Amyloidosis is a rare clinical disease. Its clinical manifestations as well as laboratoryresults are nonspecific and widely varying. The radiographic manifestations of tracheobronchial involvement are also widely varying.
One may only see evidence of secondary changes such as atelectasis, obstructiveemphysema, distal bronchitis, pneumonitis or bronchiectasis. Tomograms or bronchogramsmay demonstrate nodular masses. When a patient presents with symptoms ofairway irritability and any of the above radiographic manifestations are discovered, the possibility of a subepithelial amyloid nodule should be investigated. This is bestinvestigated with fiberoptic bronchoscopy.
The medical literature contains a small number of cases of amyloidsis of the larynxand upper trachea discovered by indirect laryngoscopy and rigid bronchoscopy. Thereare no report, however, of lower tracheal or bronchial involvement diagnosed by flexiblefiberoptic bronchoscopy.
This report concerns a 50 year old male who came to our hospital with chief comp-laints of cough, sleeplessness and generalized lymphoadenopathy.
Multiple small millet sized protrusions were found in both main stem bronchi byflexible fiberoptic bronchoscopy. The diagnosis of amyloid nodule was confirmed histopathologically.

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A rare case of primary malignant melanoma developing in the esophagus was described.
A 45 year old man was admitted to our clinic on Apr. 5, 1974, complaining ofoccasional feeling of dysphagia for several months. General examination was negativefor melanotic lesions, including examinations of the skin, anus, both eyes and upperrespiratory tract. X-ray examinations disclosed a polypoid and multilobulated lesion atthe middle third of the esophagus.
Selective accumulation of RI in this lesion was also demonstrated by 67 Ga-citratescintigraphy. Esophagoscopy revealed a dark-bluish mass protruding circumferentiallytoward the lumen of the esophagus; its surface was relatively smooth, soft, partiallyeroded and easily bled on instrumentation.
Histologic examination of a biopsy of this lesion showed a diffuse tumor growth underthe epithelial layer of the esophagus. The tumor cells formed epitheloid clusters orsheets of streaming arrays and had eosinophilic cytoplasm with or without dark-brownpigment granules which were readily removed with hydrogen peroxide and stained withsilver but did not contain iron.
All the above mentioned data strongly indicated that the tumor was a primary malignantmelanoma originating in the esophagus.
Lineac irradiation of a total dose of 5, 000 rads combined with chemotherapies wasperformed, but the patient died 5 months later by massive, multiple metastases in bothlungs.
Eleven case reports of primary malignant melanoma of the esophagus, appearing inthe literature in Japan, were reviewed.
Histopathologic characteristics, clinical course and recent advances in the treatment of malignant melanoma of the esophagus were briefly discussed.

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Although a concept of the anomalous tracheobronchial tree as a single disease is oflittle clinical value, it is necessary for a thoracic surgeon to check prior to surgery howthe bronchi are distributed. Among 9343 cases examined bronchographically in theauthors' institute, 39 cases with anomalous tracheobronchial trees were found. A clinicalconsideration was made on these cases from various viewpoints.

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Airway obstruction due to blood coagulation of hemoptysis causes a massive atelectasisand may also cause an asphyxia, while hemorrhage probably develops repeatably.
Transbronchoscopic procedures for removal of blood coagulation and hemostasis bypressuring a cotton stick soaked with combined estrogen (premalin) were performedin 4 cases of bronchial hemorrhage (fresh pulmonary tuberculosis of 1 case and secondarybronchiectasis due to pulmonary tuberculosis of 3 cases). Significant improvement ofairway obstruction was observed in 2 cases and effective hemostasis was achieved in all 4 cases.

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In the last few years various techniques have been developed with the aim of reconstructiveprocedure after total laryngectomy. Among these techniques, subtotal or totallaryngectomy with cricohyoidopexia or tracheohyoidopexia was discussed. In our clinic, 7patients underwent laryngectomy with crico- or tracheohyoidopexia. Out of the 7 cases, two patients underwent a second operation, because they had not recovered normalswallowing. In all the patients, it was impossible to respire through the natural route.Phonatory function, on the contrary, was satisfactory and voice was excellent. To solvesome problems of the postoperative function, technical modifications were proposed.

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After long study on sputum cytology and direct biopsy from pulmonary lesion, thosemethods of exfoliation with broncho-catheter, needle biopsy and direct biopsy throughbronchofiberscope have been remarkably improved for definitive diagnosis of lung cancer.The diagnostic rate has become over 90%. In Japan, definitive diagnosis of peripherallung cancer has been greatly improved thanks to the direct specimen exfoliative methodunder TV control, using flexible curette or crush introduced into the bronchus throughMétras' Sonde developed by Tsuboi. The direct specimen exfoliative methods are mainlydevided into two ways; with broncho-catheter and with bronchoscope.
The first biopsy method was develoved by use of rigid bronchoscope, which enabledcytological and histological diagnosis under direct observation of lesions. However, thismethod was effective only for the diagnosis of lung cancer located in the main bronchus, since the visible field was limited for rigid bronchoscope. The development of flexiblebronchofiberscope has extended the visible range up the IV to V ordering of bronchuswhich could not be visualized with a conventional rigid bronchoscope.
Additionally, the development of specimen collecting instruments has made the directspecimen exfoliative method much easier. The authors have got 95.5% definitivediagnostic rate; 234 out of 245 lung cancer cases, with only 11 negative cases. In thispaper, the result of cytological examination with bronchofiberscope as a definitive diagnosticmethods for lung cancer was presented along with the study on the negative cases.

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