[in Japanese]

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The cell sedimentation method, which was first designed by Sayk for analysis of cells in cerebrospinal fluid, was applied to prepare the stained specimen for analysis of cells in broncho-alveolar lavage fluid (BALF). An apparatus which was modified by Nishimura et al. was used. It consists of three parts, plastic tube, absorbent paper and glass slide. BALFs were obtained from normal volunteers and patients with various diffuse interstitial pulmonary diseases by a segmental broncho-alveolar lavage (BAL), and centrifuged at 250×g for 10 min at 4℃. The precipitated cells were suspended in phosphate buffered saline at a concentration of 1×10^5 cells/ml. Then 0.5 ml of the cell suspension was applied to the plastic tube and left to stand at room temperature for about 30 min to absorb the medium. The cells dried on the glass slide was stained with May-Giemsa and nonspecific esterase stains. The 3-38×10^6 of cells which were composed mainly of pulmonary alveolar macrophage was obtained from a segment of the normal volunteers. And it was shown that cell suspension of 0.5-1×10^5 cells/ml was optimal for differential cell count of the specimen. Therefore, the number of cells necessary for this method was only 1-2% of the cells obtained by segmental BAL even in the normal volunteers. Moreover, the preparation of the broncho-alveolar cells including pulmonary alveolar macrophages, lymphocytes and polymorphonuclear leukocytes obtained by this method, showed no significant mechanical distortion or destruction. It is concluded that the cell sedimentation method is very suitable for preparation of the broncho-alveolar cell specimen and for the diagnosis of various diffuse interstitial pulmonary diseases.

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At the authors' institution a total of 19 cases of foreign bodies in the airway were treated in the past 5 years. These consisted of 8 peanuts, 3 soybeans, 3 false teeth, 2 ball point pen caps, 1 cedar leaf, 1 pin and 1 staple. While this number is not very great, it is noteworthy that all cases were treated successfully with the fiberoptic bronchoscope. There has been considerable discussions as to whether airway foreign bodies should be treated with the rigid bronchoscope or the flexible fiberoptic bronchoscope. The authors feel that selection of the instrument depends on the case, experience of the author and the condition of each institution. Also the types of foreign bodies, most commonly observed in Japan, are soybeans seen in younger children tending to expand, soften and are sometimes treated with a Fogarty catheter. Very young children are unable to control themselves and are usually treated under general anesthesia. In the West such cases are generally treated with the ventilation bronchoscope, but at the authors' institution a Portex revolving connector used with the flexible fiberoptic bronchoscope has been found to be very effective. Due to the minimized burden on the patient, the ease for the operator and the development in accessories, it is thought that the flexible fiberoptic bronchoscope will be used increasingly in the future for the removal of airway foreign bodies.

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We encountered an interesting patient of 71-year-old male with hemoptysis. On March 7, 1980, fiberoptic bronchoscopy was done, and at the lateral portion of left B^8 orifice a protruding tumor was found. The pathological diagnosis was bronchial adenoma (possibly mucosal gland adenoma). Although no therapy was added, the hemoptysis subsided naturally. On September 19, 1980 and on March 6, 1981, the tumor was not found by fiberoptic bronchoscopy. The case of bronchial adenoma disappeared in the natural course.

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It has been reported that the lung is an organ having the most possibility of frequent metastases from any extrathoracic tumors. The so-called endobronchial metastasis, however, may rarely be found in the central large airway to form a tumor in the bronchial orifice, and it is necessary that such a tumor, if ever detected, should be distinguished from the central type primary bronchogenic carcinoma. The most frequent origin of the metastasis to the lung is the carcinoma of kidney. Two cases of endobronchial metastases are reported here. The first case was 65-year-old man whose main complaints were cough and fever with abnormal shadow on chest roentgenogram. Bronchoscopic examination showed a white irregular mass in the left upper lobe bronchus, suggesting squamous cell carcinoma of the lung or bronchial adenoma. Only necrotic tissues were gained by repeated transbronchial biopsies. Renal adenocarcinoma was revealed by transbronchial lung biopsy of the lung field lymphangitic metastasis. The second case was 53 year-old man who was admitted for evaluation of bloody sputum and atelectasis in the right middle lobe on chest roentgenogram. He recieved right nephrectomy for renal cancer 3 years ago. In bronchoscopy, a white massive lesion was detected in the orifice of right B^5_a. Endobronchial metastasis from renal adenocarcinoma was diagnosed by tumor biopsy.

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Recently we experienced a patient of 39-year-old male who complained of hemosputum and the anterior projection chest roentgenogram revealed no paticular changes. Flexible fiberoptic bronchoscopy was performed repeatedly, because of the presence of tumorous lesion compatible with malignancy of carina, but the biopsy specimen showed chronic inflammation. One year after the first visiting to our hospital, a yellow-gray, hard and irregular material which looked like a part of tooth was spitted with spasmodic cough, then we obtained the diagnosis of broncholithiasis. There are many kinds of diseases which bring hemosputum, but many Japanese people had the past history of tuberculosis. Therefore, we cannot forget that the broncholithiasis due to the tuberculous calcified lymph nodes can bring hemosputum.

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A 74-year-old man of idiopathic bilateral recurrent nerve paralysis with stidor and dyspnea was reported. Stridor was localized in the neck region and flow volume curve showed the pattern of the central airway obstruction. Bronchoscopy revealed that bilateral vocal cords were fixed in the paramedian position both on inspiration and expiration.

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