Levels of soluble CD4 (sCD4) and soluble CD8 (sCD8) in serum and bronchoalveolar lavage fluid (BALF) were determined in 36 patients with sarcoidosis and 20 healthy controls by an ELISA method. In addition, the possible sources of sCD4 and sCD8 were examined in detail. The sCD4 levels in serum did not differ significantly between sarcoidosis patients and controls. The sCD8 levels in the sera of sarcoidosis patients with a high serum angiotensin-converting enzyme (ACE) level were significantly higher than those of patients with a normal serum ACE level (413±148U/ml vs. 297±76U/ml, p<0.01). The high ACE group also had significantly increased serum sCD8 levels as compared to controls (323±111U/ml, p<0.05). In the sarcoidosis patients, the mean serum sCD8 level was 308±46 U/ml in stage 0, 339±107U/ml in stage I, 557±141U/ml in stage II, and 474±211U/ml in stage III. The stage II group had a significantly higher sCD8 level than either the stage 0 or I groups (p<0.05). In the sarcoidosis patients, the sCD8 level correlated significantly with the level of either ACE or soluble Interleukin-2 receptor in serum (p<0.05). The sCD4 level in BALF was significantly higher in sarcoidosis patients than in controls (4.10±1.90U/ml vs. 2.39±0.12U/ml, p<0.01), while the sCD8 level in BALF tended to be higher in sarcoidosis patients than in controls (4.31±4.39U/ml vs. 2.02±1.52U/ml). sCD4 was detectable not only in supernatants of cultured T-lymphocytes but also in those of cultured monocytes (Mo) and alveolar macrophages (AM). The T-lymphocytes, Mo and AM accumulated in the lungs of sarcoidosis patients were thought to be sources of sCD4 in BALF. In this study, the precise mechanism by which the serum sCD8 level was increased in sarcoidosis patients with a high serum ACE level remains to be clarified. These results indicate that sCD8 in serum is useful index of disease activity in sarcoidosis.

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It is well known that the initial reaction of monocrotaline-induced pulmonary hypertension in rats (MPH) is injury to the endothelial cells of pulmonary vascular bed by monocrotaline-pyrrole (MP), which is converted from monocrotaline (M) by cytochrome P450 monooxygenase in hepatic microsomes. It is also known that the degree of MPH differs between sexes. The mechanisms of MPH remain, however, to be elucidated. The purpose of this study is to clarify the relationship between the converting ability of hepatic microsomes and the sexual difference in MPH using castrated male rats.
A 40mg/kg dose of M was given to fifteen 6 week-old male, twelve 6 week-old female and fifteen 6 week-old castrated male, Sprague-Dawley, rats. The castration was done at three weeks of age. Four weeks after M administration, the right ventricular systolic pressure (RVSP) and the right ventricular to total ventricular weight ratio (RV/T) were measured as indices of pulmonary hypertension. Livers were taken from six 6 week-old male, six, 6 week-old female and six 6 week-old castrated male, Sprague-Dawley, rats and then homogenized and centrifuged to extract hepatic microsomes. M, at 3.3mM, was added to concentrated hepatic microsomes (0.25 to 1.5mg/ml) in order to produce MP. The concentration of the MP was measured using a modification of Mattock's method.
The mean value of RVSP was 86.5mmHg in males, 59.6mmHg in females and 73.9mmHg in castrated males.
The mean value of RV/T was 0.453 in males, 0.358 in females and 0.403 in castrated males. Both of these variables were significantly higher in males than in females and castrated males.
The mean values of absorption rates, which indicate the concentrations of the MP, are shown below.
In regard to the same microsomal protein content, the absorption rate was significantly higher in males than in females and castrated males.
These results suggest that the sexual difference in MPH may be caused a difference in the ability to convert M to MP in hepatic microsomes. Because the degree of MPH and the converting ability were decreased by castration, sex hormones and male-specific cytochrome P450s may contribute to the metabolic pathway of monocrotaline.

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The effects of repeated intravenous injections of E. coli endotoxin (ETX)-containing liposomes (LP) on the development of emphysematous change in rats were examined. Male Wistar rats, weighing 150-200g, were divided into 3 groups. Group 1; rats treated with phosphate buffered saline (PBS), Group 2; rats treated with liposome-entrapped PBS, Group 3; rats treated with liposome-entrapped ETX (10mg/ml). In each group, 0.5ml was injected intravenously once a week for 8 consecutive weeks. After 8 weeks, functional and morphometrical analyses of lungs were performed. Functional residual capacity (FRC), total lung capacity (TLC), and static compliance (Cst.) were measured using a pressure plethysmograph for small animals. Mean linear intercept (MLI) and internal surface area (ISA) were also determined.
TLC did not differ among the 3 groups. In rats treated with liposome-entrapped ETX, Cst. corrected by body weight (Cst./body weight) was significantly increased compared with that in liposome-entrapped PBS-treated rats. Further more, MLI was larger than that of the other 2 groups and ISA was less than that of the liposome-entrapped PBS-treated rats.
These results suggest that liposome-entrapped ETX induces emphysematous changes in rats.

