The right ventricular ejection fraction (RVEF) is an objective evaluation of the right ventricular systolic function. Recently a rapid-response thermister pulmonary artery catheter which measures RVEF and stroke volume (SV) was introduced.
With this new method, RVEF and the right ventricular volumes (RVV) were measured in patients with chronic pulmonary diseases (CPD) and normal subjects. In addition, to evaluate the validity of this method, the data was compared with Kr81m perfusion method. The RVEF and the RVV of CPD patients were also compared with pulmonary hemodynamic data.
There was a good correlation between the RVEFs obtained by the Kr81m perfusion method and the TD method. (r=0.71, p<0.001).
There was a tendency towards a low RVEF in patient with CPD with pulmonary hypertension (PAm>20mmHg) or high pulmonary vascular resistance (PAR>160dyne/sec/cm^-5) and the RVV increased in the same group.
These results suggested that the right ventricle was unable to respond to the increase of afterload in the CPD group and the evaluation of RVEF and RVV in patients with CPD using the new TD method was valuable for assessing the right ventricular function.

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Rounded atelectasis (RoA) is an uncommon pulmonary condition presenting as a peripheral round opacity on a chest roentgenogram. Six cases of empyema who underwent regional lung and pleural resection, had local atelectatic induration beneath the pleura. Their clinical and pathologic features were examined. Five cases had past histories of pulmonary tuberculosis with therapeutic pneumothorax, and one other case had tuberculous pleuritis. Five of seven atelectatic indurations displayed RoA on preoperative plain roentogenograms and/or CT and on soft X-ray films of resected lung preparations. With pathological examinations, the pleura showed one or several indentations, often with deep invaginations into the pulmonary parenchyma. In these regions, the appearance was occasionally more complex due to several small folds emanating from the larger fold. Outside the pleural folds, there was dense fibrous thickening. Fibrosis of the pleural interstitial layer itself was mild. Lung parenchyma adjacent to the folded pleura appeared collapsed with mild interstitial fibrosis. These findings lead to the hypothesis that RoA may result from pleural invaginations occuring after pleural effusion or therapeutic pneumothorax and from fibrous adhesions of the outer regions.

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Conventional doses of aerosolized beclomethasone dipropionate (BDP) of up to 400μg/day by inhalation has often failed to normalize the pulmonary function of chronic adult patients. Therefore it may be necessary to administer the individual maximum dose of BDP to reduce bronchial inflammation.
In 13 patients (2 males and 11 females, mean age 49.2±3.7 years old) with chronic asthma whose minimum %PEFRs were lower than 80% under treatment with conventional doses of BDP, the clinical benefit of high dose inhalation therapy with BDP was studied for four consecutive weeks by comparing % peak expiratory flow rate (%PEFR) measured four times a day both before and 10 minutes after inhaled procaterol (PCR) in a cross-over fashion.
Mean morning %PEFRs before inhaled PCR during the first two weeks with a lower dose of BDP (419±24μg/day) and during the following two weeks with a higher dose of BDP (904±55μg/day) were 60.6±3.1% and 77.5±4.1%, respectively (p<0.01).
Average increases in %PEFR during the higher dose period before and after inhaled PCR were 12.1% and 12.4%, respectively, which was observed by the end of the first week after the start of higher dose of BDP in 12 out of 13 patients. Since there were no adverse reactions such as hoarseness, oral thrush and candidiasis during the period with higher doses of BDP, it was concluded that we should promptly employ higher doses of BDP in patients who did not respond satisfactorily to conventional doses of BDP.

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To evaluate the acute effects of anti-asthmatic drugs in vitro, we examined the modulation of various antiasthmatic drugs in therapeutic concentrations on PAF-induced human eosinophil chemotaxis. Aminophylline (20μg/ml) and Isoproterenol (10nM) inhibited PAF (3×10^-8M)-induced eosinophil chemotaxis nearly 30%, whereas no inhibitory effects were observed by Dexamethasone (0.1μM), Tranilast, Ketotifen or Azelastine.
Aminophylline (20μg/ml) also inhibited LTB₄ (3×10^-8M)-induced eosinophil chemotaxis nearly 30%, whereas it did not inhibit chemotaxis induced by zymosan (5mg/ml)-activated serum.
These results indicate that anti-asthmatic drugs except for aminophylline and isoproterenol, when used acutely in therapeutic concentrations, have no striking inhibitory effects on PAF-induced eosinophil chemotaxis. These results further suggest the possibility that there are different mechanisms in eosinophil chemotaxis induced by PAF, LTB₄ or by C5a.

