Thromboxane A₂ (TXA₂) has been suggested to play an important role in the pathogenesis of bronchial asthma. In this study the effects of intravenous administration of TXA₂ on bronchial smooth muscle in guinea-pigs were investigated by measuring dynamic compliance and dynamic respiratory resistance, using a formula to exclude the effects of differences in airway wall thickness. Using this formula, the ratio of bronchial smooth muscle constriction by histamine can be estimated as an index of bronchial hyperresponsiveness. Administration of TXA₂ did not induce airway wall edema. The ratio of bronchial smooth muscle constriction by histamine was significantly (p<0.01) enhanced by the administration of TXA₂. Moreover, TXA₂ antagonists, ONO-NT-126 and ONO-8809, inhibited the effect of TXA₂ administration.
These results suggest that TXA₂ is an important mediator affecting bronchial hyperresponsiveness.

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In order to evaluate isometric tension in segments of tracheal smooth muscle in vivo, we first investigated the anatomical distribution of arteries supplying the tracheal smooth muscle in 52 dogs. The patterns of the cranial thyroid arteries were classified into the following four types.
A) Common type: the cranial thyroid artery leaves the muscular branch, and then divides into the thyroid branch and the tracheal branch.
B) The cranial thyroid artery leaves the tracheal branch, and then divides into the muscular branch and the thyroid branch.
C) The cranial thyroid artery divides into the muscular branch, the thyroid branch, and the tracheal branch.
D) The cranial thyroid artery divides into the tracheal branch and thyroid branch, and lacks a muscular branch.
Out of 52 dogs, 62% had common type bilaterally, and 23% had common type unilaterally. All dogs had a tracheal branch.
We demonstrated tracheal smooth muscle contraction by intra-arterial administration of acetylcholine, histamine, 5-hydroxy-tryptamine, phenylephrine, and clonidine using isometric technique in vivo. These results suggest that tracheal contraction induced by sympathetic amines is mediated through two subtypes of receptors, alpha₁ and alpha₂, in tracheal smooth muscle.

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The effects of intravenously administered almitrine (0.3 or 1.0μg/kg/min, for 30min) on hemodynamics and pulmonary gas exchange were assessed in eight dogs with acute lung injury induced by paraquat under controlled ventilation.
Arterial blood gases, pulmonary and systemic hemodynamics, and ventilation-perfusion distribution (V_A/Q) using the multiple inert gas elimination technique were examined before (control) and during infusion of almitrine.
Almitrine produced significant increases in mean pulmonary arterial pressure from 17.4±3.3 (control, mean ±SD) to 20.4±1.5mmHg (1.0μg/kg/min), and in total pulmonary vascular resistance. There was no change in other hemodynamic parameters, arterial gas tensions, or V_A/Q distribution.
These results indicate that almitrine causes pulmonary vasocontriction without changing ventrilation-perfusion distribution in dogs with paraquat-induced lung injury.

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The acute hemodynamic and blood gas changes caused by denopamine (2μg/kg/min, d. i.) were investigated in 13 patients with chronic respiratory failure and secondary pulmonary hypertension.
Denopamine significantly reduced mean pulmonary arterial pressure from 25±7 to 23±7mmHg (p<0.05), and pulmonary vascular resistance from 314±166 to 276±168dyne/sec/cm^-5 (p<0.05), while mean systemic arterial pressure and systemic vascular resistance showed no significant change. Pulmonary-systemic vascular resistance ratio was reduced significantly from 0.22±0.09 to 0.18±0.09 (p<0.05). These findings suggest that denopamine has more marked effects on the pulmonary artery than on systemic arteries.
Arterial oxygen tension (PaO₂) increased significantly from 59.0±8.1 to 62.5±10.5Torr (p<0.01), and arterial carbon dioxide tension (PaCO₂) decreased significantly from 49.1±6.8 to 44.6±7.0 Torr (p<0.01) by denopamine. Mixed venous oxygen tension (PvO₂), which is an indicator of tissue oxygenation, increased significantly from 33.3±3.5 to 34.4±3.3Torr (p<0.05).
We conclude that denopamine is thought to be useful for the improvement of hemodynamics and tissue oxygenation in patients with secondary pulmonary hypertension. However, further long-term studies are necessary to establish its therapeutic efficacy.

