To study the dynamic interaction between blood cells and endothelial cells in the pulmonary microcirculation, we developed a method for observing leukocytes and erythrocytes in the microcirculation of perfused rat lungs by confocal laser scanning microscopy. We examined the behavior of leukocytes in the microcirculation of rat lungs exposed to hyperoxia, because oxygen toxicity is known to be associated with leukocyte infiltration and endothelial cell damage. Rats were divided into two groups: control (21%O₂) and hyperoxia (90%O₂ for 48 hours). Lungs were perfused with Krebs-Henseleit solution equilibrated with 21%O₂ and 5%CO₂ through an artificial lung. Leukocytes stained with carboxyfluorescein diacetate succinimidyl ester and erythrocytes stained with fluorescein isothiocyanate were added to the perfusate, and images of the cells were observed and recorded with a confocal laser scanning microscope and a high-speed video camera. The mean velocities of erythrocytes (Vr) in arterioles, capillaries, and venules of the control group were 1.52, 0.50, and 1.61mm/sec, respectively. Also in the control group, the velocities of the leukocytes were divided by the mean velocities of the erythrocytes in the same arterioles, capillaries, and venules (Vw/Vr) and the results were 0.96, 0.97, and 0.98, respectively. The Vw/Vr values for arterioles in the hyperoxia group were not significantly different from those in the control group, but the Vw/Vr values for capillaries and venules were 27% and 37% lower than their respective control values. Leukocyte sequestration was seen mainly in capillaries in the hyperoxic group. These results suggest that an increase in adhesion in capillaries and venules, such as that caused by adhesion molecules, might play a key role in the behavior of leukocytes in the pulmomary microcirculation during hyperoxia.

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We developed a system for 24-hour ambulatory recording of blood oxygenation (SpO₂) and electrocardiography (ECG). Using this system, we studied 10 healthy volunteers and 7 patients with chronic pulmonary diseases. The system incorporated a portable pulse oximeter (SM50) manufactured by Fukuda Denshi KK; the first and second channels were used to record ECG data and the third was used to record SpO₂ data. An SpO₂ sensor (Dispo-sensor D-25; Nellcor Inc.) was applied to the fourth or fifth finger. The SpO₂ data (MicrO₂; Siemens AG) were digitized and stored in the ambulatory recording device; the ECG was recorded simultaneously. The data were analyzed with a model DMW-9000H analyzer (Fukuda Denshi KK). A custom-designed program was also used, to remove noise errors. In the healty volunteers, SpO₂ was at least 90% for the entire 24 hours. In all the patients, SpO₂ fell below 90% at rest during the night or after a 15-minute walk. Transient atrial tachycardia was observed in 3 patients, and during the tachycardia the SpO₂ was low. The number of extra ventricular beats divided by the total number of beats increased more in the patients than in the healthy volunteers (1.21±0.89 vs 0.6±0.3%, p<0.05). SpO₂ did not change significantly in the patients.
In outpatients and in patients receiving home health care, the present system facilitates simultaneous diagnosis of respiratory failure and arrhythmias. In patients with chronic pulmonary diseases desaturation may cause transient atrial tachycardia.

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We measured the levels of carcinoembryonic antigen (CEA) and the concentrations of neutrophils in serum from healthy smokers. The smokers (n=1396) had more leukocytes, neutrophils, and lymphocytes than did non-smokers (n=1123) (leukocytes: 5853±1627/mm³ vs 4564±1118/mm³, p<0.0001; neutrophils: 3533±1280/mm³ vs 2718±883/mm³, p<0.0001; lymphocytes: 1843±502/mm³ vs 1513±406/mm³, p<0.0001). Subjects in whom the levels of CEA was greater than 5.0ng/ml had significantly higher concentrations of leukocytes, neutrophils and lymphocytes than did those in whom it was 5.0ng/ml or less (p<0.0001). Weak correlations were found between serum CEA levels and both the duration of smoking and the Brinkman index. The CEA levels also correlated with daily cigarette consumption (ρ=0.53, p<0.0001). The concentration of neutrophils in subjects who smoked no more than 20 cigarettes per day or had a CEA level greater than 5.0ng/ml, or both, was higher than that in subjects who smoked more than 20 cigarettes per day or had a CEA level less than or equal to 5.0ng/ml, or both (4097±1325/mm³ vs 3791±1278/mm³, p<0.05). These results suggest that in healthy smokers, high serum CEA levels are related to high neutrophil levels.

