The relationship between clinicopathological findings (cytological findings, type of development, bronchoscopic findings) and the response to chemotherapy was studied in 29 cases of small cell carcinoma of the lung. The nuclear DNA of the tumor cells obtained by brushing during fiber optic bronchoscopy was measured microphotometrically. The type of development was classified into 3 types (T-I : longitudinally growing type, T-II : mixed type of T-I and T-III, T-III : deeply infiltrating type) according to Suzuki's criteria and the bronchoscopic findings were also classified into 3 types (B-I : stenosis alone, B-II : stenosis with submucosal infiltration, B-III : stenosis with tumorous masses). Clinicopathological characteristics of good responders to chemotherapy included finely granular chromatin, T-I type of development and B-I bronchoscopic findings. On the contrary non-responder showed coarsely granular or uneven reticular chromatin, T-III type of development and B-III bronchoscopic findings. In conclusion, a close relation between clinicopathological findings and the response to chemotherapy was observed.

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We analyzed a total of 16 cases of intrabronchial metastatic lung cancers, studied in our department. Their primary sites included the oral cavity, larynx, thyroid, breast, esophagus, pancreas, liver, kidney, uterus, malignant lymphoma and sarcomas. We classified bronchoscopic findings into 4 types ; surface, nodular, polyp and compression types (1, 12, 6 and 1 cases, respectively). As for the relationship between the mechanisms of metastasis and the bronchoscopic findings, the nodular type was not always an endobronchial metastatic lesion but also could be bronchial invasion of the primary tumor, lymph node metastasis or lung parenchyma metastasis. In contrast to this, most polyp type cases were of endobronchial metastasis. It is important to perform bronchoscopic examination in cases of metastatic lung cancer and mediastinal malignant tumors. It was stressed that endobronchial biopsy and brushing should be done in order to differentiate metastatic lung cancer from primary lung cancer, benigntumor, lung tuberculosis, etc. and to identify the primary sites of metastatic lung cancers.

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The surface temperature of the bronchotracheal mucosa and at the sites of tumors in 9 patients with primary lung cancer were measured, and selective increases in blood flow in tumor tissues by elevation of systemic blood pressure induced by angiotensin II (AT-II) were evaluated. Temperature was measured during bronchofiberscopic observation before and during AT-II induced hypertension by inserting a thermometer (HLB-70, Anritsu Keiki) into the instrumentation channel of the bronchofiberscope. In controls, the surface temperatures of central type tumors were higher than those of tumor at the carina or truncus superior (upper lobe bronchus). This finding suggested the presence of an active metabolism and vascularization in tumors. During AT-II induced hypertension, the surface temperature at the carina of the trachea and truncus superior rose markedly and the temperature at tumor sites rose in 4 case. From these results, it was estimated that AT-II induced hypertension increased brochotracheal blood flow as well as selective tumor blood flow.

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A screening for lung cancer primarily by cytologic examination of sputum was conducted on outpatients visiting local practitioners. Of 1, 042 patients aged ≥40 years with a Brinkman Index of ≥400, prolonged respiratory symptoms or roentgenographic abnormality, 28(2.69%) were diagnosed as having lung cancer. The histologic types consisted of squamous cell carcinoma (20 patients), adenocarcinoma (7), and small cell carcinoma (1). Hilar type lung cancer was detected in 17 patients, and peripheral type in 11. Fourteen cases were stage I, including 3 early stage cases, 4 were in Stage II, 6 in Stage III, and 4 in Stage IV. Papanicolaou sputum stain was positive in 23 patients : Class I was found in 21.21%, Class II in 68.15%, Class III in 0.38%, and Class IV or V in 2.50% ; specimens from 8.16% were valid. In nearly half of the patients (13), lung cancer was detected during examinations for other diseases. The high detection rate including that in early stage cases shows the importance of screening for lung cancer at the primary health care level.