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We studied the acoustic features of continuous adventitious lung sounds in asthmatic patients, and analyzed the characteristics of transmission by comparing the continuous sounds in asthamtic patients with those due to bronchial stenosis. The results were as follows.
1) Continuous adventitious lung sounds in patients with bronchial stenosis confirmed by bronchoscopy were well transmitted to the neck over the trachea. Therefore, it was demonstrated that continuous adventitious lung sounds generated in the lung are able to be transmitted to the tracheal region.
2) Continuous adventitious lung sounds in asthmatic patients were divided into monophonic tones and polyphonic tones, according to sound spectrographic findings. From the results of the coherence analysis, the monophonic tones were considered to be generated in the right or left lung, and were well transmitted to the neck over the trachea. The origin of the polyphonic tones was unknown, but they were also relatively well transmitted to the neck over the trachea.
It was confirmed that the tracheal region is a very important location for auscultating and monitoring asthmatic patients.

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To clarify the mechanism underlying the inhibitory effect of epithelial cells on smooth muscle contraction, we studied two types of human bronchial tissue preparations: (1) “acceptor” bronchial strip without epithelium, (2) “donor” bronchial ring with or without epithelium. We measured the contractile responses of acceptor bronchial strip surrounded by donor bronchial ring to increasing concentrations of acetylcholine (ACh). Removal of the epithelium of the donor bronchial rings significantly enhanced the contractions of the acceptor bronchial strips. Thus, airway epithelium decreases the airway smooth muscle contraction to ACh in human bronchus. The mechanism of this inhibitory effect of airway epithelium was not due to a change in mechanical property of the airway, nor to a change in diffusion path for the chemical mediators. These results suggest that human airway epithelium may have an important role in modulating airway smooth muscle tone, possibly by the release of an epithelium-derived relaxing factor.

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Microbial culture of lung specimens from 569 autopsied cases from 1986 to 1989 revealed methicillin-resistant Staphylococcus aureus (MRSA) in 28 cases, which were subsequently analyzed clinicopathologically. The number of MRSA positive cases has markedly increased in recent years (2 cases in 1986, 2 in 1987, 6 in 1988, 18 in 1989). The most frequent underlying disease was neoplasm, which was seen in 17 cases. Of non-neoplastic diseases, liver cirrhosis and diffuse panbronchiolitis were prevalent. Twenty-four cases had received a course of antibiotic therapy. Antibiotics frequently administered were third-generation Cephem and Imipenem/cilastatin sodium (used in 20 cases). Antibioties to which MRSA was sensitive were administered in only one case (minocycline). Sputum culture was performed in only 10 cases, 5 of which were MRSA positive. MRSA had acquired resistance to fosfomycin and ofloxacin.
Histological examination revealed complication by pneumonia in 19 cases. In 7 of these 19 cases, MRSA was the only pathogen detected. Pulmonary MRSA infection detected at autopsy is frequently seen in patients with terminal stage cancer, but it is frequently not diagnosed and is undertreated. This may be a factor responsible for the recent marked increase in the proportion of MRSA in pathogens causing infection within medical institutions.

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The histologic findings of BOOP are nonspecific, and the diagnosis of idiopathic BOOP is one of exclusion. We studied the clinicopathologic features of various lung diseases with histopathological appearance of bronchiolitis obliterans organizing pneumonia (BOOP) pattern in open lung biopsy specimens.
The 17 patients with BOOP pattern studied included idiopathic BOOP (n=7), unclassified interstitial pneumonia (n=1), collagen vascular disease (n=3, RA 1, PM/DM 2), hypersensitivity pneumonitis (HP, n=2), eosinophilic pneumonia (EP, n=1), multiple lung abscesses (n=1), limited form of Wegener's granulomatosis (n=1), and pneumocystis carinii pneumonia associated with adult T cell leukemia (n=1). There were no differences in clinical symptoms, laboratory data, respiratory function, and cytological findings in bronchoalveolar lavage fluid (BALF) between cases of idiopathic BOOP and other lung diseases. The duration of clinical symptoms was less than one year in 16 patients (one case had no symptoms). Chest X-rays showed bilateral patchy, nodular, or reticular shadows in all cases. Multiple patchy migratory shadows were only observed in cases of idiopathic BOOP or EP. Organizing pneumonia was recognized in the transbronchial lung biopsy specimens of all patients with idiopathic BOOP, HP or EP. Regarding prognosis, relapses occurred in idiopathic BOOP (n=5), polymyositis, EP, limited form of Wegener's granulomatosis, and Pneumocystis carinii pneumonia. Four patients with idiopathic BOOP relapsed when steroid therapy was decreased or stopped.
These findings indicate that idiopathic BOOP should be defferentiated from other lung diseases, and these patients should be followed for a long period of time.

