To determine trends of death rates for patients with chronic pulmonary diseases the author compiled the numbers of deaths per 100, 000 Japanese population per annum based on the annual reports of the Japan Vital Statistics for the past 43 years. Death rates for the newborn population as well as for the younger population decreased while those for the aged population remained unchanged. Increasing numbers of deaths from lung cancer and decreasing numbers of death from pulmonary tuberculosis were noted. The death rate from the chronic obstructive lung diseases was maintained while the death rate for diffuse fibrotic lung diseases tended to be elevated.
Baseline reference values for respiratory physiology parameters, established by the Special Commission for Respiration Physiology of the Japan Society of Chest Diseases, were presented by single linear regression equations represented in terms of age covering the subject's whole age span, including the aged population. The author carried out further analyses based on the data collected in a multi-center cross-sectional survey and concerning, some parameters found consistent differences the linear regression equation calculated for the aged population from those for the younger population.
A longitudinal survey conducted by follow-up observations at Keio University Hospital to determine the annual decline of parameters on respiraiton physiology was designed to cover healthy subjects as well as subjects with chronic pulmonary diseases. Annual declines in vital capacity, forced vital capacity, forced expiratory volume in one second, arterial oxygen tension and arterial carbon dioxide tension showed linear changes throughout the entire age span. Some parameters, such as flow max at 25% vital capacity or alveolar-arterial oxygen tension difference (AaDO₂), demonstrated statistically consistent differences in annual decline between younger and older age populations. The anual decline of parameters in patients with chronic pulmonary diseases demonstrated consistently larger values compared with those for healthy subjects.
In a study on the pathophysiology and prognosis of patients with respiratory failure with/or without cor pulmonale extension of the survival period for the patients with cor pulmonale was demonstrated.

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Chemical pleurodesis induced with fibrin glue (fibrinogen 1.0g, thrombin 500u, 2% CaCl₂ 10ml, tranexamic acid 10ml) was performed in 6 cases with spontaneous pneumothorax in whom surgery was not indicated because of various reasons, such as low pulmonary function or old age. These cases were complicated with left pneumonectomy, bilateral emphysema, pulmonary tuberculosis and interstitial pneumonia. In all cases, favorable rsults were obtained and there was no recurrence.
As side effects, only transient low grade fever and slight chest pain were observed with no liver damage or pleural thickning.
These results suggest that chemical pleurodesis induced with fibrin glue is very useful in the treatment of inoperable spontaneous pneumothorax.

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A previous study demonstrated increased levels of C5a des Arg and increased numbers of polymorphonuclear cells (PMNs) in bronchoalveolar lavage (BAL) fluids of acutely ill patients with summer type hypersensitivity pneumonitis (HP), suggesting the role of immune complexes (IC) in the early stage of HP. The present study was undertaken to compare the BAL findings in patients with acute HP and in animals which were injected intratracheally with preformed IC and to determine the correlation between the sequential BAL findings and the serial histology in animals. The results indicated that total cells recovered by BAL increased up to 24 hours. However, the most striking observation was that the increased number and percentage of PMNs in BAL cells shortly after the intratracheal injection, which the number of macrophages in BAL cells tended to be high, the increase was not statistically significant.

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Thromboxane A₂ (TxA₂) is a potent platelet aggregator as well as a vascular and 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 responses in rabbit pulmonary artery and descending aorta strips induced by various vasoactive substances.
Fourteen 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.
Arachidonic acid-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904 in a dose-dependent fashion.
Prostaglandin F₂α-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently.
Angiotensin II-induced contractile responses in rabbit pulmonary artery and descending aorta strips were attenuated significantly by the continuous infusion of DP-1904, dose-dependently.
Norepinephrine-induced contractile responses in rabbit pulmonary artery and descending aorta 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 pulmonary hypertension in patients with chronic obstructive lung diseases.

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The present study was designed to evaluate the validity of luminol-dependent chemiluminescence (CL) to evaluate the microbiocidal properties of alveolar macrophages (AM) in response to drugs. It was observed that production of CL is associated with H₂O₂ as well as O₂^-, ¹O₂, ·OH. Furthermore, our data revealed that CL is dependent not only upon the extracellular release of these oxygen radicals, but also upon intracellular metabolic events, which thus allows a complete analytical study in any given state. It should also be noted from our data that the effect of antibacterial agents on CL was greatly affected by the source of the target cells. The defect of amplified CL in AM obtained from young rabbits might be attributable to immaturity of AM.

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As the first step to investigate a possibility that viral infection is involved in the pathogenesis of idiopathic interstitial pneumonia (IIP), serum antibody titers against various viruses were studied in 98 IIP patients. The patients were positive for herpes simplex virus, cytomegalovirus, rubella virus, parainfluenza virus 3, EBV-VCA IgG and adeno virus 1, which were also assessed in 45 normal subjects. As results, IIP patients showed higher titers of EBV-VCA IgG (p<0.01). When the frequency of positive populations for each of the 6 viral antibodies was calculated, the values of the frequency in all the 6 viruses were found to be very high in both patients and normal subjects, and there was no significant difference between IIP patients and normal controls.
In conclusion, a specific relationship between IIP and a certain viral infeciton was not observed by studying serum antibody titers against various viruses in IIP patients. It might be worthwhile studying why EBV-VCA IgG titers were shown to be significantly higher in IIP patients than in normals.

