Serum and urinary neopterin levels were determined by high pressure liquid chromatography in 26 patients with pulmonary sarcoidosis and 12 healthy controls. Neopterin levels were significantly higher in sarcoidosis patients than in the controls. Neopterin levels differed from serum angiotensin converting enzyme (ACE) activities and were significantly higher in radiologic stage 1 and 2 than in radiologic stage 0 in patients not receiving prednisolone. No significant correlation was found between neopterin level and serum ACE activity. On the other hand, a significant correlation was found between neopterin level and serum adenosine deaminase activity. We believe that serum and urinary neopterin levels may be a more clinically valuable method of assessing pulmonary sarcoidosis than serum ACE activity.

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We performed unilateral pulmonary aterial occlusion test to determine the indication for lung resection functionally, and investigated 32 cases whose total pulmonary vascular resistance was over 700dyne·sec·cm^-5/M². Thirteen out of 32 cases underwent surgery. There was no difference in lung function tests between surgical and non-surgical cases. Nine out of 12 cases whose pulmonary vascular resistance was less than 800 dyne by unilateral pulmonary arterial occlusion test underwent surgery, and none of these cases died within 3 months after surgery. In non-surgical cases, two were aged patients and one had chronic renal failure. Four out of 20 cases whose total pulmonary vascular resistance was over 800 dyne underwent surgery. Two cases that underwent surgery died within 3 months after surgery. These results suggest that the functional limitation of lung resection can be exterded from 700dyne·sec·cm^-5/M² to 800dyne·sec·cm^-5/M² total pulmonary vascular resistance by application of unilateral pulmonary arterial occlusion test.

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The effects of intravenous administration of 9α, 11β-PGF₂, a stable metabolite of prostaglandin D₂ (PGD₂), on bronchial smooth muscle in guinea pigs were investigated by measurement of dynamic compliance and dynamic respiratory resistance using a formula to exclude the effects of differences in airway wall thickness. With this formula, the ratio of bronchial smooth muscle constriction by histamine can be estimated as an index of bronchial hyperresponsiveness to histamine. Administration of 9α, 11β-PGF₂ induced airway wall edema. The ratio of bronchial smooth muscle constriction by histamine was significantly enhanced by the administration of 9α, 11β-PGF_2a. TXA₂ antagonists, ONO-NT-128 and ONO-8809, inhibited the effect of 9α, 11β-PGF₂ administration. These results suggest that 9α, 11β-PGF₂ act as important mediators affecting bronchial hyperresponsivenss, and TXA₂ may play a role in 9α, 11β-PGF₂-induced airway wall edema and bronchial hyperresponsiveness to histamine.

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We observed the presence of epithelioid granulomas in follicles near lacunae in the tonsils from patients with active sarcoidosis. Bacteria isolated in these tissues were mostly α-streptococci. The present study was undertaken to determine whether α-streptococcus can induce granuloma formation. Streptococcal cell wall (SCW) fragments were injected into the foot pads of female Lewis rats. Epithelioid granulomas were abundantly formed in popliteal lymphnodes when SCW aqueous suspension was injected four times. SCW antigens were detected in macrophages in the granuloma but not in epithelioid cells, by immunoperoxidase method. These findings suggest that macrophages transform into epithelioid cells after phagocytosis and digestion of SCW, and that components of bacterial cell wall such as SCW may induce the granuloma formation in sarcoidosis.

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The efficacy of treatment of 19 patients with malignant lymphoma presenting with mediastinal tumor was evaluated. They included 7 patients with Hodgkin's disease and 12 with non-Hodgkin's lymphoma (NHL). Numbers of patients with stage I, II, III and IV disease according to Ann-Arbor's classification were 6, 4, 3 and 6, respectively. Stage I patients were treated with CHOP therapy after radiotherapy (RT). Stage II and III patients were treated with RT after COP-BLAM chemotherapy. Stage IV patients were treated with COP-BLAM III regimen. Complete remission was achieved in 16 of 19 patients (84.2%), and partial remission in 2 (10.5%). All patients with Hodgkin's disease and 9 (75%) with NHL attained complete remission. All patients in stage I to III and 3 (50%) in stage IV achieved complete remission. Overall median survival was 66 months. The incidence of bone marrow involvement and bulky mass was significantly different between stage I·II and stage III·IV patients (p<0.05). These results indicate that combination treatment with RT and chemotherapy with regimens including adriamycin was effective in patients with malignant lymphoma presenting with mediastinal tumor, especially in those without bone marrow infiltration and bulky mass.

