In order to obtain an insight into the pathogenesis of pulmonary diseases, genetic factors involved in tuberculosis and silicosis were investigated in a population study.
There are statistical associations between HLA and pulmonary silicosis or pulmonary tuberculosis. It was clearly demonstrated that there are major genes which control the immune response of the host to several antigens and which are closely linked to HLA. The statistical association between disease and HLA may well be explained by this HLA-linked immune response or suppression genes.

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Ten cases of pneumonia, which exhibited delayed resolution, were studied clinically as well as histopathologically. The presented cases accounted for roughly 5% of 202 cases of pneumonias admitted to our hospital for the last five years.
Fifty five was their averaged age. Four of them had certain underlying diseases, including none of chronic obstructive lung diseases. The laboratory findings were, as a whole, less prominent, e. g. on WBC, CRP and ESR, compared with those in the normally resolved pneumonias. Bacteriologic evaluation of the sputa for the delayed resolution provided no clue as to the causes. The underlying factors which ultimately ended up to delayed resoultion, were obscure in our series.
Histopathologically, ten cases were divided into two groups, one showing mild interstitial pneumonia with organizing intra-alveolar exudate, and the other showing severe chronic bronchitis together with bronchiolitis obliterans and so-called obstructive pneumonia.
The latter group had a tendency to have more prominent clinical symptoms, and the resolution of the shadows were slower than in the former.

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Some cases of chronic obstructive pulmonary disease (COPD) develop cough, stridor and dyspnea as soon as they walk out and are exposed to cold outside air. Mikami named this phenomenon “cold air inhalation phenomenon”. We studied 4 chronic pulmonary emphysema patients who had open mouth breathing on performing light work who showed the “cold air inhalation phenomenon”.
It was studied whether open mouth breathing is related to the “cold air inhalation phenomenon”. These patients presented respiratory muscle function insufficiency so they open their mouth to breathe when doing light work and cold air flows into the lower airway directly. Therefore, it is suggested that the cold air causes respiratory symptoms in such patients.

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We performed BAL and analyzed cellular components in 20 healthy volunteers (HV) and in 98 patients. In 52 patients the following diagnoses were established; idiopathic pulmonary fibrosis (IPF, 17 cases), sarcoidosis (SAR, 15 cases), collagen vascular disease (CVD, 8 cases), pneumoconiosis (PC, 7 cases) and non-summer type hypersensitivity pneumonitis (ns-HP, 5 cases). The other 46 patients were diagnosed as having other pulmonary diseases.
There were significant differences in the proportions of pulmonary alveolar macrophage (PAM) and lymphocyte (LY) between non-smokers and smokers of HV (p<0.05 for PAM and p<0.01 for LY). However there were no significant differences in the proportion of polymorphonuclear leukocyte (PMN) and the ratio of OKT4/OKT8 between them.
Non-smoking patients were classified as having normal or increased proportions of LY and PMN and as having low, normal or high OKT4/OKT8 ratios, taking the mean±SD of non-smokers of HV as the upper and lower limit of the normal range. Smoking patients were also classified in the same way, taking the mean±SD of HV smokers as the upper and lower limit of normal.
The most common BALF cell profile in IPF showed a PMN increase without any increase of LY and a normal ratio of OKT4/OKT8. There were a slight or moderate increase of LY without any increase of PMN and a high ratio of OKT4/OKT8 for SAR. A normal range of LY and PMN and a low OKT4/OKT8 ratio were found in CVD. A marked increase of LY without any increase of PMN and a high OKT4/OKT8 ratio were observed in ns-HP. There were no characteristic findings in the BALF cell profile of PC.
The sensitivity, specificity and positive predictive value of the BALF cell profile characteristic of each disease were calculated. Although specificity was high (92-99%), sensitivity and positive predictive value differed according to diseases; the former was 80% for ns-HP, 53% for SAR, 38% for CVD and 24% for IPF, the latter was 80% for ns-HP, 53% for SAR and less than 50% for IPF and CVD.
The positive predictive value, which refers to the proportion of patients with a particular BALF cell profile was not very high. The major reason for this was that respiratory infections due to viruses, mycoplasma and other pathogens expressed similar BALF cell profiles to ns-HP and SAR and because the BALF cell profiles of the other diseases varied widely. The predictive value of ns-HP and SAR markedly increased when the probability of the diseases was considered in conjunction with other clinical informations.
It was considered that BALF cell analysis had no definitive value in the diagnosis of pulmonary diseases, whereas it did have significance in cases clinically suspected of particular diseases such as ns-HP or SAR.

