[Two cases of Swyer-James syndrome].

Case 1: 55-year-old male was admitted to our hospital for further examination of increased transparency of X-ray in the left lower lung. He had history of pneumonia in his childhood. Left bronchography revealed mild cylindrical bronchi-ectasia in the proximal bronchi but poor filling by contrast in the peripheral bronchi. Case 2: 61-year-old male was referred to our hospital with palpitation and dyspnea. Chest X-ray film revealed hyperlucency of the left lower lung. The ventilation scan showed a marked decrease in ventilation to the left lung and air trapping was present in the left lung. The perfusion scan showed a matched decrease in blood supply to the left lung. In both cases, pulmonary arteriogram showed narrowed and withered-tree-like left pulmonary arteries. From these clinical findings, we diagnosed these two cases as Swyer-James syndrome. We are reporting two cases of Swyer-James syndrome and describing the clinical feature, differential diagnosis and etiology of the syndrome.

Effects of betazole hydrochloride and cyclic AMP on the pepsinogen secretion by rabbit gastric mucosa in organ culture.

The effects of betazole hydrochloride, dibutyryl cyclic AMP (DB-cyclic AMP) and betazole hydrochloride plus aminophylline on pepsinogen secretion by rabbit gastric mucosa were studied in organ culture. Betazole hydrochloride alone did not stimulate pepsinogen secretion at the concentrations of 10(-8), 10(-6), 10(-5) and 10(-4) M. However, 10(-3) M DB-cyclic AMP produced a significant stimulation of pepsinogen secretion into the culture medium when compared with the control. In the presence of 3 x 10(-3) M aminophylline, betazole hydrochloride in the concentration of 10(-5) and 10(-4) M stimulated pepsinogen secretion into the culture medium, and the magnitude of this increase was 2.0- and 2.8-fold, respectively, compared with the control. Aminophylline alone could not change pepsinogen secretion into the culture medium. These results suggested that the pepsinogen secretion, stimulated by betazole hydrochloride, was mediated by cyclic AMP in the chief cells.

Treatment of congenital dilatation of the choledochus- reconstruction of the bile duct after resection of the dilated choledochus.

Reconstruction of the way of bile flow was attempted in 21 cases with the resection of the dilated bile duct, and the post-operative courses were observed over a long period. It was found that ascending cholangitis is seldom caused by the hepaticoduodenostomy. It is important, when hepaticoduodenostomy is performed, that the sound section of the wall of the bile duct without stenosis in the hepatic side should be selected. Reconstruction of the way of the bile flow to prevent ascending cholangitis by leading normal bile flow into the duodenum should be devised.

Multiple-hormone producing lung carcinoma.

Endocrine and immunohistochemical studies were performed in a patient with lung cancer associated with gynecomastia. Elevated level of human chorionic gonadotropin (hCG) in plasma and mild hyperadrenocorticism were demonstrated by hormone assays. Postmortem examination proved the existence of anaplastic small cell carcinoma of the lung mixed with a feature of chorioepithelioma. The presence of significant amounts of adrenocorticotropic hormone (ACTH), beta-melanocyte stimulating hormone (beta-MSH), calcitonin, gastrin, hCG, hCG-alpha, hCG-beta and human chorionic somatomammotropin (hCS) in tumor tissues was demonstrated by radioimmunoassays, bioassay and immunohistochemical techniques. We present here a unique case of multiple hormones producing tumor elaborating both hormones of amine precursor uptake and decarboxylation (APUD) series (ACTH, beta-MSH, calcitonin and gastrin) and of placental origin (hCG, hCG-alpha, hCG-beta and hCS).

An experimental study on the role of coronary collateral development in preservation and improvement of contractile force in the ischemic myocardium.

Attempts have been made to demonstrate that the presence of coronary collateral development can preserve and improve the regional contractile force in the ischemic myocardium. Studies were carried out in dogs with developed collaterals and in control dogs. Contractile force was measured with strain-gauge sutured onto the ischemic and the border areas of the myocardium. After ligation of the anterior descending coronary artery, an augmentation of coronary collateral flow via the left circumflex artery was carried out by means of infusion pump up to two and a half fold level. In dogs with developed collaterals, contractile force decreased by 57.6 +/- 11.1% (p less than 0.01) in the ischemic area and 27.2 +/- 5.4% (p less than 0.01) in the border area after coronary ligation. The marked recovery of contractile force up to 63.5 +/- 20.4% (p less than 0.05) of control level in the ischemic area and 70.4 +/- 20.4% (p less than 0.01) in the border area was observed by the augmentation. In control dogs, however, contractile force decreased by 93.2 +/- 17.2% (p less than 0.01) in the ischemic area and 24.6 +/- 5.5% (p less than 0.01) in the border area after the ligation. The augmentation of coronary flow did not recover the depressed contractile force in both areas. These results indicated that the beneficial effect was observed only when the ischemic area was supplied by developed collaterals and closely correlated with the extent of coronary collateral development.

Effects of graded coronary constriction on regional oxygen and carbon dioxide tensions in outer and inner layers of the canine myocardium.

This study was undertaken to investigate the effects of graded coronary constriction on regional gas tensions of the myocardium. In 12 open chest dogs, tissue carbon dioxide (PtCO2) and oxygen (PtO2) tensions were measured simultaneously in outer and inner layers of the myocardium using a mass spectrometer. In normal condition, higher PtO2 and lower PtCO2 were observed in outer layer than in inner layer. With application of coronary constriction, increase in PtCO2 and decrease in PtO2 were observed in both layers of the myocardium, but the response to the ischemic stimuli by applying coronary constriction in inner layer was different from that in outer layer. Severe coronary constriction, more than 90% in its diameter, was necessary to produce significant changes in both gas tensions in both layers of the myocardium. Decrease in PtO2 was found in the condition of less severe coronary constriction and to be greater in inner layer than in outer layer of the myocardium. In terms of the changes in PtCO2, inner layer was also more susceptible to the ischemic stimuli than outer layer. The greater and earlier elevation of PtCO2 in inner layer than in outer layer is regarded as one of the possible mechanisms of the reduction of myocardial contraction in the early stage of myocardial ischemia.