We examined the effects of hypopressure on blood gases and spirograms of patients suffering from chronic respiratory failure, and compared them with those of normal subjects, using the environmental control unit (ECU). The patients consisted of 2 with idiopathic interstitial pneumonia (IIP), 1 with pulmonary fibrosis due to RA, 3 with bronchiectasis, 2 with chronic bronchitis and 1 with diffuse panbronchiolitis (DPB). We examined their blood gases and Spirograms under the condition of 760mmHg pressure, 25°C temperature and 60% humidity. Then the pressure of ECU decreased to 670mmHg in 20minutes, while the temperature and humidity were kept the same. The patients stayed in the hypopressured ECU for 1hour, and were reexamined. The pressure of 670mmHg is that of an altitude of about 1, 000m and that of the cabin pressure of commercial aircraft flying at about 9, 000m. The PaO₂ of the patients decreased from 74.7±13.8 torr to 61.8±9.5 torr significantly. We found, however, the significant decrease of PaO₂ in normal subjects from 97.2±7.8 torr to 80.4±6.5 torr under the same conditions. The rates of the decreased gases were almost same in both groups. Some patients showed remarkable decreases in VC and FEV_1.0 under the hypopressure. No patients or control subject complained of subjective symptoms.

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A total of 210 cases of terminal penumonia were studied out of 1183 autopsied cases at Tenri Yorozu Hospital from 1978 to 1985. Underlying diseases included lung cancer (77 patients), gastric cancer (26 patients), leukemia (24 patients).
There was no statistical significance between the time from death until autopsy and the bacterial examination of autopsied lung and blood. P. aeruginosau and Klebsiella sp. were the most frequently isolated organisms. Seventy percent of isolated organisms were gram negative bacilli. In spite of administration of antibiotics, bacteria isolated from specimens before death were sometimes the same as the one isolated from specimens after death. In addition it was recognized that multiple intensive examinations of sputum are necessary for rapid diagnosis of pneumonia. It was also noted that the longer the duration of antibiotic administration, the more frequently P. aeruginosa was isolated. Finally the possibility of pneumonia should be kept in mind in compromised hosts.

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Clinical comparsion of SLX with other tumor-as-sociated antigens such as CA19-9, CA125, and CEA, was made in benign respiratory diseases including diffuse panbronchiolitis (DPB), bronchiectasis (BE), bronchial asthma (BA), and pulmonary emphysema (PE). Sensitivities of each marker (>38.0U/ml) on DPB were 79.4% in SLX, 68.0% in CA19-1, 46.7% in CA125, and 35.7% in CEA. Serum levels of SLX in DPB and BE were significantly higher than those in BA and PE. There seemed to be no relationship between serum levels of SLX and CRP, ESR, and the volume of sputum. Immunohistochemical studies showed positive staining on the surface of respiratory bronchioles and alveolar walls in DPB and these findings were not observed in normal lung tissues. We consider that the high value of serum levels of SLX in DPB can be explained by these findings.

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Inducing pulmonary edema in rat, air bubbles the diameter of which was about 0.3mm were continuously infused into the right atrium through a catheter at the rate of 2.8ml/kg/hr during 0.5, 1 and 2 hours, under controled ventilation (tidal volume of 9ml/kg and respiratory rate of 80/min) with 1% halothane in room air. Saline or Dilazep hydrochloride solution was simultaneously infused into the right atrium via another catheter. Pulmonary edema was evaluated by the measurement of the ratio of extravascular water weight of lung (g) to blood-free dry lung weight (g) (EVWW) using the gravimetric method and with histologic studies using the rapid freezing method.
In control rats, which were sacrificed immediately after induction of anesthesia, the EVWW was 3.114±0.121g/g blood-free dry lung (mean±1 S. D. n=8). In baseline exeriments (2 hours ventilation and saline infusion without air embolization), the EVWW was 3.291±0.081 (n=4). In air embolization groups with 2 hours saline infusion, EVWW were 3.756±0.170 (n=4), 3.722±0.170 (n=4) and 3.731±0.245 (n=5) in 0.5, 1 and 2 hours infusion groups, respectively. Regardless of emboli infusion time perivascular cuffs and peribronchial cuffs were revealed in the 2 hour saline infusion groups. In the experiment in which the animals were sacrificed immediately after one hour infusion of air bubbles, there was no evidence of pulmonary edema and the EVWW of 3.060±0.092 (n=4) in this group control and baseline were not significantly different. In the group with 30 minutes infusion of air emboli and Dilazep hydochloride solution (0.01mg/kg/hr) following saline infusion for 90 minutes, findings of pulmonary edema were rarely revealed on histological examinations and the EVWW of 3.313±0.071 (n=4) was not significantly different between control and baseline experiments, but was significantly lower than those values in air embolization groups which were infused with saline for 2 hours. In conclusion, pulmonary air embolization simultaneously with 2 hours saline infusion induced pulmonary edema regardless of the duration of embolization and Dilazep obviously inhibited the water accumulation caused by pulmonary air embolization.

