In this experiment I tried the connecting method using the artificial trachea, tissue grafts and nylon tubes for the replacement of a defect extending over the whole circumference and 4-5 segments of the trachea, and the plugging method using the neck muscle and free skin grafts for the replacement of a partialdefect.
The following are the results:
(1) The transplantation of the homogeneous or heterogeneous trachea proved successful with a combined use of the polyethylene spiral prosthesis. In this case the use of the prosthesis both inside and outside proved more successful. It was considered that the internal prosthesis should better be removed in about 3 weeks.
(2) The reconstruction using free skin grafts and polyethylene plate was considered to be clinically applicable with further investigation.
(3) The secondary reconstruction by the transplantation of pedicle grafts proved unsuccessful, but I was interested in the method.
(4) The reconstruction of 4-5 segments of the trachea would be the maximum in a total defect of the trachea.
(5) The transplantation of a fresh trachea was considered inappropriate as it invited necrosis.
(6) A partial defect of the trachea was easy to replace. The use of supports, however, was necessary for a serious defect. A polyethylene spiral support was considered to be the most desirable. And so was the transplantation of free skin grafts in this case. It was discovered that cicatricial shrinking would not occur with no support if the skin had adhered with the surrounding part.
(7) The infection of the transplanted area invited necrosis of the skin grafts, and bronchopneumonia was frequent due to the inhalation of foreign substances and pus.
(8) Postoperative bronchoscopy is indispensable for the observation of the process and treatment.
(9) Silk thread was mostly used for suture with no observable difficulty. But if the silk thread used in suture was revealed on the surface of the mucous membrane of the trachea, stricture occurred, the thread fostering the growth of the granulation tissue. Therefore care must be taken not to reveal the silk thread on the surface of the mucous membrane of the trachea.

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I subjected 943 cases of lung tuberculosis to bronchoscopic examinations and with some of them made an observation of the inside of the bronchial tubes using an optical instrument enabling to examine sideways (90°) and obliquely (0°-60°).
1) Bronchial tuberculosis was observed in 596 cases (63.2%). It was often observed in the patients with aggravated lung lesions, with exudative process, with cavities in the lungs, with sputa bacilli-positive. It was confirmed, as has been reported by various writers, that bronchial tuberculosis is closely related with pulmonary lesions.
2) Bronchial stricture was observed in 78 (15.3%) out of 511 in-patients. There were 33 cases of inflammatory stricture, 34 cases of cicatricial stricture, 11 cases of mechanical stricture. This stricture was found oftener in females than in males with a proportion of 3: 1, and oftener in the left bronchus than in the right, and often at the left main bronchus and its peripheral ending and the right upper lobe orifice. Many of these cases presented the so-called “bronchus syndrome”. those with peculiar clinical symptoms being 73.1%, those with peculiar X-ray findings being 46.2%. These cases generally took unfavorable courses.
3) In 113 cases of tuberculosis in the left lung and 120 cases of tuberculosis in the right lung, bronchial tuberculosis was distributed in the left superior division of the lower lobe (42.5%), in the left upper lobe (31.9%) and in the right upper lobe (30%). According to X-ray findings, I classified the cases into those with the lesion in the upper lobe, those with the lesion in the middle and lower lobes, those with opaque lungs etc. In any of these cases, those with the lesion in the superior division of the lower lobe numbered most.
I explained upon these observations that it was because pathomorphological changes are extremely liable to occur in the left main bronchus, at the peripheral ending of which the upper lobe and the superior division of the lower lobe with high contraction percentages open, that advanced bronchial tuberculosis is often found in the left bronchus. I also maintained that anatomical and pathomorphological knowledge of the bronchi is required for the treatment and bronchoscopic examination of lung tuberculosis.

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I studied the influence of autonomic nervous drugs upon broncho-pulmonary function, making a small spirometer enabling to record the spirograms of rabbits on the kymograph. Respiratory rates, tidal volume, oxygen uptake and minute breathing capacity were calculated by means of the spirograms thus obtained.
(1) The average values obtained by respiratory function tests on normal rabbits were:
respiratory rate 53.5 times, tidal volume 17.05cc, oxygen uptake 19.7cc, minute breathing capacity 943.5cc.
(2) When epinephrine was injected, respiratory function showed a tendency of decrease.
(3) With atropin it showed a tendency of increase.
(4) With pilocarpine it showed the same tendency.
(5) With acetylcholine respiratory rates increased and oxygen uptake or tidal volume decreased, but normal breathing was soon restored and sometimes respiratory rates increased again. With histamine tidal volume and oxygen uptake decreased, but normal breathing was restored as rapidly as in the case of acetylcholine, and respiratory rates increased.
The spirograms obtained when pilocarpine, acetylcholine, histamine were injected suggested the existence of check-valve mechanism. But I think that these results involve complex factors such as dosage, or method of use of the drugs, the temperature of the bronchial mucous membrane, bronchial secretions and the constitution of the subject.

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The general view about the bedding of skingrafts on the bone tissue of the meatus and on the ossicular tissue of the tympanum has been reported by McLaughlin (1956), W. K. Wright (1956), Tuda (1957), Amano (1956). But to my opinion the communication through new blood vessels between the skingraft and the bone tissue on which it is embedded has seldom been studied.
I, therefore, tried to examine how the skingraft was embedded on the bone tissue i. e. the external meatus and the ossicular chain. I examined the rabbits, 56 ears of which had been operated by several types of tympanoplasty, after 24 hours, several weeks or several months of the operations, killing them by mixed injection of indian-ink and Ringer's fluid containing 7% gelatin through Aorta ascendens. The specimens were soaked in celloidin and serially sectioned. The results were as follows:
(1) Generally the skingrafts began to adhere to the granulation tissues after 48-72 hours.
(2) The skingrafts showed a tendency of epidermization after about 72 hours. Degeneration and regeneration were remarkable for a week. That part of the skingraft on the tympanum side became covered by the mucous membrane of the tympanum and the periosteum of the ossicles.
(3) The inflammatory infiltration of the skingrafts intensified temporarily but in a time disappeared. The transplanted skingrafts became to show fibrosis in 4 weeks, to cicatrize, to become thinner and take on an aspect of the normal tympanic membrane in 3 months.
(4) The blood seemed to begin to circulate in a week and the edema of the skingrafts and the surrounding tissues to disappear in 2 weeks.
(5) The inflow of the indian-ink into the skingrafts increased in 1-2 weeks, then decreased and was scarcely observable in 3 months.
(6) The skingrafts receive the blood through the branches of A. carotica externa like the normal tympanic membrane.
(7) It seems to be due to a local adaptation of the replaced tissue that it becomes to resemble the normal tympanic membrane in its formation and function.

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