The authors investigated cell populations in BALF in 7 patients with BOOP. In the acute phase, characteristic findings included an increase in the total cell counts, an increase in the percentage of lymphocytes and a decrease in the OKT4/OKT8 ratio, but there was no increase in the percentage of eosinophils. These findings tended to normalize in the remission phase. Some cases revealed abnormal BALF findings even in the remission phase, so it seems to be necessary to clarify whether abnormal BALF findings in the remission phase correlate with the recurrence of BOOP. Cell findings in BALF with BOOP were similar to those with hypersensitivity pneumonitis. Results suggested that there was room to discuss whether BOOP was an independent disease.

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T- and B-cell counts and lymphocytic subsets in peripheral blood (PB) were compared with those in the bronchial alveolar lavage fluid (BALF) of 16 untreated cases of non-Hodgkin's lymphoma (NHL). 10 cases of B-cell type and 6 cases of T-cell type. The lymphocytic subsets in PB of NHL was normal. The number of cells in BALF was normal, but slight increases in the ratios of lymphocytes and neutrophils were observed in cell fractions. There were no significant difference in the percentage of T- and B- cells in PB and BALF. Although no significant differences were noted in CD4 and CD4/8 ratios for all patients and for those with B-cell lymphoma, those in BALF were significantly lower with a significance of 5% or less than in PB from patients with T-cell lymphoma. NHL is said to cause loss of cell-mediated or humoral immunity. In the present study, we observed pulmonary immunodeficiency even when lymphocytic subsets in PB is normal.

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Between September 1990 and March 1992, 12 lesions in 10 patients with clinical stage I central type lung cancer were treated by photodynamic therapy using an excimer dye laser (EDL), which emits a pulse laser beam, after sensitization by intravenous injection of 2.0mg/kg of polyhematoporphyrin ester/ether (PHE). The power density of the excimer dye laser was 100 joule/cm^2 or more delivered to the tumor site via a quartz fiber inserted through the biopsy channel of a flexible bronchoscope. The therapeutic effect and evaluation of toxicity were assessed by an extramural committee. Ten lesions were squamous cell carcinoma, and one was a mixed tumor. Three (50%) out of 6 evaluable lesions showed complete response (CR), and 1 (17%) revealed partial response, resulting in an overall response rate of 67%. The residual lesions were then treated by radiation therapy and/or chemotherapy, and 3 patients with non evaluable lesions were resected following EDL. Except for one case that died due to COPD, all patients are alive at up to 17 months after treatment. Complications of PHE were seen in 6 patients (60%), including sunburn reaction with grade-1 toxicity. There were other complications, including allergy to PHE and grade-2 liver dysfunction. The reasons for EDL therapy were as follows : four were multiple cancers, 3 had poor pulmonary function and 1 refused operation. Photodynamic therapy with EDL can be effective in stage 1 central type lung cancer, but curative effects can hardly be expected in more advanced cases. Therefore, in these lesions, EDL should be combined with other methods.

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In experiments with twelve dogs, we studied circumferential tracheal replacement with a prosthesis made from an autogenous skin graft and artificial materials. We examined two artificial materials, namely, Gore-Tex with teflon rings and Soft Marlex Mesh. The composite prostheses were thought to be adequately hard and yet elastic enough for an artificial trachea when interposed in a canine cervical trachea and wrapped with an omental pedicle. However, in experiments with both types of prostheses, the skin flaps disappeared and the artificial materials gradually protruded into the tracheal lumen. It was concluded that Gore-Tex with teflon rings and Soft Marlex Mesh prohibited the skin flap from cultivating on an omental pedicle. The omental pedicle was useful in restricting inflammation around the implanted composite prosthesis.

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A case of middle lobe aplasia which was found during further examinations due to an abnormal chest X-ray shadow is reported. An abnormal shadow was pointed out in the left lower lung field of 63-year-old non-smoking male. However, there was no abnormal lesion in the right lung. On bronchofiberscopy and bronchography the middle lobe bronchus was a blind pouch, the right B^3 rotated downward and the right B^8 upward. Pulmonary angiography showed the absence of the middle lobe artery. As chest CT revealed no emphysematous change or mucocele in the right lung, bronchial atresia was ruled out in this case. Pulmonary function was within the normal range and there was no other abnormality or complication. There are few reports of agenesis or aplasia of the middle lobe, and this is only the second report in Japan.

