In one hundred twenty-seven patients with chronic obstructive lung diseases (chronic pulmonary emphysema 34 cases, bronchial asthma 58, and chronic bronchitis 35 cases) were twelve cases chosen who developed heart failure during observation. Values of Spirography, measurements of arterial gases and pH, and E. C. G. findings of them were compared before and after the episode.
1) The appearence of heart failure depended upon respiratory functions, especially upon changes in blood gases affected by the disturbance of gas exchange.
Arterial oxygen tensions measured were below 70mmHg in all the twelve cases and in sixty-seven per cent of them were below 50mmHg. Arterial carbon dioxide tensions were over 60mmHg in thirty-three per cent of the twelve and in eleven of them were over 50mmHg. They tended to return to normal values as symptomes disappeared.
2) In thirty-eight patients were abnormal E. C. G. observed and ST-T changes were seen in seventy-four per cent of them. These findings were thought as the relative coronary insufficiency caused by the disorder of oxygen demand and supply of the heart due to hypoxemia.
In order to clarify this cause were succeeded following experiments using adult healthy dogs confined within body respirator. Under the condition of controlled respiration dogs breathed 7% oxygen mixed gas, and coronary blood flow was observed after the hyper-ventilation was eliminated.
Results were as follows, that the measured coronary blood flow was far below the ones calculated from parameters of Rein and Balke under 70% arterial oxygen saturation, and E. C. G. showed ST depression and/or arrhythmia.
3) Normal men were confined within the hypobaric pressure chamber from 3 to 6 hours.
Activities of intelligence were disturbed as arterial oxygen tensions were below 59mmHg, and near 40mmHg, the sense of differentiation was disturbed, slow waves appeared in E. E. G. and cheyne-stokes respiration was seen. Findings of coronary insufficiency and arrhythmia in E. C. G. were observed as arterial oxygen tensions were below 40mmHg.
4) T-flattnesses and ST-depressions in E. C. G. were often observed in patients with chronic lung diseases as arterial oxygen tensions were below 70mmHg.
In some cases these findings were seen on exercise test only. These cases were considered as the latent failure of cardiac functions. These abnormal E. C. G. findings with right axis deviations and the right ventricular hypertrophy were often seen under 55mmHg of Pao₂. Most cases showed improvement as hypoxemia diminished.
5) It should always be noted that hypercapnia was preceded by hypoxemia. Therefore, patients with long continuing hypercapnia had been affected by pulmonary hypertension, right ventricular hypertrophy and disturbed cardiac function due to hypoxemia. On the other hand, it should be considered that hypercapnia itself affected metabolism of the heart and decreased sensitibity of the cardio-vascular center.
Symptomes of cardiac failure were discussed as they shortened prognosis of chronic lung diseases.
In many cases the symptomes diminished by treatment, but a few cases died of heart failure.
In some cases of chronic lung diseases values of blood gases worsened against various treatments. These cases were thought that their peripheral alveolo-bronchiolar systems were in process of destruction, therefore even hyper-ventilation could not improve the disturbed blood gases and chronic hypoxemia continued.
Moreover on acute cardio-pulmonary risks, controlls of the ventilation and the circulation were limited and many functions of important organs were impaired, then the patient would result in death. But, if infections would be protected, sputum expectorated, and airway spasm diminished, signs of cardiac failure and pulmonary encephalopathia would not appear, and the prognosis could be prolonged.

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The effect of vagotomy or sympathectomy on the responses of bronchial vasculature to adrenaline, acetylcholine and isoproterenol were studied quantitatively in anesthetized, thoracotomized dogs.
The bronchial arteries were separated from the systemic circulation and were perfused. with constant pressure head. The flow through bronchial arteries was measured with electromagnetic flowmeter and pressures in pulmonary artery, left atrium and femoral artery were recorded simultaneously with electromanometer and recorders.
The flow in the bronchial arteries decreased markedly after the administration of small dosis of adrenaline into the bronchial arteries and increased after the injection of acetylcholine and isoproterenol, without changes in the pulmonary vascular pressure.
The degree of these responses markedly decreased after bilateral vagotomy, while no changes were found after bilateral sympathectomy. These results might suggest the presence of bronchial vascular tone in anesthetized dogs, and indicated that it is mediated by the autonomic nervous system.

