[Nutritional assessment of chronic pulmonary emphysema and the significant relation of malnutrition to pulmonary function and respiratory muscle function]

We assessed nutritional status in 30 patients with pulmonary emphysema and 60 healthy controls. The relationship between nutritional status, pulmonary function and respiratory muscle function was also studied. Anthropometric measures, visceral proteins such as PA and RPB, and the Fischer ratio (BCAA/AAA), an index of imbalance of amino acids were significantly lower in the patients. The incidence of moderately malnourished patients with less than 80% of IBW was 40%. The incidence of hyporetinol-binding protein was 40%. 48% of the patients were found to show an amino acid imbalance. These findings suggested that protein-energy malnutrition in association with amino acid imbalance occurred commonly in patients with pulmonary emphysema. FEV1% correlated significantly with some anthropometric indices and the Fischer ratio. Respiratory muscle function, assessed by P1 max, correlated significantly with some anthropometric indices and grasp strength. These results suggested that the degree of airway obstruction and respiratory muscle function was associated with malnutrition characterized by the reduction of the Fischer ratio.

Clinical study on bacteria detected in the upper and lower respiratory tracts in patients with sinobronchial syndrome

The authors examined bacteria to confirm the pathogenesis of sinobronchial syndrome (SBS). There were several theories such as the pus-descending, the pus-ascending, the coinciding theory and so on. Detection of bacteria was performed in SBS patients, empyema patients with no lower respiratory disease, and healthy adults. Considering SBS bacteriologically from the obtained results, the authors consider that internal infections of aerobic gram-negative bacteria of the normal flora mainly including Haemophilus influenzae possibly develop in two directions, downward and upward (into nasal cavities) from the pharynx, and so the pathogenesis of SBS might not be explained satisfactorily by either the ascending or the descending theory alone.

[The effects of passive smoking in the development of female lung cancer in the Nara district]

Passive smoking in the development of lung cancer has been investigated in 25 female lung cancer patients in a case control study based on their histological type. Active smoking was notable squamous and small cell carcinoma, whereas passive smoking was notable in female lung cancer patients as a whole and current passive smoking being affected was the largest effect, but histological type was not notable. Adenocarcinoma was notable in cancer family aggregation. The female lung cancer patients as a whole was found the effect in the combination with passive smoking in each stage and cancer family aggregation.

[Effects of smoking on asbestos-related pulmonary and pleural changes]

A radiologic study was made on 184 male asbestos workers in order to determine the effects of smoking on asbestos-related pulmonary and pleural changes. The effects of smoking on the prevalence of pleural changes could not be demonstrated, but the prevalence of pulmonary changes significantly increased with length of smoking history (p less than 0.01). It was found that smoking elevated the prevalence of asbestos-related pulmonary changes. These findings are of great importance in the health management of asbestos workers.

The relationship between natural killer cell activity and delayed-type hypersensitivity reaction to 2,4-dinitrochlorbenzene in the spectrum of chronic, intractable pulmonary tuberculosis

We examined natural killer (NK) cell activity and delayed-type hypersensitivity reaction to 2,4-dinitrochlorbenzene (DNCB) in the spectrum of chronic, intractable pulmonary tuberculosis. A high reactive group as defined by high NK cell activity and positive reaction to DNCB were characterised by stable clinical courses assessed by radiographical and clinical changes. A low reactive group defined by non-augmented NK cell activity and negative reaction to DNCB were characterised by progressive clinical courses. Although far advanced radiographic lesions were observed more frequently in the low reactive group and moderately advanced lesions more frequently in the high reactive group, there was not a significant statistical trend.

[Role of immune skin reactions in progressive lung cancer during the administration of OK-432--relation to reactions to DNCB, PPD and Su-PS]

In order to study the role of immune skin reactions (DNCB, PPD, Su-PS reaction) in progressive lung cancer, various investigations were conducted, in particular during the administration of OK-432, and the following results were obtained. Before and after chemotherapy, only a slight decrease in the skin reactions was noted. Su-PS reaction was intensified by the administration of OK-432, but other skin reactions were not changed after 3 months, being only slightly intensified by long-term administration. At the time of remission achieved through radiochemotherapy during administration of OK-432, Su-PS reaction was intensified compared to the level before treatment, and a lowering tendency was noted at the time of recurrence. PPD reaction presented a similar tendency, but DNCB reaction did not show this trend. Concerning the relationship between skin reaction and survival period, the positive DNCB reaction group before treatment had a significantly extended survival period compared to that of the negative group. During administration of OK-432, Su-PS reaction was most useful at all timings, while PPD reaction occurred during the intermediate period. Upon observing the Su-PS reaction after 3 months of treatment, the prognosis was excellent in cases with erythema of 10 mm or more. However, no such tendency was noted for the PPD reaction. Thus, for understanding the pathologic state and prognosis of patients with progressive lung cancer, the Su-PS reaction was most useful during intra dermal administration of OK-432, the PPD reaction was moderately useful, but the DNCB reaction produced different results. Therefore, for the evaluation of prognosis, it was considered essential to select and combine the skin reactions according to the examination timing and treatment schedule.

Changes in the peripheral vasculature of various organs in patients with sarcoidosis--possible role of microangiopathy

Vascular involvement in sarcoidosis is briefly reviewed with emphasis on the outcome of a 10-year project-study by the Sarcoidosis Research Committee of the Japanese Ministry of Health and Welfare. Examples of vascular disorder associated with sarcoidosis are presented, including basal lamina layering of the capillaries in the skeletal muscle, cardiac muscle, and lung, glomerulopathy in the kidney, vascular changes in the ocular fundus and bronchi, and impaired peripheral circulation that could be detected by thermography. According to our tentative definition, all of these disorders should be collectively called microangiopathy. The possible role of microangiopathy in the pathogenetic mechanism of sarcoidosis is also discussed. Although microangiopathy in sarcoidosis is a comprehensive term, it should be included, in addition to systemic granulomatous disease, as part of the clinicopathological entity of sarcoidosis.