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Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) is a metabolite of type I collagen representing more than 90% of organic substances in bone and expected to be one of the markers reflecting bone resorption. We measured ICTP to evaluate its clinical usefulness for diagnosis of bone metastasis from primary lung cancer by comparing serum alkaline phosphatase (ALP), a bone formation marker, which was simultaneously measured. In addition, using the receiver operating characteristic (ROC) curve, we calculated the cut-off value of ICTP from which the diagnostic accuracy serves as best. The subjects were 87 patients with primary lung cancer including 21 patients with bone metastasis. ICTP was significantly higher in patients with bone metastasis than in the group without bone metastasis. On the other hand, in the serum ALP there was no significant difference between the two group. The result suggested that measurement of serum ICTP is worthwhile as a diagnosis method of bone metastasis from lung cancer. The calculated cut-off value was 6.4 ng/ml, higher than the 4.5 ng/ml indicated by the appending document which was from patients with lung, breast and prostate cancer. It is possible that the reason for the style of bone metastasis from lung cancer is mainly a osteolytic process.

We have performed bronchoalveolar lavage (BAL) examination in 27 cases; 5 with Chlamydial pneumonia, 7 with Mycoplasmal pneumonia and 15 in the control group (5 non-smokers, 10 smokers), and the following results were obtained. 1. In Chlamydial pneumonia and Mycoplasmal pneumonia, the cell population of alveolar macrophages in BALF decreased (p < 0.01) and that of lymphocytes increased compared with control group (p < 0.01). 2. In all cases of Mycoplasmal pneumonia without peripheral eosinophilia, the cell population of eosinophils in BALF increased compared with cases of Chlamydial pneumonia (p < 0.05). These results indicate that lymphocytes played the main role in the immune host defense in Chlamydial pneumonia, whereas infiltration of lymphocytes and eosinophils into the pneumonic lesion occurred in Mycoplasma pneumoniae infection.

A 64-year-old male consulted our hospital with a 6-day history of malaise, body temperature to 38 degrees C, anorexia, and light headedness. The chest radiograph showed consolidation in the left lower lung area. Chest CT and ultrasonography revealed left pleural fluid. The pleural fluid was exudative (yellowish in color, protein 3.0 g/dl, Rivalta reaction positive, adenosine deaminase 19.4 U/L), and had a total cell count of 4.7 x 10(6)/ml with 45% lymphocytes, 40% histiocytes, and 15% polymorphonuclear leukocytes. He had kept a budgerigar, but we could not isolate Chlamydia from the pleural fluid or the pet bird. Transbronchial lung biopsy from left S10 revealed an increase of mononuclear leukocytes within the interstitial spaces, and the alveolar spaces contained polymorphonuclear leukocytes, fibrin, and organized alveolar exudate. Bronchoalveolar lavage cellular constituents were 50% lymphocytes, 27% neutrophils, and 23% macrophages. Serologic studies demonstrated C. trachomatis specific IgM antibody titers at 1:20 in a serum sample and at 1:10 in pleural fluid. We report a case of community-acquired pneumonia caused by C. trachomatis diagnosed by serologic studies.

Twelve cases of drug-induced pneumonitis were clinically investigated. Treatment of antimicrobial agents in 8 cases of drug-induced pneumonitis ranged from 7-21 days (mean 12 days) and that of other drugs in 4 cases from 18-150 days (mean 70 days). The patients developed fever and dyspnea at a high rate of frequency. Abnormal laboratory findings included increased IgE (44%), eosinophilia (36%), and increased GOT and GPT in 33%. Chest X-ray films revealed a large reticulo-nodular or ground glass shadows in both lung fields. The results of lymphocyte stimulation tests were positive in 5 of 11 cases (45%). Eight cases demonstrated a rapid improvement by discontinuation of the drug and corticosteroid was administered in 4 cases. The drug received by the patient and their known risk of pulmonary toxicity should be kept in mind in order to reach a diagnosis of drug-induced pneumonitis and grasp the clinical picture of this disease. A provocation test is potentially dangerous, therefore it should not be carried out lightly.

