Six cases of pulmonary M. kansasii infection were studied. The ages of the patients ranged from 26 to 51, with a mean of 39.6 years. All the patients were male. None had any underlying systemic or lung diseases.
On chest X-ray and CT scan, the majority of cases showed a solitary thin-walled cavitary lesion with little satellite or scattered lesions, which were perdominantly located in S¹ or S².
The strains of M. kansasii isolated from the 6 patients showed a certain pattern of antibiotic sensitivity being highly sensitive to TH, CS, EB and RFP. In 5 out of the 6 patients, chemotherapy with RFP combined with 2 or 3 other antituberculous drugs for 12 months was successful. In another patient, chemotherapy with RFP, EB and INH for 12 months was unsuccessful and surgical resection was required.
Comparison of patients with M. kansasii (n=6), M. tuberculosis (n=112) and M. avium complex infection (n=51) revealed that the former two had some common clinical features: predominance in males, younger age than the patients with M. avium complex infection, predominant involvement of S¹, S² and S⁶, and involving a single rather than multiple lung lobes.
Even in cases clinically suspected of having M. tuberculosis infection, bacteriological examination should be carried out routinely to rule out M. kansasii infection.

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Pulmonary fibrin deposition suggests the involvement of coagulation and fibrinolysis in pulmonary inflammation. The present study was designed to investigate the alterations of coagulation and fibrinolysis in rabbits that received thoracic irradiation. Serial bronchoalveolar lavage (BAL) was performed after the irradiation, and procoagulant activity (PCA) and tissue plasminogen activator (t-PA) were measured in BAL fluids. PCA increased from 2 to 8 weeks after irradiation with increased number of macrophages and increased PCA per macrophage. T-PA also increased with a significant difference at 4 weeks compared to controls. Although irradiation activated both PCA and t-PA, PCA increased prior to t-PA and the elevation lasted longer.
It was concluded that activation of the coagulation system promotes pulmonary fibrin deposition and may contribute to the progression of pulmonary injury.

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Serum tumor markers (CEA, SLX, CA125) were evaluated in 123 patients with active pulmonary tuberculosis. The results were as follows: Elevated serum CEA, SLX and CA125 levels were found in 16.9%, 39.5% and 44.4%, respectively, of patients with active pulmonary tuberculosis. Markedly elevated serum CA125 levels were found in some cases. On chest X-ray films, the factors associated with elevation of serum tumor marker levels were examined. Serum CEA and SLX levels were correlated with the extent of disease. Pleural effusion had no influence on serum tumor marker levels. Serum SLX levels were higher in patients without a tuberculous cavity than in those with a tuberculous cavity. After therapy with antituberculous drugs, the mean values of serum SLX and CA125 levels significantly decreased. The decrease in mean value of serum CEA levels was not significant, but in 4 of 8 cases, elevated serum CEA levels were normalized after therapy. On the other hand, two cases with increased serum CEA or SLX level died of respiratory failure.
These results suggest that to follow up patients with elevated serum tumor markers is useful for the evaluation of disease activity of pulmonary tuberculosis. Further elevation of serum tumor marker levels after antituberculous therapy may indicate the presence of cancer or deterioration of the disease.

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The efficacy of the combination therapy of fluconazole plus flucytosine against pulmonary cryptococcosis was investigated. The minimal inhibitory concentrations of antifungal agents were measured by growth inhibition on Yeast-morphology agar plates, and the fractional inhibitory concentration index of each antifungal combination were calculated by checker-board titration. Eight of Cryptococcus neoformans clinical isolates showed sensitivity for AMPH, 5-FC, MCZ and ITZ. C. neoformans showed resistance against FLCZ. The combination of FLCZ plus 5-FC showed synergistic effect against C. neoformans.
Three cases of pulmonary cryptococcosis were treated by combination therapy of fluconazole plus flucytosine. After treatment, C. neoformans isolates were eradicated and the chest X-ray improved remarkably. The combination therapy of fluconazole plus flucytosine was effective for the treatment of pulmonary cryptococcosis.

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To clarify the mechanism of the eosinophilia in patients with bronchial asthma (BA), we examined the production and inhibition of eosinophil colony stimulating factor (Eo-CSF) of mononuclear cells (MNC) and lymphocytes from BA. After bone marrow cells from normal volunteers (NA) were incubated with culture media of MNC or lymphocytes cultured in the presence of interleukin-2 (IL-2, 1U/ml) or Dermatophagoides farinae (10μg/ml, Df), the number of eosinophils was increased and GM-CSF production was increased after 5 days of culture. Interleukin 5 (IL-5) production was increased in some cases of BA, but did not differ between BA and NA delete. When MNC were incubated in the presence of IL-2 and interleukin 4 (IL-4), neither eosinophilia nor GM-CSF production occurred. These results suggest first that MNC and T cells in BA have increased responsiveness to IL-2 and Df, second that increased GM-CSF production partly causes eosinophilia, and third that IL-4 inhibited IL-2-induced eosinophil proliferation by inhibition of GM-CSF production.

