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A 48-year-old man with dyspnea, cough, and fever was found to have a diffuse ground-glass pulmonary lesion without lymphadenopathy on chest X-ray. The lesion shifted to the peripheral lung zones 2 months later when transbronchial biopsy demonstrated noncaseating granulomas with Langhans type giant cells. After 6 more months, prominent bilateral hilar lymphadenopathy and highly elevated serum angiotensin-converting enzyme confirmed the diagnosis of pulmonary sarcoidosis. Such a course is quite rare in that it goes the opposite way of the conventional staging system.

結核対策はまず感染性結核患者の早期発見と迅速適正な医療が必須であるが,感染して発病のリスクが高い集団における発病予防もきわめて重要である.それには, BCG接種と化学予防があり,後者は既感染者で発病の危険性が高い者に対して抗結核薬INHを投与して発病を防止するものである.結核発病阻止率でみた化学予防の有効性は,内外で報告されているが,その適応,服薬法,副作用を知り,過不足のない対応が必要である.

A53-year-01d woman who was hypoxemic due to primary lung adenocarcinoma with both pleuritis and pericarditis carcinomatosa was treated with gefitinib，an inhibitor of the epithelial growth factor receptor (EGFR) tyrosine kinase.The tumor seemed to produce mucin because the extremely high serum KL-6 and almost normal Sp-D values on admission.After 3 days of treatment，the patient became asymptomatic and oxygen was discontinued.The response to this drug was remarkable on chest CT findings.Mucin overproduction could offer a candidate marker to determine the patient subset displaying good responseto gefitinib.

Dose-related curves of the airway responses to Methacholine by Astograph are frequently biphasic. That is, respiratory resistance (Rrs) increases slowly at first and rapidly after that. We proposed (-dGrs/dt)/Grs obtained by using Astograph as an index of dynamic property of the airway, which we suggested was related to a coefficient of the contraction or dilatation of the airway. Grs represents respiratory conductance. By calculating (-dGrs/dt)/Grs, we found that biphasic dose-related curves were composed of the slow and subsequently rapid contraction of the airways. And by mathematical analysis, we found that all segments of the airway contracted simultaneously at a uniform velocity. The combination of slow and rapid contraction explains three types of the airway responses, that is, the monophasic reactivity of the airway with slow contraction, the monophasic reactivity of the airway with rapid contraction and the biphasic reactivity of the airway with slow and subsequently rapid contraction. We found that the frequency of the monophasic reactivity of the airway with slow contraction was significantly higher in patients with COPD than in healthy subjects or in patients with mild asthma. But there was no significant difference in (-dGrs/dt)/Grs values among healthy subjects, patients with mild asthma and patients with COPD.

Effects of acute, progressive isocapnic hypoxia on heart rate (HR) and ventilation were determined in 31 patients with chronic obstructive pulmonary disease (COPD) and in 24 normal control subjects. There was an inverse linear relationship between heart rate and SaO2 in each subject. The slope factor (delta HR/delta SaO2) obtained from the regression line was significantly higher in the patients with COPD than in the normal control subjects (0.888 +/- 0.309 SD beats/min/% fall in SaO2 versus 0.693 +/- 0.287; p less than 0.05), whereas the ventilatory response (delta VE/delta SaO2) was not significantly different between the two groups. To elucidate factors responsible for the augmented heart rate response to hypoxia in the patients with COPD, we examined the relationships of delta HR/delta SaO2 with age, physical characteristics, pulmonary function data, and arterial blood gas data in all the subjects. A weak but significant relationship was found only between delta HR/delta SaO2 and FEV1/VC, %FEV1, RV/TLC, and %RV. Because the HR response to hypoxia correlates only with parameters that reflect the grade of airway obstruction, we believe that the enhanced HR response seen in patients with COPD is a result of the disease process in the airway and tissue, although the precise mechanism was not specified in this study.