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Monocrotaline (MCT) causes lung inflammation and chronic pulmonary hypertension associated with lung vascular thickening in rats. We hypothesized that leukotrine B₄ (LTB₄) and LTB₄-induced accumulation of leukocytes in the lung play a role in MCT-induced lung disease, and therefore measured LTB₄ and myeloperoxidase (MPO) levels in lung tissue of MCT-treated rats. Next, we examined the effect of an orally active LTB₄ receptor antagonist (ONO4057) on MPO levels in lung tissue, on pulmonary hypertension, and on pulmonary vascular remodeling induced by MCT. Lung LTB₄ and MPO levels had increased by 3 days after MCT injection. In the ONO4057-treated MCT rats, lung MPO levels were significantly lower than in the rats given MCT but not ONO4057. By the third week after injection, MCT had caused increases in mean pulmonary arterial pressure, in the ratio of right ventricular weight to left ventricle+septum weight (RV/[VS+S]), and in media wall thickness of the muscular arteries of the lung. Treatment with ONO4057, either for 3 weeks or during the first week after MCT injection, significantly reduced pulmonary hypertension, right ventricular hypertrophy, and lung vascular thickening induced by MCT.
These results indicate that ONO4057 reduces both the accumulation of leukocytes in lung tissue and the chronic pulmonary hypertension induced by MCT, and they suggest a role for LTB₄ in the inflammatory process that contributes to pulmonary hypertension and lung vascular remodeling induced by MCT in rats.

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To study changes in Na⁺ and fluid transport that occur soon after irradiation of the thorax, we used fluid-filled isolated rat lungs. Irradiation 15Gy of ⁶⁰Co doubled the fluid absorption rate across the alveolar epithelium within 2 weeks, but fluid absorption had returned to the baseline values by 3 weeks after irradiation. The timing of this change in fluid absorption was parallel to the time course of Na⁺ escape across alveolar epithelium and the two correlated closely. These data suggest that a dysfunction of alveolar epithelial Na⁺ transport is involved in the development of pulmonary edema after irradiation of the thorax.

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We studied the effect of heparin on the inositol 1, 4, 5-triphosphate (IP₃)-dependent increase in intracellular calcium (Ca²⁺) caused by ATP. The Ca²⁺ concentration ([Ca²⁺]_i) in cultured epithelial cells from cow tracheas was measured by the fura-2 method. ATP (10^-4M) stimulated IP₃ production and caused a biphasic increase in [Ca²⁺]_i: a transient response and a subsequent sustained response. Heparin (1-100U/ml) dose-dependently inhibited the ATP-induced increase in [Ca²⁺]_i, but had no effect on IP₃ production. Dextran sulfate, a polysaccharide with negative charge density, had a similar inhibitory effect on the ATP-induced increase in [Ca²⁺]_i. These data suggest that heparin inhibits intracellular Ca²⁺ mobilization by acting at a site “distal to” IP₃ production, and that the mechanism of action of heparin may be related to its negative charge.

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A 55-year-old man was admitted to our hospital because of an abnormal shadow at the right hilum on a chest radiograph. The chest radiograph and the chest CT scan showed a nodular shadow in the right S⁶. There was no air-crescent sign in the shadow, but CT-guided percutaneous needle biopsy led to the diagnosis of pulmonary aspergillosis. Anti-fungal agents (miconazole, fluconazole, and itraconazole) were given but the patient's condition did not improve. Surgical resection was done and the postoperative course was uneventful. The resected lung had a bronchiectatic area with a fungus ball. Attempts to culture the fungus ball were not successful. Histologic examination revealed conidial heads characteristic of Aspergillus fumigatus. This case is interesting because the pulmonary aspergilloma appeared as an isolated nodular shadow. This might have been a case of primary pulmonary aspergilloma.