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We studied the effects of inhaled anticholinergic (oxitropium bromide, 0.2mg) and beta-adrenergic (fenoterol 0.4mg) drugs on respiratory function and arterial blood gases in fourteen male patients with pulmonary emphysema (age 63±8 years; FEV₁/FVC1.41±0.73L) using a three day, randomized, double-blind placebocontrolled design. Each day, spirometry and arterial blood gas analyses were performed before and 45min after inhalation. Both fenoterol and oxitropium bromide significantly improved FEV₁ by 21% and 16%, respectively, although there was no significant difference between the two drugs. However, the mean value of PaO₂ significantly decreased from 74.5±2.6 to 69.3±2.7Torr with fenoterol, but not with oxitropium and placebo. Change of PaO₂ with fenoterol was significantly correlated with %FRC, but not with FEV₁ nor change of FEV₁.
We therefore conclude that an anticholinergic inhalant bronchodilator is more favorable for patients with COPD than a beta-adrenergic agent.

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Bronchography is essential for evaluation of morphological changes in the bronchial tree. However, conventional bronchography using Propyliodone (Dionosil) is extremely invasive, especially to those with pulmonary infections. In the present study, we developed a new less invasive method of bronchography with the aid of digital subtraction technique (DSBG), and evaluated its clinical benefits.
Bronchography was performed by injecting contrast medium (Iopamidol: Iopamiron 300) via the lumen of the bronchoscope (Olympus Type 20), and image processing of the respiratory tract was performed using digital subtraction technique. From 1991 to 1992, DSBG was performed in 15 cases (8 bronchiectasis, 1 diffuse panbronchiolitis, 1 lung cancer, 1 pulmonary emphysema, and 4 others). DSBG clearly demonstrated the morphological changes of large and segmental bronchial lesions in cases of bronchiectasis and lung cancer, as well as conventional bronchography using Dionosil. In addition, it was possible to image the morphological changes of bronchiolar lesions in diffuse panbronchiolitis and pulmonary emphysema to the same detail as obtained using classical selective alveolo-bronchography (SAB). Since DSBG can provide enhanced images the bronchial tree without being affected by cardiac and respiratory movements, we could obtain detailed information on bronchial and/or bronchiolar lesions. With respect to side effects, Iopamiron was quickly drained and/or absorbed within 2 hours after injection. Pulmonary infection and bronchial bleeding, which are well known primary complications of classical bronchography using Dionosil, were not observed.
We conclude that 1) DSBG is useful new technique for examining morphological changes of the respiratory tract, and 2) DSBG is less invasive than conventional bronchography.

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In asthmatic patients, the threshold for specific airway conductance during quiet breathing (sGawqt) in the airway hypersensitivity test was determined using our newly developed pressure corrected flow type body plethysmograph and compared with that measured by means of respiratory resistance (Grs) Astograph* in relation to the following parameters: 1) Dmin, an index of airway sensitivity (accumulated methacholine concentration at the time of onset of linear decrease in the dose-response curve), 2) SsGawqt and SGrs, indicators of airway sensitivity (slope when the value begins to decrease) and 3) PD₃₅ (accumulated methacholine concentration when the valve has decreased to 35% of the initial value), although no significantly difference was observed in SsGawqt and SGrs, significantly lower values of Dmin and PD₃₅, indexes of airway sensitivity, were obtained with sGawqt method as compared to Astograph^®. These findings may indicate that the airway hypersensitivity test using our body plethysmography technique can be performed using a smaller amount of inhalated methacholine with less patient burden as compared to Astograph^®.