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We investigated the prognosis of chronic respiratory diseases in children by questionnaires to the pediatric departments of 4 universities and 14 national or public hospitals in Fukuoka Prefecture. The total number of patients was 155, consisting of 77 males and 78 females. These diseases included bronchiectasis, which had the highest incidence (37, 23.9%), prolonged respiratory disorders in the newborn, pulmonary hypoplasia, pulmonary cysts and pulmonary fibrosis, etc. These 5 diseases comprised 65.8% of all cases.
The number of cases on oxygen therapy was 9 (5.8%) and 5 of these 9 cases were on home oxygen therapy. A total of 18 cases (11.6%) were surgically treated. Of 155 cases, 91 cases were cured or improved, while 31 cases were unchanged, 6 cases deteriorated and 6 cases died. The prognosis of 21 cases was unknown. The number of cases whose daily activities were limited was 25 (16.1%).

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Thromboxane A₂ (TxA₂) is a potent platelet aggregator and vascular or bronchial constrictor. DP-1904, a newly synthesized imidazol TxA₂ synthetase inhibitor, is a potent and long-acting agent.
The present investigation was conducted to explore the effect of DP-1904 on the contractile or relaxing responses in guinea pig trachea and lung tissue strips induced by various vasoactive substances.
Fourteen guinea pigs, weighing 300-350g, were sacrificed. Trachea and lungs 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.
Arachidonic acid-induced relaxing responses in guinea pig trachea strips were attenuated significantly by the continuous infusion of DP-1904 in a dose-dependent fashion.
Arachidonic acid-induced contractile responses in guinea pig lung strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently.
Acetylcholine-, histamine- and prostaglandin F_2α-induced contractile responses in guinea pig lung and trachea strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently.
The above results suggest that DP-1904 might be a useful therapeutic agent for the treatment of chronic obstructive lung diseases.

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To investigate the changes of testosterone (T) secretion under sustained hypoxia, we determined basal levels of urine T, 17 ketosteroid, luteinizing hormone releasing hormone (LHRH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and response to LHRH and HCG (human chorionic gonadotropin) in male patients with respiratory failure. After evaluating blood gas data, we also measured serum T, LH, FSH, plasma progesterone (P) and 17 hydroxyprogesterone (17OH-P). The subjects were divided into 3 groups according to PaO₂, Group 1 with a PaO₂ under 60Torr, Group 2 with a PaO₂ between 60Torr and under 70Torr, Group 3 was an age-matched control group. Urine T and serum T were significantly lower in Group 1 compared with those of Group 3. In the LHRH test, augmented relative responsiveness and delayed peak value in LH secretion were observed in Group 1, compared with those of Group 3. As for the HCG test, no differences were observed among the 3 groups. The ratio of 17OH-P to P, which indicates activity of 17-hydroxylase, was observed to be diminished with increasing degrees of hypoxia.
These data suggest that in male patients with respiratory failure there was depression in T secretion as well as 17-hydroxylase activity due to hypothalamic-pituitary hypofunction.

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A case of progressive muscular dystrophy of the limb girdle type is reported. The patient, a 37-year-old man, showed severe hypoxemia upon blood gas analysis, which had been predicted by pulmonary function tests, together with elevated pulmonary arterial pressure revealed by cardiac catheterization. He showed abnormal symptoms of respiration during the night, and so a sleep study was performed. The results revealed central type apnea not only during REM sleep but also frequently during NREM sleep. Acidosis and hypoxemia induced by sleep apnea caused vasoconstriction of the pulmonary artery and long-term repetition of this had caused pulmonary hypertension.

