Recent trends concerning bronchoscopy in Japan were examined based on the information obtained by questionnaires completed by 263 departments of major institutions throughout the country. This information provided by the questionnaire was compared with the results of 2 studies performed approximately 10 years ago, and vicissitudes of the status of bronchoscopy were examined. Recently bronchoscopy has come to be most frequently performed by physicians or respiratory disease specialists in contrast to previous times when bronchoscopy was performed primarily by ENT doctors, bronchoesophagologists and thoracic surgeons. Local anesthesia and transoral insertion without a tracheal tube were employed in almost all institutions in Japan. The average number of fiberoptic bronchoscopes per department was 5. 7. Almost all department possessed the standard type and T-type (for treatment instruments). The average number of procedure per year in the 263 departments was 450. Moreover, in 90% of these departments rigid bronchoscopy was never used since 1984. For recording bronchoscopic findings 16 mm or 35 mm film were most commonly employed. Complications occured in 0.5% of 95, 240 procedures. Eight deaths (0.008%) due to complications related to bronchoscopic procedures were reported in this series. Complications in TBLB procedres were highest (1.3%) than the other procedures, and 3 cases (0.02%) which died due to complications of TBLB were reportd.

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Bronchial artery embolization (BAE) was performed in 22 patients with massive hemoptysis in non-malignant Lung disease. Recurrent hemosputum was noted in 10 patients after BAE. The mean period of remission of the Recurrent cases was 4.43±3.46 (Mean±SD) months. As to adverse effects, fever, back pain and bradycardia were observed immediately on BAE, but no severe side effects such as spinal injury were obserbed. There was a significant difference in the BAE findings between diffuse inflamatory lung disases and localized inflamatory lung diseases.

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In the past 5 years, we operated on 83 patients with roentgenographically occult lung cancer who were discovered mainly by mass screening. We compared their bronchoscopic findings and their histological findings obtained from the serial blocks sectioned at a thickness of 2mm. There were a few cases in which a difference was found between the proximal margin of the cancer extent determined bronchoscopically and that confirmed histologically. In a case in which cancer extended longitudinally within the epithelium, as clarified on histological examinations, bronchoscopy revealed no abnormality in the mucosa in which cancer was confined within the epithelium. In a case in which cancer extended continuously within a lymphatic and involved only the epithelium at and near the proximal margin, biopsies via bronchoscopy failed to demonstrate cancer cells at the portion of the bronchus which would be cut surgically. However, postoperative pathology revealed that the margin of even the bronchus resected additionally was positive for cancer cell. In a case in which a small nodule was seen at bronchoscopy and which was regarded bronchoscopically as early stage, cancer invaded beyond the bronchial wall and extended beneath the epithelium, forming a discernible mass. Retrospectively, it was difficult to bronchoscopically confirm the proximal extent of cancer in those cases. Therefore, when such a case is treated surgically, it is advisable to examine the frozen sections and/or imprint smears of the margin of resection infraoperatively. It is also necessary to give a careful consideration to these points when laser therapy is performed.

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The relationship between the oxygenation and temperature of bronchial mucosa and bronchial mucosal blood flow (BMBF) was studied in carine bronchial mucosa. We developed and prepared a needle electrode which can be used to measure the tissue oxygen partial pressure (PmO_2) and the mucosal temperature (MT) under bronchoscopy, and measured BMBF together with PmO_2 and MT in 7 dogs which had been given isoproterenol (ISP) to increase BMBF. In this experiment, a significant positive correlation was observed between PmO_2 and BMBF at the same site, and PmO_2 increased as well as BMBF by ISP administration, but MT did not vary. PmO_2 significantly decreased after the blood flow stopped. According to the above-described results, BMBF probably has great influence on the oxygen metabolism in the bronchial mucosa in vivo, and this method will be useful to reveal bronchial mucosal changes and bronchial mucosal blood flow behavior cardiopulmonary disease.

