The possibility of a squamous cell carcinoma related antigen (SCC-Ag) in pleural effusion as a tumor marker for lung cancer was investigated.
The cut-off value of SCC-Ag was set at 4.50ng/ml, and the average value and positive rate were, 6.45ng/ml, 33.3% in primary lung cancer (45 cases), 5.94ng/ml, 31.8% in metastatic lung tumors (22 cases), 4.46ng/ml, 34.6% in tuberculous pleurisies (26 cases) and 2.02ng/ml, 2.5% in miscellaneous non-malignant pleural diseases (40 cases).
Carcinomatous pleural effusions had significantly higher levels of SCC-Ag than non-malignant pulmonary disorders (p<0.01).
In primary lung cancer, squamous cell carcinoma (12 cases) showed the highest value of (10.90ng/ml) and a high positive rate (75.0%), therefore, SCC-Ag had sufficiently high specificity for screening and clinical diagnosis in patients with pleural effusion due to squamous cell carcinoma of the lung, and peripheral type cases showed a higher level than hilar type cases.
Although the positive rate of SCC-Ag in tuberculous pleurisies was high, combination assay with ADA may be useful in distinguishing them from malignant pleurisies.

View full abstract

We found frequent association of NTI (low T₃ and/or low T₄ syndrome) with respiratory failure. No specific causes could be found in the patients with respiratory failure associated with NTI. The mortality of NTI patients with respiratory failure was higher than that of normal subject or cases of hypothyroidism. In particular, the prognosis was worse in NTI patients with high age, poor performance status, lower PaO₂, lower serum thyroxine levels and chronic type of respiratory failure.
It was considered that association of NTI was helpful to evaluate the present condition and prognosis in patients with respiratory failure.

View full abstract

Examination of intra-pleural space, using the fiberoptic bronchoscope through the chest drain was performed for the diagnosis of patients with pleural effusion. In the present study, 20 patients were examined. They consisted of 16 men and 4 women aged between 16 and 89 years, averaging 57.8 years. Among these, there were 7 cases of pleuritis tuberculosa, 8 cases of pleuritis carcinomatosa and 5 cases of other various respiratory diseases. Characteristic findings were observed on the surface of the parietal pleura. Further, selective biopsy of abnormal lesions on the surface of the parietal pleura is thought to be useful for the definitive diagnosis of cases of pleural effusion. No serious complications occured in the present study. In the investigation of safety by this method, we analyzed the arterial blood gas for 7 patients with pleural effusion before, during and after the procedure. They consisted of 6 men and 1 women aged between 33 and 89 years, averaging 58.6 years. During the examination decrease of PaO₂, SaO₂ and pH, the increase of PaCO₂ and A-aDo₂ occurred. The results of these arterial blood gas changes suggests that an increase of the anatomical shunt rate and alveolar hypoventilation may occur during the examination.

View full abstract

The peripheral airway in the presence of sarcoidosis was examined by means of bronchiolar fiberscopes, 1.8mm∅ and 1.6mm∅ in outer diameter, that we have developed. Endoscopic examination was conducted at all stages, I through III, according to chest roentgenographs. Marked changes were observed in stage II. Among the endoscopic findings, the incidence of erythema was greatest, followed by vascular swelling, vascular occlusion, irregular surface of the bronchial mucosa, edema of the bronchial mucosa, dilatation of the bronchial mucosa and elevated bronchial mucosa, in that order.
To detect lesions by endoscopy is easier than by selective alveolar bronchoscopy. For the accurate diagnosis of a sarcoidosis-induced disturbance in the peripheral airway, endoscopic examination which provides observation of the mucosal surface of the bronchiole under direct vision is necessary. Endoscopic examination seems to represent a basic examination for analyzing the pathologic conditions of sarcoidosis.