A 50-year-old man was referred and admitted to our hospital because of pneumonia and pleuritis. The patient had attempted suicide by inhaling automobile exhaust 3 years ago. Carbon monoxide intoxication had caused persistent disturbance of consciousness and quadriplegia. He had been tracheostomised and under nutrition by percutaneous endoscopic gastrostomy. On admission the presence of left pleural fluid with thickening of the pleura was shown on computed tomography. Thoracocentesis produced suppurative fluid with Actinomyces species nova identified by the 16S rRNA method. The patient was successfully treated with antibiotics and drainage of suppurative fluid.

The ventilatory response to hypercapnic progressive hypoxia and the breathing pattern during steady-state hypercapnic hypoxia were compared before and after intravenous infusion of 3 mg of naloxone in a relatively large number of healthy adults (n = 21). In addition, the withdrawal response from hypercapnic hypoxia (modified transient O2 test) was measured to investigate the possible role of endogenous opioids in the peripheral chemoreceptors. The average ventilatory response (delta VE/delta SaO2) increased significantly from 0.51 +/- SD 0.26 to 0.65 +/- 0.42 L/min/% (p less than 0.05) after naloxone infusion, whereas there were no significant changes between two tests with normal saline in the control study (n = 7). Because there was considerable interindividual variation in the response to naloxone administration, we selected "high responders" (n = 8) who showed larger increases with naloxone than the upper limit of the 95% confidence interval for the change with the second saline in the control study. They showed greater delta VE/delta SaO2 (p less than 0.01), respiratory frequency (p less than 0.01), and mean inspiratory flow (p less than 0.01) during hypercapnic hypoxia before naloxone infusion than did the other subjects. There was no significant change in the withdrawal response before and after naloxone infusion, even in such high responders. We conclude that endogenous opioids participate in the control of breathing in normal adults during hypercapnic hypoxia. This may be particularly true for those subjects who exhibit greater chemosensitivity to hypercapnic hypoxia. Endogenous opioids appear to act centrally rather than peripherally.

Isolates of M. tuberculosis were analyzed for their DNA fingerprints to facilitate understanding of ongoing transmission of tuberculosis in Sapporo (population 1.87 million), Japan, where the incidence rate of tuberculosis was 15.0 per 100,000 in 2004.Out of all tuberculosis patients registered in the city from November 1998 to December 2003, isolates from culture-positive respiratory tuberculosis cases for whom written informed consent had been obtained, were analyzed by restriction fragment length polymorphism (RFLP). The study included 345 cases (249 men and 96 women) whose isolates were available for DNA patterns.Using standard IS6110-RFLP typing, cases whose isolates shared identical fingerprints were considered to belong to the same cluster. Proportions of clustered cases were evaluated according to their clinical and socio-economical characteristics.Out of 345 cases, 207 (60.0%) were classified into 59 clusters, and 15% of clustered cases having definite epidemiological links. Multiple logistic regression analysis in men showed that age and infectiousness were significantly related to clustering. The adjusted odds ratios (OR) [95% confidence intervals (CI)] were 0.17 [0.03-0.79] for 30-59 years, 0.15 [0.03-0.69] for 60 years or over and 2.35 [1.17-4.70] for those cases assigned as the highest level of transmission of tuberculosis from the infectiousness index of cases. For women the final model showed the adjusted OR [95% CI] were 0.52 [0.22-1.22] for those with previous history of tuberculosis and 0.33 [0.06-1.85] for diabetics. In male cases with a previous history of tuberculosis, most highly infectious cases were significantly associated with clustering (OR [95% CI], 4.53 [1.16-17.68]).The results suggest that highly infectious male tuberculosis cases with endogenous reactivation have contributed to recent transmission of tuberculosis in the studied area.

