The spontaneous production of interleukin-1 alpha and beta by alveolar cells obtained by BAL from 7 active pulmonary sarcoidosis and 5 normal volunteers was evaluated. The activity of disease in one case was considered to be highly active because of the chest X-ray pattern (diffuse micronodular shadows), highly intense Ga up take in lungs, increased number of BAL cells and high level of S-ACE. The contents of IL-1 alpha and beta were measured by ELISA in the culture supernatants of alveolar cells after 24 hours culture without any stimulus. Large amounts of IL-1 alpha and beta production were found in highly active case. No significant amount of IL-1 alpha and beta, however, was detected in 6 other active sarcoidosis cases and 5 normal volunteers. Therefore, spontaneous release of IL-1 alpha and beta in vitro from alveolar cells in sarcoidosis might be considered as an index for the necessity of systemic corticosteroid treatment and its relationship to the spontaneous remission of sarcoidosis in Japanese patients was discussed.

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To assess the role of arachidonic acid metabolites in pathogenesis of bronchial asthma, we measured thromboxane B₂ (TxB₂), 6-keto PGF_1α, leukotriene (LT) C₄, and LTB₄ in venous blood plasma in patients with bronchial asthma and in controls.
The level of TxB₂ was significantly higher in 18 asthmatics with attacks than that in 11 controls (77.3±48.8pg/ml vs 48.8±9.4pgml). The levels of 6-keto PGF_1α in both asthmatics with attacks (17.8±6.7pg/ml) and without an attack (16.4±9.7) were significantly higher than that in controls (11.6±3.9pg/ml). The levels of LTC₄ in asthmatics with attacks (0.84±0.11ng/ml, n=11) were significantly higher than that in controls, furthermore the level of LTC₄ in asthmatics without an attack. The level of LTB₄ was significantly higher in asthmatics with attacks (295.0±160.7pg/ml, n=26) than that in controls (161.7±25.3pg/ml, n=12) and asthmatics without an attack (182.4±97.9pg/ml, n=22).
These findings suggest that the arachidonic acid metabolites are related to the asthma attack and are associated with the pathogenesis of bronchial asthma.

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Twenty-nine patients with bronchiolitis obliterans organizing pneumonia (BOOP) in Japan diagnosed by an open lung biopsy were reviewed. A total of 70% of the patients were idiopathic and 2/3 of the remaining were associated with connective tissue disease. All 29 cases of BOOP showed bilateral pulmonary infiltration on chest X-rays. BOOP can be classified based on the chest X-ray findings into three major types, Type I, Type II and unclasified type. In Type I shadows appear in the lung fields. In Type II abnormal shadows are seen in the bibasilar peripheral field with the reduction of the lung volume. Cases of Type I showed inflammatory findings more frequently than cases of Type II. Among 29 BOOP patients, two idiopathic cases died.

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The efficacy rate, minimal inhibitory concentraions (MICs), and resistance of fluoroquinolone agents against causative organisms in respiratory tract infections from January to March, 1988 were investigated. Of 333 pathogenic strains 85% consisted of 5 major causative organisms of respiratory tract infection (Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Branhamella catarrhalis, and Staphylococcus aureus). In 61 (59 cases) of these 333 strains, including 3 cases of acute pharyngitis, 5 of acute bronchitis, 3 of pneumonia, and 48 of chronic lower respiratory tract infection fluoroquinolone agents were administered. The efficacy rate was 76.3% in all cases, and 75% in cases with chronic lower respiratory tract infection. The fluoroquinolone agents were 100% effective in H. influenzae and B. catarrhalis, though the efficacy rate was 67% in S. aureus and 40% in P. aeruginosa. The susceptibility of all strains to fluoroquinolone agents were investigated. There was no resistant strain in H. influenzae and B. catarrhalis, though resistant strains to flouroquinolone agents have increased in S. aureus and P. aeruginosa. The efficacy rate was investigated using the MIC of administered fluoroquinolone agent against causative organisms. It is surmised that the efficacy of that agent has an MIC of 1.56-3.13μg/ml.