View full abstract

To demonstrate the etiologic agents and home environmental characteristics of cases of summer-type hypersensitivity penumonitis, mycological studies were carried out in 22 homes of patients and 195 homes of controls.
Indoor sampling was performed by open plate culture, house dust culture and swab culture in 10 homes of 14 patients with summer-type hypersensitivity pneumonitis admitted in our hospital (group 1), but in the 12 homes of 13 patients admitted in other hospitals (group 2) sampling was only by house dust culture, and in 195 homes of controls (group 3) sampling was performed by one or two of the three culture methods.
We isolated 2, 507 strains of fungi including 302 strains of yeasts from the 22 homes of patients and 9, 371 strains of fungi including 962 strains of yeasts from the 195 homes of controls. All yeasts were identified and, as for the 302 strains of yeasts isolated from homes of patients, were examined immunologically with respect to the specific antibody activities in the sera of patients with the indirect fluorescent antibody (IFA) method.
The incidence of genera Trichosporon was significantly higher in patients′ homes than controls′ as assessed by every culture method. T. cutaneum was isolated from 7 of 10 homes in group 1, and 4 of 12 homes in group 2, but no T. cutaneum was isolated from 195 homes in group 3. Among the isolated yeasts from the patients' homes, 23 strains were reactive to patients' sera at 1:128 or higher in IFA titers; 10 were T. cutaneum isolated from 10 homes of 14 patients, but the other 13 were each a different species isolated from 10 different homes. The colonizing places of T. cutaneum; old damp wood of bathrooms or/and kitchens, bed clothes, floor mats (tatami) of living rooms and budgerigar droppings; were revealed by the swab culture method.
These results confirmed that T. cutaneum was a major etiologic agent of summer-type hypersensitivity pneumonitis.

View full abstract

Most cases of sarcoidosis show spontaneous regression but there are some cases with a long duration. Therefore, there must be some factors which result in a state of continuous activation of marcophages to maintain T lymphocyte alveolitis. It has been reported that ACE is released from activated macrophages at the lesions. We hypothesized that this enzyme could convert Angiotensin I to Angiotensin II, which could enhance the accessory function of BALF macrophages in T cell proliferation.
From this viewpoint, we investigated the effect of A-I/A-II, which was added exogenously, on the accessory function. The study population included 7 cases of active prolonged sarcoidosis, 7 freshly active cases and 8 healthy controls. In mixed cell culture or blood T cells and BALF macrophages under stimulation of anti-OKT3 antibody for 72hrs, ³H-thymidine incorporation in the last 18hrs was counted. Angiotensin I/Angiotensin II was added from the start of culture.
We found that A-II enhanced this accessory funciton in the cases of sarcoidosis with longer duration, but not in the cases of freshly active sarcoidosis and healthy controls.
These findings suggest that T lymphocyte alveolitis is maintained in the cases of sarcoidosis with longer duration by an autostimulatory mechanism wherby A-II is derived from activated macrophages.

View full abstract

Polysomnography was performed in four patients with active acromegaly who had not undergone medical treatment. Two patients with relatively high HGH level (70.27ng/ml, 113.16ng/ml) and one obese patient with a relatively low HGH level (14.13ng/ml) exhibited sleep apnea and oxygen desaturation. The non-obese patient with a relatively low HGH level (15.99ng/ml) was free from apnea episodes. Both central and obstrutive apneas were seen in three patients. The patient with central apnea had congestive heart failure. The magnitude of desaturation was mild in two patients with no obesity. The obese patient demonstrated the most severe desaturation among the three. Ventilatory responses to O₂ and CO₂ did not reveal any relationship with sleep apnea and desaturation. We speculated that the high HGH level and development of obesity and complication of congestive heart failure maylead to sleep apnea in active acromegalic patients.