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A 31-year-old woman was admitted to our hospital because of dyspnea on exertion. She had had the same symptom a few years earlier.
A chest radiograph revealed ground-glass-like shadows on both sides, and the arterial PaO₂ was 54 Torr when the patient was breathing room air. We first suspected hypersensitivity pneumonitis, but the dyspnea and hypoxemia did not resolve during treatment in the hospital, and returned home. She felt no obvious changes in symptoms while at home. We found no antibodies to Tricosporon cutaneum in her serum. Computed tomography of the chest revealed diffuse pan-lobular areas of high density. Bronchoalveolar lavage was done and the total cell count was 9.6×10⁷. About three quarters (73%) of the recovered cells were lymphocytes.
Examination of a transbronchial biopsy specimen showed alveolar thickening with infiltration of small mononuclear cells. No granulomas or Massons' bodies were seen, and no antibodies specific to collagen-vascular disease were detected. We therefore excluded the diagnosis of hypersensitivity pneumonitis, idiopathic interstitial pmeumonia and collagen-associated pneumonitis. There was no evidence of drug-induced pneumonitis. She was seropositive for HTLV-I. We suspected that this was a case of HTLV-I-associated pneumonitis.

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A 63-year-old stoneworker complained of fever and a productive cough. His chest roentgenogram showed a nodular mass and a diffuse interstitial shadow in the right lung. Angiography of the pulmonary artery revealed obstruction of the right upper trunk. Open-lung biopsy was done. Histologic examination showed mixed-dust pneumoconiosis with a massive focus of mixed-dust fibrosis with silicotic nodules, and diffuse interstitial fibrosis of pattern with lymphoid infiltration. Chemical analysis revealed a high content of aluminum in lymph node, which was thought to be due to inhalation of alumina used for lettering stones. The unilateral interstitial pneumonia was thought to have developed due to deposition of free silica and aluminum dust. Although this patient had been given a diagnosis of rheumatoid arthritis and the value of rheumatoid factor was high, the interstitial pneumonia was not believed to be associated with the collagen vascular disease.

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A 53-year-old woman was admitted because of dyspnea and coughing of about 8 months duration. On examination she had left pleural effusion and ascites. The serum CA125 level was high (1150U/ml) but gynecological examinations were negative. Radiological and ultrasonic studies revealed bilateral pleural effusions and ascites. Cytological and bacteriological studies of the pleural effusions and ascites were all negative. The pleural fluid was exudate with high lymphocyte counts and elevated ADA (87.4IU/l) and CA125 (1800U/ml). Tuberculous pleuritis was diagnosed based on the findings of sputum culture and of pleural biopsy. The latter revealed epithelioid cell granulomas and giant cells. Cells in both pleural effusion and ascites were stained with antibodies to CA125. Antituberculois chemotherapy was started and the patient responded well. Both pleural effusions and ascites decreased; the level of CA125 also decreased to the normal range in about two months.

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Bronchogenic cysts are common cystic lesions in the mediastinum. Most are located in the middle or posterior ares of the mediastinum, especially around the carina.
We encountered a patient with a mass in the superior and anterior areas of the mediastinum, where bronchogenic cysts are not usually found. The mass was, there-fore, thought to be a thymic cyst.
The cyst was located just behind the sternum and in front of the left brachio-cephalic vein, and was 5.5×3.5×1.2cm. It originated in the upper and median part of the thymus, and was not attached to the respiratory tract.
Histological examination showed ciliacted epithelium and a layer of smooth muscle in the wall of the cyst.
The cyst contained viscid, yellowish, turbid fluid. Preoperative computed tomography and magnetic resonance imaging showed findings characteristic of bronchogenic cysts, except for the location.
We know of no previous reported case of a thymic cyst resembling a bronchogenic cyst.

