The Journal of the Japan Society for Respiratory Endoscopy
Online ISSN : 2186-0149
Print ISSN : 0287-2137
ISSN-L : 0287-2137
Volume 6 , Issue 2
Showing 1-50 articles out of 58 articles from the selected issue
  • Type: Cover
    1984 Volume 6 Issue 2 Pages Cover1-
    Published: June 25, 1984
    Released: September 15, 2016
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  • Type: Cover
    1984 Volume 6 Issue 2 Pages Cover2-
    Published: June 25, 1984
    Released: September 15, 2016
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  • Type: Appendix
    1984 Volume 6 Issue 2 Pages 143-
    Published: June 25, 1984
    Released: September 15, 2016
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  • Type: Index
    1984 Volume 6 Issue 2 Pages 145-146
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 147-
    Published: June 25, 1984
    Released: September 15, 2016
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  • Type: Appendix
    1984 Volume 6 Issue 2 Pages 148-149
    Published: June 25, 1984
    Released: September 15, 2016
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  • Yasuki Saito, Eiichi Akaogi, Noriyoshi Nagamoto, Masami Satc, Shinichi ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 151-161
    Published: June 25, 1984
    Released: September 15, 2016
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    This paper discusses the method of localization and the bronchoscopic findings of roentgenologically negative lung cancer detected by sputum cytology. Since the possibility of cancer of the upper respiratory tract exists, it must be carefully examined before bronchoscopy. Conspicuous findings, which are easily localized, include polypoid, nodal or flat elevation of the bronchial mucosa with an irregular surface and/or hypervascularity. Inconspicuous findings, which sometimes were difficult to localize, were small nodules, slight elevation or mucosal irregularity without elevation. Cases without abnormal bronchoscopic findings were classified into two categories. In one, the lesion is within the visible range of the bronchofiberscope, but the mucosal changes are so minimal that the lesion cannot be recognized. In the other, the lesion is located peripherally beyond the visible range of the bronchofiberscope, and is not detectable radiographically because of its minor size. Such cases should be examined carefully by systematic methods using washing cytology, brushing cytology and bronchial biopsy via bronchofiberscopy.
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  • Etsuro Yamaguchi, Tatsuo Nagai, Kaoru Kamishima, Yasuhiro Tsuneta, Sho ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 163-171
    Published: June 25, 1984
    Released: September 15, 2016
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    Inflammatory polyp of the respiratory tract is a protruding lesion composed of granulation tissue. Clinically it is extremely important to distinguish this disease entity from malignant neoplasms in terms of choice of treatment, and possible complications it may produce, such as atelectasis, pneumonia, and asphyxia. Our three cases were as follows. Case 1 : A 61-year-old man with a small red polyp 2mm. in diameter in the truncus intermedius. Case 2 : A 54-year-old woman with a red plump polyp 10mm. in diameter in the lower trachea. Case 3 : A 69-year-old man with a white firm polyp 7.5mm. in diameter in the trachea, possibly due to intratracheal intubation of 6 months' duration. Fifty-one cases of inflammatory polyp in the respiratory tract of unknown etiology, such as our first and second case were collected and reviewed. The patients ranged from 5 to 76 years old, most were affected in their fourth decade. The male to female ratio was 1.6 : 1. The most frequent site of the lesion was the right main bronchus and the right bronchial tree was more frequently affected than the left. Most cases were treated by endoscopic resection. Although the pathogenesis is obscure, considering the chronological changes reported, respiratory tract infection seems to be one of the important causes of inflammatory polyp. The recognition of this disease and its differentiation from neoplasms deserve special emphasis when surgical treatment is considered, because in this desease transbronchoscopic removal would be the treatment of choice.
