The author presents a statistical analysis of foreign bodies in the air and food passages based on the data obtained from 37 medical school hospitals throughout Japan.
Of 7371 total number of cases 1571 (20.3%) were of foreign bodies of the respiratory tract and 5800 (79.7%) were of the food passage; the latter constitutes 3.6 times of the former.
Sex: Of the total number, 4365 (59.3%) were males and 3006 (40.7%) were females: the ratio between two sexes is 3 to 2. In the foreign bodies of the air passage males accounted 891 and females 650, and in the food passage 3444 and 2356 respectively.
Age: In my experience the youngest patient was one month old and the oldest, 85 years of age. In the foreign bodies of the respiratory tract, 1104 (75.1%) were under 15 years old and in those of food passage 2659 (45.8%) were under 15 years old.
Kind of foreign bodies in the air passage : Of 1557 known intruders 505 (33.7%) were peanuts and beans, 122 (7.9%) were pins of various kinds, 73 (4.7%) were toys, 71 (4.5%) were pencilcaps, 51 (3.2%) were nails and 725 (45.6%) constituted various other objects.
Kind of foreign bodies in the food passage: Of 5388 known intruders 1588 (29.8%) were bones mostly of fish, 2002 (37.1%) were coins, 269 (5.0%) were food particles, 394 (7.3%) were dentures, 168 (3.1%) were toys and 967 (17.9%) were various other objects.
Place of lodgement: In the respiratory tract 285 (22.1%) were found in the nasal cavity, 212 (16.4%) in the larynx, 291 (22.6%) in the trachea and 497 (39.6%) in the bronchi. In the food passage 959 (18.5%) were in the pharynx, 2701 (51.8%) in the upper esophageal region, 687 (11.1%) in the midesophagus, and 154 (2.9%) in the loweresophagus and 653 (12.5%) were in the stomach.
Diagnosis: Of 789 foreign bodies in the air passage in which an accurate date were available 562 (72.5%) were diagnosed accurately and promptly; and of 3006 foreign bodies of the food passage 2649 (88.2%) were similary diagnosed.
Endoscopic removal: Of 984 foreign bodies in the air passage 786 (70.7%) were removed at the first endoscopic examination, 139 (14.1%) require two or three times and 104 (10.4%) required more than four endoscopies.
Of 3037 foreign bodies in the food passage 2631 (86.6%) were removed at the first endoscopic examination. 141 (4.7%) required two and 113 (3.3%) required three examinations. 152 (5.0%) were expelled spontaneously.
Death: Of 1239 foreign bodies in the air passage there were 60 (4.8%) deaths, and of 5455 foreign bodies of the food passage there were 55 (1.0%) deaths.
The author illustrated numerous cases with X-ray pictures in which diagnosis was either missed and/or treatment delayed before first seen by him.

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A 35 year old housewife suffering from abdominal distension began to develop chronic intestinal obstruction on July 1957. Because of nausea and vomiting with left lower abdominal pain patient was admitted to the Department of Surgery. A Millier-Abbot tube was inserted and high pressure enema given. A roentgenogram taken 4 days later indicated that the tube was in the stomach. An attempt made to remove the tube was unsuccessfull and a request was placed to authors for removal. Upon esophagoscopy a coil of the tube was found at a level of 27cm from upper alveolar process. The proximal end of the tube was grasped and was removed.

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Authors report two cases of bronchiectasis resulting from prolonged sojourn of foreign body in the bronchus.
One case is that of a 33-year-old male who aspirated while in his primary school grade a peanut kernel which remained for about one year. Recent chest examination revealed bronchiectatic changes involving the left lingular bronchus.
The second case is that of 28 years old female who aspirated a denture in a fit of epileptic seizure. Years later she developted bronchiectasis in the left lower and lingular bronchi.

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Authors report surgical experiences on 4 cases of periesophageal abscess resulting from foreign body lodgement and/or esophagoscopic examination. The abscess developed was in the region between the esophageal wall and perivertebral space. A surgical drainage was considerd essential.

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SM and/or INH were bronchoscopically instilled into tuberculous cavities in 98 cases and the progress studied on the efficacy of these treatments.
In 14 cases which did not respond to the bronchoscopic treatment an extirpation of the affected lesion was made and histologic examinations were carried out. The author found that in addittion to cleaned-out cure which he noted in one case, factors which resisted the tretment are cicatricial changes of the lesion, tortuous stenosis of the draining bronchus, and thick pleural adhesions.