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Pathological studies on lung carcinoma associated with pneumoconiosis were made in order to clarify the etiological significance of pneumoconiosis in carcinoma of the lung.
Between 1960 and 1986, the author evaluated approximately 450 autopsies of pneumoconiosis. Of these, 150 were consecutive autopsies in our over laboratory and the remaining 300 were kindly provided by other hospitals. Carcinoma of the lung was seen in 48 of the autopsies.
Pathological studies determine histologic type, cancer site, and severity of pneumoconiosis were performed in the 48 cases.
The severity of pneumoconiosis was determined by the extent of progressive massive fibrosis (PMF). Simple pneumoconiosis was classified as mild, pneumoconiosis with PMF smaller than segmental region as moderate and pneumoconiosis with PMF larger than lung segment as severe.
Carcinoma of the lung was seen in 25 of our own consecutive autopsies, an incidence of 17.9%. The incidence of lung carcinoma was high among cases of mild pneumoconiosis and low among cases of severe pneumoconiosis.
Overall, the predominant cancer was squamous cell carcinoma (54.2%) followed by small-cell carcinoma (22.9%) and adenocarcinoma (14.6%). There was a clear trend that most of the squamous cell carcinomas were found in the larger airways, whereas the adenocarcinoma was found only in the peripheral lung tissues.
In cases of mild pneumoconiosis, the majority of tumors arose in the right, upper and larger airways. On the other hand, in cases of moderate and severe pneumoconiosis, more tumors arose in the left, lower and peripheral lung areas.
In cases of mild pneumoconiosis many tumors arose in main and lobar bronchi, whereas many tumors arose in segmental bronchi in cases of moderate and severe pneumoconiosis.
In case of pneumoconisosis with PMF, the majority of tumors arose in segmental bronchi leading to PMF.
The majority of tumors in peripheral lung tissues were centered on or closely adjacent to PMF or related for the development of PMF. In these cases, there were three cases of scar cancer arising in scar tissues of PMF.
Diffuse intestitial fibrosis of the lung was often associated with pneumoconiosis. Among these cases, five cases of carcinoma of the lung were found.
These data indicate a close relationship between pathologic changes of lung tissue by dust exposure and carcinoma of the lung.

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A 52 year-old male farmer was admitted to our hospital because of cough, sputum and dyspnea on exertion. Chest X-ray showed pulmonary edema and arterial blood gas analysis showed hypoxemia. Silo-fillers' disease was diagnosed because he had allegedly inhaled yellowish gas in the silo. The day following steroid therapy, symptoms and pulmonary edema improved. Silo-fillers' disease is chemical pneumonitis due to exposure to the oxides of nitrogen which are produced in silos. Although reported cases of silo-fillers' disease in Japan are rare it should be kept in mind in areas involved with dairy farming.

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A 39-year-old heavy drinker was admitted to Saga Medical School Hospital on February 21th, 1987. He had suffered from dyspnea, chest pain and lumbago three weeks prior to admission. His chest X-ray showed right hydropneumothorax and right lower lobe atelectasis and his CT scan showed a cystic lesion in the mediastinum. His laboratory data showed a high level of amylase in serum, urine and pleural effusion. A fistula connecting the pancreas to right pleural cavity was demonstrated by endoscopic retrograde cholangiopancreatography (ERCP). In addition, bronchoscopy showed complete obstruction of the right lower bronchus (B⁷). These bronchoscopic findings and hydropneumothorax on his chest X-ray suggested the leakage of pancreas juice through the pancreaticopleural fistula injured the lung tissue directly and produced a bronchopleural fistula. In this case, hyperalimentation and drug therapy using protease inhibitor resulted in successful closure of the firstula and reexpansion of the collapsed lung.

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A 36-year-old man was admitted with cough and sputum. He had cafe-au-lait spots and multiple subcutaneous neurofibromas. Chest X-ray revealed multiple emphysematous bullae in bilateral upper lobes and a tumor in the bulla of the right upper lobe. Needle aspiration biopsy of the tumor showed small cell carcinoma. Although chemotherapy and radiation resulted in decrease in tumor size, it subsequently increased in size and he died 11 months after admission. Including this case there have been 7 reports of Recklinghausen's disease associated with multiple lung cysts and 8 reports with lung cancer in Japan. However, cases with lung cysts and cancer are very rare. The cancer of this case was considered to be associated with emphysematous bulla rather than Recklinghausen's diseases.

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A 67-year-old woman was admitted to our hospital with chest pain and dyspnea which occurred suddenly after vomiting. She was well until admission except for cholelithiasis and hypertension which had been pointed out 3 years earlier. Arterial blood gas analysis showed hypoxemia without hypercapnea. Chest X-ray examination on admission revealed intra-mediastinal air with a niveau behind the heart which compressed the vasculature of the left lower lobe and a small amount of air in the regions adjacent to the trachea, left main bronchus and aortic arch. The serial chest radiographs showed pneumomediastinum, subcutaneous emphysema, pneumothorax and pleural effusion in that order within 16 hours after the onset. The diagnosis of esophageal rupture was made by CT scan of the chest performed after oral administration of Gastrografin, which demonstrated extravasation of contrast medium into the mediastinum. Surgical treatment including eversion stripping and esophagogastrostomy was performed 23 hours after the onset. Pathological examination of the removed specimens revealed a rupture of the lower portion of the esophagus originated in the gastric ulcer of the cardia. In spite of intensive care, she died 45 days after surgery because of renal failure.
It was considered that the most important point in the early diagnosis of esophageal rupture was to suspect this disease based on the gastric symptoms followed by the respiratory symptoms and to demonstrate pneumomediastinum in chest X-ray. Chest CT scan performed after the oral administration of contrast medium could be an useful and non-invasive diagnostic procedure.

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