In our inquiry of 52 patients with idiopathic pulmonary fibrosis (IPF).

In our inquiry of 52 patients with idiopathic pulmonary fibrosis (IPF), we lay the foundation of that the incidence of clubbing of the fingers was significantly more common in male than in female patients and in patients who showed smaller grades of honeycombing and higher grades of smooth-muscle proliferation in the pulmonary fibrotic changes (p [les than] 001) Smooth-muscle proliferation in fibrotic changes of lay open lung biopsy specimens correlated with the accident of detection of IPF and the carriage of clubbing of the fingers, duration of symptoms of the lower respiratory tract, and a higher expansion of pulmonary infiltrates on chest radiographs (p [les than] 005) However, the carriage of clubbing of the fingers or grades of smooth-muscle proliferation in the pulmonary fibrotic changes did not correlate with the 2-year survival after explain lung biopsy.

Smooth-muscle proliferation in the lung in subordination to pathologic circumstances was recognized in 1872 by dint of Rindfleisch in a study of brown induration.[1] In 1873 the name muscular cirrhosis was applied by way of von Buhl.[1] Recently, smooth-muscle proliferation in pulmonary fibrotic lesions is considered to be undivided of the pathologic features of idiopathic pulmonary fibrosis (IPF) or usual interstitial pneumonia (UIP).[2-4] However, a relationship between clinical findings and smooth-muscle proliferation in pulmonary fibrotic changes has not been established to our knowledge.[5,6] Therefore, we graded semiquantitatively the expanse of smooth-muscle proliferation in pulmonary fibrotic changes and evaluated the relationship between the grade and the clinical findings in patients with IPF. We raise that the presence of clubbing of the fingers was correlated with the expanse of smooth-muscle proliferation in fibrotic changes of lung biopsy specimens.

METHODS

Patients

Fifty-two patients (42 male and 10 female) who underwent render free of access lung biopsy and were diagnosed as having IPF clinically and UIP pathologically were studied.[2,3] Mean age of the patients was 577 years (range, 38 to 72 years) at the time of lung biopsy. Twenty-six patients (25 male and 1 female) were smoker 15 male patients were ex-smoker while 11 patients (2 male and 9 female) had not at any time smoked.

Open lung biopsy specimens were fixed using 10 percent formalin and were embedded in paraffin. Four-micron-cut sections were stained with Meyer's hematoxylin-eosin, and Weigert's mode for elastic fibers. Selected specimens were stained immunohistologically with mouse monoclonal antibodies using the streptoavidin-biotin entangled method. Monoclonal antibodies for desmin (DAKO-Desmin, D33) and vimentin were purchased (Dakopatts, Glostrup Denmark) and the antibody to alpha-1 polished muscle actin was obtained commercially (Sigma Chemical Company, St Louis, Mo) These staining meanss confirmed the presence of smooth-muscle enclosed spaces in the pulmonary fibrotic changes. After excluding smooth-muscle confined apartments in the vascular and airway walls, the length of smooth-muscle proliferation in pulmonary fibrotic lesions was graded semi-quantitatively by way of two of us (T.K. and MK) without any knowledge of clinical information as follows: Grade 1: les than several smooth-muscle lonely dwellings in pulmonary fibrotic changes; grade 2: intermediate between grade 1 and grade 3 (Fig 1); and grade 3: diffuse smooth-muscle proliferation forming put into bundless or a nodular growth of smooth-muscle enclosed spaces in the pulmonary fibrotic changes (Fig 2)

Grade of honeycombing was scored according to the report of Cherniack et al.[4]

After grading these histopathologic findings, the relationship between clinical and pathologic findings was evaluated. Several clinical findings were choiceed for evaluation: (1) sex and age of the patients; (2) smoking habits; (3) whether conditions of patients were exposeed by subjective symptoms of IPF or through a health examination with or without subjective symptoms; (4) duration of symptoms of the lower respiratory a whole such as exertional dyspnea and dried cough; (5) extent of chest radiographic abnormalities (the stretch of pulmonary infiltrates was divided into three grades: grade 1 infiltrates mean pulmonary infiltrates les than a third of the bilateral lung fields; grade 2 infiltrates mean pulmonary infiltrates between a third and brace thirds of the bilateral lung fields; grade 3 infiltrates mean pulmonary infiltrates more than pair thirds of the bilateral lung fields); (6) the air or absence of clubbing of the fingers[7]; (7) vital capacity (VC) percent predicted; (8) diffusing capacity for carbon monoxide (Dco) percent predicted; (9) arterial oxygen tension when patients were at rest; and (10) the postbiopsy 2-year survival was assessed in relation to the air of clubbing of the fingers and the grade of smooth-muscle proliferation.

Statistical Analysis

Student's unpaired t experiment one-way analysis of variance (multiple comparison), and [[chi].sup.2] example were applied to test statistically significant differences. The significance was determined at the 5 percent level

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