[Effect of smoking on the decline in forced expiratory volume in one second].

We used multiple regression analysis to study the effects of smoking cessation on the decline in forced expiratory volume in one second (FEV1). We studied 429 healthy men for about 3 years. Each subject was assigned to one of three groups, according to their self-reported smoking history: 281 were current smokers, 67 were former smokers, and 81 had never smoked. After statistical adjustment for initial age, initial FEV1, and decline in Maximum Mid-expiratory Flow (MMF), current smoking was found to be associated with a faster decline in FEV1. Having stopped smoking was associated with a slower decline in FEV1. The rate of decline in MMF was associated with the rate of decline in FEV1, which suggests that the rate of decline in FEV1 was greater in those subjects with small airways disease.

[Two cases of lung infection due to Mycobacterium chelonae subsp. abscessus].

Two cases of lung infection due to Mycobacterium chelonae subsp. abscessus are reported. Case 1, a 50-year-old female, was a secondary infection-type, and case 2, a 53-year-old female, was a primary infection-type. The 16 cases reported, between the ages of 29 and 76 years, there were 6 males and 10 females. The roentgenographic examinations, revealed that the ratio of the primary and secondary infection-type was 3:1. Effective agents for this organism has not been yet confirmed. In the present study, we treated two patients with AMK and IPM/CS, and obtained negative conversion of the sputum culture as well as improvement of roentgenographic features.

[Two cases of mediastinitis as a complication of odontogenic infection and tonsillitis].

We experienced two cases of descending necrotizing mediastinitis with different etiology. Case 1: A 59-year-old woman presented with chief complaints of dyspnea and swallowing disturbance. She had been diagnosed as having tonsillitis one week before. She was very pyrexic, and laboratory examination indicated acute inflammation. Chest X-ray and CT-scan showed enlargement of the mediastinum and pleural effusion. We diagnosed the mediastinitis to be a complication of tonsillitis. Case 2: A 54-year-old man had a tooth extracted 3 weeks prior to admission. His chief complaints were craniomandibular disturbance and neck swelling. Laboratory examination disclosed multiple organ failure and DIC. Chest X-ray and CT-scan showed enlargement of the mediastinum and pleural effusion. We diagnosed the mediastinitis in this case to be a consequence of an odontogenic infection following tooth extraction. Both patients received continuous drainage and irrigation of the abscesses and recovered in about 2 months. Case 1 showed an impaired glucose tolerance after recovery from mediastinitis. Although the main causes of mediastinitis are cardiac surgery and esophageal perforation, our cases demonstrate that mediastinitis may occur as a complication of deep neck infection.

[A case of malignant rheumatoid arthritis associated with obstructive sleep apnea due to mandibular lesions].

A 55 year old man with malignant rheumatoid arthritis (MRA) was admitted because of severe snoring during sleep and hypersomnolence in the day time. The patient developed an episode of respiratory distress and cardiac arrest, which responded rapidly to tracheal intubation and mechanical ventilation. He could be easily weaned from ventilator after 3 days. Polysomnography showed that the patient had an obstructive sleep apnea syndrome. Lateral view of cranial radiography revealed acquired micrognathia and destruction of the temporomandibular joints caused by RA, which induced obstructive sleep apnea. It is important to consider that obstructive sleep apnea can occur in RA patients showing snoring, hypersomnolence and disordered sleep behavior.

[Clinical evaluation of combination assay of tumor markers in primary lung cancer patients].

Recently, the measurement of tumor markers, particularly for combined measurement, have been reported to be useful for the early diagnosis of cancer. In this study, the authors measured the serum levels of SLX, CA19-9, CA153, CA125, NCC-ST-439, CEA, SCC, NSE, TPA and IAP in 155 patients with primary lung cancer before treatment (76 adenocarcinomas, 40 squamous cell carcinomas, 36 small cell cancers, 3 large cell cancers). Seventy three benign lung disease cases were also studied as controls. The serum levels of CA19-9, CA153, CA125, NCC-ST-439, CEA, NSE and TPA were significantly higher in lung cancer patients than in benign lung disease patients. CA125 and CEA levels in adenocarcinoma, SCC levels in squamous cell carcinoma, NSE levels in small cell cancer and NCC-ST-439 in non-small cell cancer were significantly higher than those of other histological types of cancer. The level of each marker became higher, and was related with advance in stage. The probability of lung cancer was 90% when three markers were positive except for IAP, which was frequently false positive in benign lung disease. In conclusion, the simultaneous, combined measurement of at least three markers, including CEA and/or TPA was considered to be useful for the diagnosis of lung cancer.

[A case of hypersensitivity pneumonitis due to isocyanate (TDI)].

A 46-year-old man who had worked in a paint processing plast for over 29 years was admitted to our hospital with complaints of nocturnal dyspnea and dry cough. A chest X-ray film showed diffuse granular shadows in bilateral lungs. Pulmonary function tests revealed reduction of diffusing capacity and restrictive impairments. Hypersensitivity pneumonitis (HP) due to isocyanates was speculated from his occupational history and clinical course. Positive skin tests against TDI-HSA and MDI-HSA, precipitating antibody against TDI-HSA, and negative lymphocyte stimulating tests of peripheral blood and bronchoalveolar lavage fluid were also noticed. Environmental provocation test was positive. Histological findings of transbronchial lung biopsy specimens showed diffuse alveolitis and Masson body, but no granulomas. According to these results, the patient was diagnosed as HP due to TDI. Type III allergy of Gell-Coombs seems to participate in this case. The granulomatous lesion is seen less frequently in isocyanate-related HP than in HP induced by organic dusts, which suggests the difference in immunological and histological reactions between both types of HP.

