On 36 patients with diffuse lung diseases including idiopathic interstitial pneumonia, sarcoidosis, pneumoconiosis, rheumatoid arthritis and so-called disseminated eosinophilic collagen disease etc., forty transbronchial lung biopsies have been performed by means as previously described. Specimens were taken from two or three segments of one lung in most of the patients.
Twenty nine of 36 patients had definite roentgenologic evidence of diffuse pulmonary diseases, but in other 7 casses chest x-ray showed almost normal finding, though we could suspect of the presence of histopathological changes in their lungs because of their systemic involvement.
(1) The size of a specimen on an average was appoximately 1.0×2.0mm, and it was found that specimens were larger in the biopsy without bronchography than in the one with bronchography (Shibayama et al., 1970) as our experimental study (cf. part 1). So we performed the biopsy without bronchography later.
(2) Biopsies of 22 cases in 36 casses were useful for diagnostic and therapeutic purposes. We believe that diagnosis may be possible in many cases with the aid of all the clinical data.
(3) There were seven cases in which biopsy specimens disclosed pulmonary lesions histologically, though their chest x-rays were almost normal, showing that of the method may contribute to an early diagnosis.
(4) Only one complication, pneumothorax, was encountered among the 36 patients. Occasionaly and, transient bllody sputa were observed after biopsy, but they were minimal and negligible.
(5) Better biopsy forcep is hoped to be designed which is possible to penetrate the bronchus or bronchiole more easily and with greater certainty for obtaining pulmonary tissue.

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From 1970 through 1972, the symptom prevalence of chronic bronchitis was studied in people over 40 years of age living in 7 districts in Osaka by Osaka Prefecture and Sakai city. On the basis of the data obtained a statistic analysis was made of the symptom prevalence of chronic bronchitis in reference to air pollution in those districts with the following results:
1) The relations between the symptom prevalence of chronic bronchitis and sulfur dioxide level which was used as air pollution index led to
y=1.94α+2.87
where y: the symptom prevalence of chronic bronchitis in people over 40 years of age, in percent, and α: sulfur dioxide values measured by the PbO₂ method in mgSO₃/day/100cm².
2) The value from this formula was 2.2% higher than what was obtained previously from a 1962-1966 survey in Osaka city.
3) The relations between the symptom prevalence of chronic bronchitis and the nitrogen oxide level, instead of the sulfur dioxide level, were formulated as
y=0.88β+2.81
where β: nitrogen oxide values estimated on conjecture by the smoke diffusion equation in pphm.
4) A combined effect of sulfur dioxide and nitrogen oxide might be
y=1.0(α-1.0)+0.6β+2.7

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A case of respiratory failure due to airway obstruction in hypopharynx probably due to glossoptosis.
A fourty-four year old man accompanied by cough, shortness of breath and drowsiness was admitted to Keio University Hospital. After the patient suffered from measles with left otitis media in infancy he noticed stertorous breathing on supine position and difficulty of fully opening his mouth. The patient had had his complaint after he received surgery on his left maxillary joint. Snoring, cyanosis and pitting edema were evident. Physical examination revealed chronically ill male with hypoplasia of the mandible, glossoptosis and funnel chest. Pulse rate was 84 perminute and blood pressure was 122/70mmHg on admission. No abnormal heart murmur was evident. Rhonchi were audible on the whole lung field.
The chest X-ray demonstrated mottling shadow in the right lower lung field and leftward enlargement of the heart silhouette with prominent main pulmonary artery.
ECG showed the pattern of right atrial hypertrophy with suspected biventricular hypertrophy.
Routine pulmonary function testings revealed slight restrictive ventilatory impairment. Markedly increased respiratory impedance on the forced oscillation procedure performed on the range of 3Hz to 30Hz was obtained.
Airway resistance measured by the bodyplethysmographic technique was 2.99cmH₂O/L/sec.
Repeatedly performed arterial blood gas study demonstrated consistent arterial hypoxemia with significant CO₂ retension. On breathing room air arterial O₂ tension was 50 to 68mmHg and arterial CO₂ tension was found in the range of 79.5 to 90mmHg, pH of the arterial blood was approximately 7.30. On breathing 100% O₂, increased arterial CO₂ tension was noticed.
Right heart catheterization demonstrated a mean pulmonary arterial pressure of 23mmHg and pulmonary capillary pressure of 9mmHg.

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[in Japanese]

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