中葉切除，2葉切除を除いた肺葉切除例20症例に対して，呼吸リハビリテーションを手術直後から施行した群10例と施行しなかった群10例について術後の肺機能検査を両群間で比較検討した．肺切除術後早期において，リハビリテーション群はリハビリテーション非施行群に比べMVV（最大換気量）およびPEF（最大呼気速度）について改善傾向を示したことから術後の呼吸リハビリテーションは術後早期の呼吸機能改善に有用である可能性が示唆された．

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The clinical, rentgenologic, laboratory findings and treatment of 39 patients with pulmonary aspergillosis admitted to Muramatsuseiranso National Sanatorium have been reviewed.
1) general description
The number of cases per year was generally 2 to 8 during the period from 1957 through 1968.
This figure suggests that pulmonary aspergillosis is rare disease, and does not indicate an annual increase of this disease.
Most of them were found in the course of the treatment of pulmonary tuberculosis for 3 to 10 years. All except one showed an aspergilloma on chest X-ray film. Five cases accompanied with non-tuberculous changes also showed an aspergilloma.
No significant difference between both sexes was observed. The more cases were found rather in higher age.
The basic changes of them were pulmonary tuberculosis or pulmonary cysts or bronchiectasis.
All of the aspergilloma were suprophytic.
2) chest X-ray findings
The key point of the rentgenologic diagnosis is to inspect an open healed tuberculous cavity of the lung and bronchiectasis. The tuberculous changes in the background field were cicatrization or fibrosis lacking in perifocal opacity. In some cases the cavity showed diffuse opacity at the beginning of the disease.
The rentgenograms of some types of aspergilloma were presented.
3) clinical symptoms and the results of laboratory examination
Although hemoptysis was common at the time of the confirmation of an aspergilloma on the chest X-ray film, it was unlikely that the hemoptysis attribute to the development of an aspergilloma. Usually sputum culture for tubercle bacilli were negative at this time. It was noticeable that a typical conidiophore and vesicle with sterigmata was not found in resected fungus balls except one which was obtained from a big well airated cyst. All except one aspergillus cultured from sputum or resected fungus balls could be classified in Aspergillus fumigates group.
4) treatment
Pulmonary resection or cavernostomy were performed for 27 patients out of 29 cases. Eight out of 12 conservatively treated cases died of cardiopulmonary insufficiency caused by their previous pulmonary tuberculosis or other diseases which were not related to the aspergilloma.

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A group of 149 patients with cultures resistant to one or more of the primary antituberculosis drugs was treated with the secondary antituberculosis drugs for 6 months or more.
Of whole patients 25.8% became sputa negative on smear and culture.
Of the patients treated with secondary drugs in combination with primary drugs 26.8% became negative.
In the group treated with three drugs 34.8%. and with two drugs 15.6% became negative. Three drugs treatment is more effective than two drugs.
One group had one secondary drug in combination with two primary drugs and 29.8% became negative. Another group had two secondary drugs and one primary drug and 45% became negative. The third group had three secondary drugs only and 44.4% became negative.
One group of streptomycin resistance patients was treated with one of the secondary drugs in combination with isoniazid and PAS, and 16.8% became negative. Another group of streptomycin resistance patients was treated with two secondary drugs in combination with isoniazid and 40% became negative.
The 33 patients treated with secondary drugs for 6 months and had positive cultures had been continued to have same treatment for 8 to 12 months length and only one of them beame negative. The 14 patients who became the sputa negative had been continued to have same treatment and 5 of them became again positive.
In the first treatment group with the secondary drugs 30.4% became negative, and in the re-treatment group 20.3% became negative. First treatment was better than re-treatment.
Radiographic improvement occured in 13.4% of noncavernous diseases, and in 10.5% of cavities.
Treatment was interrupted because of drug toxicity in 16.1% of the whole patients. In this series pyrazinamide has been stopped because of toxic effect in 27.8% of cases, ethionamide in 15.4%. cyclocerine in 8.3%, and kanamycin in 1.7%.
Joint-pain by pyrazinamide, jaundice by ethionamide, aberration by cyclocerine were most unpleasant symptomes to patients. One patient with jaundice by ethionamide died. These toxic effects are abstacles of treating patients wtih the secondary antituberculosis drugs.