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Histochemical and ultrastructural studies of respiratory mast cells (MC) were carried out in 6 cases of bronchial asthma including one atopic 19 year-old female and five non-atopic patients consisting of 3 men and 2 women averaging 59 years of age.
During the asymptomatic period transbronchial lung biopsies were taken from four different areas of S4, 5 and S8, 9, 10 of the right lung and were fixed by formaldehyde to stain MC granules with naphthol-ASD chloroacetate esterase, or fixed by glutaraldehyde and osmic acid to study the ultrastructure of the MC granules. Histologically MC granules generally showed a weak reaction to esterase. Most MC showed obvious metachromasia to toluidine blue on semi-ultrathin sections, however, cytoplasmic vacuolization occasionally occurred in the MC of the bronchiolar and alveolar interstitium. A total of 81 MC examined in this study were classified into two subgroups: type S with predominance of scroll or cylinder subelements in their granules; and type P with cytoplasmic granules mostly composed of particulate substructure. Particulate granules occasionally fused and showed remarkable disorganization leaving only fine filamentous contents in the labyrinthine structures (type L). These granule membranes became continuous to the plasma membrane to form an open connection with the outside environment. They suggest massive release of chemical mediators, in contrast to the stable condition of the scroll substructure, and the partial degranulation in the particulate one. In the present study MC recovered from 2 patients were of type P in 68% and 64% respectively, most of which showed labyrinths or vacuoles in the cytoplasm, and one other patient had a small number of type P MC (8%) although they were not vacuolated. In the remaining 3 patients all MC were of type S with no alteration of granule dissociations. MC granules from bronchial asthma were characterized as heterogeneous in their morphology and MC consisting of typical anaphylactic degranulation were present in only one-third of the patients. It remains to be elucidated whether or not MC contributed to provoke asthmatic symptoms in the two-thirds of the patients examined in this study.

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To assess the diagnostic value of antibody activities to Trichosporon cutaneum antigen in bronchoalveolar lavage fluids (BALF) in patients with summer-type hypersensitivity pneumonitis in Japan, we measured specific IgG, IgA and s-IgA antibody activities in BALF from 9 patients with summer-type hypersensitivity pneumonitis, 2 asymptomatic exposed family members, 9 patients with sarcoidosis and 6 normal subjects by the enzyme-linked immunosorbent assay (ELISA) method.
We observed a significant increase of specific IgG, IgA and s-IgA antibody activities in BALF from all patients with summer-type hypersensitivity pneumonitis compared with those of normal subjects or patients with sarcoidosis. In 2 asymptomatic seropositive family members, the specific IgG antivities were slightly greater than those of normal subjects, but specific IgA antibody activities did not differ. Interestingly, in patients with summer-type hypersensitivity pneumonitis, specific IgA and s-IgA antibody activities in BALF were significantly greater (p<0.001) than specific IgG antibody activities when these antibody activities were divided by those in serum samples. Furthermore, the specific IgA and s-IgA antibody activities correlated well with the clinical course.
We conclude that measurement of anti T. cutaneum antibody activities in BAL fluid is a useful method for the serodiagnosis of summer-type hypersensitivity pneumonitis, and it is possible that local IgA and s-IgA antibody activities could be involved in the immunopathological mechanism of summer-type hypersensitivity pneumonitis.

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A case of paragonimiasis westermani complicated by repeated spontaneous pneumothorax and cerebellar infarction was reported.
The patient was a 27-year-old male who had a history of eating cooked freshwater crabs (Potamon dehaani) several times. He suffered spontaneous left pneumothorax in August, 1983 and cerebellar infarction in April, 1984. He was admitted to Keio University Hospital because of spontaneous right pneumothorax on February 5th, 1985. His serial chest X-ray films showed a migratory solitary shadow. Both peripheral blood eosinophil counts and serum IgE values were elevated. The diagnosis of paragonimiasis westermani was confirmed by immunoserological examination (Ouchterolony test) and ova detected from sputum, stool and bronchoalveolar lavage fluid.
Cases of Paragonimiasis reported in Japan for the last 15 years were reviewed. They consisted of 47 cases of paragonimiasis westermani and 96 cases of paragonimiasis Miyazakii. The frequency of both types of paragonimiasis remained unchanged for these 15 years. Cases of paragonimiasis westermani frequently showed neurological abnormalities and rarely showed pneumothorax, although the present case also showed the latter repeatedly. On the other hand, cases of paragonimiasis Miyazakii often showed pneumothorax and pleural effusion, but seldom showed other signs.

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A case of malignant mesothelioma caused by exposure to asbestos is presented in terms of the clinical findings and pathology. The patient had worked in an atmosphere containing asbestos bodies. In the chest X-ray, a bulky mass was present in the left lung field with thickening of both pleura and calcifications in both pleura and the upper diaphragm. The histology of this tumor showed biphasic malignant mesothelioma. Many asbestos bodies were found in the autopsy lung.
It was concluded that this case was caused by exposure to asbestos bodies.

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A 47 year-old man suffered massive hemoptysis three years after healing of pulmonary tuberculosis with diabetes mellitus, and was admitted as an emergency case. A chest roentogenogram on admisson showed a tumor-like shadow in the right hilum, and lung cancer was strongly suspected. Massive coagula were expectorated after a few days, and the shadow disappeared. Further examinations showed that hemoptysis was caused by pulmonary Aspergillosis in the cavity, and the shadow was considered to have been formed by the coagula. Angiography revealed that the cause of bleeding was a shunt between the right bronchial artery, pulmonary artery and the internal thoracic artery.

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