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Surface activity of alveolar lining layer has been investigated with modified Wilhelmy balance which is getting popular, but there were only a few papers regarding the fundamental problems.
In this studies we investigated the influences of rate of compression-expansion cycle, blood, and the concentration of lung extract on surface activity.
Maximal surface tension increased as the rate of compression-expansion cycles increased which was sinusoidal. The mean of γ max was 57.6 and 39.8dynes/cm at the rate of 1min. per cycle and of 10min, per cycle respectively. However, γmin was not influenced by change in the rate of cycling.
There were no significant differences in γ max, γmin, and S among three lung extracts; bronchial washing, the lung extract produced by mincing lung tissue, and lung extract produced by mincing blood-free lung tissue. The mixing of 10cc of blood with the lung extract made from 2g of lung tissue in 20cc of saline increased γmin in 5 out of 15 extracts. These five extracts were surface-active (γmin<15dynes/cm) in the concention of 2g of lung tissue in 30cc of saline, but inactive (γmin>15dynes/cm) in the concentration of 1g of lung tissue in 30cc of saline.
γmin of all 12 extracts were less than 15dynes/cm in the concentration of 2g or 3g of lung tissue in 30cc of saline, but γmin showed more than 15dynes/cm in 5 out of the 12 extracts in the concentration of 1g of lung tissue in 30cc of saline and in 10 out of them in the concentration of 0.5g of lung tissue in 30cc of saline.
The relationship between γmin and stability ratio (SR) measured by Pattle's method was investigated in normal rabbit lung and the lung with ligated pulmonary vein. The lung with γmin less than 15dynes/cm had SR more than 0.7 and the value of SR decreased and reached to nearly O as the γmin increased.

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We have shown the decrease in surface activity in pathological change of the lung; chronic simple atelectasis, and pneumonia.
Recently it has shown that the production of surfactant in alveolar cells was dependent on the blood flow in the lungs whether it was pulmonary or bronchial circulation.
In the present studies the change in surface activity was investigated after pulmonary vein ligation in rabbits. The lungs showed liver-like appearance 48 hours after pulmonary vein ligation and the value of stability ratio (SR) decreased with the average of 0.36±0.21. The mean values of γmin and S measured with surface balance were 21.3±3.0dynes/cm and 0.77±0.17 respectively. Hystersis loop on surface tension-area diagram was very narrow. There was no significant change in SR of the lung after sham operation, and 48 hours after autogenous blood was injected into the normal lung through trachea, nor 1 hour after the injection of blood into the subpleural lung tissue.
The values of SR of the 5 rabbits sacrificed longer than 35 days following pulmonary vein ligation returned to the control and the lobe with ligated pulmonary vein was inflated and showed no atelectasis except pleural adhesion.
These results indicate that the circulatory disturbance induced by ligation of pulmonary vein produces the decrease in surface activity and this change returns to the normal following collateral circulation may develop.