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Bronchiectasis complicated by tuberculosis was studied bronchographically and/or histologically on removed specimens on 299 patients. As a contrast medium 60% Urokolin oil suspension was instilled into the bronchus by means of Metras' catheter and following results were obtained.
1) Bronchiectasis was found in 208 cases (69.9%). Of this number cavities were present in the affected lung in 143 cases. The incidence of bronchiectasis was found increased with increase of duration of pulmonary tuberculosis. Of 47 cases in which tuberculosis had been present for 6 months bronchiectatic changes were found in 26 cases (55.3%). Of 23 cases in which tuberculosis had been present with cavitation for 6 months 17 cases (73.5%) showed bronchiectasis, and of 36 cases in which tuberculosis had been present more than 5 years, 35 cases (97.2%) showed bronchiectasis. However, of 24 cases in which tuberculosis had been present for 6 months and in which no avitation was present, 9 cases showed bronchiectasis and of 23 in which tuberclosis had been present 15 cases (73.9%) showed bronchiectasis.
2) Relationship between various types of pulmonary tuberculosis and Bronchiectasis:
Type Number of cases studied Bronchiectasis
H 8 none
B 67 58 (86.6%)
C 183 93 (50.8%)
D. 18 11 (61.1%)
OK 4 3 (75.0%)
OT 19 9 (47.5%)
3) Pattern of bronchiectasis
The incidence of column shaped bronchiectasis was found decreased as the duration of tuberuculosis process increased, while club and rosary shaped ones showed increase with the increase of the duration of tuberculosis process.
4) Location of involved bronchiectasis
Right side: B1, B2, and B3 were involved in 95 (82.6%) of 116 cases. B6 was involved next in frequency.
Left side: Majority involved were B1 plus, 2, and B3.
These findings indicate a distinct difference of bronchiectasis complicated by tuberculosis from spontaneous one.
5) No remarkable changes were noted in the course of one year in 73 cases of bronchiectasis which were examined regularly at 3 month intervals.
6) Symptoms of bronchiectasis
Group A. With average amount of cough, sputum, blood tinged sputum and/or hemoptysis. Group B. No symptoms but tubercle bacilli were found in sputum.
Group C. No symptoms and no tubercule bacilli in sputum.
Group A. constituted 61 cases (29.3%) which are mostly of rosay and grape shaped ectasis located in the central region.
Group B and C which are mostly of column and club shaped are seen in peripheral parts.
7) Treatment
Chemotherapy was given to all cases irrespective of whether or not a surgical operation had to be required.
A. Surgical operation
Although it is too early to discuss the long range results, patients with a few exceptions have taken good turn after operation.
B. Chemotherapy
Among those who received only chemotherapy good results were obtained in
As shown in the above figure club shaped ectasis responded better to chemotherapy than other types.
8) Histological studies of the removed lungs.
Observations made on 64 cases showed that the bronchial mucosa has general tendency to form fine winkles and to exfoliate its epithelium. Some parts were seen papilliformed projecting into the lumen. Cellular infiltrations were seen in the submucosa. In only one case tuberculous lesion was noted in the submucosal tissue, and all the other specimens showed non-specific infiltrations. In some areas cellular infiltrations were so marked that the muscular tissues were found broken or atrophied. While a very few cases showed tuberculous infiltration, non-specific infiltrations and increase of fibrous tissues and athelectasis around bronchi are observed. Therefore bronchiectasis accompaning pulmonary tuberculosis is considered to be due to lymphogenic infection around the bronchi.

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Gastrostomy is performed mainyl to facilitate the intake of nourishment thereby prolonging life of patient suffering from advanced esophageal cancer or as a means to dilate cicatrized stenosis by retrograde bouginage.
In the application of gastrostomy authors have gone one step further. They attained a beneficial result in performing gastrostomy prior to laryngectomy, surgery of cleft palate or and periesophageal abscesses.
Authors point disadvantages of nasal catheter in that 1) it entails discomfort to patient, 2) it is difficult to supply sufficient nourishment through a small calibred tube ; 3) the operative wound is lskely injured by the tip of catheter which would delay healing.
Authors experience with socalled “advance gastrostomy” in 6 laryngectomies, one cleft palate operation and one resection of carcinoma of the esophagus, one cicatricial stenosis of the esophagus showed remarkable result in recuperation and shortening the hospitalization.

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As one of the specialties in a general hospital, the clinical procedures performed in our clinic are carried out in close collaboration and cooperation with the other services in our hospital, especially the departments of internal medicine, respiratory diseases, thorasic surgery and radiology. To appreciate the actual scope of the medical service rendered in the department of bronchoesophagology in a general hospital, a review of the patients managed in our clinic during a recent two-year-period (from August, 1956 to July, 1958) is presented and the role which should be assumed by the department of bronchoesophagology in a general hospital is discussed.
The most frequent disorders which were encountered in our clinic were pulmonary tuberculosis, hemoptysis, suppurative diseases of the lung, lung tumors and foreign bodies. The procedures performed in patients with the these disorders were bronchoscopic and esophagoscopic examinations, bronchography endoscopic irrigation and medication, suction of secretions, removal of foreign bodies in the bronchus or esophagus, biopsies, bronchospirometric studies, etc.
During this two-year period 1073 procedures were carried out. Approximately twothirds of the total number were for diagnostic purposes and the remaining one-third therapeutic procedures. The therapeutic procedures consisted mainly of endoscopic irrigation and medication in patients with pulmonary tuberculosis or suppurative diseases of the lungs (24%), and only 3.8% or 19 of 491 endoscopic exminations were performed to remove foreign bodies from the bronchus or esophagus.
As the figures in this study show, the clinical procedures rendered in the bronchoesophagolog ical department are mainly diagnostic in nature. Moreover, it was clearly demonstrated that active performance of endoscopic examinations in many patients for diagnostic purposes in cooperation with the related specialties was of value in early detection of diseases and in establishing early diagnosis and course of treatment, thus contributing not a little to the overall medical care of patients in a general hospital.
It is the author's opinion that this is the most important function of the department of bronchoesophagoloy in a general hospital and it is emphasized that the active and early use of endoscopic examination should be adopted so that it can be performed as readily and easily as other routine clinical methods of investigation.

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A case was reported of tuberculosis of thyroid gland in a 54 year old female who was operated on adenoma of the gland.
Tuberculosis of the thyroid is a rare occurrence and this makes the 23rd case of its kind heretofore reported in Japan. It was considered necessary for this case to institute a chemotherapy in addition to surgical extirpation of the lesion.

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