The following conclusions were based on a series of ultrastructural observations with reference to relations between morphological and functional characteristics of the air way and alveoli. In addition to type B(II) alveolar epithelial cells, all type of air way and alveolar cells, predominantly goblet cells, might play a role in the synthesis and secretion of surfactant (Sf). Moreover, characteristic reactional changes of each type of epithelial cells, such as hyperfunction, degradation, regeneration and repair were represented in various diseased conditions. Typical findings, such as different direction angles of cilia, presence of non-ciliary areas and squamous metaplasia were demonstrated on the ridge at the bronchial bifurcation. As to the physiological events in alveolar pores, the closing mechanism of Sf and its role as a migrating route of macrophages were shown. Sf was considered to be an essential substance in the surface lining layer. Air tract epithelial cells seemed to take the first step in Sf synthesis and secretion during the fetal period, and alveolar epithelial cells appeared to take over as a main player in Sf synthesis and secretion later on. The Sf membrane and air-fluid interface seemed to be suddenly formed in the lungs of a new born infant immediately after the first inspiration of air had taken place. The Sf membrane remains covering the whole surface of the air way and alveoli for the entire period of life. In addition, the Sf membrane might play a role as the first barrier of prevention mechanism against exogenous etiologic factors. Beneath the Sf membrane various types of cells might maintain their biological microenvironment for living and their roles as a second barrier system. Sf might be an essential substance to help remove a sputum from the air way because of its close relations with air way fluid, abnormal collections of liquid substances and sputa. It is stressed that it is necessary to understand the basic structure of the lungs and its weak points for the prevention of various diseases, when discussing the functions of the lungs and pathophysiology of pulmonary diseases.

View full abstract

Wistar strain rats, weighing 330 to 460g, continuously exposed to O_2 at concentrations more than 80%, were studied by electron microscopy. Fourteen rats all died of suffocation during 40-63hs. Body weight and survival time showed positive correlation (P<0.05). The lung/body ratio of control and hyperoxic lung changed from 0.598±1.05% to 0.934±1.38% (p<0.001). Electron microscpically, the thickness of epithelium markedly decreased from 40.2±9.68 to 11.72±1.13μm (p<0.001). Shortening of cilia, decrease in cilia and relative increase in microvilli were minor changes. Degneration of ciliated cells were most severe among epithelial cells with a tendency toward desquamation from the basement membrane. It was speculated that the target cell of hyperoxia might be ciliated cells among the bronchial epithelial cells in rat.

View full abstract

To understand morphological changes of smooth muscle and airway dimensions in bronchial asthma, we performed a morphometric study in bronchioles and respiratory units (alveolar duct) of guinea pigs exposed to acetylcholine everyday for three weeks. Recurrent asthma-like breathting during exposure to acetylcholine contributed to a significant increase of smooth muscle in bronchioles and respiratory units. Histologically, it is possible that these changes were mainly derived from work hypertrophy. The increase in smooth muscle did not affect the distribution of internal diameter. In contrast, airway wall thickness (PW) defined by Freedmen was increased in acetylcholine-exposure group. It is suggested that smooth muscle of respiratory units as well as bronchioles plays a considerable role in the pathogenesis of bronchial asthma and that measurement of airway wall thickness (PW) is useful to disclose relationships between increased smooth muscle and airway narrowing associated with increased airway resistance.

View full abstract

In order to develop a bedside method of evaluating the revacularization and hemodynamic condition following lung transplantation, the authors developed a method of fluorsecein-assisted broncho-fiberscopic imaging (FABI). The method was applied experimentally in dogs that had undergone lung transplantaion and results obtained by FABI were compared with the postmortem angiography findings at different time periods after the procedure. In a cyclosporine A group, partial bronchial arterial revascularization was observed submucosally at the anastomotic site from the 3rd. postoperative day on. From the 14th. day on, marked fluorescein "staining" was recognized extending around the entire periphery of the anastomotic site, and postmortem bronchial arteriography at this point revealed the revascularization to extend through all layers. On the other hand, submucosal staining of the subsegmental bronchi of the transplanted lung was demonstrated by immediately postoperative FABI findings. And this fluorescein staining progressively disseminated to the larger bronchi. This finding corroborates the presence of pulmonary vein-to-bronchial venous plexus blood flow.

