Flexible bronchoscopy was performed in a total of 17 patients with esophageal cancer in our emergency and intensive care unit, consisting of 15 males and 2 females. The reasons for bronchoscopy were : observation before extubation, postoperative atelectasis, pneumonia, and respiratory failure. Bronchoscopy was useful in the evaluation of the degree of bronchial mucosal injury, and in the detection of the cause of atelectasis. Bronchoscopy was used for bronchial toilet in 8 cases and as a guide for nasotracheal intubation in 4 cases. Retention of bronchial secretions (11 cases) and bronchial edema (8 cases) were common findings. Bronchial erosion (5 cases) and airway bleeding and bronchomalasia were observed in patients with severe respiratory failure. In conclusion, bronchoscopy is useful for the postoperative treatment of cases of esophageal cancer.

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A total of 48 patients over 80 years old underwent bronchofiberscopy during 1980∿1991 in our university hospital. Detailed examination for abnormal shadows of the lung was the purpose of the examination in approximately 50% of cases. Bronchial brushing and washing were the most common procedures. No serious complications were observed. Among pulmonary diseases, infectious disease was the most common (15 patients) and lung cancer was second (13 patients). In 9 out of 13 lung cancer patients, definitive diagnosis was made by bronchofiberscopy. Bronchofiberscopy was safe even in elderly patients, and bronchoscopy is considered to be an indespensable tool for the management of pulmonary diseases.

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In a series of 53 patients in whom a twin-lumen endobronchial tube was used during pulmonary surgery, complications developed in five cases (incorrect location of the endobronchial tube in four and injury of the mucosa of the left main bronchus in one). The tube was inserted too far into the left main bronchus in two cases and not far enough in one. In the former situation there was atelectasis of the left upper lobe and in the latter emphysema of the left lung. The left endobronchial tube was displaced into the right main bronchus in the other patient. These four complications were detected by chest X-ray or fiberoptic bronchoscopy and disappeared immediately after correction of the tube location. Selection of the optimal tube size, gentle maneuvering and observation by bronchoscopy are important considerations when twinlumen endobronchial tubes are used.

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Bronchial arteriography was performed in 28 cases with hemoptysis. Among these patients, bronchial artery embolization was carried out in 19 cases. Gelfoam particles were used for embolization in all cases and a coil was used additionally in one case. Angiographic findings of bronchial angiography consisted of dilatation (89%), peripheral hypervascularity (100%), bronchopulmonary shunt (32%), and extravasation (5%). Acute hemoptysis was immediately halted after bronchial artery embolization in 93% of the cases. In one patient with bronchiectasis and lung abscess 3 embolization procedures were performed in a period of one month and a half. Since hemoptysis recurred, however, surgical resection was performed. Six out of 16 cases (38%) showed recurrent hemoptysis during long-term follow up ranging from 1-43 months. Five cases had bronchiectasis and 1 case had pulmonary tuberculosis. Operation was performed in one case and reembolization procedures were performed in three cases. In all three cases who received reexamination during episode of recurrent bleeding, the angiograms demonstrated increased vascularity as well as recanalization of previously embolized arteries.

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We reanalyzed airway lesions of moderate or severe emphysema in humans. Emphysema was categorized into three types (panacinar type, centrilobular type and mixed type). The severity of airway lesions was identical among the three types of emphysema. In panacinar or mixed type of emphysema, the severity of peripheral lesions, such as inflammatory cellular infiltration and muscle hypertrophy were different when the upper lobe and the lower lobe were compared, whereas the lesions were similar in centrilobular type emphysema. These findings suggest that in advanced emphysema, airway lesions are observed. irrespective of the type of emphysema and that parenchymal lesions and airway lesions may mutually affect the development.

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After resection of a metastatic brain tumor, a 55-year-old man was diagnosed as having tracheal stenosis caused by lung cancer. To prevent suffocation the tracheal tumor was vaporized by a YAG-laser. The Dumon tracheobronchial stent was inserted to prevent restenosis. The patiant was treated safely with chemotherapy and radiation therapy for the next 4 months until he died of recurrent brain metastasis.

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An 89-year-old male was admitted due to an aftereffects of left brain infarction on December 13th, 1991. Because of difficulty of expectoration of sputum, tracheostomy was perfomed on December 19th, 1991. The patient began to complain of bloody sputum on March 10th, 1992. Bronchoscopic examination revealed the ulcer lesion at the right antero-lateral wall of midtrachea. MRSA was detected from culture of bronchial washing. although no bacterium including M. tuberuculosis was cultured. Malignant cells were not obtained by cytology. By chemotherapy using vancomycin hydrochloride (lg/day) and an anti-ulcer drug (Solcoseryl, 170mg/day) for 14 days improvement of this ulcer was obteined. This was a rare case of tracheal ulcer caused by MRSA.

