In order to increase the positive rate of cytology for peripheral lung cancer, rapid staining cytology (Gill-Shorr rapid staining and rapid diagnosis) was examined during transbronchial curetting. In consequence, the positive rate of cytology on initial examination for each patient was increased. In addition, rapid staining cytology was informative to confirmation between the curette and the objective tumor. We concluded that rapid staining cytology is an useful method for cytological diagnosis in peripheral lung cancer.

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The properties and locations of 128 lesions in 116 cases of roentgenographically occult lung cancer were examined. In 98 cases of resected lung cancer, the relation between the bronchoscopic findings and the depth of tumor invasion as well as the relation between the findings and the length of axial involvement of the bronchus were also analyzed. As a criterion for endoscopic detection of carcinomas, the bronchoscopic findings of tumors were classified into three groups, namely, remarkable findings, minute findings, and no abnormal findings in terms of ease of observation and diagnosis of the protruding states of the lesions. Only 65 (51%) out of 128 lesions showed remarkable findings, and 34 lesions (27%) had minute findings. No abnormal findings were observed for the other 29 lesions (23%) by a proficient bronchoscopist at the first bronchoscopic examination. Seventeen of the 29 lesions were located within the range of endoscopic visibility, and the other 12 lesions were located beyond the range of endoscopic visibility. The depths of invasion (mean±SE) of the bronchial wall in the cases with remarkable findings, minute findings, and no abnormal findings within the range of endoscopic visibility and beyond the range of endoscopic visibility were 3.07±0.40mm, 1.62±0.47mm, 0.93±0.36mm, and 0.78±0.21mm, respectively. The maximum values of the length of axial involvement of the bronchus were 19.6±1.5mm, 9.9±1.4mm, 5.5±1.0mm, and 8.6±2.1mm, respectively. Non-early stage cases accounted for 9 (17%) of 52 lesions with remarkable findings, 3 (11%) of 27 lesions with minute findings, 0 (0%) out of 8 lesions with on abnormal findings within the range of endoscopic visibility.

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Preoperative bronchofiberscopic findings of the patients with lobectomy and bronchoplasty for lung cancer were analyzed. Among the 76 patients, 63 had the direct extension of the primary tumor into the proximal bronchi and 13 had bronchial invasion from metastatic hilar and mediastinal lymph nodes in cases in which the primary lesions were located in the periphery of the lung. The predominant sites of the lung cancer were in the right upper lobe, left upper lobe and right lower lobe. Seventy-nine percent of the patients with direct extension of the tumor were affected by polypoid lesions which obstructed or narrowed the lobar bronchi, 13 percent of them in segmental bronchi. In cases with hilar or mediastinal nodal extension to lobar bronchus, 4 of 5 had polypoid tumors or narrowing of segmental or subsegmental bronchi without evidence of abnormal findings due to bronchial invasion from the nodes.

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In order to clarify the pathogenesis, especially the mechanism of inflammation and tissue injury of chronic bronchial infection (CBI) found in patients with diffuse panbronchiolitis (DPB) and bronchiectasis, cell profiles and elastase, alpha 1-antitrypsin and lysozyme contents of bronchoalveolar and bronchial lavage fluids from these patients were compared with those from normal volunteers with a mean age of 22 and control patients with a mean age of 54. Marked increase of neutrophils in both bronchoalveolar lavage fluid (BALF) and bronchial lavage fluid (BLF) was found in the CBI group compared with the two control groups, and neutrophils constituted about 70 and 80%, respectively, of total cells in BALF and BLF from the CBI group. Activities of elastase, a lung injury factor in original 250 xg supernatants from BALF and BLF were measured with succinyl-alanyl-prolyl-alanyl-aminomethylcoumarin as a substrate. Elastase activity per total protein (TP) in both BLF and BALF was found in the CBI group, being approximately 4 times higher in BLF than in BALF. The elastase activity/ml was significantly (P<0.01) positively correlated with number of neutrophils (10^4/ml) in both BLF and BALF from the CBI group. Inhibitor studies showed that the elastase activity in BLF of the CBI group is mainly due to serine elastase, indicating that it is primarily due to neutrophil elastase. Contents of immunoreactive alpha 1-antitrypsin per albumin in both BLF and BALF were elevated in the CBI group compared with two control groups, and in the CBI group, it was about 2.5 times higher in BLF than in BALF. The activity of this protease inhibitor in BLF and BALF from the CBI group was thought to be impaired because of increased elastase activity in these samples. Elevated activity of lysozyme, a modulator of inflammation, per TP in either BLF or BALF was not found in the CBI group compared with two control groups. These results indicate that in CBI, the inflammatory process including tissue injury by neutrophils and neutrophil elastase exceeds the antiinflammatory defence process by substances, such as alpha 1-antitrypsin and lysozyme, and CBI causes airway damage.

