[en] Ventilatory steady state measurement with ¹³³Xe, using Ventil-Con (Radx) and a large area scintillation camera (Searle, LFOV) combined with a mini-computer system (Shimadzu, Scintipac 230) was employed to evaluate regional pulmonary function of 94 patients with chronic obstructive lung disease (COLD), fibrosis, carcinoma and other lung diseases. In the patients with COLD, mean washout times (anti t) were markedly prolonged in whole lung fields (anti m 130 +- 33 sec.) and ventilation indices (V*/V) (*: radical) and perfusion indices (Q*/V) (*: radical) were reduced in regional zones, especially in bilateral lower lung zones. For the patients with lung fibrosis, anti t values were short and the distribution of ventilation indices were uniform, and in contrast perfusion indices were reduced in the lower lung fields. In the area most affected by carcinoma, lung volumes (V) were reduced in parallel with the regional ventilation (V*) (*: radical) and perfusion (Q*) (*: radical). As the tumor approached the hilum, the relative ventilation and perfusion of cancerous side decreased remarkably in patients with obstructive findings on bronchoscopy. The mean washout times (anti t) for ¹³³Xe, calculated by a modified height over area method without background subtraction, were significantly longer than indicated by the data yielded by the least squares curve fitting of initial washout curve after background subtraction. Although the accuracy of these data was limited, it appeared that the prolonged anti t is a good parameter of regional ventilatory disturbance because significant correlations were found between the whole lung anti t in patients with lung diseases and their FEV 1.0% r = -0.66, RV/TLC r = 0.64, % TLC r = 0.43, PaCO₂ r = 0.41, PaO₂ r = -0.35. (author)

[en] Scintigraphy with ²⁰¹TlCl and ¹⁹⁷HgCl₂ was performed in 323 patients with various respiratory diseases. Diffuse, marked bilateral lung uptake of ²⁰¹Tl or ¹⁹⁷Hg was demonstrated in 2 of 3 cases with hypersensitivity pneumonitis, 26 of 29 cases with silicosis and 28 of 29 cases with diffuse interstitial pneumonia, but in diffuse panbronchiolitis, chronic bronchitis and pulmonary emphysema, only slight lung uptake or negative results were obtained in most cases. In diffuse interstitial pneumonia, no close correlation was observed between the grade of the lung uptake and the various clinical findings such as fever, cough, rales, ESR, S-LDH, α₁-globulin, %VC, PaO₂ and so on. With regard to roentgenological findings, marked lung uptake was observed in cases not only with reticulonodular shadows but also those with ring shadows and those without any shadows. Concerning the microscopic findings of lung biopsy specimens, marked uptake was observed in cases with slight interstitial fibrosis as well as infiltration of mononuclear cells. The right ventricle was visualized in 13 of 19 cases (68.4%) with diffuse interstitial pneumonia. Lung scintigraphy with ²⁰¹Tl chloride is non-invasive and seems a more sensitive indicator of diffuse intersitial changes such as inflammatory disorders than the clinical findings, chest X-ray and so on. (author)

[en] A scinticamera computer system was used to measure the distribution of blood flow in both upright and supine lungs sequentially with the same counting geometry. The counting ratio of the upper half to the lower half lung, and the difference of distribution indices between supine lung and upright lung which is the fraction of postural change from the supine upper half to upright lower half lung to total distribution of blood flow, were referred to as ''U/L ratio'' and postural ''Change of Distribution'' respectively. U/L ratio correlated well with left atrial mean pressure (r = 0.87, p < 0.001) with the regression equation and Change of Distribution correlated well with pulmonary artery mean pressure (PAm) (r = -0.88, p < 0.001) in cardiac diseases. The relationship between the Change of Distribution and PAm was investigated using various regression analyses and the best fit was obtained by logarithmic regression (r = -0.92) with the regression equation. This regression equation means that there is no change of distribution of pulmonary blood flow with pulmonary artery pressure over 58 mmHg and that entire pulmonary blood flow comes to the lower half lung when the pulmonary artery pressure decreases to zero level. Pulmonary parenchymal and vascular disorders including primary pulmonary hypertension also held the same relationship with PAm. The relationship between upright U/L ratio and postural Change of Distribution permitted differentiation between precapillary pulmonary hypertension and postcapillary pulmonary hypertension. (J.P.N.)

[en] A 31 year-old male was admitted because of abnormal chest X-ray findings simulating atelectasis of the right middle and lower lobe. Bronchogram showed that the middle and lower lobe bronchi were displaced by a mass on the diaphragm. Computed tomography (CT) demonstrated that the mass consisted of low density material, suggesting a lipoma originating from the anterior mediastinum. Thoracotomy revealed that it was an entirely encapsulated, yellowish and pliable tumor weighed 700 gm. Histologically, the tumor consisted mostly of mature adipose tissue, scattered with small islands of thymic tissue, and was diagnosed as thymolipoma. (author)

[en] We have evaluated the value of computed tomography (CT) in distinguishing benign and malignant pulmonary nodules. CT was performed on 30 cases of solitary pulmonary nodules consisting of 17 primary lung cancers, 3 metastatic tumors and 10 benign nodules. The CT number was calculated for each lesion. Three benign nodules showed CT numbers well above the range of malignant nodules, and only in one of them was calcification visible on conventional tomography. In 6 benign nodules, the CT numbers overlapped those of malignant lesion and could not be differentiated. Thus the measurement of CT number can be useful to confirm the benign nature of certain nodules when calcification is unclear or not visible on conventional tomography. As for the morphological observation of the nodule, CT was not superior to conventional tomography and its value seems to be limited. (author)