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This study was made mainly to investigate the clinical significance of lavage fluid recovery rate, influences of smoking on BAL cells and morphologic features of alveolar macrophages recovered in BALF. One hundred and twenty patients with various diffuse interstitial lung diseases including controls were classified according to diagnosis, smoking history, age and pulmonary function, and then their BALF findings were examined. The results led to the following conclusions ; 1. Lavage fluid recovery rate shows a decreasing tendency with advancing age, increased smoking depressed level of V25 or V50, and idiopathic interstitial pneumonia. 2. Recovery rate over 50% might be expected with results of V25>1.0l/sec or V50>3.5l/sec. 3. Smoking agents exert considerable influences on the recovery rate, total number of cells, relative decrease in cell populations, except for macrophages, and the high incidence of multinucleated alveolar macrophages. It seems to be essential to include the consideration of smoking agents for evaluating cell differentiations. 4. The appearance of multinucleated alveolar macrophages in BALF was closely related to foreign factors and granulomatous lung diseases. Quantitative estimations of the nucleus in BAL macrophages may serve to confirm granulomatous changes in lung.

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Specimens of bronchial mucosa and lung were obtained from 22 patients with peripheral eosinophilia and the interrelationships among peripheral blood eosinophil count, degree of tissue eosinophile infiltration, lung function and allergological test were studied. Thirteen patients showed mild peripheral eosinophilia (400-1, 000/mm^3), 6 were moderate (1, 000-2, 000/mm^3) and 3 were marked (2, 000/mm^3-). Judging from all data, 8 of 22 cases were bronchial asthma, 6 were chronic bronchitis, 6 were PIE syndrome and 2 were allergic granulomatous angitis. No bronchial asthma or chronic bronchitis case showed moderate or marked peripheral eosinophilia. A significant relationship was found between the peripheral eosinophil count and degree of eosinophilic infiltration in the bronchial mucosa and also between the peripheral eosinophilic count and degree of eosinophilic infiltration in the lung parenchyma. No significant relationship was found between the peripheral blood count and the serum IgE level or respiratory threshold to acetylcholine. No differences were found in the %VC and FEV_<1.0>% among patients with mild, moderate or marked eosinophilia. However, a significant difference was found in %DL_<CO> between patients with mild and moderate eosinophilia. This finding might be explained by damage to lung parenchyma due to major basic protein released from eosinophils.

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Although it has been recognized that mitral stenosis may cause hemoptysis, little emphasis has been focused on the site of the bleeding in characteristic membranous changes of bronchi. This study was performed to clarify this question using a flexible bronchoscopy for patients with mitral stenosis. Bronchoscopic procedures were carried out in fifteen patients with mitral stenosis, comparing those who showed mucosal longitudinal arranged hypervascularity in larger bronchi (Group 1, 11 patients) with those who did not (Group 2, 4 patients). A hemodynamic study by the cardiac catheterization showed that group 1 patients had higher pulmonary wedge pressure (25.5±5.9mmHg) than group 2 patients (17.0±6.7mmHg) (P<0.05). There were no significant differences in terms of pulmonary artery pressure and right atrium pressure between these two groups. t was proved that mucosal hypervascularities consist of dilated tortuous bronchial veins by autopsy findings. It has been previously recognized that two distinct groups of bronchial veins exist, the intrapulmonary bronchial veins related to the bronchi and which drain into the pulmonary veins, and a second group of veins which drain the subpleural and hilar structures into the azygos and hemiazygos veins, and communication between this second group of veins and pulmonary veins exist. In the presense of mitral obstruction and elevated left atrial pressure, it has been previously speculated that part of the pulmonary venous blood drains via the pleuro-hilar bronchial veins into the low pressure azygos-hemiazygos system. This speculation was compatible with our bronchoscopic and autopsy findings in cases of mitral stenosis.

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We experienced a case of triple primary roentgenographically occult lung cancer. The patient was a 56-year-old man with a complaint of persistent cough. Chest roentgenogram was normal. Sputum cytology showed class V squamous cell carcinoma. Bronchoscopic examination revealed three independent lesions consisting of a polypoid tumor at the orifice of right B^2, a nodular tumor at the orifice of right B^4 and thickening and a partial polypoid prominence of the bifurcation of left B^<1+2> and B^3. Histologically, all three lesions were squamous cell carcinoma. We should take into consideration the possibility of multicentricity in roentgenographically occult lung cancer.

