This work was carried out to clarify characteristics of bronchial secretion of normal subjects and patients with chronic bronchitis. (1) Experiment 1 Both bronchial lavage (BL) and bronchoalveolar lavage (BAL) were performed in young normal volunteers. And the biochemical components of BL and BAL fluid (secretion) were measured. Bronchial mucous glycoprotein content of the secretions was estimated by its fucose and sialic acid content. The biochemical component contents of the secretions were expressed according to the method of Stockley et al., to see degrees of local production of these components. The secretion-to-serum concentration ratios for albumin, IgG, IgA, lysozyme and sialic acid were calculated, and then the secretion-to-serum IgA, lysozyme and sialic acid ratios when standardised for the corresponding albumin ratio were 3, 430 and 2.5, respectively, even in the BAL fluid and significantly higher in the BL fluid than in the BAL fluid. In particular, the lysozyme ratio was about 5, 000 times that of albumin in the BL fluid. These results indicate that IgA and lysozyme, especially the latter in the bronchial region are locally secreted mainly from bronchial wall with mucus. The IgG ratio, however, was about 1-1.5 in both the BAL and BL fluid, suggesting that this immunoglobulin in the bronchoalveolar region of normal subjects is mainly derived from plasma. (2) Experiment 2 Mucoid sputa from patients with chronic bronchitis were centrifuged at 105, 000 xg for 1 hour, and the IgA, albumin, fucose and sialic acid contents of whole sputum and the supernatant were measured. The result indicated that about 80% of mucous glycoprotein and 50-60% of albumin, IgA and lysozyme were distributed in the precipitate (gel phase). The fucose, sialic acid, IgA, lysozyme and albumin concentration in the 105, 000 xg supernatant were significantly correlated with each in the whole sputum. The secretion-to-serum IgA, lysozyme and sialic acid ratios standardised for the corresponding albumin ratio were similar in the BL fluid of normal subjects and the 105, 000 xg supernatant from mucoid sputum of patients with chronic bronchitis, suggesting that secretion of mucus and proteins by bronchial mucous and serous glands are proportionally increased with release of immunoglobulin by lymphocytes and probably with transudation of proteins from blood, in bronchial region of patients with chronic bronchitis. (3) Experiment 3 It was shown that by gel filtration of the supernatant from sputum on Sepharose 4B that both fucose and sialic acid in sputum exist in free form besides as constituents of mucous glycoprotein, and amounts of free fucose and sialic acid vary from sputum to sputum. Therefore it is postulated that fucose and sialic acid contents of whole sputum do not always reflect its mucous glycoprotein content.

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In order to examine the reliability of synthetic absorbable suture 16 canine tracheas were anastomosed with Dexon Plus then the animals were sacrificed 3 to 28 days following surgery. After removal of all Dexon Plus at the site of anastomosis, both the strength of the tracheal anastomosis and that of the removed Dexon Plus were measured. The strength of the tracheal anastomosis following removed of sutures gradually increased, becoming about 1 kg/cm after 3 weeks, while that of the removed Dexon Plus gradually decreased reaching almost zero after 3 weeks. Histological examination showed that tracheal cartilage showed degeneration as early as the 3rd day and appeard fragile for 1 to 3 weeks. However, during the fourth week, tracheal cartilage around the anastomosis showed evidence of repair microscopically, i.e. development of new capillaries around them. Dexon Plus sutures were absorbed earlier outside the trachea than inside it. Chronological measurement of the hydroxyproline content of the tracheal wall around the site of anastomosis showed no specific tendency in relation to the histological changes. We tried to measure the strength of the anastomosis without removing the sutures after 10 days to 2 weeks, in a few dogs. Surprisingly, sutures did not tear but tracheal cartilage ruptured under about 1 kg/cm tension. Based on these results, we consider that synthetic absorbable sutures maintain sufficient strength until healing of tracheal anastomosis is almost completed and that rupture of tracheal cartilages due to their fragility may result in granulation, stenosis or insufficiency at anastomosis.

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To study the healing process at the site of anastomosis following tracheal reconstruction in dogs, microvascular casts obtained by a silicon rubber perfusion technique, tissue collagen contents, breaking strength and conventional histology were examined at day 3, day 7, day 14 and day 28 postoperatively. Stereomicroscopic observation of the vascular cast revealed that vascular anastomosis presented at 7th day and covered the whole tracheal anastomosis at 14th day. The breaking strength increased remarkably after 7 days postoperatively. Although the collagen content in the tissue at the site of anastomosis decreased at day 3, it returned to preoperative levels at day 7. Histologically, proliferation of collagen fibers were abundant around the perichondrium rather than in the submucosal layer or in the adventitia of the trachea.

