Recently, the roles of inflammatory processes in the pathogenesis of asthma have been emphasized. To elucidate the roles of T lymphocytes in local inflammatory sites in asthma, we examined T cell phenotypes with flow cytometry and carried out cytokine message amplification phenotyping (MAPPing) of bronchoalveolar lavage (BAL) cells taken from patients with steady-state asthma (n=11).
The percentage of CD4⁺ T cells in total lymphocytes correlated significantly (r=0.784, p<0.005) with that of lymphocytes in total CD45⁺ BAL cells. The positivities of T cell activation markers (CD25, HLA-DR) in CD4⁺ T cells were inversely correlated with the ratio of CD3⁺ T cells to total CD45⁺ BAL cells (CD25, r=-0.648. p=-0.059, HLA-DR, r=-0.741, p<0.05). Most CD4⁺ T cells were of the CD45 RO⁺ “memory” phenotype.
With cytokine MAPPing, IL-2 or IFNγ were detected in only 2 of 11 patients, but IL4 or IL-5 were detected in 8 patients.
These results suggest that non-activated T_H2 type memory CD4⁺ T cells accumulate in local inflammatory sites of the bronchi of patients with steady-state asthma, and that these cells releases cytokines (IL-4, IL-5) when activated by some stimuli, which can lead to an asthma attack.

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We encountered a 63-year-old man whose dry cough due to interstitial pneumonia had been successfully treated with an anti-thrombin drug, argatroban, which was given to treat exacerbated Buerger's disease. We therefore prospectively evaluated fibrinogen, fibrin-degradating product D-dieter, thrombin anti-thrombin III complex, and plasmin anti-plasmin complex in patients with interstitisal lung diseases. In a preliminary study, we found that some patients actually had elevated levels of these markers. These findings suggested that increased coagulability was involved in the pathophysiology of interstitial pneumonia. In this study, we measured the levels of serum-soluble thrombomodulin as a marker of endothelial cell damages that lead to hemostasis. We found that serum levels of thrombomodulin were high in about 35% of patients with sarcoidosis, interstitial pneumonia associated with collagen diseases, or idiopatic interstitial pneumonia. Furthermore, these levels decreased as the patients' conditions improved. Although further evaluation is needed, these results suggest that endothelial cell damage and hemostasis are involved in the pathophysiology of interstitial pneumonia.

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The effects of repeated intravenous injection of E. coli endotoxin (ETX) and intraperitoneal injection of D-galactosamine (GAL), which decreases the circulating level of α₁-antitrypsin, on the pathophysiology of chronic lung injury was studied in rats. Four groups were prepared as follows for 8 weeks. Group 1 (control): Intravenous injection of saline. Group 2: Intravenous injection of ETX (2mg/kg) once a week. Group 3: Intraperitoneal injection of GAL (200mg/kg), 2 times daily on 3 consecutive days each week. Group 4: Injection of both ETX and GAL, at the same dosages as used in groups 2 and 3. Total lung capacity and static lung compliance divided by weight were high in the ETX group and the ETX+GAL group, comparative when compared with those in the control and GAL groups, even though weight gain rates in the ETX+GAL group was less than in other groups. Mean linear intercept of rats in the ETX+GAL group was significantly greater than in other groups. These results sugest that ETX+GAL-treated rats have more emphysematous changes in pulmonary function and structure.

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The nuclear DNA contents of 18 freshly resected specimens of primary lung cancer tissue were determined by flow cytometry with a multiple sampling method. A DNA aneuploidy pattern was observed in all cases. In three cases, a diploid DNA pattern was observed along with abnormal DNA stem lines. Twelve cases (66%) had two or more abnormal DNA stem lines, and were classified as DNA multiploidy. The frequencies of DNA aneuploidy and DNA multiploidy were higher than in previously reported studies. Intratumoral DNA heterogeneity was observed in 10 cases (55%). Three of these were a mixture of DNA diploidy and DNA aneuploidy, and the other seven were a mixture of DNA aneuploidy and DNA multiploidy. If multiple sampling had not been performed in these cases, their ploidy patterns would have been misinterpreted. We conclude that multiple sampling is important in determining the precise DNA ploidy patterns of primary lung cancers.