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A 66-year-old woman was admitted on May 13, 1989, because of an abnormal round shadow in the right hilum on chest X-ray film. Bronchoscopy revealed a stenosis of the right B⁸ caused by a bulging lesion. An aortogram showed a large meandering bronchial artery and a saccular aneurysm. The aneurysm was about 25mm in diameter and associated with a bronchopulmonary anastomosis. It was surgically removed by right lower lobectomy. Pathological examination proved that the resected lesion was an arterial aneurysm. Patchy arteriosclerotic change was present in the intima of the aneurysm, but there was no evidence of inflammatory change in the arterial wall and the adjacent alveoli and bronchi.
Twenty-six cases of bronchial artery aneurysm have been previously reported in the literature, but this is the first case that appeared as a solitary nodule on conventional chest X-ray.

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A 33-year-old albinotic woman whose parents were consanguineous was referred to our hospital with dry cough, dyspnea on exertion, and diffuse reticulonodular shadows on chest X-ray film. She had no apparent bleeding diathesis, although platelet serotonin content and ATP release were reduced.
Open lung biopsy revealed pulmonary interstitial fibrosis with deposition of ceroid-like material with alveolar and interstitial macrophages. From these findings, the diagnosis of Hermansky-Pudlak syndrome (HPS) with interstitial pneumonia was mode.
The reported characteristics of pulmonary interstitial pneumonia associated with HPS are occurrence of this disease in the thirties to forties, diffuse reticulonodular shadows in all lung fields with sparing of the subpleural zones, and bullous formation in the upper lobes. Progression usually occurs to diffuse interstitial fibrosis, but these is little decrease in lung volume.
The prognosis of HPS with interstitial pneumonia is worse than that of uncomplicated HPS, and patients die of respiratory failure within 1 to 6 years after diagnosis. Steroid therapy is not effective.

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A case of localized mesothelioma with a history of asbestos exposure is reported. A significant number of ferruginous bodies were detected in the lung of autopsy. The tumor mainly consisted of which did not show mitosis. The tumor stained weakly with cytokeratin and vimentin.
Thus, this tumor was very difficult to differentiate from malignant mesothelioma. Clinical symptoms such as pulmonary osteoarthropathy, hypoglycemia, and very slow growth are important characlesistics in the diagnosis of localized benign mesothelioma.

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A 76-year-old man with spindle cell (squamous) carcinoma of the lung developed fatal respiratory failure after limited thoracic irradiation at a total dose of 18Gy. He developed severe pulmonary toxicity, which presented as dry cough, dyspnea, and pulmonary infiltrates extending beyond the radiation field. Microscopically, a transitional form of squamous to spindle-shaped cells was observed in the primary tumor, located at right S8. Immunohistochemical examination showed positive staining of spindle cells for keratin, vimentin, and EMA, but not for desmin. These results indicate that the spindle cells had characteristics of squamous epithelial cells, and differed from carcinosarcoma. Distant metastatic lesions were composed of only the spindle cell component.

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A 18-year-old boy was admitted to hospital in an unconsciousness state as a result of taking a large dose of several psychotropic drugs simultaneously in an attempt to commit suicide. Blood studies revealed hypoxia (55.7mmHg) and hypercapnia (59.7mmHg). Hypoxia (74.3mmHg) and hypercapnia (46.7mmHg) were still present on the fourth day after admission, and the patient was becoming lethargic. Reduced vascular markings in the right upper lung field on chest roentgenogram in spite of hypercapnia suggested that the persistent hypoxia was the result of a pulmonary embolism. This diagnosis was supported by a perfusion defect on 99mTc-MAA scintigram and arterial obstruction in right pulmonary angiogram.
Hypercapnia is an unusual finding in pulmonary embolism, and in this case was considered due to depression of respiration by psychotropic drugs.

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A 65-year-old man was noted to have an abnormal shadow on chest X-ray at mass screening examination, and was seen at Douhoku Byoin National Sanatorium. Chest X-ray showed a homogeneous mass shadow and a lytic lesion of the right 5th rib with extra-pleural tumor sign at the right upper and middle lung fields. Retroperitoneal tumor of 5cm in diameter was detected in the right adrenal area by ultrasonography. Because of increasing plasma levels of norepinephrine and dopamine, the diagnosis of malignant pheochromocytoma with rib metastasis was made. Histologically, chromogranin staining was positive in each resected specimen. The retroperitoneal tumor was separate from the right adrenal gland. We report a rare case of malignant paraganglioma which was asymptomatic in spite of increasing plasma levels of cathecholamines.

