The purpose of this paper is to descrive the typical features of clinical and pathological findings in patients with diffuse panbronchiolitis and how the author and his colleagues have come to reach their conclusion that this disease is a definite clinical and pathological entity, based on the data which have been accumulated in the last fifteen years by them.
The study is based on 39 cases, composed of 29 males and 10 females, or 10 autopsied cases and 29 strictly selected cases under observation at least more than 18 months including open-lung biopsied cases. The first autopsied case appeared in 1960.
1. Sex ratio: There are 29 males a 10 females giving the ratio ca 3 to 1.
2. Age of onset: Most of 39 cases are in thier fifties and sixties, but age of onset is variable from teens to old ages.
3. Mode of onset: Usually insidious. Initial symptoms are cough, tenacious sputum and shortness of breath, frequently accompanied by wheezing. More than 90% of the cases complain shortness of breath indicating early occurance of hypoxemia.
4. Smoking: No close relationship with the habit of smoking is noted.
5. Diagnosis prior to admission: Bronchial asthma, bronchiectasis, chronic bronchitis and pulmonary emphysema are most frequently suspected or diagnosed.
6. Complication: Over 70% of the cases have or once had chronic sinusitis.
7. Clubbed finger: 34% of the cases show clubbing of the digits on admission.
8. Sputum bacteriology: Hemophilus influenzae and Pneumococci are most often identified in the initial stage, later followed by Pseudomonas superinfection.
9. Chest x-ray findings: Miliary or fine nodular dissemination in both lung fields is characteristic picture, often accompanied by overinflation which makes the dissemination defficult to be seen. Bronchogram frequently shows slight dilatation of the terminal bronchioles which indicate the obstruction of the respiratory bronchioles.
10. Pulmonary function: Mixed ventilatory impairment consisted of slight restrictive and marked obstructive disturbance, early hypoxemia later accompanied by hypercapnea and cor pulmonale, and increase in closing volume.
11. Prognosis: Missing of early diagnosis and early treatment with corticosteroids may be followed by relentless progressive pulmonary insufficiency accerelated by pseudomonas pulmonary infection.
12. Pathology: The inflammatory lesions arising in the region of respiratory bronchioles are primary and essential pathological picture, These are noticed diffusely in both lungs. The lesions are composed of bronchiolitis and perbronchiolitis which are classified into two types; obliterative type charaeterized by obstruction of the lumina with granulation tissues and intra-mural proliferative type characterized by the marked round-cell infiltration with new growth of lymph follicles.
In conclusion, the description of diffuse panbronchiolitis at the present moment is as follows: a chronic inflammation confined in the region of respiratory bronchioles, namely, in the intermediate zone between the terminal end of the small airway and the pulmonary parenchyma, spreaded widely in the both lungs accompanying distinctive respiratory disturbance including blood gas impairment. Pathological lesions are usually made of a combination of bronchiolitis and peribronchiolitis, which is classified into two types: intramural proliferative type and obliterative type respectively. Diffuse panbronchiolitis may be called as a disease of the transit zone in the lung.

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Utilizing a network of health institutions throughout Japan, we performed a program of respiratory function tests on healthy Japanese. Regression equations and standard levels for vital capacity, FEV_1.0 and MMF were obtained and compared with the reports of other workers.
The standard level of vital capacity reported by Baldwin was found to be too low when compared to the value we obtained for adult Japanese males (20-59 years old), but too high for those aged over 60. On the other hand, the level was found to be reasonable for females.
On account of remarkable increases in physical standards it is necessary to check vital capacity every several years for children below 19.
The equations we obtained are as follows:
VC (ml)=3.57H-27.77A+4555 (male)
VC (ml)=31.68H-13.23A-1563 (female)
FEV_1.0 (ml)=2.76H-34.84A+4151 (male)
FEV_1.0 (ml)=24.92H-18.74A-800 (female)
MMF (1)=0.002H-0.063A+5.94 (male)
MMF (1)=0.0015H-0.033A+1.77 (female)
H=Height (cm), A=Age (yr.)

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Recently, increases in the incidence of respiratory diseases which may be connected with air pollution have developed into a serious social problem.
The purpose of the present study is to estimate experimentally whether low concentrations of SO₂ similar to levels actually recorded in the atmosphere in Japan have injurious effects on the respiratory system.
The d-d strain mice were continuously exposed to low concentration (0.05, 0.15, 0.23ppm) of SO₂ for periods of 6 weeks or 3 months, using a specially constructed exposure chamber coupled with a standard gas generator with a built-in Teflon tube.
Histopathological studies were conducted through light microscopic observation.
Following results were obtained:
1) Increase in mean body weight of each SO₂ exposure group was no different than that of the control group.
2) There was no death in the control group. Three of the ninety six mice belonging to the SO₂ exposure groups died, but there was no difference of mortality among each group.
3) Incidence of the changes such as goblet cell-like formation in the epithelia in the nasal respiratory region (80%) and slight irregularity in arrangement or decrease of olfactory hairlets (44%) were higher among the SO₂ exposure groups than the control.
4) The trachea, the bronchi and the alveoli did not show any significant changes in both the control group and the SO₂ exposure groups.
5) Incidence of bronchitis and pneumonia was not significantly different between the control and the SO₂ exposure groups, but the seriousness of the pneumonia was greater in the groups exposed to SO₂.
6) There was no significant correlation between goblet cell-like formation in the nasal respiratory region and changes in the bronchus and the alveolus.
The results above mentioned can be summarized as follows:
Continuous exposure to low concentrations of SO₂ produces significant pathological changes i. e. slight goblet cell-like formation in nasal respiratory regions, but changes occuring in the lower respiratory tract and alveolus were of little significance.
It is considered that the changes found in nasal respiratory regions are a reactive feature to the irritative effect of SO₂ or H₂SO₃.

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51 year-old man received surgical treatment who had a tumor of the diaphragm discovered by chest x-ray mass survay for lung cancer. The tumor was a cyst which histologically had ciliated columnar epithelium, cartilage and bundles of smooth muscles, and was diagnosed as a bronchogenic cyst. As to bronchogenic cyst of the diaphragm, this is the second case reported in Japan. The interesting thing in this case is that the fluid in the cyst presented extremely high amylase values.

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