Causative agents of respiratory infections has been changed because of increase in number of aged people and compromised host and the rapid development of new chemotherapeutic agents. Especially Branhamella catarrhalis (B. catarrhalis), which is very unique and has become a common respiratory pathogen, since 1980, in my department. Attachment ability of B. catarrhalis to oropharyngeal cells coincided with the acute exacerbation of chronic respiratory infections by this bacterium and the same phenomenon in pneumococcal infections was also established. In the hospital for aged people, two major pathogens Staphylococcus aureus (S. aureus) and Psudomonas aeruginosa (P. aeruginosa) are specially seen. In these patients, the two major ones were isolated from the oropharynx. Non-typable Haemophilus influenzae (H. influenzae) is also very important in Japan like USA. Recurrent infection with this pathogen occured due to the change of OMPs during the time period of more than one month. Complement and some amount of ceftadizim were inactivated by destroyed neutropils in vitro. This result may explain one of the cause of intractability of P. aeruginosa infection. Monoclonal antibody against P. aeruginosa showed effectiveness in P. aeruginosa pneumonia model in mice. Intraabdominal administration of fibronectin also was effective for staphylococcal pneumonia in rat.
Oropharyngeal pathogens like S. aureus, S. pneumonia, B. catarrhalis, H. influenzae and P. aeruginosa were killed by 100-500 times diluted solution of 7% povidonjod solution. Moreover the frequency of recurrence of infection by these bacteria were decreased by gargling this solution 3-4 times/day. New question has been arised about the common bacteria in oropharynx. Control or adjustment of these bacteria may become very important in future. Modern therapy should be constituted by clear understanding of the pathogenesis of respiratory infections.

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The present study reviwed and summarized the long-term therapeutic effects of erythromycin or newquinolone antibacterial agents on diffuse panbronchiolitis.
Various parameters before and after the treatment were analyzed in 101 patients selected from 227 diffuse panbronchiolitis patients gathered from 26 insititutes in Japan. Patients had been treated with either erythromycin or newquinolone antibacterial agent for more than 3 months.
Patients treated with erythromycin showed significant improvement of dyspnea on exertion, findings of chest X-ray, data on blood gas analysis, rate of ESR, titer of cold coagulation and amount of sputum, compared with patients treated with the newquinolone antibacterial agent.
Among the patients treated with erythromycin, those patients with the initial high cold coagulation titer showed better improvement following treatment. However, there was no significant difference in improvement, depending upon either the duration between the time of onset of the disease, the initiation of treatment, and the initial severity of the disease.

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Systemic administration of interleukin-2 (IL-2) in patients with malignant diseases induces peripheral eosinophilia. In the present study, to clarify the mechanisms of eosinophila induced by IL-2, we examined the changes in the number of eosinophils and in eosinophil colony stimulating activity (Eo-CSA) in the pleural fluid of six patients with malignant pleurisy caused by lung cancer or malignant mesothelioma, during and after intrapleural administration of IL-2. Results showed that intrapleural administration of IL-2 induced marked eosinophila in the pleural fluid and mild eosinophilia in the peripheral blood, and that during IL-2 administration, marked Eo-CSA appeared in the pleural fluid before increase in the number of eosinophils. The Eo-CSA seemed to be a polypeptide or protein because it was trypsin-sensitive and had a molecular weight of 40-60kDa

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Seven cases (1.9%)of simultaneous bilateral pneumothoraces were found in a retrospective study of 377 patients with spontaneous pneumothorax during the period from July, 1977 to June, 1989. Their symptoms were essentially those of unilateral pneumothorax, but with more severe dyspnea.
All but two cases, both young, had underlying pulmonary diseases. Three (two lung cancers and one metastatic lung disease) had malignant pulmonary disease. During this period, five lung cancer patients were complicated with pneumothorax, and two of them had simultaneous bilateral pneumothoraces. Therefore the frequnecy of bilateral pneumothoraces in the lung cancer patients associated with pneumothorax is high. In these three patients with malignant disease, tube drainage was carried out but all died of respiratory failure. Two senile patients had small bilateral pneumothoraces. Bed rest without invasive treatment led to successful cure. Two younger patients without underlying pathology initially underwent tube drainage, followed by operation.
We conclude that many patients with simultaneous bilateral spontaneous pneumothoraces have underlying pulmonary disease, the frequency of lung cancer being particularly high. Young patients without underlying disease should be operated on following alleviation of symptoms by tube drainage. Older patients and patients with malignancy should be treated with great care and individually.