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A case of postinflammatory pseudotumor is reported. A 35-year-old woman was admitted to Higashisaga National Sanatorium Hospital with a small amount of hemoptysis. There was a nodular shadow in the left S^6 on her chest X-ray on admission. The nodular shadow was 2.5×2.0 cm in size. Phsical examination and laboratory data revealed no significant findings. Endoscopic examiantion showed a polyp in the orifice of left B^6. The surface of the polyp was smooth and lustrous. We found bleeding from the bronchial mucosa around the polyp. Bronchography revealed no left B^6 bronchus. Left lower lobectomy was performed without pleural adhesion or lymph node swelling. The case was histologically diagnosed as a postinflammatory pseudotumor. We suggest that the postinflammatory pseudotumor appearing as a ployp on bronchoscopy is very rare.

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A 26 year-old woman was admitted with left chest pain. A chest X-ray film showed a large mass shadow in the left lung field. The mass was surgically resected, and diagnosed pathologically as benign mediastinal teratoma. Before surgery, bronchofiberscopy revealed submucosal vessel dilatation, mainly in the left main bronchus. These changes decreased after operation, and the dilated vessels seemed to be bronchial veins dilated due to increased blood flow via the bronchopulmonary anastomoses from the compression of left pulmonary vein by the tumor. This case was very significant for understanding the significance of the correlations between bronchial and pulmonary circulation.

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A 40 year-old male who had a previous history of progressive necrotizing rinopathy was admitted with chief complaints of cough and sputum. A chest roentgenogram showed a multiple nodular shadow with cavitation in the mucosa from the left main bronchus to left upper division. The brushing specimen showed moderately atypical cell. Lung biopsy and nasal tumor specimens demonstrated non-Hodgkin's malignant lymphoma.

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A 76 year-old man with amyloidosis of the laryngopharyngeal lesion was referred to our hospital because of an abnormal shadow on chest X-ray. His chest X-ray showed multiple tumors in the tracheal lumen. Fiberoptic bronchoscopy revealed multiple polypoid and nodular lesions in the trachea and they were confirmed to be amyloidosis lesions by biopsy. We considered this case to be secondary amyloidosis since gastric carcinoma was subsequently found. Five cases of amyloidosis affecting the trachea have been reported in Japan, all of which were primary lesions. Secondary amyloidosis with multiple amyloid lesion in trachea is extremely rare.

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The accessory cardiac bronchus is the single true supernumerary bronchus arising from the medial wall of the truncus intermedius bronchus. In this study we presented three cases with accessory cardiac bronchi that were discovered during systemic bronchoscopies performed for other diseases. The incidence of this abnormal bronchus was 0.42% of all cases undergoing fiberoptic bronchoscopy in our department. Bronchial mucosal inflammation was observed in three cases and mucosal bleeding in one. In Japan, 33 such cases have been reported including our cases. They are consisted of 15 males and 18 females, and the age range was from 21 to 74 years. In 14 cases, hemoptysis was reported, and in 11 cases, inflammatory findings were observed bronchoscopically. It is possible that hemoptysis is caused by this anomaly.

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This is a report of a 40-year-old male patient with a severe tracheal stenosis, treated by a silicone tracheal T-tube. The patient was admitted to our hospital with unconsciousness due to dissecting aortic aneurysm. For mechanical ventilation, tracheal intubation was continued transorally during the first 1 week and by tracheostomy during the following 2 weeks. Since the general condition was remarkably improved, the intratracheal tube was removed. He had, however, a progressing severe dyspnea, 24 days after the extubation. Bronchofiberscopy revealed a cicatrizing stenosis of 5 mm in inner diameter and a light inflammation in the middle portion of the trachea. As an emergency, Nd-YAG laser irradiation was repeated 7 times at 6 to 14 day intervals. Thereafter, a silicone tracheal T-tube, with 1 cm in diameter and 10 cm in length, was inserted through the tracheostomy fenestration. The lower end of the intraluminal limb of the T-tube was placed 2 cm above the carina passing through the stenosis, and the upper end was placed just below the vocal cords. The horizontal limb was sealed by a plug, so that he could normally speak and cough. The T-tube was removed 102 days after the insertion. Bronchofiberscopically, the stenotic portion was dilated up to 1 cm in inner diameter and cicatrized without inflammation. A marked improvement of lung function test was observed. There has been no sign of progressing stenosis bronchofiberscopically and he has had no symptoms of stenosis up to date, 1 year and 7 months after the removal of the T-tube.

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