A huge-molecular mycobactericidal fraction associated with cathepsin and acid phosphatase activities was separated from detergent-extract of the lung granular fraction of BCG-revaccinated guinea pigs by gel-filtration on Sepharose 2 B column (Fig.1, Fig.2, Table 1). The mycobactericidal activity was heat-stable at 100°C and pH 5.6 for 10 minutes, but the enzymatic activities were lost. Further fractionation was conducted using organic solvents (Fig.3, 4), and the mycobactericidal moiety was obtained as 90% acetone-soluble and ether-insoluble components of still high molecular weight. The components were free from the enzymatic activities. Separation of such mycobactericidal components was also successful from the extract prepared by freezing and thawing, but this fraction was negative in cathepsin activity unlike the preparation by the detergent.
A discussion was m a de that the mycobactericidal principle might exist in the membrane structure associated with lysosomal hydrolases, but as a factor distinct from them.

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For the past one year we observed isolation of atypical mycobacteria from sputa of inpatients and outpatients in Nagahama Sanatorium, and we investigated each cases discharging them. The results are summarized as follows:
1) Cases giving out atypical mycoba c t eria were classified by the state of isolation (frequency of the discharge) into frequently, continuously, and sporadically discharging types.
And these 3 types were compared each other with regard to number of cases (Table 4), sex and age (Table 5), previous tubercle bacilli detection and previous chemotherapy for tuberculosis (Table 6), the cavity in chest X-ray findings, and relation between discharge of atypical mycobacteria and change in clinical symptom (Table 7), and type of bacilli by Runyon and maximum number of colonies (Table 8).
2) Under the frequently discharging type were classified those who gave the atypical mycobacteria more than several times in consecutive sputa tests for 5 days without chemotherapy (performed only with inpatients) and in one monthly test. Seven inpatients belonged to this type. Their clinical courses were described. And their chest X-ray findings, chemotherapies and discharges of the atypical mycobacteria were represented in a figure (Figure 1).
All the cases of this type were considered to have pulmonary atypical mycobacteriosis or to be complicated with its disease, since their mycobacteria were isolated frequently and in a large amount, and indicating its relationship to change in the symptoms (inclusive of chest X-ray and other laboratory findings) with discharge of the atypical mycobacteria. In other words, we had no evidence to deny the pulmonary atypical mycobacteriosis in these cases.
In 3 of this type, large amounts of the atypical mycobacteria were isolated only in the consecutive sputa tests at hospitalization. Therefore consecutive sputa tests are considered important for the detection of atypical mycobacteria as well as of tubercle bacilli.
3) Under the continuously discharging type are classified those who g ave the atypical mycobacteria more than 2 times in 3 monthly tests. Nine outpatients belonged to this type. Their chest X-ray findings, chemotherapies, discharges of atypical mycobacteria, and detection of acid-fast bacilli (estimated to be tubercle bacilli) in the past were represented in a figure (Figure 2).
In 3 cases of this type, sedimentation rate of erythrocytes was elevated or symptom altered in association with discharge of the atypical mycobacteria. But in none of this type chest Xray findings indicated excerbation at discharge of them.
Discharge of the atypical mycobacteria in thi s type is assumed to be partly due to: the bacterial alternation-like phenomen, since there were 6 cases that tubercle bacilli were detected in the past and after a certain period of chemotherapy the atypical mycobacteria were found continuously.
4) To the sporadically discharging type belonged those who gave the atypical mycobacteria only once or twice with a interval during the period of the observation. This type was evidently more frequent among outpatients than among inpatients, and number of colonies was small in many of them. But discharge of the atypical mycobacteria in this type too is not considered to be deribed only from contamination, since this type was not found among the young patients.
We want to continue observation on atypical mycobacteria discharging cases in order to contribute to the elucidation of its clinical significance.

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Many papers have been published on the pathology of the pulmonary sarcoid granulom. In spite of that a few are concerned only about the pulmonary arterial changes, not about the venous changes.
In 1967-1968 we have reported the pulmonary venous sarcoid granulornogi.
In generally the necrosis in the tuberculous lesion is common, b ut rarely in sarcoidosis.
It's report of Prof. Dr. Oka and Dr. Iwai that there are patho-histelogical difference between the necrosis in these two diseases, i. e. characteristic localisation of necrosis and attitude of arginophilic fibers in them.
But there is no paper about the pathogenesis of necrosis.
New findings of the pathogenesis of necrosis of pulmonary sarcoid granulom are reported in this paper.
Case: Mr. T. S.31 years old, male, the desk. B. H. L., soft nodular lesions in both upper lobe and left lower lobe (S₆) (Fig.1, 2) Tuberculin reaction Kveim test negative, scalen node biopsy, “reticulosis”, culture of tubercle bacilli, fungus and other bacteria negative.
Details of clinical observation are reported in another paper.
It is postulated the following conclusions by the patho h istological findings of the biopsy materials of pulmonary sarcoidosis.
(1) Some vascular granulom of lung project in the lumen of pulmonary vein. (see Fig.3∼6) and some others press the vessel wall from outside. (see Fig.5, 6) Thereby the resu lts are the stenosis of the vessel (see Fig.3∼6) and furthermore may occurs stasis of blood flow, so-called “sludged blood”.
(2) Sarcoid g ranulom of the pulmonary vessel wall slowly injure and destroy the elastic fibers and collagen fibers (see Fig.3-10) and some time occurs degeneration, desquamation of endothelium. (see Fig.5, 8)
(3) Injuries of the endothelium means the loss of heparin.
(4) Above mentioned three factors, i. e. the stasis of blood flow, injuries of the endothelium and loss of heparin may be the most important factors of thrombus formation.
(5) It is postulated that the necrosis of the pulmonary sarcoid granulom is ishemic necrosis caused by coagulation thrombosis. (see Fig.11, 13-16).

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At the 13th Annual Meeting of the Japanese Society for Thoracic Surgery (1960), the authors reported that the thoracoplasty was as effective as the resection for tuberculous lesions located in the upper lobe and S⁶ segment. Since then, the number of cases undergone resection and collapse therapy has been increasing in our Sanatorium, and reexamination on the same subject was conducted.
The follo w ing three methods are indicated as the method of surgical treatment for lesions located in the upper lobe and S⁶ segment: 1. resection of the upper lobe and S⁶ segment, 2. resection of the upper lobe and thoracoplasty for S⁶ segment, 3. thoracoplasty for the upper lobe and S⁶ segment. Each method has its own merits and demerits. A comparison was made among these three methods to find out the best method of treatment.

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