To find a new method to predict the result of the egg based Ogawa medium using the Mycobacterium Growth Indicator Tube (MGIT) system and to evaluate the usefulness of a new discharge criterion that uses the new prediction method for smear positive pulmonary tuberculosis patients.We compared mycobacterial growth of sputum specimens weekly between the Mycobacterium Growth Indicator Tube (MGIT) and the egg based Ogawa solid media, using a total of 3952 sputum specimens of patients with pulmonary tuberculosis (TB) who underwent chemotherapy in our hospital from September 2001 to March 2006 to find relationship between the results of the two culture methods and to utilize the findings to new discharge criteria of pulmonary TB patients. And we compared the duration of hospitalization between two patients' group: one group using the new discharge criterion, the other the old one.We found that if a specimen shows negative culture on the MGIT system within the first two weeks, the same specimen shows negative or scant growth on the Ogawa media in the 8th week. Introducing this fact as a part of new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened from 121 days to 71 days and no patient showed treatment failure.We have used the result of sputum culture on Ogawa medium as a standard when we judge infectivity of patients with pulmonary tuberculosis in Japan, but it was one of the reasons why Japanese pulmonary tuberculosis patients stay long in TB hospital. Using our finding, we can predict the results of Ogawa system six weeks earlier, when a specimen shows negative culture on the MGIT system in the first 2 weeks. After we introduced this fact into new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened and no patient shows treatment failure until now. We highly recommend the usefulness of the MGIT system (especially when a specimen shows negative growth in the first two weeks) as a reliable method of predicting infectivity of patients with pulmonary tuberculosis and propose that the new TB discharge criterion should be widely confirmed and used in other hospitals.

肺内結核腫は結核性胸膜炎の治療開始2～4カ月後に, 稀に出現する肺内結節状陰影である. いわゆる初期悪化の1種で抗結核剤を継続すると次第に縮小する. 肺CTでは胸膜病変と, それに連続した肺内病変がみられ, 内部に低吸収域を認めることが多い. 今回経過を観察しえた2症例で病変は胸膜から始まって次第に肺内へと進展した. 発生機序として肺内の微小病変からの初期悪化とする説があるが, それとは異なる機序が推察された.

We propose (-deltaG(rs)/deltat)/G(rs) obtained from Astograph as an index of dynamic property of the airway. G(rs) represents respiratory conductance. Fluid mechanics suggests that (- deltaG(aw)/deltat)/G(aw) is related to a coefficient of airway contraction or dilatation. G(aw) represents airway conductance. R(rs) (=1/G(rs)) is approximately equal to R(aw) (=1/G(aw)) + Constant. R(rs) and R(aw) represent respiratory and airway resistance, respectively. As R(rs) is thought to be closely correlated to R(aw), G(rs) should be correlated to G(aw). Thus, if G(rs) is used as a substitute for G(aw), (-deltaG(rs)/deltat)/G(rs) should also be related to a coefficient of airway contraction or dilatation. We found that asthmatics had significantly higher (-deltaG(rs)/deltat)/G(rs) than normal subjects. That is, the airway smooth muscles of the asthmatics are more contractive than those of normal subjects.

A 76-year-old man with a history of pulmonary tuberculosis was found to be sputum smear positive for acid-fast bacilli. The 16S rRNA sequence identified the culture isolate as Mycobacterium intermedium , the pathogenicity of which has not been confirmed. Chemotherapy with isoniazid, rifampin, and ethambutol resulted in clinical improvement.

The suppositories of rifampicin (RFP) containing sodium para-aminosalicylate dihydrate (PAS-Na) were prepared in order to enhance the rectal absorption of RFP. By the addition of PAS-Na, the in vitro release of RFP from the suppositories was enhanced and the hardness of the suppositories decreased. The rectal absorption of RFP from the suppositories containing no PAS-Na (control suppositories) was significantly lower compared to oral administration of it (26%) in human subjects. When PAS-Na was added to the suppository (300 mg), both the area under the plasma concentration-time curve (AUC) and the maximum plasma concentration (Cmax) increased significantly compared to those of the control suppositories. The rectal absorption of PAS-Na itself from the suppositories seemed to be fast. PAS-Na might increase the absorption of RFP dissolved in the rectal fluid from the suppositories, but not affect the undissolved RFP.