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The efficacy of intrathoracic administration of pirarubicin (THP-ADM), a derivative of adriamycin, was evaluated in 20 patients with malignant effusion due to lung cancer. All 20 patients had no previous intrapleural therapy. According to the criteria of ECOG, eight patients were at performance status 1 (P. S. 1), nine were P. S. 2, and three were P. S. 3. Fourteen patients were clinical stage IIIB, and six stage IV. The effusions were first completely drained by thoracocentesis or tube thoracostomy drainage, and 30mg/m² THP-ADM was instilled. Overall response rate was 50.0%. The response rate for treatment with tube thoracostomy drainage was 69.2%, which was significantly higher than that for treatment with thoracocentesis (14.3%). Significant difference in survival was not seen between the tube thoracostomy drainage group and the thoracocentesis group. There were no severe side effects. In conclusion, intrapleural administration of THP-ADM with tube thoracostomy drainage was considered to be useful for the control of malignant pleural effusion due to lung cancer.

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Body weight loss is often observed in patients with chronic obstructive pulmonary disease (COPD). Bone mineral loss has also been reported in COPD, but the mechanisms are not well determined. To elucidate what factors influence on bone mineral content in COPD patients, we measured bone mineral content (BMC) by dual energy X-ray absorptiometry (DXA) (XR-26, Norland), pulmonary function, and ten minute walk distance (TMD) in Japanese elderly male patients with COPD. The subjects were 21 male patients with COPD (72.6±9.5 years) and 18 age-matched male normal individuals (66.5±9.5 years). COPD patients showed significantly (<0.05) lower BMC (1.82±0.33, 2.27±0.3kg, respectively) compared with age-matched controls. BMC was significantly correlated with body weight and TMD (r=0.71, r=0.51, respectively). These results demonstrate that lower body weight and decreased exercise capacity account for the significantly lower bone mineral content of our COPD patients and that COPD patients with body weight loss may be at high risk for osteoporotic fracture.

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Sputum samples were collected from 15 immotile cilia syndrome (ICS) cases, 12 diffuse panbronchiolitis (DPB) cases, and 11 bronchiectasis without ICS (BE) cases, during stable clinical state, to clarify the physicochemical properties of sputum from patients with ICS and to compare them with the properties of sputum from patients with DPB and BE. We measured sputum rheological properties and concentrations of several biochemical components. In ICS, spinnability was higher than that in DPB. No significant difference was seen between ICS and the other cases regarding other rheological properties. Albumin was lower, but fucose, sialic acid, and IgA were higher in ICS than in DPB. Although no significant difference was seen between ICS and BE, the sialic acid/albumin ratio was higher and the sialic acid/fucose ratio was lower in ICS than in BE. These results revealed that sputum from ICS cases was characterized by an absolutely or relatively increased mucus component with high spinnability and by a decreased extravascular transudate component. In view of these rheological properities, sputum from ICS cases was not always indicated to be associated with efficiency in cough clearance. The results suggested that chronic airway inflammation in ICS is not such a serious problem compared with DPB and BE.

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A 53-year-old man underwent chemotherapy (CDDP, VDS, MMC) for treatment of lung cancer. He was given 125μg/m² of GM-CSF subcutaneously every day for 8 consecutive days, in order to prevent neutropenia. Three days after starting GM-CSF therapy, marked eosinophilia in peripheral blood was observed. The maximum eosinophil count was 89% of leukocytes. Nine days after stopping the treatment with GM-CSF, the number of eosinophils had normalized spontaneously. There were no clinical symptoms except for slight fever, up to 37.5°C. Moreover, there was no relationship between the number of eosinophils and the serum levels of cytokines (IL-3, IL-5, GM-CSF), although we observed minimal but significant elevation of serum ECP level. This case indicates that GM-CSF may induce marked eosinophilia rather than widely stimulating granulocytes and monocytes.

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We report a case of yellow nail syndrome (YNS) associated with recurrent episodes of pneumonia. The patient, a 31-year-old female, presented with yellow nails, chronic bronchitis and pleural effusion. The etiology of YNS remains unknown although it has been postulated to be associated with lymphatic abnormalities. YNS is a rare disease with only 22 cases reported in Japan. However, YNS is often associated with respiratory infections, and should thus be borne in mind.