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Seven asbestos workers with asbestos pleurisy were investigated in terms of clinical symptoms, findings of pleural biopsies and course of chest roentgenograms. All cases were male and smokers. Duration of asbestos exposure ranged from 3 to 33 years (mean: 20.6 years). Duration between initial exposure and onset of the pleurisy ranged from 22 to 34 years (mean: 28.7years).
Five pleural effusions were aseptic and exudative, and one had sanguinous and eosinophilic effusion.
According to the findings of pleural biopsies, our cases were classified into 2 groups. Group A (4 cases) had “basketweaving formation” on the parietal side and inflammatory changes on the visceral side. No circulating autoantibodies were found in group A.
Group B (3 cases) had no “basketweaving formation” but only intensive inflammatory changes. These 3 cases were respectively complicated with anti-GBM antibody mediated glomerulonephritis, with acute interstitial pneumonia, and with rheumatoid arthritis and acute interstitial pneumonia. They all had circulating autoantibodies.
In the course of chest roentgenograms, 6 of the 7 cases finally showed diffuse pleural thickneings which involved obliterations of costophrenic angles. Among them, one case developed into progressive pleural fibrosis.
It was concluded that asbestos pleurisy can be classified into 2 groups according to the mechanism of occurrence, and immunoloical changes should be recognized as one of the mechanisms of asbestos pleurisy.

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Oxidant production by peripheral granulocytes stimulated with phorbol myristate acetate (PMA) was investigated in 11 patients with idiopathic pulmonary fibrosis (IPF), 6 with interstitial pneumonia associated with collagen vascular disease (IP-CVD), 8 with sarcoidosis and 12 healthy subjects. Oxidant production was examined by flow cytometry using dichlorofluorescein deacetate. The reactivity of granulocytes to PMA was assessed according to the ratio between mean fluorescent intensity of granulocytes stimulated maximally with PMA and that without PMA, (stimulation index: S. I.). The concentration of PMA that induced half maximal fluorescent intensity of granulocytes (PC_1/2max) was used as the index of sensitivity.
The S. I. was 7.2±0.45 in IPF, 6.3±0.6in IP-CVD, 6.0±0.71 in sarcoidosis, and 5.8±0.2 in healthy subjects. However differences between groups were not significant. PC_1/2max was 7.3±2.1ng/ml in IPF, 9.1±3.0ng/ml in IP-CVD, 12±6.9ng/ml in sarcoidosis and 16.1±5.8ng/ml in healthy subjects. There was significant difference between IPF and healthy subjects (p<0.05) indicating that peripheral granulocytes in patients with IPF are more highly sensitive to PMA than healthy subjects.

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Small airway obstruction in idiopathic interstitial pneumonia was studied in 54 cases of interstitial pneumonia accompanied by restrictive, but not obstructive impairment (%VC<80%, FEV₁/FVC%>70%). Correlation analysis of%VC showed that small airway obstruction seemed to play a role in the decrease in VC in these cases. Cases were then divided into two groups. In group A, restrictive impairment was caused by the decrease in TLC (%TLC<80% & %RV<120%)and in group B, it was caused by increase in RV (%TLC>80% & %RV>120). Cases of idiopathic interstital pneumonia (IIP) were preferentially categorized into group A. Statistical comparison of the lung function measurements revealed that lung parenchyma was altered less severely whereas small airway obstruction was more advanced in group B than group A. Group B was divided into two subgroups, the subgroups of IIP cases and of the other disease cases, and the latter had a larger lung volume and more severely impaired small airway function. Furthermore, IIP cases from group A had less severely altered lung parenchyma than IIP cases from group B. Smoking habits did not seem to be related to these results. The results indicate that in most cases of interstital pneumonia othert than IIP, the lung function was characterized by small airway obstruction rather than decreased lung volume, and some cases of IIP also showed a similar trend. In addition, a long-term study of lung function was made in some cases of interstitial pneumonia and it was shown that small airway obstruction could change severity after a time interval.

