Ultrasonographic evaluation of pleural and chest wall invasion of lung cancer

The significance of ultrasonography was tested in evaluation of cancerous invasion into the pleura and chest wall in patients with lung cancer. The degree of the invasion was ultrasonographically classified into four grades, that is, uP-0, uP-1, uP-2 and uP-3, corresponding with the classification proposed by the Japan Lung Cancer Society, which is graded by surgical findings. The total accuracy of this method was 77 percent. Especially for uP-3, which is the most critical grade regarding decisions on surgical intervention, this figure was 100 percent. It is suggested that this approach can delineate cancerous invasion into the pleura and chest wall sufficiently well for daily clinical use and staging of patients with lung cancer.

Detection of the mediastinal lymph nodes metastasis in lung cancer by endoscopic ultrasonography

Mediastinal lymph nodes metastasis of lung cancer was analysed by endoscopic ultrasonography in 96 patients in whom histological diagnosis of the lymph nodes could be proven by thoracotomy. A Receiver Operating Characteristic (ROC) curve was drawn up for determining the criteria for metastatic lymph nodes by endoscopic ultrasonography. The ROC curve was evaluated by using four parameters: The long diameter, the short diameter, the long diameter plus the short diameter, and the product of the long diameter times the short diameter. The long plus short diameter and the long-times-short diameter showed the highest detectability of the metastasis of all histological types on the ROC curve. The reasonable criteria levels were found to be 18 mm and 75 mm2 by means of a moderate threshold. In this level, sensitivity were 77%, 76%; specificity 84%, 84%; and accuracy 82%, 82%, respectively. When examinations were done by histological types, the criteria level for the epidermoid carcinoma should be increased to more than that for the adenocarcinoma. And, sensitivity and specificity were better in the epidermoid carcinoma. Thus, these results suggest that endoscopic ultrasonography is clinically useful for the detection of lymph nodes metastasis in lung cancer.

Comparative studies on the leukotriene D4-metabolizing enzyme of different types of leukocytes

1. The leukotriene (LT) D4-metabolizing enzyme which catalyzes the conversion of LTD4 to LTE4, was investigated in various types of leukocytes from guinea pigs and humans. 2. In guinea pigs, the enzyme activity was present in macrophages but was hardly present in neutrophils, lymphocytes and eosinophils. 3. In humans, neutrophils, lymphocytes and macrophages all possessed the enzyme activity. However, enzyme activity varied with cell types and macrophages showed the highest enzyme activity among the leukocytes. 4. The subcellular localization of the LTD4-metabolizing enzyme was studied and leukocytes were divided into two groups: one which has the enzyme activity exclusively on the cell surface and the other which has the activity both on the cell surface and in the granules of leukocytes. 5. The enzyme activity was remarkably inhibited by o-phenanthroline and dithiothreitol and the inactivated enzyme was considerably reactivated by Co2+ and Zn2+, suggesting that the LTD4-metabolizing enzyme of leukocytes is a metalloenzyme.

The level and stability of residual catalase in cultured acatalasemic skin fibroblasts

In an attempt to determine the level and heat stability of residual catalase in somatic cells of acatalasemic Japanese, skin fibroblasts from an acatalasemic subject were cultured, and the catalase activity of the cultured fibroblasts was compared with that of cultured normal fibroblasts. Catalase activity was determined using an oxygen electrode. The residual catalase activity in cultured acatalasemic fibroblasts was 10% of the normal. The heat stability at 55 degrees C of residual catalase in the acatalasemic fibroblasts was similar to that of normal fibroblasts.

Estimation of personal exposure to ambient nicotine in daily environment

To evaluate the actual exposure level of nonsmokers to environmental tobacco smoke (ETS) in their daily life, the exposure level of ambient nicotine was measured with a nicotine personal monitor carried by a nonsmoker. Average exposure levels of nicotine, even in such smoky places as cars, coffee shops and pubs, were less than 45 micrograms/m3. As a result of all-day monitoring, the highest amount of nicotine inhaled in a day was estimated, in this study, to be up to 310 micrograms, equivalent to actively smoking 0.31 ordinary cigarettes.