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Inhaled sterioids are currently the first-line treatment of chronic asthma. Because each metered dose of beclomethasone dipropionate (BDP) is small (50μg), short term burst or continuous use of oral steroids are combined in moderately to severely asthmatic patients. The effect of these treatments on bone metabolism remains unclear. Bone mineral density (BMD), osteocalcin (OC), PTH, Ca, and ALP were assessed in 130 asthmatic patients. There were 3 groups: the first group [B+R] consisted of 17 patients taking BDP (1190±536μg/day) and also taking oral steroids (8.0±3.8mg/day, 8.11±5.52 years), the second group [B+S] had 35 patients taking BDP (885±320±g/day) and short-term bursts of oral steroids (PSL 20-40mg/day, 3-7 days course, 7.51±4.54 courses/year) and the third group [B alone] consisted of patients who were taking BDP (480±260μg/day) alone. BMD was measured by dual energy X-ray absorptiometry (DEXA). In the [B+R], [B+S], and [B alone] groups, the BMD of vertebra (L 1-4) was 0.75, 0.86, and 0.90g/cm², respectively. The percentages of predicted values based on age and sex were 92.0, 102.7, and 106.9% respectively. BMD and percent decrease were significantly lower in the [B+R] group than in the [B+S] or [B alone] group. It is likely that this phenomenon is caused by long-term use of oral steroids rather than by BDP inhalation but there is no significant difference between the [B+S] and the [B alone] groups. Daily BDP dose did not correlate with BMD by multiple regression analysis. There were no significant differences in OC, PTH, Ca or ALP among the three groups. The results show that BDP and short-term bursts of oral steroids can be used safely, though longitudinal studies are needed.

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We report a case of sarcoidosis complicated by middle lobe atelectasis. A chest radiograph and a chest CT film on admission revealed middle lobe atelectasis and mediastinal lymphadenopathy.
Bronchofiberscopic findings showed slit-like stenosis and reddish, edematous mucosal change of the middle lobe orifice. On admission, the serum angiotensin-converting enzyme (ACE) level was within the normal range. However, the ACE level had increased beyond the normal range by 2 months later. histological examination of a specimen from a transbronchial lung biopsy (TBLB) of the middle lobe revealed noncaseating epithelioid cell granulomas. We diagnosed sarcoidosis because of the histological findings from the TBLB and serum ACE elevation.
Treatment with predonisolone resulted in remarkable alleviation of middle lobe atelectasis and mediastinal lymphadenopathy. Cases of sarcoidosis with middle lobe atelectasis are rare in Japan.

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A 78-year-old man was admitted to the hospital with exertional dyspnea and fever. Chronic idiopathic interstitial pneumonia (IIP) had been diagnosed a year before. Follow-up chest X-ray examinaiton showed diffuse reticular shadows and progressive shrinkage of both lower lobes. Chest CT scan revealed honeycomb appearance of both lower lung fields. Moderate hypoxemia was found by arterial blood gas analysis. The patient responded to an orally administered corticosteroid. Because tapering of the medicine caused exacerbation of the hypoxemia, methylprednisolone pulse therapy was given with poor response. Then high-dose (750mg) of cyclophosphamide (CPM) were given intravenously 6 times, every 3 or 4 weeks. After the second administration of CPM, decreases in hypoxemia and in blood LDH levels were observed. This treatment allowed as to taper the dose of oral corticosteroid from 60mg/day to 15mg/day, This case suggests that intravenous administration of high-dose CPM may be effective against IIP.

