The amplitude of cardiogenic oscillations (CO) which were seen on the alveolar plateau of the simultaneous helium and nitrogen single-breath washout curves was studied in 7 healthy subjects in the sitting position. Flow and volume were measured with a wedge-spirometer which was connected to a bag-box system and the gas concentrations were monitored continuously at the mouth level with a mass-spectrometer. To standardize the amplitude of CO, the maximal CO on a single-breath washout curve was divided by the height of phase III.
The change of expiratory flows altered the amplitude of CO both in helium and in nitrogen. The maximal amplitude of CO appeared when the expiratory flows ranged between 0.15 and 0.5L/sec in helium, and between 0.2 and 0.3L/sec in nitrogen. The change of inspiratory flows did not alter the amplitude of CO in nitrogen, but increase of inspiratory flows slightly decreased the amplitude of CO in helium. The greater the bolus inspired from RV increased, the more the relative amplitude (amplitude of CO/height of phase III) decreased.
By changing the lung volume at which a bolus of 200ml of helium was inhaled, the amplitude of CO was altered. The maximal amplitude of CO was seen when a bolus was inhaled from RV. As the lung volume at which a bolus inhaled increased, the amplitude of CO decreased and the alveolar platueau became almost flat. When a bolus was inhaled above this lung volume, the amplitude of CO increased once more.
The relative amplitude of CO in nitrogen increased gradually in a series of three consecutive washouts of nitrogen with 100% oxygen. If the subject did not change the inspiratory and expiratory flows during his maneuver, the maximal CO appeared at the almost same lung volume on the three consecutive curves. Thus the emptying pattern did not alter in the same subject with the same expiratory flow rates.
If the effects of cardiovascular pulsations in each lung compartment in the thoractic space do not change, the amplitude of CO does not change regardless of whether the emptying patter has changed or not during expiration in the two-compartmental lung model which has been used by several authors. This suggests that the effects of pulsations to the lung compartments change the flow which creates the CO during expiration. If this is not the case, three or more lung compartments with different emptying patterns from each other are necessary to change the amplitude of CO in one single-breath washout curve.
Nevertheless, the amplitude of CO in concentrations of expired gases is an useful indicator to detect uneven distribution of the inspired gas and asynchronous lung emptying.

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We examined the prevalence of dirofilariasis (DF) and its effects on V_A/Q distribution in mongrel dogs. Dirofilaria was tested with routine techniques (direct smear and microfilaria concentration technique) and autopsy in 36 dogs. Continuous distributions of V_A/Q ratios by multiple inert gas method were determined in 6 dogs with DF (DF group) and 9 dogs without DF (non-DF group).
1) The prevalence of DF was 16.7% (6/36). Autopsy was more accurate than the routine techniques for detection of DF. The routine techniques revealed one false negative case (1/6), but they seemed to be useful to detect DF reliably.
2) PaO₂ was significantly lower in the DF group than in the non-DF group (72.4±10.1 and 98.1±9.8 torr, respectively, p<0.001). LogSD(Q) tended to be larger in the DF group then in the non-DF group (1.01±0.37 and 0.64±0.12, respectively, p<0.1).
3) PaO₂ correlated inversely with LogSD(Q) (r=-0.60, p<0.025) and shunt blood flow, i.e. V_A/Q=0 (r=-0.54, p<0.05). In 3 of the DF group, more than 10% of blood flow distributed to units of low V_A/Q ratios less than 0.01.
In conclusion, mongrel dogs with DF are substantially inappropriate for physiological studies on the cardiopulmonary system.

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Cases of primary lung cancer often have other pulmonary diseases involving the loss of pulmonary function. If a complicating disease is more pronounced in the noncancerous lung, unexpected postoperative respiratory insufficiency may appear. For this reason it is desirous to predict the postoperative lung function preoperatively. In this study the predicted postoperative vital capacity was calculated according to the following formulae from the spirometry data, bronchoscopy, bronchography and lung scintigram using ^81mKr gas.
As for the summation of NNSS, two methods were employed. First was the evaluation of the number of obstructed sub-segmental bronchus by means of bronchoscopy or bronchography. The second method was summation from the count rate of the lung scanning. In younger patients both methods had equal accuracy. However in older patients the latter method had inevitable error, because the assumption for calculating NNSS did not hold in that patient group. We therfore accepted former method for the summation of NNSS.
As for the measurement of unilateral vital capacity (or VCc), ^81mKr lung scintigram which visualizes the actual distribution of ventilation in the lung was useful in comparison with the cumbersome bronchospirometry.
To investigate the overall accuracy of our predicting formulae, 16 patients who were alive and cancer free 6 months after surgery were selected. However 5 had to excluded for the study because they had postoperative pulmonary complications which reliably are accompanied by loss of lung function. In the remaining 11 cases the predicted value was within±10% deviation of the actually measured value. This accuracy was also acceptable for older patients whose respiratory function was impaired both in cancerous and non-cancerous lung. These formulae were considered to be useful in predicting postoperative lung function and very helpful in deciding surgical indications in cases of severely impaired pulmonary function. However careful management to avoid postoperative lung complications is necessary because the predicted postoperative vital capacity is a final result of the lung function when there are no another function-impairing factor.

