Congenital anomalies of the lower respiratory tract in children are said to be uncommon diseases. The development of the lower respiratory tract in the intrauterine life starts as the primitive lung bud and the formation of bronchial tree is completed by 24th week. Thereafter, alveolar bronchioles, alveolar ducts and alveoli begin to develop, and then alveolar growth in number is completed by the age of 8 years.
Some disturbances that occur during the process of development of the respiratory tract could be the cause of the congenital anomalies of tracheobronchial tree.
In this paper, the author described the congenital agenesis, stenosis and anomalous branching of the tracheobronchial tree, and presented their symptoms, diagnosis, treatment and so on.
Congenital anomalies of the tracheobronchial tree usually show a variety of symptoms ranging from asymptomatic cases to those which require an emergency operation. It is necessary to make an early diagnosis and to start an appropriate treatment.

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The main congenital disorders of the esophagus requiring surgery consist of esophageal atresia and esophageal stenosis. Of these disorders, esophageal atresia is most common and one of the important diseases in the neonatal surgical field. Esophageal atresia and its similar disorders require surgery in the early neonatal period. On the other hand, esophageal stenosis which demonstrated a delayed initial symptom after the weaning period, usually underwent surgery after one year of life.
During the last twenty years, surgical managements in the neonatal patients have made a rapid progress in Japan and surgical results have now been comparable to those from the advanced countries in the world.
In recent years, therefore, surgical results of esophageal atresia have been improved except in high risk patients with severe anomalies, severe pulmonary complication and extreme prematurity.
In this paper, the author commented on the present states of surgical treatment of esophageal atresia including its similar disorders such as isolated tracheoesophageal fistula and laryngotracheoesophageal cleft.

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An eight-month-old infant suffering from dyspnea on crying was diagnosed as Fraser's syndrome because of having multiple malformations such as cryptophthalmos, small auricles, syndactily, and so on. After the death, the larynx was obtained at autopsy and glandular development was investigated using immunopathologic techniques. Glandular tissues developed well at the level of the false vocal cord and the ventricle. In the subglottic area, submucosal connective tissue became thick and a relatively small number of glandular acini distributed irregularly. Immunopathologic examination revealed the presence of secretory component or lactoferrin in the glandular acini, surrounded by mucous glands, in the congenital stenotic lesion of the subglottis.

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Thirteen infants from Department of Pediatrics and Pediatric Surgery underwent ventilation bronchoscopy. Four infants had congenital abnormalities such as tracheal stenosis and tracheomalacia. It seems that there are increasing opportunities to perform bronchoscopy of infants with congenital defects of trachea as neonatal medicine progresses.

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Among various anomalies related to the trachea and esophagus, atretic and stenotic lesions are the most common and challenging objects in pediatric surgery. Tracheoplasty with the costal cartilage grafts is the treatment of choice for the extensive congenital stenosis of the thoracic trachea. We treated 4 cases of tracheal stenosis with this technique. Observation for following 2 years suggests that this technique is useful for such extensive lesions as an end-to-end anastomosis is not indicated.
One hundred and thirty seven cases of esophageal atresia were treated at our institute with an overall mortality rate of 38%. Primary or staged end-to-end esophageal anastomosis was performed on 94 patients with a 20% mortality rate, whereas jejunal or colonic interposition was indicated for 13 patients with a mortality rate of 30%.
The cause of stenosis of the esophagus was fibromuscular hypertrophy in 20, bronchial remnants in the esophageal wall in 7 and the ectopic gastric mucosa in 2 of our series of patients. Esophagoesophageal anastomosis was a possible procedure when the length of resection of the esophagus was limited to within 2.5cm. Intestinal interposition was, however, required when the esophagus was resected 3.5cm and more.

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Among various esophageal anomalies, congenital pyriform sinus fistula is a unique new lesion because it has not yet been described in any textbooks. There is some debate at this moment whether this anomaly is an embryonic remnant of the third or fourth pharyngeal pouch. The diagnosis is easily established with an esophagogram, and a permanent cure can be achieved by complete removal of the fistula with the guide of a Fogarty catheter left in place. The authors would like to stress that this anomaly should be kept in mind in treating patients of every age with an inflammatory neck mass.

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The study was undertaken to clarify the mechanism causing bronchoconstriction after inhalation of cold air and to determine the site of bronchus most severely affected. A series of experiments were performed on 11 healthy subjects who had history of bronchial asthma only in childhood. The respiratory resistance was continuously measured by a newly developed system to test the effect of cold air inhalation and also the pulmonary function was measured before and after the inhalation. The bronchial hyperresponsiveness to methacholine was measured by the astograph. The effects of various drugs (atropine, ipratropium bromide and disodium cromoglycate) on the increase of respiratory resistance were investigated. The respiratory resistance was increased immediately after the inhalation of cold air in all subjects. The increase in respiratory resistance was inhibited by atropine and ipratropium bromide but not by disodium cromoglycate. The decrease of V₂₅ induced by inhalation of cold air was significantly greater than that of FEV₁. Thus it was concluded that from a pharmacological point of view, inhalation of cold air caused bronchoconstriction, predominantly in small airway via cholinergic mechanism. Also, the degree of increase in the respiratory resistance was correlated with the bronchial sensitivity to methacholine.

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It has been reported that plasminogen activator existed in tracheobronchial secretion of rats. From the results of previous studies, it was expected that inhibition of proteolytic enzyme in tracheobronchial secretion conducted to control the process of inflammation in the respiratory tract. In this study, Miraclid, a polyvalent inhibitor derived from human urine was used in this experiment of in vitro and nebulization of rats. Furthermore, the effect of Miraclid nebulization on fibrinolytic activity was studied in tracheobronchial secretion of rats. From the result of in vitro study, it was clarified that Miraclid could inhibit caseinolytic activity of trypsin, and fibrinolytic activity of urokinase and papain. However, it was clarified that Miraclid could not inhibit caseinolytic activity of papain. On the other hand, from the results of animal experiment, it was clarified that fibrinolytic activity in tracheobronchial secretion of rats decreased in administration group in comparison to non-administration group after administration of Miraclid through nebulizer. From the above-mentioned results, it was suggested that nebulization of Miraclid might be useful to control the inflammation in the respiratory tract.

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