BACKGROUND: It is known that theophylline reduces cerebral blood flow in humans. To quantitatively assess the possible adverse effect of theophylline on brain tissue oxygen tension (PO2) due to decreased cerebral blood flow, two sets of experiments were conducted in mildly hypoxaemic patients with chronic obstructive lung disease. METHODS: Firstly, internal jugular venous PO2 (PjO2) was measured simultaneously with arterial and mixed venous blood PO2 (PaO2 and PvO2) during right heart catheterisation in 10 subjects (mean PaO2 73 mm Hg; conversion factor: 10 mm Hg = 1.33 kPa)) before and after intravenous infusion of aminophylline (6 mg/kg). The PjO2 and PvO2 were considered to reflect the average tissue PO2 for the brain and for the whole body respectively. Secondly, the relation between PaO2 and PjO2 over a wide range, with the PaCO2 similar to that in the first study, was investigated in a different group of 12 subjects by stepwise changes in inspiratory gas composition. RESULTS: The mean PjO2 decreased by as much as 6 mm Hg 15 minutes after an infusion of aminophylline, whereas PaO2 stayed at the same level and PvO2 showed only a small decrease. The low PjO2 value of 29 (SD 6) mm Hg with aminophylline in the first study was similar to the PjO2 value of 30 (2) mm Hg obtained during severe hypoxia (PaO2 45 mm Hg) in the second study. The coefficient of oxygen delivery for the brain decreased by 29% with aminophylline treatment, but did not change significantly during severe hypoxic challenge. CONCLUSIONS: These data suggest that an infusion of aminophylline lowers brain tissue PO2 appreciably when given to mildly hypoxaemic patients with chronic obstructive lung disease.

The ability to detect added resistance at rest was compared to the magnitude of breathlessness (evaluated by a modified Borg scale) during bronchoconstriction in 27 stable asthmatics. Threshold for resistive load detection was analyzed in terms of the Weber fraction (delta R/R0) and mouth pressure (P) at the threshold. Bronchoconstriction was induced by inhalation of aerosolized acetylcholine. Both delta R/R0 and P correlated inversely with the Borg score during bronchoconstriction (r = -0.537 and r = -0.689, respectively; p less than 0.01). On the other hand, during bronchoconstriction the Borg score did not correlate with increased lung volume, acute changes in arterial blood gas composition and drive and timing component of ventilation during bronchoconstriction, although bronchoconstriction caused significant changes in these variables. These results indicate that central processing of afferent stimuli rather than peripheral sensor contribute both to the ability to detect added resistance at rest and to the magnitude of breathlessness during bronchoconstriction in asthmatics.

In 58 patients with chronic obstructive pulmonary disease, pulmonary gas exchange efficiency was assessed by the ratio: arterial to mixed venous PO2 difference (efficient part) versus alveolar to mixed venous PO2 difference (driving pressure for O2 transport). Patients with PaO2 below 75 mm Hg had a ratio lower than 50%. Patients with PaO2 below 60 mm Hg had lower values for arterial to mixed venous O2 content difference and higher blood lactic acid concentration than patients with PaO2 over 60 mm Hg. Arterial to mixed venous PO2 difference decreased linearly against PaO2 till PaO2 reached 60 mm Hg from which the difference began to attenuate. These figures in PaO2 are in close agreement with the criteria for pulmonary failure presented by the Ciba guest symposium (PaO2 below 75 mm Hg) and for respiratory failure by the National Heart, Lung and Blood Institute (PaO2 below 60 mm Hg).

α1アンチトリプシン欠乏症(α1ATDと略)は本邦では非常に希な疾患で, 5家系の報告があるにすぎない.大橋ら(1978年)により報青された世界で4家系のみのPinu1l家系の一家系を追跡調査中に,肺気腫,肺小細胞癌を合併し経過中著しい高LDH血症を呈した症例を報告した.症例は69才,男性. Warthin腫瘍の既往があり,重喫煙者であつた.入院時,左S6域に腫蕩を認め諸検査から肺小細胞癌(中間細胞型)と診断した.手術摘出,放射線照射,化学療法により治療開始したが,約15カ月の延命に留まつた.手術時残存肺に気腫性変化を確認し,剖検肺からも混合性肺気腫(PE+CE)を認めた.血清LDH値は臨床経過に推移して変動し,最高17820WUを記録した.

