We studied the relations between preoperative and postoperative lung function in 62 patients with lung cancer who were admitted to our hospital from January 1985 to December 1994. Postoperative pulmonary function, especially vital capacity (VC) and forced expiratory volume in one second (FEV₁), could be predicted from the number of unobstructed subsegmental bronchi, and correlations between predicted and measured values of VC and EFV₁ were computed. In patients whose pulmonary function was measured more than 4 weeks postoperatively. The predicted and measured VC and FEV₁ were found to be strongly correlated (r=0.892 for VC, and 0.852 for FEV₁). Similar correlations were found in patients without obstructive pulmonary dysfunction (FEV₁%≥70%, r=0.897 for VC, and 0.884 for FEV₁). In one patient who had obsructive lung dysfunction due to pulmonary emphysema (EFV₁%<70%), an error of more than 30% was noted between the predicted and measured FEV₁ values. Therefore, patients with lung cancer who have pulmonary emphysema may have postoperative FEV₁ valves that are higher than their predicted values. This might be an effect of volume reduction.

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One crucial step in tumor metastasis is detachment of cells from the primary lesion. This involves down-regulation of homophilic binding intercellular adhesion molecules. To determine whether this occurs in metastasis of human small-cell lung cancer to lymph nodes, we examined expression of E-cadherin, carcinoembryonic antigen (CEA), and neural cell adhesion molecule (NACM) on cells from patients with small-cell lung cancer, some cells were obtained from primary lesions and others from lymph-node metastases. Cells in all of the five lines from primary lesions expressed E-cadherin, unlike those in all of the five lines from lymph-node metastases. Cells in all of the five lines from primary lesions expressed CEA, as did those in only one of the five cell lines from lymph-node metastases. Cells in lines from primary and metastatic lesions did not differ in the expression of NCAM (4/5 positive). Expression of E-cadherin and of CEA were closely correlated. Because E-cadherin and CEA are involved in the binding of epithelial cells, these findings demonstrate that metastasis of small-cell lung cancer to lymph nodes is associated with a lack of the epithelial intercellular adhesion molecules E-cadherin and CEA. The expression of these molecules is involved in the metastasis of small-cell lung cancer to lymph nodes.

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Conventional CT (10-mm thick) and helical thin-section CT (2-mm thick) high-resolution images were obtained to study the relationship between the appearance of small peripheral adenocarcinomas of the lung and pathological findings. Eleven cases in which adenocarcinomas less than 1.0cm in diameter were resected were retrospectively reviewed. Conventional CT images revealed air spaces within pulmonary nodules in 82% of tumors, an ill-defined margin in 91%, and involvement of vessels in 91%. When these findings are observed in pulmonary nodules, thin-section CT should be used for further examination. Helical thin-section CT images showed inhomogeneous internal attenuation (91%), irregularly undulating margins (91%), and vascular involvement (100%).

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To determine the role of interstitial lung disease (ILD) in the outcome of polymyositis-dermatomyositis (PM/DM), we studied 41 patients who had radiographic evidence of ILD among 51 patients with PM/DM. The patients were divided into 3 groups according to the response to therapy: progressive, no change, or improved. Those classified as progressive had significantly higher rates of skin and lung symptoms, milder muscle symptoms, and lower levels of muscle enzymes than the other 2 groups, and none was positive for the anti-Jo-1 autoantibody. Nine patients with DM died of respiratory failure; they had low serum creatirle kinase levels, no anti-Jo-1 antibodies, and a rapidly progressive course before death. Autopsy findings were obtained in 7 patients, and all had diffuse alveolar damage as the main pulmonary histological finding. A subgroup of patients with PM/DM-ILD have a poor prognosis, and ILD in PM/DM is an important prognostic factor.

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Restriction-fragment-length polymorphism, analysis was used to study two outbreaks of pulmonary tuberculosis, one in a family and one in a hospital. The DNA probe was derived from the insertion sequence IS 6110. Two groups of isolates were analyzed, both of which were suspected to be common sources of each infection. Both groups showed identical fingerprints within each group. These results suggest that analysis of restriction-fragment-length polymorphism is useful in epidemiological studies of pulmonary tuberculosis.

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Effects of erythromycin on surfactant synthesis, secretion, and recycling by rat alveolar type II cells were examined. Type II cells were isolated from rat lungs and incubated with ³H-choline, a precursor of surfactant. Synthesis was quantified from the amount of ³H-phosphatidylcholine and from the distribution to lamellar body fractions as measured with sucrose density gradients. Secretion was quantified from the percent of synthesized ³H-phosphatidylcholine released into the medium over 3hr. Recycling was quantified from the percent uptake over 1h of ³H-labeled synthetic liposomes. Type II cells incubated with erythromycin (5-50μg/ml) for 22hrs secreted less surfactant in response to PMA and ATP than did control cells. Erythromycin did not affect synthesis or recycling of surfactant by type II cells. These results show that erythromycin inhibits surfactant secretion from type II cells, and suggest that erythromycin may be effective in surfactant-excess states such as alveolar proteinosis.

