The pulmonary function in bronchial asthma was analysed from three new viewpoints; 1) arterial-alveolar carbon dioxide tesion difference, 2) expiratory carbon dioxide distribution curve and carbon dioxide (%)-air flow-volume curve, 3) changes of viscous resistance throughout the respiratory cycle, the inspiratory dynamic resistance and the difference of the coefficient of laminar flow resistance (K₁) and the coefficient of turbulant flow resistance (K₂). At the same time the reversibility which is characteristic of bronchial asthma was analysed.
1) Arterial-Alveolar Carbon Dioxide Tension Difference
Expired air was sampled by four different methods consisting of end-tidal method, Haldane-Priestley method, breath-holding method and rebreathing method, and was served for carbon dioxide measurement by means of Capnograph. It was found that end-tidal method was the most adequate for the measurement of P_ACO2 in bronchial asthma. The peak of end-tidal P_CO2 was regarded as the mean alveolar carbon dioxide tension, and this was subtracted from the arterial carbon dioxide tension measured by Combianalyser to obtain arterial-alveolar carbon dioxide tension difference. The mean arterial-alveolar carbon dioxide tension difference in 15 cases of bronchial asthma was 6.5±2.7mmHg, which approached to zero by administering bronchodilators manifesting the presence of reversibility. The difference between arterial and alveolar carbon dioxide tension suggested that the formerly believed evenness of the pulmonary blood distribution in the patients of bronchial asthma was erroneous, and this assumption was proved in one case using the oxgen saturation method of Briscoe, et al.
Further observations on the arterial and alveolar carbon dioxide lead to the conclusion that the estimation of arterial carbon dioxide tension from alveolar carbon dioxide tension is impossible in the cases with bronchial asthma where the wide variation of arterial-alveolar carbon dioxide tension difference is present.
2) Expiratory Carbon Dioxide Distribution Curve and Carbon Dioxide (%)-Air Flow-Volume Curve
The expiratory carbon dioxide distribution curves in the normal and emphysematous individuals assume characteristic patterns, each falling within certain range. In these cases, diagnosis and classification of severity can be carried out by the combined use of FEV₁CO₂ with expiratory carbon dioxide distribution curve, while expiratory carbon dioxide distribution curves in bronchial asthma fall in between those of normal and emphysematous cases with a very wide variation, and the degrees of change of the curve after administering bronchodilators are also variable according to the individual, some approaching to nearly equal to that of the normal and the others only slightly. Consequently, it is assumed that the pathophysiologic mechanism of bronchial asthma is complex.
Observations on carbon dioxde (%)-air flow-volume curves obtained by forced expiration suggested that trapped gas is expelled from relatively upper respiratory tract in some case, so that it was considered that the airway constrictions is induced simultaneously both in the upper and lower respiratory tracts in the early stage of asthmatic attack.
3) Viscous Resistance Throughout The Respiratory Cycle and Inspiratory Dynamic Resistance.
The viscous resistance throughout one respiratory cycle was measured on the curve obtained by the intraesophageal pressure method, and FEV₁/VC based on the spirogram during forced expiration does not necessaaily indicate the elevation of viscous resistance in the attack free state of bronchial asthma. Some cases of bronchial asthma showed elevation in the expiratory resistance more than the inspiratory resistance, as in chronic emphysema, while others showed elevation in the inspiratory resistance more than the exspiratory resistance,

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The phonocardiographic studies in far advanced tuberculosis were made in relation to electrocardiographic findings (=“Prognosis index”, stated in the first report) and cardio thracic rate (=C.T.R. Stated in the 2nd report).
1) The amplitude ratio of the 2nd heart sound (PII/AII) taken in high frequency increased in the cases of far advanced group (PII/AII>1:88% in far advanced group, 43% in control group as well as in minimal tuberculosis group). In far advanced group, this ratio was paralled with the prognosis index in some extent. The cases with amplitude ratio over 1 showed 81% in high prognosis index group (Pathologic E.C.G. finding group), 37% in low prognosis index group (normal E. C. G. findings group).
2) In the phase of expiration, splitting of the 2nd heart sound at pulmonary ostium showed higher incidence in the far advanced group (61%) than the control group (14%). The cases whose amplitude ratio of IIP and IIA (IIP/IIA) were over 1, were more often observed in the far advanced group (72%) than the control group (0%). In the far advanced group, the amplitude ratio of IIP and IIA were closely related to E.C.G. finding, and the ratio was high in the cases with higher prognosis index.
3) Systolic murmurs of pulmonary ostium were more frequent in the far advanced group (62%) than the control group (6%). In the far advanced group, the murmurs were encountered in higher incidence in the cases with pathologic E.C.G. findings (70%) than those with normal E.C.G. fining (37%). In addition, these findings revealed higher incidence in the cases with left side lesion than the right side. (left side lesion=29%, right side lesion=6%)
4) Gallop rhythmus were observed in almost all cases with high prognosis index, and all cases with this finding died from cardio-pulmonary dysfunction with in 1 year after examination of P. C. G. tacklu.
5) It may be concluded that the above mentioned findings will have a morbid significance to some extent in diagnoisis of cardiac state of far advanced pulmonary tuberculosis.

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In last few years, we have experienced about 50 cases of mediastinal tumor in this clinic.
Nearly 30% of these mediastinal tumor belongs to teratoid, histologically.
The classification of teratoid seems to be very complicated according to their embriological picture. One of the rarest teratoid in the chest, intra-pulmonary teratoma, which we were unable to find a single case in literature in this country.
Recently, however, we came cross to a case who developed egg size mediastinal teratoma in the left upper mediastinum. One of the most striking picture was that, there was an existance of the fibrotic tissue band from mediastinal teratoma into deep inside the lingular where another tumor existed.
The tumor in the lingular was found to be a teratoid by pathlogist. We have named this teratoma in the lung which were connected with mediastinal teratoma “Atypical intra-pulmonary teratoma”.

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Two cases of localized interlobar pleural effusion so-called “Vanishing tumor of the lung” due to congestive heart failure is described and the subjects is reviewed.
The problem of localized interlobar pleural effusion discussed, and the importance of their differentiation from Cancer of the lung is stressed.
“Vanishing tumor of the lung” may be due to congestive heart failure and the effusion will usually disappear when cardiac compensation is restored.
More than half of the patients with “Vanishing tumor of the lung” are in older men and the etiology of the congestive heart failure is in most arteriosclerotic heart disease or coronary artery disease.
It is generally agreed by most authors that a localized interlobar pleural effusion induced from obliterative pleuritis. The considering of the etiology in our cases, both of that are in old age and has pulmonary emphysema, it could be accept freely the above opinion.

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