View full abstract

The value of ultrasonically guided aspiration needle biopsy (UGAB) of intrapulmonary lesions was investigated in 90 cases. Using UGAB, we were able to diagnose 63 (93%) of 68 cases with primary lung cancer. The positive rates for UGAB according to the size of the tumor and extent of invasion to the pleura and chest wall were both high. The relationship between cytologic diagnosis by UGAB and histologic subtyping was also investigated in 25 cases for which histologic subtyping was confirmed using surgical or autopsy specimens. The agreement rate between cytologic diagnosis and histology was 88%. Malignant cells were obtained in all 6 cases of metastatic lung cancer. In 6 of 16 cases of inflammatory diseases, such as lung abscess and mycosis, specific organisms contributed to a definite diagnosis. Complications occurred in only 1 case (1%). In this case, pneumothorax occurred but did not require treatment.
Our results indicate that UGAB is a safe and simple technique that can be applied to most intrapulmonary lesions, and we believe that it is the method of choice in such cases.

View full abstract

It has been thought that lung perfusion reflects regional alveolar ventilation. In order to evaluate abnormalities of the lower respiratory tracts, ^99mTc-MAA lung perfusion scintigraphy was performed in 46 patients with chronic airway diseases. The findings of perfusion scintigraphy were assessed by comparison with the bronchograms and chest computed tomograms. Lung perfusion scintigraphy showed segmental defects in the lung areas where bronchiectasis was found in 43 out of the 43 lungs. The lung scintigraphy showed multiple non-segmental defects in the subpleural regions where micronodular shadows were found on computed tomograms, especially in diffuse panbronchiolitis, and also revealed the perfusion defects where no abnormalities were found on both bronchograms and chest computed tomograms. In conclusion, lung perfusion scintigraphy is a sensitive screening method for evaluating the abnormalities in the lower respiratory tract. Because of its high quality imaging, this technique could be useful for detecting airway disease at an early stage.

View full abstract

One hundred thirteen and 114 patients with sarcoidosis, who were diagnosed histologically, have been typed for HLA class I (A, B, C) and class II (DR, DQ) antigens, respectively. Controls consisted of 478 healthy Japanese.Among HLA class I antigens, the frequencies of HLA, A1, Bw46, and Cx46 were significantly increased in sarcoidosis compared to controls, but only three patients were positive for HLA A1. Regarding HLA class II antigens, HLA DRw8, w9 and w52 were significantly higher in sarcoidosis than in controls, but no significant difference was observed between the two groups in terms HLA DQ antigen. Increased frequencies of HLA Bw46 and Cx46 were thought to be attributable to linkage disequilibrium with DRw8.
Patients with DRw52 were the most common (84 cases of 113, 74.3%). No significant differences in clinical features were observed between DRw52-positive and negative patients but all the patients with muscular involvement (5 palpable nodule cases and one myopathy case) were positive for DRw52. Among patients positive for DRw52, those with DR5 showed a significantly better clinical course and earlier onset of the disease than those without DR5.
These results suggest that HLA antigens may play an important role in the pathogenesis of sarcoidosis.

View full abstract

This study was designed to examine the effects of smoking on lung. To accomplish this, bronchoalveolar lavage was performed in normal non-smokers and normal smokers. Cell numbers and the elastase/α1-antitrypsin balance in alveolar lavage fluid were evaluated. To quantify antielastase capacity, total immunoreactive α1-antitrypsin and active α1-antitrypsin was measured in alveolar lavage fluid and in serum. To quantify elastase burden, elastase/α1-antitrypsin complex and enzymatic elastase activity in alveolar lavage fluids was measured. Significantly increased numbers of macrophages and neutrophils were recovered from the alveolar lavage fluid of normal smokers compared to normal non-smokers. Although elastase/α1-antitrypsin complex in alveolar lavage fluid was significantly higher in normal smokers compared to normal non-smokers, acitve α1-antitrypsin was not decreased in either alveolar lavage fluid or serum. In addition, enzymatic elastase activity was not detected in alveolar lavage fluid. It was concluded that in normal smokers, the dominancy of α1-antitryspin was preserved in both alveolar lavage fluid and serum.