[A case of pulmonary alveolar proteinosis associated with fibrotic changes and alveolitis].

A 62-year-old male, who had worked for 20 years as a farmer and who had been exposed to respirable agricultural chemicals apart from silica, was admitted in April, 1987, because of progressed exertional dyspnea. The chest X-ray film on admission showed irregularly-distributed infiltrative shadows in both lung fields. The chest CT also revealed irregular increase of densities in lung fields. Though the TBLB specimen from right B8 indicated only fibrotic changes, the tissues obtained by open lung biopsy from right S3 and S8 revealed PAS-positive proteinaceous deposits in the alveoli as well as alveolitis or fibrotic change of alveolar septum. Bronchoalveolar lavage fluid (BALF) contained phospholipids composed mainly of lecithin. According to these findings, the case was diagnosed as pulmonary alveolar proteinosis associated with alveolitis and patchy fibrotic changes. It is not completely clear whether fibrotic changes are induced by pulmonary alveolar proteinosis itself or fibrosis and proteinosis result coincidentally from direct response to fibrogenic agents. Inhaled agricultural chemicals may play a role for the pathogenesis of this case, for which further studies are required.

[A case of pneumonitis due to serrapeptase].

A case of pneumonitis due to Serrapeptase was described. A 69-year-old man was treated with Serrapeptase for 16 days because of common cold, then fever, nonproductive cough and dyspnea developed and chest X-ray revealed diffuse fine granular shadows in bilateral lung fields. Once the administration of Serrapeptase was halted, symptoms, chest X-ray abnormalities and laboratory data improved markedly. The fraction of lymphocytes increased in bronchoalveolar lavage fluid and OKT4/T8 decreased. Microscopic examination of transbronchial lung biopsy showed interstitial pneumonia. Both leukocyte migration inhibition test and sensitized hemagglutination test were positive for Serrapeptase. Based on these findings, we diagnosed this case as Serrapeptase-induced pneumonitis.

Serum angiotensin converting enzyme activity in ex-smokers.

A low activity of angiotensin converting enzyme (ACE) has been reported in people who smoke. To determine whether this low ACE activity would be reversible on cessation of smoking, we measured serum ACE activity in 107 healthy male volunteers. They included 27 active cigarette smokers, 28 non-smokers, 24 ex-smokers who had stopped smoking for less than 10 yr, and 28 ex-smokers who had stopped smoking for more than 10 yr. The mean value (+/-SD) of serum ACE in those who had stopped smoking for more than 10 yr was comparable to that of non-smokers: 23.2 +/- 5.1 and 23.5 +/- 4.5, respectively. ACE activity in smokers and the ex-smokers who had stopped smoking for less than 10 yr was significantly lower (17.8 +/- 4.5 and 17.8 +/- 3.9, respectively) than values obtained in non-smokers and the group who had not smoked for more than 10 yr (p less than 0.001). These findings suggest that the effect of chronic smoking on the serum ACE activity may be reversible.

Physiologic approach to dialysis-induced hypoxemia. Effects of dialyzer material and dialysate composition.

This study was undertaken to evaluate the effects of membrane-related complement activation and dialysate composition on dialysis-associated hypoxemia. Seven chronic hemodialysis patients were hemodialyzed 3 times sequentially with the following three combinations; Cuprophan membrane with acetate dialysate, polymethylmethacrylate (PMMA) membrane with acetate dialysate, and PMMA membrane with bicarbonate dialysate. During dialysis with acetate dialysate, the pulmonary diffusing capacity (DLco) at 30 min after the start of dialysis was decreased to 88% (p less than 0.01) of the predialysis value with PMMA and to 79% (p less than 0.01) with Cuprophan, and the degree of DLco on PMMA membrane was different from that on Cuprophan (p less than 0.01). The degree of leukopenia with PMMA was less than that with Cuprophan. However, the fall in DLco did not alter the alveolar-arterial O2 tension gradient. Although the changes in transcutaneous PO2 (tcPO2) were not constant in all three combinations, a distinct fall in tcPO2 was observed in the first half of dialysis with acetate dialysate. During dialysis with acetate dialysate but not with bicarbonate, the extracorporeal dialyzer removed an average of 60 ml/min of CO2, and the respiratory quotient dropped from a mean predialysis value of 0.86 to 0.59 (p less than 0.001). The arterial CO2 tension was not significantly changed throughout dialysis, but the alveolar ventilation decreased significantly in proportion to the fall in carbon dioxide output. The arterial tension fell from a control level of 91 +/- 6 to 77 +/- 8 mm Hg (p less than 0.01) in 30 min. It is concluded that, in spite of a fall in DLco, dialysis-induced hypoxemia in this group of patients on maintenance dialysis is caused by CO2 loss via the dialyzer, resulting in reflex hypoventilation.

Gastric sarcoidosis in Japan.

Seventeen cases of gastric sarcoidosis have been reported in Japanese literature. Age distribution was from the 3rd decade (6 cases) to the 6th decade (3 cases) and the sex ratio was 2 females to 1 male. Preoperative diagnosis included 10 cases of gastric carcinoma and 6 cases of gastric ulcer. Sites of the granulomas were limited to the mucous membrane in 4 cases, from serosa to the mucous membrane in 9 cases and from the muscle layer to the mucous membrane in 1 case. As there are granulomas in the mucous membrane in all cases, it appears that granulomas may spread from the mucous membrane to outside and they can possibly be detected by biopsy. There were no BHL in any chest X-ray. Kveim test was positive in only 2 out of 11 cases. Prognosis is very good. There has been a question whether the gastric granuloma is a local or a generalized manifestation. From our findings, we will report in detail, it may not be a local reaction, but a gastric manifestation of generalized sarcoidosis.