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A 56-year-old male was admitted because of respiration arrest during sleep, and precordial crushing sensation which repeatedly occurred early in the morning. He had been hypertensive and aware of daytime sleepiness for ten years. After admission, all night polysomnography was recorded a total of four times. Apnea index was 37.5 times/hour, and central type apnea was perdominant. The diagnosis of sleep apnea syndrome was made. In the early morning of the fourteenth day after admission, the patient developed anterior chest pain associated with ST elevation in leads II, III, and _aV_F of the electrocardiogram. Thus, the case was thought to be complicated by variant angina. There were no anginal attacks during the all night polysomnography recordings. However, a causal relationship between the sleep apnea and variant anginal attacks was suspected. Since both the sleep apnea and the variant anginal attacks tended to occur during the stages of REM sleep, and they are both related to changes in activity of the autonomic nervous system. It was considered that hypoxemia following sleep apnea and/or the hyperventilation after the apneic episodes might be the cause of the variant anginal attacks.

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A 23-year-old male with bronchial asthma developed eosinophilia (eosinophils>2, 000/mm³) and was observed at our hospital. After using a prescribed indomethacin suppository for fever at home, he experienced an attack of acute chest pain and severe dyspnea. He suffered cardiac arrest while being transferred to the ward. After resuscitation, he was diagnosed as having acute myocardial infarction on the basis of electrocardiographic and ultrasonic cardiographic findings, and marked elevation of serum concentrations of myocardial enzymes. Thereafter, he often complained of precordial pain and abdominal pain. When he was administered an analgesic in another hospital, he developed severe precordial pain, and marked ST elevation was recorded on the electrocardiogram. Coronary angiography revealed no stenosis nor atherosclerotic changes, suggesting that severe spasm of the coronary arteries and direct myocardial injury by eosinophils were the causes of the myocardial infarction-like symptoms and angina pectoris-like attacks. He was diagnosed as having Churg-Strauss syndrome (allergic granulomatous angiitis) on the basis of the clinical findings; skin biopsy and transbronchial lung biopsy findings were consistent with the diagnosis. Following steroid administration, his angina-like attacks and abdominal pain ceased.
This patient developed two episodes of acute cardiovascular symptoms upon administration of antipyretic analgesics. This suggests that in cases of Churg-Strauss syndrome with aspirin-induced asthma, physicians must be aware of the cardiovascular complications, and such drugs should be administered with caution.

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A 67-year-old woman was admitted on June 21, 1990 because of an abnormality on chest roentgenogram, a three-month history of palpitations on exertion, and a 2kg weight loss. Chest roentgenogram revealed a huge mass in the posterior mediastinum. The results of needle aspiration cytology from the mass and celiac angiography were suggestive of leiomyosarcoma of the esophagus. The patient underwent tumor enucleation. The tumor originated from the lower-portion of the thoracic esophagus, measured 23×13×13cm, and weighed 1110g. The tumor was diagnosed as leiomyosarcoma histologically. Esophageal leiomyosarcoma is a very rare malignant tumor. The present case had no history of dysphagia in spite of the large tumor size.

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A 33-year-old man with a 6-month history of rhinitis and bronchial asthma was referred to our hospital with polyarthralgia, severe anemia, hypoxemia, mononeuropathy multiplex, and renal insufficiency with hematuria.
Marked eosinophilia was observed in his sputum, peripheral blood, and bronchoalveolar lavage fluid (BALF).
In addition, his sputum contained many hemosiderin-laden macrophages, indicative of pulmonary hemorrhage. His chest roentgenogram on admission showed diffuse ground grass appearance. High resolution computed tomography (HRCT) demonstrated diffuse high density areas throughout the lung fields and characteristic irregularity and enlargement of the peripheal pulmonary arteries.
His general condition rapidly deteriorated, but dramatically improved with oral steroid administration, and his major symptoms disappeared within a few days.
Examination of the biopsied lung tissue revealed unequivocal evidence of pulmonary angitis with marked eosinophilic infiltration and perivascular granulomas. Bone marrow biopsy showed hyperplasia of eosinophilic leukocytes in contrast to the low cellularity. Suppression of erythroid hemopoiesis was thought to be the primary cause for his rapidly progressive anemia. Serum anti-GBM antibody titer returned to within the normal range soon after the initiation of steroid therapy.

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A 71-year-old male was found to have bilateral posteromedial masses on routine roentgenogram during admission for treatment of traffic accident related injuries. These masses were initially considered to be posterior mediastinal tumors, however, CT scan demonstrated a left diaphragmatic defect and the adipose nature of the bilateral masses (CT number: left-29, right-132).
MRI also demonstrated a large amount of fat accumulation in the abdomen. CT scan and MRI are therefore very useful for the diagnosis of Bochdalek hernia in adults.

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