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A 44-year-old man with a unilateral brain-stem tumor (ganglioglioma) presented with marked hypoventilation and irregular breathing. His respiratory muscle strength was impaired slightly, and his ventilatory responses to chemical stimuli were markedly diminished. Magnetic resonance imaging of the brainstem revealed that the tumor was located in the left superior cerebellar peduncle and the medulla, and involved the left lateral portion of the medullary reticular formation, ambiguous nucleus, and solitary nuclear complex. From these findings, we conclude that the abnormality of ventilatory control may have been caused by damage to both the unilateral respiratory neuron group in the medulla and the afferent pathway to the respiratory motor unit on the opposite side.

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A 57-year-old woman came to our hospital complaining of multiple subcutaneous nodules that developed while she received corticosteroid therapy for pulmonary sarcoidosis. She was treated with interferon-alpha (IFN-α) at another hospital for C-type chronic hepatitis and she noticed these nodules with tenderness two months after treatment began. A biopsy speciemen of the nodule revealed subcutaneous sarcoid granuloma. Her abnormally high serum-ACE value and subcutaneous nodules resolved after the dose of IFN-α was gradually reduced. IFN therapy should be used with care in cases of sarcoidosis in which IFN-γ and T-lymphocytes are mainly involved

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Metastatic pulmonary adenocarcinoma was found in a 79-year-old man, who had symptoms of general malaise and poor appetite. An extensive work-up including a transurethral resection of the prostate, failed to establish the primary site of the malignancy. By administering chlormadinone acetate for prostatic hypertrophy, the pulmonary metastases improved dramatically. The tumor cells in the lung, which had previously been obtained by transbronchial lung biopsy, stained positive for prostatic acid phosphatase and prostatic specific antigen. These data suggested that prostatic carcinoma had metastasized to the lung. The prostatic carcinoma was finally confirmed at autopsy.

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We treated a 63-year-old man in whom asbestosis developed after he had sprayed asbestos for 24 years. He was admitted with the chief complaint of dyspnea and was managed for 4 years with artificial ventilation. We believe that he survived for this long because he was free of severe pneumonia and because the lower lung, which is primarily affected by asbestos, was relatively intact so his pulmonary function did not deteriorate rapidly. Pathological findings included plate-like atelectasis in both upper lung fields and marked thickening of the pleura. Lung fibrosis was centrilobular but showed no honeycombing. The lung tissue contained 265×10⁶ asbestos particles and 910×10⁶ asbestos fibers per gram (dry weight), and the pleura also had 805 asbestos particles and 3, 035 asbestos fibers. Most of these asbestos fibers were 20μm or longer and were crocidolite.

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A 71-year-old woman was admitted to our hospital for evaluation of a chest X-ray abnormality. Heart murmur was not heard. Chest X-ray showed a bulge with calcification at left third arch. Chest computed tomography revealed contrast enhancement of masses, which appeared to originate from the vascular system. Coronary angiography demonstrated multicystic aneurysmal dilatation of a coronary artery fistula originating from the proximal left descending and right coronary artery.
Electrocardiography showed no remarkable findings and a treadmill exercise test showed no significant ST-T change. The size of the mass of 3cm in diameter on chest X-ray remained the same for two years. We concluded that surgery was not necessory immediately. In Japan, nineteen cases of coronary-pulmonary artery fistula with multicystic saccular aneurysms have been reported in the literature, including our case. The majority of these cases are elderly women from fifty to sixty years old.

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A 58-year-old female, who had complained of dryness of the conjunctiva and mouth for nine years, was admitted to our hospital because chest X-ray films revealed increases in both the size and the number of pulmonary nodules in comparison to four years earlier. Histological findings of the salivary gland biopsy confirmed a diagnosis of Sjögren's syndrome. An open lung biopsy was performed. Histologically, the pulmonary nodules consisted of homogenous, acellular eosinophilic materials, which were identified as amyloid by Congo red staining. Immunohistochemical examination showed the amyloid to be composed of AA protein. There were no deposits in other organs. Peribronchial lymphocytic infiltration associated with Sjögren's syndrome was present.
Nodular pulmonary amyloidosis with Sjögren's syndrome is very rare condition. To our knowledge, this case is only the ninth to be reported in the literature.

