The Journal of the Japan Society for Respiratory Endoscopy

The flow-volume (FV) curve test is now a widely used clinical test and much literature has been published about it. Therefore in this manuscript, the author did not dwell on the examination method or theory but concentrated mainly on its clinical significance. The FV curve test was developed for the early detection of airway disease. Much importance has been attached to end expiratory FV results, e.g., V_<50> and V_<25>. However we must remember that the reproducibility of test results is doubtful. At the same time, we must remember that the V_<50> is the most sensitive for the asthma induction test. We must also recognize that we can obtain important information that is unavailable by spirometry through examination of the relationship between the FV HeO_2 curve and the tensionvolume curve. The significance of the FV curve results is very important because they can be directly applied to clinical diagnosis of obstructive disease of the upper airway. The author illustrated this significance using clinical cases of obstructive disease of the upper airway.

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Recently, lung cancer has increased in Japan, and most cases are of bronchogenic origin. The author explained the normal structure of the bronchial tree, and showed that the hyperplasia of epithelial cells of bronchioles are related to the severe alveolar disturbance in pneumonitis caused by BLM. With regard to diffuse pneumonitis of unknown cause which is associated with disturbance of alveoli over a long period, these are accompanied by not only increased bronchiolar epithelial reactvity but also by tumorlet, and on occasion by lung cancer. Bronchioalveolar cell carcinoma is classified into 4 types, Clara cell type, bronchial goblet cell type, alveolar type and bronchial gland type. In cases treated by the author Clara cell type and bronchial goblet cell type predominated, and there were no alveolar type cases. One operative case was Clara cell type by electronmicroscopical diagnosis, but some cells resembled alveolar epithelium. This is an interesting problem in terms of the differentiation of epithelial cells of bronchioles.

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In accordance with the developments in the optical and mechanical aspects of the fiberoptic bronchoscope the instrument is becoming increasingly employed in examination of the bronchi and instances in which it is difficult to decide on the exact nomenclature of a given bronchus are sometimes encountered. Since bronchial nomenclature is based on the segment to which the bronchi bifurcate and distribute, it has heretofore been considered that such nomenclature should be based on the bronchographic findings. However, from the point of view of composing a "reference map" for endoscopy, it is now clear that it is essential to develop a nomenclature method based entirely on endoscopy. Furthermore, individual characteristics peculiar to each lobar bronchus exist, and their absence indicates the presence of some abnormality. Therefore, the ability to correctly grasp an analyze abnormal and pathological endoscopic findings depends upon the possession of a firm knowledge of the normal findings. The present study was undertaken to contribute to the development of the above mentioned nomenclature and to further understanding of the findings in the normal lingular and middle lobe bronchi. The results are based on the endoscopic findings of 300 cases treated between July, 1979 and April, 1980 in which the lingular bronchus or middle lobe bronchus of the uninlved lung could be fully examined and correlated with the bronchographic findings. Reference was also made to types of bifurcation and their relative frequency.

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This study was intended to evaluate the characteristics of the volume-dependent deformation of central airways at different lung volumes, including maximum inspiratory level (MIL) and maximum expiratory level (MEL). Observation of cross-sectional airway changes was performed by a flexible bronchofiberscope. In normal subjects, slight bulging of membranous parts of extrapulmonary bronchi and various types of deformation of intrapulmonary bronchi were observed at MEL and no difference was noted between right and left bronchi compared to the deformation of the intrapulmonary upper lobe bronchus, marked deformation was observed in the lower lobe bronchus. In patients with lung cancer in the hilar region, bulging of the membranous part of the affected main bronchus was not seen at MEL. This observation can be attributable to infiltration of cancer into the bronchial submucosal layer. Direct visual observation of the cross-sectional changes in airways at two extreme lung volumes, TLC and RV, seems to be clinically useful, because the differences in volume-dependent deformation of airways can be attributable to various pathophysical causes.

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