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Bronchial stenosis and complete obstruction as sequelae in the treatment of endobronchial tuberculosis (EBT) were studied. Based on clinical study of patients with EBT, active in 26 cases and inactive in 5, we recognized that the localization of lesions and the extention and depth of the cross section of affected sites are important factors to determine prognosis. Because there is no method to evaluate depth except by operation, we proposed a new classification of the severity of this disorder based on the bronchoscopic findings of (A) ; the localization (trachea 20, main bronchus 15, truncus intermedius 10, lobar bronchus 5, segmental bronchus 1) and (B) ; the extention of the cross section of the affected sites (circular 5, half and over 3, below half 1). The maximum value of products of (A) and (B) is the score of the patient. The score of the extremely advanced type (gradeIV) is 100 : in which case, it is necessary to secure the air way in emergency. The score of the advanced type (gradeIII) is over 60 : monthly bronchoscopy is recommended. The moderate type (grade II) score is over 15, bronchoscopy every two months is recommended, and mild type cases (grade I) is below 15 points, bronchoscopy at cessation of chemotherapy is recommended. Bronchography is recommended for all patients to assess changes of affected bronchi before cessation of chemotherapy, especially for candidates of surgery.

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Five cases of mucoepidermoid carcinoma of the lung, one a low-grade malignant tracheal tumor and the others high-grade malignant bronchial tumor, were presented. The patient with low-grade malignant tracheal tumor underwent a segmental tracheal resection and is well and alive eight years after the operation. The four patients with high-grade malignant tumor succumbed to disease : one died 17 months after lobectomy ; the others had already had distant metastasis on admission and were dead within eight months. Chemotherapy was not effective in any patients. Ultrastructurally, mucous tumor cells had fibrillar inclusion bodies or central condensation, and hence we consider that these tumors are possibly of bronchial gland origin.

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A 48-year-old man complained of cough, sputum and fever. Chest roentgenogram showed atelectasis of left S^<10>. Fiberoptic bronchoscopy revealed a polypoid tumor at the bifurcation of left B^<10>b+c and bronchoscopic biopsy was performed. Subsequently, the patient underwent left lower lobectomy. The resected specimen showed a polypoid tumor which was 27×23×20mm in size and protruded into the orifice of left B^<10>b. Histological examination showed low-grade malignant mucoepidermoid carcinoma. The clinical and pathological features of 43 sundar cases reported in the Japanese literature were reviewed.

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A case of carcinoma of bronchial gland origin from a subsegmental bronchus with intrapulmonary metastasis was reported. A 39-year-old woman was admitted to our hospital because of chest pain. Chest X-ray film revealed two separated tumor shadows in left S^4 and S^8. Adenoid cystic carcinoma was strongly suspected due to the histopathological findings of the transbronchial biopsy. Detecting no apparent tumor in other organs, we concluded that the lesion was primary lung cancer, following which surgical treatment (left upper lobectomy and S^8 partial resection) was performed. The resected specimen was composed of an admixture of various carcinomatous patterns and was diagnosed as carcinoma of bronchial gland origin. Other lesions in S^<1+2> and S^3 were also demonstrated, and hematogenous metastasis was suggested.

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We reported a case of adenocarcinoma of lung treated with intratumoral injection of 99.5% ethanol to eliminate airway obstruction by an endotracheal tumor. The patient was a 56-year-old female with stage IV(T1 N3 M1) adenocarcinoma of the lung originating from right S^4. She had developed diffuse bilateral lung metastasis, lymphangitis carcinomatosa and submucosal bronchial infiltration. Bronchofiberscopic findings revealed a large polypoid tumor based on the right tracheal wall occupying about 2/3 the tracheal lumen and small polypoid lesions on the bronchial wall. The endotracheal tumor moved in synchrony with respiration. It ruptured and regressed after puncture by a TBAC (transbronchial aspiration cytology) needle. However, the tumor recurred at the same site to occupy about hafe of the tracheal lumen 2 months after it had ruptured. As the patient complained of dyspnea due to airway obstruction by the endotracheal tumor, intratumoral injection of 99.5% ethanol was carried out to prevent death by suffocation. The endotracheal tumor necrotized and exholiated from the tracheal wall and recurrence of the tumor was not observed for about 3 months until her death due to respiratory failure. Accordingly, intratumoral injection of 99.5% ethanol was shown to be a very useful therapeutic method to remove airway obstruction by endotracheal tumor in this case.