Correlative analysis of longitudinal changes in bronchoalveolar lavage, 67gallium scanning, serum angiotensin-converting enzyme activity, chest X-ray, and pulmonary function tests in pulmonary sarcoidosis

Despite the relatively high cost and complicated procedures, Gallium-67 (67Ga) scanning and bronchoalveolar lavage (BAL) are increasingly advocated as more sensitive indicators of disease activity in sarcoidosis than chest X-ray and serum angiotensin-converting enzyme activity (SACE). To evaluate the clinical usefulness of 67Ga scanning and BAL, we followed 31 patients with pulmonary sarcoidosis, using these four parameters, at 9- to 24-month intervals over periods of 9 to 48 months. We obtained 68 complete evaluations. Close correlations were observed among chest X-ray, 67Ga scanning, SACE, and the percentage of lymphocytes in BAL fluid (p less than 0.1 to 0.001). Longitudinal changes were also well correlated in these four parameters (p less than 0.001) and paralleled the changes in vital capacity (p less than 0.01 to 0.001). However, we were unable to predict the patients' outcome from the initial evaluation of these four parameters. These results suggest that, in terms of their usefulness for estimating disease activity, the differences among these four indicators are negligible. We therefore conclude that chest X-ray and SACE sufficiently reflect disease activity and that, at present, routine evaluation by 67Ga scanning and BAL are not necessarily indicated in the long-term management of pulmonary sarcoidosis.

Observation of lymph nodes and great vessels in the mediastinum by endoscopic ultrasonography

The mediastinum was studied by endoscopic ultrasonography in 121 lung cancer patients. This method facilitates the observation of the lymph nodes, the large vessels and heart in the mediastinum in real time and dynamically. In this paper, the orientation of mediastinal lymph nodes was ultrasonographically studied. This method can detect lymph nodes as small as 3 mm in diameter, and very highly those in bracheobronchial, subaortic, subcarinal, and hilar regions. The mediastinal vascular structures were also easily detected. This method can provide full clinical applicability for analysis of mediastinal involvements in lung cancer patients.

Flow cytometric analysis of lymphocyte subsets in the bronchoalveolar lavage fluid and peripheral blood of healthy volunteers

The lymphocyte subsets in the bronchoalveolar lavage fluid (BALF) and the peripheral blood of 25 healthy volunteers were examined by analysis with a fluorescence-activated cell sorter. Comparison of the lymphocyte subsets in the BALF with those of the peripheral blood revealed much higher values for the ratios of each Leu 3a+ (CD4), Leu 3+8-, and Leu 2+15- cells, while the ratios of Leu 1+ (CD5), Leu 2a+ (CD8), Leu 7+, Leu 8+, Leu 10+, Leu 11a+ (CD16), Leu 12+, and Leu 2+15+ cells were low in the BALF. The above results indicate that the lymphocyte subsets in the BALF from healthy individuals are mainly composed of cells with surface phenotypes of helper T cells and cytotoxic T cells with virtual absence of cells carrying suppressor T and NK cell phenotypes, and with low B cell ratio. Therefore, it is assumed that the local immune mechanism of the lung is different from that of the peripheral blood.

Carcinoembryonic antigen in bronchoalveolar lavage fluid in patients with idiopathic pulmonary fibrosis

An increased incidence of lung cancer and epithelial metaplasia or hyperplasia which is felt to be as a precursor of cancer, has been reported in patients with idiopathic pulmonary fibrosis (IPF). In this study, carcinoembryonic antigen (CEA) in bronchoalveolar lavage (BAL) fluid was measured in 53 control patients, 31 patients with sarcoidosis, 10 patients with hypersensitivity pneumonitis, 16 patients with primary lung cancer and 26 patients with histologically confirmed IPF. High ratio of CEA to albumin (Alb), exceeding mean + 2SD of nonsmoking control patients, were found in 8 (25%) out of 32 smoking control patients, 4 (44%) out of 9 nonsmoking patients with IPF, 8 (62%) out of 13 smoking patients with IPF, 3 (75%) out of 4 smoking patients with IPF and lung cancer and 13 (81%) out of 16 patients with primary lung cancer, although BAL was performed at the noncancerous parts of the lung in the cases of lung cancer. Furthermore, it was confirmed that CEA increased in BAL fluid in these subjects were different from nonspecific cross-reacting antigen (NCA) which was detectable in the normal lung. Thus we consider that the increase of CEA/Alb ratio in BAL fluid is a possible marker of these early histological disorders in the lung, and also suggests a greater risk of malignant change in the clinical course of IPF.