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Angiotensin-converting enzyme (ACE) is a glycoprotein that catalyzes the conversion of angiotensin I to angiotensin II and the inactivation of bradykinin.
In the present investigation we measured ACE activity in broncho-alveolar lavage fluid (BALF) and in peripheral blood from mice with BCG-induced chronic granulomatous pulmonary inflammation. The body and lung wet weight of female C57BL/6N mice did not show any significant changes 5 weeks after the administration of various drugs, including BCG. After the intravenous administration of BCG, serum ACE activity showed no significant change, while ACE activity in BALF showed a significant weekly increase. ACE activity in BALF from mice receiving captopril showed significantly low values and they showed suppression of pulmonary granulomatous inflammation comparing with control mice receiving BCG. In addition ACE activity in BALF from mice receiving prednisolone or interferon showed significantly low values and they showed suppressed pulmonary granulmatous inflammation compared with control mice receiving BCG.

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Aerosol inhalation cine-scintigraphy which is a new method for estimation of mucociliary clearance, was studied in patients with diffuse panbronchiolitis (DPB), pulmonary emphysema (PE), chronic bronchitis (CB) and normal controls. The deposition pattern of inhaled aerosols showed mainly a central pattern in PE, but mainly a peripheral pattern in DPB.
According to serial observation of inhaled aerosols by cine-scintigraphy, tracheal transport of aerosol-bolus was in a cephalad direction and moved smoothly in normal controls, but transport was slow, zigzag and sometimes regurgitant in patients with PE and CB. Especially, no transport was observed in patients with DPB.
Therefore, the authors considered that DPB had the worst impairment of mucociliary clearance, because of both ciliary abnormality and rheological disorders, in the diseases of respiratory tract.

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We tried to differentiate mediastinal tumors from tumor of the chest wall by computerized tomography.
1) We defined the heads of the ribs as the boundary between the posterior mediastinum and chest wall.
2) Based on the definition of the mediastimum as described in 1) above, half of all neurogenic tumors (two of four cases) were classified as tumors of the chest wall, which was reasonable from the point of view of operative findings and procedures.
3) It is important to precisely show the pleural envelope of the tumor and pleural deviation by tumor growth for the differential diagnosis of mediastinal tumor and tumor of the chest wall.

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To find the etiologic agents of summer-type hypersensitivity pneumonits, we conducted an environmental survey of the patiens' houses and isolated some strains of Trichosporon cutaneum (T. cutaneum). The possible role of T. cutaneum as an etiologic agent was studied clinically and immunologically in 21 cases of hypersensitivity pneumonitis due to the inhalation of unknown etiologic agents. The results obtained were as follows;
1) T. cutaneum was isolated from 3 of the 5 patients' houses, but no Cryptococcus neoformans (C. neoformans) was found in the patients' environment.
2) Incidences of precipitating antibodies to T. cutaneum and to C. neoformans in the sera from patients with hypersensitivity pneumonitis were 76% (16 of 21 patients) and 48% (10 of 21), respectively. On the other hand, no precipitating antibodies to both antigens were noted in the control sera from other pulmonary diseases and normal subjects.
3) When the antibodies to T. cutaneum and C. neoformans were assayed by the indirect fluorescent antibody method, 20 (95%) of 21 patients with hypersensitivity pneumonitis were positive for both antigens. In control sera, almost all sera were negative.
4) The precipitin bands to the antigens of T. cutaneum and C. neoformans were always cross-reactive when the precipitating antibodies to both antigens were present simultaneously in the sera from hypersensitivity pneumonitis patients and from rabbits immunized by T. cutaneum. A cross-absorption test with both antigens revealed that C. neoformans antibody was completely absorbed with T. cutaneum, but the anti-T. cutaneum antibody was only partly absorbed with C. neoformans, leaving antibody still reacting with T. cutaneum in 13 to 20 patients.
5) A bronchial provocation test with T. cutaneum antigen was done on a patient, with a positive result.
6) It was also found that bird droppings was one of the growth factors of T. cutaneum our everyday surroundings.
From these results, we conclude that T. cutaneum is a likely etiologic agent of hypersensitivity pneumonitis, especially of the summer-type hypersensitivity pneumonitis.