View full abstract

A 54-year-old woman complained of general fatigue, and after examination a diagnosis of tuberculous lymphadenitis was made on the basis of a lymph node biopsy of the right neck. She also developed azotemia and succumbed following a rapidly progressive course of two months. Autopsy findings revealed old pulmonary tuberculosis, extensive miliary tuberculosis and secondary amyloidosis mainly in the lungs and kidneys. The pulmonary amyloidosis was of the diffuse alveolar septal type: the least common type which is usually associated with severe dyspnea. Diffuse alveolar septal amyloid deposits were positive for Congo Red stain, and the stained sections showed no polarizing green birefringence after the potassium permanganate method. The present case was characterized predominantly by renal failure but showed little dyspnea because of the absence of left side congestive heart failure due to cardiac amyloidosis. It revealed diffuse alveolar septal amyloidosis of the lungs, which was the manifestation of generalized secondary amyloidosis.

View full abstract

A 63-year-old male patient was admitted to our hospital because of a chest roentgenographic abnormality, which had been recognized every year since 43 years ago. Plain films of the chest showed a huge mass in the lower field of the right lung. The physical examination and laboratory data showed no abnormalities. Bronchogram demonstrated no communication between the mass and the tracheobronchial trees. At thoracotomy, a 10×8×6cm tumor was attached to the pulmonary pleura and the parietal pleura.
The histology of this tumor showed benign mesothelioma.

View full abstract

This report discribes a case of bronchiolitis obliterans organizing pneumonia (BOOP) in a patient with longterm administration of antibiotics and bone graft. A 57-year-old male, admitted with complaints of fever and dyspnea, had suffered from an open fracture of the right lower leg, and had been given antibiotics for 2 months and had undergone bone graft a week before admission. His chest roentgenogram showed infiltration of the peripheral zone of the right lung with pleural effusion. Blood studies revealed mild eosinophilia (930/mm³), an elevation of serum IgE level (1300IU/ml), severe hypoxia and severe inflammatory signs (CRP 14.2mg/dl). Analysis of bronchoalveolar lavage and pleural effusion disclosed an increased eosinophil count.
The histological findings demonstrated by open lung biopsy a month after admission were 1) organizing exudates in the air space of bronchioles, some of them were obstructed, 2) organizing exudates in alveolar ducts and 3) thickening of alveolar septae, especially near the bronchioles and alveolar ducts, which were compatible with BOOP. Administration of corticosteroid (prednisolone 60mg/day) after biopsy resulted in a rapid resolution of symptoms and a marked regression of infitlates on the chest roentgenogram. Because of the clinical data as stated above and, the improvement of inflammatory signs observed after the treatment with antibiotics was discontinued, it was suggested the patient had an allergy to antibiotics, which was a possible etiological factor of BOOP. However it was considered that the worsened chest roentgenographic findings before corticosteroid therapy suggested some other factors participate in the formation of the pulmonary lesion.

View full abstract

A 56 year-old slightly obese woman was admitted to our hospital because of a chest roentgenographic abnormality, which had been recognized on previous film and gowing gradually. Physical examinations and laboratory data were unremarkable except for mild hypertension. Posteroanterior and lateral roentgenograms of the chest showed a large, sharply defined, homogeneous oval mass posterior to the heart.
The CT scans revealed the mass to have the density of fat, with an absorption value of approximately -100HU. The mass was thought to be encapsulated in the thorax and extended into the abdomen on the basis of CT and MRI examination information.
At thoracotomy, a 10×5.5×5cm encapsulated fatty mass was found, which proved to be an omental herniation through the esophageal hiatus. We repaired the esophageal hiatus after the resection of the omental mass and the hernia sac. Intrathoracic omental herniation through the esophageal hiatus has been rarely reported, and our patient is the second case in Japan. We discussed the diagnosis of this case of omental herniation on CT and MRI examinations.

View full abstract