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The incidence and latency period of collagen vascular disease (CVD) were surveyed prospectively in patients originally diagnosed as idiopathic interstitial pneumonia (IIP). We also examined whether there were differences between IIP and CVD preceded by interstitial pneumonia. Background information, extrapulmonary symptoms, smoking history, laboratory findings, prognosis (Kaplan-Meier estimates), respiratory functions, and radiological findings were compared.
The subjects consisted of 68 patients of whom 13 (19%)developed CVD (RA; 5 cases, DMPM; 5 cases, SLE; 1 case, Sjoegren syndrome; 1 case, Overlap syndrome; 1 case). The latency period for development of CVD was 24.9±39.2 (mean±SD)months. IIP patients who developed CVD were predominantly female and were younger than those without CVD (p<0.05). These patients also had faster ESR, higher CPK values, and a higher incidence of arthralgia, joint deformity and clubbed fingers (p<0.05). Abnormal shadows around constophrenic angles were seen more frequently in patients with CVD (p<0.05).
These results suggest that quite a number of patients with IIP develop CVD. The clinical course of these patients should be followed by keeping these clinical findings in mind.

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The activity of angiotensin converting enzyme (ACE) released into the culture medium of human umbilical cord vein endothelial cells in culture (HUVEC) for 24-hour incubation with or without various serotypes of lipopolysaccharide (LPS) was unchanged. ACE activity, however, in cell lysate or monolayer HUVEC after 24-hour incubation of various serotypes of LPS except LPS from E. coli, 026:B6, showed significant decrease, compared with no LPS treatment. Cell lysate contained much higher ACE activity than monolayer HUVEC after 24-hour incubation with or without LPS. These findings give rise to speculation that ACE or ACE-like substance might be located not only on the luminal surface, but also in cytoplasm of HUVEC, and also that decrease of ACE activity in the serum of septic adult respiratory distress syndrome (ARDS) patients might be due to reduced synthesis by vascular endothelial cells.

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A 63-year-old woman was referred to our division because of massive hemoptysis (200ml) after administration of ticlopidine, an anti-thrombotic drug, for prevention of recurrent brain infarction. Ticlopidine treatment was stopped on the first hospital day, thereafter the patient's hemoptysis immediately disappeared. A chest roentgenogram and bronchofiberscopic examination did not reveal any organic lesion associated with hemoptysis. Laboratory data revealed prolonged bleeding time and decreased platelet aggregation, suggesting that the patient had had a hemorrhagic diathesis associated with the administration of ticlopidine. Although many anti-thrombotic drugs have been recently employed in a variety of clinical cases, the patient's hemoptysis was considered to be due to side effects.

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A 52-year-old man receiving maintenance hemodialysis for 6 years was referred to our division for further evaluation and additional therapy for cough and hemosputum lasting 2 months, and for examination of a chest roentgenographic abnormality. Transbronchial lung biopsy specimens revealed squamous cell carcinoma of the lung. A total of 8 courses of anticancer chemotherapy with 25-30mg/m² of CDDP performed biweekly resulted in a partial remission (56%) but no side effects, including gastrointestinal damage and agranulocytosis. Few cases of lung cancer receiving anticancer chemotherapy with CDDP during maintenance hemodialysis have been reported. Administration methods and dosage of CDDP for patients receiving maintenance hemodialysis were discussed.

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A 48-year-old male was admitted for furher examination of a coin lesion with a diameter of 8mm seen on chest X-ray. The patient was a heavy smoker and his serum level of CEA was elevaed to 29.8ng/ml. Since the bronchofiberscopic examination was not able to yield a definitive diagnosis, an operation was performed as lung cancer was suspected. According to the histological examination, the small nodule was diagnosed as an intrapulmonary lymph node with anthracosis and silicotic nodules.
A review of the limited number of case reports shows that men are more prone to intrapulmonary lymph nodes, and that the patients were all smokers but not necessarily with occupational experience of exposure to silica.

