Recently, chest surgical procedures are frequently performed in aged patients because of increased carcinomas of the lung. Reliable circulation monitors are indispensable at the bedsides of patients in order to prevent severe postoperative complications. In 46 patients with chest diseases, pulmonary arterial wedge pressure(PAW), pulmonary artery pressure (PAP), central venous pressure (CVP) and cardiac index (CI) were routinely monitored for evaluation of hemodynamics using a Swan-Ganz flow-directed catheter during the operation and postoperatively. In patients 60 years of age and over neither PAW and PAP showed remarkable changes pre- and postoperatively in comparison to CVP.
In patients 59 years of age or under, PAW, PAP and CVP did not show particular changes in pre- and postoperatives course. In patients 60 years of age and over who received pulmonary lobectomy, PAW and PAP paralelled hemodynamic changes while CVP showed a lower figure postoperatively. In patients 59 years of age or under, CVP reflected intravascular blood volume and hemodynamics fairly well. From these studies, the author could state that when PAW is over 15mmHg or PAP is over 25mmHg, a hypervolemic situation may exist, and when PAW is less than 5mmHg or PAP is less than 10mmHg, hypovolemia may exist. The correlation between CVP and intravascular blood volume might be poor in aged patients after thoracotomy. It is considered that PAW, PAP and CI are the best means to evaluate the restoration of fluid volume postoperatively.

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There have been many attempts to induce lung cancer in dogs through the intrabronchial application of various carcinogens in order to elucidate the pathogenesis and development of human lung cancer, however rates of induction have been negligible. The author succeeded in inducing lung cancer in dogs with a high rate of success by intrabronchial application of 20-methylcholanthrene (20-MC), and in this paper discusses the characteristics of the induced tumors. 10mg of 20-MC was instilled weekly in the right diaphragmatic lobe bronchus of adult mongrel dogs, for periods of over two years.
Lung cancer was induced in eight out of ten dogs, and the carcinogenetic treatment was continued for 29 to 51 months. Total dosages of 20-MC ranged from 12.0 to 19.4gm. Two cases were diagnosed clinically, three died after developing chronic cough and emaciation and the other three cases under anesthesia during the experiment. The rate of tumor development in this experimental series was much higher than the rate of lung cancer developing spontaneously in dogs. Four of the dogs were seen to have a single solid nodule, one had an infiltrative tumor, two had two tumors and one had a tumor with cavity formation. Metastases to the tracheobronchial lymp nodes were seen in five cases, the bifurcative lymph nodes in three and the paratracheal lymph nodes in three. However no hematogenous metastasis or distant lymphnode metastasis such as can be seen spontaneous in cases of canine lung cancer, was observed.
All tumors developed in the periphery of the lung, and no tumor developed in the large bronchi. The reason for this is that the 20-MC was instilled in peripheral bronchi. Histologic examination revealed squamous cell carcinoma in three, adenocarcinoma in three and combined adeno and squamous cell carcinoma in two cases. There was no case of undifferentiated cell carcinoma, which is often seen in dogs which spontaneously develop lung cancer, and this may be due to the limited number of experimental subjects. Furthermore, the author included cases in which large cell carcinoma features could be seen in the category of combined adeno and squa mous cell carcinoma because they also included features such as tubular formation keratinization or intercellular bridges. Concerning the carcinogenetic process of peripheral type lung cancer, a denomatous hyperplasia first appeared in the columnar or cylindrical epithelium after application of the carcinogens, and increasingly atypical cells grew before the appearance of the carcinoma cells. During the process, the tumor cells differentiate to adenocarcinoma or squamous cell carcinoma at some point. There was no case of squamous cell carcinoma derived from the squamous cells of the bronchial epithelium, because mucin producing cells could be observed in the squamous cell carcinoma lesions by periodic acid-schiff and Alcian blue stain. There was no case of bronchiolo-alveolar carcinoma in this series, and this may be due to differences in the lung structures of humans and dogs. The author suggests that this research and experimental study has great value concerning basic and clinical studies of human lung cancer.