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A 77-year-old man complained of productive cough. Bronchoscopy revealed a white-colored lobulated polypoid tumor at the orifice of the right upper lobe bronchus. The tumor was very hard but it was removed completely by transbronchial biopsy with almost no bleeding. Pathological diagnosis was non-chondromatous hamartoma. Among 45 reported cases of endobronchial hamartomas in Japan, this is the first case in which the tumor was completely removed by transbronchial biopsy.

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We experienced two cases of broncholithiasis. Case 1 was a 54 year-old female with chief complaints of cough and chest pain. Her chest X-ray film revealed a mass lesion with calcifications in the right upper lobe and hilar region. Bronchoscopic examination disclosed a white stone in the right B^3b. Right upper lobectomy was performed and the resected specimen showed a incarcerated stone in the right B^3b and pulmonary abscess in the right S^3. Case 2 was a 46 year-old female with cough and back pain. Her chest X-ray film showed an infiltrating shadow in the left Sc^<1+2> and calcifications in the left hilum and left upper lobe. The orifice of the left B^<1+2>c showed inflammatory change and slight stenosis and the bronchial calculus was easily removed by the bronchofiberscope. Analysis of the stone component revealed of magnesium ammonium phosphate and calcium phosphate in Case 1 and more than 95% calcium carbonate in Case 2. Compositions in both cases differed significantly from previous reports.

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It is difficult to distinguish leukemic pulmonary infiltrates from other infections, and give effective treatment. We report a case of acute respiratory failure due to leukemic pulmonary infiltrates treated with bronchial arterial infusion of nimustine (ACNU). Leukocytopenia and high titer of serum LDH level were pointed out in a 35-year-old man complaining of lumbago. The diagnosis was acute monomyelocytic leukemia (AMMoL), and on the following day we started combined chemotherapy. After three weeks hematological remission was induced, but progressive hypoxia from alveolar capillary block appeared with increasing diffuse pulmonary infiltrations. Under 35% oxygen inspiration the oxygen level of his arterial blood gas analysis was 66mmHg. To improve the acute respiratory failure, we performed bronchial arterial infusion with 150mg ACNU. After the infusion, dyspnea improved rapidly, and arterial blood oxygen level recovered from hypoxia. The next day bronchoscopy was performed with transbronchial biopsies of the mucosa and peripheral lung. The entire bronchial mucosa was swollen, and longitudinal folds were seen clearly at the right lower division bronchus. Histological examination of the samples showed leukemic pulmonary infiltrates. In this way bronchial arterial infusion of ACNU can be very useful as an emergency treatment for acute respiratory failure from leukemic pulmonary infiltrates.

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A 38-year-old woman was admitted for examination of an abnormal chest shadow. The physical examinations and laboratory data showed no abnormalities. Chest roentgenogram revealed a solitary nodule with low density in right S^4. On the chest CT the mass was continuous with the orifice of right B^4, but focal emphysema was not present. On bronchography right B^4 was not demonstrated. Bronchoscopy showed the complete obstruction of the orifice of right B^4_a and the stenosis of right B^4_b. After bronchial biopsy of the occluded part of right B^4_a milky mucous secretions issued forth. Mucous secretions from the cyst were aspirated through the fine bronchial tube and contrast medium was instilled into the cyst. A branching bronchus-like structure connecting with the cystic area was confirmed. The biopsy specimen revealed that the wall of the cyst was lined by ciliated bronchial epithelium. It was interesting that thin membranous septum between the cyst and obstructed bronchus was confirmed by means of bronchoscopy.

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Serial bronchoscopical examination was performed on a 26-year old man with smoke inhalation injury by the fire in the enclosed submarine on days 1, 2, 3, 6, 9 and 20. Bronchoscopy just three hours after injury showed a thick layer of sooty material adhering firmly to the whole visible surface of the trachea and bronchi, under which hyperemic bronchial mucosa was seen after removed with flushing of saline. Examination between days 2 and 6 revealed hemorrhagic and edematous mucosa, attachment of mucopurulent membrane and retention of secretions mixed with sooty material and sloughing of the bronchial mucosa, but the bronchial mucosa became almost normal by day 20. Bronchoscopy also revealed that parts of the bronchial mucosa showed more damage as a result of prolonged attachment of sooty deposits, in the form of severe and prolonged inflammatory reaction ; this suggested that it is preferable to remove sooty material as soon as possible. It was also suggested thet the role of fiberoptic bronchoscopy in the management of smoke inhalation injury victims includes removal of soot deposits and debris as well as visualization of the extent of airway injury.

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