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Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.

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Throat secretions (TS) and bronchial secretions aspirated from tracheostomy sites (TSTA) from six subjects with long term tracheostomy were simultaneously collected and then cultured every two weeks from January, 1990, to December, 1992. Isolated bacteria were mainly α-streptococci (96.2%) and Neisseria (69.6%) in TS, and Pseudomonas aeruginosa (75.7%) in TSTA. In all cases, P. aeruginosa was isolated from and colonization of the lower respiratory tract by this organism was apparent 24.4 months, on average, after tracheostomy. There were ten episodes of respiratory infection in five cases, eight of which occurred after colonization. P. aeruginosa was the causative organism in seven of these episodes.
Findings in patients with long term tracheostomy indicated seperate colonization of the upper and lower respiratory tracts and that P. aeruginosa colonized the lower respiratory tract. The colonization of the lower respiratory tract by P. aeruginosa would thus appear to be an important factor inducing respiratory infection.

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A 52-year-old woman who had received a right upper lobectomy and thoracoplasty for the treatment of pulmonary tuberculosis 30 years prior to the present disorder, was admitted to our hospital with massive hemoptysis.
We diagnosed aspergilloma clinically because chest X-ray showed a fungus ball-like mass with meniscus sign. Right middle and lower lobectomies were performed after the 7th bronchial arterial embolization for recurrent hemoptysis.
The resected specimen showed a mass of old gauze, a so-called “gauzeoma”. We have found no previous reports of gauzeoma with both meniscus sign and recurrent massive hemoptysis mimicking aspergilloma.

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A 74-year-old man was admitted to our hospital for work up of a shadow in the right middle lobe on chest X-ray film. He had hypertension, aortic regurgitation, and atrial fibrillation on admission. Bronchoscopy demonstrated total obstruction of the right B⁴ orifice, but the etiology of obstruction was unknown. He was discharged and followed up. The shadow in the middle lobe disappeared spontaneously and the cardiac silhouette was slightly smaller than that on the first admission.
The shadow in the middle lobe reappeared again with the progression of cardiomegaly. Because hypertension became uncontrolled and pretibial edema developed, he was readmitted. Bronchoscopy showed the same findings as on the first admission. After treatment of heart failure for one month, bronchoscopy demonstrated partial patency of the right B⁴ orifice. As cardiomegaly improved, the shadow in the middle lobe diminished and then disappeared, and chest CT scan showed patency of the right B⁴.
These findings suggest that congestive heart failure caused the atelectasis of the right middle lobe, so-called middle lobe syndrome. A possible mechanism of the right B⁴ obstruction is that the right B⁴ was compressed between the middle lobe artery and the dilated middle lobe vein due to heart failure.

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A 65-year-old male was admitted with diagnosis of bronchial asthma. On admission, he was orthopneic, cyanotic and distressed. Marked hypoxemia with PaO₂ of 31.1mmHg was noted, but no obvious localized Airway obstruction on plain chest X-ray film could be detected. These was minimal response to intensive treatment with steroid in addition to various bronchodilators on the presumed diagnosis of bronchial asthma.
Two weeks later, chest X-ray disclosed complete atelectasis of the left lung. Stenosis of the left main bronchus with enlarged mediastinal lymph nodes on chest CT was suggested. Endoscopic examination disclosed complete obstruction of the left main bronchus just beyond the carina and polypoid tumors in the right main bronchus and basal segment bronchus. The biopsy specimens revealed squamous cell carcinoma.
Chemotherapy with CDDP and VDS resulted in disappearance of atelectasis after one week and marked relief of respiratory distress. Four months later, at the completion of irradiation therapy, an abdominal tumor associated with pain appeared and bone scintigram showed multiple bone metastases. After four times chemotherapy including CDDP, hypercalcemia and renal hypofunction developed, and the patient died.
Autopsy disclosed a tumor in the extrahepatic bile duct, cystic lesions of the pancreas and swelling of subcarinal lymph nodes, but no tumorous lesion in the lung and endobronchial tissue. Histological examination of the extrahepatic bile duct tumor revealed adenosquamous cell carcinoma, with predominantly squamous cell carcinoma. Other metastatic lesions consisted of squamous cell carcinoma.
These findings are compatible with pulmonary metastases of adenosquamous cell carcinoma of the extrahepatic bile duct.

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A 63-year-old male was hospitalized due to persistent cough on August 19, 1991. He was suspected to have pulmonary tuberculosis based on the findings of chest roentgenograms. He was therefore given anti-tuberculous drugs and antibiotics as of the first hospital day. Approximately two months later, he developed high fever, and the infiltrative shadows on his chest roentgenograms worsened. Therefore, he was readmitted to our hospital on October 31, 1991. Despite the use of several antibiotics, his high fever persisted and the infiltrative shadows on chest roentgenogramphy continued to worsen after admission. Although no pathogenic microorganisms were isolated, in spite of frequent sputum examinations, we strongly suspected pulmonary aspergillosis because serum precipitin antibody against aspergillus antigens was positive. Intravenous administration of miconazole was thus initiated and lead to reduction in the fever. The fever recurred but, after the start of miconazole inhalation, gradually diminished. Serum precipitin antibody subsequently became negative. We diagnosed this case as chronic necrotizing pulmonary aspergillosis based on the clinical course. It is often difficult to confirm the presence of aspergillus hyphae. Therefore, this disease should be suspected on the basis of serum precipitin antibody. In such cases, a therapeutic diagnosis should be attempted.