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This study was designed to determine the effects of varying dosages of preoperative irradiation on anastomotic healing of the trachea and bronchus. Twenty mongreal dogs were divided into 5 groups of 4 each : the control group receiving no radiation therapy and four groups receiving 30, 35, 40, and 50 Gy preoperative irradiation, respectively. Three weeks after completion of radiation therapy, two rings of the cervical trachea were resected and the trachea was reconstructed by primary anastomosis. There were no significant adverse effects on healing of the trachea in dogs receiving up to 35 Gy. In 7 of 8 animals receiving 40 or 50 Gy preoperative radiotherapy stenosis developed at the tracheal anastomosis, resulting in clinical evidence of tracheal obstruction. In 3 of the 4 dogs receiving 50 Gy the stenosis was severe. Sections taken from dogs receiving 40 and 50 Gy revealed greater degrees of edema and inflammation. The most striking differences, however, were at the site of anastomosis. The vascular network adjacent to the anastomotic site remained markedly dilated. Edema, chronic inflammation, and fibrosis were all increased at the anastomosis site. Clinically two patients were treated by preoperative radiotherapy and carinal reconstruction. Though the course of the patient who had 60 Gy preoperatively and right pneumonectomy was relatively good, the other patient who received 40 Gy and underwent anastomosis of the trachea and the truncus intermidius continued to show edema at the anastomotic site 4 month after the operation. This difference is probably due to the stump being closed in the former case, while two stumps of the airway were anastomosed in the latter case.

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Resection of the esophagus together with the trachea or the bifurcation of the trachea was performed in four patients with esophageal carcinoma or mucoepidermoid carcinoma of bronchial origin. Three patients had carinal resection, of whom two patients had an uneventful recovery and survived five and 10 months but one patient died in the immediate postoperative period from aspiration pneumonia and respiratory failure. One tracheal resection case died due to renal failure. Postoperative care is not so different from that following tracheoplasty, however, the indications for combined resection of the esophagus and part of the airway should be determined by precise judgement of the extent of malignancy.

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Fourteen patients who underwent tracheobronchial reconstruction due to traumatic injury were reviewed. The Problems underlying postoperative management for such patients were discussed with reference to the prevention of postoperative complications. Cases of tracheal injury due to blunt chest trauma frequently require emergency surgery regardless of whether there are aditional injuries. Long-term mechanical ventilatory support may be necessary in these patients for respiratory failure caused by wet lung and/or flail chest. In one case with complete rupture of the lower trachea due to severe blunt chest trauma in which emergency reconstructive surgery was performed followed by mechanical ventilatory support resulted in dehiscence of the anastomotic site 7 days postoperatively. This fact indicates the importance of complete suture techniques of tracheal anastomosis as well as intensive respiratory care during the early postoperative period when the patient is in the most critical. To prevent disruption of the anastomosis, prophylactic and/or intensive chemotherapy are necessary in addition to intensive respiratory care. There were no patients of emergency surgery for bronchial trauma ; all patients received delayed reconstructive operation from one month to 6.5 months after the injury. Three of 6 patients of traumatic injury with end-to-end anastomosis of the right or left main bronchi showed transient re-expansion pulmonary edema for a few hours after the completion of anastomosis. These phenomena appeared in a case with apparent collapse of the lung from 2 to 3.5 months after injury. This complication should be kept in mind in cases of long-term atelectasis. Insertion of a double-lumen tracheal tube may be necessary in these patients during reconstructive surgery.

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Five patients with thyroid carcinoma involving the trachea underwent segmental resection of the trachea and reconstruction by primary anastomosis of the airway. The major operative complication, observed in 3 cases, was airway obstruction at the glottic level due to bilateral paralysis of the recurrent laryngeal nerve. Emergency respiratory management for paralysis of the vocal cord was needed soon after surgery. Although tracheostomy could be a life-saving maneuver, it can result in severe wound infection in the immediate postoperative period. Then, we employed an endotracheal tube by nasal intubation to prevent airway complications. The endotracheal tube was inserted between the vocal cords into the trachea, and was placed below the anastomotic area at the end of the operation. Patients in whom an adequate airway was established were extubated after several days postoperatively. If they cannot breathe adequately because of recurrent larygeal nerve paralysis, the endotracheal tube was replaced until tracheostomy could be done with safety. This method is usuful to control postoperative airway complications.