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A 59-year-old woman with diabetes and rheumatoid arthritis was given predonisolone following the diagnosis of rheumatoid lung disease. She developed fever and bloody sputum, and chest X-ray showed a massive shadow in the right lower lung field. Chest CT revealed a giant massive shadow with unclear margin in the right posterior lower lobe. With enhancement, a round low density area appeared in the shadow. Aspergillus hyphae were detected from a bronchial brushing specimen. Pulmonary aspergillosis was diagnosed administration of anti-fungal agents was commenced but the improvement was not satisfactory. Surgical resection, which may be curative, was subsequently performed. The resected lung contained an aspergillus ball formation within an enlarged bronchus, that is, a bronchial aspergilloma, surrounded by widespread inflammatory cell infiltration. Most pulmonary aspergillomas are of the “colonization type”, but in our case progression to subacute process occurred according to the extent of our patient's immunological reaction. For the treatment of localized pulmonary aspergillosis, our results suggest that surgery is recommended.

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A 49-year-old female was admitted because of high grade fever and dyspnea. Chest roentgenogram revealed diffuse reticulo-linear shadows. Laboratory findings showed peripheral blood eosinophilia, and blood gas analysis demonstrated severe hypoxemia. A few days after admission, her symptoms and signs improved, and the abnormal shadows on the chest roentgenograms decreased without treatment. To determine the diagnosis and evaluate the pathological findings and pathogenesis, we performed open lung biopsy. Bronchoalveolar lavage at the operation revealed increased total cell count and increased markedly, number of eosinophils, and the open lung biopsy specimen showed acute interstitial pneumonia with eosinophilic infiltration.
We performed a study of precipitating antibodies against fourteen kinds of fungi and environmental provocation tests, with all results being negative. We diagnosed this case as having acute eosinophilic pneumonia clinicopathologically (Allen, 1989).
We reviewed 22 cases with acute eosinophilic pneumonia previously reported in Japan including our case. These 22 cases demonstrated a seasonal tendency of onset in spring and summer. Eleven of 22 cases were tested for precipitating antibodies to several fungi, 3 of which showed positive results against Trichosporon cutaneum, Trichoderma viride and Aspergillus species. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. Therefore, it is important to diagnose AEP on the basis of clinical symptoms, and precipitating antibody, viral titer and pathological findings.

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A case of acetaminophen-induced pneumonitis is described. A 63-year-old woman took 2350mg of acetaminophen for fever. She subsequently developed a non-productive cough and dyspnea. Chest X-ray revealed diffuse reticulonodular shadows in bilateral lung field and she was admitted to our hospital. PaO₂ was 45.0Torr and PaCO₂ 35.7Torr while breathing room air. Bronchoalveolar lavage examination showed an increase in the percentage of lymphocytes and a decrease of CD4/CD8 ratio. Microscopic examination of a transbronchial lung biopsy specimen showed alveolar septal thickening. The lymphocyte stimulation test was positive for acetaminophen, with a stimulation index of 237%, while other drugs used were negative.
Because drug-induced pneumonitis was suspected, all drugs were stopped and she was administered methylprednisolone. Consequently her symptoms, laboratory data and chest X-ray findings improved. Based on these findings, we diagnosed this case as acetaminophen-induced pneumonitis. To our knowledge, there has been only one previously reported case of acetaminophen-induced pneumonitis.

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A 48-year-old woman who was diagnosed to have bronchial asthma induced by chironomid midges is reported. In spring of 1985, massive growth of chironomid midges occurred in the river beside her house. Since then, moderate growth has occurred in every spring or summer. She had wheezing attacks every May or June since June 1986. On May 2, 1991, she was hospitalized because of exacerbation of wheezing and dyspnea. Wheezing attacks were improved by appropriate medical treatment during hospitalization.
Examination was performed during the state of stable clinical symptoms. RAST scores to Chironomus thummi thummi (CTT) and Chironomus plumosus (CP) were 4 and 3, respectively. Allergic skin reaction showed the threshold dilution of CP of 10^-6. CP skin test concomitantly provoked a mild acute asthma attack. The midges found swarming around her house were identified as Chironomus nippodorsalis.
Accoring to her clinical history and allergic skin reactions followed by acute asthmatic attack, this patient was diagnosed to have bronchial asthma induced by chironomid midges. Chironomid midge can be one of the inhalant allergens in adults.