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Postmortem autolytic changes mainly attributable to the long interval between death and autopsy interfere with electron microscopical research on the human lungs. In order to resolve these difficulties, the transthoracically induced fixation method described by Bachofen et al, was studied.
0.5ml of 2.5% glutaraldehyde was injected into the lungs of rats by transthoracic route without opening the chest immediately after death obtained by administration of overdose of pentabarbiturate then the cadavers were kept in an oven at 30°C. At intervals for up to 20 hours after death, several cadavers were withdrawn and the lungs were removed en bloc Lung tissues into which transthoracically injected fixative permeated were diced, immersed in the same fixative, and postfixed in 1% OsO4. Then the pieces were embedded in Epon 812, and ultrathin sections were observed with a transmission electron microscope. Tissues into which fixative was not injected, were also treated in the same way.
In the tissues into which the fixative permeated, pneumocytes and endothelial cells of alveolar capillaries were well preser ed despite exposure to high temperature for up to 20 hours except for sporadic appearance of dilated endoplasmic reticulum and localized edematous swelling of cytoplasm. On the other hand, the cells in non-permeated lung tissues showed increasing severity of alterations with the passage of time after death, dilated endoplasmic reticulum one hour post mortem, disrupted cytoplasmic membrane after four hours and complete loss of the cell structures after 20 hours were observed.
These facts showed that the transthoracic injection of fixative into the human lungs immediately after leath should be very effective to prevent postmortem autolytic alterations and supply well preserved lung tissues or ultrastractural studies despite long periods between death and autopsy.

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Reports of pneumocystis carinii pneumonia have increased in the past several years. Only five cases were diagnosed in their lifetime in Japanese literature though the importance of rapid diagnosis is obvious.
In eight patients suspected of pneumocystis carinii pneumonia, percutaneous needle aspiration biopsy was performed with or without fluoroscopic guidance and of these three cases were performedat the bedside.
Causative organisms were recovered from smears obtained by this method in five cases. Two positive cases were cured with drug therapy. Complications included three pneumothorax and one subcutaneous emphysema but none were serous. Tube drainage was performed in two cases.
Percutaneous needle aspiration biopsy for pneumocystis carcinii pnumonia is a good diagnostic procedure for the following reasons.
1. High ratio of detection of causative organisms.
2. Few technical problems and possibility of bedside procedures.
3. Indicated for all ages.
4. Fewer complications in comparison with other procedures.

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A case of primary macroglobulinemia with lung involvement was reported. The patient, a 30 year-old male, was admitted to our hospital because of cough and weight loss. His chest X-ray showed left pleural effusion and an abnormal shadow in the right lung field. Protein fraction studies of plasma and pleural fluid revealed a monoclonal M band which was identified as IgM-K type by immunoelectrophroresis. Cytologically, there were many abnormal lymphocytoid and plasmacytoid cells in the pleural fluid. These abnormal cells stained positively with fluorescein-conjugated antisera to K-chains, μ-chains and to both. Diagnosis of primary macroglobulinemia was made, although there was no lymphoadenopathy, anemia, hepatosplenomegaly and hyperviscosity syndrome. Abdominal lymphography showed no abnormalities.
From these findings, we concluded that the macroglobulinemia in this case originated from and was confined to the pleuropulmonary lesion.

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A 23 year old woman who had high fever, frequent cough and sputum, showed abnormal shadows on her chest roentgenogram.
A diagnosis of pneumonia was first entertained but the lesions did not respond to the antibiotics and steroid hormones. She gradually developed respiratory insufficiency and expired 18 days after admission.
At autopsy, the pulmonary lesions was proved to be a widespread ulcerative granulomatous inflammation with cavity formation and necrotizing or granulomatous panagitis in many organs were also noted.

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