[The evaluation of single administration of cisplatin in non-small cell carcinoma of the lung]

The effects of chemotherapy by single administration of Cisplatin were studied in 26 patients with non-small cell carcinoma of the lung. There were 22 males and 4 females with a median age of 63 years. 21 cases were epidermoid carcinoma, 4 cases were adenocarcinoma and 1 case was atypical carcinoid. Cisplatin 20 mg/m2 with hydration and diuresis was given daily for 5 consecutive days. The course was repeated every 3 weeks. Partial response was observed in 4 patients (3 epidermoid carcinoma and one atypical carcinoid). The response rate was 19%. Side effects induced by Cisplatin were gastrointestinal toxicity including vomiting, nausea and appetite less, bone marrow toxicity and renal damage. These were not so severe, and reversible. Gastrointestinal toxicities were controlled successfully by corticosteroids. In 12 patients gastrointestinal toxicities were not observed. We conclude that Cisplatin is effective for non-small cell carcinoma, especially for epidermoid carcinoma. Hematologic toxicities of Cisplatin were not so severe. Therefore, combination chemotherapy including Cisplatin would improve the quality of life of patients suffering from non-small cell carcinoma of the lung.

Variability of breath-by-breath tidal volume and its characteristics in normal and diseased subjects. Ventilatory monitoring with electrical impedance pneumography

To assess clinical significance of breath-by-breath variation of tidal volume and its distribution pattern displayed as a histogram, continuous measurement of tidal volume was made with electrical impedance pneumography for about 60 minutes. Subjects were composed of 26 normal male and 46 patients including 17 patients with restrictive lung disease and 29 patients with obstructive lung disease. To evaluate variation of tidal volume quantitatively, coefficient of variance (C.V.) was used. In comparison to the normal pattern of distribution (C.V. = 26.0 +/- 7.5%, mean +/- S.D.), patients with restrictive lung disease showed extremely narrow pattern of the distribution and significantly smaller C.V. (17.5 +/- 4.6% in old pulmonary tuberculosis, P less than 0.005 and 18.9 +/- 9.3% in pneumonitis, P less than 0.025). Whereas, patients with obstructive lung disease showed widespread pattern of the distribution and significantly greater C.V. (43.2 +/- 13.0% in pulmonary emphysema with hypercapnia, 33.0 +/- 7.5% in normocapnia and 35.8 +/- 9.4% in asthmatic attack, P less than 0.005). In all the patients with bronchial asthma after the treatment, the extremely widespread pattern of histogram was returned toward the normal one and the C.V. was decreased (22.4 +/- 6.4%). It was suggested that the distribution pattern of tidal volume was affected by the change of clinical condition, and was well correlated to the pathophysiological process related to restrictive or obstructive lung disease. We conclude that analysis of tidal volume distribution by the histogram is one of the useful approach to manage patients with respiratory diseases.

The effect of changing the contact surface area between pleural liquid and pleura on the turnover of pleural liquid

To study the dynamics of pleural liquid, 250 ml of saline labeled with markers were injected into the pleural cavity of anesthetized dogs. For 3 h, liquid volume and concentration of these markers were measured. In a control group of dogs, the turnover rate of pleural liquid was 19.6 +/- 5.6 ml/min and lymphatic flow was 0.58 +/- 0.07 ml/min. In a group of pneumonectomized dogs, the turnover rate and lymphatic flow fell to about one fourth of those in the control group. When the left pulmonary artery was occluded, the turnover rate was halved, but lymphatic flow was not significantly different from that in the control group. These results suggest that the turnover rate of pleural liquid is dependent on the area of contact between pleural liquid and pleura and on the blood flow of the pleura. In addition, it appears that changes in pleural liquid volume are dependent on lymphatic flow.

Diffuse panbronchiolitis. A disease of the transitional zone of the lung

Diffuse panbronchiolitis (DPB) is a disease with chronic inflammation exclusively located in the region of respiratory bronchioles. The pathologic features of the disease are characterized by thickening of the wall of the respiratory bronchiole with infiltration of lymphocytes, plasma cells and histiocytes, and extension of the inflammatory changes toward peribronchiolar tissues. In the advanced stage, secondary ectasia of proximal bronchioli may occur. These changes appear as diffusely disseminated small nodular shadows throughout both lungs on the chest roentgenogram. Obstructive respiratory functional impairment, occasional symptoms of wheezing, and also cough and sputum resemble the feature of emphysema, bronchial asthma, or chronic bronchitis, respectively. In the advanced stage, large amounts of purulent sputum and dilatation of proximal terminal conducting bronchioli resemble bronchiectasis. However, diffuse panbronchiolitis belongs to a distinctly different category from these diseases, and should be distinguished from them, because it may often show rapid progression with fatal outcome. The disease is dominant in males and the onset is unrelated to age. More than 1,000 cases of probable diffuse panbronchiolitis and 82 histologically-confirmed cases have been collected in Japan.