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Tracheal rupture following endotracheal intubation successfully treated by bronchoscopic fibrin gluing has not previously been reported. We report such a case of lung cancer. The patient is a 77-year-old female with primary lung adenocarcinoma. On June 11, 1990, she was intubated with the Sher-i-BRONCH^<TM> (SHERIDAN CATHETER CORP.), 37Fr double-lumen tube. Airway hemorrhage and subcutaneous emphysema occurred intraoperatively. Bronchoscopy revealed a rupture of the membranous portion of the lower trachea, approximately 5cm long. Chest X-ray showed mediastinal emphysema. The operation was immediately discontinued, in favor of conservative management. Bronchoscopic fibrin gluing was performed, under spontaneous respiration. The intubation tube was removed on the following day. From the 9th day, she started oral intake and was discharged on the 16th day. Three months later, the defect was completely repaired, and its surface was covered with normal epithelium. On October 12, 1990, she underwent left lower lobectomy, as an absolutely curative operation. Her postoperative course was favorable, and she was discharged on the 19th day.

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We report a case of intrabronchial foreign body which had remained for 31 years. A 40-year-old male who had suffered from pneumonia several times underwent bronchoscopy because of bloody sputum. A foreign body was revealed in the truncus intermedius. After detailed interviews with the patient, the foreign body was ascertained to be a pencil cap which he had aspirated when he was 9. As the surrounding granulation was hard, bronchofiberscopic approach was unable to remove the foreign body. It was therefore removed by rigid bronchoscopy under general anesthesia. Preoperative scintigraphy showed decreased blood flow and ventilation in the right lower field, and no improvement was observed 3 months after the operation. This decrease was thought to be due to inflammatory granulation caused by long-standing irritation. We consider lung scintigraphy to be useful for follow-up observation after removal of long-standing foreign bodies.

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Seven patients (5 males and 2 females, aged 52-78 years) with severe dyspnea due to malignant tracheal or bilateral bronchial stenosis were treated with self-expanding metallic stents. Two patients had bilateral bronchial stenosis caused by primary lung carcinoma, and five had tracheal stenosis caused by primary carcinoma (n=2), invasion to the trachea (n=2) or lymph node metastases (n=1). No patient was eligible for laser treatment. The stents were constructed of 0.016-or 0.018-inch stainless steel wire bent in a zig-zag pattern with six bends. In all patients the severe dyspnea was resolved immediately and satisfactorily. In two patients in whom intraluminal tumor extended over the stents, additional covered stents prevented tracheal obstruction. Perforation of the trachea and pneumomediastinum occurred in one patient 13 weeks after placement, and this complication was controlled by conservative therapy. None of the other patients has experienced complications secondary to the stent placement. During follow-up periods ranging from 1 to 28 weeks, none of the patients had symptoms attributable to tracheobronchial stenosis. Six patients died and 1 is alive. Autopsy performed in one patient revealed that the patent stent was covered with tracheal epithelium. We conclude that expanding metallic stents are very useful in alleviating symptoms of tracheobronchial stenosis.

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The patient was a 48 year-old male. with an obstruction of the left main of an esophageal carcinoma. Although YAG Laser and radiation therapy had opened the left main bronchus, invasive bronchial stenosis remained, and re-obstruction from tumor growth was suspected. Since conventional expandable metallic stent (EMS) was not indicated because of tumor growth between the wires, we used an EMS covered with dacron mesh. After insertion of the mesh-covered EMS, the left main bronchus was kept open satisfactorily for 43 days. Thereafter, the patient died of aorto-tracheobronchial fistula caused by the tumor. Mesh-covered EMS might be effective for dilatation of invasive tracheo-bronchial stenosis resulting from a tumor, because it prevents tumors growing between the wires.