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Pulmonary involevment in rheumatoid arthritis (R. A.) is known to occur at times, though informations concerning the patho-physiology is rather scarce inspite of many clinical and pathologic reports of this entity.
The purpose of this report is to describe the pulmonary function in 31 cases of R. A. met the criteria of American Rheumatism Association after eliminating Possible R. A. cases.
A group with roentogenologic pulmonary fibrosis (fibrosis+) belongs to the combined type of restrictive and obstructive disturbance by spirography and another group with pulmonary fibrosis suspected (fibrosis+) is the restrictive type by the same manner. Slight decrease of the vital capacity is observed in older age of over 60 but no definite pattern is found by the duration of disease.
As for the classification of R. A. progression by Steinbrocker, the group III and IV are slightly restrictive.
Abnormal gas distribution is found in all cases of fibrosis (+) but in about one third of cases of both fibrosis (±) and fibrosis (-).
Severity of disturbance of D_Lco is in the order of fibrosis (+), fibrosis (±), and fibrosis (-).
The order of disturbance by D_Mco and fibrosis comes out same as above.
Correlation between % D_Lco, predicted values by Ogilvie and ages is found to be r=-0.74.
Similary, the value between D_Mco and fibrosis is r=-0.86.
As for blood gas analysis, hypoxemia is found in fibrosis (+), older age group of more than 40 and stage III and IV combined.
Respiratory alkalosis is observed in the group of fibrosis (+), of over 50 years of age and of cases with the disease more than 5 years.
Mean value of A-aD_O2 in fibrosis (+) is 21.7mmHg and higher than other groups. A-aD_O2 and Qs/Qt in 100% oxygen inhalation are calculated in order to estimate anatomical shunt in the A-aD_O2 while breathing room air, however no signficant increase is observed in anatomical shunt of fibrosis (+).
The increase of A-aD_O2 with fibrosis (+) depends on the decrease of Pa_O2 and the reverse correlation between A-aD_O2 in the same entity and DLco, DMco is observed.
That is to say the increase of A-aD_O2 against the decrease of Pa_O2 and of DLco, above all disturbance of DMco seems to play critical roles in the pathology of pulmonary function.

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A case of idiopathic pulmonary artery dilatation is presented. A 72 year old male was referred for evaluation of a cardiac murmur and hilar abnormal shadow on the routine chest X-ray film. At the admission on Jan. 14. 1967, there was no complaint and no history of cyanosis, rheumatic fever, tuberculosis or syphilis. Otherwise the family history was not contributory.
On physical examination, the patient was found to be normal. Blood pressure was 140/80mmHg in both arms. The cardiac rate was 60 per minute, and the rhythm was regular. Respiration was normal. There was no edema. Pertinent physical findings were confined almost entirely to the heart. The point of maximum impulse was in the 3rd intercostal space of the left sternal border, and there were no thirills. There was respiratory splitting of the second component of which was moderately accentuated.
Analysis of peripheral blood, urine, feces, blood chemistry and serologic test for syphilis were all within normal limits. Pulmonary function test were within normal limits and electro-cardiogram showed incomplete right bundle branch block. Chest X-ray film and pulmonary arteriography revealed a prominent main pulmonary artery dilatation without evidence of enlargement of the cardiac chambers. Right heart catheterization revealed normal pressure for both pulmonary artery and right ventricle in spite of a pulmonary artery dilatation, and gave normal oxygen saturation.

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A case of bronchogenic cyst of the mediastinum which was detected in a 20-year-old male incidentally received the chest examination. On the frontal chest x-ray photography, it was seen as a homogenous, sharply defined shadow of semicircular form (7cm×4cm) in the upper field of the right lung which being prominent from the mediastinum. The radiological examination of the oesophagus and the angiography of the superior vena cava disclosed the compressed figure of the oesophagus and the superior vena cava by the cyst. The patient has none of complaints as well as physical signs. No changes of laboratory findings were detected. Movement and deformation of the shadow by swallowing and respiration were not distinct. However, by the artificial pneumothorax, the shadow of the cyst shifted down and changed the configuration. Thoracoscopic examination disclosed the balloon-like tumor, and it was elastically pushed in by a probe. From these data, the tumor was clinically diagnosed as the benign cyst of the mediastinum and subjected to the surgical removal. Fluid of the removed cyst was mucous, and many of the ciliated cells of the bronchial mucosa were detected by the microscopic observation. It was also diagnosed as the benign bronchogenic cyst by the histological study.

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