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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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Article type: Appendix
1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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Article type: Index
1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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[in Japanese]
Article type: Article
1992 Volume 14 Issue 5 Pages
413-414
Published: July 25, 1992
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Takashi Suzuki, Akihiko Kitami, Shuichi Suzuki, Gouichi Hori
Article type: Article
1992 Volume 14 Issue 5 Pages
415-421
Published: July 25, 1992
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Specimens were obtained from resected lung lobes which had no diffuse lung diseases. The nerves were classified into adrenergic nerves, cholinergic nerves, and nonadrenergic inhibitory nerves on the basis of the ratio of small agranular vesicles (SAGV), large granular vesicles (LGV), and small granular vesicles (SGV). The result was that at the level of the segmental bronchus, cholinergic nerves and nonadrenergic inhibitory nerves were distributed in the bronchial smooth muscle, the bronchial gland, the smooth muscle of the bronchial artery, and the smooth muscle of the pulmonary artery. In particular, direct contacts were observed between the nerve fibers and the bronchial smooth muscle cells, the bronchial gland cells, and the myoepithelial cells. On the contrary, adrenergic nerves were sparse. It was concluded that the innervation of the bronchial muscle, the bronchial gland, the pulmonary artery, and the bronchial artery is mainly by the cholinergic nervous system and the nonadrenergic inhibitory nervous system.
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Atsushi Sakai, Jun Tamaoki, Isao Yamawaki, Fumiko Yamauchi, Atsushi Ch ...
Article type: Article
1992 Volume 14 Issue 5 Pages
422-426
Published: July 25, 1992
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Excerbation of asthma has been reported in some female patients immediately prior to or at the time menstruation. To assess the possible involvement of sex hormones in menstrual asthma, we examined the effect of progesterone (PGS) and estriol (EST) on rabbit tracheal smooth muscle contraction under isometric conditions in vitro. The addition of PGS decreased the contractile responses to electrical field stimulation (EFS) in a dose-dependent manner. In contrast, PGS lead no effect on responses to exogenously administered acetylcholine (ACh). On the other hand, EST did not affect EFS- or ACh-induced muscle contractions. The inhibitory effect of PGS was not altered by preincubation of tissues with propranolol, indomethacin, bicuculline, or naloxone. These results indicate that PGS, but not EST, may reduce cholinergic neurotransmission in the airway probably involving the inhibition of ACh release from nerve terminals, and suggest that PGS could contribute to the development of menstrual asthma.
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Osamu Katoh, Rinzo Soejima
Article type: Article
1992 Volume 14 Issue 5 Pages
427-432
Published: July 25, 1992
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Pathological findings in mice exposed to 20 ppm NO_2 for 18 hours were mainly shortness and/or loss of cilia in the bronchioles. These changes returned to normal appearance 7 days after NO_2 exposure. In one group in which S-carboxymethylcysteine (S-CMC) was administered orally 7 days before NO_2 exposure and 7 more days after it, changes of the bronchioles were slight and returned to an almost normal appearance 3 days after NO_2 exposure. There was a significant difference in pathological change between this group and the group without S-CMC (P<0.01). On the other hand, there was no significant difference between the group treated with S-CMC for 7 days after exposure and the group without S-CMC. These findings suggest that S-CMC may have prophylactic effects and give the ability to repair cilia injured by NO_2 exposure in the bronchioles.
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Toshiya Amari, Takayuki Honda, Keishi Kubo, Keisaku Hujimoto, Sekiya K ...
Article type: Article
1992 Volume 14 Issue 5 Pages
433-437
Published: July 25, 1992
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Six cases of adult intrabronchial foreign body were treated in our hospital with a flexible bronchofiberscope. The foreign bodies consisted three dental crowns, a piece of cucumber, a corn grain and a fish bone. Five of them were found in the right lung, and one in the left lung. A chest X-ray examination was useful for diagnosis in three cases, showing the radiopaque foreign bodies and infiltrating shadows. In the other two cases, chest X-ray films showed atelectasis of a lobe or a lung only and bronchofiberscopic examinations were performed for diagnosis. All foreign bodies were removed with conventional forceps with flexible bronchofiberscope. This technique is considered the first choice of treatment to remove intrabronchial foreign bodies because it is easy and not painful for the patient.
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Takuma Bando, Masahide Yasui, Mikio Ueda, Hirotoshi Miyamori, Yasuhito ...
