Identification of diseases in the peripheral airway is one of current topics in respiratory medicine. The cross-sectional area of the peripheral bronchiolar tree is estimated to be much larger than the area in the central part of the airway, so that functional and clinical signs of disturbances in this area are supposed to be silent at least at their early stages. However, when inflammatory or destructive changes progress to some extent, the impairmentshould be severe and irreversible, because of weakness of the defence mechanism in this area. Characteristic clinical features of diseases in the peripheral airway and main principles of diagnostic approaches to them were reviewed.
As the second part of the lecture, possibility of discrimination of the diseases based on pulmonary function studies was examined. Fifty-nine cases of the diseases were chosen and divided into 7 groups depending on roentgenologic findings; chronic bronchitis (n=7), diffuse panbronchiolitis (n=5), atypical bronchobronchiolitis (n=7), bronchiectasis in large bronchi (n=8), bronchiectasis in small bronchi (n=12), atypical pulmonary fibrosis (n=12), and idiopathic pulmonary fibrosis (n=7). The patients were tested for multiple discrimination analysis, using ten parameters ofpulmonary function tests. As the results, chroiic bronchitis, diffuse panbronchiolitis, and idiopathic pulmonary fibrosis were fairly well discriminated, and atypical pulmonary fibrosis was found to locate in the middle part between the three groups. Atypical bronchobronchiolitis overlapped with diffuse panbronchiolitis. Bronchiectasis (in large bronchi) overlapped with chronic bronchitis, while bronchiectasjs (in small bronchi) overlapped with diffuse panbronchiolitis. Those were poorly discriminated. The result indicates that roentgenologic and functional discriminations of diseases in the peripheral airway are pretty good but have certain limitations.

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Paediatric otolaryngology, not only in its broad aspect, but particularly in laryngology and bronchoesophagology has flourished in the recent era of development and expansion and now demands the development of new skills. A newborn infant or developing child may have familial, congenital, acquired or inflammatory conditions producing problems which require expert care.
Miniaturisation of endoscopes and high quality optical systems allow permanent photographic documentation and detailed evaluation of the changes seen in the various pathological conditions encountered.
These new and challenging problems demand a multi-disciplinary approach involving paediatric specialists in the fields of anaesthesia, medicine, surgery, perinatology, thoracic medicine and surgery and gastroenterology.
Acute or chronic airways obstruction may occur at or shortly after birth and thereafter at any age. A patient with respiratory distress, or impending respiratory obstruction, may requireprompt and appropriate treatment if there is a life-threatening problem.
At the Royal Alexandra Hospital for Children, Sydney, we have found that a combination of the lateral airways x-ray or xeroradiogram, together with endoscopic photography is a useful way of documenting diseases of the paediatric airway.

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In relation to the epidemiology of respiratory virus infections, various modes of transmission of respiratory viruses were explained on the basis of experimental data reported to date. Then, epidemiologic factors influencing the outbreaks of respiratory virus infections were reviewed, taking mainly influenza as an example.

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Respiratory syncytial virus (RSV) is one of the most important pathogens of infectious respiratory tract illness of children. An outbreak of infection with RSV regularly occurs in winter yearly, and is accompanied by an increased incidence of infants with severe lower respiratory tract illness, such as pneumonia or bronchiolitis. It has also been reported that RSV was isolated from middle ear exudate of children with otitis media. Although the pathogenesis of diseases induced by this virus is not fully elucidated, recent observations suggest an involvement of some immune mechanisms, particularly in the development of such a wheezy respiratory tract illness as bronchiolitis.

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The respiratory viral infection is the most frequent and common group of illnesses affecting mankind in all age groups. Since it is virtually impossible to estimate the etiologic agent in a given case by clinical diagnosis, laboratory diagnosis shoud be carried out.
A printed punch-card is used at the author's department for each case to record clinical and laboratory data from clinical virological examinations of respiratory viral infections.
The clinical specimen collected by means of sterile cotton swabs, e.g. throat swabs and nasal discharge, is placed in several small test tubes containing 2-4ml of veal infusion broth with added 0.5% bovine albumine, one containing antibiotics and other no antibiotics. The former is used for virologic examination while the latter is submitted for detection of mycoplasma and bacteria. Various suitable media may be employed for these microbiologic examinations.
In case virologic examination cannot be immediately started, the specimen should be quickly frozen in a dry-ice ethanol or dry-ice aceton mixture and stored in a Revco ultradeep-freezer at -70°until the time of inoculation.
The specimen is inoculated in 0.2-ml aligots onto monolayer cultures of various cell cultures, e. g. HEK, HEL, MK, Vero, HEp. 2, HeLa and L 132.
Embryonated chicken eggs and suckling mice may also be used when necessary, for the purpose of isolation of influenza virus or Coxsackie virus.
If the inoculated cultures has developed a CPE or hemadsorption, then biochemically and serologically typed.
For rapid diagnosis fluorescentantibody techniques, ELISA techniques and electron microscopic examination should be used.
Serological examination should be used for antibody arrising detection.
We have been carrying out various isolation from clinical specimens and serologic diagnosis steadly in cooperation with clinicians over these past 20 years.
Clinicovirological investigation of respiratory viral infections is considered to have profound importance in basic and clinical medicine as well as in preventive medicine.