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A 38-year-old woman was admitted because of left pneumothorax on March 16, 1991. She had undergone modified radical mastectomy in Dec. 1986. Chest roentgenogram on admission show a tumor shadow in the left upper lobe. She was diagnosed to have pneumothorax due to metastatic lung tumor. She underwent left upper lobectomy. Histologically poorly differentiated papillotubular adenocarcinoma was found and the cause of pneumothorax was thought to be necrosis of the tumor and direct invasion of the pleura.

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A 60-year-old man was admitted to our department for investigation of abnormal shadows on his chest X-ray. He had been diagnosed as having neurilemmomatosis in 1987. His chest X-ray showed nodular shadows in left S5 and S8 and localized spontaneous pneumothorax in left lung field. The nodular shadows, which were in contact with thickening of the pleura, showed curved shadows of bronchi and vessels (so-called comet tail sign). We suspected that they were round atelectasis, but to confirm the diagnosis and to treat the pneumothorax, limited resection of the lung and resection of the bulla were performed. The diagnosis of round atelectasis was confirmed by histological findings. Round atelectasis related to spontaneous pneumothorax is a very rare condition; however, we consider this to be an important case for understading the pathogenesis of round atelectasis.

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We report two cases of idiopathic interstitial pneumonia (IIP) with acute deterioration after bronchoalveolar lavage (BAL). Case 1 was a 54-year-old woman, and case 2 was a 75-year-old man. Both were diagnosed as having IIP, and hospitalized with complaints of high fever and dyspnea. After BAL, the degree of dyspnea increased. White blood cell count and lactate dehydrogenase were elevated, and PaO₂ was decreased. Chest X-ray revealed consolidation of the upper lung fields and reticulogranular shadows spreading through both lungs. BAL fluid examination showed an elevated neutrophil fraction (case 1: 6.5%, case 2: 35.2%), suggesting respiratory tract infection although bacteria could not be detected. Case 1 died of respiratory failure despite corticosteroid therapy. Autopsy revealed diffuse alveolar damage with focal pneumonia in the right S⁶ corresponding to the upper lobe consolidation. Case 2 improved after antibiotic therapy.
These findings suggest that aspiration of infected fluid during BAL can cause acute exacerbation of IIP. It is important to recognize that the BAL procedure can induce an acute exacerbation of IIP.

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A 74-year-old male who had been infected with pulmonary tuberculosis since 1938 underwent thoracoplasty in 1955. After the operation, no symptoms manifested until 1988 when he developed hemosputum and hemoptysis in association with a cold with fever. Although he was admitted to a hospital, the symptoms could not be controlled, so he was referred to our department. The lesion causing the hemorrhage was considered to be in the upper lobe of the left lung. However, it would have been difficult to preserve respiratory function in the case of left upper lobectomy, because he had already undergone thoracoplasty on the right side. Therefore, bronchial artery embolization (BAE) using Spongel was performed. Second embolization was performed because hemoptysis referred after one month. However, the hemoptysis recurred again, so that two branches of the left subclavian artery and the left internal thoracic artery were ligated. No hemoptysis and hemosputum occurred for a while, but 2 years and 9 months after the operation, the patient was admitted due to hemoptysis with fever and coughing. Since the bronchial artery was embolized twice with spongel and twice with platinum coil, the patient's course has been good for 5 months.

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A 34-year-old man with persistant cough was admitted to our hospital. Bronchoscopic examination revealed a polypoid tumor with smooth surface which almost completely obstructed the right main bronchus. The tumor was removed by transbronchial snaring forceps and histologically confirmed as neurofibroma. Residual tumor was excised by biopsy forceps and further endoscopic Nd-YAG laser vaporization was performed. This is the first case in our country in which bronchoscopic treatment was performed for bronchial neurofibroma. Bronchoscopic removal might be the preferred treatment in the present case, although long-term follow-up is also required.

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Diagnosis of intralobar pulmonary sequestration has required demonstration of systemic blood supply by arteriography. We report two cases in which retrocardiac abnormal shadows were observed on chest radiographs and aberrant arteries arising from the descending aorta toward the sequestrum were demonstrated by magnetic resonance imaging (MRI). The sequestra were observed as high intensity area suggesting cystic lesions on T₂weighted MRI. In both cases, the sequestra were excised and aberrant arteries (5mm and 10mm in diameter) arising from the aorta were recognized at surgery. Both cases were diagnosed as intralobar sequestrations histopathologically. MRI is a safe noninvasive alternative for diagnosis of pulmonary sequestration instead of arteriography in some cases with a larger aberrant artery.

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