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We reported two cases of idiopathic interstitial pneumonia (IIP) who developed acute exacerbation after bronchoalveolar lavage (BAL). One case was a 67-year-old male who presented with dry cough and exertional dyspnea. He was diagnosed as IIP and transbronchial lung biopsy revealed alveolitis. BAL was performed after administration of prednisolone. He complained of severe dyspnea after BAL and was diagnosed as having an acute exacerbation of IIP. In spite of extensive treatment including pulse therapy with methylprednisolone, he died.
The other case was a 57-year-old male noted to have a chest X-ray abnormality who presented with dry cough and dyspnea on exertion. He was diagnosed as having IIP and primary lung cancer. BAL was performed to evaluate the activity of IIP, and respiratory distress subsequently became severe. After BAL, he developed an acute exacerbation of IIP and died in spite of treatment.
In both cases, peripheral white blood cell counts were increased just before BAL. It was suggested that this condition might participate in acute exacerbation of IIP. It should be kept in mind that some patients with IIP may develop acute exacerbation after BAL.

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Unilateral whole lung lavage (UWLL) was performed four times in a patient with pulmonary alveolar proteinosis. PaO₂ was 94 Torr even under ventilation with 100% O₂. Because of the difficulty in providing adequate arterial oxygenation, extracorporeal membrane oxygenation (ECMO) was indispensable in accomplishing the first right UWLL. During the second left UWLL, the left lung was ventilated with nitrogen (N₂) and an attempt was made to predict the lowest PaO₂ occurring during lavage in order to establish criteria for the use of ECMO during UWLL. When both lungs were ventilated with 100%. O₂, PaO₂ rose to 150 Torr. PaO₂ fell to 65 Torr after ventilation of the left lung with N₂ while the right lung was ventilated with 100% O₂ for 7 minutes. The N₂ was replaced with 100% O₂ and ventilation was continued for another 10 minutes to wash the N₂ out of the left lung. When the tracheal tube in the left lung was clamped for 7 minutes for degassing, PaO₂ fntll to 59 Torr. Subsently 1, 200ml of physiological saline was injected into the left lung, and PaO₂ rose to 155 Torr. A 6 Torr difference was found between the value of PaO₂ under ventilation with N₂ and that of degassing, but this difference was not statistically significant. The lowest PaO₂ occurring during UWLL was considered to be predictable if the unilateral lung was ventilated with N₂.

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A 71-year-old woman admitted to our hospital with complaints of progressive dyspnea on excertion and weight loss. Roentgenological examination demonstrated peripheral pulmonary fibrosis and a mediastinal tumor suggesting thymoma. The pathological findings of transbronchial lung biopsy (TBLB) confirmed pulmonary fibrosis. Moreover, cytomegalic inclusion bodies in TBLB and a high titer of serum CMV IgG antibody suggested pulmonary CMV infection. It is considered that pulmonary fibrosis and CMV infection were coexistent in this patient.

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A 23-year-old woman was admitted to our hospital because of cough and fever. Coarse crackles were audible over her left chest. A chest X-ray obtained on May 5, 1989, showed consolidation in the left S¹⁰ and a nodule in the right S¹. Clinical symptoms improved during the course of hospitalization. Neither antibody titers against mycoplasma and chlamydia nor viral titers were elevated in paired sera. BALF findings of the left B¹⁰ showed increased numbers of eosinophils and lymphocytes. We diagnosed this case as eosinophilic pneumonia (EP). Environmental provocation testing was carried out in her home and yielded a positive result. After clearing of the house, she was able to return and has since experienced no relapses. We suspect that environmental conditions influence the pathogenesis of EP.

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A case of true thymic hyperplasia in a 33-year-old man is reported. Radiographic findings of the chest (including computer tomography and magnetic resonance imaging) showed a mass in the anterior mediastinum. Thoracotomy revealed an enlarged thymus. Histological examination identified true thymic hyperplasia. True thymic hyperplasia is a lesion rarely observed in adults. This case was reported because of the age of the patient.

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A 73-year-old woman was referred to our hospital because of left pleural effusion. Chyle was obtained by thoracocentesis. Because there was no organic lesion to cause chylothorax, idiopathic chylothorax was diagnosed. Her condition improved by chest-tube drainage and pleurodesis with intrapleural injection of OK-432. We report a rare case of idiopathic chylothorax and conclude that pleurodesis with intrapleural injection of OK432 is very useful for the treatment of idiopathic chylothorax.

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