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Fifty-two patients with lung cancer underwent bronchoplastic procedures between 1955 and 1984 in our department. Sleeve resection was performed in 31 patients and wedge resection in the remaining 21. Squamous cell carcinomas was the most frequent histologic type (34). Hilar lymph nodes were involved in 15 patients and mediastinal nodes in 17 patients. The post surgical stages were as follows : 10 cases in Stage I, 13 Stage II cases, 26 Stage III cases, and 3 Stage IV cases. There were 3 operative deaths (6%). One was ascribed to postoperative intrathoratic bleeding, one to tension pneumothorax, and the other to myocardial infarction. Difficulty of expectoration and atelectasis of lobes of bronchi in which bronchoplasty was performed were frequent postoperative complications after bronchoplasty for lung cancer. Bronchofiberoptic aspiration of sputum was the most effective procedure to improve difficulty of expectoration or atelectasis. Another important complication was suture granulation at the anastomotic sites. Granulation was observed in 9 patients and 7 of these were managed by removal of threads protruding into the bronchial lumen from the site of anastomosis with the fiberoptic bronchoscope. Other complications occuring after bronchoplasty were anastomotic stenoses, anastomotic obstruction, bronchial fistula, and broncho-pulmonary arterial fistula. To prevent these serious and unpleasant complications, careful technique is required in suturing the bronchi. Local reccurence of carcinoma at the suture line occurred in 3 cases treated by irradiation therapy.

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Ninety two patients (32 men and 60 women) with bronchial tuberculosis were diagnosed by bronchofiberscopic examinations during the period from January 1975 to December 1983. In this report, the clinical features and bronchofiberscopic findings of these patients were discussed. Initial symptoms were productive cough in 86 patients (93.5%), fever in 30 (32.6%), bloody sputum in 11 (12.0%) and stridor in 9 (9.8%). Seven patients, however, had no symptoms. In the chest X-ray, normal or nearly normal findings were seen in 48%, and atelectasis in 37%. Endoscopic findings were classified into the following types : redness and edema of the bronchial mucosa as type I ; intra-mucosal nodules as type II (without ulcer as lla and with ulcer as llb) ; granulation as type III ; scar-formation as type IV (without stenosis as IVa and with stenosis as IVb) ; and penetration of the tuberculous lymphadenitis as type LN. Among the 61 patients without a previous history of tuberculosis, type III was seen most frequently (63.9%), while type IV was most common (83.9%) among the 31 patients with a previous history. In total, type II, type III and type IVb were seen in 13.0%, 46.7% and 40.2% respectively. Type III included type III + LN (11.6% of III). The site of involvement was the left main bronchus in 73.5%, and the right main bronchus in 41.5%. Because of the difficulties in differentiation from bronchogenic carcinoma not only in terms of clinical features, but also bronchofiberscopic findings, determination by the bacteriological examination and bronchofiberscopic biopsy is always necessary, whenever bronchial tuberculosis is suspected.

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There are many factors and diseases causing injury to the peripheral airways, e.g., smoking, air pollution, viruses, chronic bronchitis, pulmonary emphysema and pulmonary fibrosis. Elucidation of the pathological conditions of peripheral airway lesions is therefore an important problem. We developed an extremely thin bronchofiberscope enabling direct observation and photography of peripheral airways less than 2mm in diameter and applied it to cases of bronchiolitis, sarcoidosis, chronic bronchitis and Kawasaki asthma. The findings obtained for bronchiolar areas are reported with some comments, in the hope of contributing to analysis of the pathological condition of the above diseases.

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It has been known that there can be striking venous anastomoses between bronchial and pulmonary circulation. To assess the changes in submucosal vessels under left atrial load, fiberoptic bronchoscopy was performed in 11 cardiac patients without broncho-pulmonary disorders. Non-pulsatile submucosal vessel dilatation was recognized in 10 cases out of 11. The dilated vessels tended to be located at the distal portion of bilateral main bronchi. The degree of vessel dilatation was graded, and characteristically correlated well with wedge pressure at right heart catheterization in 6 cases with mitral stenosis. The vessel dilatation decreased after reduction of left atrial load by operation. These results seem to support the viewpoint that those engorged characteristic submucosal vessels are bronchial veins dilated due to increased blood flow via the bronchopulmonary anastomoses. Rupture of dilated bronchial veins should be taken into consideration as one of the causes of bloody sputum or hemoptysis in cardiac patients.

