We have explained about the history of bronchology in the world, and about the status of bronchoscopy along with the development of bronchofiberscopes and the subsequent establishment of bronchology in Japan. Bronchology is not a study only for bronchoscopic examinations, but also for a research study for pathophysiology, diagnosis and treatment of the air way and its surrounding organs. Therefore, we have explained about the presently expanded range of bronchology from the diagnostic and therapeutic viewpoints brought up by the application of bronchofiberscopes. We have also referred to the potential progressive improvements in diagnosis and therapy, in the modern endoscopic equipments, the TV image process, its recording methods, and in the molecular biologic diagnosis and treatment that will come to realize in 10 years from now.

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Nd-YAG laser treatment via the fiberoptic bronchoscope can vaporize lesions causing airway obstruction or stenosis as far as segmental bronchi with minimized danger of bleeding and improve ventilatory disturbances. 63 lesions in the trachea and bronchus consisting of 46 malignant lesions and 17 benign lesions were treated with endoscopic Nd-YAG laser treatment. The procedure were performed under local anesthesia, and no significant side effects were recognized. The lesion was irradiated with 20-80W. power. In 43 of 63 cases effective results were obtained. The non-effective results in 20 cases were considered to be due to inexact preprocedural evaluation of the extent of the lesions. Benign tumor originating in sites from the trachea to segmental bronchi are good indications. This treatment can be a single modality for benign tumor. And lesions of cicatricial stenosis are an indications for this therapeutic modality but lesions extending 1 cm or more longitudinally length, cases in which Tb granulomatous tissue are obtained from the lesion should be excluded from the indications for this treatment. While it can be dramatically effective in some cases of lung cancers, it must be remembered that it often does not achieve complete vaporization of all tumor cells. Therefore when applying this modality in the palliative treatment of ventilatory disturbance in cases of lung cancer, great consideration must be devoted to the site and size of lesion, as well as the depth of invasion and how this method can best be combined with other therapeutic modalities.

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Alveolar macrophages were obtained by bronchoalveolar lavage from 27 healthy volunteers, of whom 12 were nonsmokers and 15 were cigarette smokers with a smoking index of more than 90. Smokers showed an approximately three-fold increase in the number of alveolar macrophages as compared to non-smokers. The alveolar macrophages from smokers had significantly greater β-galactosidase and acid phosphatase activity than did those from nonsmokers. Furthermore, in smokers, more cells adhered and spread out on the glass slides in association with increased NBT reduction and glucose utilization. Scanning electron microscopy revealed that the alveolar macrophages from smokers showed a surface morphology similar to that of activated macrophages. Thus, smokers' alveolar macrophages were recognized to be in an activated state morphologically and functionally. These results suggest that in smokers proteolytic enzymes and active oxygen such as superoxide released from the activated alveolar macrophages may be related to injury of surrounding lung tissues.

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The influence on the trachea of mediastinal goiter extending from the neck into the mediastinum was studied in six cases. The deviation and stenosis of the trachea were measured quantitatively by chest X-ray and CT scanning. Changes in the tracheal lumen were observed with a bronchofiberscope. (1) More than 4 mm of deviation of the trachea was defined as "deviation" and more than 30 percent reduction of the tracheal lumen was defined as "stenosis" on the basis of chest X-ray film findings. Two cases of follicular adenoma and one case of follicular adenocarcinoma were classified as deviation type, while nodular two cases of hyperplasia and one case of papillary adenocarcinoma were classified as the deviation-stenosis type. The method for calculating such tracheal changes quantitatively was useful in understanding the shape of the trachea. (2) In cases in which the area of goiter at the maximally stenotic region was 15-25 cm^2 tracheal stenosis due to mediastinal goiter was conspicuous around the orifice of the thorax. (3) Diagnosis of goiter infiltrating the tracheal wall can be diagnosed by endoscopy or CT scanning if evidence of goiter is exposed in the tracheal cavity, that is, infiltration through all layers of the tracheal wall, but it is difficult in cases of shallow infiltration. In three out of four cases the endoscopic findings were false positive.

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As bronchofiberscopy became a common diagnostic technic in detection of various respiratory diseases in recent few years, 803 patients whose age ranged from 1 to 86 years old were examined with flexible bronchofiberscope in our hospital from April 1981 to August 1983. The suspected diagnosis were ; primary lung cancers 138, other malignancies 24, bronchopneumonia (for detection of caused bacterias) 105, tuberculosis 88, bronchoectasis 66, COLD 41, sarcoidosis 13, fungous diseases 9, PIE 7, and so on. The diagnostic rate by bronchofiberscopy was 76.8% in general, however 83% of bronchial brushing, 80% of bronchial biopsy, 65% of TBLB and 60% of bronchial lavage were diagnostic by each of these methods. Six hundred twenty four patients required treatment with bronchofiberscope, 367 patients for suction during general anesthesie, 218 with acute or chronic respiratory failure for evaluation of artificial airway and suction of intrabronchial secretions, 16 patients for intrabronchial administration of effective drugs. Four foreign bodies removed and one pulmonary proteinosis treated with broncheoalveolar lavage through bronchofiberscope. There were very few complications. The incidence of these complications were less than 30 ml. intrabronchial bleeding in 0.75% of the patients, and pneumothorax in 4 cases (0.25%) of those received this procedure, and the one required thoracic drainage. Lastly we conclude that ; flexible fiberscopy is a safe and effective procedure in detection, treatment and management of different kinds of respiratory diseases.