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  • Seiichi Nakamura, Terumichi Fujikawa, Satoru Jinno, Mitsuko Kondo, Mic ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 173-178
    Published: June 25, 1984
    Released: September 15, 2016
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    Bronchoscopic examinations were carried out on four cases of bronchial burn, three of which were caused by fire and the other was the result of attempted suicide. As the results of these examinations, remarkable pathological findings were noted in the upper airway, carina, bilateral main bronchi and the bifurcations of lobar bronchi. Pathological findings were more limited in more distal airway. All factors considered, it is thought that repeated bronchoscopic examinations are unnecessary in cases showing minimal clinical changes during the initial two or three days after burn.
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  • Akimitsu Yamaguchi, Toshinari Itaoka, Hidetsugu Nakajima, Yasushi Kasa ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 179-183
    Published: June 25, 1984
    Released: September 15, 2016
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    Bronchofiberscopy and CT scan were performed preoperatively on 30 cases of anterior chest deformity. Both right and left subsegmental bronchi were examined for types of branching. In addition the mean flatness coefficiency of both main bronchi was measured, on the basis of endoscopic photographs, using the ratio of the horizontal to vertical length. The depression coefficiency of the anterior chest was measured by chest CT scan, using the horizontal length ratio of the thorax to the vertebra-sternum distance for the most depressed portion. Both parameters related well to each other. Applications of bronchofiberscopy in chest deformity was discussed.
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  • Pal Barzo, Gabor Szakacs
    Type: Article
    1984 Volume 6 Issue 2 Pages 185-188
    Published: June 25, 1984
    Released: September 15, 2016
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    The bronchofiberscope has facilitated endoscopic examinations through tracheostoma making it essentially more tolerable and safe. Because of anatomical and technical reasons it is not possible however to insert a rigid tube through a stoma to the proximal part of the trachea. In this report the authors deal with retrograde tracheo-laryngofiberscopy (RTL), namely the intubation of the above-mentioned area through the stoma for endoscopic examination, the possiblilities, limits and indications of the method and their own experience up to the present.
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  • Makoto Saito, Jonson Lay, Harumasa Sakai, Hidenobu Takahashi, Komei Ki ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 189-199
    Published: June 25, 1984
    Released: September 15, 2016
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    The diagnostic procedure of transbronchial aspiration cytology (TBAC) using a needle that can be inserted through the fiberoptic bronchoscope for tumors, covered with normal epithelium and/or proliferating beyond the bronchial wall, including peribronchial lymph node involvement was developed at the Department of Surgery, Tokyo Medical College. This procedure was employed in 53 cases suspected of lung cancer and here we discuss the results. These cases included 39 cases of primary lung cancer, 3 cases of metastatic lung cancer, 2 cases of benign lung tumor, 3 cases of pulmonary tuberculosis and 6 cases of other pulmonary disease. A definitive diagnosis with the TBAC technique was obtained in 34 cases of 39 primary lung cancer cases including 35 cases of central type and 4 cases of peripheral type lung cancer. Therefore in primary lung cancer the rates of diagnostic accuracy were 87.18% for TBAC, which included 85.71% in central type lung cancer and 100% in peripheral type lung cancer. most cases of central type lung cancer had no mucosal invasion in the bronchial wall macroscopically and/or cytologically. These data indicated that in central type lung cancer TBAC was effective in the cases in which the lesion was covered with normal epithelium and/or proliferating beyond the bronchial wall. As regards peripheral type lung cancer, it was suggested that TBAC might yield higher diagnostic rates and fewer complications than T.V. brushing and needle aspiration. There was no relationship between the positive rafe and clinical stage or histologic type. No significant complication was seen except for a small amount of bleeding that halted spontaneously in a few cases but the operator must have a thorough knowledge of the anatomy of the lung and the distribution of the pulmonary vessels to avoid the possibility of puncture. While this method can be extremely valuable in certain cases the problem concerning the evaluation of negative cases remains.