To assess the effect of brain blood flow on hypoxic ventilatory response, we measured arterial and internal jugular venous blood gases and ventilation simultaneously and repeatedly in eight healthy male humans in two settings: 1) progressive and subsequent sustained hypoxia, and 2) stepwise and progressive hypercapnia. Ventilatory response to progressive isocapnic hypoxia [arterial O2 partial pressure 155.9 +/- 4.0 (SE) to 46.7 +/- 1.5 Torr] was expressed as change in minute ventilation per change in arterial O2 saturation and varied from -0.16 to -1.88 [0.67 +/- 0.19 (SE)] l/min per % among subjects. In the meanwhile, jugular venous PCO2 (PjCO2) decreased significantly from 51.0 +/- 1.1 to 47.3 +/- 1.0 Torr (P less than 0.01), probably due to the increase in brain blood flow, and stayed at the same level during 15 min of sustained hypoxia. Based on the assumption that PjCO2 reflects the brain tissue PCO2, we evaluated the depressant effect of fall in PjCO2 on hypoxic ventilatory response, using a slope for ventilation-PjCO2 line which was determined in the second set of experiments. Hypoxic ventilatory response corrected with this factor was -1.31 +/- 0.33 l/min per %, indicating that this factor modulated hypoxic ventilatory response in humans. The ventilatory response to progressive isocapnic hypoxia did not correlate with this factor but significantly correlated with the withdrawal test (modified transient O2 test), which was performed on a separate day. Accordingly we conclude that an increase in brain blood flow during exposure to moderate hypoxia may substantially attenuate the ventilatory response but that it is unlikely to be the major factor of the interindividual variation of progressive isocapnic hypoxic ventilatory response in humans.

Minute ventilation (VE) during sustained hypoxia is not constant but begins to decline within 10–25 min in adult humans. The decrease in brain tissue PCO2 may be related to this decline in VE, because hypoxia causes an increase in brain blood flow, thus resulting in enhanced clearance of CO2 from the brain tissue. To examine the validity of this hypothesis, we measured VE and arterial and internal jugular venous blood gases simultaneously and repeatedly in 15 healthy male volunteers during progressive and subsequent sustained isocapnic hypoxia (arterial PO2 = 45 Torr) for 20 min. It was assumed that jugular venous PCO2 was an index of brain tissue PCO2. Mean VE declined significantly from the initial (16.5 l/min) to the final phase (14.1 l/min) of sustained hypoxia (P less than 0.05). Compared with the control (50.9 Torr), jugular venous PCO2 significantly decreased to 47.4 Torr at the initial phase of hypoxia but did not differ among the phases of hypoxia (47.2 Torr for the intermediate phase and 47.7 Torr for the final phase). We classified the subjects into two groups by hypoxic ventilatory response during progressive hypoxia at the mean value. The decrease in VE during sustained hypoxia was significant in the low responders (n = 9) [13.2 (initial phase) to 9.3 l/min (final phase of hypoxia), P less than 0.01], but not in the high responders (n = 6) (20.9–21.3 l/min, NS). This finding could not be explained by the change of arterial or jugular venous gases, which did not significantly change during sustained hypoxia in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Whether reversibility in airway obstruction with β-adrenergic stimulant is a significant determinant for the outcome was tested in 59 patients with pulmonary emphysema and chronic bronchitis. During four years of follow-up, 43 (73 percent) patients survived and 16 (27 percent) died. Initial VC, FVC, FEV 1 , and PaO 2 were significantly smaller, and PaCO 2 was significantly larger in nonsurvivors than those in survivors. After orciprenaline sulfate (10 mg in 0.5 ml solution) inhalation, VC and FEV 1 increased in comparable amount between the two groups. Airway reversibility as estimated by percentage changes in FEV 1 before and after the bronchodilator (reversibility index) was similar between the two groups. In the 16 nonsurvivors, hypoxemic patients had similar FEV 1 , FEV 1 /FVC, and reversibility indices as normoxemic patients. These results indicate that not airway reversibility per se but a fixed or irreversible component of airway obstruction is one of the determinants of the prognosis in pulmonary emphysema and chronic bronchitis. Chronic hypoxemia is related to neither airway obstruction nor its reversibility, while it does influence the prognosis.