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The frequency and duration of fever elevation after bronchography following flexible fiberoptic bronchoscopy were compared out in cases of various respiratory diseases, with and without administration of antibiotics after the bronchography procedures. In 37 cases not receiving administration of antibiotics the frequency of fever elevation was significantly (P<0.01) higher and the duration of fever elevation was significantly (P<0.01) longer than in 133 cases receiving antibiotics. Research on the differences of results concerning the type of disease, antibiotics administered, and the involved lung were also carried out.

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Photoradiation therapy (PRT) was performed using an argon laser to treat obstructed or stenotic bronchi in 9 inoperable cases of lung cancer. This paper primarily describes the methodology of the procedure. Hematoporphyrin Derivatives (HPD) was administered intravenously prior to PRT. The wave length of the argon laser beam was 514.5nm and the power was 20-1000mW. When evaluating the effectiveness of PRT, it is also important that photochemical effects should be differentiated from thermal effects of the laser beam. In experiments in canine bronchi, a 200-400mW/cm^2 beam showed no thermal effects and it is therefore likely that the main effects in PRT are photochemical this PRT method appears effective in preventing bleeding or carbonization of bronchial mucosa or tumor surface.

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A 62 year-old man complained of cough and sputum. His chest roentogenogram showed multiple micronodular shadows in both lung fields, egg-shell calcification of hilar and mediastinal lymph nodes and so-called "middle lobe syndrome". Bronchofiberscopy revealed a yellow broncholith occluding orifice of right B^4. Removal of the broncholith was carried out successfully via the fiberoptic bronchoscope. No complication occured. Microscopic examination revealed silicosis with a calcified lymph node perforating into the bronchial space.

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We reported a case of tracheopathia osteochondroplastica diagnosed by fiberoptic bronchoscopy with biopsy. A 62-year-old man with silicosis complained of chronic cough. His chest roentgenogram showed multiple milliary shadows in both lung fields. A fiberoptic examination revealed multiple irregular nodular lesions on the wall of the trachea except in the membranous portion. Biopsy of the nodular lesions revealed submucosal cartilage and bone covered with normal bronchial epithelium.

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We report a case of classic Wegener's granulomatosis. The lung specimen obtained via TBLB showed necrotic degeneration and bleeding around granulomatous vasculitis. Electron dense deposits (EDD) which were found under the basement membrane of capillaries in the alveolar wall were different from fibrin in terms of electron density. The results of immunofluorescence studies of the lung tissue obtained via TBLB were negative for IgG, IgM, IgA, C_3 and C_<1q> except fibrin. Therefore, although serum CH_<50>, C_3 and C_4 were decreased and circulating immune complex (CIC) were strongly positive, we could not elucidate the relation between the pathogenesis of Wegener's granulomatosis and CIC. We consider that TBLB is useful for diagnosis of Wegener's granulomatosis, and that further electron microscopy and immunofluorescence studies will help to clarify the pathogenesis of this disease. In order to prevent bleeding, a serious complication of TBLB, we must pay attension to the bleeding tendency of the disease itself and the artificial bleeding tendency of anticoagulant medication.

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A 76 year-old male was admitted because of slight fever and left chest pain. Chest-X-ray examination showed atelectasis of the left upper and right middle lobes. Bronchograms showed that the left upper division bronchus and right middle lobe bronchus were obstructed by irregular bronchial tumors and the right upper bronchus also showed a filling deficit of contrast material. Bronchoscopy findings showed that three polyp-like prominences with irregular surfaces were present at the orifice of the left upper division, right upper and right middle lobe bronchus respectively and these polypoid tumors were independent of each other. However there were no remarkable changes in both main bronchi and other bronchi. Histologically the three tumors were squamous cell carcinoma. Therefore we considered this case as primary triple cancer of the lung. We treated this case with intratumoral injection of OK-432 and the tumors were observed to decrease in size.

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Two cases of bronchial carcinoid tumor confirmed by TBB (trans-bronchial biopsy) successfully treated with surgical resection were reported. Case 1, a 41-year-old female with complaints of hemoptysis and fever, was admitted to our hospital. Chest X-ray film showed an infiltrative shadow in the right middle lobe. Bronchoscopic examination demonstrated a round vascularized tumor in B^5a. Because of continuous hemoptysis, embolization of the bronchial artery was performed successfully. The histological diagnosis of carcinoid tumor was confirmed by TBB. The excised tumor was 1×0.5×0.5 cm in size and there was no metastasis. In case 2, a 55-year-old female who was admitted to our hospital complaining of cough, chest X-ray film showed obstructive pneumonia in the right upper lobe and tapering of the right main bronchus. Bronchoscopic examination demonstrated a well vascularized round tumor at the orifice of the right upper lobe bronchus and it was confirmed to be bronchial carcinoid tumor by biopsy. The excised tumor was 2.3×1.3×1.4 cm in size and there was no metastasis. Electronmicroscopy revealed neurosecretory granules in the cytoplasm of the tumor cells of both cases. Furthermore, VIP, CEA, Gastrin were detected in the cytoplasm of the tumor cells of both cases by immunohistological examinations (PAP method).

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