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Although serum CA 19-9 is considered to be a useful and specific tumor marker for pancreatic cancer, some patients with benign pulmonary diseases show elevated serum CA 19-9 levels. We measured serum CA 19-9 levels of 156 patients with benign pulmonary diseases (55 with asbestosis, 11 with bronchial asthma, 32 with bronchiectasis, 16 with idiopathic pulmonary fibrosis (IPF), 13 with healed pulmonary tuberculosis (HPT) and 29 other benign diseases). The percentage of patients with positive serum CA 19-9 was 42.3% (14.5% in asbestosis, 27.3% in bronchial asthma, 59.4% in bronchiectasis, 81.3% in IPF, 61.5% in HPT and 51.7% in others). In some patients, serum CA 19-9 levels were as high as those found in malignant gastrointestinal diseases. Serum CA 19-9 levels correlated well with disease activity. Immunohistochemically, CA 19-9 was expressed in mucous cells of the bronchial gland and surface of the bronchiolar surface epithelium cells in benign pulmonary disease. Gel filtration study suggested some difference in molecular weight between the serum CA 19-9 antigen of lung cancer and that of benign pulmonary diseases. It is suggested that serum CA 19-9 increases in the case of hyperplasia of the bronchiolar epithelium cells or the mucous cells of the bronchial gland.
We conclude that benign pulmonary disease is one of the factors that affect serum CA 19-9 levels.

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It is well known that some asthmatic patients develop bronchoconstriction after exercise challenge (exercise-induced asthma, EIA). Recently, it has been pointed out that isocapnic hyperventilation also induces similar bronchoconstriction (hyperventilation-induced asthma, HIA) in the same asthmatic subjects. However, the mechanism of HIA has not yet been determined. In the present study, we performed exercise and hyperventilation challenge in the same patients and pulmonary function data and neutrophil chemotactic factor (NCF) in peripheral blood were examined before and after both challenges.
Twelve asthmatic patients with normal pulmonary function data on testing days were subjected to exercise test on a bicycle ergometer and then isocapnic hyperventilation tests in subsequent days. Subjects breathed dry air from the cylinder. Isocapnic hyperventilation was performed by monitoring minute ventilation and each patient followed the same minute ventilation exercise.
The reduction of FEV_1.0 and time course of airway obstruction were almost the same after exercise and hyperventilation testing. All patients who developed EIA also developed HIA and other patients did not develop both EIA and HIA.
Changes of Rrs, V₅₀ and V₂₅ and their time course after each test were also similar in EIA (+) and HIA (+), and in EIA (-) and HIA (-).
NCF increased significantly after both challenges in EIA (+) and HIA (+) patient, although increment of NCF was much less these the increases of HIA(+).
These data may suggest that the development of bronchoconstriction was compatible after exercise and hyperventilation in each asthmatic patient, however, the mechanism of HIA may differ from EIA, although NCF slightly but significantly increased in HIA, suggesting the possible role of a chemical mediator.

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Ofloxacin (OFLX) or Enoxacin (ENX) was intramuscularly administered at a dose of 100mg/kg to rats (normal and pneumonia model). Bronchoalveolar lavage (BAL) was performed at 30min after administration and concentrations of OFLX or ENX in the recovery fluid were determined.
Total recovery amounts of OFLX from 10 BAL procedures were 64.7±18.7μg in the normal group and 126.5±16.1μg in the pneumonia group, and the amounts of ENX were 15.6±4.6μg in the normal group and 32.8±6.1μg in the pneumonia group.
Regarding the ratio of total recovery amounts in BAL to serum concentrations of OFLX or ENX, the pneumonia group was higher than the normal group and the ratio of OFLX was higher than that of ENX.
Regarding the ratio of total recovery amount in BAL to the amount in lung parenchyma, the ratio of OFLX was higher than that of ENX, but there was no significant difference between the normal group and the pneumonia group in the ratio of OFLX or ENX.
With regard to the ratio of the amount of OFLX or ENX in lung parenchyma to their serum concentrations, the ratio was higher in the pneumonia group than in the normal group, but there was no significant difference between OFLX and ENX.
Based on the above results, it was concluded that the permeability of OFLX into epithelium of blood capillary is the same as that of ENX, but the permeability of OFLX into alveolus epithelium is superior to that of ENX. Furthermore, increase of the recovered amount from BAL in the pneumonia model is due to acceleration of permeability into the epithelium of blood capillaies, and it is not related with permeability into alveoluis.

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A 61-year-old woman with low grade obesity index complained of general fatigue. Cardiomegaly had been present since the age of 45. According to a roentgenogram on admission, her cardia-thoracic ratio was 61%. Pericardial effusion was strongly suspected because of extra echo spaces on both posterior and anterior walls, and unsynchronized echocardiagraph waves of epicardium and pericadium. However, values of dynamic CT measured at areas equivalent to the extra echo spaces were-120. On admission, T1-emphasized MRI image showed a high signal density in those areas. After significant weight reduction, the abnormal values and signs of the clinical examinations, as well as the patient's complaints were attenuated or disappeared. Together with these results, cardiomegaly of the patient was diagnosed to be due to excessive fat deposit between the epicardium and cardiac muscle. Dissociation between mildness of obesity index and excessive deposition of fat in the pericardium was discussed from the point of view of body mass index and time course of fat deposition.