Whether or not serum selenium and vitamin E (alpha-tocopherol) concentrations were changed was examined among healthy families of lung cancer patients. Family members as a whole (115 sons and daughters of 55 patients with primary lung cancer) were found to have a trend to lower serum selenium levels (0.116 +/- SD 0.024 microgram/ml, 0.05 less than P less than 0.1). Particularly among families of adenocarcinoma patients, the mean level was significantly lower (0.111 +/- 0.019 microgram/ml, P less than 0.05) than that (0.122 +/- 0.014 microgram/ml) in age-ratio matched controls who did not have cancer patients among their second-degree relatives. Serum vitamin E levels (11.85 +/- 2.85 micrograms/ml) were significantly lower among family members of adenocarcinoma patients than the controls (14.1 +/- 3.1 micrograms/ml, P less than 0.01). Serum selenium and vitamin E levels were significantly lower in lung cancer patients (n = 37, mean age, 63.9 +/- 11.2 yr) than in the controls (P less than 0.001). These data suggest that there are familial factors in serum selenium and vitamin E levels among families of lung cancer patients.

例は28才の男性で, I型糖尿病患者である.経過13年にわたり不定期であるがインスリン治療を続けていた.右下肢の血栓性静脈炎を発症し当科に入院した.入院時に糖尿病性眼症(Scott Vb),糖尿病性腎症,糖尿病性神経障害などの合併症を認めた.なかでも,起立性低血圧,神経因性膀胱,インポテンス,筋緊張性瞳孔などの自律神経障害が著明であつた.また,脳CTスキャンで脳皮質・脳幹部に萎縮所見を認めた.入院中に血栓性静脈炎が原因と考えられる肺塞栓症を突然発症した.また第37病日に低血糖症状にひきつづいて心停止がおこつた.高度の自律神経障害のある糖尿病患者に突然心停止のおこることは最近注目されており,原因は心臓を支配する自律神経の調節失調と推定されている.本症例でも心血管系に基礎疾患を認めないことより,この心停止は高度の自律神経障害のあるためにおきたと考えた.炭酸ガス濃度を一定にした条件下で吸気の酸素濃度を低下させると,この患者は正常成人とは反対に換気量が減少した.この現象をhypoxic depressionという.このためにこの現象をもつ人にとつて,心不全や呼吸不全などの低酸素血症に陥りやすい疾患は致命的である.また高度の自律神経障害をもつ糖尿病患者は, hypoxic depressionを合併している可能性があるので,重篤な糖尿病患者の治療の際には呼吸状態の観察も重要であると思われる.

Factors affecting erythrocyte K+ content and plasma electrolytes during light exercise were examined in 8 normal subjects and 27 patients with chronic obstructive lung disease. The patients were classified into bronchitis, emphysema and intermediate groups. Arterial blood was obtained during rest, after 2, 5, and 7 min. of exercise on a bicycle ergometer (30 km/h without mechanical brake), and at 10 and 20 min. during recovery for analysis of PO2, PCO2, plasma H+, Na+, K+, and Cl(-), erythrocyte K+ content and whole blood lactate. Plasma H+ increased significantly in all subjects after 2 min. of exercise and PCO2 rose in normal, bronchitis, and emphysema groups during exercise, whereas PO2 did not change significantly. Plasma K+ rose promptly after the beginning of exercise and remained at high values during exercise. The rapid rise in PCO2 was associated with a significant decrease of calculated erythrocyte K+ in patients with chronic bronchitis. Although changes in plasma H+ were dependent on both PCO2 and lactate, erythrocyte K+ changes were significantly related only to changes in PCO2. These results indicate that the decrease in erythrocyte K+ is mainly controlled by changes in arterial PCO2 during light exercise in patients with chronic bronchitis.