View full abstract

Endoscopic findings and TBLB histological findings were examined in 22 cases with hematological disorders, in the course of which subjective and objective respiratory symptoms occurred and bronchoscopy was performed. Intrathoracic lesions of these 22 cases comprised cellular infiltration of the tumor (5 cases), swelling of hilar and mediastinal lymph nodes (5 cases), pneumonia and pulmonary mycosis (4 cases), pulmonary carcinoma (2 cases), organized pneumonia (2 cases), acute bronchitis (1 case), in addition to chronic obstructive lung disease (2 cases) old pulmonary tuberculosis (1 case) and pneumoconiosis (1 case) as underlying diseases. Five cases in which bronchoscpic findings were obtained and which were all malignant lymphoma included the primarily submucosal type (4 cases) and primarily mucosal type (1 case). Of 5 cases with tumor cellular infiltration due to underlying diseases observed in the pulmonary area, 4 and 1 were ATL and Hodgkin's disease, respectively and TBLB obtained a definite diagnosis in 4. TBLB in addition to histological and clinical findings enabled us to obtain a diagnostic rate of 9/12 (75%) in 12 cases with various lesions in various areas of the lung, associated with hematological disorders. The only complication observed was slight pneumothorax in one case. For respiratory complications of hematological disorders, TBLB was considered to be useful as a comparatively safely test in certain cases.

View full abstract

The effectiveness of measuring bronchial wedge pressure (BWP) to identify the drainage bronchus with pulmonary air leak was determined in 4 patients with prolonged pulmonary air leak. After balloon occlusion of bronchi, insufflating air into the occluded lung. We measured the intrabronchial pressure (BWP). The BWP of the drainage bronchus showed a rapid downward curve or did not elevate in spite of air insufflation. Drainage bronchus of these patients were r-B^3, r-B^6, l-B^<1+2+3>, l-B^6. We performed bronchial embolization using fibrin glue and all pulmonary air leaks disappeared. It concluded that measurement of air-loaded BWP is more effective for identifying drainage bronchi than the balloon occlusion test by which air leak from the chest tube may decrease.

View full abstract

Twenty-four dogs were divided into two groups, and traceal reconstruction using allografts preserved in 1.5% glutar aldehyde was performed. Group I dogs underwent tracheal reconstruction without omental wrapping and group II dogs underwent tracheal reconstruction with omental wrapping. In group I, all dogs died in the early postoperative phase because of desquamation of graft and peritracheal empyema. In group II, dogs survived for over 3 weeks but they also died due to the graft desquamation. In the latter group no peritracheal infection was recognized macroscopically, and psudo-tracheal formation around the graft caused by the omental wrapping was observed. This paper described the bronchofiberscopic findings after reconstruction.

View full abstract

To analyze the correlation between the fiberoptic bronchoscopic findings and the treatment and the prognosis in cases of advanced esophageal carcinoma with tracheobronchial involvement, pre-operative bronchoscopy was performed on 147 patients. Bronchoscopic findings could be classified into five types based on the grade of tracheobronchial invasion. In type I[++], tracheobronchial obstruction or stenosis caused by the polypoid tumor of esophageal carcinoma was observed. In type II[+], there was evidence of both protrusion of tracheobronchial wall and abnormal findings of the mucosa such as thickening of longitudinal folds, irregularity and/or redness of the mucosa, and engorgement of mucosal blood vessels. In type IIIa[+-] and type IIIb[+-], either protrusion of tracheobronchial wall with normal mucosa or abnormal findings of the mucosa was present. In type IV[-], no abnormalities were definable. Type I was found in 9 patients (6%) out of 147, II in 36 (24%), III in 6 (4%) and IV in 91 (66%). Out of the 9 patients with type I, one had bypass operation without thoracotomy and 8 radiotherapy or conservative therapy. Out of 36 with type II, 22 had surgical therapy (7 curative resection, 6 non-curative resection, 3 bypass operation with thoracotomy and 6 bypass operation without thoracotomy), 14 radiotherapy. Out of 6 with type III, 5 had surgery and one radiotherapy. One year survival rate was 13.3% in type I, 28.8% in type II, 53.3% in type IIIa and 50.0% in type IIIb. In conclusion, pre-operative bronchoscopy seems to be very important in assessing the sites and the grade of tracheobronchial involvement, indication of surgery and prognosis of advanced esophageal carcinoma.

View full abstract

Nine cases of foreign bodies in the tracheobronchial tree in children were reviewed. Six cases were younger than 2 years. Two of 6 cases had clear histories of foreign body aspiration and were treated within 24 hours. Four of 6 cases, who had aspirated nuts and a shell, came to our hospital from 2 days to 11 days following the aspiration. Their chest roentgenogram showed emphysema or atelectasis. Rigid bronchoscopy under general anesthesia was successful in removing the foreign bodies of 5 cases, and laryngoscopy in 1 case. A 6-year-old boy and a 11-year-old girl had clear histories of decayed tooth and inlay, and were managed with flexible fiberoptic bronchoscopic removal of the foreign bodies within 24 hours. A 14-year-old boy had suffered from recurrent pneumonia of the right S^<10> segment during 2 years. An aspirated plastic bullet which could not be removed using bronchoscopy was removed through bronchotomy. Rigid bronchoscopy remains the procedure of choice for retrieval of foreign bodies from the tracheobronchial tree of younger children. Flexible fiberoptic bronchoscopy is effective for the diagnosis and removal of foreign bodies from that of older children.

