Our method of anesthesia for bronchoscopy was reported and recent trend of the anesthetic management was briefly reviewed.
General anesthesia for bronchoscopy carries complex problems and bronchoscopic examination itself involves the airway directly. There is always a problem of competing for the airway between anesthesiologist and endoscopist. During the removal of foreign body from the trachea or bronchus, fairly deep anesthesia is required to facilitate smooth surgery. Anesthesiologist should be aware of the development of hypoxia and hypercapnea under anesthesia.
Recent development of jet injector or ventuli bronchoscope makes it possible to perform bronchoscopic examination of relatively long duration. From our clinical experiences, ventuli technique is an efficient and safe method of ventilating a pediatric patient during open-end bronchoscopy.

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Pulmonary scintigraphy has proved to be useful for indicating diminished pulmonary blood flow. In the present study, pulmonary scintigraphy using ^99ITc-MAA clearly demonstrated perfusion defect in all four cases with radiolucent endobronchial foreign bodies in children. Discussion was made on the mechanism of decrease in pulmonary blood flow secondary to endobronchial foreign bodies.

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A case of congenital stenosis of the trachea is reported.
A one-month-old male infant was admitted to the Jikei University Hospital because of stridor after birth and occasional dyspnea during suckling. On admission a harsh breathing sound was heard over the chest, but fever, dyspnea or cyanosis was not noted. Chest X-rays and esophagogram revealed no abnormalities. Bronchoscopic examination revealed a gradual narrowing of the trachea from approximately 2cm below the glottis down to the carina, where a slitty tracheal lumen was observed. Following the examination, stridor increased together with dyspnea. A nasotracheal tube was inserted, but the infant died several days later.
Postmortem examination showed that the cartilages from the 8th tracheal ring to the left 4th bronchial ring were collapsed as if they were missing. There were no malformations in the heart, the large vessels, the lung and other organs.
Congenital deformity of the tracheal cartilage inducing severe tracheal stenosis is considered to he rare.

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This paper concerns a patient with a teratoma in the upper part of the mediastinal septum which shifts upward and downward in the right side of the neck and infraclavicular fossa with respiratory movement. This patient was 2 months old when first seen in our clinic, at which time he had a history of wheezing starting around the 3rd day after birth. This symptom appeared to become worse with time and its cause was not confirmed. A mobile tumor appeared in the neck, accompanied by increased wheezing when the patient was 6 months old. It was a solid mass which disappeared into the infraclavicular fossa at the end of the expiratory phase and protruded at the end of the inspiratory phase. It was assumed that the wheezing and labored respiration were caused by the tumor pressing on the larynx and upper trachea. After a close observation period of several months, when the patient was one year old the tumor was surgically removed through an incision in the right lateral part of the neck and it was found to be a teratoma histo-pathologically.

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Foreign body accidents in the air and food passages occur to anyone at any time anywhere. Foreign bodies of dental origin hold a unique position because of their: (1) life-threatening character; (2) requiring a special skill in their removal; and (3) possibility of implicating a medicolegal dispute.
One case of a child, who had a tooth as foreign body of bronchus (left upper lobe, B₃), was reported. A new flexible forceps was developed for this case. Jackson's forceps is usually used for removal of foreign bodies in the air and food passages; and not for the upper lobe. This instrument, however, is for the removal of foreign body from the upper lobe. By using this forceps it is readily facilitated to solve these cases.

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Twenty-one cases of esophageal foreign bodies in children were treated at the authors' clinic during the last 9 years (1970-1978). In the present paper, 4 cases out of the 21 who presented troublesome clinical courses were reported.
Case 1: A 16-month-old girl misswallowed a piece of washer. The initial symptoms of vomiting and odynophagia disappeared gradually, while dysphagia continued. The foreign body was removed endoscopically 20 days later.
Case 2: A 10-month-old boy suffered from a hypopharyngeal foreign body (pin). The main symptom was stridor and, for this reason, the definite diagnosis was delayed. It was found that the pin penetrated through the hypopharyngeal wall to the laryngeal cavity.
Case 3: A 3-year and 8-month-old boy, who underwent a surgery for congenital atresia of the esophagus at age 1, misswallowed an iron ball. The foreign body stuck at the stricture of the site of anastmosis.
Case 4: A 5-year and 11-month-old boy misswallowed his dental prosthesis. This was a rare foreign body in childhood.
The incidence of such foreign bodies in children as observed in Cases 3 and 4 may increase in future. In order to prevent foreign bodies of these types, a good knowledge of the parents and child himself seems mandatory.

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A case of female infant who had recurrent episodes of foreign bodies in the esophagus was reported. The first incident occurred at her age of 18 months, when she had a piece of meat caught in the esophagus. A year later, she had a piece of sausage as a foreign body for the second time. In both occasions the foreign bodies were endoscopically removed by forceps. Roentgenological and endoscopic examinations showed no organic changes in the esophagus. In both incidents the foreign bodies were caught at the junction between the middle one thirds and the lower one thirds of the esophagus, where the musculature of the esophageal wall is composed solely of the smooth muscles. Therefore it was assumed that, in this infant, the foreign body incidents were caused by a kind of functional constriction, which might result from peculiarities in the structure of the wall, actions of the smooth muscles and innervations, as well as from a functional disturbance of the autonomic nervous systems.
According to the author's experiences and literature as well, the incident of foreign body caused by an accessory whistle of a nibbling toy always occurred in infants of three months to six months of age. The sequelae were often serious and frequently fatal because of suffocation and difficulty in extraction.
The author proposed some ideas to prevent foreign body incidents in infants, especially those of coins which occur most frequently, and those of accessory whistles of nibbling toys which are very dangerous. A preliminary effect of the prevention was also presented.

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An unusual case of abnormal position of the larynx was presented. The patient was a 62-year-old man, who had a low-pitched voice since childhood and noticed a hoarseness for 3 months before the admission. Indirect laryngoscopy revealed a mass in the right false and true cord. Histological examination of the specimen obtained by peroral biopsy revealed a squamous cell carcinoma. The hyoid bone and thyroid cartilage were positioned extremely downward compared with those of the normal subject. The right lamina of the thyroid cartilage was noted nearly in the horizontal plane on inspection and palpation. On surgical exploration of the anterior portion of the neck prior to the total laryngectomy a hard tendon-like bundle was found to be stretched between the right lamina of the thyroid cartilage and the posterior surface of the sternum. The right lamina of the thyroid cartilage was pulled downward and medially by the tendon-like bundle, which was identified with a remnant of the sterno-thyroid muscle from the standpoint of its anatomical location. The sectioning of this bundle immediately corrected the thyroid cartilage to the normal position. Histological examination of this bundle revealed a tendon tissue.

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In previous papers, we reported that the plasminogen activator existed in the tracheobronchial secretion of normal rats and its activity was modified by some drugs However, the existence of the proactivator, other proteases and antiproteases in the tracheobronchial secretion has not been exactly studied yet In this experiment we examined whether they existed or not in the secretion, and the pH- and thermo-stability of the plasminogen activator was also examined.
The results obtained were as follows.
1. The fibrinolytic activity owing to the plasmin and other proteases was not detected.
2. The inhibitory activities to urokinase, papain and trypsin were not found.
3 The plasminogen activator was detected in spite of the absence of the proactivator.
Additionally it was observed that the pH- and thermo-stability of plasminogen activator in the tracheobronchial secretion was similar to that of the tissue plasminogen activator with the low molecular weight found in human paranasal mucous membrane From the results obtained, it was concluded that the potential system of fibrinolysis was present in the tracheobronchial secretion although the plasminogen itself was absent

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