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A 59-year-old woman was admitted with back pain and an abnormal chest shadow in the left hilar region. Her chest CT scan showed a posterior mediastinal mass surrounding the descending aorta. By transesophageal ultrasonography, a diagnosis of mediastinal cyst was made. She underwent thoracoscopic resection under general anesthesia with new endoscopic devices including endo-scissors, endoscopic hemoclips and electrocautery. Pathologically, the tumor was an esophageal cyst lined by ciliated columnar and squamous epithelium overlying smooth muscle layers. She made an uneventful recovery. Her back pain subsided following the operation.
Thoracoscopic resection is a useful technique for patients with mediastinal cystic tumor.

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A 73-year-old woman admitted to the hospital with dyspnea on exertion. Chest radiography revealed a diffuse interstitial shadow; PaO₂ was 72 Torr, and PaCO₂ was 41 Torr. Laboratory examination results were compatible with idiopathic pulmonary fibrosis (IPF). Prednisolone relieved the dyspnea, but tapering of the drug led to a recurrence of this symptom. Pulse therapy was started and azathioprine was added to the corticosteroid. Over the course of 6 months of treatment, the patient's respiratory function remained fairly stable. Then respiratory distress was induced by an attack of atrial fibrillation, with relief provided by anti-arrhythmic drugs and large doses of corticosteroids. The patient died suddenly 3 weeks later. An autopsy revealed large thrombi in both pulmonary arteries with 90% stenosis. Parts of the thrombi were organized, which suggests that 2-3 weeks had elapsed since initial thrombus formation. Histological examination of lung tissue showed usual interstitial pneumonia. Pulmonary thromboembolism should be considered in patients with IPF if respiratory distress suddenly and unexpectedly worsens.

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Invasive pulmonary aspergillosis generally occurs in immunocompromised hosts such as patients with leukemia, and other malignancies, who are receiving anti-cancer chemotherapy. In this report, two non-immunocompromised patients who developed invasive pulmonary aspergillosis are presented. Case 1: A 63-year-old man complained of productive cough and fever. He received antibiotic therapy from his personal physician. This symptoms did not respond, however, and dyspnea developed. He was then transferred to our hospital, about one month after the onset. The chest X-ray showed a meniscus shadow suggesting an aspergilloma in the right upper lung field and an infiltrative shadow in the remaining right lung field. Case 2: A 78-year-old man was admitted because of dyspnea, productive cough and appetite loss over the previous three months. The chest X-ray showed a meniscus shadow in the left upper field, an infiltrative shadow in the left lower field and a right pleural effusion sign was also observed. Both cases were diagnosed as having aspergillosis, early in their illness, by the detection of aspergillus antigen in their sera and histopathological and cultural studies of specimens obtained by TBLB. Both improved with intravenous amphotericin B (30mg/day) and intravenous ulinastatin (200000IU/day) administration. On the examinations conducted during hospitalization, there was no evidence of any immunosuppressive diseases or immunoincompetent conditions such as leukemia, and other malignancies human immunodeficiency virus infection, diabetes or alcoholism.

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We present two cases of pericardial cyst diagnosed by cyst puncture and the injection of contrast medium.
The first patient was a 48-year-old man. He was admitted for the evaluation of an abnormal chest X-ray which demonstrated a mass lesion inseparable from the right heart border. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of -0.3HU. Under CT guidance a 21-G needle was inserted into the cyst and 3ml of clear fluid was obtained, and then contrast medium was injected. A thin smooth walled cyst was outlined by the CT scan. A presumptive diagnosis of pericardial cyst was made. Surgery was performed and the diagnosis was confirrned.
The second patient was a 24-year-old woman. An abnormal shadow was noted at annual check up. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of +10.4HY. We made the diagnosis of pericardial cyst by cyst puncture and injection of contrast medium The CT scan after three months showed no recurrence of the pericardial cyst.
We consider that pericardial cyst can be diagnosed clearly by cyst puncture and the injection of contrast medium, and only percutaneous aspiration of the cyst fluid may be sufficient for the treatment.

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