Arterial blood gas analysis in pulmonary tuberculosis often reveals hxpoxemia in varying degrees. And this hypoxemia is presumed to be largely due to the complicated disturbance of ventilation and perfusion, and the abnormality of their ratio in and around the tuberculosis lesions.
In this study the pulmonary function tests, including ventilation, measurement of lung volumes, arterial blood gas analysis during breathing air and nearly pure oxygen and diffusing capacity, were carried out in 77 patients with pulmonary tuberculosis.
Roentgenologic extent of the disease (small, medium, and large for Gakken), age and roentgenologic changes before and after chemotherapy are the subjects of analysis here in order to investigate the contribution of anatomical shunt as a causative factor for hypoxemia in this disease. The study revealed that the type of ventilatory disturbance was marked restrictive one in the group with large lesion, RV/TLC was increased according to the extent of the disease, Pa_o2 was decreased in the group with large lesion during air and O₂ breathing, A-aD_o2 and Q_s/Q_t were increased according to the extent of the disease during air and O₂ breating and diffusing capacity was abnormally low in the group with large lesion. In addition to the above, the decreasing of Pa_o2 during air breathing and the increasing of A-aD_o2 during air and O₂ breathing were correrative, and it was estimated that about 40-45% of A-aD_o2 during air breathing is attributable to venous admixture via anatomical shunt which is proportional to A-aD_o2 during breathing O₂, in all groups of extent of the disease.
Venous admixture during O₂ breathing decreased in all cases which showed any roentogenologic improvement after chemotherapy.

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Goodpasture's syndrome in association with silicosis in a 36-year-old male foundry worker was presented.
Three months after the development of initial symptoms including fever, anaemia, purpura, polyarthralgia, shortness of breath and Raynaud's phenomenon in winter, the patient was hospitalized.
Silicosis, mild renal insufficiency and iron deficiency anaemia were found. Renal biopsy revealed focal embolic glomerulonephritis. Rumpel-Leede test was positive, ESR increased and CRP strongly positive; hypergammaglobulinaemia and strongly positive RA reactions were noticed.
After admission, renal insufficiency and anaemia progressed rapidly with development of generalised oedema, retinal bleeding and eruptions resembling multiple exudative erythema. Corticosteroid administration and blood transfusion induced a remission lasting for 5 months.
Ten months after the onset of symptoms, he died following sudden aggravation of dyspnoea with haemoptysis. Autopsy revealed, in addition to silicosis, diffuse haemorrhage of the lungs and diffuse subacute glomerulonephritis, compatible with Goodpasture's syndrome.
Silicosis probably bears a causal relationship to Goodpasture's syndrome in this case through an autoimmune mechanism. Another case of Goodpasture's syndrome associated with silicosis is found in the literature (Burilkov, T. et al.).
The initial symptoms suggest the possibility of intrapulmonary bleeding occurring long before the onset of clinical manifestations, although haemoptysis was a terminal event.
The skin rash seen in this case had already been described in Osler's cases preceding Goodpasture's original report.
Concerning the remission from advanced renal failure, Munro, J. B. et al. reported a similar result.
The present case seems to suggest that oedema, retinal bleeding, purpura and eruptions resembling multiple exudative erythema are indications of poor prognosis.
It is the 10th case of Goodpasture's syndrome reported in Japan and the 6th autopsy-confirmed case in the literature.

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It will be not easy to treat the patients who suffered from severe infectious lung diseases, such as acute severe pneumonia, lung gangraen, lung sbscess; and the old agged patients suffering from lung infections; and the petients who complicated with lung infections and some very severe other diseases, such as lung cancer, other malignant diseases, severe heart diseases, etc. It will be sometimes very difficult to examine the sensitivities of the original microbens against antibiotics, and in cases, it will not be always rapidly effective by the treatments with some sensitive antibiotics against the original microbens in sputum.
In such instances we have treated the patients by the dripping infusion therapy with five grams of Viccillin resolved in 5% Glucose 300ml or with one shot injection of two grams of Viccillin in bronchial artery with good results, but without any side effects.