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  • Y. Shimizu, S. Watanabe, T. Nakamura, S. Sumitomo, A. Mitsuoka, T. Tak ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 201-207
    Published: June 25, 1984
    Released: September 15, 2016
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    Thirty two patients requiring reconstruction of the trachea were treated at the Department of Thoracic Surgery of Chest Disease Research Institute of Kyoto University from 1972 through 1983. There were 10 primary tracheal tumors, of which five were adenoid cystic carcinomas, three were squamous cell carcinomas, one was giant cell carcinoma and one was plasmacytoma. Tumors with tracheal involvement included 15 thyroid carcinomas and three esophageal carcinomas. The remainder were four inflammations, of which two were tracheal tuberculosis and two were granulation after tracheostomy. In'eight of the primary tracheal tumors, direct anastomosis was performed. Fenestration was per-formed in two patients. The longest resection of the trachea in direct anastomosis cases was six cm, i.e. ten cartilage crescents. The resectable extent for direct anastomosis was influenced by age and preoperative irradiation. In cases of thyroid and esophageal carcinomas, primary end-to-end anastomosis could be performed in only four cases. In 14 cases, fenestration was performed because of difficulty of swallowing due to resection of the recurrent nerve. Postoperative complications, such as anastmosis dehiscence and perforation of large arteries were noted in six patients. All cases were irradiated before surgery. Preoperative irradiation was considered to be a large contraindication of tracheal surgery.
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  • Ryosuke Tsuchiya, Naoto Miyazawa, Tsuguo Naruke, Takeshi Yoneyama, Kei ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 209-214
    Published: June 25, 1984
    Released: September 15, 2016
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    The standard operation for lung cancer is lobectomy with mediastinal lymphnode dissection. We closed the bronchial stump following lobectomy according to the methods proposed by Sweet or Overholt but found transformation of the residual bronchus on postoperative fiberoptic bronchoscopy to remove sputum. We developed a new method which has the suture line crossing at right angles with the longitudinal axis of the residual bronchial airway. This new method causes no transformation of the residual bronchus and results in a right angle between bronchi following closure of the bronchial stump. We used our new method in 300 cases in the point 4 years and 6 months, and did not experience a single case of bronchopleural fistula.
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  • Akira Yokoyama, Koichi Kinameri, Yuzo Kurita
    Type: Article
    1984 Volume 6 Issue 2 Pages 215-221
    Published: June 25, 1984
    Released: September 15, 2016
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    Since the establishment of our institution in 1961, 10 radiographically negative lung cancer cases were experienced in our hospital. The male : female ratio was 9 : 1 and ages ranged from 55 to 74, with an average of 68.5. All but one were heavy cigarette smokers. The cause of detection was hemoptysis in 4 and 6 were detected in sputum cytology mass surveys for lung cancer. Sputum cytology was positive in 8 of 10 cases. In all cases, tumors were localized bronchoscopically. Bronchofiberscopy revealed superficial infiltration in 6, a nodular tumor in 2, a polypoid tumor in one and superficial infiltration combined with a polypoid tumor in one case. Histology revealed squamous cell carcinoma in 9 cases and small cell carcinoma in only one case. In all cases, tumors were successfully resected. 8 of 10 cases were early stage central type lung cancer. One patient died 2.5 months after operation due to liver insufficiency. The other 9 cases are surviving from 4 to 64 months without any recurrence. In conclusion, it is important to detect and biopsy widened bronchial bifurcations for the diagnosis of roentgenologically negative lung cancer.
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  • S. Ishihara, [in Japanese], [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 223-226
    Published: June 25, 1984
    Released: September 15, 2016
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    We experienced an early stage case of adenoid cystic carcinoma. This patient was a 46-year-old male. His chief complaint was hemoptysis. The chest X-ray findings, bronchography and PAG revealed no abnormal shadows. Bronchoscopy revealed adenoid cystic carcinoma in the submucosa of the right B^3 orifice. The tumor was 5.0×6.0mm in size. Curative right upper lobectomy with dissection of hilar and mediastinal lymph nodes were performed. There was neither lymph node metastasis nor residual tumor in the right main bronchus.