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The bronchoscopic findings of 24 patients with early stage hilar type lung cancer were studied. Out of the 24, 14 patients with roentgenologically negative lung cancer (including one with double primary lung cancer), were examined for localization. In 10 patients with superficial infiltrative type of early stage lung cancer, bronchoscopic findings were compared with pathological findings. Bronchoscopic findings revealed polypoid tumors in 11 patients, nodular tumors in 2, superficial infiltration in 5, thickening of the bronchial spur in 6 and a polypoid tumor with superficial infiltration in 1. All roentgenologically negative lung cancer cases were examined for localization by bronchofiberscopy. In five patients (including three with carcinoma in situ), tumor localization was difficult and localization was possible only after selective brushing of each segmental bronchus or biopsy were performed two or three times. In all five patients, thickening of the spur was the only endoscopic feature. All cases of superficial infiltrative type of early lung cancer were chest X-ray negative, but the bronchoscopic findings correlated well to the depth of invasion and all cases had thickening of the spur. Since the tumors originated at the bifurcation of bronchi, "thickening of the spur" can be a most important sign for the localization of the superficial infiltrative type of early stage lung cancer, especially carcinoma in situ.

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Comparing the histopathological findings of transbronchial biopsy and frozen sections of the bronchial stump to the endoscopic findings in advanced hilar type lung cancer, the following results were obtained as follows. Between 1977 and 1983 five cases of surgically resected lung cancer were experienced in which biopsy findings were negative but delete cytology findings were positive. Therefore, it is very important to examine by both biopsy and cytology simultaneously in endoscopical examination. Examining 143 transbronchial biopsy specimens between 1981 and 1983, some correlation between tumor histology and growth pattern were recognized. Squamous cell carcinoma mainly tended to replace the bronchial mucosal epithelium and to grow exposed as a tumor in the bronchial lumen. On the other hand, adenocarcinoma, small cell carcinoma and large cell carcinoma tended to proliferate invading submucosally including lymphatics. As an exception some adenocarcinomas grew exposed as a tumor. In the past 7 years, there have been 39 cases positive for malignancy at the initial bronchial surgical margin (1977-1983). There were some correlation between patterns of tumor growth in the bronchial wall and tumor histology, reflecting the results of bronchial biopsy. Moreover, all types of malignant tumor involved the adventitia of bronchial wall, especially adenoid cystic carcinoma. It was very difficult to endoscopically find abnormal bronchial wall findings in both main stem bronchi. Therefore, it is necessary for some new approaches to obtain biopsy and/or cytology materials to judge malignancy in these areas. Since there are some clear differences in the type of proliferation and development of carcinoma by tumor histology, it is very important for the endoscopic examiner to always to consider the possible histological types of tumors when he performs the procedure.

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Carcinomatous invasion into lymphatic vessels in the peripheral lung parenchyma and bronchial submucosa was studied in 23 cases of pulmonary carcinomatous lymphangiosis. Pathological changes were evaluated on the basis of tissue samples obtained by TBLB and bronchial biopsy and were further confirmed in cases in which autopsy was performed. It was observed that the invasion to lymphatic vessels in bronchial submucosa progressed in parallel with those in the peripheral lung parenchyma. Those results, suggest that the submucosal lymphatic vessels may act as a collateral channel of lymphatic vessels in lung parenchyma, and that bronchial biopsy is equally valuable TBLB but less invasive, in the detection of this pathological disorder.

