ml)and the degree of potentiation became more marked by increasing the dose of PAF.
The above results may suggest that PAF plays a very important role in the regulatory mechanism of pulmonary circulation and systemic circulation.

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Clinical manifestations and prognosis were studied in 554 patients with sarcoidosis diagnosed in Kyoto between 1963 and 1986. The group included a large number of patients in their 20's with BHL alone in whom the disease was detected by health screening. Since many of these patients show spontaneous clearance, steroids are not only unnecessary but are possibly considered to be harmful. Symptomatic patients often showed ocular symptoms. Severe pulmonary fibrosis as reported by European and American authors was observed in only 2.5% of our patients after 5 years observation. It is of profound interest whether such patients will increase in Japan.

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A case with sarcoidosis involving the central nervous system (CNS) is presented. A 63 year-old male, who had been troubled with cerebellar ataxia, dysmetria and asynergia, was diagnosed as having sarcoidosis by open lung biopsy.
Chest X-ray film showed unilateral hilar lymphadenopathy, and accumulation of ⁶⁷Ga citrates in the bilateral hilar lymph nodes were observed. A tuberculine test was negative. Although CT scans showed no intracranial mass lesions, cerebrospinal fluid (CSF) examination disclosed lymphocyte pleocytosis and elevated protein, which was compatible with the findings of CNS sarcoidosis.
Treatment by 60mg/day prednisolone resulted in improvement of symptoms. Even though cerebellar biopsy was not performed, the clinical data and course strongly suggested sarcoidosis involving the CNS.
The incidence of involvement of the CNS in sarcoidosis is about 5% in the literature, and many of these cases were very resistant to treatment. Fortunately, 60mg/day prednisolone (p. o.) in this patient markedly improved symptoms and clinical data.

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A 72-year-old man was admitted because of pulmonary tuberculosis and hypertension. On admission X-ray films of the chest disclosed a cavity in the posterior segment of the left upper lobe. Acid-fast bacilli were found in the sputum (Gaffky 2), and the cultures yielded mycobacterium tuberculosis. The blood pressure was 182/102mmHg. He was treated with INH, streptomycin, rifampicin, ethambutol and trichloromethiazide.
Seven months after the beginning of the treatment, he suddenly complained of dyspnea and non-productive cough. Chest X-ray films showed diffuse intersitial infiltrates in both mid- and lower-lung areas. The partial pressure of oxygen of the arterial blood (PaO₂) was 59.1 Torr, PaCO₂ 32.4 Torr and the pH7.376, while he was breathing room air. The tests for antinuclear antibody, RA and LE-cells were positive, but those on admission negative. Fiberoptic bronchoscopical examination was performed and cultures of the washing and brushing materials yielded no acid-fast bacilli. Transbronchial biopsy specimen obtained from the right middle lobe showed pulmonary fibrosis with mild infiltration of lymphocytes. Prednisolone 30mg/day was administered, and dry cough, dyspnea and the diffuse interstitial shadows in the lung diminished gradually. Lymphocyte stimulation index by INH was 198% and that by trichloromethiazide 85%, when tested 6 months later.
These findings suggest strongly that the pulmonary interstitial lesion is INH-induced interstitial pneumonia.

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A case of hypersensitivity pneumonitis caused by a humidifier for home use was presented. The patient was a 54 year-old man. Although he had cough and fever repeatedly every night at home from three months previously the symptoms improved admission after spontaneously. Furthermore, whenever he returned home, these symptoms recurred. The chest roentgenogram on admission showed diffuse nodular shadows, in the bilateral lower lung fields and respiratory function tests revealed a decrease in vital capacity and diffusion capacity.
These findings suggested hypersensitivity pneumonitis caused by a humidifier. In the provocation test using the humidifier in a hospital room, symptoms similar to those experienced at home appeared. Also, chest roentogenogram showed diffuse nodular shadows again and vital capacity, diffusion capacity and arterial oxygen tension decreased remarkably. Investigating the humidifier water, there were many Gram-negative bacilli as Flavobacterium and others. The precipitin antibody reaction of the patient's serum to humidifier water was negative, but the complement fixation test of that to antigen of culture fluid of Flavobacterium was positive. We therefore speculated Flavobacterium to be the pathogenic antigen.

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A 33-year-old man was admitted to the Division of Respiratory Diseases for evaluation of repeated fever and purulent sputa of more than 10 years' duration. Based on the presence of chronic sinusitis and repeated lower respiratory infections, and chest roentgenogram, bronchogram, seminal examination and testicular biopsy specimens, a diagnosis of Young's syndrome was made. A special serum analysis revealed a polyclonal gammopathy. In addition, a drip infusion pyelogram revealed bilateral medullary sponge kidney, suggesting a complication of this disorder in Young's syndrome.

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A 56-year-old Japanese man with rheumatoid arthritis was admitted to our hospital with fever and dyspnea. The chest X-ray showed a patchy ground-glass appearance in the right lung and small nodular opacities in the left lung. The laboratory data showed elevated titers of CRP, RA and RAHA. Pulmonary function tests showed restrictive dysfunction and reduced diffusing capacity. An open-lung biopsy specimen showed bronchiolitis obliterans organizing pneumonia (BOOP). There was a remarkable clinical, physiological and roentogeographic recovery in response to corticosteroids. In the view of therapeutic response, a histologic confirmation of BOOP by open lung biopsy is important in rheumatoid lung disease.

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Two cases of mediastinal germ cell tumor in 26- and 19-year old men were reported. They were clinically diagnosed as having a mediastinal germ cell tumor because of the elevation of serum α-fetoprotein (AFP) and a large mass in the anterior mediastinum. In the first case, the tumor was completely removed by surgery and the histological examination revealed embryonal carcinoma, seminoma, and yolk sac tumor. Immunohistochemically, AFP was demonstrated in the region of the yolk sac tumor. The serum AFP rapidly decreased after the operation and is still within normal limits at 10 months. In the second case, operation was not indicated because the tumor was thought to have invaded the heart and lung. The serum AFP level was continuously high in spite of chemotherapy and the patient died of dyspnea 4 months after admission. Histological examination of the tumor revealed embryonal carcinoma, seminoma, and immature teratoma without features of yolk sac tumor.
The relation between serum AFP and the histology of germ cell tumors was discussed. Further, the relation between serum AFP and prognosis of the patient with a mediastinal yolk sac tumor was discussed in the present first case and 33 cases in the literature.

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A 43-year-old woman complaining upper abdominal pain and abdominal fullness was referred to us. Thirtythree years ago she was involved in a motor vehicle accident. Since the accident, she sometimes had abdominal fullness. Barium examination of the upper gastrointestinal tract revealed a whole stomach with mesentoaxial volvulus incarcerated into the left hemithorax. The diaphragmatic repair was performed through left thoracotomy and subcostal laparotomy. Whole stomach with mesentoaxial volvulus, cecum, transverse colon, and entire small intestine except the duodenum herniated into the left hemithorax. Only the duodenum, descending and sigmoid colons, liver, pancreas, and spleen were identified in the abdominal cavity. The diaphragm was primarily repaired. Thirty-three years is one of the longest interval phases of traumatic diaphragmatic hernia in Japan.

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