We developed a new methodology to examine the bronchial response to the bronchoconstrictants, acethylcholine and methacholine. An inhalation device was connected to the body plethysmograph circuit so that a minute inhalation of serially concentrared bronchoconstrictant could be quickly switched to the circuit of the measurement of the airway resistance. The following were calculated: airway responsiveness in terms of sensitivity, provocative dose to increase the airway resistance up to 35% from the baseline. PC35 or PD35 and the reactivity, the slope of the declining specific airway conductance and %ΔSGaw. The airway responsiveness was examined in asthmatics, COPD outgrowed-childhood asthma patients and normal subjects. These three groups were categorised differently from each other in both sensitivity and reactivity.

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The activation of B lymphocytes and formation of immune complexes were suggested to play important roles in the pathogenesis of idiopathic UIP. To investigate the mechanism of the activation of B lymphocytes, we studied the production of B cell growth factor (BCGF) and B cell differentiation factor (BCDF) in patients with idiopathic UIP and those with IP-CVD, in comparison with healthy controls. Culture supernatants of peripheral blood mononuclear cells from patients with idiopathic UIP induced more IgM- and IgA-production than those from healthy controls, indicating a higher production of BCDF. Culture supernatants of peripheral blood mononuclear cells from patients with idiopathic UIP did not induce higher proliferation of B lymphocytes than those from healthy controls, indicating that production of BCGF was not enhanced in the patients. Increase of production of BCGF and BCDF from patients with IP-CVD was not observed. From these results, it was suggested that T lymphocytes that release lymphokines like BCDF are activated in patients with idiopathic UIP, but not in those with IP-CVD, and that the process of activation of B lymphocytes might be different between these fibrotic diseases.

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Home oxygen therapy is now considered indicated in cases of severe sleep oxygen desaturation.
To explore whether we could choose cases with severe sleep desaturation by measurement of waking physiological parameters, we examined the relationship between arterial blood gases, lung functions and pulmonary artery pressure while awake and the degree of sleep oxygen desaturation in 21 patients with chronic obstructive pulmonary disease and 22 cases with a past history of pulmonary tuberculosis. There were significant correlations between waking Pa_O2, Pa_CO2 and pulmonary artery mean pressure and sleep lowest Sa_O2, respectively, whereas no significant relation was found between %VC or FEV_1.0% and sleep lowest Sa_O2. However, we found wide ranges of Pa_O2 and Pa_CO2 in cases who had 10min or more with Sa_O2 below 85% during sleep. This was also true in the patients who underwent 60min or more with Sa_O2 below 85% while a sleep. These results suggest that it may be difficult to find out the indications for cases with severe sleep desaturation by evaluation of arterial blood gases while awake.

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Hypersensitivity pneumonitis (HP) and pulmonary sarcoidosis (Sa) are characterized by an accumulation of large numbers of lymphocytes within the interstitium and the epithelial surface of the lung. Although the lymphocytes in bronchoalveolar alvage fluid (BALF) are representative of interstitial cells in these diseases, the mechanism involved in an accumulation of lymphocytes on the epithelial surface are yet unknown. To explore the possibility that the lymphocytes on the epithelial surface are migrated cells from the interstitium, we studied the motility of the BALF lymphocytes in five patients with HP and nine patients with Sa and compared them to that of peripheral blood lymphocytes. The lymphocyte migration assay was performed using blind well chemotaxis chambers and cells migrated into the cellulose nitrate membranes were assessed. The total migrated cell numbers of BALF lymphocytes in HP and Sa were 753.3±86.5 and 334.2±41.0, respectively. The migration distance of BALF lymphocytes in HP and Sa assessed with leading front method were 50.2±3.8μm and 57.9±4.6μm, respectively. The motility of BALF lymphocytes in HP and Sa was significantly greater than that of peripheral blood lymphocytes and the motility of BALF lymphocytes were comparable to that of PHA-activated lymphocytes. The motility of BALF lymphocytes were correlated with the proportion of lymphocytes in BALF cells and the proportion of Ia⁺T lymphocytes. These results suggest that BALF lymphocytes in these diseases are activated and enhanced motility may facilitate the accumulation of lymphocytes to the epthelial surface.

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To clarify the effect of cigarette smoking on pulmonary function among patients with pneumoconiosis, we studied the relationship between the smoking index (number of cigarettes smoked per day×number of years of continued smoking) and lung function tests. The value of V25/Ht was significantly decreased with an increase of the smoking index, but there were no difference between %VC, FEV_1.0%, AaDo₂ and smoking index. Moreover, there was no relationship between pulmonary function and duration of dust exposure. These results show that antismoking campaigns are important among workers in a dusty work environment.

