Diffuse panbronchiolitis (DPB) seems to be similar to cystic fibrosis regarding respiratory symptoms and clinical course. Therefore, to differentiate DPB from cystic fibrosis, we examined the chloride concentration in the sweat and pancreatic function diagnostant (PFD) of patients with DPB. The sweat chloride concentration in 12 patients with DPB was 20.6±12.2mEq/l (mena±SD), and the mean value was significatly lower (p<0.05) than that in healthy adults. There were no patients with DPB who had sweat chloride concentration greater than 60mEq/l. PFD test was performed on patients with DPB, and 3 of 9 had low response.
In summary, from the findings of the sweat chloride concentration, it was suggested that 12 cases of DPB studied sign differed from cystic fibrosis.

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During the period from 1973 to 1980, 7 cases of Pneumocystis carinii pneumonia (PC pneumonia) developed in compromised patients in our hospital. All cases were fatal.
In 1981, chemoprophylaxis with co-trimoxazole was commenced for patients at risk of PC pneumonia, namely, for compromised patients on corticosteroid for more than one month. None of these patients have thus far developed PC pneumonia; the treatment has been well tolerated by all.
However, during this time two patients not receiving chemoprophylaxis developed PC pneumonia, and both died. There is the strong impression that chemoprophylaxis is effective in preventing PC pneumonia; therefore, wider indications for chemoprophylaxis will probably become recognized in the near future.

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We studied the CT findings of 17 emphysema patients with special reference to the extent of emphysematous changes. Characteristic CT findings were low-attenuation area (LAA) and vascular abnormality and the appearance of various images on CT. To assess the extent of emphysematous changes, we classified the CT images into 4 grades based on the distribution and size of LAAs. As the grades progressed, the distribution and size of LAAs became wider and larger and vascular abnormalities were clearly evident. Although this CT-grading is a semi-quantitative method, it is simple to use and gives information on the approximate extent of disease.
This CT-grading was also used to show pulmonary function. The RV/TLC and expiratory flow showed a tendency to be impaired in Grade IV and the diffusion capacity was impaired parallel to CT-grading.
CT is able to demonstrate the presence and distribution of LAAs noninvasively. Therefore it is considered that CT is useful for clinical diagnosis and the assessment of the extent of pulmonary emphysema.

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A large number of subjects with sleep apnea syndrome are known to be obese. Obesity per se may be a predisposing factor to sleep apnea syndrome.
We studied the disordered breathing during sleep in 22 morbidly obese subjects without hypersomnolence who were referred for weight reduction therapy and in 6 obese subjects with hypersomnolence. Three subjects with hypersomnolence were hypercapnic and 25 other subjects were eucapnic. Disordered breathing with oxygen desaturation during sleep was observed in all the subjects with hypersomnolence and in some subjects without hypersomnolence, being predominant in the male. Our study suggests that it is important to treat the obese subjects with care in their disordered breathing during sleep. In 13 patients with sleep apnea syndrome examined in this study, oxygen desaturation during sleep exhibited significant negative and positive correlations with awake PaO₂ and PaCO₂, respectively.
Subjects with hypercapnia revealed most severe oxygen desaturation during sleep. Obesity hypoventilation syndrome may induce sleep apnea syndrome with severe oxygen desaturation during sleep.

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We reported here a familial case of summer-type hypersensitivity pneumonitis induced by Trichosporon cutaneum serotype I, in which three of four members in a family were symptomatic and one was asymptomatic. Trichosporon cutaneum was isolated from their house dust and identified as serotype I by factor sera. Serum anti-T, cutaneum antibody was positive in symptomatic members, but negative in the asymptomatic member. In provocation tests with serotype I (culture-filltrated antigen isolated from the patient's house) or with serotype II (culture-filtrated antigen isolated from other patient's house), symptomatic cases were positive or probable positive to the serotype I antigen, but negative to the serotype II antigen. The asymptomatic case was negative to both antigens.
From these results, we emphasize that the decision on the causative antigen should be discussed based on the serotype of T. cutaneum, which is a major causative agent of summer-type hypersensitivity pneumonitis.

