Soluble interleukin-2 receptor (IL-2R) level and IL-2R positive (IL-2R+) cells were studied in twenty patients with carcinomatous pleural effusions. The mean value of soluble IL-2R level in carcinomatous pleural effusions was 2930±1722U/ml and that in sera was 965±610U/ml. Soluble IL-2R level in carcinomatous pleural effusions was found to be significantly higher (p<0.001) than that in sera of patients with carcinomatous pleural effusions and that in transudates. Serum soluble IL-2R level in patients with carcinomatous pleural effusions was found, to be significantly higher (p<0.001) than that in normal controls (264±70U/ml). We also studied IL-2R+ cells in pleural fluids and peripheral blood of patients with carcinomatous pleural effusions. The mean percentage of IL-2R+cells in carcinomatous pleural fluid lymphocytes was 22.8±17.8%, as compared with 3.0±2.2% in peripheral blood lymphocytes of normal controls (p<0.001). No significant differences were observed among the cell types of lung cancer examined (adenocarciona, squamous, small cell and large cell carcinoma) and no correlation among levels of soluble IL-2R and IL-2R+ cell in either pleural fluid or blood. Our results suggest that in patients with carcinomatous pleural effusions, T cell-mediated active immune mechanisms (IL-2/IL-2R system) against cancer cells are more active in pleural fluid than in peripheral blood.

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The relationship between the effect of deep inspiration on V_max and basal bronchomotor tone was studied by partial and maximum expiratory flow-volume curve in 16 young healthy females (20-21 years old).
Effect of deep inspiration on V_max (DI index; (PEF₂₅-MEF₂₅)/PEF₂₅) significantly related to percent increase in PEF₂₅ not only by inhalation of ipratropium bromide (r=-0.81, p<0.0002) but also by inhalation of salbutamol (r=-0.62, p<0.01). Furthermore, day to day variation of DI index significantly related to day to day variation of PEF₂₅ (r=0.68, p<0.005) but not to that of MEF₂₅.
These findings suggest that the bronchodilating effect of deep inspiration in young healthy females may depend on intensity of basal bronchomotor tone caused by tonic vagal nerve activity.

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We developed a hypersensitivity pneumonitis model by sensitizing rabbits intratracheally (IT) twice after two subcutaneous sensitizations (SS), and investigated the serial changes in the production of antibody against micropolyspora faeni (Mf), macrophage migration inhibition test (MIT), and histopathologic features.
On the third day after the last IT, the proportions of neutrophils in bronchoalveolar lavage fluid (BALF) increased. The antibody levels of Mf specific-antigen in BALF decreased transiently, but those in serum began to increase. The number of AFC in spleen increased rapidly. Histopathologic examination revealed alveolitis and prominent acute pneumonia.
On the seventh day after the last IT, the proportion of lymphocytes in BALF, the antibody levels of Mf specific-antigen in BALF, the number of AFC in BALF, and the percent inhibition of MIT were highest. Histopathologic features were characterized by the formation of prominent epithelioid granulomas. On the fourteenth day after the last IT, these features retured to the state of untreated group. These results indicate that the lesions in this HP model are formed by both type III and type IV immune reactions (Coombs-Gall). It was concluded that the seventh day after the last IT was most appropriate for the study of pathophysiology of human HP.

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To determine whether the involvement of thromboxane A₂ in bronchial hyperresponsiveness is specific to asthma, we examined the effects of a selective thromboxane synthetase inhibitor (OKY-046) and a cyclooxygenase inhibitor (indomethacin) on bronchial responsiveness to methacholine in patients with bronchial asthma and chronic bronchitis. The provocative concentration of methacholine producing a 20% fall in forced expiratory volume in one second (PC₂₀-FEV₁) was measured before and after oral administration of OKY-046 and indomethacin in eight asthmatic and 10 bronchitic subjects. Baseline FEV1 value was not altered by OKY-046 or indomethacin. The geometric mean value of PC₂₀-FEV₁ increased significantly (p<0.005) from 1.78 to 4.27mg/ml after OKY-046 in asthmatic subjects, but not in bronchitic subjects. On the other hand, PC₂₀-FEV₁ was not altered by indomethacin in all subjects.
It was concluded that the involvement of thromboxane A₂ in bronchial hyperresponsiveness may be specific to asthma.