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気胸の内視鏡的治療を目的として, 肺切除後末梢肺胞瘻4例, 自然気胸6例の計10例に対し, フィブリン・グルーによる気管支塞栓術を施行した。10例中8例に有効でair leakは消失したが, このうち2例に再発(1か月と4か月後)が認められた。無効例2例はair leakに関与する気管支の同定が不正確であったことや, フィブリン・グルーの注入量が不十分であったためと考えられた。本法によるair leakの治癒機転はフィブリン・グルーによる一時的な気管支閉塞効果のみでなく, 注入肺に惹起された炎症反応も関与していると考えられた。本法は手技的にも比較的簡単で合併症も少なく, air leakが遷延する気胸症例に試みるべき治療手段の一つと考えられた。

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症例は72歳, 男性。左背部痛を主訴に来院。胸部X線写真上, 左胸部に石灰化を伴った慢性膿胸の壁がみられ, 胸部CTでは, その慢性膿胸壁に連続しかつ胸壁に浸潤したと考えられる小児手拳大の腫瘤陰影が認められた。またGaシンチ検査で腫瘤に一致した異常集積像が認められた。血清および胸水中のNSEが高値であった。経皮針生検では, 悪性腫瘍と診断された。以上より膿胸関連悪性リンパ腫を疑い, 摘出術を行い摘出病理標本で膿胸関連悪性リンパ腫と診断された。術後化学療法および放射線療法を行った。本疾患は比較的まれな疾患でありその診断も困難とされているが, 慢性膿胸の存在と血清中および胸水中のNSEおよびLDHが高値であったことが本疾患を疑う根拠となった。また血清中のNSEおよびLDHが腫瘍の摘出とともに正常化し, 腫瘍が再発すると再上昇した。結核性慢性膿胸の患者では本疾患を常に念頭におき, 血清中のNSEおよびLDHが高値の際には積極的に本疾患を疑い検査を進める必要があると考えられた。

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人工気胸術後の慢性結核性膿胸壁に発生したリンパ腫 (pyothorax-associated lymphoma, PAL) の1例を経験した.症例は69歳男性.24歳時に肺結核のため人工気胸術を施行された既往がある.1995年6月頃より左胸痛が出現し, 同年9月18日入院.入院時の検査所見では赤沈の亢進および血清NSEの上昇がみられた。左側胸部に腫瘤を認め生検したところ, びまん性大細胞型非ポジキンリンパ腫と診断された.免疫組織化学的にT細胞型であり, in situ hybridizationで腫瘍細胞の核内にEBER-1の発現を認めた.従来より本疾患の発生に慢性の炎症刺激が関与しているといわれてきたが, さらにEBウイルスが関与していることが示唆された.本症例は慢性膿胸壁に発生したT細胞型悪性リンパ腫にEBウイルスの存在を証明した本邦初の症例であり, 貴重であると考え報告した.

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国療肺癌研究会で経験した肺芽腫8例を対象として, その臨床像および病理像を検討した.8例のうち男性6例, 女性2例であった.5例では胸痛および血痰などの自覚症状がみられたが, 残りの3例は無症状であり検診などで発見された.今回検討した8例はすべて手術例であった.術前に肺芽腫と診断されていたものは経皮針生検で診断された1例のみで残りの7例はすべて切除標本で肺芽腫と診断されており, 術前診断は困難であった.切除後の予後をみてみると2例は術後10年5ヵ月および3年2ヵ月の現在生存中であり, 3例は術後9ヵ月, 4ヵ月および3ヵ月で原病死していた.残りの3例は他病死であった.その病理組織像をみてみると生存中の2例は上皮性成分が主体で間葉系成分はわずかであり, 術後1年以内に原病死した3例では逆に間葉系成分が主体となっており, 腫瘍の病理像とその予後は深く関係していることが示唆された.