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Broncho alveolar lavage is performed as a diagnostic procedure in various pulmonary diseases. Quantitative analysis of cellular components in bronchoalveolar lavage fluid (BALF) is extremely valuable to evaluate disease activity and select the treatment. Cytocentrifuge and sedimentation preparations have been commonly employed for analysis in Japan. We made a comparative study of cell differentials obtained by the following three methods ; cytocentrifuge, sedimentation and smear preparations stained with Giemsa in a total of 30 cases. Furthermore, we compared the proportion of lymphocytes analyzed from smear preparations with that of smaller cells by a hemocytometer in BALF of 16 cases with a low percentage of polymorphonuclear leukocytes, in which the cell differentials were chiefly considered to consist of alveolar macrophages and lymphocytes. There was no significance (P>0.05) in proportions of polymorphonuclear leukocytes in cell differentials obtained by three methods mentioned above. The proportion of lymphocytes decreased significantly (P<0.01) in cell differentials made from both cytocentrifuge and sedimentation preparations compared with smear preparation. The higher proportions of alveolar macrophages in cell differentials made from cytocentrifuge and sedimentation preparations were considered to be secondary to the relative decrease in lymphocytes. Moreover, the proportion of lymphocytes in cell differentials made from smear preparation decreased by about 20% compared with that of smaller cells by the hemocytometer. These observations may suggest that the proportion of lymphocytes in cell differentials obtained by the smear method is also underestimated. A more accurate method for the analysis of cell differentials of BALF is required.

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To elucidate the pathogenesis of pulmonary sarcoidosis, bronchoalveolar lavage fluid (BALF) T lymphocytes and blood T lymphocytes were analyzed from several aspects. 1. Significant increase of BALF lymphocytes was not always paralleled by a significant lymphocytopenia in the blood, so T cell proliferation in the lung was suspected. 2. OKT4^+ cells and OKla^+ cells in BALF increased in active cases, but Tac^+ cells did not increase. 3. The response of BALF T cells to exogenous IL-2 was lower than that of blood T cells. No difference between healthy and sarcoidosis patients was observed. The above findings suggest that accompanied by or through sarcoidosis does not advance according to the proliferation to T cells. There may be a mechanism which inhibits the proliferation of T cells in sarcoidosis, since there are indications that sarcoidosis is a self-limiting disease.

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The effect of bronchoalveolar lavage (BAL) on cardiopulmonary function was measured and the results were compared with those of TBLB and bronchography. This study included 45 cases in which BAL was performed in 21 patients (22 procedures), TBLB in 24 (28 procedures) and bronchography in 13 (14 procedures). The decrease of Pa_<O2> during BAL was 20 torr, 15 minutes following the procedure it was 16 torr and 2 hours after the procedure it was 6 torr. In addition, the decrease of Pa_<O2> caused by BAL was greater than that caused by TBLB in the same patients. There was no change in Pa_<CO2>, but there was some change in blood pressure and heart rate during the procedure. The decrease in Pa_<O2> was more protracted in cases with poor recovery of fluid, such as interstitial pneumonia accompanying collagen disease. The reason for the decrease in Pa_<O2> included the filling of bronchoalveolar spaces with saline and bronchial contraction as a result of the insertin of the fiberoptic bronchoscope. Therefore, in cases with low blood oxygen levels oxygen should be administered during the procedure.

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The diagnostic value of bronchoalveolar lavage (BAL) in posttransplant interstitial pneumonia (post-BMT IP) was studied in 10 allogeneic and 3 autologous bone marrow transplant (BMT) patients. BAL fluid cells were analyzed morphologically on Giemsa-stained smears. An increased proportion of lymphocytes in BAL fluid was characteristic of post-BMT IP. Follow-up study showed that these lymphocytes increased and decreased in accordance with exacerbation and improvement of the disease. Cytomegalovirus (CMV) was isolated from the viral culture of BAL fluid in 4 of 7 patients who developed post-BMT IP. An increase of lymphocytes in BAL fluid before BMT was investigated in 3 of 5 patients studied. All three developed post-BMT IP earlier than the other two. In summary, our data from a limited number of patients might suggest that BAL is a useful, conventional and harmless tool in the diagnosis of post-BMT IP : namely, lymphocytes in BAL fluid correlate well with disease activity, causative organisms like CMV can be frequently isolated from BAL fluid and an increase of lymphocytes in BAL fluid before BMT is one of the risk factors indicating the early onset of post-BMT IP.