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Bronchial stenosis can be difficult to cure because of recurrence. We experienced two cases of successful balloon dilatation for bronchial stenosis. Case 1. A 38-year-old male with a history of bronchoplasty due to traumatic rupture of the right main bronchus complained of fever and dyspnea on exertion. A chest X-ray and bronchoscopy revealed stricture of the anastomosis of the right main bronchus. We had performed Nd-Yag laser therapy for the stenosis twice, but the stenosis recurred after each procedure. Therefore, we performed balloon dilatation during bronchoscopy. Though his condition has been followed up for 4 years and 1 month, no recurrence of the stenosis has been found. Case 2. A 33-year-old female was admitted because of left bronchial stenosis due to tuberculosis. A bronchogram showed stenosis of the left main bronchus and obstruction of the left basal bronchus. Under bronchoscopy and fluoroscopy balloon dilatation of the stenosis of the bronchus was performed 4 times. Dilatation was eventually accomplished and her complaints of cough and sputum disappeared. This method of dilatation is not painful for patients and can be performed easily and safely, therefore, it can be done repetitively. Balloon dilation is a useful and effective treatment for bronchial stenosis.

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A case of bronchiolitis obliterans organizing pneumonia (BOOP) which showed wandering infiltration and spontaneous remissionis is reported. A 55-year-old male was admitted to our hospital for further examination of an abnormal shadow on chest roentgenogram. His chest roentgenogram showed a ground glass appearance in the right upper and middle lung fields. A month later, the ground glass shadow appeared in the left middle lung field and increased on admission. After admission, his chest roentgenogram showed spontaneous regression without steroid therapy. Transbronchial lung biopsy showed diffuse distribution of thickening of alveolar septae with infiltration of lymphocytes and organized exudates extending from respiratory bronchioles into alveolar ducts and alveoli. These findings were compatible with those of BOOP.

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Case 1 was a 54-year-old male. The patient was admitted with complaints of high fever and bloody sputum. The chest X-ray film revealed a hemispheric mass protruding from the right margin of the cardiac shadow. Pulmonary carcinoma or bronchial adenoma was suspected preoperatively. The tumor, arising from the S^6 segment of the right lower lobe, exhibited bidirectional growth to the pulmonary parenchyma and bronchial lumen, and was removed by lower lobectomy. The histopathologic diagnosis was pulmonary hamartoma occupied predominantly by chondro-osseous components. Case 2 was a 60-year-old male. An abnormal mass shadow was detected on a mass survey chest X-ray film. Pulmonary hamartoma was suspected preoperatively. Intraoperative findings showed the tumor, arising from the S^6 segment of the left lower lobe, to have a stalk and to have grown in the interspace between the upper and lower lobes. The tumor was excised locally. The histopathologic diagnosis was pulmonary hamartoma with predominant components of chondro-osseous tissues. The postoperative course of the two patients was uneventful, and no evidences of recurrence has been recognized.

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A rare case of multiple endobronchial hamartomas is reported. A 66-year-old male was admitted to our hospital with complaints of cough, sputum and fever. Chest X-ray showed opacification of the entire right hemithorax, and chest CT scan revealed a suspected multilocular abscess in the right lung. Bronchoscopic examination revealed a yellowish white polypoid tumor which protruded from the orifice of the right upper lobe bronchus and a yellowish white polypoid tumor which occluded the truncus intermedius. A large amount of pus was discharged from behind the tumors. Pathological diagnosis of the tumors by punch biopsy was chronic bronchitis. He was therefore diagnosed as having lung abscess with inflammatory bronchial polyps. Antibiotic therapy reduced the size of the polyps, and the polyps become white and lobulated. We biopsied the polyps again and diagnosed them as hamartomas. We removed the tumors which protruded from the orifices of B^2 and B^6 by transbronchial biopsy. The pathological diagnosis of both tumors was chondromatous hamartoma. The lung abscess was also ameliorated after eliminating the obstruction of the right upper lobe bronchus and the truncus intermedius.

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A 58-year-old female was admitted to our hospital complaining of dysphagia. She had been healthy apart from an episode of pneumonia at age 3. A chest X-ray showed an elevation of the left diaphragm and barium-filled stomach was displaced into the left hemithorax. Bronchography showed that her left main bronchus was interrupted with normal mucosa. Frontal angiogram demonstrated the complete absence of the left pulmonary artery. These findings revealed pulmonary aplasia with atony of the diaphragm. To improve this complaint we performed Raffung of the diaphragm and insufflating sulfur hexafluoride gas into the left pleural cavity on the first postoperative month. After these procedures, although the complaint improved, epigastric distress has appeared on the second month. Chest roentgenogram on the 6th month reveals 2.5cm elevation of gastric air bubble compared with the first month, it suggests re-elevation of the diaphragm.

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