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  • Shoji Namikawa, Kentaro Higashi, Yoshihiro Takeuchi, Kuniyoshi Tanaka, ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 227-232
    Published: June 25, 1984
    Released: September 15, 2016
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    Among 54 cases of metastatic lung tumors, bronchoscopy revealed endobronchial metastasis in 6 cases (11.1%) in all of which symptoms such as hemoptysis were noted. The primary tumors were malignant epithelial tumors in 5 and sarcoma in one. On bronchoscopy, polypoid lesions were observed in the bronchial lumen in 5 cases, macroscopically attributable to destruction of peripheral bronchi due to growth of tumors which then protruded into larger bronchi. In one case in particular, metastasis to the bronchial wall via lymph nodes or bronchial artery was considered.
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  • Takumi Ichihashi, Tetsuzi Yamada, You Watanabe, Takashi Iwa
    Type: Article
    1984 Volume 6 Issue 2 Pages 233-238
    Published: June 25, 1984
    Released: September 15, 2016
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    A 48-year-old male with complaints of cough and bloody sputum underwent right sleeve pneumonectomy for lung cancer. Bronchoscopy revealed a granular tumor obstructing the orifice of the right upper lobe bronchus with invasion to the right main bronchus and carina. Biopsy revealed squamous cell carcinoma. After a 5-week course of 40 Gy of preoperative irradiation and a bronchial arterial infusion of anticancer drugs had been performed, the patient was operated on. The trachea was transected 2cm proximal to the carina and the left main bronchus was transected 0.5cm distal to the carina. End to end anastomosis between the trachea and left main bronchus was successful. His postoperative course was not unremarkable and immunochemotherapy was continued. The tumor size was 2×2.5×3cm. The whole tumor had become necrotic by preoperative radiation. The only lymphnode metastasis found was in the No.13 lymphnode. He was discharged from the hospital on the 42nd postoperative day.
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  • Ken Araki, Kazunori Motomura, Youichiro Ichikawa, Masaro Kaji, Toshihi ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 239-244
    Published: June 25, 1984
    Released: September 15, 2016
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    A 49 year-old man was admitted because of fever, cough and sputum. A chest X-ray film showed infiltrative shadow in the middle lobe and calcification along the mediastinum. Bronchofiberscopy showed a bronchial calculus covered with purulent secretion at the orifice of right B^4 and the surrounding bronchial mucosa was edematous and reddish. The Bronchial calculus was removed by the bronchofiberscope safely without damage to the vocal cords, trachea or right main bronchus. After aspiration of the purulent secretion at the orifice of the middle lobe brouchus, biopsy of peripheral bronchi revealed normal bronchial epithelium. The PPD reaction was strongly positive (15×10/22×18). No other pathological findings were shown by laboratory data. Tuberculous mycobacteria were not found by Z-E staining and bacterial culture. Cytological examination of sputum showed no malignant findings. This case was considered to be an intra-bronchial perforation of a calcified lymph node in pulmonary tuberculosis.
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  • Ryuichi Higashiguchi, Hitoshi Katada, Hirofumi Ako, Teruhiko Imai, Rii ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 245-252
    Published: June 25, 1984
    Released: September 15, 2016
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    The asperglloma cavity of a 67 year-old female was infused with amphotericin B via the bronchofiberscope. Six doses of 25mg amphotericin B and one dose of 35mg all in 10ml of 5% glucose solution, were administered at weekly intervals. The aspergilloma disappeared and thickening of the cavity wall regressed on chest X-ray films. Fungi were not observed in sputum after treatment. There were few side effects. In inoperable cases, this method of aspergilloma treatment is thought to be effective and safe.