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To evaluate the role of Na⁺-glucose cotransport in fluid absorption across alveolar epithelial walls in isolated rat lungs, we measured the inhibitory effects of amiloride (a Na⁺ channel blocker) and phlorizin (a Na⁺-glucose cotrasport blocker) on the fluid absorption rate in fluid-filled lungs. Amiloride (10^-5-10^-4M) reduced alveolar fluid absorption by 30%. This value was similar to that obtained in the presence of 10^-3 M phlorizin. The coefficient of Na⁺-glucose cotransport was estimated to be 2.5. The strong correlation between Na⁺ escape and fluid absorption (r=0.907) was not affected by phlorizin. These findings suggest that the impact of Na⁺-glucose cotransport was similar to that of Na⁺ transport alone, and that glucose molecules transported by Na⁺-glucose cotransport do not play an important role in alveolar fluid absorption across rat alveolar epithelium.

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A 64-year-old woman presented with a dry cough. The common cold was diagnosed and she was given medication, but the symptom did not resolve. She came to our hospital, and multiple patchy shadows were seen on a chest X-ray film. Bronchoalveolar lavage fluid contained an abnormally high percentage of eosinophils. Microscopic examination of transbronchial lung biopsy specimens showed infiltration of eosinophils into the alveoli and alveolar septa. Chronic eosinophilic pneumonia was diagnosed.
Analysis of bone marrow cells showed high percentages of mature eosinophilic cells, and blood serum had a high concentration of eosinophil cationic protein. An inhalation challenge test with methacholine revealed bronchial hypersensitivity and hyperresponsiviness. Prednisolone (30mg/day) was given and the symptoms resolved. After steroid treatment, the patient was asymptomatic, although airway hyperresponsiveness remained. The concentration of eosinophil cationic protein in serum and the results of the methacholine inhalation test reflected the degree of chronic eosinophilic pneumonia, and the production of eosinophils in bone marrow was suppressed by steroid medication.

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A 22-year-old woman was admitted to the hospital with complaints of fever, loss of appetite, coughing, sputum production, and right-sided chest pain. The chest X-ray film and computed tomogram showed infiltrates in both lower lung fields. Meningococcal pneumonia was diagnosed when a sputum culture was found to be positive for Neisseria meningitidis. Infection with this organism is uncommon in Japan. The patient had never gone abroad, and the route of infection was unknown.
N. meningitidis is a rare cause of respiratory infections. When this organism does cause respiratory disease, it is usually acute bronchitis rather than meningococcal pneumonia. The patient in this case was not immunodeficient. She was also not deficient in a terminal lytic component sequence (deficiency in that sequence promotes meningococcal infection). The patient was emaciated and malnourished, which was thought to have made her more susceptible to infection.
Orally administered DU-6859a, one of a new generation of quinolones, was very effective and had no side effects.

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Hemangiopericytoma is a rare tumor originating from pericytes. In May 1983, a 33-year-old man was found to have a well-defined nodular shadow in the right upper lobe during a routine chest X-ray examination. Although the mass had been thought to be benign, in December 1992 it was found to have grown. In May 1993, the patient was reffered to our hospital for furthur examination. A chest X-ray film and a high-resolution CT scan revealed a well-defined nodule in the right upper lung field without vascular gathering or pleural puckering. The tumor was slightly less dense than was soft tissues. There was no evidence suggesting another primary tumor or metastasis. In July 1993, because the mass was suspected to be a love-grade malignant tumor, a segementectolny (rt-S₂) was done. On the basis of histologic, immunohistchemical and electronmicroscopic findings, pulmonary hemangiopericytoma was diagnosed. The postoperative course was uneventful. The patient has been well for 2 years and five months after the operation, with no sign of recurrence or metastasis.

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A 68-year-old woman with bronchial asthma complained of fever, right thigh pain, sensory disturbance at the tips of the upper and lower limbs, and abdominal pain. She had severe eosinophilia and radiologic examination showed a mass-like shadow in the left lower lobe of the lung. Allergic granulomatous angiitis was diagnosed on the basis of findings from a muscle biopsy (gangrenous vasculitis with eosinophilia). This patient also had positive results of serological tests (Ouchterlony method) for various parasite antigens, despite the fact that no eggs of parasites were found in her feces. After steroid administration, the serological reactivity to parasite antigens had decreased. The positive reactions to parasite antigens was probably related to the cause of the vasculitis.

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A 57-year-old woman was admitted to our hospital for examination of an abnormal shadow in the left middle lung field. The lesion was in S⁴ of the left upper lobe, with dilation of A⁵b and V⁵b, and was suspected to be a pulmonary arteriovenous fistula. A three dimensional CT scan showed a tortuous and irregularly dilated vessel. Color doppler imaging showed a mosaic pattern of blood flow. These findings indicated that the fistula was attached to the pleura. The patient underwent thoracoscopic partial resection of the lung.