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A 57-year-old male, who had undergone extensive resection of a leiomyosarcoma of the right shoulder 14 months previously, presented with an abnormal X-ray film shadow. The roentgenological findings showed a small nodular shadow in the right upper lung field. At bronchoscopy, a polypoid tumor was seen protruding from the right B2b. Four months later, he was admitted our hospital because of rapid growth of his pulmonary lesion. The primary nodule had increased in size and some adjacent small nodules were recognized. Bronchoscopically the polypoid tumor had grown further and the right main bronchus was almost obstructed by the tumor. A right upper lobectomy was performed and pulmonary metastatic leiomyosarcoma was diagnosed. Endobronchial metastasis of leiomyosarcoma is rare, but all reported cases, including our case, originated in peripheral lung parenchyma and extended through the airway. In our case the metastatic tumor extended to adjacent lung tissue through the airways. In some areas which developed toward the peripheral site, the wall of the bronchiole was destroyed because of the rapid tumor growth and the lesion compressed the peripheral parenchyma, resulting multinodular shadows adjacent to the main nodule on chest X-ray film. On the other hand, some areas of invasion which went through large bronchi showed progressive endobronchial extension because of the large extent in the airway and the solid structure of its wall. Bronchoscopically the tip of the protruding mass was seen as endobronchial metastasis.

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A 57-year-old man was admitted with an abnormal shadow on chest X-ray. He suferred from acute myocardial infarction. Four days after onset, an infiltrative shadow in the right upper lung field was detected. This shadow disappeared without antibiotics or corticosteroids. About two months later, new patchy shadows appeared in the left middle and lower lung fields with antimyocardial antibody in the serum and mild restrictive change on pulmonary function tests. Bronchoalveolar lavage revealed an increase in total cells, especially in lymphocytes. The biopsied specimens were compatible with organizing pneumonia. These findings suggest that this case was one type of post-myocardial-infarction syndrome caused by autoimmune reactions related to necrotic myocardium. The mechanism of the interstitial pneumonia associated with acute myocardial infarction should be clarified by bronchoalveolar lavage and transbronchial lung biopsy.

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A 67-year-old female with double early stage squamous cell carcinoma of the lung is reported. Lobectomy was performed for the just squamous cell carcinoma in the right lower lobe. The other lesion in the left upper division bronchus was removed transbronchially and then was irradiated with Cobalt 60. No recurrence has not been recognized during a course of two years and ten months.

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A 70-year-old man who had recurrent hemoptysis was admitted to our hospital. Mucosal protrusions without pulsation were found in the left bronchi by bronchoscopic examination. Computed tomography (CT) scan demonstrated small nodules enhanced by contrast medium between the left main bronchus and the descending aorta. The nodules were suspected to be enlarged bronchial arteries. Angiography showed that the left bronchial artery was enlarged and tortuous. Marked hypervascularity was recognized. The mucosal protrusions on bronchoscopy seemed to correspond in part with the small nodules on CT scan and to the enlarged bronchial artery on angiography. The bronchogram showed cystic bronchiectasis in the left B^5 and irregularities of the walls of the left lower lobe bronchi. The bronchial arterial lesions might have been induced by bronchiectasis. It was concluded that CT scanning is useful for the identification of bronchial artery dilatation causing mucosal protrusions in a case of bronchiectasis.

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A case of bronchial aspergillosis with lung cancer in a 74-year-old male is reported. He was admitted with bloody sputum. His chest X-ray showed a tumor shadow in the right upper field. Bronchofiberscopy revealed a polypoid lesion in the right upper bronchus. Though we suspected typical squamous cell carcinoma, histological examination of the polypoid lesion revealed hyphae of aspergillus and squamous cell carcinoma. He underwent right upper lobectomy. Cases of bronchial aspergillosis with non-cavitary lung cancer are rare.

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Three cases of parasitic thoracic diseases were reported together with the results of BALF analysis. Case 1 was a 43-year-old female, whose chest roentgenogram showed nodular lesions. Serological examination showed the positive precipitation for Toxocara canis. Case 2 and 3 were a 54-year-old male and a 56-year-old female, whose roentgenogram showed pleural effusion. Their serum revealed positive precipitation for Paragonimiasis Miyazaki. All cases revealed hypereosinophilia. All the BALs were performed in the area of right S^3b where no pulmonary lesion could be detected by CT and chest roentgenogram, before and after the treatment. The proportion of eosinophils and IgM was elevated in every BALF. However, total cell counts in BALF did not elevated. After the treatment, the fractions of eosinophils in serum and BALF were reduced. It may be possible that the data of BALF were influenced not only by pulmonary parenchymal inflammation but extrapulmonary factor, to some degree.

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A 17 year-old male complained of productive cough and sputum for a long period, and the bronchiectasia was suspected. Chest X ray showed an abnormal shadow in the right lower lung field. Bronchoscopy revealed obstruction of the right basal bronchus with granulation tissue. Under a diagnosis of lung abscess in the right lower lobe, lobectomy was performed. A foreign body was found in the lower lobe bronchus in the specimen. The foreign body was a plastic toy bullet, 8 mm in diameter and 15 mm length. It was suggested that he had inspired it at age 7. Twenty cases of endobronchial foreign body which required thoracotomy in the Japanese literature are reviewed from a clinical perspective.

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A 63-year-old male complained of cough, sputum and slight fever. His chest X-ray film revealed a nodular shadow in the right lower lung field. Bronchoscopic findings were normal in the trachea, right and left main bronchi and all segmental bronchi. The specimen of transbronchial lung biopsy from the nodular shadow revealed amyloid deposition. Immunohistochemical examination showed the amyloid to be composed of κ type AL protein. This case was diagnosed as primary nodular pulmonary amyloidosis. This is the first report in Japan of primary nodular pulmonary amyloidosis composed of κ type AL protein and diagnosed by TBLB.

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