肺癌患者家族の血清中セレン, ビタミンE (αトコフェロール) およびビタミンA (レチノール) 値に家族性因子があるかどうか検討した. 肺癌患者家族115例の血清セレン値0.116±0.024μg/ml (±S.D.) は対照群 (2親等以内に癌疾患のなv健康人で, 年令, 性構成は家族群と一致) 0.122±0.014μg/ml より低い傾向を示し (P

Summary We describe herein a newly defined pulmonary tumor presenting as an irregular shaped nodule in the peripheral lung, arising in a 62-year-old man. Histologically, the tumor showed papillary configuration, bronchioloalveolar spread, and a mucus lake, consisting of ciliated columnar cells and goblet cells with basaloid cell proliferation. The tumor was diagnosed as ciliated muconodular papillary tumor of the peripheral lung.

The presence of chronic hypoxia in peripheral tissue in patients with chronic obstructive pulmonary disease (COPD) is one of the major factors leading to a poor prognosis (Kawakami et al., 1983) If hemoglobin-oxygen affinity can be reduced by pharmacological agents, oxygen delivery to the tissues should be improved in mild hypoxemia. We examined the effects of three agents on hemoglobin-oxygen affinity in vivo and in vitro. The first is pentoxifylline which is a xanthine derivative and has the effect of improving capillary circulation’ and increasing intracellular ATP (Ohshima and Sato, 1981; Stefanovich, 1975). The second was coenzyme Q10 (CoQ10) which improves oxygen utilization in ischemic heart muscles (Mochizuki et al., 1980). The third was calcium hopantenate which increases glucose utilization in brain tissues (Tamura et al., 1986).

In 11 normal subjects (mean age = 22.8 years) and 8 patients with pulmonary emphysema (mean age = 70.4 years), the role of chemosensitivity in determining ventilation, cardiac output, lactic acid, and cyclic AMP and GMP was evaluated quantitatively during 150 or 30 W exercise and simulated exercise. Simulated exercise was done while the subjects took a rest by regulating arterial blood gases at exercise levels in patients and at PaO2 = 65 mm Hg and PaCO2 = 48 mm Hg in normal subjects. In normal subjects, the role of arterial blood gases in determining exercise ventilation, cardiac output, cyclic AMP and GMP are large, while those contributed much less to lactic acid. In patients, PaO2 contributed only half of the exercise ventilation. It accounted for a negligibly small portion of exercise cardiac output, lactic acid, and cyclic GMP. These results indicate, by deduction, that either augmentation of chemosensitivity, pH, or humoral factors is responsible for about half of the changes of exercise ventilation in patients with pulmonary emphysema. These factors seem to influence cardiac output, lactic acid, and cyclic AMP and GMP more strongly than PaO2 alone in exercising patients.

The ventilatory response to isocapnic progressive hypoxia and hyperoxic progressive hypercapnia in 24 diabetic patients were compared with those of sex and age matched normal control subjects. The heart rate response to hypoxia was also measured in both groups. In diabetic patients the ventilatory and heart rate responses to hypoxia were significantly lower than those in the control group (0.10 v 0.24 l/min/% fall/m2 and 0.5 l v 1.27 beats/min/% fall respectively). The ventilatory response to hypercapnia was significantly higher (1.09 v 0.76 l/min/mm Hg/m2) in the diabetic patients. There was a significant correlation between the hypoxic ventilatory response and the heart rate response in diabetic patients (r = 0.56), but not in the control group (r = 0.28). In addition, both the ventilatory and the heart rate responses to hypoxia in diabetic patients had weak but significant correlations with the heart rate variation during deep breathing. It is concluded that the ventilatory and heart rate responses to hypoxia in diabetic patients are impaired, whereas the ventilatory response to hypercapnia is well preserved.

