As a result of a routine contact survey for sputum culture positive tuberculosis male patient aged 52 years, four new other patients out of seven houshold members were detected. They were his wife aged 49, his son aged 22, his second son aged 17 and his daughter aged 14. His wife suffered from smear positive cavitary tuberculosis and was considered as a source of infection in her family members. She complained sever cough and sputa for around four months. Soonafter, it was reported that his wife was working actively as a nurse of one nursery school at Kurume City. A total of nine coworkers and 99 children were examined for tuberculin test and X-ray examination, if needed. The prevalence of tuberculin positive among the children in this nursery was much higher than that of control children in another nursery near by. Moreover, three new tuberculosis cases were detected among nurses and nine new tuberculosis cases were detected among children. The cases who had not vaccinated with BCG were more seriously injured than the cases who had vaccinated with BCG.
This report suggests the followings
i) Careful attention should be paid for the respiratory symptom (s) as well as the routine examination of tuberculosis for nurses of nursery.
ii) Tuberculosis epidemics may occur not only in children but also in adults.
iii) The effects of BCG vaccination could be observed clearly in this epidemic of tuberculosis.

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In order to treat chronic thoracic empyema, pleropneumonectomy is one of the best methods of radical operation. In our institute 35 cases (23%) out of 110 were operated in the recent ten years by this procedure. This procedure is the most risky operation due to possible huge amount of bleeding during operation and possible post-operative impairment of pulmonary function.
The cure rate of this operation is 89% (68% by a single-step operation and 20% by multi -steps operation). The failure cases (11%) consist of four operational deaths and one case with external fistula. The post-operative change of pulmonary function (%VC, FEV_1.0/pr. VC%) were 20%-30% reduction of pre-operative values at 6month after operation; no more remarkable changes were seen during long-term observation, and %FEV_1.0showed no change or slightly upward trend. The reason of no more reduction of pulmonary function during the long-term observation is that almost all cases survive under nearly lowest limit of pulmonary function for survival and below this level they could not survive. Comparing cases with and without thoracoplasty, there was no distinct difference in post-operative pulmonary function.
Nevertheless, those with thoracoplasty could not survive longer than those without it. In conclusion,
1) Pleuropneumonectomy is one of the radical but risky operation of treatment of chronic thoracic empyema with low pulmonary function.
2) The cure rate was 89%.
3) Cases without thoracoplasty could survive longer than those with it.

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Enzyme-linked immunosorbent assay (ELISA) was developed for IgG antibody against purified protein derivative of tuberculin (PPD). PPD antibodies of 15 patients with active pulmonary tuberculosis and 19 patients with inactive patients were measured at admission to hospital. The control material consisted of 7 healthy blood donors and negative sera consisted of 7 healthy umbilical cord bloods. The mean antibody levels correlated to the tuberculosis infection. The mean antibody levels were significantly higher in the active tuberculosis patients than in the inactive patients. The mean antibody levels were higher in the active patients than in the controls. The mean antibody levels in the patients, with in 6 months after stopping the discharge of bacilli, were still as high as in the active patients.
We thought that this assay was very simple and useful for diagnosis of the tuberculosis patients.

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As a survey to investigate the source of lung infection by atypical mycobacteria to humans, mycobacterial isolation from dust of Japanese houses was conducted. Mycobacteria belonging to the Mycobacterium avium-M. intracellulare complex were isolated at a rate of 2.8% among relatively slowly growing mycobacteria isolated from the dusts. The dusts contained a large number of strains of Mycobacterium thermoresistibile and Mycobacterium pulveris. The dusts of the Japanese houses seem to be a treasure source of new species of mycobacteria, as suggested from the fact that unidentifiable mycobacteria reached ca. 30% of the isolates.

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In this paper, problems on the pathogenesis of various pulmonary granulomas and alveolitis are reviewed.
1. Diffuse histiocytic reaction due to atypical mycobacteria.
A few cases of mycobacteriosis demonstrated diffuse histiocytic reaction with abundant intracellular acid-fast bacilli without caseous necrosis. Three possibilities might be consid ered for this peculiar lesion: (1) Mycobacteria in specific serotype may cause such lesion, (2) Suppressed immunological, especially cell-mediated reaction, may play an important role, as many simillar cases were reported in PPD negative children. (3) Specific intracel lular situation of the mycobacteria may result in the reaction: clear halo between the phagosomal membrane and the engulfed mycobacteria, which is also seen in leproma cells electronmicroscopically, may inhibit transmission of antigenic information to the cell.
2. Sarcoidosis, berylliosis and extrincic allergic alveolitis.
Epithelioid cell granulomas in sarcoidosis are presumed to develop by mitosis of single epithelioid cell which appeared in lymphocytic infiltration, not by gathering of many infiltrated precursor cells. Alveolitis in sarcoidosis is found extensively in the lung which show cotton-like shadow on chest X-ray films, accompanying dystelectasis in granulomatous area. Both of granuloma and alveolitis represent immunologic reactions to an unknown agent, which may be enhanced by adjuvant activities of Propioni-bacterium cultured in a high percentage in sarcoidosis lymph nodes.
In berylliosis, acute interstitial pneumonia, alveolitis, or chronic granulomatous change appears following inhalation of soluble or insoluble beryllium respectively, in conjugation with serum albumin.
In extrinsic allergic alveolitis, both of diffuse alveolitis and typical or immature epithe lioid cell granuloma with slight bronchiolitis are the characteristic features of the disease. The extent of each lesion may depend upon wheather the antigen is water-soluble or in particulate form.
3. Eosinophilic granuloma (EG), HandSchullerChristian‘disease (HSC) and Letterer Siwe’ disease (LS).
EG, HSC and LS had been included in a disease entity, Histiocytosis-X (HX), by Lichterstein in 1953. However, histopathological features of the three diseases were found to differ markedly, upon the observation of autopsy and biopsy cases collected from many institutions in Japan. Early change of pulmonary EG seemed to appear in the bronchiolar walls, spread in the wall of peripheral airways, replacing them by granulomatous changes and resulted in cystic dilatation of airway lumens. Otherwise, nodular lesions are formed based on the alveolar walls, with intraalveolar changes.
Characteristic histologic feature of HSC are foamy Langerhans' (L) cell infiltration with marked fibrosis, usually limited to the interstitial connective tissue of various organs. Intra-lymphangic or intra-sinus accumulation of L cell were found in the lobular septum of lung or of the lymphnodes, respectively.
In LS, diffuse infiltration of L cells and mononuclear cells were found in the alveolar walls of the lung, lymphatic tissue of the lymph nodes, thymus, white pulp in the spleen, tonsils, intestinal lymphatic tissues and liver sinusoids. Intra-vascular localisation was noted in the lung, indicating hemic spread of the L-cells.
It is better to diagnose using each name of the disease, or to diagnose as HX (EG), HX (HSC) and HX (LS).
4. Idiopathic interstitial fibrosis of the lung (IIF)

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