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We investigated the effects of various doses (0.2 to 2000μg/kg) of endotoxin on physiological and hematological parameters in our guinea pig model. Bronchoalveolar lavage (BAL) and lung tissue sampling were performed 6 hours after endotoxin injection. Lung damage was assessed by measuring wet to dry lung weight ratio (W/D), lung tissue to plasma accumulation of ¹²⁵I-albumin (AL: albumin leakage) and BAL fluid to plasma accumulation of ¹²⁵I-albumin (BALL: bronchoalveolar lavage leakage). Changes in peripheral cell counts were estimated at times 0, 1, 2, 4 and 6 hours after endotoxin injection. Pulmonary cell accumulation was determined by counting the number of cells in BAL fluid and tissue samples fixed for light microscopic examination. Increased W/D and AL were observed only in the high dose endotoxin treatment groups (200 and 2000μg/kg), while BALL increased even in the low dose endotoxin treatment groups (2μg/kg). Decreases in peripheral neutrophil counts at one hour were observed in all endotoxin treated groups. Increase in BAL fluid neutrophils was seen in the 20, 200, and 2000μg/kg groups, while neutrophil accumulation assessed by light microscope was observed in all endotoxin treated groups. We conclude that different amounts of endotoxin are required to affect different parameters of lung injury.

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We studied the clinical features and prognosis of 11 patients with Churg-Strauss syndrome (CSS). Subjects included 1 man and 10 women with a mean age of 56.3 years. All subjects had a history of bronchial asthma prior to the onset of CSS. It was noted that the age of onset of bronchial asthma was high, and most of the patients had suffered from frequent and severe asthmatic attacks during the periods preceding the vasculitis. Skin tests and IgE RAST revealed that less than half of the subjects were atopic. Therefore it is considered that asthmatics with late onset and severe symptoms have a high risk for CSS, and poor control of asthmatic symptoms may contribute to the onset of the vasculitis. Eleven of 12 cases including 1 patient with a relapse were treated with PSL alone (9 cases) or PSL plus cyclophosphamide (2 cases). Three patients died of heart failure or central nerve involvement. Vasculitis was ameliorated in the other cases (75%). Seven patients received maintenance therapy with low-dose of PSL (5 cases) or cyclophosphamide (2 case). None suffered from relapse of vasculitis during maintenance therapy. Discontinuation of therapy in five cases resulted in a relapse in only one case 62 months after the cessation of low-dose PSL. Although maintenance therapy appears to be useful in some CSS patients, the significance and indications for maintenance therapy should be further clarified.

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A 36-year-old woman with lung adenocarcinoma is reported. Chest X-ray film showed a high CT number, but no calcified lesion was detected. Histologic examination demonstrated no bone formation, calcification, or psammoma bodies. Calcium staining with Kossa method was negative. An elementary analysis with penetrating type electron microscopy and energy dispersion type analyzer showed high calcium concentration in the tumor. It was thought that the tumor showed a high CT number because of masked soluble calcium.

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A 70-year-old man was admitted for evaluation of an abnormal shadow on his chest X-ray film, consisting of a mass containing an air bronchogram. He was also found to have a monoclonal gammopathy (IgM kappa type) and Sjögren syndrome. Open lung biopsy was performed with the suspicion of primary pulmonary lymphoma or pseudolymphoma.
Southern blot analysis of the tissue revealed clonal rearrangements of immunoglobulin gene, supporting the diagnosis of B-cell lymphoma. Using conventional immunoperoxidase staining (PAP) method, the monoclonality in the tissue specimen is sometimes quite difficult to prove. Southern blot analysis, however, gives more accurate and reliable results. The analysis of immunoglobulin gene rearrangements is quite useful in determining the presence or absence of monoclonality in a specimen in cases of suspected lymphoproliferative disease such as primary pulmonary lymphoma and pseudolymphoma. We strongly recommend the use of Southern blot analysis in making the diagnosis of lymphoproliferative disease.

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A 18-year-old female with a history of precordial pain was admitted. There was a mass (3.5×2.5cm) in the right inframammary region which was suspected to be chest wall tumor on the basis of CT scan and Ga scintigraphy findings. Exploratory surgery, consisting of total resection of the tumor without removing the ribs, was performed and revealed an abscess. Culture of pus from the abscess grew Salmonella newport (0 antigen 8, H antigen eh; 1.2).
Focal infection with Salmonellosis is discussed. Surgical treatment is necessary in addition to chemotherapy.

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The patient was a 57-year-old male with long-standing bronchiectasis who developed severe respiratory failure and died in 1991. Autopsy revealed multiple broncholithiasis in both lungs, but no calcified lymph nodes in the hilar region. Since histological examination of the broncholiths showed only stratified structures but no tissue structure, most likely cause was casidered to be calcification of mucus in the bronchi. Analysis of the stone components revealed 78% calcium and 22% protein. This patient represents a case of multiple broncholithiasis caused by mucus retention, which is thought to be very rare.