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The concentration and activity of neutrophil elastase (NE) in sputa were measured in 24 patients with chronic respiratory diseases such as diffuse pan-bronchiolitis, bronchiectasis and chronic bronchitis. The results were compared to the clinico-pathophysiological parameters such as clinical impairment score, concentration of albumin and ciliary transport velocity of the sputum. Furthermore, the relationship between the post-therapeutic change of NE in sputum and clinical effect of erythromycin (EM) was investigated in the same cases. Physico-chemical properties of the sputum, including rheological characteristics, mucus transport velocity, phospholipid composition, concentration of albumin and fucose were also analyzed before and after EM therapy.
There was a significant positive correlation between NE in sputum and the clinical impairment score, which suggested that the concentration and activity of NE in sputum reflected the clinical severity in such diseases. The concentration and activity of NE also had significant positive and negative correlation to the concentration of albumin and ciliary transport velocity, respectively. Therefore, it was considered that NE in airway could bring the leakage of albumin from serum and interfere with mucociliary transport.
The patients were divided into responders (n=12) and non-responders (n=12) after EM therapy based on the change of the clinical impairment score. The clinical effect of EM in chronic respiratory diseases was not associated with its bacteriostatic action, but with the quantitative and qualitative suppression of sputum NE. The decrease of the adhesive properties of the sputum, which was observed in responders after administration of EM, was considered to depend on the reduction of the concentration of albumin in sputum. Concerning the phospholipid composition of sputum, sphingomyeline and phosphatidyl-ethanolamine, which had been suggested to be components of serum and cellular membrane, had a tendency to decrease in responders. The proportion of phosphatidylcholine increased in responders. The improvement of ciliary transport velocity of the sputum, which was noted in responders, was probably due to the results mentioned above. In non-responders, these findings were not observed after EM therapy.
EM had no influence on the production, release and activity of NE as a result of in vitro experiments using human peripheral neutrophils. Neutrophil chemotaxis was however suppressed after incubation with EM. These results suggest that the mechanisms of the effect of EM is not direct action on NE but through suppression of neutrophil chemotaxis.

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A 61-year-old man was admitted to our hospital with cough, bloody sputum, and chest pain. Bronchoscopy showed a tumor in the truncus intermedius which biopsy and brushing cytology revealed to be squamous cell carcinoma. Also, bronchial washings grew only N. asteroides. Treatment with minocycline and trimethoprim-sulfamethoxazole (TMP/SMX) over one month resulted in some improvement in pulmonary symptoms and resolution of the infiltrates in the right lower field. Then, right pneumonectomy was performed. N. asteroides was isolated from the resected tumor. Aggressive bacteriological examinations should be utilized when the possibility of pulmonary nocardiosis is considered.

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A case of Stevens-Johnson syndrome caused by Mycoplasma pneumoniae in a 34-year-old woman is presented. At first, she was admitted for treatment of pneumonia with cefuzonam. She was discharged in good health twelve days after admission. However, three days after discharge, she was admitted again with fever, erythematous lesions, oral ulcerations and exudative conjunctivitis. Because M. pneumoniae infection was confirmed by the presence of an elevated IHA titer, a clinical diagnosis of Stevens-Johnson syndrome associated with M. pneumoniae infection was made. Also, Mycoplasma CF antigen-lymphocyte stimulation test (LST) gave positive results, while the cefuzonam-LST was negative. Treatment with methylprednisolone and minocycline was initiated.
Resolution of lesion was evident only after thirty days and then steroid therapy was discontinued. This association has rarely been reported in adults. M. pneumoniae infection should be considered in cases of Stevens-Johnson syndrome in adults with pneumonia.

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Spontaneous regression of a malignant tumor is a rare phenomenon, especially in advanced lung cancer. We reported a case of spontaneous regression of lung cancer with tracheal stenosis due to tumor invasion and multiple skin metastases. A 60-year-old man was admitted to our hospital on September 10, 1985, because of a dry cough. A chest roentgenogram showed a mass shadow in the right upper lung field. Bronchoscopic examination revealed tracheal stenosis due to the tumor mass, and transbronchial aspiration cytology (TBAC) yielded a diagnosis of large cell carcinoma of the lung. In spite of treatment by chemotherapy with cisplatin and vindesin and irradiation, dyspnea deteriorated and multiple skin metastases appeared. After Nd-YAG laser irradiation via a brochofiberscope to maintain his airway and ethanol injection into the skin metastases, his dyspnea improved and he was discharged on February 6, 1986. Two months after discharge all skin metastasis had completely dissapeared, and the primary lesion also regressed and finally disappeared on chest roentgenogram until August, 1986. The mechanism of regression is unclear, but now he has been free of tumor clinically for four years.