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The concentration of angiotensin-converting enzyme (ACE) was measured in sera from 104 subjects and in bronchoalveolar lavage fluid (BALF) from 62 subjects by direct radioimmunoassay (RIA) using antiserum to human kidney ACE. Serum ACE concentration in normal controls was 335.2±109.1ng/ml (mean±SD). The serum ACE concentration was significantly higher in patients with sarcoidosis (658.0±239.0ng/ml, p<0.01) and silicosis (509.5±186.1ng/ml, p<0.01) than that in normal controls. In patients with asbestosis, lung cancer, pulmonary tuberculosis and pulmonary emphysema, specific activities of serum ACE were significantly lower than in normal controls. The concentration of ACE in BALF was calculated from urea dilution of BALF (epithelial lining fluid; ELF). ACE concentration in BALF from normal controls was 293.4±124.9ng/min, which was similar to serum ACE concentration. The ACE concentrations in BALF from patients with sarcoidosis (771.5±450.8ng/ml, p<0.01) and silicosis (487.1±264.6ng/ml, p<0.05) were significantly higher than in normal controls. The concentration of BALF ACE per pulmonary alveolar macrophage (PAM), corrected with the number of PAMs, was significantly elevated only in patients with sarcoidosis. In the immunofluorescence study, intense fluorescence was shown only in PAMs from patients with sarcoidosis and weak fluorescence with silicosis. The number of PAMs in BALF from patients with silicosis was significantly more than that in normal controls. Data show that the increase in ACE in BALF from patients with sarcoidosis and silicosis may be caused by augmentation of ACE production by PAM in patients with sercoidosis, and by multiplication of ACE-producing PAM in patients with silicosis.

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In order to evaluate clinical significance of neuron-specific enolase (NSE) as a tumor marker, serum levels were measured in 82 previously untreated patients with lung cancer. The positive rates of NSE in small cellung cancer (SCLC) and in non-small cell lung cancer (non-SCLC) were 76.3% and 40.9%, respectively. Mean NSE level was 33.3ng/ml for patients with SCLC and 10.9ng/ml for patients with non-SCLC: The difference was statistically significant (p<0.01). As for the extent of disease in SCLC, NSE level was significantly higher in patients with extensive disease than in those with limited disease (p<0.01). Serum NSE levels in SCLC excellently correlated with clinical responses: NSE levels promptly returned to normal after chemotherapy in the majority of responders and re-elevated at the time of disease progression or relapse. Furthermore, re-elevation was observed prior to relapse in a considerable proportion of complete responders. In conclusion, serial measurement of serum NSE in patients with SCLC was considered to be very useful for the evaluation of response and for the prediction of relapse, as well.

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Five resected cases of invasive superior and anterior mediastinal tumors with superior vena caval (SVC) reconstruction using expanded polytetrafluroethylene (EPTFE) grafts were reported. Tumor extirpations were successfully carried out with combined resection of great veins, lung, pericardium, phrenic nerve, vagal nerve and so on, and reconstruction of SVC with EPTFE graft was performed. Modalities of reconstruction were as follows; one graft between the left brachiocephalic vein and right appendage and another graft between the right brachiocephalic vein and SVC in 3 cases, I graft between the left brachiocepohalic vein and right appendage and SVC patch in one case, and 1 graft between left brachiocephalic vein and SVC in one case. Excellent long patency was maintained in grafts with external ring support anastmosed between the brachiocephalic vein and SVC. The case with germ cell tumor is free of disease 16 months postoperatively, who is the longest survivor in this study.
In conclusion, reconstruction of SVC using EPTFE graft is considered to be significant for the improvement of resectability, the relief of clinical symptoms and the extension of surgical indication in invasive superior and anterior mediastinal neoplasms.

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We compared S-IgA contents of serum and sputum from patients with diffuse panbronchiolitis (DPB) with those from patients with chronic bronchitis (CB) and bronchiectasis (BE), to clarify the relationship of the IgA system to the pathogenesis of chronic airway disease and to clarify differences of the pathophysiology of DPB, and CB and BE. Male healthy volunteers were used as controls.
Serum level of S-IgA was shown to rise in all the airway diseases, and the elevation was greater in DPB than in CB. BE showed an intermediate S-IgA level between DPB and BE. Markedly increased level (greater than 8mg/dl) was specific for DPB. The serum level of IgA was also shown to be higher in DPB than in CB, but the degree of elevation in serum compared with healthy controls was markedly greater in S-IgA than in IgA in all the chronic airway diseases. S-IgA concentration in sputum from patients with DPB was not significantly different from those from patients with CB and BE, although its concentration in sputum tended to be higher in purulent sputum than in mucoid and mucopurulent sputum, irrespective of the chronic airway disease.
These results indicate that there is a difference between the pathophysiology of DPB and CB, and that the serum level of S-IgA is useful to examine the pathophysiology of chronic airway disease.

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Recently we successively treated two cases of pericardial diverticulum. Case 1 (Male, 40 years old) and case 2 (female, 55 years old) were both found to have abnormal shadows in the right upper mediastinum on chest X-ray and consulted our department. As pericardial diverticula occur more frequently in the upper mediastinum than pericardial cysts, X-ray films taken by changing posture were useful for differential diagnosis. Both tumors showed a tendency to grow.
As the pericardial diverticulum seems to be more symptomatic than pericardial cyst, the former should be removed surgically.

