Since bronchoscopy is widely used for the diagnosis and therapy of pulmonary infectious diseases, there might not only be a possibility of transmitting microorganism to the next patient in successive bronchoscopy but also of an environmental contamination caused by expectoration of contaminated sputum during the procedure. On this hypothesis, we performed a bacteriological study on several chosen locations of the examination room as well as the bronchoscopes. Materials were obtained at 21 occasions of bronchoscopy performed on patients with respiratory diseases before and after each bronchoscopy from 3 spots on the surface of the bronchoscopes, a head portion of the sliding panel of the X-ray TV apparatus, the floor immediately below that, the top panel of an indoor TV monitor, the protective apron worn by the endoscopist, a drip infusion stand, a carrier of accessories by using food agars from which the materials were immediately inoculated to chocolate agars. The results revealed a significant increase in bacterial numbers after bronchoscopy in the materials from the tip of bronchoscope, its control unit, head portion of the sliding panel and the floor. Although the outcome merely showed such bacteria as are commonly seen in the mouth and normal environment, careful measures should be taken to prevent the bronchoscopy site from contamination in case of possible dispersion of potentially infective microorganisms.

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The majority of differentiated thyroid carcinomas have high post-operative survival rate. However, some cases have biological malignancy which invades the trachea. Five patients with tracheally invading thyroid carcinoma were treated over the past three years at our hospital. Of these patients, tracheoplasty was performed in three of them and they survived for six to twenty-two months. In the other two cases, only thyroidectomy were performed. Those cases survived for five and six months after their operations. Both died of hemoptysis. We measured the nuclear DNA contents in these five patients and cases without tracheal invasion (ten papillary and four follicular carcinomas). The histogram of the normal thyroid gland showed diploidy. That of the control group showed aneuploid but a nearly diploid pattern. The pattern of all tracheally invading cases showed polyploidy. So tracheally invading thyroid carcinoma have "biological malignancy".

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Eight patients with aspergillosis at sites of bronchial anastomosis were studied clinically and bronchofiberscopically. A definite diagnosis was obtained in all 8 cases. The incidence of this disease originating at sites of bronchial anastomosis was 4.5%. The period until postoperative diagnosis was more than 6 months in all cases. The location of the site was the upper lobe bronchus in half of the patients. Positivity rates for sputum cultures and gel precipitation tests were both 12.5%, the accuracy thus being low. Conversely, the rate for bronchofiberscopic biopsy was 100% positive. Upon evaluation of the bronchofiberscopic findings, the lesions were found to be localized only at the bronchial anastomosis, and were visualized as a necrotic mass or necrotic coat. We believe that it is possible to differentiate such lesions from recurrence of lung cancer at the bronchial anastomosis on the basis of bronchofiberscopic findings alone. Without therapy, amelioration was seen in 4 of 6 cases, and no aggravation of the lesions was found in all cases. We conclude that aspergillosis at sites of bronchial anastomosis is a localized disease, for which bronchofiberscopy is of diagnostic value.

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Tracheal injury, although rare in Japan, has been increasing recently. During the past 15 years there were 8 cases of tracheal injury. The cause of injury was traffic accident in 2 cases, factory accident in 2 and iatrogenic trauma in 4. This paper is a report of two rare cases of tracheal injury due to iatrogenic trauma. Case : A 25-year-old female had received tracheostomy for the management of pneumonia. Massive hemorrhage from a tracheal-brachiocephalic artery fistula occurred 5 months after tracheostomy. She was successfully treated by surgical repair in an emergency operation. This was a very rare case, which was fortunately treated successfully by emergency operation. Case : A 52-year old male received left sleeve upper lobectomy for squamous cell carcinoma, using double lumen endotracheal tube. Tracheal longitudinal rupture of the membranous portion was shown bronchofiberscopy 2 days after operation. The laceration was successfully repeired by interrupted sutures. His postoperative course was uneventful and bronchoscopic findings showed clear healing of the lacerated site. Double lumen endo-tracheal tubes should be used carefully because of their associated complications, such as atelectasis and bronchial rupture.

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A 38-year-old man was brought to the emergency room after an automobile accident. He was markedly dyspneic with extensive subcutaneous emphysema involving the chest wall and neck. A chest roentgenogram demonstrated on enlarged mediastinal shadow, deep cervical emphysema and subcutaneous emphysema. Bronchoscopic finding showed disruption of the trachea, immediately above the carina. Emergency operation was carried out. In the superior mediastunum, hematoma was sen, the mediastinal pleura was opened at the membranous portion, immediately above the carina. The tear was closed by interrupted suture with 4-0 PDS. The postoperative course was satisfactory. In cases of blunt chest trauma, bronchoscopy is the most reliable means of establishing the site, nature, and extent of the tracheobronchial disruption.