[en] Digital radiography for diagnosis of chest diseases using Fuji Computed Radiography (FCR) was evaluated. The results were as follows; 1. Compared to the conventional chest X-ray films, various types of image enhancement could be made by manipulation of the digital information such as tone conversion, spatial frequency modification etc. 2. Digital radiography lessens the X-ray exposure dose and will ultimately permit speedy transmission of image data from outlying clinics to central processing hospitals. 3. Digital radiographic images are useful in chest X-ray diagnosis especially in mass surveys for lung cancer and in primary care medicine because of its full imaging capability. (author)

[en] Three types of aerosol nebulizers used in clinical practice, a jet type (JT), and IPPB (Bennett PR-2) and an ultrasonic nebulizer (Mistogen EN 142) (US) were studied regarding aerosol size distribution, efficiency in aerosol output, efficiency in lung deposition and deposition patterns in the lungs. The JT was operated both manually and mechanically. Tc-99m-albumin solution was the agent for aerosol generation. Aerosol size was measured by a cascade impactor, efficiency by measuring radioactivity in the lungs and nebulizers and deposition patterns by visual comparison. Mass median diameter (MMD) was the largest (4.18 μ) with its geometric standard deviation of 1.76 with the US, and the other nebulizers showed smaller MMD (2.00 - 2.35 μ) and broader geometric standard deviations. Aerosol output was 4 times more efficient with the US than with the others. Lung deposition was 8 times more efficient with the US, 7 times with the mechanically operated JT, and 6 times with the IPPB than the manually operated JT. Overall aerosol deposition in the lungs was the most efficient with the US, but the IPPB showed better penetration in normal subjects and patients with the least obstructive disturbance. Manually operated JT tended to produce the so-called central deposition pattern even in normal subjects. In conclusion, of the three nebulizers tested, the MMD of aerosol generated was the largest with the US, and the US was the most efficient in aerosol output and lung deposition. (author)

[en] Heparin and dextran sulfate (D.S) are known to accelerate fibrinolytic activity and the recent increasing evidence of the inhibitory effect of D.S on fibrosis suggests the possibility of this drug being useful for prevention of radiation fibrosis of the lung. To evaluate this we undertook both clinical and experimental studies and obtained the following results: 1) Pulmonary radiation injuries were less severe in degree and more delayed in onset in D.S treated cases. Preventive effects of D.S were most prominent in small radiation fields. There was no significant difference among the various radiation doses. 2) Experimentally, pulmonary radiation injuries were observed in 94% of x-irradiated mice. (unilateral lung field, 3000R, once a week, 3 weeks). Histological evaluation revealed no significant difference in pulmonary injury between the D.S-treated group and control. (author)

[en] Mucociliary transport and cough effect were studied in 10 healthy controls and 116 patients with respiratory diseases using aerosol inhalation cine-scintigraphy which permits visualization of the movement of inhaled aerosols. Additionally, the effectiveness of β-adrenergic stimulant on mucociliary transport was evaluated in 8 normal cases by this method. 1. In healthy controls, the aerosol-bolus moved to the cephalad side rapidly and smoothly in the main bronchus and the trachea, but in many cases of respiratory diseases, we recognized various abnormal patterns such as slow movement, spiral movement, regurgitation etc. We consider that the bolus movements can be used as an index of the mucociliary transport. 2. We found low grade abnormality of bolus movement in cases of atopic bronchial asthma, pulmonary emphysema, silicosis, interstitial pneumonia and asbestosis, but high grade abnormality in cases of bronchiectasis, pulmonary emphysema with chronic bronchitis, mixed or infectious bronchial asthma, chronic bronchitis and especially acute pulmonary infection and diffuse panbronchiolitis. Normal patterns were observed in atopic asthma patients in remission, but abnormal patterns in cases of attack. With larger daily volumes of sputum, the bolus movements showed higher greater abnormality. 3. Bolus movements by coughing were seen most frequently in patients who had produced moderate volumes of sputum and in whom the bolus had stopped at the first carina. Bolus movements by coughing were classified into three groups: expectoration, cephalad movement that stopped halfway, and regurgitation. When the bolus was in the trachea, especially located on the oral side, we observed that expectoration by coughing was more effective. Patients with obstructive pulmonary diseases had lower effciency of expectoration by coughing. 4. We confirmed that terbutaline (β-adrenergic stimulant) accelerated the mucociliary transport. (author)

[en] A 41 year-old male was admitted to our hospital, complaining of slight fever, dry cough and general fatigue. On auscultation, bubbling rales were audible at the mid to lower portion of left posterior chest. Plain chest roentgenogram showed multiple cystic shadows with an air-fluid level in the left lower lobe. An abnormal finger-like shadow, which extended from the left hemidiaphragm to the multiple cysts, was found on lateral chest tomogram. Bronchogram revealed cystic dilatation of left B6 and B10. Computed tomogram with contrast enhancement demonstrated multiple cysts and an abnormal round-shaped structure, consisted of high density material, in the left lower lung. At the level of 12 mm below the round-shaped structure, an abnormal finger-like structure contiguous to the thoracic descending aorta was demonstrated. The density of these abnormal structures was 80 Hounsfield units, which was the same as that of the descending aorta. Thoracic aortogram disclosed an abnormal artery arising from the thoracic descending aorta, just above the left hemidiaphragm, which proceeded to the left lower lung horizontally, and extended to superior direction and divided into multiple branches. These vessels drained into the left atrium via left lower pulmonary vein. Diagnosis of intralobar pulmonary sequestration was confirmed by operation and consequently, the sequestered lung and the abnormal artery were successfully removed. It is emphasized that computed tomography with contrast enhancement is useful to detect the abnormal artery of pulmonary sequestration and that this method should be used to evaluate the vascular relationship of lung lesions. (author)