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A 20-year-old man was admitted with acute dyspnea. A chest roentgenogram showed diffuse patchy shadows in both lung fields. A diagnosis of lung edema due to NO₂ toxicity was made based on the history of NO₂ inhalation 4hrs before the onset of the dyspnea and transbronchial lung biopsy. The O₂^- generating activity of peripheral PMNs was measured weekly. The activity was remarkably enhanced in cells collected on the 6th day after onset, and thereafter returned to a normal level accompanied with disappearance of dyspnea and the improvement of patchy shadow in chest roentgenogram.
Chemiluminescence of the PMNs was also enhanced when measured on the 7th day. The present observations indicate that O₂^- generated from PMNs is responsible in part for the NO₂-induced lung edema.

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A 64-year-old man was admitted to Tenri Hospital complaining of productive cough and dyspnea. Forty-six years prior to this admission, he had suffered from exudative pleuritis. Fluid in the pleural space which was initially tuberculous became aseptic, and then he was attacked by enteric fever 3 years later. Chest X-ray film on admission showed the presence of fluid in the right pleural cavity and bronchopleural fistula. Salmonella typhi was isolated from culture of pleural effusion and sputum. Insertion of an intercostal catheter was not performed because of a long-established calcified shell of chronic empyema. Typhoid empyema cavity was filled with an omental pedicle flap and the bronchopleurol fistula was successfully closed.
Empyema due to S. typhi, occurring 43 years after the attack of enteric fever is thought to be sufficiently unusual to justify a case report, and we believe the surgical usefulness of omental pedicle flap for such a case has been demonstrated by it.

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A 14 year-old girl was admitted because of low grade fever and frequent seizure attacks. Brain CT yielded a diagnosis of brain abscess and tapping aspirations were carried out. No pathogen was isolated from culture. The chest X-ray showed nodular shadows on bilateral lung fields. Pulmonary angiography identified the feeding arteries and draining veins with multiple minute fistulae. Hereditary hemorrhagic telangiectasia was diagnosed based on oral cavity telangiectasia, and a family history of nasal bleeding. Laboratory tests of blood coagulation showed normal bleeding time, and coagulation factors, but decreased aggregation of platelets. Brain abscess in hereditary hemorrhagic telangiectasia with pulmonary arteriovenous fistula is a rare complication, but should be considered in cases with neurologic manifestations.

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A 26-year-old woman was admitted to our hospital complaining of progressive dyspnea and hemoptysis with a past history of chylothorax and recurrent pneumothorax. The diagnosis of pulmonary lyphangiomyomatosis was made by transbronchial lung biopsy.
She was first treated with intramuscular progesterone therapy unsuccessfuly. Thereafter she received lineac irradiation (14Gy) in the bilateral ovarian regions and oral tamoxifen therapy in addition to progesterone. Despite these treatments her clinical condition deteriorated and refractory chyrous ascites developed. She underwent peritoneo-jugular shunt and bilateral oophorectomy. Seven days after operation she suddenly died of respiratory failure due to pneumothorax. At autopsy, microscopic examination revealed abundant proliferation of smooth muscle in the pleura, walls of blood vessels and bronchi, alveolar septa and acinar interstitial tissues. Neither estrogen-receptor nor progesterone-receptor was detected in the pulmonary tissue obtained at autopsy.

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A 39-year-old male, who had been suffering from idiopathic interstitial pneumonia (IIP) since seven years previously, was admitted with dyspnea. The important laboratory finding on admission was a serum CA19-9 of 3, 710U/ml. Pancreatic cancer, lung cancer and other malignancy were considered as possibilities, but none of these diagnoses could not be made definitely.
Despite treatment for IIP, his condition gradually deteriorated concomitant with the increase of serum CA19-9 level up to more than 120, 000U/ml, and he died of respiratory failure. However, autopsy proved that he had no malignancy. We discussed the mechanism of elevated serum CA19-9 level in IIP.

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An autopsy case of malignant hemangioendothelioma with multiple Cavitating pulmonary metastasis was reported.
The patient was a 75-year-old male, who died of respiratory failure due to pulmonary metastasis accompanied with recurrent spontaneous pneumothorax two years after the initial therapy for malignant hemangioendothelioma arising from the skin of the head.
At autopsy, multiple cavities were found in both lungs. The walls of the cavities were divided into two types macroscopically; one was a hemorrhagic rough-walled type and the other was a round smooth-walled type. Microscopically, both consisted of malignant cells similar to the primary lesion. Concerning smooth-walled cavities, there were concentric collapses of lung tissue around cavities though no bronchial or bronchiolar obstruction could be found. Pathologically and clinically, the smooth-walled cavities were considered to be formed by the following mechanism; early central necrosis at the metastasis of malignant hemangioendothelioma, elimination of necrotic materials and increase of pressure in the cavity consequently completing a distended air space.

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