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A 54-year-old man felt pain on the right side of his chest. Two months later, paraplegia developed. A chest CT scan revealed a pleural effusion and a mass lesion along the right parietal pleura. The lesion extended directly into the adjacent part of the spinal canal and compressed the spinal cord. Cytologic examination of the pleural effusion revealed atypical lymphoid cells, and examination of a transcutaneous biopsy specimen showed monotonous atypical B lymphocytes. The diagnosis was pleural malignant lymphoma. Chemotherapy induced a partial remission, but 14 months after the first examination he died of central nervous system involvement. Pleural lymphoma can directly compress the spinal cord and cause paraplegia. Early diagnosis and therapy greatly affect the outcome in patients with spinal cord compression.

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A 70-year-old man was given a diagnosis of small cell lung cancer because of the findings of examination of a specimen obtained by transbronchial lung biopsy from the rS⁴ a. He was treated with 2 courses of neoadjuvant chemotherapy (CBDCA, Etoposide) and underwent right middle lobectomy. He was then given 3 courses of adjuvant chemotherapy (CBDCA, Etoposide) as an inpatient and recieved oral etoposide (50mg/day) as an outpatient. He was then admitted to our hospital because of dyspnea and fever. A chest-X ray film showed reticulonodular shadows in both lung fields and blood gas analysis showed marked hypoxemia. A differential cell count of bronchoalveolar lavage fluid showed a high level of lymphocytes; and examination of a specimen obtained by transbronchial lung biopsy revealed edema of the alveolar walls, lymphocyte infiltration, and marked proliferation of type II alveolar epithelial cells. Administration of etoposide was stopped and steroid therapy was given. The symptoms, hypoxemia, and bilateral reticulonodular shadows resolved. The clinical course along with the findings from examination of bronchoalveolar lavage fluid and of the biopsy specimen, suggest that this patient had drug pneumonitis caused by oral etoposide.

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A 71-year-old man was admitted to our hospital for evaluation of a solitary pulmonary nodule in the left lower lung field.
He had been treated for Parkinson's disease for two years, and had no respiratory symptoms on admision. No abnormal findings were detected in laboratory tests on admission, and Mantoux's skin test was negative. A postero-anterior chest roentgenogram, a conventional tomogram, and a computed tomogram showed that the nodule was located in the left anterior basal segment (S⁸). The nodule was not calcified, the contour was clear but irregular, and pleural indentation could be seen, so the nodule was strongly suspected to be a primary malignant lung tumor.
Because two attempts at transbronchial lung biopy and bronchial brushing and washing were of no diagnostic value, a thoracotomy was done. The lesion was found in the subpleural region of the left S⁸ with pleural iudentetion, and it was partially resected. The nodule was elastic, soft, and filled with suppurative fluid. Histopathologic examination of the nodule revealed epithelioid cell granuloma. A smear test of the fluid was negative but a culture was positive for mycobacteria, which were identified as Mycobacterium kansasii. Rifampicin and isoniazid were administrated to the patient for 1 year. Two years after the operation, the patient was asymptomatic.

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A 52-year-old man was admitted to our hospital with chief complaints of fever, general fatigue, and weight loss. A chest roentgenogram showed hyperinflation and many small nodular shadows in both lung fields. A chest CT scan showed centrilobular shadows distributed equally over all lung fields. Examination of a transbronchial lung biopsy specimen revealed a small non-caseating granuloma composed of a giant cell of Langhans type, epithelioid cells, and a few lymphocytes. There was a dark red eruption about 1cm in diameter on the right forearm, which had been present for a few years, to the best of the patient' s memory. Examination of a skin biopsy specimen revealed many non-caseating granulomas composed of epithelioid cells. Uveitis developed about 2 months after admission. Our diagnosis was sarcoidosis. Steroid therapy was started. The patient's symptoms rapidly disappeared and a chest roentgenogram showed remarkable improvement. We believe this was a very peculiar case of Sarcoidosis: the patient had systemic symptoms only, and roentgenographic examinations showed hyperinflation and centrilobular shadows distributed over all lung fields.

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A 77-year-old man with hemoptysis was admitted to our hospital. A coin lesion in the right middle lung field was observed on a chest X-ray film. Enhanced CT scans of the chest showed the coin lesion with clear ring enhancement. Ring-enhanced mass shadow in cases of pulmonary diseases are very rare. The level of anti-aspergillus antibody in serum was high and the patient was given the diagnosis of aspergillosis. An upper lobectomy was done and aspergillus organisms were found.