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It was commented on the significance of the local immunity and cell-mediated immunity in respiratory virus infections. The present situations of the prophylaxis and drug therapy were also explained.

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Two kinds of surgical technique of laryngoplasty are presented for vocal rehabilitatio n after laryngectomy. One is two stage secondary laryngoplasty and the other is one stage primary laryngoplasty. The principle of those laryngoplasties is just the same in that it attempts to create a neoglottis between the trachea and the hypopharynx. A skin tube is used to connect the trachea and the hypopharynx in the former technique, while a mucous membrane tube is used in the latter. The surgical technique of one stage primary laryngoplasty is described. This method is applicable to most patients following laryngectomy.

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Various techniques of reconstructive laryngectomy, especially the tracheo-hyoidpexia (Serafini) and total laryngectomy with reconstruction of phonatory glottis (Staffieri) were evaluated from a view point of post-operative function.
One dysfunctional problem of these techniques is a continuous aspiration during swallowing. To obtain better function, a new procedure, that is, indirect connection of Staffieri's neoglottis to the trachea with a dermal tunnel is proposed.
Finally the direct internal tracheo-hypopharyngeal fistula and the retrograde internal tracheoesophageal shunt techniques (Staffieri) were discussed

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The tracheoesophageal (T-E) shunt technique by Komorn's modification was used for vocal rehabilitation in 37 laryngectomized patients including 35 cases of laryngeal cancer and 2 cases of hypopharyngeal cancer before the end of July, 1981. Laryngeal cancer consisted of 21 supraglottic types, 12 glottic types, one subglottic type and one case of secondary type. The eldest, youngest and mean ages underwent this method were 73, 44 and 60.4 years old, respectively. This modified method succeeded in 30 (81%) out of 37 cases. The causes of failure comprised of spontaneous closure or stenosis of the shunt in 5 cases, surgical closure due to excessive aspiration in one case and death by other cause in one case. The mean phonation time was 18.2 seconds. Mean maximal sound pressure level at one meter distance was 77.1dB.
Some problems after the shunt operation were discussed. As for aspiration, intra-esophageal pressure at deglutition was measured. This result suggested that the most important fact for pr evention of aspiration was to create valve function at the shunt.

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The present state of T-E shunt operation devised by the author for the postlaryngectomy voice rehabilitation is reported in this paper.
Fifty-two of sixty-seven patients (78%) attained the good speech using the shunt, while fifteen patients failed to develop the speech.
The most frequent cause of the failure was the stenosis of the esophageal orifice of the shunt.
Ten of fifteen unsuccessful cases belonged to this category. However, six of ten patients, whose speech was attained in a short period following the operation, developed the esophageal speech spontaneously without any instruction.
Thirty-three of fifty-two successful cases could control the aspiration during swallowing, while nineteen patients avoided it by percutaneous digital pressure on the shunt.
Based on the respects above-mentioned, recent ideas of the author and Kato to prevent the stenosis of the esophageal orifice of the shunt and the technique for the avoidance of the postoperative aspiration were introduced.

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Based upon long term experiences of partial laryngectomies, a technique of glottoplasty has been developed for voice rehabilitation after supracricoid or total laryngectomy. The pseudoglottis is made at the mesopharynx and does not open to the hypopharynx, while the larynx does. The pseudoglottis consists of the mucosa of the base of the tongue, and cervical dermal tunnel which connected to the trachea. The pseudoglottis works as a vocal organ, and prevents inflow of food to the airway, because it is located at the anterior corner of the forwardly extended mesopharynx at the base of the tongue, which covers the glottis during swallowing. However, 76 patients could not breath through the glottis, except for one case.

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