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A 55-year-old male was introduced to our clinic in October 1987 because of an abnormal shadow in the left lung field. The infiltrate disappeared spontaneously and an another infiltrate appeared in his right upper lung field during the observation period. Since no eosinophilia was noted in the peripheral blood or bronchoalveolar lavage fluid, bronchiolitis obliterans organizing pneumonia (BOOP) was suspected and transbronchial lung biopsy (TBLB) was performed for confirmation. The pathologic finding was alveolitis with organizing pneumonia. We were unable to detect any obstructive findings in the bronchioli, since few bronchioli were obtained by TBLB. However, we diagnosed this case as BOOP on the basis of the clinical pictures. The infiltrate in the right lung showed a tendency to improve spontaneously and no therapy was performed. The shadow had disappeared almost completely by February 1988.

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A case of inflammatory bronchial polyp associated with pneumonia is reported. A 72-year-old man was admitted to our hospital with complaints of fever and appetite loss. Chest X-ray film showed an infiltrative shadow with air bronchogram in the right lower lung field. Laboratory data showed slight leucocytosis and accentuation of ESR and CRP. A diagnosis of pneumonia was made and treatment with antibiotics was commenced. Bronchoscopy was performed on the 14th hospital day in order to exclude the possibility of malignancy. A small hemispherical polypoid tumor was found in the membranous portion of the right intermediate bronchus, protruding into the internal space of the bronchus. The biopsied specimen showed squamous metaplasia and subepithelial infiltration of inflammatory cells but no malignant cells were seen. The lesion was diagnosed as an inflammatory bronchial polyp and treated only with antibiotics. After 3 months, no growth of the polyp was seen in the right intermediate bronchus on the bronchoscopic examination. It was thought that pneumonia and bronchial polyp originated from the same pathologic organism.

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A 71-year-old female was admitted to our hospital on the suspicion of lung cancer. Chest X-ray film showed two small nodules in the right lung. Bronchoscopic examination was performed and an irregularly surfaced lesion with bleeding was found at the orifice of the left lower bronchus. Microscopic findings of transbronchoscopically biopsied specimens from the bronchus showed amyloid deposition in the submucosal space, and biopsied specimens from the right S^6_a and S^5_a showed amyloid deposition in the lung parenchyma. Immunohistological examination by the PAP method revealed that the protein type was AA. This case corresponded to localized primary broncho-pulmonary amyloidosis, and may be the second case reported in Japan.

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A 48 year old male was referred to our clinic for further examination of an abnormal shadow on chest X-ray film. Bronchoscopy revealed a polypoid tumor which obstructed left B^<10>_<b+c>. Histologically the tumor was composed of mature cartilage and bone tissue with fatty marrow covered with normal bronchial epithelium. The majority of osteochondromas of the lung are located in the periphery, however in this case, the tumour occurred in the subsegmental bronchus, appearing as a polyp in the bronchial lumen.

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Tumors originating from the trachea often remain asymptomatic until they reach a very advanced stage. The case presented have had dyspnea, syncope and disturbed consciousness in the presence of common cold. The patient was diagnosed to have cerebrovascular diseases, hysteria, epilepsy and bronchial asthma. During treatment she had acute respiratory failure and was transported to the Emergency Center of our hospital. A 71-year-old woman had a chief complaint of disturbed consciousness. Early in December 1987, she had symptoms of the common cold. She visited a local doctor and received treatment with no improvement in her cough or wheezing and a tendency towards exacerbation. On January 2, 1988 dyspnea suddenly developed, for which she was admitted to an emergency hospital. During treatment, she frequency showed symptoms such as dyspnea, wheezing, syncope and cyanosis. She was treated under a diagnosis of neuropathy and bronchial asthma. On January 26, she had acute respiratory failure and was admitted to the Emergency Center of our hospital. From roentgenographic and bronchoscopic findings, primary tracheal carcinoma was diagnosed and tracheal tumor was resected. Histologically, the tumor was moderately differentiated squamous carcinoma. In the treatment of tracheal carcinoma differentiation from bronchial asthma is important. However, caution should also be exercised not to misdiagnose it for a neural disease as happened in the present case.

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A 71-year-old male case of adenocarcinoma of the lung (T2, N2, M1), was treated with CDDP, MMC and VDS. He showed partial response after one course of chemotherapy, but he was readmitted because of hemoptysis. Bronchoscopic findings revealed a smooth-surfaced polypoid tumor located in the posterior wall of trachea and another irregular tumor exposed in the lateral wall of the left main bronchus. Histological examination of the biopsied specimens showed metastasis of the lung cancer. At autopsy, the tumor had infiltrated, replacing the epithelium of the trachea and left main bronchus, and tumor cells were found in the submucosal lymphatic vessels. We concluded that the endotracheobroncheal tumors resulted from lymphogenic metastasis of lung cancer.