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A 16-year-old male was admitted with a history of cervical lymph node swelling, high fever, cough and hemosputum. On admission, bilateral cervical lymph nodes swelling and fine crackles in the right lower lung field were noted. A chest X-ray film showed an infiltrative shadow in the right lower lung field and right hilar enlargement. Cervical lymph node biopsy specimens revealed wide areas of necrosis with nuclear debris. Transbronchial lung biopsy showed infiltration of lymphocytes in the interstitium and bronchoalveolar lavage fluid showed increased T-lymphocytes and a decreased T4/T8 ratio. The patient was diagnosed to have subacute necrotizing lymphadenitis with T-lymphocyte alveolitis. Additionally, antinuclear antibodies were positive, and anti HTLV-I antibody was false positive. These findings suggested an immonological abnormality in this case. His cervical lymph node swelling and infiltrative shadow on chest X-ray film improved with steroid therapy. Our case may be the first case of subacute necrotizing lymphadenitis with T-lymphocyte alveolitis.

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We reported two operated cases (a 35-year-old male and 52-year-old male) of mediastinal goiter accompanied by marked tracheal deviation. The two patients did not have any clinical symptoms.
CT, MRI, ultrasonography and angiography finding of the two cases are presented. Fluid was obtained from the cystic lesions by ultrasonically guided needle aspiration. The levels of thyroid hormones (T₃, T₄) in the fluid were not high in comparison with serum levels. Surgical resection was performed on the 35-year-old male case by collar incision and on the 52-year-old male case by median sternotomy.

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A 61-year-old man was admitted to our hospital with fever, cough and dyspnea on exertion. The chest X-ray showed diffuse reticulogranular infiltrates. Deterioration of clinical features and remarkable elevation of BALF lymphocytes (64.3%) suggested active interstitial pneumonia. The open lung biopsy specimen showed chronic interstitial pneumonia with DIP-like pathologic change. There was a remarkable clinical, physiological and roentgenographic improvement associated with decrease of BALF lymphocytes in response to steroid therapy. BAL is useful for monitoring disease activity and tapering steroids in patients with interstitial pneumonia who respond to steroid therapy.

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This paper reports a 73-year-old male case of lung cancer presenting as thin-walled cavity which was suspected to be pulmonary mycosis of the fungus ball type. Routine chest X-ray film showed a thin-walled cavity without a round shadow inside it. CR tomogram taken 2 months after the previous plain chest X-ray film showed an irregular thickening of the cavity wall and a round shadow inside it. Pulmonary mycosis of the fungus ball type was suspected based on the CR tomogram. But chest X-ray CT film taken 1 month after the previous CR tomogram revealed that the entire cavity wall was thickened with irregular convexity and no round shadow was seen in the cavity. Cavitary lung cancer was also suspected based on the findings of X-ray CT film. The surgical specimen, obtained by right upper lobectomy, revealed a moderately differentiated squamous cell carcinoma unaccompanied by pulmonary mycosis in the cavity space. Even in cases suggestive of mycosis, aggressive surgical intervention is recommended in those suspected of malignancy.

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A case of septic pulmonary emboli due to parenteral nutrition catheter infection was reported. Characteristic radiologic features were recognized.
A 50-year-old man, who was receiving parenteral nutrition after total gastrectomy, consulted our department with complaints of fever and general malaise. A chest radiograph showed scattered ill-defined small peripheral nodules, which were not present before parenteral nutrition, and these nodules were quickly cavitalized in 2nd day. He was suffering from high fever, hemosputum and dyspnea after removal of the parenteral nutrition catheter. Pseudomonas aeruginosa was isolated from the tip of parenteral nutrition catheter and sputum cultures. Septic pulmonary emboli were diagnosed and antibiotic therapy was performed. Bacterial endocarditis and septic thrombophlebitis were ruled out. The multiple cavitary nodules extended to involve the perpheral areas of the lung and invasive shadows appeared on the chest radiograph in 8th day. Then, the invasive shadows disappeared and the walls of the cavitary lesions became thinner. After 2 months, all cavitary lesions dissappeared with only linear shadows remaining.

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