Clinical application of ultrasound endoscope using linear array transducer for transesophageal ultrasonographic diagnosis of the disease of the mediastinum

Transesophageal ultrasound endoscopy by the linear array transducer built-in on top of the fiber optic gastroduodenoscope was applied for 13 clinical cases with various mediastinal lesions. It was quite valuable to diagnose mediastinal lesions such as lymphadenopathy in sarcoidosis, lymph node metastasis and direct invasion of lung cancer, dilatation of the diameter of the right pulmonary artery in pulmonary hypertension.

Responses of serum and lung angiotensin-converting enzyme activities in the early phase of pulmonary damage induced by oleic acid in dogs

Changes in angiotensin-converting enzyme (ACE) activity in the lung tissue, edema fluid, and bloodstream were studied during induction of lung edema by oleic acid. Left lungs of 25 mongrel dogs were unilaterally treated with oleic acid (0.1 ml/kg) injected into the right atrium during right pulmonary artery occlusion for 2.5 min. Lung tissue and serum ACE activities and physiologic parameters were followed for as long as 180 min. Serum ACE activity increased to 106% at 2.5 min (p less than 0.025) and to 128% at 180 min. The ACE activity of treated lung tissue decreased compared with the zero time control in terms of tissue DNA content (at 180 min, p less than 0.05). Furthermore, the left to right activity ratio of the precipitate fraction decreased to 0.59 as early as 5 min after oleic acid injection (p less than 0.01). Changes in these ACE activities preceded those of arterial oxygen tension and base transthoracic electrical impedance. Edema fluid at 45 min had a specific activity that was 1.62 times greater than that in serum. These data indicated that the change in ACE activity reflected the impairment of pulmonary vascular endothelial cells and that the oleic acid injured endothelial cells of the pulmonary capillaries as early as 2.5 min after administration.

[Effects of physical loads on the urinary excretion of metabolites from organic solvents. Part I. Change in the urinary excretion of glycine conjugate, hippuric acids, and glycine after a physical burden]

Effects of physical loads on the excretion of urinary glycine conjugates, which are commonly used as an index of organic solvent intake, were examined. After physical exertion by Kendo exercise university students for about 2 hours, urinary protein excretion changed from the levels of (-) or (+) before the exercise to (+) to (formula: see text) after the exercise revealed by the test-tape semi-quantitative indication, and the levels of urinary creatinine increased to approximately 1.9 time and initial level. Under the present experimental conditions, the following results were obtained. 1) Statistically no significant change was observed in the levels of urinary hippuric acid, but an increasing trend was recognized. 2) The glycine levels in the urine decreased and the significance was stressed when the values were adjusted with reference to the specific gravity of urine or to the levels of urinary creatinine. 3) The ratio of hippuric acid to the glycine in the urine increased almost twice as high as the initial ratio and the physical load seemed to promote the glycine conjugation. 4) As to the adjusted levels of urinary metabolites, especially due to several organic solvents, values adjusted with reference to the specific gravity of urine and those to the levels of urinary creatinine correlated well in the samples collected before the exertion. But a poor correlation was observed in the samples collected after the exertion. Therefore, a notice should be given when the adjustment of the values with reference to the levels of urinary creatinine, which is widely used in the health administration practice for organic solvent workers to assess the levels of exposure, since the adjusted values were lowered unnecessarily by excess excretion of creatinine after the physical exertion and the tendency would be exaggerated especially under the low level exposure to organic solvent vapours in the work yard.

Ultrasonically guided aspiration needle biopsy in disease of the chest

Ultrasonically guided aspiration needle biopsy has been used in our department as a diagnostic procedure in chest disease. Twenty patients with chest disease judged to have lesions abutted to the thoracic wall were selected as candidates for this technique, which was a linear electronic array scanner provided with a specially designed guide channel. In all sixteen patients with malignant disease, this method provided biopsies that yielded malignant cells on cytologic examination. The diagnostic accuracy was excellent and no complications were encountered.

Comparison of several methods for the measurement of urinary hippuric acid as an index of toluene exposure

The levels of hippuric acid in the urine of people exposed to toluene vapour were measured by paper chromatography, direct colorimetry, high performance liquid chromatography and gas chromatography. The control was a similar group not exposed to toluene vapour. The values were analyzed statistically, conversion equations calculated, and the propriety of these equation discussed. Since the three chromatographic methods gave similar values, the measurement of urinary hippuric acid by these methods can be used as an index of toluene exposure. The colorimetric method gave higher levels the chromatographic methods, especially for the urine of people not exposed to toluene. This may have been due to glycine conjugates (other than hippuric acid) developing a similar color, resulting in elevated values for hippuric acid. This colorimetric method should be used with caution for biological evaluation of workers with low toluene exposure.