Dyspnea is one of the major symptoms which clinicians frequently experience, and in addition to dysphagia, dyspnea has been thought to be the most important subject of the Broncho-esophagological Society.
In the present paper, measures for dyspnea in our department were described in four respects.
(1) Symptoms of patients who visited the department of pneumonology in our University hospital during the past one year were analyzed and importance of dyspnea was indicated. Several cases of pulmonary cancer were refered since these were misdiagnosed as bronchial asthma due to complaint of stridor.
(2) It was emphasized that psychosomatic approach was required for dyspneic patients including bronchial asthma.
(3) Effectiveness of oxygen therapy at exercise was mentioned on the basis of our analysis with patients of chronic respiratory failure. Additionally, our experience of domiciliary oxygen therapy for 6 years was introduced.
(4) Diminution or removal of dyspnea is frequently difficult in cases of terminal stage of lung cancer, however, we should hardly try to remove this complaint by referring to the current terminal cares in western countries.

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The clinical indications for tracheostomy have been modified during the last decade by the increasing importance of intubation technique. Early and late complications of both methods are compared. The different problems following tracheostomy are shown and the therapeutical guidelines are discussed. We finally present our own tracheostomy technique, which helps to reduce the postoperative complication rate.

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It is known that some pathologic situations may produce a deviation of the larynx, showing lateral displacement of the anterior commissure on mirror examination and distortion of the thyroid cartilage on palpation of the neck. When laryngeal deviation with no apparent cause is observed, it should be labeled idiopathic laryngeal deviation.
The author has seen more than a few cases of idiopathic laryngeal deviation, and most cases were male patients over 50 years of age with deviations to the right. The thyroid notch deviates to the right, the anterior crest of the thyroid cartilage inclines toward the right and the larynx as a whole may twist to the right around the body axis, making the deviation three-dimensional.
The possibility of the association of laryngeal deviation with cancer of the larynx or hypopharynx must be emphasized. In associated cases, the extent of cancer may not be properly estimated in the staging process and a correct therapeutic strategy may not be established unless the characteristic findings of laryngeal deviation are well understood by the examiner.
In this paper, several typical findings of laryngeal deviation are mentioned and problems in staging the cancer associated with it are discussed.

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Immunologic mechanism of allergic diseases in airway is known to be concerned with allergic response of Type I, III or IV and mainly allergic response of Type I by IgE antibody (or occasionally IgG₄ antibody).
On this occasion, various chemical mediators released from mast cells by antigen-antibody reaction affect the upper and lower airways, and induce inflammatory change.
The function of the cells such as macrophage, lymphocyte, basophils, eosinophils and monocytes which take part of the allegic inflammation have been confirmed. Histamin, SRS-A, ECF-A, prostaglandins (PG), PAF, NCF and leucotrienes (LT) are also thought as chemical mediators. PGF_2α, LTC₄ and LTD₄ are concerned as a factor of hyperresponse in airway.
Recent studies suggest that major basic protein (MBP) in granule of eosinophilis induce the inflammation on bronchial epitherium, accelerate the release of LT from the mast cell and increase the bronchial spasms and secretion of bronchial gland.
Eosinophilis and neutrophilis which act as inflammatory cells are thought to cause late phase asthmatic response.
Concerning the treatment, drugs to have the supressive function of the chemical mediators by means of cell membrane of mast cell, LT and anti-LT agents based on the immunopathologic mechanism discussed above have been developed.

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The purpose of this paper is to introduce the basic aspects of the laser surgery in broncho-esophagological region. At first, this paper describes CO₂, Nd-YAG and Ar laser as the most commonly used laser in medicine from the tissue reaction point of view, and then widely introduces the topics of the newest laser such as excimer, gold-vapor, diode, CO and tunable laser and its prospect in the near future.
Moreover, it refers to the laser safety in clinical application, and emphasizes the necessity of giving great efforts for developing the laser diagnostic equipments in this field.

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We evaluated experimentally and clinically the results of the laser endoscopic treatment for esophageal and cardiac lesions.
The canine experimental esophageal cancers similar to human esophageal cancers of early or superficial type were treated by photocoagulation method and photodynamic therapy of the laser endoscopy. The cancer lesions almost disappeared by the laser therapy.
Clinically, we succeeded in the hemostasis of gastrointestinal bleeding, the relief of stenosis and the removal of benign tumor in the esophageal and cardiac regions. We could treat early or superficial cancer lesions by laser, too. However, this treatment had some problems because we had no procedures for the detection of metastatic lesions. So, the laser endoscopic therapy was limited to treat only the case which was refused surgical treatments by some reasons. The treatment of laser endoscopy for advanced cancers was only palliative.