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In the present investigation we measured plasma levels of complement C3a and C5a, thromboxane B₂ (TxB₂) and 6-keto PGF_1α in anesthetized rabbits by radioimmunoassay after the intravenous injection of nicotine and cigarette smoke extracts.
Plasma levels of complement C3a in rabbits showed a significant increased and reached a maximum value 60 minutes after the intravenous injection of nicotine and cigarette smoke extract. Plasma levels of complement C5a in rabbits showed a significant increase and reached a maximum value 30 minutes after the intravenous injection of nicotine. Plasma levels of complement C5a in rabbits showed a significant increase and reached a maximum value 60 minutes after the intravenous injection of cigarette smoke extract. Plasma levels of TxB₂ in rabbits showed a significant increase after the intravenous injection of nicotine and cigarette smoke extract. Plasma levels of 6-keto PGF_1α in rabbits did not show any change aftert the intraveous injection of nicotine and cigarette smoke extracts.
The above results may suggest that the intravenous injection of nicotine and cigarette smoke extracts induces an increase of plasma levels of complement C3a and C5a and TxB₂ in anesthetized rabbits.

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Pulmonary emphysema may be a disease in which some elastin in lung is lost. In order to evaluate lung elastin degradation, we developed an enzyme-linked immunosorbent assay for desmosine and measured urinary desmosine excretion and serum desmosine levels in healthy individuals and patients with pulmonary emphysema and other chronic pulmonary disorders. The measurement was performed by the inhibition technique of ELISA so that the samples had to be applied to CF11 cellulose mini-column for partial purification of desmosine. Total urinary excretion of desmosine was uniformly low in healthy individuals and patients with lung cancer, but urinary desmosine was elevated in some cases of pulmonary emphysema and diffuse panbronchiolitis. Using this ELISA method, more than 0.06μg/ml serum desomsine concentration could be measured in 3 out of 25 healthy subjects who had never smoked (13.6%), 4/9 healtly current smokers (44.4%) and 19/26 patients with pulmonary emphysema (73.1%). Mean serum desmosine levels of meseared 19 cases of empysema were 0.182μg/ml. It has been reported that approximately 15% of smokers develop pulmonary emphysema. The most important problem now is whether smokers with elevated urinary desmosine or with high serum desmosine will eventuality develop pulmonary emphysema.

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The effects of mild exercise on pulmonary hemodynamics and ventilatory responses in COPD were studied. Six patients with FEV₁% less than 70% received 20 watt exercise tests by cycle ergometers for 5 minutes. Changes in hemodynamics and ventilation were observed before and during exercise. Nine patients with an FEV₁% of more than 70% also received exercise tests as controls. There were no differenes in changes in repiratory frequency, tidal volume and minute ventilation between control and COPD group. However, the mean pulmonary arterial pressure were higher in the COPD group than in the control group before exercise. Moreover increments of mean pulmonary arterial pressure by exercise were also greater in COPD group. It was concluded that hemodynamics in COPD are much more influenced by mild exercise than in healthy subjects.

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Two cases of primary racemose hemangioma of the bronchial artery are reported. The first case was admitted because of massive hemoptysis after transbronchial biopsy in another hospital. Bronchoscopic examination revealed a polypoid tumor of the left B⁴ bronchus, which was resected and diagnosed as racemose hemangioma.
The second case was admitted because of massive hemoptysis. Bronchoscopic examination revealed polypoid tumor in the left B³b bronchus, which was resected and diagnosed as racemose hemangioma.

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A 48-year-old man was admitted because of ischialgia. The CT scanning revealed tumors in the right pelvic cavity and the gluteal muscle. The bodies of Sparganum proliferum and granulation tissues were revealed by the tumor biopsy. In his hospital course, the chest roentgenogram revealed patchy infiltrative shadows in both lungs and left pleural effusion while chest CT scanning revealed multiple nodular shadows. Eosinophils increased in the peripheral blood and transbronchial lung biopsy (TBLB) showed non-destructive vasculitis with eosinophilic infiltration. The pulmonary lesion was diagnosed as intrapulmonary migration of Sparganum proliferum and PIE syndrome caused by this worm. Thiabendazole and prednisolone were administrated, but he died of pulmonary embolism.

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A 67 year-old man was admitted to our hospital because of cough and sputum. He smoke one pack of cigarettes a day for more than twenty years and the chest X-ray film revealed a mass in the left hilum and left sided pleural effusion. The diagnosis of small cell carcinoma of the lung (limited disease, T4N1MO, stage 3B) was made by trans-bronchial lung biopsy and radiographic studies. Both chemotherapy (nimustine (ACNU), cyclophosphamide, vincristine, and methotrexate) and radiation therapy was started, however, the chemotherapy was discontinued in July 1987 because of severe anemia. The diagnosis of refractory anemia with excess of blasts in transformation (RAEB in T) was made by bone marrow aspiration and the patient was treated by transfusion (400-800ml/week). In December 1987 transition to acute myeloblastic leukemia was confirmed by another bone marrow aspiration biopsy and the patient was given low dose cytosine arabinoside (Ara-C). The response was favorable in the beginning but in about two months pancytopenia became refractory and the patient died in June 1988. Clinically there was no sign of local or distal recurrences of lung cancer, and the complete remission of small cell lung cancer (SCLC) was confirmed by autopsy. Survival in SCLC remains poor, so that the choice of treatment is still the primary concern, however, development of other malignancies which include acute leukemia is another problem which should be taken into account when the treatment is extensive.