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A previously healthy 40-year-old woman was admitted with severe dyspnea, cough and slight fever. Chest X-ray film revealed bilateral widespread opaque infiltration with ground glass shadows around it. The laboratory examination showed moderate hepatic and muscular injury with disseminated intravascular coagulation. In addition her arterial blood gas showed severe hypoxemia (Pao₂: 25Torr under room air). Moreover, about 1 week prior to admission, 2 baby budgerigars she had been raising for half a year died.
Because of this history and multi-organ injuries, this disease was considered to be acute pneumonia owing to fulminant psittacosis causing acute respiratory failure. On the first day of admission, she was intubated and ventilated mechanically with an oxygen concentration (FIO₂) of 100%. Subsequently, treatment with intravenous minocycline (400mg/day), heparin for D. I. C. and corticosteriod were started. Abnormal findings in both chest X-ray and several laboratory parameters improved gradually though fever continued for a week. On the 14th day of her hospital stay, she was weaned from the ventilator successfully and the administration of corticosteroid and heparin tapered. On the 41st day, she was discharged without any symptoms.
Results of complement fixation (CF) antibodies against chlamydia on paired sera showed a significant rise from 1:32 to 1:256. Moreover, both IgG and IgM antibodies for Chlamydia psittaci with microplate immunofluorescent antibody technique (MFA) showed an 8 times' rise during 10 days after admission. The definitive diagnosis was made with positive isolation of C. psittaci from both the throat swab of this patient and the spleen and liver of the dead budgerigar by the cell culture method.
Psittacosis should always be borne in mind as a possible cause of fulminant pneumonia with acute respiratory failure, and such a situation can be handled successfully if emergency care including mechanical ventilation is available.

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A 55-year-old woman was admitted for examination of bilateral hilar lymphadenopathy. Serum angiotensin converting enzyme was not elevated, but gallium-scan revealed an increased uptake in both lung hill. The percentage of lymphocytes in the bronchoalveolar lavage fluid (BALF) was elevated (28.9%), and the proportion of OKIa1 positive cells was also elevated (50.5%). However, the ratio of cluster differentiation (CD) 4/8 was inverted at 0.5. Microscopic examination of the mediastinal lymph nodes revealed epithelioid cell granulomas without caseation, and a diganosis of sarcoidosis was made. Immunohistochemical examination of the lymph nodes showed predominancy of CD8 positive cells. Patients with pulmonary sarcoidosis having a low CD4/8 ratio in BALF are extremely rare in the early stage of sarcoidosis. The inverted CD4/8 ratio was of interest in regard to the pathogenesis of sarcoidosis.

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We reported 4 cases diagnosed as myocardial sarcoidosis. One of them was diagnosed by endomyocardial biopsy, however, the others were diagnosed by cardiological findings and biopsy of the scalene node, liver or skin.
Analysis of ECG findings showed conduction distrurbances in all cases and disorderes of impulse formation in two.
Thallium 201 myocardioal perfusion scans (T1 scan) revealed inferior and anterosepral wall defects in case 4 and entire heterogenous defect in case 2. And also in case 2, left ventricular perfusion defect detected in T1 scan before steroid therapy changed to entire heterogenous defect. Thus, T1 scan was thought to be useful for the evaluation of therapy and for follow up study of myocardial sarcoidosis.
In the cardiac echogram, thickening of the wall was seen in cases 3 and 4, and dilated ventricle in another case.
Steroid was given in all cases and a pacemaker was implanted in two cases. The therapy was effective in all cases and ECG abnormalities were improved. In one case (Case 3) treated by a pacemaker steroid administration was halted and subsequently developed heart failure, but the other (Case 1) continued treatment with steroid caused return to a natural beat. Thus steroid therapy with a pacemaker implantation was considered to be effective for severe myocardial sarcoidosis.

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A 33-year-old female was evaluated for abnormality of her chest roentgenogram which showed diffuse fine granular micronodulation in the lower two thirds of both lung fields. The bone image (soft tissue cancelled image) of dual-energy subtraction radiography obtained with Fuji Computed Radiography (FCR) demonstrated that the abnormal shadows were characterized by calcified deposits.

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