The purpose of this study was to clarify the clinical usefulness of Perfluoroctyl Bromide (PFB), developed by Long et al in 1972, as a contrast medium for bronchography as well as alveolography. Compaired to Dionosil, bronchography by PFB emulsion showed slightly less effect in terms of contrast per se, but great advantage was seen in terms of shortening the time necessary for bronchiolar absorption of PFB emulsion. On the other hand alveolography by pure PFB showed the following advantages ; 1. Alveoli in question can be depicted by postural change. 2. Quantitative evaluation of the intrapulmonary distribution of destroyed alveoli is possible. 3. Excretion in expired gas by vaporization in a short period of time. 4. In experiment animals no pathological changes were seen 1 month after alveolography. 5. No clinically significant side effects. In conclusion Perfluoroctyl Bromide showed clinically more usefulness for alveolography than bronchography.

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Segmental or subsegmental broncho-alveolar lavage was carried out in 10 normal volunteers aged 21 to 25 years. One segment or subsegment of the middle lobe of right lung was washed with 50 ml of saline 5 times. The lavage fluids recovered by the 1st, 2nd and 3rd lavage, and those by the 4th and 5th lavage were separately combined, and referred to as lavage fluid I and II, respectively. The cellular component and protein component contents of the lavage fluids I and II were measured, and the ratio of each component content of the former to that of the latter (II/I ratio) was calculated. 1) The II/I ratio of total cell count (0.61±0.16) was significantly higher than that of total protein (0.47±0.10) (p<0.05). This indicates that protein components can be more easily obtained than cellular components, by the present broncho-alveolar lavage method. 2) The broncho-alveolar cell picture of lavage fluid I was almost the same as that of lavage fluid II. This indicates that it is sufficent to perform lavage 3 times to differentiate broncho-alveolar cells for diagnosis of pulmonary interstitial disease. 3) The II/I ratios of albumin and IgG, which are considered to originate from peripheral lung, were almost the same (about 0.47). The II/I ratio of alkaline phosphatase (AIP) was also similar to the former. 4) The II/I ratio of lysozyme was significantly lower than those of albumin, IgG and AIP. This suggests that in the broncho-alveolar system, lysozyme is localized more proximally than albumin, IgG and AIP. It is postulated that amounts of broncho-alveolar components obtained by broncho-alveolar lavage are influenced by various factors, such as their solubility in washing medium, location in the broncho-alveolar system, and method of lavage.

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Normally, the trachea and main bronchi in the central shadow are visible on routine chest X-ray films or tomogram as an air column. Irregularity or thickening of the contours of these air columns indicates the presence of lesions of the tracheo-bronchial tree. Assessment of deviation of trachea is also important radiographically. In the lung field, bronchi are only visible as end-on ring shadows near the hilar area. The contour of this ring-shadow is also thickened by inflammatory processes or interstitial edema. When the wall of the bronchi is thickened due to inflammation, a parallel line shadow is seen, the typical case of this condition being bronchitis and bronchiectasis. When the air surrounding the bronchi is replaced by either transudate or exudate, bronchi are seen in the chest radiograph as negative arborization, known as the airbronchogram sign. One other condition manifesting abnormal shadows due to bronchial involvement is the replacement of the air in the bronchi by water-dense materials. This type of abnormal shadow has several characteristic features, such as Y or W shaped, pointing the tip toward the hilus, and fanlike distribution, because abnormalities are based on bronchi themselves. Until recently, only two water-dense materials which produce abnormal shadows were known namely mucus and pus. When mucus is retained and inspissated in the bronchi, mucoid impaction is the term applied for this condition. Bronchial pyocele is used to descrike pus retention in the bronchi, and gloved-finger shadow or tooth-paste shadow is used in the roentgen diagnosis. We have recently experienced impaction of cellular components in the bronchi due to small cell carcinoma and intra-bronchial bleeding of unknown origin, which produced the same type of abnormal shadows. We named the former cellular impaction of the bronchi and the latter bronchial haemocele. We have confirmed that water-dense materials manifesting abnormal shadows include cellular component and blood, in addition to well-known mucus and pus. From our experience, we propose "bronchial cast shadow" as an inter-grated term to denote these conditions, on chest X-ray film. Three mechanisms of bronchial involvement, which produce bronchial shadow in the lung field, were described. i.e., thickening of the wall, replacement of the extra- and intra-bronchial air by water dense materials.

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Flexible fiberoptic bronchoscopy was performed in 4 patients with massive hemoptysis. After localization of the bleeding, the tip of the flexible fiberoptic bronchoscope was lodged into the appropriate segmental bronchus to tamponade any bleeding and thus prevent blood from flooding the airway. The technique is rapid, simple and effective in controlling life-threatening hemoptysis in patients who are not candidates for resection due to inadequate pulmonary reserve or other causes.