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It is well known that the surfactant system of the lung plays an important role in respiratory mechanics and its essential surfactant is phospholipids, particularly dipalmitoyllecithin. However, there are a few papers on the alteration of the surfactant under various pathological conditions. The purpose of this study is to investigate the effects of pulmonary circulatory and ventilatory disturbances on the surfactant system of the dog lung, especially on phospholipid.
Thirty-five dogs were divided into four groups; in the first group consisting of fifteen dogs the pulmonary vein was ligated, in the second of four dogs pulmonary artery was ligated, in the third of four dogs both pulmonary artery and vein were ligated, in the fourth of ten dogs bronchus was tied up at the hilum of left upper lobe. They were sacrificed in between 8 hours and 60 days after ligation. Lipid extraction and purification from the lung tissue was done by the Folch's method and total lipid content was determined gravimetrically. The individual phospholipids were identified and separated by thin layer chromatography, and phosphorus was assayed colorimetrically.
The fatty acid compositions of phosphatidylcholine were determined by gaschromatography. Surface tension was measured by a modified Wilhelmy surface balance. Histological studies of the lung tissues were carried out by hematoxylin-eosin staining.
Principal results obtained are as follows:
1) The mean contents of total lipid, phospholipid and phosphatidylcholine in lung tissues of thirty-five normal dogs are 151, 101 and 57mg/g dry tissue, respectively. Palmitate of phosphatidylcholine-fatty acid (PCFA) comprised 47% of the total. The average of γmin is 8.8 dynes/cm, and that of S1.38, indicating surface active.
2) Pulmonary vein ligation induces congestive atelectasis. Total lipid, phospholipid, and phosphatidylcholine contents are found decreased remarkably from 8 to 96 hours after the ligation, but almost recovered after 30 to 60 days. C_16-0 of PCFA reduces slightly from 24 to 96 hours after the ligation. Surface activity is not demonstrated after 24 to 96 hours of ligation, and returns to normal 30 days after ligation.
3) Pulmonary artery ligation and pulmonary artery-and-vein ligation causes almost similar changes, but the decrease of C_16-0 of PCFA is prominent at 96 hours after the ligation. In dogs with pulmonary artery-and-vein ligation, surface activity dose not recover in 30 days and the fractional content of each lipid shows decrement. They are considered to show the delay of recovery.
4) In the group of bronchus ligation, total lipid, phospholipid and phosphatidylcholine contents reduce approximately 75% of those of non-ligated lobes and surface activity is decreased 96 hours after the ligation. Although lipid content returns to about 90% of that of normal lungs 30 days after the ligation, surface activity dose not recover in four out of five animals.
5) Two additional sampling methods for the surfactant are comparatively evaluated with that described above. They are bronchial lavage with saline and saline extract from minced lung tissue. After lyophilization of each sample, lipids are extracted with chloroform-methanol. All of these three methods are discussed on their characteristics and are confirmed to be useful for the lung surfactant analysis.
These results indicate that the pulmonary blood flow is essential for the maintenance of lung surfactant system.

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I. Purpose of investigation
In order to elucidate the dynamic aspect of the mucosa of the respiratory tract, its electric resistance was determined on cases with various tracheo-bronchial and pulmonary diseases applying the phenomenon of the galvanic skin reflex which has been already well documented. (The mucosal resistances for the trachea and the main bronchus are to be abbreviated as TER and BER respectively)
II. Method
The subjects consisted of 81 clinical cases with various respiratory and other diseases and 276 dogs experimented upon. Measurements were carried out as follows: in clinical cases, an electrode was attached to the membrane-like part of the trachea and the main bronchi of the both sides with the aid of a bronchoscope under local anesthesia, on the animals, the same procedure was performed under intravenous anesthesia with sodium pentobarbital. Electric resistance of the mucosa was measured under several conditions with a view to clarifying the mechanism for this phenomenon.
III. Results
1) In normal man, TER was 11.0±1.14KΩ, right BER 11.2±0.90KΩ and left BER 11.7±1.56KΩ. There was no significant difference in the values among the sites measured on.
In the normal dog, the values were lower than those for man, TER being 8.2±0.93KΩ, right BER 6.4±0.88KΩ, and left BER 6.8±0.79KΩ. It was found that TER was higher than BER and that BER tended to be higher on the left side.
2) In respiratory diseases such as bronchitis and bronchiectasis, the resistance was markedley decreased from the normal level in the following order: bronchiectasis>chronic bronchitis>acute bronchitis.
In bronchiectasis, the decrease of BER was all the more striking on the affected side. In experimental bronchiectasis produced in dogs were obtained similar results, too.
3) In pulmonary tuberculosis, both TER and BER showed a definite reduction. In active tuberculosis, the fall of TER was more distinct than that of BER as compared to the case with inactive tuberculosis.
4) In bronchopneumonia, both TER and BER were decreased as in pulmonary tuberculosis. The decrease of BER was larger on the affected side.
5) In lung cancer, TER and BER showed the greatest decrease as against the other diseases. BER was particularly lower on the affected side than normal side.
6) In exudative pleuritis and spontaneous pneumothorax, too, TER and BER were lower than the normal values.
No definite relationship could be established between the decrease in the electric resistance and the amount of pleural effusions or the degree of pneumothorax on account of paucity of the subject cases.
7) In dogs, determinations were carried out under several experimental conditions such as occlusion of the bronchus, exposure of the vagus, and mono- or bilateral vagotomy. Both TER and BER were lowered under any of these condition with some difference in the degree of decrease. Automonic nerve stimulants were found to have a strong effect on TER; pilocarpine and adrenalin caused a decrease in the value, but atropine enhanced the electric resistance, thus presenting a striking contrast.
8) No definite relationship could be demonstrated between TER or BER and the pathohistological changes in the wall of the respiratory tract.
9) It may be concluded that TER and BER are decreased in various pathological conditions, though the degree of decrease varies from disease to disease. Further studies are still necessary to elucidate the mechanism underlying the development of such electric changes in the mucosa of respiratory tract, but this method may be regarded as one of helpful observations to be made in investigating pathophysiology of the respiratory tract wall.

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