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Six resected cases of early stage papillary polypoidal squamous cell carcinoma were examined clinicopathologicaly, and compared with early stage non-papillary polypoidal squamous cell carcinoma. Cytomorphological findings obtained by optical and electron microscopy showed resemblance to those of the non-papillary polypoidal type. Some cases of non-papillary polypoidal tumor showed, though only partial, exophytic endobronchial papillary polypoidal growth, and intermediate type growth between both type. These findings seemed to indicate a close relation between both types of squamous cell carcinoma, and that not only the characteristics of the cancer cells, but also host immunoreaction to the tumor is one of the important factors in the formation of papillary pollypoidal squamous cell carcinoma. There was not much difference, between either type, in history, immunohistochemical findings and clinical findings such as smoking, age, location of the tumor, ring and nodular shadow on chest X-ray and respiratory function, except in the adjacent epithelium. Most of epithelium adjacent to papillary polypoidal tumors were almost normal, unlike those of non-papillary polypoidal tumor.

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For the treatment of spontaneous pneumothorax, there are various kinds of therapies ranging from conservative treatment to bilateral simultaneous thoracotomy. At present it has almost been established where thoracotomy should be used. Even though there are cases of pneumothorax, in which air liakage would not disappear even after performing thoracic cavity drainage over a long period, thoracotomy should be employed. However, from time to time, it has been observed that there are cases where an operation can not be done due to poor systemic condition of the patients. In this paper nine such cases are presented, Where Fogarty balloon catheters were inserted to confirm the bronchi and then bronchial obstruction was performed. For the filler, sliced "sponzel" was applied to two patients, and fibrin glue to seven patients. It was comfirmed as a result that air leakage disappeared, or was decreased, immediately after bronchial obstruction. And in about one or two weeks the thoracic cavity drains in almost all patients could be draw out. At the sites of obstruction, no complication like pneumonia, lung abcess or pyothorax were observed, nor did any relapse occur. In addition a filling agent "fibrin glue" were infused into the bronchie in the six dogs, and these bronchus of dogs exmined histologically and partially by scanning electron microscope. It is considered that this method of bronchial obstruction can be used simply and safety in case of refractory pneumothorax on which an operation can not be done due to poor systemic condition, and that it should be chosen as one of the posible treatment.

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A 25-year-old man who sustained a chemical bomb injury in the Iran-Iraq war developed symptoms of shortness of breath, wheezing and cough for the last three years. On bronchofiberscopy an irregular zig-zag type of stenosis with multiple pseudodiverticulae formation was observed in the trachea and major bronchi. To our knowledge this delayed complication of burn injury due to a chemical bomb containing mustard gas has not been perviously reported.

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We reported a case of intrabronchial leiomyoma and reviewed 44 cases from the Japanese literature. The patient was a 59-year-old woman with a chief complaint of bloody sputum. The diagnosis of leiomyoma of the bronchus was made by bronchofiberscopic biopsy. Wedge resection of the right lower bronchus, bronchoplasty and right S^6 wedge segmentectomy were performed. The removed specimen showed that a tumor with smooth surface had protruded into the bronchial lumen. The tumor was elastic hard and 5×6×6mm in size. In a series of 45 cases, including our case, in the Japanese literature, the sex ratio was equal. Only three of 21 woman had a history of uterine leiomyoma. The average age of presentation was 42.9 years. Common symptoms were cough and sputum. Routine chest X ray film of all except 5 cases showed some abnormal findings. The tumor was mostly located in the trachea or the large bronchus and showed a pedunculated form more frequently than a sessile form. As a rule, the most common treatment has been a surgery preserving lung function. Endoscopic treatment will be more popularly used, especially for the pedunculated form, in the future.

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Obstruction of the contralateral major bronchus by the detached tumor mass from primary lung cancer during pulmonary resection is a rare intraoperative complication. We experienced two cases of this kind of complication. The first case was a 75-year-old male with ademocarcinoma originating from right upper bronchus. Ventilation became difficult after further insertion of the tracheal tube into the left main bronchus in order to maintain respiration during right upper lobectomy with bronchoplasty. The second case was a 73-year-old female with ademocarcinoma in the right B^6. Right middle and lower lobectomy was done, and ventilatory failure occured during upper mediastinal lymph node dissection, requiring compression of the right upper lobe. Ventilatory failure in these two cases occured from obstruction of the contalateral left main and upper bronchi by detached tumor masses from the right side resected tumor. The tumor masses were successfully removed by fiberoptic bronchoscopy through the tracheal tube in two cases. The prevention and the management of this possibly fatal complication are discussed.