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One hundred and sixty-three male and 78 female cases of lung sarcoma, registered over 29 years from 1958 to 1986, were selected and analyzed, and were compared with lung cancer cases.
The incidence of the lung sarcoma cases was one per 2, 600 in males and one per 3, 600 in females among all autopsy cases, and one per 1, 400 in males and one per 1, 800 in females among all autopsied cases of fatal malignancies. The relative incidence of lung sarcoma was one per 240 lung cancer cases in males and one per 170 in females and gradually decreased with each decade (1st to 3rd periods). The male/female ratio was 2.1 overall and 2.6 in the 3rd period.
In the 3 decades, the average age at detection 55, 55 and 66 years in males and 38, 51 and 49 years in female lung sarcoma cases. Female sarcoma cases were significantly younger than male cases, except for the 2nd period. In the 3rd period male cases were almost the same as lung cancer cases in terms of average age. Significant elevation was observed in lung sarcomas.
The most frequent lung sarcomas in males were rhabdomyosarcoma, leiomyosarcoma, and malignant lymphoma in the 3 decades. In females, the above three sarcomas were most frequent in each chronological period. Malignant fibrous histiocytomas appeared remarkably in the 3rd period in both sexes.
The peak and mean ages for each type of lung sarcoma were higher than other reports. In malignant lymphoma and rhabdomyosarcoma, male cases were signicantly older than female cases. The high mean ages of male malignant fibrous histiocytoma (71) and pulmonary blastoma (67) were remarkable. In both sexes, malignant lymphoma was the most frequent lung sarcoma in the young (less than 40) and the aged (over 70) groups, and leiomyosarcoma was the most frequent in the middle aged group (40 to 69).

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We investigated the role of alveolar macrophages and neutrophils on the defense system against infection of Pseudomonas aeruginosa (P. aeruginosa) in the lower respiratory tracts of rats. Intratracheal inoculation of formalin-inactivated P. aeruginosa to normal rats showed an increased number of neutrophils in bronchoalveolar lavage (BAL) fluid obtained at 24 hours after the inoculation. This response of neutrophils was induced by intravenous administration of MDP-Lys, which is muramyl dipeptide. Phagocytic activity of neutrophils for P. aeruginosa was higher than that of alveolar macrophages, indicating that neutrophils are essential phagocytes in the defense system against P. aeruginosa infection in the lower respiratory tract. Alveolar macrophages released neutrophil chemotactic factor after phagocytosis of P. aeruginosa. This function of alveolar macrophages was increased by MDP-Lys administration. These results indicated that alveolar macrophages play an important role in neurtrophil accumulation by release of neutrophil chemotactic factor after the P. aeruginosa phagocytosis in the lower respiratory tract. Moreover MDP-Lys can amplify the neutrophil-dependent defense system against P. aeruginosa by activation of the alveolar macrophage function in vivo.

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Two cases of bronchiolitis obliterans organizing pneumonia (BOOP) were diagnosed by clinical features and pathological findings of open lung biopsy specimens. Findings of repeated (bronchoalveolar lavage (BAL) fluid analysis were also reported.
Case 1 was a 54 year-old woman complaining of dry cough and low grade fever. Multiple infiltrative shadows in both lung fields were pointed out on her chest roentgenogram.
Case 2 was a 68 year-old woman with symptoms of cough, sputum and low grade fever. Her chest X-ray films also showed multiple infiltrative shadows bilaterally.
Although various antibiotics wer given to both patients, new shadows appeared on their chest films without any improvement of clinical symptoms or inflammatory findings. TBLB specimens obtained from the two cases showed the findings of organizing pneumonia. In each case, open lung biopsy was performed, and the pathological diagnosis was consisitent with BOOP. However exclusion of the possibility of eosinophilic pneumonia and lymphoproliferative disorders of the lung was somewhat difficult in case 1.
BALF analysis showed an increased number of lymphocytes in both cases, 75% and 37% respectively. The inverted ratio of OKT4/OKT8 (0.71) in BALF of case 1 was similar to that of hypersensitivity pneumonitis. In spite of clinical and roentgenological improvement after steroid therapy, the abnormal BAL findings still remained.
Therefore it is suggested that BAL may be a useful tool for monitoring the steroid treatment of patients with BOOP.

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Two cases of spontaneous pneumomediastinum and subcutaneous emphysema were reported.
The first cases was a 21-year-old man who had a past history of recurrent spontaneous pneumothorax. The second was a healthy 20-year-old man. They were admitted to our hospital becausee of dyspnea and chest pain, which occurred at or after vocal exercise for Xiao-lin Temple boxing. Physically, a mediastinal crunch on auscaltation heard over the cadiac apex and the left sternal border (Hamman's sign) was recognized in the first case, and subcutaneous emphysema was palpated in both cases. The chest X-ray films revealed intramediastinal air and subcutaneous emphysema in both cases.
We diagnosed these patients as spontaneous pneumomediastinum because of no underlying disease. This is a report of rare cases of spontaneous pneumomediastinum occurring at the same time, and one of the mechanism causing them was considered to be a sudden increase in intrathoracic pressure due to the vocal exercise of chinese boxing.

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A 74 year-old man, a known asthmatic since 1972, was treated by timolol eye-drop for acute glaucoma. Several hours later the patient developed a severe attack of asthma, and died subsequently. The autopsy findings were consistent with those of typical status asthmaticus. Our patient is, to our knowledge, the first case of fatal asthma induced by timolol eye-drop in Japan.