Article type: Article
1992 Volume 14 Issue 5 Pages
438-442
Published: July 25, 1992
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A 60-year-old man was admitted with dyspnea and productive cough. Chest X-ray film and thoracic CT revealed the diffuse stenosis of the trachea and bronchi. The airway was found to be collapsed by bronchoscopy. The biopsied specimen from the auricula showed decrease of the cartilage matrix. These findings were similar to Damiani's criteria for relapsing polychondritis. Relapsing polychondritis is a rare disease of unknown etiology, and the prognosis is poor. In particular airway collapse due to the chondritis of trachea and/or bronchi can be fatal. Previous reports have suggested that corticosteroids are effective, but the dosage has not been established. This case was thought to be a rare case as the symptoms were confined to the airway, and subsided without steroid therapy and so on. However the criteria for the indications of corticosteroid therapy and dosages should be established.
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Kazushi Kishi, Hisashi Kobayashi, Naotoshi Suruta, Tetsuo Sonomura, No ...
Article type: Article
1992 Volume 14 Issue 5 Pages
443-448
Published: July 25, 1992
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A Z-stent covered with an expandable Dacron mesh sheet to which epinephrine and thrombin were infiltrated, was employed to retain the patency of the airway stenosis due to invasion of malignant tumor, preventing the airway from compression by the tumor, and delivering hemostatic agents to the lesion. This stent was applied to a patient who developed dyspnea and disturbed consciousness due to stenosis of bilateral main bronchi as a result of invasion of easy-bleeding cancers. Immediately after implantation of the stents, the stenotic areas were dilated and no bleeding was observed. The dyspnea improved. The next day, the patient's consciousness became clear, the dyspnea disappeared, and conversation became possible. At the bronchofiber-scopy 4 and 6 weeks after, the patency of the airway was shown to be retained, the tumor surface was compressed, and the surface of the stent seemed to be covered by a mucosal layer. It may be concluded that for treatment of airway stenosis due to cancer invasion, stents covered with Dacron mesh sheet infiltrated with hemostatic agents are effective in dilating the stenotic region, preventing the airway from compression by the cancer and achieving local hemostasis.
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Kouichi Nishi, Shigeharu Myou, Takio Ooka, Masaki Fujimura, Tamotsu Ma ...
Article type: Article
1992 Volume 14 Issue 5 Pages
449-453
Published: July 25, 1992
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An 82-year-old woman suffered smoke inhalation injury caused by a fire. Daily examination of the tracheo-bronchial tree, and bronchial toilet were performed by fiberoptic bronchoscopy. The bronchial mucosal lesion of acute bronchial injury almost improved until day 20. A bronchial polyp was observed at day 22 and forceps biopsy and polypectomy were performed. Histologic examination of the polyp demonstrated benign granulation tissue. After the forceps polypectomy, recurrence of the inflammatory polyp was observed besied the site of the initially resected polyp at day 30. The early recurrence of inflammatory bronchial polyp in a patient with smoke inhalation injury is rare.
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Yoshizou Chiba, Seiichi Nakamura, Masashi Mikami, Masahiko Kawakami, H ...
Article type: Article
1992 Volume 14 Issue 5 Pages
454-459
Published: July 25, 1992
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A 69-year-old woman was hospitalized with marked hypoxemia and unconsciousness after inhaling incompletely combusted material from a kerosene stove in a closed room. A band like shadow extending from the hilum to the peripheral region of the right lower lung field was found by chest roentgenogram taken three weeks after disappearance of the initial symptoms. Fiberoptic bronchoscopy revealed several polypoid lesions causing stenosis in the right basal bronchus. Biopsy showed squamous metaplasia and submucosal infiltration of inflammatory cells, including lymphocytes and plasma cells. Three weeks later bronchoscopy revealed disappearance of the polypoid lesions. Inflammatory bronchial polyps are known to be caused by various stimuli. The present case is a rare one in which inhalation of incompletely combusted material smoke from a kerosen stove is thought to have been the cause of the polyps.
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Ichiro Terao, Satoshi Tanigawa, Hajime Suguro, Tatsuya Hirota, Chiharu ...
Article type: Article
1992 Volume 14 Issue 5 Pages
460-464
Published: July 25, 1992
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A 44 year-old man was admitted to our hospital with a complaint of more than 200ml hemoptysis. Chest X-ray film on admission showed an infiltrative shadow in the right lower lung field. Bronchofiberscopic examination revealed a 4cm elevated mass at the membranous portion of the right basal bronchus. During the obervation approximately 1500ml bleeding suddenly developed and bronchial arteriography, which was performed immediately revealed a circular aneurysm about 5mm in diameter at the right basal bronchus. Therefore, bronchial arterial embolization (BAE) was successfully performed using gel sponge cubes and bronchial artery was knoted in fear of resumption. The patient has experienced no episode of hemoptysis since.
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Shin Teramoto, Hiroshi Tanaka, Akira Nakagawa, Tomofumi Igarashi, Yuta ...