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  • Hiroshi Yamamoto, Nobuo Ohya, Hirohisa Toga, Chokudai Maeda, Hiroshi Y ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 253-260
    Published: June 25, 1984
    Released: September 15, 2016
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    A case of tracheobronchomegaly (TBM) was reported. A 66 year-old male was admitted to our hospital with complaints of massive purulent sputum, wheeze and dyspnea of long duration. His cough was extremely loud and booming. A chest X-ray film disclosed marked enlargement of the trachea and both main bronchi, and an infiltrative shadow in the right lower lung field. Bronchography confirmed marked dilatation of the trachea (40mm in diameter), the right main bronchus (35mm) and the left main bronchus (25mm). At bronchoscopy, the trachea and main bronchi were dilated and collapsed on coughing and forced expiration. The lumen of the trachea bulged between the cartilaginous rings and diverticula of the trachea and both main bronchi were noted. Pulmonary function tests revealed moderate restrictive and obstructive impairment (%FVC : 56.3%, FEV_<1.0%> : 56.6%). The flow volume curve demonstrated a sudden fall of flow rate at 75% of lung volume in the expiratory phase and fine notchs (40-50H_z) thereafter. The collapsed downstream volume from the choke point, which was measured during the forced expiration maneuver was 180ml (preliminary normal value : 80ml). The loud and booming cough and these characteristic patterns of flow volume curve were thought to be caused by easy collapsibility of the large airway and to be very valuable for diagnosis of TBM.
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  • Toshiharu Matsushima, Hiroki Hara, Susumu Yagi, Osamu Katoh, Rinzo Soe ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 261-267
    Published: June 25, 1984
    Released: September 15, 2016
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    Clinical courses of two patients with bronchial mucoepidermoid carcinoma were reported in relation to serum CEA levels. The first case was a symptomatic 55-year-old woman with a left hilar mass on chest X-ray films, endobronchial tumor on bronchoscopy, and a high serum CEA level. Exploratory thoracotomy revealed tumor infiltration to the posterior chest wall. Transbronchial and open lung biopsy specimens showed bronchial mucoepidermoid carcinoma. Her serum CEA levels temporarily normalized with tumor regression due to radiotherapy, but subsequently increased gradually as the tumor regrew. The second case was an asymptomatic 62-year-old woman with a coin lesion in the right lower lobe, and a high serum CEA level. Right lower lobectomy revealed mucoepidermoid carcinoma of anterior basal segment, and serum CEA levels became normal.
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  • S Sekiya, K Kuramitsu, H Kiuchi, T Kawaguchi, M Hagimori, T Yoshida, K ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 269-273
    Published: June 25, 1984
    Released: September 15, 2016
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    Endotracheal intubation for emergency or temporary control of respiration is a common procedure. In this study, transnasal endotracheal intubation using a bronchofiberscope, instead of conventional oral endotracheal intubation using a pharyngoscope, was attempted in 43 patients who were expected to require endotracheal intubation for a year and a half. As a result, this method was found to have the following advantages : 1) Its procedure is easier than that of conventional methods. 2) Aspiration following intubation is possible under direct vision, and the location of the tip of the bronchial tube can be verified. 3) Performance is easy even in subconsious cases or cases incapable of fully opening the mouth. Nasal hemorrhage, mycteric pain, and damage around the cuff of the bronchial tube were noted as side effects in several patients.
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 275-276
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 277-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 279-280
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 281-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 281-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 281-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 281-282
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 282-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 282-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 282-283
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 283-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 283-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (183K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 283-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (183K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 283-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 284-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 284-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 285-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 285-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 285-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (273K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 285-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (273K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 285-286
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 286-
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese]
    Type: Article
    1984 Volume 6 Issue 2 Pages 286-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (176K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 287-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (275K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 287-
    Published: June 25, 1984
    Released: September 15, 2016
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    Download PDF (275K)
  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 287-288
    Published: June 25, 1984
    Released: September 15, 2016
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  • [in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
    Type: Article
    1984 Volume 6 Issue 2 Pages 288-
    Published: June 25, 1984
    Released: September 15, 2016
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