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A case of pulmonary arteriovenous fistulas (PAVF) treated with detachable balloon embolotherapy is reported.
A 31-year-old man was admitted to hospital because of polycythemia and hypoxemia. He had a history of dyspnea on exertion and transient cerebral ischemic attacks (TIA). Chest roentgenogram revealed a peripheral lobulated lesion in the right upper lung field and a coin lesion in the left lung field connected by dilated blood vessels to each hilus.
Pulmonary angiography and right heart catheterization were performed. Four PAVFs were observed in bilateral lung field, and the intrapulmonary shunt ratio was 25.8%. Because the patient was symptomatic, we embolized each PAVF with a detachable balloon without complications.
After embolotherapy, there was improvement in his symptoms. hypoxemia and shunt ratio.
Recent reviews have highlighted the need to consider embolotherapy for bilateral multiple PAVF. We conclude that embolotherapy with detachable balloon is a very useful procedure for treatment of bilateral mutiple PAVF.

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A 75-year-old man, a heavy smoker with a history of exposure to dust, was admitted to our hospital because of right back pain. Since café au lait spots, diffuse pigmentation and multiple neurofibromatosis were observed on the skin, he was considered to have von Recklinghausen's disease. Chest X-ray film showed a tumor shadow in the right S², and chest CT demonstrated that the tumor involved the chest wall. Histopathological examination of the percutaneous lung biopsy specimen demonstrated large cell carcinoma. Following radiotherapy to the tumor, he underwent right upper lobectomy with chest wall resection. Macroscopic examination of the resected specimen revealed invasion of tumor into the external intercostal muscles, although microscopically all cancerous tissue was replaced by necrotic tissue and no viable tumor cells remained. The patient survived for three years after treatment, and subsequently died of respiratory failure caused by pneumonia.

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A 23-year-old female was admitted to our hospital because of a mediastinal tumor. She complained of primary amenorrhea, and abdominal echosonograpny was therefore performed, revealing the absence of a uterus. Chromosome analysis revealed a 46XY genotype, indicating the patient to be a male, not a female. Left renal venography demonstrated residual blood vessels originating in the Muellerian ducts. Thoracotomy and laparotomy were performed, and the mediastinal tumor and bilateral testes were resected. Postoperative pathology revealed that the mediastinal tumor was a neurinoma. There was no spermatogenesis, but hyperplasia of Sertoli cells in the testes was seen. Neither the neurinoma nor the testes were malignant. Bioassay of the testes showed no androgen receptors, leading to the diagnosis of testicular feminization syndrome with the complete form of androgen insensitivity. There have been many reports of an association between testicular feminization syndrome and malignant tumors of the testes, but few reports of an association between testicular feminization syndrome and benign tumors such as neurinoma. Accordingly, the present case was considered to be unusual and worth reporting.

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We present a 53-year-old female with pulmonary embolism (PE), who had been taking oral contaceptive for 13 years. She was admitted to our hospital with upper abdominal pain and was found to be in shock. The diagnosis of PE was made from chest X-ray examination, electrocardiogram and pulmonary angiography. Pulmonary hypertension was observed on right heart catheterization, and an anticoagulant was administered. Multiple defects of the right pulmonary artery were detected on lung perfusion scan, and there were no significant findings on leg phlebogram. Home oxygen therapy was effective for the treatment of pulmonary hypertension and chronic hypoxemia which still persisted after her recovery from the acute stage. We are concerned that wide spread use of oral contraceptives will increase the incidence of PE in the near future in this country. We conclude that contraceptive users should be warned of their higher risk of PE, and that they should visit a clinic for examination.

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A 45-year-old male was admitted with chief complaint of hemoptysis. Prior to admission, a tumor in the S3 segment of the right lung had been detected by chest radiography. Despite a detailed examination after admission, no definite diagnosis was made, and right upper lobectomy was performed. Histopathological examination of the surgically resected tissue led to the diagnosis of pulmonary actinomycosis.
In Japan, 52 cases of this condition were reported between 1964 and 1991. This paper discusses the epidemiology, diagnosis and diagnostic imaging of the condition, with reference to the literature.