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In April 1993, a 51-year-old woman had a fever, and an infiltrative shadow was seen in the left upper lobe on a chest X-ray film. Repeated sputum cultures were positive for Mycobacterium avium complex. She underwent antituberculosis therapy consisting of pyrazinamide, ofloxacin, and streptomycin. Her symptom disappeared and the abnormal shadow resolved. In January 1994, she was admitted to the hospital because of bloody sputum and abnormal chest X-ray findings consisting of a left hilar mass and atelectasis of the left upper lobe. Bronchoscopy revealed multiple polypoid lesions without necrosis in the left upper-lobe bronchus. Histological examination showed that the tumor consisted of an aggregation of lymphocytes and plasma cells, and was positive for Ziehl-Neelsen stain. The acid-fast bacillus was identified as Mycobacterium avium by the DNA probe method. Anti-tuberculosis treatment was given: rifampicin, isoniazid, sparfloxacin, and clarithromycin. Three months later, the atelectasis and the polypoid mass in the left upper-lobe bronchus had disappeared. We believe that the polypoid lesions in the left upper-lobe bronchus were due to infection by Mycobacterium avium. The patient was HIV-negative and immunocompetent. Such endobronchial lesions caused by Mycobacterium avium are rare in HIV-negative hosts.

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Four healthy men were exposed to an anti-rust substance in a stainless steel tank. Acute respiratory failure developed in two of them, both non-smokers. Their chest roentgenograms revealed marked infiltration, which suggested pulmonary edema due to the inhalation of NO₂ and hydrogen fluoride. These two patients recovered from respiratory distress within several days. However, small airway disease was still evident one year later. The other two, who were smokers, had only mild respiratory symptons. These cases indicate that smoking may reduce the sensitivity to NO₂. Further study is needed to elucidate the releationship between smoking and the severity of responses to NO₂ inhalation.

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A 53-year-old woman with a smoking history of 20 pack-years was admitted to the hospital because of dry coughing and exertional dyspnea that had progressed over the previous 3 months. A chest X-ray film taken one month before the onset of symptoms was almost normal. Diffuse small nodular shadows with infiltration were evident one month after the onset of symptoms, and increased rapidly until admission to the hospital. Eosinophilic granuloma was diagnosed histologically after thoracoscopy. The symptoms, chest X-ray findings and pulmonary-function data improved spontaneously after admission to the hospital and the nodular shadows had almost completely disappeared by 5 months later; the patient confinued to smoke. The present case is unique and valuable because it shows the natural course of eosinophilic granuloma from the onset of symptoms to remission.

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A 61-year-old woman was admitted to our hospital with a two week history of knee-joint pain, dry coughing and dyspnea on exertion. A chest roentgenogram revealed bilateral patchy and infiltrative shadows. Laboratory examination revealed high CK and aldolase levels. Although myositic symptoms were absent, the respiratory symptoms rapidly worsened and respiratory failure developed. An open-lung biopsy and a muscle biopsy were done. The open-lung biopsy specimen showed bronchiohtis obliterans organizing pneumonia (BOOP), but the muscle biopsy specimen revealed non-specific findings.
After 4 weeks of intravenous intermittent high-dose corticosteroid therapy, 50mg of cyclophosphamide was given daily, along with 20mg of prednisolone on alternate days. There were marked clinical, physiological and roentgenographic improvements. A test for anti-Jo-1 antibody was positive, which suggeted that this patients had pulmonary manifestations of polymyositis/dermatomyositis.
Although BOOP can have an indolent course and a good prognosis, it may rapidly worsen and respiratory failure may develop, in which case it should be treated aggressively with a combination of intravenous high-dose corticosteroids and immunosuppressants.

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A 67-year-old patient with pulmonary tuberculosis sequela had undergone a tracheostomy. The patient was receiving nasal intermittent positive pressure ventilation and the stoma failed to close. Temporary use of chest negative pressure ventilation facilitated closure of the stoma and probably shortened the patient's hospital stay. Nasal interrmittent positive pressure ventilation at home was begun safely and effectively.

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The serum IgE level is usually not high in hypersensitivity pneumonitis (HP) because it develops from Type III and Type IV allergies (Gell and Coombs). However, we have previously reported infiltration of lymphocytes and mast cells in patients with summer-type HP and a high serum IgE level.
We encountered a 56-year-old woman with summer-type HP who had a high serum IgE level and a positive skin reaction to the causative antigen. She was admitted to our hospital because of coughing, fever, and dyspnea. On admission, a chest X-ray film and a chest CT scan disclosed ground-glass opacity and diffuse small nodular shadows. Her PaO₂ was 56mmHg on room air and her serum IgE level was high (725U/ml). Pulmonary-function testing revealed a low DLCo, but the FEV₁ was normal.
Summer-type HP was diagnosed because of a positive test for serum antibody to Trichosporon mucoides (TIMM1573), a positive result on an antigen challenge test, and because pathological examination of specimens obtained by transbronchial lung biopsy showed severe infiltration of lymphocytes. After admission, her serum: IgE levels gradually improved along with the symptoms and the PaO₂. A skin test for the causative antigen was done to study the early immunological reaction, and a positive result (22mm×24mm) was obtained for T. mucoides (TIMM1573) in only 15 minutes. We could not elicit any history of atopy that may have been associated with the high serum IgE level and the positive skin test. Therefore, we suspect that this patient had an early immunologic reaction (Type I allergy) to T. mucoides, and that Type I allergy is involved in the development of HP.

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