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Endoscopic surgical techniques for the trachea and bronchus via the fiber-optic bronchoscope have changed dramatically due to the introduction of the Nd-YAG laser in this field in 1980. Before then, only electrosurgery and forceps resection were available for endoscopic surgery via the fiberoptic bronchoscope. Endoscopic Nd-YAG laser surgery is quite efficacious for vaporization of tumor mass causing airway obstruction or stenosis as far as segmental bronchus, caused by lung cancer, metastatic malignancy, benign tumor, tuberculosis, posttraumatic granulation etcetera. Usually Nd-YAG laser photoirradiation is performed at 40w with a continuous wave. In the exposed area thermocoagulation of protein tissue components occurs, therefore a superficial necrotizing mass is sometimes observed, which can cause restenosis of the airway due to accompanying accumulation of secretions. This is easily treated by suction via the fiberoptic bronchoscope However, following photoirradiation of the tumor, delayed reduction of the tumor can be observed and one or two weeks subsequently the tumor mass may shrink without any other treatment. Nevertheless, as cartilage in the trachea and bronchial wall can interfere with the thermal conduction, hardly any thermocoagulation may occur in the tumor located beyond the cartilage layer. When a pulse wave is employed (pulse interval : 0.5 sec) for photoirradiation, it takes twice or three times longer to vaporize a tumor mass than when using a continuous wave. However, since the pulse wave has reduced superficial thermal conduction, it is indicated for extremely minimal necrosis shallow depth photoirradiation or at the end of the photoirradiation to procedure to prevent necrosis. Endoscopic Nd-YAG laser surgery, for inoperable cases, can improve the performance status maintaining the airway, which can make it possible to administer further treatment such as chemotherapy and radiotherapy. Also for operable cases, it can decrease obstruction caused by inflammation in the peripheral lung improving the airways and facilitating postoperative management.

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Three cases of bronchial carcinoid were reported. Case 1 : an 18-year-old male complained of persistent wheezing following frequent recurrence of acute pneumonia for 5 years. A tumor was found at the distal portion of the left main bronchus bronchoscopically, and proved to be carcinoid histologically. Argyrophil granules in tumor cells were recognized. Left pneumonectomy was performed. He is alive well after more than 1 year. Case 2 : a 26-year-old female had bloody sputum and productive cough for 7 months. A tumor detected in the truncus intermedius proved to be carcinoid histologically. Endoscopic removal of this tumor and complete cauterization of its site of origin were performed. After 7 years, recurrence of carcinoid occurred at the same site and carcinoid syndrome developed. Right pneumonectomy was performed. Four years later she developed Cushing's syndrome and died. Autopsy revealed widespread metastatic lesions containing an excessive amount of ACTH and serotonin in paratracheal lymph nodes, pancreas, left adrenal, thyroid and both ovaries. Case 3 : a 33-year-old woman complained of cough, sputum and high fever for 2 months. A tumor was detected at the orifice of the right lower lobe bronchus bronchoscopically. Biopsy revealed no definifive diagnosis. Right pneumonectomy was performed on the suspicion of lung cancer. Histological diagnosis of this tumor was carcinoid. She is disease-free at over 12 years. Bronchial carcinoid resembles a hard red cherry bronchoscopially and can be cleary distinguished from the usual appearance of lung cancer. Bronchial carcinoid is considered to originate from neurosecretory cell i.e. Kultschitzky cell in the bronchial gland and is characterized by slow growth and long symptomless primary stage, sometimes resulting in malignant change with serious complications such as carcinoid syndrome, Cushing's syndrome etc. Therefore the most suitable treatment for bronchial carcinoid appear to be lung resection.

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Tuberculosis of major bronchi has become rather rare in Japan recently, and it is usually difficult to diagnose at early stage because routine chest X-ray films show no or only slight changes. The patient was a 19 year-old female. She was admitted to the orthopedics department of our hospital complaining of pain in the left shoulder and was found to have bone tuberculosis of the left humerus head. At the same time lung tuberculosis with abnormal shadows on chest X-ray film was detacted. From that time, antituberculous therapy was begun but after about 7 months, atelectasis of the right middle and lower lobes was recognized on chest X-ray film. Bronchofiberscopy demonstrated complete obstruction of the truncus intermedius by a necrotic substance which was removed by Biopsy forceps. The atelectasis improved. Repeated smears and cultures of sputum were negative for acid-fast bacilli but a definitive diagnosis was obtained by bacterial examination of smear material obtained by bronchofiberscopy. Follow-up bronchofiberscopy procedures were performed to prevent reoccurence of atelectasis due to necrotie tuberculous granulation.

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Endobronchial hamartoma is an extremely rare disease. Only 6 cases have been reported in our country. This is the seventh case reported. A 39 year-old male suspected of benign lung tumor in the right lower lobe received lower lobectomy. Gross examination revealed a firm smooth polypoid lesion 1.5×1cm in size in the mucosa of the orfice of B^9. Microscopically, the tumor was composed of submucosal chondromatous masses, which were covered with regular ciliated columnal epithelium and bronchial gland was contained in the tumor mass.

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This is a rare and interesting disease that was first recognized following the description given by Altherr (1936) and Van Meyenberg (1936), although it had been originally discribed by Jaksch-Wartenhorst (1923) who called it "Polychondroplasia." In relapsing polychondritis the cartilage tissue in the trachea and large bronchi is often involved, together with the large cartilages and the external portions of the ears and septum, parts of the internal and external ears, and joint surfaces. The pathological findings show degenerative destruction of cartilage of unknown etiology. This case was a 66 year old male with remarkably transformation of both binnas and nose who complained of serious dyspnea and of painful inflammatory swellings in the nose, ears and peripheral joints. Marked narrowing of his trachea and both main bronchi was observed on chest tomographs Bronchofiberscopy reveled disappearince of cartilagerings in the trachea and main bronchi due to mucosal edema. The case was treated with predonisolon, but this symptoms fluctuated. He was suffocated to death after three years. Autopsy findings revealed remarkable atrophy of the cartilage in the trachea and large bronchi due to degenerative distruction and replacement by granulation or collagenous fiber. The intervals between adjoining cartilage rings in the trachea and bronchi were greater than normal.

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