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When laser is adapted to the region of trachea and esophagus, it must have merits in comparison with usual scalpel and other new therapeutic methods developed by modern engineering. For the application of laser to the region of trachea and esophagus, following five items were examined.
1. Characteristic mark in this region
2. Characteristic mark of laser in comparison with other new therapeutic methods
3. Various kinds of lasers to be adapted to this region, and these merits and demerits
4. Applicable diseases
5. The problems and the side effects
In conclusion, laser is very effective therapeutic method to many kinds of tracheal and esophageal diseases and has special merits in comparison with other therapeutic methods. However, we must grasp enough it's characteristics and recognize the limitation to it's adaptation.

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One hundred and thirty six patients with lung cancer were treated photodynamically by administration of hematoporphyrin derivative (HpD) and argon dye laser irradiation. The effectiveness of this therapy was evaluated, and the indications and limitations were discussed. The patients consisted of 127 males and 9 females and ages varied from 36 to 85 years. As far as the clinical stage is concerned, 32 cases were early stage (stage I_a according to the UICC classification), 18 were non-early stage I, 11 were stage II, 56 stage III and 20 stage IV, respectively. Histologically there were 106 squamous cell carcinomas, 14 adenocarcinomas, 6 large cell carcinomas, 6 small cell carcinomas, one case of adenoid cystic carcinoma and 3 cases of bronchial metastases of malignant melanoma and renal carcinoma. Complete remission was observed in 23 out of the 33 early stage lesions. Tumor recurrence was recognized in 2 cases out of the 22 cases which had showed complete remission. All cases showed at least partial remission of tumor. The indications for PDT should be limited to the treatment of early stage lung cancer in order to obtain complete cure and to the palliative treatment of advanced lesions to improve performance status.

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The application of laser therapy to cases of esophageal cancer is considered as follows: Early cancer which is inoperable by some reasons; remaining and/or recurrent cancer which has received the maximum dose of the combined therapy in the inoperable case; malignant esophageal stenosis progressed to the difficulty in passing bolus; airway stenosis due to cancer invasion; intraoperative irradiation to prevent recurrence from invaded neighboring structures (aorta, trachea and bronchus) and the dissected regional metastatic lymph nodes.
Photodynamic therapy (PDT) is applied during intraoperative laser irradiation. The method will be generalized in future.

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For carcinomas of the tongue, we have employed three types of laser usage. Carcinomas confined within the mucosa are treated by laser alone. Carcinomas with a superficial muscular invasion are treated with mass reduction laser surgery followed by chemoradiotherapy. Carcinomas with a deep muscular invasion are first treated with induction chemotherapy. When the chemotherapy in effective, we add mass reduction laser surgery followed by chemoradiotherapy. Thirty-five patients were treated and none has developed local recur-rence. The 5-year cumurative survival rates were 86.4%. Speech intelligibility is much better in the treatments using laser than those after extensive surgeries.

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Mucociliary transport system is an important defense mechanism of the respiratory system and its function needs coordination of mucous layer and ciliary movement. Sinobronchial syndrome causes chronic inflammatory diseases of upper and lower respiratory systems and mucociliary dysfunction is a characteristic morbid status of the respiratory systems. Factors related to mucociliary function can be classified into quality of the mucous layer, structure of the system and ciliary function. Cilioinhibitory factors previously reported are as follows: 1) A low molecular glycoproteins and family of proteins purified from materials of patients with cystic fibrosis, asthma, etc., 2) Serine protease from patients with bronchiectasis, probably neutrophil elastase, 3) major basic protein (MBP) and eosinophil cationic protein, 4) metabolites of arachidonic acid. In this study MBP, leukotriene C₄, leukotriene D₄, prostaglandin E₂, prostaglandin F_2α and platelet activating factor were tested on effect on ciliary activity using a newly developed apparatus with a VTR system and changes in mucosal surface profile of humans were observed following these substance challenges at a concentration of 10^-6M. These mediators except for prostaglandin E₂ caused mucosal damage such as ciliodyskinesis, ciliostasis and exfoliation of the cells and resulted in coarse profile of the mucosal surface within several hours at a concentration of 10^-6M suggesting their possible destructive action to the mucosa.

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Mechanisms of the defence of the airway was studied with 54 cases of sinobronchial syndrome (SBS) by means of trans-tracheal aspiration (TTA) and aerosol inhalation cine scintigraphy (AICS).
1. TTA obtained from the lower airway of cases of SBS revealed continuous infection with organisms usually observed in the normal upper airway such as Haemophilus influenzae and others. We estimated that the clinical course of SBS took a turn of worse with continuous infection.
2. Damages of mucocilliary transport in lower airways were clearly observed by AICS in cases of SBS.
We strongly suggested that continuous infection due to the damage of the mucocilliary transport in the lower airway was the main factor causing symptoms observed in cases of SBS.