Article type: Article
1992 Volume 14 Issue 5 Pages
465-470
Published: July 25, 1992
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A 55-year-old female who had been involved in a traffic accident visited our hospital because of bloodysputum and persistent cough. CT-scan and tomography showed an abnormal shadow in the right mainbronchus. Bronchofiberscopic examination revealed a foreign body (a piece of a broken denture) and multiple polyps. Biopsy of the polyps demonstrated inflammatory granulation tissue. The foreign body was removed by the bronchofiberscope. The symptoms improved and the size of the polyps decreased after the removal of the foreign body.
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Atsushi Nagai, Kyoichi Sakamoto, Eriko Yamaguchi, Eikou Takahashi
Article type: Article
1992 Volume 14 Issue 5 Pages
471-473
Published: July 25, 1992
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A 69-year-old man was admitted to our hospital because of aspiration of foreign bodies (rice cakes). Most of them were removed by a bronchofiberscope through a tracheal tube. When the tube was withdrawn, other foreign bodies between the tracheal lumen and intratracheal tube were removed by bronchoscopy. In another 81-year-old patient, a large amount of rice was noted in the same area. Bronchoscopy following extubation is therefore important to remove residual bodies.
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Atsuko Satoh, Kazuo Takaoka, Keiji Suzuki
Article type: Article
1992 Volume 14 Issue 5 Pages
474-478
Published: July 25, 1992
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A 73-year-old woman had a middle and lower lobectomy with metastatic lung cancer. After the operation she had an intractable fever and was found to have bronchopleural fistula by bronchoscopy. Reoperation was difficult because of her poor general condition. Endoscopiclly ethanol was injected to the bronchopleural fistula after unsuccessful treatment by OK432 injections. The ethanol injection induced tissue marked fibrosis which closed the fistula. The use of ethanol injection to close a bronchopleural fistula has not as yet been reported in the medical literature. The idea to use this method was suggested by the effects to endoscopic sclerotherapy of esophageal varices and endoscopic ethanol injection therapy to gastric bleeding and early gastric cancer.
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Kazuhiro Yoshida, Hiroyuki Koba, Yuji Mori, Masahiko Nishino, Satoshi ...
Article type: Article
1992 Volume 14 Issue 5 Pages
479-483
Published: July 25, 1992
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A bronchial inflammatory polyp originating from the stump of the right upper bronchus was treated with ethanol injection. Right upper and middle lobectomy for hamartoma of the lung was performed in a 74-year-old male in 1981. Five years later, he developed bloody sputum. Bronchofiberscopic findings revealed an inflammatory polyp originating from the stump of the right upper lobe bronchus. Since the lesion was not severe, the patient did not undergo any treatment. When he was readmitted with stridor and bloody sputum in 1991, bronchofiberscopic findings showed an enlarged polyp obstructing the right main bronchus. He was successfully treated with ethanol injection without any complications.
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Yoshiko Noguchi, Tokihiko Suyama, Reiko Ebihara, Mikio Doi, Kouji Nish ...
Article type: Article
1992 Volume 14 Issue 5 Pages
484-488
Published: July 25, 1992
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An 80-year-old female was admitted with obstructive pneumonia caused by a tumor in the right main bronchus which had been discovered two years previously. She had refused surgery and had suffered from obstructive pneumonia on several occasions. Fiberoptic bronchoscopic examination on admission revealed complete obstruction of the right main bronchus by the tumor which tended to bleed easily. The bleeding became less after injection of the total of 4ml of 99.5% ethanol. However, it did not reduce significantly in size and continued to obstruct the bronchus. Almost the entire tumor was removed by endoscopic electrosurgery using a snare for colon polypectomy. Blood loss was limited to approximately 1000ml by an unilateral intubation. Histological examination revealed that most of the removed tumor was necrotic and typical carcinoid was observed in the neck of the tumor. Endoscopic resection following ethanol injection for a vascular rich endobronchial tumor is an treatment if the tumor stalk is necrotic which means that massive bleeding can be avoided.
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Hiroaki Nomori, Ryuichirou Kobayashi, Rokuichi Iga, Kenichi Kodera, Ke ...
Article type: Article
1992 Volume 14 Issue 5 Pages
489-494
Published: July 25, 1992
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Expandable metallic stents (EMS) were used in 3 cases of stenosis of the main bronchus and one with stenosis of the trachea due to tumor. Of these 4 cases of stenosis, 3 were due to compression and I was due to invasion. In the former three cases, EMS dilatated the trachea and bronchus immediately. However, in the invasive stenosis cases, the EMS was not effective because the tumor grew between the wire of the stent. EMS is effective for compressive stenosis of the trachea and bronchus, caused by tumor.
