Sinobronchitis is a syndrome, which indicates a subacute or chronic inflammatory process involving the paranasal sinuses accompanied with an infection of the trachiobronchial mucosa and with hilar lymphnodes swelling.
In this presentation, first the frequency of sinobronchitis was treated from the rhinologic standpoint. Second, the characteristic clinical findings were described. Third, the results of analysis of the sweat electrolytes in the patients with chronic sinusitis and sinobronchitis, and comparative observation between the histopathologic changes of the sinusal mucosa of the affected paranasal sinuses and those of the bronchial mucosa taken from the resected lung specimens with chronic bronchial inflammation were reported.; Finally, the long term prognosis of the patients with this syndrome were added.
The results of the chest x-ray examination and the thorough investigations of the anamunesis and the complaint showed chronic bronchitis and bronchiectasis in 23 or 5% of 461 patients with chronic sinusitis, in 33 or 16% of 205 (primary, middle and high school, and university) students with chonic sinusitis, and in 2 or 10% of 20 miners with chonic sinusitis and polyposis.
Besides headache, nasal obstruction, anterior and posterior nasal discharge, couching and expectoration were added as the synptomes of chronic bronchial disorders in almost all of the 38 cases, which suffered from sinobronchitis for about ten months. Nasal and sinusal changes were similar to those of the banal paranasal sinusitis. Chest x-ray findings of the patients with this syndrome were characterized occasionally by increased hilar marking, cloudiness in the lower lung field and emphysematous change (chronic bronchitis), and sometimes, by triangle shadow in the phrenicocardial angle, mediastenal shifting and honey comb shadow (bronchiectasis). The obstructive ventilatory insufficiency was occasionally found in the patients, even in youths, suffering from sinobronchitis.
One hundred thirty patients suffering from chronic sinusitis and sinobronchitis were sudjected to the analysis of sweat electrolytes. The sweat for analysis was obtained by pilocarpine iontophoresis in all cases tested.
If the level of more than 60meq/1 of chloride and the level of more than 70meq/1 of sodium could be considered as a high abnormal level, the following could be said.
1) In eleven out of 130 cases tested the analysis of the sweat revealed the high abnormal level of both sweat chloride and sodium concentration.
2) There was no relationship between the high abnormal level of both sweat chlocide and sodium and the opacity of paranasal sinuses on x-ray films or nasal polyposis.
3) There was some relationships between the high abnormal level of both sweat chloride and sodium and the extent of the density in the lung field on x-ray films.
4) Cases with sinobronchitis presented frequently elevated sweat electrolytes concentration.
5) It was impossible to detect the case with fully manifested cystic fibrosis of the pancreas through the sweat test in Japanese with paranasal sinusitis and with sinobronchitis.
Sinusal mucosa removed surgically from fourteen patients with sinobronchitis were classified histopathologically as follows: edematous 5, fibrotic 3, fibroglandular 3 and inflammatory 3. On the other hand, bronchial mucosa of the lung specimens with chronic bronchitis or bronchiectasis could be classified into four types. 1) The affected bronchial wall and the surrounding parenchyma of the lung have various inflammatory changes. 2) Chronic inflammatory processes develop predominantly on the bronchial wall alone. 3) The structural weakness of bronchial wall and emphysema are predominant, dispite little or no inflammatory change. 4) combined typy of 1) -3).

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Since 1954 Transbronchial biopsy for the periferal pulmonary lesion has been successfuly applied for early diagnosis of the pulmonary neoplasm.
218 cases accumurated at the National Cancer Center Hospital for the past three years have been repoted.
Positive diagnosis were made in 83% of all cases and among those lesions of which the tumor measures less than 2cm in diameter, it was 90%.
Pathological diagnosis upon resected specimen confirmed the accuracy of the diagnosis by this method in 80%.
Anatomical exemination of the 47 resected lungs found the direct tumor invasion of the periferal bronchus in all cases. This evidence proves the feasibility of this diagnostic procedure.
There are no complication such as massive hemorrhage or dissemination of the tumor has not been encountered following this procedure.
We believe that this is the superior diagnostic method for early cytological detection of the pulmonary neoplasms.

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Cytological and bacteriological study on the bronchial secretion has been performed in the cases of chronic bronchitis, acute bronchitis, pulmonary cancer, tracheal bleeding, bronchiectasis, mediastinal tumor, laryngectomized patient, laryngeal syphilis, chronic pharyngitis accompanied by atrophic rhinitis and struma.
The results obtained are as follows:
1) Eosinophilic leucocytes, lymphocytes, histiocytes and erythrocytes gere largely appeared in the cases of bronchial diseases.
2) Eosinophilic leucocytes, lymphocytes and histiocytes were dominant to be appeared in the ceses of chronic bronchitis, however, in the cases of acute bronchitis, histiocyte was not appeared whereas the others mentioned above were present.
3) In the cases of bronchiectasis, there were highly appeared non-epithelial cells in the secretion and pneumococci in the cultured secretion.
4) In the cases of pulmonary cancer, the case of which the tumor appeared in the main bronchus revealed numeraus atypical cells (class 4) whereas the two cases without the tumor in the main bronchus revealed no atypical cells (class 1).
5) In the cases of laryngeal cancer to which laryngectomy was performed there was a few atypical cells (class 2) in the secretion.

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Tha bronchoscopic examination was carried out among 340 patients having pulmonary tuberculosis for two years. Abnormal findings were found in 72 cases (21.17%); in detail, the ulcerative form occupied 1.47%, constrictive form, 3.53%. This data indicates an extremely decreased rate of abnormal findings as compared with those reported before. But the bronchoscopic examination should be performed routinly. Even if the performance of the examination is restricted to a minimum, it must be done among the patients expected to have total pneumonectomy as such patients have a high frequency of abnormal findings were discoverd. In 22 of 23 patients having blood sputum postoperatilly or discharging a small amount of bacilli continuously, abnormal findings were found in the resected ends and resistant bacilli were seen in most of these patients.

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The foreign body was composed of 2 pieces of 50 yen and 10 yen metal coins.
The removal was not extracted by, at one time, esopbagoscopy with two coins; two coins was not noted in preoperation.
The authors stress the importance of making x-ray diagnosis (one made in the anteroposterior and one in the lateral plane) to establisch the identity and number of the foreign body.

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