It is well known that tissue hypoxia is an important prognostic predictor in patients with respiratory failure especially in acute exacerbation. It can occur for a number of reasons such as hypoxemia, peripheral circulatory disturbance, malfunction of the hemoglobin, and disturbance of oxygen supply to the tissue. Compensatory responses to acute hypoxia occur in various organs and the magnitude of such response is also an important factor in prognosis. In the circulatory system, cardiac blood flow and output together with heart rate and systemic blood pressure, all increase although the magnitude of these responses may be affected by age, the nature of the disease, severity, and so on. Whether differences in oxygen supply to the tissue under stable conditions affect the magnitude of response is as yet unknown.

気管支喘息患者35例,家族に気管支喘息あるいはアレルギー性疾患を有しない健常人9例および気管支喘息患者の兄弟姉妹17例について,気道過敏性検査あるいは血清IgEレベルを検討した.その結果,喘息患者の兄弟姉妹の3例に血清IgEの高値が認められ,全てアトピー性喘息患者の兄弟姉妹であった.気道過敏性は健常人では認められなかつたが,喘息患者の兄弟姉妹の5例に軽度認められ, 1例がアトピー性喘息患者の兄弟姉妹で, 4例が非アトピー性喘息患者の兄弟姉妹例であった.以上の成績から,喘息患者の気道過敏性の亢進には,家族性因子が存在することが示唆された.

右肺動脈上行大動脈起始症(origin of the right pulmonary artery from the ascending aorta)は右肺動脈が上行大動脈より直接分岐する先天性奇形であり,しばしば動脈管開存症を合併している.本症は比較的希な奇形であり,欧米では40例前後,本邦では9例の報告があるにすぎない.本邦例のうちそのほとんどが小児例であり,本例は25才であることから本邦最年長例と思われる.本例は右心カテーテルおよび逆行性火動脈造影にて右肺動脈が完全に欠損し,上行大動脈より直接分岐していることを確認した.本例はRosenbergの分類のtype IIである.さらに本例の臨床的所見について述べ,本症の発生学的要因および血行力学的状態についての文献的考察も行なつた。なお本例は現在経過観察中である.

To examine possible genetic influence on the sensation of dyspnea and on load compensation, we conducted a twin study using healthy adult pairs (10 monozygotes, MZ, and 9 dizygotes, DZ). The ventilatory response to progressive hypercapnia (HCVR) was examined under three different conditions: hyperoxia (PETO2 > 150 mm Hg), hypoxia (PETO2 maintained at 50 to 55 mm Hg), and hyperoxia with an inspiratory flow-resistive load (17 mm H2O/L/s), with simultaneous assessment of the dyspnea sensation by visual analog scale (VAS). Although the VDZ/VMZ ratio (VMZ and VDZ are within-pair variances in MZ and DZ, respectively) for the slope value of the minute ventilation-PETCO2 regression line was not different from 1 in hyperoxia either with or without an inspiratory load, it was significantly larger than 1 in hypoxia (F = 5.17, p < 0.05), suggesting that a genetic influence on HCVR existed only in the presence of hypoxia. During 3% CO2 inhalation, the VDZ/VMZ ratio for the tidal volume (VT) was larger than 1 in hyperoxic HCVR with loading (F = 7.89, p < 0.01), and that for respiratory frequency (f) was larger than 1 only in hypoxic HCVR (F = 3.59, p < 0.05). At a PETCO2 of 55 mm Hg, the VT ratio was larger than 1 under all conditions (F = 5.91, p < 0.05; F = 6.99, p < 0.05; F = 3.75, p < 0.05; respectively), and the f ratio was significantly larger than 1 again only in hypoxic HCVR (F = 3.48, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)