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A 71-year-old man was admitted to our hospital because of dyspnea and productive cough. His chest X-ray revealed diffuse reticular opacifications predominantly in the lower lung fields and a nodular shadow in the left lower lung. Pulmonary function tests demonstrated restrictive ventilatory disturbance and blood gas analysis showed hypoxemia. Chest tomograms revealed a cavitary mass in the left S^4. Based on these results, idiopathic interstitial pneumonia (IIP) accompanied by lung cancer was suspected, however pulmonary tuberculosis could not be ruled out because of a positive PPD reaction. Histological and bacteriological examinations using the bronchoscope showed negative results for each possibility. In order to establish the definitive diagnosis and to perform surgical reduction therapy if malignant, we performed wedge resection of the cavitary nodule and open lung biopsy of the left S^9 simultaneously, which histologically revealed squamous cell carcinoma and usual interstitial pneumonia, respectively. In addition to such findings, an endobronchial polypoid tumor was found out in the truncus intermedius through the bronchoscopy. Endoscopic electrosurgery was performed using a wire snare. Histological examination of the removed tumor revealed small cell carcinoma. After endoscopic electrosurgery and wedge resection, both of which were non-curative, corticosteroid was administered for the treatment of IIP. Six months later, when clinical improvement was noted, re-examination was carried out. No recurrence of carcinoma was found endoscopically, radiographically and histologically. In conclusion, it was considered that the stabilization of IIP obtained by the administration of corticosteroid might be related to the suppression of the growth activity of both types of lung cancer.

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Tracheal or bronchial leiomyoma is an extremery rare disease, the numbers of reported cases are gradually increasing as a result of increasing numbers of bronchofiberscopic examination. In all of the reported cases in the Japanese literature, the tumors occurred in bronchi proximal to segmental bronchus. We found a leiomyoma originating from a subsegmental bronchus by endoscopic examination in a patient with obstructive pneumonia. The patient was a 29-year-old woman, who suffered from acute pneumonia in the region of right S^3 twice in a period of nine months being cured by treatment with ofloxacin each time. We suspected the prescence of a bronchial lesion which might be the cause of pneumonia and performed endoscopic examination The patient was diagnosed as having a leiomyoma in right B^3_b which was successfully treated by endoscopic snaring and Nd-YAG laser therapy, resulting in complete cure.

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Two cases of successful sleeve lobectomy of the right middle and lower lobes for cicatricial bronchial stenosis due to bronchial tuberculosis were reported. Case 1 ; a 33-year-old female complained of fever, cough and exertional dyspnea. The diagnosis was established after sputum examination and bronchoscopy. She was operated on after treatment with medication and SM nebulizer. Case 2 ; a 28-year-old male complained of cough. The diagnosis was also established after sputum examination and bronchoscopy. He was operated on after treatment with medication and INH nebulizer. Bronchial stenosis extended from the carina to the right truncus intermedius in each case. The final diagnosis was established by bronchoscopy, therefore it is an essential examination for tuberculosis with asthmatic or irritation symptoms of the central air way. Bronchography was useful for the selection of the operative procedure. The postoperative course was not eventful and re-stenosis did not occur. For bronchial tuberculosis, the operative procedure should be selected from the viewpoint of not only resection but also functional preservation. Preoperative medication including use of nebulizers is important in bronchoplasty for bronchial tuberculosis.

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A 56-year-old male who had undergone an operation for gastric cancer, had fever and abundant purulent sputum and was examined after complaining of dyspnea. Aspiration pneumonia was suspected from the chest X-ray findings, and bronchoscopy and selective bronchography were performed. As a result, a diagnosis of a left diaphragmatic abscess which had developed into a left pulmonary abscess resulting in aspiration pneumonia of the right lung was made. Because of the abundance of purulent sputum, remaining in a supine position was impossible, and after intubation per os was performed in a sitting position, aspiration of the purulent sputum was performed via bronchoscopy, and resection was performed after the left B^6, B^9 and B^<10> segmental bronchi, from which purulent sputum had been flowing, were each blocked by a cotton ball. As a result of thoracotomy, a subphrenic abscess was found to have perforated the diaphragm, having progressed into the lung to form an abscess in the left B^<10>, Several daughter abscesses in the surronding area were also present. The subphrenic abscess was drained, and the left lower lobe was excised. This method makes it possible to block the segmental bronchus of a lesion using a bronchoscope and a cotton ball only, and it seems that it can be applied in operations in "wet" cases, or in cases with the segmental bronchus blocked in patients with hemoptysis.

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A 62-year-old male case of squamous cell carcinoma of the lung with widespread chromomycosis underwent a right lower lobectomy. On the 31th postoperative day, 2 bronchopleural fistulas, 2mm in diameter respectively, were detected. Fibrin gluing was performed via a flexible fibroptic bronchoscope, and the fistulas were completely controlled. This application of fibrin gluing appears very useful for the treatment of postoperative bronchopleural fistula.

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