Ofloxacin (OFLX) or Enoxacin (ENX) was intramuscularly administered at a dose of 100 mg/kg to rats (normal and pneumonia model). Bronchoalveolar lavage (BAL) was performed at 30 min after administration and concentrations of OFLX or ENX in the recovery fluid were determined. Total recovery amounts of OFLX from 10 BAL procedures were 64.7 +/- 18.7 micrograms in the normal group and 126.5 +/- 16.1 micrograms in the pneumonia group, and the amounts of ENX were 15.6 +/- 4.6 micrograms in the normal group and 32.8 +/- 6.1 micrograms in the pneumonia group. Regarding the ratio of total recovery amounts in BAL to serum concentrations of OFLX or ENX, the pneumonia group was higher than the normal group and the ratio of OFLX was higher than that of ENX. Regarding the ratio of total recovery amount in BAL to the amount in lung parenchyma, the ratio of OFLX was higher than that of ENX, but there was no significant difference between the normal group and the pneumonia group in the ratio of OFLX or ENX. With regard to the ratio of the amount of OFLX or ENX in lung parenchyma to their serum concentrations, the ratio was higher in the pneumonia group than in the normal group, but there was no significant difference between OFLX and ENX. Based on the above results, it was concluded that the permeability of OFLX into epithelium of blood capillary is the same as that of ENX, but the permeability of OFLX into alveolus epithelium is superior to that of ENX.(ABSTRACT TRUNCATED AT 250 WORDS)

A 33-year-old previously healthy woman was seen at this hospital after a week of fever and nonproductive cough. A roentgenogram of the chest showed consolidation in the left upper and middle lung fields. Transbronchial lung biopsy from left S1 + 2 revealed an increase of mononuclear leukocytes within the interstitial spaces and slight cell infiltration with in the alveoli. Bronchoalveolar lavage cellular constituents showed 47% alveolar macrophage, 38% lymphocytes and 15% neutrophils. She had kept a parakeet, which died just after her illness. We could isolated organisms from the liver, spleen, kidney, lung, heart and bowel of her pet bird revealing C. psittaci by Giemsa stain, three days after it was buried in the ground. She was given three hundred mg of ofloxacin per day orally for fourteen days and the clinical effect was good. The in vitro activity of ofloxacin was 0.75 microgram/ml.

Adhesion of P. aeruginosa to normal and injured rat tracheas was examined. Rat tracheas were injured by exposure to 0.1N HCl for 10 min, and incubated with P. aeruginosa. Adhesion was quantitated by direct count of the number of bacteria attached to a fixed surface area as viewed by scanning electron microscopy. P. aeruginosa adhered to injured tracheas much more than to normal tracheas. The adhesion of P. aeruginosa, preincubated with mucin and sugars, to acid injured trachea was examined. Mucin, N-acetylneuraminic acid and N-acetyl-D-galactosamine inhibited the adhesion of P. aeruginosa to injured tracheas, but not N-acetylglucosamine, L-fucose, D-mannose and D-galactose. Periodate oxidation and neuraminidase treatment of acid injured tracheas reduced the adhesion of P. aeruginosa. These data suggest that N-acetylneuraminic acid (sialic acid) is the receptor for P. aeruginosa or a part of the receptor in acid injured rat trachea and in tracheobronchial mucin.

Various bacteria with pili are able to agglutinate human and animal red blood cells. Hemagglutinating activity of 131 strains of Escherichia coli isolated from respiratory tract (24 strains), urine (64 strains), feces (36 strains) and blood (7 strains) were tested using human type A, guinea pig, bovine and chicken erythrocytes. Concerning the hemagglutination activity for erythrocytes from at least one of four species (human, guinea pig, bovine, chicken), the strains isolated from respiratory tract showed a higher level than those isolated from feces (p less than 0.01) or those isolated from blood (p less than 0.1). Agglutination of human erythrocytes: Of 131 strains, mannose-sensitive agglutination was observed in 31 strains, mannose-resistant agglutination in 40 strains and non-agglutination in 60 strains. More agglutinated strains were isolated from the respiratory tract than those isolated from blood but not with statistical significance (p less than 0.1). Agglutination of guinea pig erythrocytes: Of 131 strains, mannose-sensitive agglutination was observed in 56 strains, mannose-resistant agglutination in 10 strains and non-agglutination in 65 strains. More agglutinated strains were isolated from the respiratory tract than from urine, feces and blood (p less than 0.01), and of those, 89% were mannose-sensitive agglutination. Agglutination of bovine erythrocytes: Of the 131 strains, mannose-sensitive agglutination was observed in 4 strains, mannose-resistant agglutination in 6 strains and non-agglutination in 121 strains. Therefore, only a few agglutinated strains were seen.(ABSTRACT TRUNCATED AT 250 WORDS)