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A 27 year-old female was hospitalized with a diagnosis of bilateral spontaneous pneumothorax without any history of decreased intelligence or convulsion since she had suffered from Pringle's disease at the age of 3 years. Lung and lymph node biopsies at thoracotomy yiedded a diagnosis of diffuse pulmonary hamartoangiomyomatosis complicated with lymphangiomyomatosis. Although the postoperative course progressed favorably, she was rehospitalized because of spontaneously ruptured angiomoylipoma of the right kidney 2 years and 11 months after the first attack. The right kidney was removed but she died of acute pulmonary edema on the second day after the surgery.

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A 50-year-old polyurethane paint sprayer developed dry cough, dyspnea on exertion (Hugh-Jones II), and general malaise in 1980, after 10 years employment. The symptoms improved during a period away from work, and again worsened after returning to her spray work. Her symptoms became unbearable in December 1982, and diffuse abnormal shadows on chest X-ray were found. These, however, resolved spontaneously after she stayed away from her work.
Suspecting hypersensitivity pneumonitis (HP), the patient was readmitted to our hospital on January 15, 1983. The PPD skin test was negative. Peripheral blood tests were normal. Lung function tests showed severe restrictive dysfunction with small airway obstruction, which recovered with time, leaving a reduced transfter facter. Broncholaveolar lavage (BAL) showed striking lymphocytosis with T lymphocyte activation and OKT 4+/8+ ratio reversion, suggesting HP. Open lung biopsy was performed on March 29, and epithelioid cell granuloma and Masson body formation in the alveolar structure were found as well as partial fibrosis. These pathological findings strongly suggested HP. Dust cell granuloma suggested pneumoconiosis.
Isocyanates and human serum albumin (HSA) conjugates were made by Tse's method. The following immunological tests were performed in the patient and 5 controls: 1) Positive late skin test against TDI-HSA in the patient. 2) Precipitin antibody in patient's serum, and positive lymphocyte stimulation test of patient's peripheral lymphocytes, against TMI-HSA. 3) Specific IgE RAST were all negative for all isocyanates-HSA conjugates. 4) HSA itself was always negative in the patient, and all isocyanate-HSA conjugates showed no immunological reaction in 5 controls.
Based on the clinical features, BAL, and pathological findings, this case was diagnosed as HP, and based on her occupational history and immnuologocal positive tests, the causative agent was diagnosed as isocyanate (TDI).

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A 56 year-old female was admitted with a 2-year history of hoarseness. Laryngoscopic examination revealed right false vocal cord tumor. A diagnosis of sarcoidosis was confirmed by biopsy of the tumor, which showed non-caseating granuloma. No other sarcoid lesion was found in any organ. Corticosteroid therapy resulted marked improvement of the hoarseness.

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An 81-year-old female with fever, anterior chest pain and relative bradycardia due to Legionella longbeachae serogroups 1 and 2 pneumonia is reported. The diagnosis was made serologically by indirect fluorescent antibody test and enzyme-linked immunosorbent assay. Legionella could not be isolated from the patient, but the patient has been successfully treated with erythromycin.
Legionella longbeachae serogroups 1 and 2 have been only rarely recognized as the agent of legionellosis, in five U.S. patients and one Canadian patient, and this is the first case of Legionella longbeachae pneumonia in Japan.

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ACTH producing thymic carcinoid has been rarely reported in the literature. A case of ACTH producing thymic carcinoid accompanied by Cushing's syndrome in a 53-year-old man was presented. The patient had suffered from hypertension and frank diabetes mellitus for a half year and the mediastinal tumor was discovered on chest X-ray just before admission.
The patient was characterized by a striking redistribution of fat with the obesity confined to the face, neck and trunk on admission. “Moon face” and “buffalo hump” were also noted. Moreover, dermal pigmentation and an overt psychosis appeared. The tumor shadow was located in the anterior mediastinum and was partially hidden within the cardiovascular shadow on chest X-ray film.
Cushing's syndrome was found in association with the mediastinal tumor, followed by surgical removal of the tumor. The tumor developed in the thymus and anterior mediastinum. Histological examination demonstrated typical carcinoid of the thymus without lymph nodal involvement. After removal of the tumor, the level of urinary 17-OHCS and 17-KS, plasma ACTH and serum cortisol, which were elevated preoperatively, were all normal. Other clinical manifestations improved with the postoperative stage.
In this case, preoperative cytological examination of the material obtained by transthoracic needle biopsy revealed carcinoid tumor. This is the first report in which ACTH in carcinoid cells was detected by cytological examination using the method of PAP (peroxidase anti-peroxidase) and it appears valuable in cytological evaluation of ACTH producing tumor.

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A 82-year-old man was admitted with bronchial asthma. At that time a well-defined giant mass shadow measuring 23×18×16cm was detected in the left chest. He died of cerebral hemorrhage and pneumonia fifteen months later. Autopsy findings showed giant mediastinal teratoma (dermoid cyst), 2950gram in weight, containing a large amount of yellow-brown mushy substance.

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