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A 29-year-old female was admitted to our hospital because of right pleural effusion. Chyle was obtained by thoracocentesis. She received conservative therapy, however, the pleural effusion did not decrease. Thoracic duct ligation was performed, and improvement of the chylothorax was observed. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. Idiopathic chylothorax is a rare disease and only 24 cases have been reported in Japan.

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We report a case of chylothorax in a 51-year-old male with non-Hodgkin's lymphoma. Combination chemotherapy reduced the size of mediastinal lymph nodes dramatically, but retroperitoneal lymph nodes remained almost the same, and chylothorax subsequentlly developed. Lymphangiogram showed reticular spread of contrast material from the thoracic duct downwards but not above the diaphragm. These findings suggest that an obstruction of the infra-diaphragmatic but not the supra-diaphragmatic thoracic duct caused development of collateral lymphatic channels penetrating the diaphragm into the thoracic cavity, with subsequent formation of chylothorax.

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A 61-year-old man was admitted to our hospital on October 8, 1991 because of abnormal shadows on chest X-ray at annual checkup at his company. Chest X-ray and CT on admission showed diffuse reticular shadows in bilateral lower lung fields and a nodular opacity approximately 10mm in diameter in the right lower lung. Since transbronchial lung biopsy was not diagnostic, an open lung biopsy was performed on October 28, 1991.
The lung specimens showed diffuse pulmonary fibrosis compatible with usual interstitial pneumonia and an intrapulmonary lymph node containing silicotic nodules. Only 29 cases (including the present case) of intrapulmonary lymph nodes have been reported. Although the causes of intrapulmonary lymph nodes are not clear, smoking is considered to play an important role in the development of pulmonary lymphoid tissue.
In our case, the intrapulmonary lymph node contained silicotic nodules. Only several case have been reported to have silicotic nodules in the lymph nodes. As suggested by Kradin, they may be induced by relatively low levels of exposure to dust.
Our case also had pulmonary fibrosis (IIP), and is the first reported case of intrapulmonary lymph node associated with IIP. Although it is difficult to determine these two diseases occurred coincidently or not, it is possiblle that a low level of dust exposure may have contributed to both silicotic nodules in the lymph node and IIP.

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A 65-year-old man with a history of a common cold two months earlier was referred to our division for further evaluation of an abnormality on chest X-ray film. Transbronchial lung biopsy findings revealed an inflammatory pseudotumor, a plasma cell granuloma (PCG). The pulmonary nodule disappeared completely six weeks after steroid therapy. To our knowledge, all PCG cases to date have been surgically resected. Therefore, this case of PCG diagnosed by transbronchial lung biopsy and successfully treated nonsurgically with steroid therapy is worthy of note.

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A 73-year-old man was admitted on April 1984 because of an abnormal shadow on chest X-ray. He was diagnosed as having small cell lung carcinoma (oat cell type) with inappropriate secretion of antidiuretic hormone (SIADH). Initial chemotherapy with cyclophosphamide, ACNU, vincristine, adriamycin, cis-platinum and etoposide was administered. The mass subsequently disappeared, and the serum sodium level normalized. About 2 years later, the patient developed a relapse of the primary lesion with hyponatremia. The same regimen as the initial chemotherapy was initiated and a complete response was again obtained. Similar episodes were repeated four times, and he died in April 1991. This patient survived for about seven years after the initial treatment without maintenance chemotherapy.

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We report three cases of lung cancer with calcification shown on chest CT scans. Case 1 was a 63-year-old man with well differentiated squamous cell carcinoma of the lung. Chest CT scan showed pronounced central calcification within the tumor. Case 2 was a 57-year-old woman with small cell carcinoma of the lung. Chest CT scan showed diffuse amorphous calcification within the tumor. Case 3 was a 70-year-old man with lung cancer for which pathologic data was not available. Chest CT scan showed punctate and linear calcification of the cavity wall within the tumor. Microscopic examinations revealed dystrophic calcification in cases 1 and 2.
Calcification has long been recognized as a distinguishing radiologic feature of a benign pulmonary mass, however, the presence of calcification within a tumor on chest CT scan does not exclude the diagnosis of lung cancer.

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