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Mitsuyo Nishimura, Hiroyuki Nishiyama, Tetsuro Kodama, Kenro Takahashi ...
Article type: Article
1992 Volume 14 Issue 5 Pages
495-501
Published: July 25, 1992
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Two cases of occult lung cancer were reported. Case 1 was a 58-year-old chromate worker, exposed to chromium for 17 years. The chest X-ray film was negative but sputum cytology revealed squamous cell carcinoma. Based on the results of repeated bronchoscopy, left upper lobectomy was performed. The resected early stage squamous cell carcinoma was 0.5×0.2cm in size and was located in left B^4biiα. Two years after lobectomy, multiple metachronous early stage squamous cell carcinomas were found by brushing cytology in right B^2 and B^6 bronchi and radiotherapy was performed. At 8 years and 3 months after initial surgical resection, thyroid cancer developed and was surgically resected. Case 2 was a 61-year-old male heavysmoker. Chest X-ray film was negative but squamous cell carcinoma cells were detected by sputum cytology. The early stage squamous cell carcinoma located in left B^<1+2>aiβ was 1.2×0.4cm in size. After left upper lobectomy, patient was disease-free for 2 years and 10 months. The tumors of these two cases were located in small bronchi which were beyond the range of view of the bronchoscope. If they were beyond the view of the bronchoscope why are frequent bronchoscopies needed?
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Hitoshi Shimoyama, Shoji Kobayashi, Kenji Fujisawa, Takatoshi Yamada, ...
Article type: Article
1992 Volume 14 Issue 5 Pages
502-507
Published: July 25, 1992
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A coin lesion, 2cm in diameter, was recognized in right S^2a of a lung of 65-year-old female. The radiographic characteristics of the lesion strongly suggested primary bronchogenic carcinoma (adenocarcinoma), and we performed right upper lobectomy. The main lesion was 1.8×1.8×1.7cm in diameter and was histologically diagnosed as well differentiated papillary adenocarcinoma. Pathological examination also demonstrated 11 additional lesions of atypical adenomatous hyperplasia of various sizes (from 1mm to 15mm). In atypical adenomatous hyperplasia, atypical alveolar cuboidal cells are regularly arranged along the thick alveolar septa. No atypical adenomatous hyperplasia grew beyond secondary pulmonary lobules. Pathological examination demonstrated an atypical adenomatous hyperplasia to be located in the entire field of secondary pulmonary lobules, and one was located at the periphery of adenocarcinoma. The latter two lesions suggested that adenocarcinoma might have arisen from atypical adenomatous hyperplasia in this case.
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Motoyasu Sagawa, Yasuki Saito, Chiaki Endo, Satomi Takahashi, Katsuo U ...
Article type: Article
1992 Volume 14 Issue 5 Pages
508-511
Published: July 25, 1992
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Lobectomy of the lung with concomitant lymph node dissection is a common surgical approach for lung cancer. In this article, we report a patient who experienced ischemic change of the bronchial wall after undergoing lobectomy of the lung and lymph node dissection. A 75-year-old man underwent left upper lobectomy and lymph node dissection for adenocarcinoma of the lung. Bronchoscopic examination on the 4th postoperative day revealed that he had an extensive pale lesion extending from the left main bronchus to the bronchus of the left lower lobe. In this lesion, there were some small ulcers. Two months after surgery, he had bronchial stenosis of the left main bronchus because of granulation. In some cases, lobectomy of the lung and lymph node dissection leads to ischemic change of the bronchial wall. Prior to administration of adjuvant therapy, bronchofiberscopy should be done for patients who undergo lobectomy and lymph node dissection.
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Teruhisa Kobayashi, Toru Kakizaki, Nanae Hangai, Makoto Sawafuji, Tats ...
Article type: Article
1992 Volume 14 Issue 5 Pages
512-516
Published: July 25, 1992
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A 42-year-old female with relapsing polychondritis, who presented with dyspnea due to laryngeal and tracheal stenosis underwent tracheostomy and T-tube placement. However, progressive stenosis caused difficulty in enunciation. She underwent surgery to insert a T-tube stent extending for the whole length of the larynx and trachea, the length of which were 10mm, 8mm, 55mm and 50mm in their external diameter, internal diameter, proximal length and distal length respectively. The proximal end of the T-tube was placed immediately above the vestibular fold. The distal end of the T-tube was located immediately above the carina. Due to this procedure nasal breathing and enunciation was restored. She is doing well 18 months after surgery. We recommend the placement of a T-tube under surgical intervention rather than simple tracheostomy because it restores nasal respiration, enunciation and sputum expectoration, improving the patient's quality of life.
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Article type: Appendix
1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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1992 Volume 14 Issue 5 Pages
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