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A case of bronchial aspergilloma with metastatic lung cancer in a 74-year-old woman is reported. She had undergone resection for rectal cancer 8 years previously. Her CEA value increased and an abnormal shadow on chest X-ray film was pointed out and she was admitted to our hospital for further examination. Chest X-ray film showed a tumor shadow with pleural indentation in left S^3b. Bronchofiberscopy revealed a soft yellow polypoid lesion occluding the orifice of the left upper division bronchus. Histologic examination of the polypoid lesion revealed a lot of interwoven segmentated Y-shaped mycelial filaments, and aspergillus was detected by culture. The histology of the tumor specimen obtained by TBLB showed well-differentiated adenocarcinoma with negative lactoferrin staining. Accordingly, the tumor was thought to be metastasis from the rectal cancer. It is considered that the bronchial aspergilloma of this case appeared against the background of metastatic lung cancer. In future, a bronchofiberscopy becomes even more common and effective anti-cancer therapy becomes more widespread, cases such as this may increase.

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The patient was 67-year-old male of gouty kidney who suffered from cough and sputum production during hemodialysis. No abnormal shadow was observed on chest X-ray, but bronchoscopy revealed a yellowish smooth polypoid tumor obstructing the right B^6_c. The biopsy specimen of tumor showed mature adipose tissue covered with normal bronchial epithelium. It was diagnosed as lipoma by biopsy. Three months later, chest X-ray revealed a tumor shadow and a vague cavity in the left middle lung field. Sputum cytology revealed squamous cell carcinoma. In Japan, this is the third case diagnosed by biopsy specimen, and the second case accompanied by lung cancer.

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A 17-year-old male was admitted to hospital because of increasing anterior chest oppression which had suddenly appeared 10 hours before during a hard basketball practice. He had no obvious history of falling down or being crushed during the practice. Physical findings were subcutaneous emphysema and pericardial crackles. Chest X-ray revealed mediastinal emphysema and subcutaneous emphysema. Bronchoscopy revealed a small hole which changed its size and shape on respiration at the right main bronchus between the second and third cartilage ring below the carina. Summarizing the clinical course, his mediastinal and subcutaneous emphysema were considered to be caused by bronchial perforation. He was treated conservatively and recurrence has not occurred. Bronchoscopy performed 3 months after showed that the small hole in the right main bronchus had almost disappeared. This finding supported the idea that the small hole in this case was different from an accessory cardiac bronchus.

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A 74 year-old male complained of dyspnea and bloody sputum. Lung cancer caused left pulmonary atelectasis caused by lung cancer. Endoscopic microwave therapy was carried out after chemotherapy and endoscopic local injection of peplomycin. The microwave tissue coagulation was performed every week with 20∿30 W for 15∿30 seconds. After the second coagulation the left upper bronchus was opened and dyspnea was relieved. He was able to be discharged from the hospital for about 2 months. It is considered that the endoscopic microwave therapy can be useful for endobronchial polypoid lesions and cancers as well as laser treatment and electrosurgery.

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A 37-year-old woman was admitted to our ward with bloody sputum and a history of repeated attacks of pneumonia since infancy. Bronchoscopy revealed a fistulous opening which had a diameter of 8 mm in the posterior tracheal wall. MRI demonstrated the tracheoesophageal fistula at the level of T 3 and this was corroborated by ^<133>Xe ventilation scintigrams. Bronchogram of the right lung showed bronchiectasia in B^2 that was considered to be an acquired disease. Surgical repair of the fistula was done via a right posterolateral thoracotomy. Division and closure of the fistula and S^2 segmentectomy was performed under high frequency jet ventilation.

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