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A 67 year-old male complaining of cough and exertional dyspnea was hospitalized for evaluation of an abnormal chest shadow. Chest X-ray films revealed bilateral diffuse nodular shadows, honeycombing in the lower lung fields and pleural thickening suggestive of idiopathic interstitial pneumonia. He had worked as a boilerman and painting using various materials. Transbronchial lung biopsy did not reveal silicotic nodules or asbestos bodies. Analytical electron microscopic study demonstrated amounts of free silica without other elements and asbestos fibers. This case suggests a pathognomonic releationship between indiopathic interstitial pneumonia and silica inhalation.

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A 34 year-old male pigeon breeder developed a sudden fever, cough, and dyspnea with diffuse nodular shadows on the chest X-ray film and computer tomogram. His symptoms and diffuse nodular shadows on the chest X-ray film improved and gallium (Ga) scintigram showed no accumulation of ⁶⁷Ga-citrate in his lungs when examined after corticosteroid therapy. Serum precipitin against pigeon serum and pigeon dropping extracts could be detected. In his bronchoalveolar lavage (BAL) fluid, total cell count, mainly lymphocytes, were increased. OKT8⁺-HLA-DR⁺ T cells were dominant in the lymphocyte subpopulation of the BAL fluid. Pathological examination of transbronchial lung biopsy specimen showed interstitial pneumonia. Blastogenic response of peripheral blood mononuclear cells when cultured with pigeon serum could not be observed, which suggested suppressive effects of lymphocyte blastogenesis by corticosteroid therapy. An inhalation provocation test with pigeon serum was performed. The patient developed fever, leucocytosis, hypoxemia and decreased vital capacity after the inhalation provocation test. Consequently, the case was diagnosed as a pigeon breeder's lung.

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A 58 year-old man was admitted to our hosptal with complaints of dyspnea and cough. Chest X-ray examination revealed diffuse nodular shadow, infiltration in the left upper and lower lobes, and volume loss.
BALF showed increased number of cells, particularly eosinocyte (65.6%). Eosinophilia (17-13%) was also seen. The histological examination of the TBLB specimen revealed irregular thickening and edema of alveolar septa. From these findings together with clinical features the case was diagnosed as eosinophilic pneumonia. Oral administration of prednisolone started with 30mg. Within a week, eosinophilia in peripheral blood decreased to 1%, PaO₂ increased to 87.5 Torr in room air, and CRP became negative. His chest X-ray film showed the disappearance of infiltrative shadows in the left upper and lower lobes.
On the 19th day was predonisolone decreased to 20mg. Laboratory data and chest roentgenogram showed exacerbation, and PaO₂ gradually decreased to 62.9Torr. Patchy shadows were seen in the right upper lobe.
The dose of prednisolone was again increased to 60mg/day, and was quite effective. The drug dosage was tapered by 10mg/10days to 40mg/day, however all data exacerbated again. The clinical course seemed peculiar for eosinophilic pneumonia, however small reticulonodular shadows on chest X-ray did not change. Therefore, open lung biopsy was performed. The histology of the specimen showed fibrosis, lymphocyte infiltration and thickening of alveolar septa.
The clinical course and histopathological findings led to a diagnosis of idiopathic pulmonary fibrosis accompanied with chronic eosinophilic pneumonia.

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A case of primary macroglobulinemia with pleural and gastric involvement was presented. A 48-year-old female was admitted with productive cough. On physical examination neither lymphoadenopathy nor hepatosplenomegaly were found. In addition, no bleeding tendency nor disturbance of the visual acuity were detected. Her chest roentgenogram showed a moderate amount of pleural effusion in the left pleural cavity without infiltration in the lung fields and no evidence of swollen hilar or mediastinal lymphnodes. A monoclonal M-band of to IgM-κ type was observed in her serum and the pleural effusion. The diffuse ulcerative lesion in the gastric mucosa was detected by gastrofiberscopy. The lymphoid cells taken from the pleural effusion and the gastric mucosa stained positively with fluorescein-conjugated antiserum to u or the κ chain. Pleural effusion and gastric infiltration of lymphoid cells improved remarkably following ACOP therapy.

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A 73-year-old man had been treated with Aprindine because of paroxysmal atrial fibrillation. On July 13, 1987, five months after the commencement of aprindine administrtation, he developed dyspnea and low grade fever. His chest X-ray revealed multiple infiltrative shadows in both lung fields. He was treated by various antibiotics, but the infiltrative shadows increased. BALF showed increased percentage of lymphocytes and a decrease in the OKT4/T8 ratio, and the histological findings of TBLB carried out on August 6, 1987, showed alveolitis with Masson bodies. The lymphocyte stimulation test by drugs was positive only for aprindine. After cessation of Aprindine administration, his complaints and laboratory data improved, but his abnormal shadow on chest X-ray did not diminish completely. Open lung biopsy was performed for differential diagnosis of BOOP, on Sep. 14, 1987. The histopathology of specimens of the lung was compatible with drug-induced pneumonitis. The administration of 30mg of prednisolone was started on Oct. 14, 1987, and the dosage was decreased gradually. The abnormal shadow on chest X-ray improved.
To our knowledge, there has been no reported case of Aprindine-induced pneumonitis, and this could be the first report.

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