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A 76-year-old man was admitted because of multiple nodular opacities in both lungs on chest X-ray. Cryptococcus was identified in the specimens obtained from bronchial brushing and bronchial washing. Primary pulmonary cryptococcosis was diagnosed as he had no underlying diseases and no foci in any other organs except the lung. Transbronchial injection (TBI) of amphotericin B was administered to the largest focus, in addition to the intravenous administration of miconazole. The chest tomogram 25 days after the first TBI showed marked decrease in the size of the largest focus, but no improvements were observed in other foci. TBI can be performed easily and safely, and perhaps more effectively than administration of amphotericin B with aerozol. This procedure may be of value in the treatment of pulmonary cryptococcosis.

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A case of adenomatoid mesothelioma of the pleura was presented. The patient was a 69-year-old woman with diabetes millitus. She was admitted to our hospital because of a chest roentgenographic abnormality, which was pointed out during her clinical course. Chest X-ray-film on admission revealed a semicircular lesion located in the left lower lung field. The physical examination and laboratory data showed no abnormalities. Left lower lobectomy was performed. The tumor was approximately, 3.0×3.0×3.0cm, elastic soft, encapsulated, and originated from the pulmonary pleura.
The histological findings of the tumor showed benign epithelial localized pleural mesothelioma. However histologically, the tumor tissue was not like the usual epithelial type. That is, most cells which had intracellar vacuoles, were similar to signet ring cell.
The tumor was diagnosed as adenomatoid mesothelioma of the pleura.

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A 60-year-old woman was admitted to our hospital in June 1985, complaining of fever, cough and right lower chest pain, with a five-year history of asymptomatic primary biliary cirrhosis. Chest X-ray on admission showed an infiltrative shadow in the right lower lung field.
She was first treated with various antibiotics unsuccessfully. Hemoptysis continued. Dyspnea and anemia appeared. Chest X-ray 17 days after admission showed multiple infiltrative shadows in the both lung fields. She was treated with steroid pulse therapy successfully. During prednisolone treatment decreasing nodular shadows with cavities appeared on chest X-ray. An open lung biopsy was performed in March 1986. The histologic findings showed a necrotizing vasculitis with granuloma and perivascular fibrosis. She was treated with prednisolone and prednisolone-azathiopurine therapy unsuccessfully, but successfully with prednisolone-cyclophosphamide therapy.
This case was a rare case of Wegener's granulomatosis with transition from fulminant type to granulomatous type. No similiar case of Wegener's granulomatosis with asymptomatic primary biliary cirrhosis has been reported in the literature.

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A 33-year-old woman was admitted as an emergency case because of shock condition after delivery. Physical examination revealed fever, cyanosis and coarse crackles throughout the entire chest. Laboratory data showed leukocytosis and increase of CRP value. Adult respiratory distress syndrome (ARDS) was diagnosed based on progressive severe hypoxemia and bilateral diffuse alveolar shadows on chest X-ray film. The cause of ARDS was considered to be septicemia as staphylococcus aureus was cultured from lochia. The patient was intubated, then artificially ventilated employing PEEP. Chemotherapy using three different kinds of antibiotics was started, combined with the administration of corticosteroid and a protease inhibitor, Urinastatin. The patient finally recovered completely.

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We reported a case of pneumonitis due to Sho-Saiko-to. A 71-year-old woman was admitted to our hospital because of pneumonia. She complained of dry cough, pyrexia and severe dyspnea. Fine crepitation was heard on physical examination of the chest and a chest X-ray film revealed diffuse reticulo-nodular shadow in both lung fields. We suspected summer-type hypersensitivity pneunonitis and followed her up, however her condition deteriorated. Under a suspicion of drug-induced pneumonitis, all drugs were stopped and she was given prednisolone. Consequently her complaints, laboratory data and chest X-ray findings markedly improved. Microscopic examination of a transbronchial lung biopsy specimens showed interstitial penumonitis. The results of a lymphocyte stimulation test were positive for sho-saiko-to. She gave informed consent after receiving an explanation of the challenge test. She was tested with 2.5g sho-saiko-to twice and developed high fever and dyspnea with hypoxia, while the chest X-ray film also revealed diffuse infiltrative shadows similar that on admission.
Based on these findings, we diagnosed this case as pneumonitis due to sho-saiko-to. To our knowledge, there has been no previous case of pulmonary hypersensitivity due to sho-saiko-to reported in the world.

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An asyptomatic 37-year-old woman visited our outpatient clinic for evaluation of an abnormal shadow of the right thorax detected by a mass roentgenographic survey. P-A chest roentgenogram showed a round homogenous mass with a convex superior margin in the posterior portion of the right thorax. The CT with contrast enhancement and intravenous pyelography demonstrated the ectopic high location of the right kidney. Renal arteriography showed the right renal artery originated from the abdominal aorta at a normal level. Renal function tests showed no abnormality.

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