View full abstract

A 65-year-old man with a past history of left lung tuberculosis was transported to the emergency room of our hospital by ambulance with a complaint of severe dyspnea. At breakfast he ate a baked rice cake (Mochi) and misswallowed a piece of it. After a while dyspnea occurred and became progressively severe. Arterial oxygen pressure breathing room air at admission was 34 Torr. Exploration of the larynx and the pharynx failed to find any foreign body. Fiberoptic bronchoscope, performed under mechanical ventilation, revealed a piece of rice cake impacted in the orifice of the right lower bronchus. Soon after the the removal of the rice cake via bronchoscopy, the patient's PaO_2 improved markedly up to 369 Torr. (FiO_2 1.0) Pulmonary scintigraphy one month later showed neither perfusion nor ventilation in the left lung. This was the reason why only right lower bronchial obstruction caused severe respiratory failure in this patient.

View full abstract

A 23-year-old female patient presented with complaints of stridor and dyspnea. Around September 1988, the patient had begun to have cough, sputum and discomfort in the chest region. She received outpatient treatment in a hospital in her neighborhood, but the treatment did not relieved the symptoms, the patient was admitted to our hospital on November 21, 1988. Ordinary treatment for asthma and antibiotic therapy failed to prove effective. At the otorhinological department, tracheal obstruction immediately below the vocal cord was noted : Upon tracheal tomography, the symptoms were diagnosed as upper tracheal obstruction, for which tracheotomy was performed. Respiratory sounds of the left lung were not audible. Chest tomograms, chest CT and bronchofiberscopy revealed edematous changes in the entire tracheobronchial tree and with edematous obstruction of the left main bronchus. One week after the patient received 50mg oral predonine (PD), bronchofiberscopy was performed. Although edematous changes were still noted in the entire tracheobronchoial tree, the left main bronchus was found to be patent. Biopsy showed only inflammatory and reactive changes without any specific findings. Following PD dosage reduction to 30mg, the trancheobroncial lesion relapsed, complicated by bilateral auricular chondritis and keratoconjunctivitis. At that time, a diagnosis of relapsing polychondritis was made. Increase of PD dosage to 60mg produced relief of the symptoms. At present, the patient is on 40mg PD therapy and is recovering smoothly. We report this case of relapsing polychondritis which was difficult to diagnose and treat.

View full abstract

A 60-year-old male who had been under the insulin therapy for diabetus mellitus was admitted because of fever, non-productive cough and pulmonary atelectasis in the right middle lobe. Initial bronchofiberscopy revealed many whitish-yellow spots on the wall of the trachea and both main bronchi. The orifice of right B^4 was also covered and obstructed with them. Biopsy from right B^4 showed invasion of aspergillus into the bronchial wall. After inhalation and bronchofiberscopic infusion therapy of amphotericin B, the white spots in the trachea disappeared, but right B^4 was still obstructed. This case was diagnosed as bronchial aspergillosis of right B^4, which occured on an inflammatory scar of probable old bronchial tuberculosis. Bronchial aspergillosis is a relatively rare disease, and only 4 cases have been reported in the Japanese literature.

View full abstract

A 55-year-old male was admitted to our hospital on the suspicion of lung cancer because of bronchoscopic findings. He had been treated for bronchial asthma for two years. Amyloid deposition was demonstrated in the bronchial submucosa by transbronchoscopic biopsy. Thirteen cases of tracheobronchial amyloidosis have been reported in Japan. Compared with cases reported in other countries, hemoptysis is seldom seen in Japan. As bronchoscopic findings are very similar with those of lung cancer, biopsy is essential to establish the correct diagnosis. Laser therapy can be useful to relieve the symptoms in some cases.

View full abstract

A 46-year-old male patient complained of chest discomfort and chest X-ray revealed a tumor shadow in the right S^3 region and atelectasis associated with a tumor shadow in the right middle lobe. Bronchoscopy showed a black tumor at the orifice of the right middle lobe bronchus which was diagnosed as malignant melanoma by transbronchial biopsy. On bone scintigram and CT, bone metastasis was observed in the left ischium. No effect was obtained after two courses of chemotherapy (DTIC, ACNU, VCR). But at present he is still alive 1 year and 8 months after admission and he is treated as an outpatient. Twelve years before, this case was diagnosed as choroidal malignant melanoma of the right eye and the eyebell was removed and he received radiotherapy. Therefore the case was diagnosed a having both lung and bone metastasis from the primary choroidal malignant melanoma.

View full abstract