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The lung washings were obtained from 25 patients with pulmonary tuberculosis before and after operation. Surface tensions were measured on Wilhelmy balance and stability indexes were calculated. The relationships between the surface activity of washings and the results of the lung function tests performed at the same time were studied.
The surface activity of washings obtained after surgery was identical to that obtained before surgery regardless the loss of lung tissue.
After surgery minimal surface tension of washings inversely related with %VC and forced expiratory volume/predicted vital capacity ratio (FEV_1.0/ VC_Fred.). The stability index also correlated with %VC and FEV_1.0/VC_Fred. These relationships were not found before surgery.
The surface activity of washings were not correlated with %MVV both before and after operation.
These findings suggested that surgical procedure for pulmonary tuberculosis may change the metabolic activity of the affected lung

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We experienced a patient with giant emphysematous bulla which occupied the who right thoracic cavity. Progressive dyspnea suggested that the bulla might exert pressure on the residual lung. Surgical removal usually makes prolonged air leakage. Therefore, laser coagulation shrinkage of bulla was indicated. Carbon monoxide and Nd:YAG laser were used. The collapsed lobes reexpanded and blood stream restored and pulmonary function returned to good level. We concluded CO laser therapy is useful for patient of respiratory disorder with giant bulla.

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A 24 Year-old male with pulmonary tuberculosis in right upper lobe developed two lesions of extrapulmonary pleural tuberculoma during the course of antituberculous therapy.
He had no history of lung tuberculosis nor pleurisy.However, the chest X-ray film on first admission showed scattered nodular shadows in right upper lung field.He had no subjective symptoms and no abnormalities of laboratory findings except mild iron deficiency anemia, from which he recovered completely without specific therapy. Three months after starting the antituberculous therapy including SM, INH, and RFP, a new round homogeneous opacity appeared in the right lower lung field (S⁴).Chest CT scan revealed the lesions in S¹⁰ as well as in S⁴. Microscopic examination of the specimen obtained by ultrasound-guided needle aspiration biopsy dislosed positive acid-fast bacilli.
Because of the lack of effect of drug therapy on pleural lesions, surgical treatment was performed.The viceral pleura was found adherent fibrously to parietal pleura, which was easily separated by hand.However, at the site of lesions, the adhesion was so tight that extrapleural resection was needed.Because lung tissue and tumor were connected tightly, the lung had to be partially resected.Most content of tumors were caseous necrosis.Although main lesion was located outside of the lung, intrapulmonary invasion was also noticed.Double lesions of this kind of disease seem to be very rare.There is no evidence of relapse until eight months after surgery.

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We present a case of 52 year old male patient with tuberculous mediastinal lymphadenitis. During diagnostic process, CT scan was considered to be especially effective in the differentiation from other mediastinal tumors.
It was quite useful in diagnostic process to predict the internal structure of the lesion by the grade of CT density.
From this point of view, the accumulation of the basic data is mandatory in order to apply CT scan for diagnosing the character of lesions such as calcification and caseous necrosis.

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上大静脈再建は原因疾患が悪性腫瘍である場合には一般にその成績は不良であるが, 最近では浸潤性胸腺腫に対してGore-Texを用いた再建例で長期開存がえられている。自験例でも48ヵ月開存を認めるが, graftは強いkinkingを示しておりその長期開存性についてに充分の検討が必要である。したがって我々は雑種成犬5頭を使って, 長さ3cm, 内径10mmのGore-Texを用いて上大静脈再建を行い, 再建後30～41ヵ月の開存性について組織学的検討を行った。閉塞が1頭にみられその原因は感染であり術中汚染によるものと考えられた。開存例の光顕では肉芽形成および再建部中央での内皮細胞下の結合組織増生の不良が認められ, 電顕でも再建部中央に内皮細胞の紡錘形化, 内皮細胞表面の凹凸不整および内皮細胞の易障害性が確認された。これらの結果より市販のGore-Texは比較的再建長の短い上大静脈浸潤を示す悪性腫瘍症例に対してのみ使用されるべきであると考えられる。

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新しいprimary sensitizerであるmethyl heptine carbonateならびにcostus root oilの感作免疫能とDNCBの感作免疫能とどのような関係にあるか検討した.肺癌を含む155例の胸部疾患患者において3つのprimary sensitizerについて同時に比較検討したところ, methyl heptine carbonateならびにcostus root oilの感作免疫能はDNCB級であることが判明した. methyl heptine carbonateとcostus root oilはDNCBの代わりに使用することが可能であり,その結果は信頼できる.

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