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A 65-year-old woman was admitted with exertional dyspnea. She had a history of syncopal attack and cerebral infarction.
On admission, her chest roentogenogram revealed two mass shadows in the right upper and lower fields. Pulmonary angiography and right heart catheterization were performed.
Six arteriovenous fistulas in the right lung and five in the left were observed. The percent of R-L shunt was 51.5%. Because of exertional dyspnea, large shunt and history of cerebrovascular disorders, excision resection of two fistulas in right upper and middle lobes and right lower lobectomy were performed. Her symptoms improved and the percent of the R-L shunt markedly decreased after the operation. There is no sign of enlargement in size of the remaining arteriovenous fistulas.

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A 37-year-old female with refractory asthma taking betamethasone orally (1mg/d), showed a fever of 38.5°C, productive cough and dyspnea. The chest X-ray demonstrated diffuse infiltration in the left lower lung field. The WBC count was 16, 600/mm³ with 6% eosinophils. She was treated with intravenous drip infusion of antibiotics (Cefotiam 2mg/d and Sisomicin 150mg/d) for 2 weeks, and her symptoms and the chest X-ray findings improved. However, at the end of the therapy eosinophilia was noticed. Sixteen days after the completion of antibiotic therapy, she again experienced fever, cough and dyspnea. The chest X-ray again demonstrated diffuse infiltrations in the left lower lung field. The total IgE level, histamine and circulating immune complex titers were elevated. The WBC count was 14, 700/mm³ with 34% eosinophils. Although a sputum culture yielded no organisms, many eosinophils were observed in the sputum. There were no clinical or laboratory findings compatible with allergic bronchopulmonary aspergillosis. After the administration of oral prednisolone (40mg/d), the patient showed rapid improvement with resolution of all symptoms and normalization of the IgE, histamine and circulating immune complex levels. The chest X-ray revealed marked regression of the pulmonary infiltrations. A microscopic examination of a transbronchial biopsy specimen demonstrated moderate eosinophilic infiltrations. It was compatible with the diagnosis of pulmonary infiltration with eosinophilia. Treatment was performed with prednisolone. The result of a lymphocyte stimulation test was positive for Cefotiam. An in vitro test was performed to evaluate the diagnosis of drug allergy in this case. Later, she suffered recurrent pulmonary infiltrations when the prednisolone was reduced from 7.5mg/d to 5mg/d.
In our experience, there has been no previous case report of pulmonary infiltration with eosinophilia in response to an allergic reaction to Cefotiam. In this case type I and III allergic reactions appeared to be the mechanism of pulmonary infiltration with eosinophilia. To prevent recurrent pulmonary infiltrations, this patient may require daily dosages of at least 7.5mg prednisolone.

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A 30-year-old male was admitted because of dyspnea, which had started three years before the admission. Chest roentgenogram showed prominence of the proximal pulmonary arteries and diminished vascularity of the peripheral pulmonary arteries. Electrocardiogram showed right axis deviation and right ventricular hypertrophy. Right heart catheterization revealed a markedly elevated pulmonary arterial pressure and pulmonary vascular resistance with normal capillary wedge pressure. Oximetry showed no evidence of intracardiac shunt. Perfusion lung scan revealed nonsegmental, patchy defects in both lungs. Pulmonary arteriography showed no evidence of pulmonary thromboembolism. From the above findings, primary pulmonary hypertension was diagnosed.
Nifedipine, ISDN, prazosin, and captopril were administered to evaluate the short term-effect of he vasodilators. Nifedipine was found to be the most effective.
The venous thromboxane B₂ level was high. After oxygen therapy, venous thromboxane B₂ level fell within the normal range following improvement of arterial oxygenation and decrease in venous FDP level. Hemodynamic changes induced by ice-water hand immersion showed marked increase in the mean pulmonary arterial pressure and total pulmonary arterial resistance.
These results suggested that chemical mediators such as thromboxane, and pulmonary arterial vesospasm were involved in the pathogenesis.

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A 62-year-old female was referred to our division because of general fatigue, low grade fever and exertional dyspnea for 2 months. Laboratory data and chest roentgenograms on admission revealed polycythemia vera associated with idiopathic interstitial pneumonia. Alkylating therapy with carboquone and cyclophosphamide resulted in the improvement of abnormalities on chest X-ray films which had previously shown decreased lung feilds and abnormal interstitial shadows, as well as hematological abnormalities. Six months later, the results of the patient's pulmonary function tests and arterial blood gas analysis became within normal limits. Little information about polycythemia vera associated with idiopathic interstitial pneumonia is available. This case indicated that alkylating therapy with no steroidal combination is effective for idiopathic interstitial pneumonia.

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Two cases of thymic hyperplasia with Basedow's disease were reported. One case was a 23-year-old female. The CT examination disclosed a mediastinal mass, which was reduced in size after an anti-thyroid drug and subtotal thyroidectomy normalized the thyroid function. The other case was a 29-year-old male with thyrotoxic myopathy. The CT examination disclosed a mediastinal mass, which suggested thymoma. A total thymectomy was performed and the mass was pathologically diagnosed as thymic hyperplasia.

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