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The diagnosis of pneumoconiosis is usually made on the basis of the patient's occupational history, chest X-ray findings, clinical symptoms and the results of lung function tests. It is not always possible to detect causal dust. We therefore tried bronchoalveolar lavage (BAL) to detect causal agents in the BAL fluids. BAL was performed in 14 asbestos workers, 2 cases of silicosis, one bentonite worker, one arcwelder and 20 cases of other pulmonary diseases. Physical examinations, chest X-ray analysis and lung function studies were also performed. BAL fluid was analyzed for asbestos bodies as well as lavage cells and humoral components. Most of the alveolar macrophages contained dusts in all cases of exposure, but in 20 unexposed patients only small numbers of macrophages contained dusts. Asbestos bodies and fibers were found in the BAL fluids of all asbestos workers, but were not detected in other patients. The numbers of asbestos bodies were significantly high in cases with well fine crackles, and the changes in % D_<LCO> and D_<LCO>/VA were correlated well with the counts of asbestos bodies in BAL fluid (p<0.01). It was considered that in cases with more than 5 asbestos bodies per 1000 alveolar macrophages asbestosis could be strongly suspected. In the bentonite worker, foreign bodies in the macrophages were shown by analytical electron microscopy to be identical to bentonite dust. Similar examinations revealed the causal dust in the cases of silicosis and arcwelder's lung. BAL is safe, simple and very useful to diagnose penumoconiosis.

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Cell analyses in the bronchoalveolar lavage fluid (BAL) ; a total cell counts and ratios of each inflammatory cell were made on an each fractional fluid of the bronchoalveolar lavage (FBAL), instead of the conventional way of cell analyses which were made on a total fluid recovered in one routine BAL. In normal rats the first fluid (FBAL-I) always contained a highest ratio and absolute number of neutrophil and, did the FBAL-I in normal guinea pigs both highest ratios and absolute counts of neutrophil and eosinophil as well, and those ratios and absolute counts showed a clear tendency of gradual decrease in FBAL II and III. And neutrophils almost diminished in the third fraction of lavage fluid (FBAL III). On the contrary, macrophages were best collected in FBAL-III in both animals showing the highest ratio and largest number, while lymphocyte ratios did not alter significantly at any levels of FBAL. As it is naturally supposed that the first lavage fluid should reflect proximal portion of the airways rather than the peripheral respiratory system, the present result indicates that acute inflammatory cells mainly lie in the bronchial mucus blanket, and macrophages in contrast locate in the terminal respiratory system in normal. Histological observations in semi-serial sections apparently demonstrated a close relationship of the topographical cell distribution to the FBAL results. In the early stages of endotoxin-induced shock animals, cell differential ratios in FBAL-I, II and III did not differ markedly. Neutrophils and eosinophils in FBAL-I greatly increased above the control level as early as 10 minutes of endotoxin-injection in guinea pigs and these ratios remained relatively high in FBAL-II and III, which was consistent with the histological result as these inflammatory cells are widely scattered through the bronchial tracts and alveolar structures. In the patients with bronchial asthma, average cell differentials are characterized by predominant infiltration of eosinophil and neutrophil in atopic type and neutrophil predominant in the non-atopics. However neutrophils and eosinophils showed strikingly high ratios in FBAL-I in both types and decreased in FBAL-II and III. Dense infiltration of the inflammatory cells was histologically proved in the bronchial system and also at the peripheral airways in such patients as FBAL-III was characterized by relatively high ratios in those cells as well. Based upon these results, it was proved that FBAL-I reflects the cells distributed in bronchial airways, and FBAL-III really does lower respiratory systems. New method of cell analyses of bronchoalveolar lavage (FBAL) is considered worthwhile to try particularly in making differential diagnoses of small airway diseases.

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In order to clarify the distribution of immune and inflammatory cells on the alveolar surface and on the surface of the respiratory tract, and to evluate the effect of cells from the respiratory tract on cell analysis of broncho-alveolar lavage fluid (BALF), BALF and bronchial lavage fluid (BLF) obtained from normal volunteers, control patients and patients with idiopathic pulmonary fibrosis (IIP) were examined by cellular analysis and neutrophil chemotaxis. BALF obtained from normal volunteers contained a large population of alveolar macrophage (88.2±6.2%), and small amount of neutrophils (less than 1%). Compared to BALF, BLF was characterized by a larger population of neutrophils (normal volunteers ; 8.8±9.5%, IIP ; 33.9±9.3%). An increased number of neutrophils was observed in BALF obtained from patients with IIP. Neutrophil chemotactic activity was detected in both BALF and BLF. Importantly, C5-derived chemotactic factor was present in BLF obtained from normal volunteers and in BALF obtained from patients with IIP, but not in BALF from normal volunteers. These findings suggest that cellular and biological components in BALF obtained from patients with IIP derived not only from alveolar spaces but also partly from the respiratory tract.

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