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Pulmonary function tests are the valuable approach for understanding the mode of progression of airway disease in cases of sinobronchial syndrome (SBS). We performed the pulmonary function study with 34 cases of chronic sinusitis and 59 cases of SBS. In cases of chronic sinusitis, routine pulmonary function tests were mostly within normal ranges. Small airway dysfunction examined by flow volume curve, closing volume, dynamic compliance and upstream resistance was rarely found in nonsmokers of chronic sinusitis. These results may indicate that chronic sinusitis is not the premonitory condition of SBS. On the other hand, spirometry was normal only in 19 cases of SBS. Vital capacity tended to decrease in cases of SBS and this reduction was negatively correlated with %RV/TLC and %Rrs, and decrease of vital capacity was associated with air trapping and obstructive ventilatory failure. Forced expired volume in one second (FEV₁%) was reduced in 50% of cases, however, small airway dysfunct 2. was frequently observed among patients whose FEV₁% was in normal range. It is suggestea that ascending progression of airway disease may be considered in cases of SBS.

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DPB in a form of chronic inflammation involving respiratory bronchioles with the full thickness of the bronchiolar wall infiltrated by lymphocytes, plasma cells and macrophages. As a result, obstruction or stenosis of the bronchioles ensues resulting in air trapping with subsequent dilatation of the distal air spaces. Accumulation of xanthoma cells are frequently found in the connective tissue as well as in the alveoli. After a long course of disease, the affected foci become scarred and secondary lesions such as focal emphysema, or bronchiolectasis of the more proximal, non-respiratory bronchioles may follow. In the materials presented, in addition to the findings above described, the segmental and subsegmental bronchi showed hyperplasia of the bronchial glands and Reid indices were significantly increased as compared to the controls. Paranasal sinus examined in an autopsy case exhibited hyperplastic sinus glands.

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Sinobronchial syndrome is defined as a coexisting pathology of chronic sinusitis and nonspecific chronic inflammatory lesion of the lower airway (e. g. chronic bronchitis, bronchiectasis, and diffuse panbronchiolitis).
The cases of sinobronchial syndrome were found in 10.4% of 309 patients with chronic sinusitis, and in 55.4% of 74 patients with chronic lower respiratory infectious diseases. In many cases of sinobronchial syndrome, the time lag between the onset of nasal symptoms and that of bronchial ones was found. The nasal symptoms had appeared in childhood and bronchial symptoms had appeared after adolescence. The clinical courses in 20 cases with sinobronchial syndrome were observed after the radical operation to chronic sinusitis. The results of treatment were not satisfactory especially as far as their bronchial symptoms were concerned (only three cases were improved).
Sinobronchial syndrome, especially diffuse panbronchiolitis was significantly associated with HLA-Bw54, which was found specifically in Japanese and not in Caucasians. These facts may suggest that there is a gene controlling the susceptibility to sinobronchial syndrome, especially diffuse panbronchiolitis.

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Fifty patients of SBS were surveyed from one hundred and twelve cases of chronic obstructive lung diseases (COLD) of both pulmonary clinics for three years, and categorized into three types: chronic bronchitis (CB), bronchiectasis (BE) and diffuse panbronchiolitis (DPB).
This study was summarized as follows;
1) The percentage of SBS was 56.8 of the patients with the chronic bronchial symptoms.
2) Dysosmia was observed in 26% of SBS.
3) The chest X-ray of EK type of SBS showed the bronchiectatic findings such as ring and tramline and patchy shadows in two or three lobes of middle (lingular) or lower lobes, but the findings of EK of non-SBS were limited to single segment or lobe.
4) The clinical features of DPB (7 cases) were characterized by several points compared with other types of SBS.
5) Bronchial hyperreactivity may suggest another aspect of the related disorders between upper and lower airways as well as chronic productive cough.

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Diffuse panbronchiolitis (DPB) which is the representative of Japanese sinobronchial syndrome is grave in prognosis. Eighteen paients with DPB, including sixteen cases with H. influenzae infection and two with P. aeruginosa infection, were treated with 600mg of Erythromycin (EM) per day for 19.8 months on an average. After the therapy, dyspnea on exertion, body weight, chest X-ray findings, pulmonary function data including VC, FEV1.0 and RV/TLC, PaO₂, cold agglutinin titer and IgM level were significantly improved. There were no significant side effects. There was no change of bacterial flora in sputum except one.
Low-dose, long-term chemotherapy of EM could be useful in treatment of DPB.

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Chest examinations of 2.827 patients, aged 2 to 77 years, with paranasal sinusitis, revealed that the frequency of sinobronchitis was 5.4% and the highest 36.9% being in age group of 2 to 5 years. Sinobronchitis seemed to occur in childhood below 15 years of age and pneumonia was the most frequent induced factor. In our series of sinobronchits, following treatments were performed: 1, conservative therapies for children (with occasional recurrence); 2. sinectomy, lung resection and conservative therapies for the adluts having unilateral bronchiectasis (most effective); 3. sinectomy and/or polypotomy and conservative therapies for the elderly adluts having chronic bronchitis or bilateral bronchiectasis, especially with hypoxemia.

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