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Cutaneous Kaposi's sarcoma (KS) is a well-kown manifestation of the acquired immunodeficiency syndrome, but pulmonary KS is very rare in Japan. We encountered a 27-year-old Japanese homosexual man who had extensive pulmonary KS. He came to our hospital because of a cough and dyspnea. On admission, there were some small nodules on the skin, and examination of a biopsy specimen led to the diagnosis of KS. The test for the human immunodeficiency virus antibody was positive and the CD₄⁺ cell count was 69 per cubic millimeter. A radiograph of the chest showed multiple diffuse nodules, linear opacities, and some pleural effusion. Computed tomography also revealed multiple nodules and linear densities distributed along the bronchovascular bundles. Bronchoscopic examination revealed diffuse erythematous changes of the bronchial mucosa with some red polypoid lesions, which was compatible with endobronchial KS. Hypoxia developed one month after bronchoscopy. Two courses of chemotherapy with bleomycin and vincristine were given, and resulted in temporary improvement. A definite diagnosis of KS was made by necropsy.

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A 62-year-old woman was admitted to the hospital because of dyspnea. A chest X-ray film showed a massive left pleural effusion. Thoracentesis was done and purulent fluid was found. Streptococcus intermedius was detected in the fluid. Chest drainage and administration of antibiotics were successful, but computed tomography of the chest revealed a mass in the left main bronchus. The mass was removed with transbronchial electrosurgical snaring forceps and was found to be a lipoma. This tumor had low CT numbers (from -70HU to -140HU), and this finding may be useful in the differential diagnosis of endobronchial tumors.

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A 60-year-old man was admitted to the hospital with anterior chest discomfort and superior vena cava syndrome. A chest X-ray film revealed a right upper mediastinal mass. A needle biopsy was done. Anaplastic tumor cells was found after HE staining. No melanin was found and the origin of the tumor cells could not be determined. Radiation and chemotherapy caused the tumor to shrink markedly. Because the tumor had invaded the superior vena cava, only reduction surgery could be done. The patient died 6 months after admission. Amelanotic malignant melanoma was diagnosed after immunohistochemical study of the resected specimen. Mediastinal malignant melanoma has been reported very infrequently and to our knowledge this is the first report of mediastinal amelanotic malignant melanoma.

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We report a case of intrapulmonary hematoma in which magnetic resonance imaging was useful in establishing the diagnosis. A 53-year-old man had bronchial asthma that was well controlled with inhaled beclomethasone dipropionate and salbutamol, and with oral theophylline. A spherical mass was found in the right lower lung field on a chest radiograph taken during a regular physical examination. A CT scan showed a well-circumscribed spherical mass, which was attached to an intrapulmonary bullae. Magnetic resonance imaging showed a well-circumscribed mass in the superior segment of the right lower lobe. On a T1-weighted image the mass was hyperintense and had a higher-intensity rim. On a T2-weighted image the mass was hyperintense and had some hypointense areas. We therefore diagnosed intrapulmonary hematoma. Chest radiography 6 months later revealed a substantial decrease in the size of the mass, which supported the diagnosis. As in this case, intrapulmonary hematoma can be difficult to diagnose because of the lack of a history of injury and because of the slow regression. In this case, magnetic resonance imaging was useful in making the diagnosis.

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An 18-year-old man had bronchial asthma and a pneumomediastinum. A computed tomographic scan of the chest revealed the pneumomediastinum, intrapulmonary laceration of the S¹b, and a small amount of air in the perivascular space from V¹a to V¹. Increased pressure in intrapulmonary airways may have resulted in ruptured S¹b alveoli and air leakage into the interstitium between the surrounding secondary lobules. The air may have moved along the perivascular space (pulmonary vein) toward the hilum, and eventually into the mediastinum.
We know of no previous report of pneumomediastinum in which images of intrapulmonary lesions are presented. In this case compated tomography revealed the mechanism by which the pneumomediastinum probably developed.

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