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A 28-year-old man with solitary nodular shadows in both lungs was admitted. The erythrocyte sedimentation rate was accelerated, with elevation of the serum IAP values, and the tuberculin reaction was strongly positive. The X-Ray film of the chest revealed symmetrical and bilateral nodular shadow in both lung apices. Both nodular lesions revealed a tendency to grow, pleural indentation and spiculated margins. Moreover, the tomogram film showed convergence of the pulmonary vein branch in the central part of the left apex nodule. Since it was extremely difficult to distinguish these lesions from malignant nodules based on just these radiographic findings, an exploratory thoracotomy was carried out. The histologic diagnosis of both nodules was tuberculoma.
Currently, the radiologic criteria used to distinguish between benign and malignant lesions are assessment of size, contour, absence or presence of tumor growing tendency by serial radiographs, calcification as well as the relation between the lesion with the pulmonary vasculature. It was concluded that, as was shown by this case, the radiographic criteria appear to be insufficient to categorize the nature of a lesion into benign or malignant. Consequently, more reliable non-invasive techniques would be desirable for the accurate diagnosis of tuberculosis.

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46-year-old male patient was born in Niigata Prefecture and thereafter lived in Tokyo. In late January 1985, he noticed swelling of the bilateral inguinal lymphnodes followed by fever and lumbago. In February, he consulted a local doctor and hepatosplenomegaly, marked leukocytosis and renal dysfunction were pointed out and he was referred to our hospital on February 22nd. The clinical laboratory data on admission were as follows; WBC 23, 200/μl, serum-Ca 18.4mg/dl, BUN 85.3mg/dl, creatinine 5.4mg/dl, antibody to ATLV×160. ATL was diagnosed by biopsy of lymph nodes and examinations of peripheral blood and bone marrow hemogram. Remission was achieved in March by the treatment with adriacin. Renal failure and hypercalcemia also improved. However his respiratory dysfunction gradually worsened. The chest rentgengrams showed pulmonary edema, although there was no clinical evidence of heart failure. When his condition became stable, TBLB was performed and revealed extensive deposition of calcium along alveolar septae, suggesting that pulmonary edema was induced by the metastatic calcification of the lung. After the second treatment for ATL, he died of pneumonia. The autopsy showed calcium deposition not only in the lung but in pyramids of the kidney and in subserous layer of the small intestine. There was no tumor cell invasion into the bone or parathyroid gland. High urinary c-AMP together with normal levels of PTH suggested that the hypercalcemia in this case was induced by PTH-related protein. It was concluded that careful treatment for hypercalcemia is important as regards the occurrence of pulmonary edema.

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A 65-year-old man was admitted to our hospital because of shortness of breath on exertion. As the results of examinations including pulmonary angiography, pulmonary perfusion scan and pulmonary ventilation scan, we diagnosed the case as chronic recurrent pulmonary embolism. Although the patient received thrombolytic therapy by a tissue plasminogen activator (t-PA), there was no noticeable improvement. However, oxygen and vasodilator therapy had marked effective on the hemodynamics.
In chronic pulmonary embolism, vasodilators are generally not considered to be effective for improvement of hemodynamics. However, if the acute effects of vasodilators were confirmed, we should try to administer them while paying attention to possible adverse effects.

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A 55-year-old female was admitted to our hospital because of high fever, nonproductive cough and dyspnea. Initially she had been treated with cephem antibiotics by a local doctor. However, acute respiratory failure due to severe pneumonia developed. The partial pressure of oxygen in arterial blood was 55.5 Torr. Her chest X-ray revealed wide-spread infiltrates with air bronchograms throughout the entire left lung, and pleural effusions were also present in the chest CT scan.
Because the patient had a history of the contact with birds, we suspected psittacosis and administered Minocycline immediately. As a result, her clinical condition improved and the abnormal shadow on the chest X-ray film improved markedly in three days. Because the serum titer of a complement fixation test against Chlamydia rose to 1:512, we made the diagnosis of psittacosis. In addition, femoral muscle pain, and a high level of serum GOT, GPT, CK, Aldolase and Myoglobin indicated hepatitis and myositis.
In the lung tissue specimens obtained by TBLB performed on the 10th hospital day, slight interstitial pneumonia and intracellular inclusion bodies were found by light microscopy and Chlamydial agents were found electron microscopically.

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