To investigate the mechanism and nature of expiratory obstruction in the airway of chronic obstructive lung disease, the following study was performed.
Materials:
Seven normal individuals, seven patients with chronic bronchitis, eight patients with chronic pulmonary emphysema, and others were selected.
Methods:
In these cases, manometric, bronchographic and bronchoscopic examinations were used.
Manometrically, tracheal pressure, bronchial pressure, esophageal pressure and flow at the mouth were simultaneously measured, during forced expiration and cough.
Tracheal and bronchial pressure were measured through two edman red catheters each with two side holes and blind tip, passed into the trachea and segmental bronchus.
Whereas, withdrawal airway pressures were measured through a cournand No. 8 catheter with open tip from subsegmental bronchus to subglottis, at several points with each 4cm distance.
According to the pressure curves obtained by these examination, the site and grade of obstruction were suspected.
To confirm these results, cinebronchography and flexible bronchofiberscopy were conbined.
Results:
1) Four in seven patients with chronic bronchitis, one in eight patients with chronic pulmonary emphysema, in whom both trachea and main bronchus obstructed expiratory flow.
One of them was typical tracheobrochial collapse syndrome.
2) One in seven patients with chronic bronchitis and one in eight patients with chronic pulmonary emphysema, in whom the lobal-segmental junction obstructed expiratory flow.
3) Three patients with chronic pulmonary emphysema in whom wide spread zone from the small bronchi to the trachea obstructed expiratory flow.
4) In two patients with chronic bronchitis, obstruction was observed only during cough, and negative during forced expiration.
5) Bronchoscopically, invagination of the posterior membranous wall at the trachea and large bronchi was considered one of the pathogenesis of expiratory obstruction.
6) Between two patients with chronic pulmonary emphysema, whose spirogram was almost same, each bronchial pressure curve was different in their patterns. Upon the enlarged bronchographic findings, it was manifested that the difference in pattern of pressure curve depended on the atrophic change of the nature of bronchial wall.
These results show that the trachea and large bronchi were the main zone of expiratory obstruction, contrary to the traditional theories which described the peripheral airways to be obstructed.
Whereas, the nature of bronchial wall, especially atrophic changes should be recognized to be great factor of mechanism of expiratory obstruction.
These results could be manifested only by means of examination approached into the airway, never out of the airway.

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The parietal pleural biopsy was performed in patients with exudative pleurisy, and results obtained are as follows.
I. Pleuritis tuberculosa:
i) Diagnostic evidences for tuberculosis were obtained in 92 patients by pleural biopsy among 127 patients diagnosed clinically pleuritis tuberculosa. The diagnosis was made in 86 of the 92 cases only by the first biopsy. Typical tuberculous nodules were observed in 60% of the biopsy-positive cases.
ii) It was demonstrated that the diagnostic findings of tuberculosis were more frequently obtained in the early stage than the late stage of the disease. In contrast, chronic inflamation and scar formation were the common findings of tuberculosis (or biopsy specimens) in the late stage of the disease.
iii) There exist some clinical findings which are often associated with the biopsy-positive cases. There were the pleural effusion in severe degree and an increased erythrocyte sedimentation rate.
II. Pleuritis carcinomatosa:
i) Positive findings were obtained in 29 of 45 patients by pleural biopsy. The first biopsy allowed the above diagnosis in 25 of the 29 cases.
ii) Carcinoma tissue were more frequently demonstrated by biopsy in the advanced stage than the early stage of the disease.
iii) The pleural biopsy specimens often provided informations which might indicate the location of the primary lesion.
iv) Carcinoma tissue were frequently demonstrated in the biopsy specimens from advanced cases with a severe effusion or bloody in character, and with an increased erythrocyte sedimentation rate.

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Forty-one strains of weakly acid-fast organisms were isolated from sputa of patients with pulmonary disease. The organisms resisted treatment of sputum with alkali solu ion and grew on Ogawa egg medium showing R-type colonies like M. tuberculosis. The organisms had similar characteristics and appeared to belong to the same species. These differed from Mycobacterium and Nocardia and were considered to be an intermediate between Mycobacterium and Nocardia. Similar but not identical organisms were isolated from soil. These soil isolates were divided into two subgroups. Among the microorganisms hitherto described, the organisms resembled most “Mycobacterium” rhodochrous. Although it is possible that these organisms belong to the genus Mycococcus, the possibility has not been confirmed, as it is impossible, at present, to obtain the type strains of this genus described by Russian author, Krassilnikov. A new genus name, Gordona, has been proposed preliminarily for this group of the organisms, and the name, Gordona bronchialis, gen. nov., sp. nov., has been proposed for the organisms isolated from sputum. The characters of the organisms are described.

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