Although the histopathology of biopsy specimens is most useful in transbronchial diagnostic procedures for solitary pulmonary nodules, the biopsy forceps is sometimes unable to hit the lesion depending on the site. We performed this study with a 5Fr teflon sheath to obtain more accurate biopsy in five cases with pulmonary nodules which could be approached accurately by curettes but not by biopsy forceps. Curettes inserted through the teflon sheath reach the lesion through control of the tip and the sheaths are advanced to the lesion under the guidance of the curette. Then, the curette is replaced by the biopsy forceps and biopsy is carried out. In three cases we obtained diagnostic materials including two adenocarcinomas and an epithelioid cell granuloma. No complication related to the insertion of the teflon sheath was observed, and neither cough reflex nor bleeding increased compared with usual technique. This new additional technique is necessary because it can be performed directly after conventional techniques if the teflon sheath is prepared.

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Deformation of the residual bronchus after left or right upper lobectomy of the lung was analyzed in relation to the methods of bronchial stump closure and the length of the visible cartilaginous ring of the stump (R). The subjects of this study were 35 patients with pulmonary carcinoma who had undergone upper lobectomy more than 3 months before and who were examined bronchoscopically in order to observe a bronchial stump or to explore the causes of respiratory symptoms. Right or left upper lobectomy of the lung was performed for 18 and 17 patients, respectively. Deformation of the residual bronchus was diagnosed by the stenosis at the orifices of the truncus intermedius and middle lobe bronchi in patients with right upper lobectomy and by the protrusion of the cartilage at the orifice of the basal bronchus in those with the left upper lobectomy. In patients with right upper lobectomy, there were no differences in the incidence of bronchial deformation between the transverse (T) method for the stump closure, in which the stump suture line was parallel to the residual bronchus, and the vertical (V) method, in which the stump suture line was vertical to the residual bronchus. In patients with left upper lobectomy, the incidence of bronchial deformation was 100% (4/4) by the T method with an R value being equal to 1 ring, while it was 20% (1/5) by the V method with an R value being equal to or greater than 2 rings. These results suggest that deformation at the orifice of the basal bronchus may be reduced by using the V method leaving 2 or more visible cartilaginous rings at the stump when left upper lobectomy of the lung is performed.

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Bronchoscopy was performed to clarify the etiology of pulmonary abnormalities in 30 patients with hematopoietic malignancies who showed abnormal shadows on chest X-rays. The causes of abnormal shadows on the chest X-ray were clarified in 26 patients (86.7%). The diagnostic rate was high for diffuse interstitial shadows, localized alveolar solid shadows and nodular shadows. Of patients with acute leukemia, 33.3% of the patients had pulmonary bleeding and there were 16.7% cases each of leukemic cell infiltration, fungi infection and bacterial infection. In cases of chronic myelocytic leukemia, the most common cause was tuberculosis, in 66.7%. In malignant lymphoma it was fungi infection in 46.2%, tuberculosis in 15.4% and bacterial infection in 15.4%. Because most patients with hematopoietic malignancies have some immunodeficiency, they are often complicated with pulmonary infections, many of which are fatal. The prognosis of pulmonary complications depends on their early diagnosis and treatment. However, in some cases, bronchoscopy is difficult to perform because of their tendency to bleed due to severe thrombocytopenia or DIC. We conclude that bronchoscopy is useful for the early diagnosis and treatment of pulmonary complications in selected patients with abnormal shadows on chest X-ray.

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To elucidate whether macrolide antibiotics affect cholinergic neuro-effctor transmission in the airway, we studied canine isolated bronchial segments under isometric conditions in vitro. Addition of erythromycin (3×10^<-4>M) attenuated the contractile responses to electrical field stimulation (EFS), so that the stimulus frequency required to produce a half-maximal contraction (ES_50) increased from 1.3±0.3 to 5.1±0.5Hz (P<0.001). This effect was concentration-dependent and not influenced by propranolol, indomethacin, ouabain or mechanical removal of the epithelium. In contrast, contractile responses to acetylcholine were not altered by erth-romycin. These results suggest that erythromycin may inhibit neuro-effector transmission in the airway cholinergic motor pathway, probably involving the reduction of exocytotic release of acetylcholine from the nerve terminals.

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A rare case of solitary bronchial papilloma was reported and a review of the literature was made. A 71-year-old man was admitted to our hospital complaining of hemoptysis and a cavity with a fungus ball on chest roentgen gram. Bronchoscopic examination revealed a yellowish polypoid tumor at the orifice of right B^1b. Transbronchial lung biopsy from right S^1 showed aspergillus. The punch biopsy from the tumor revealed a solitary bronchial papilloma. This patient has been maintained under medical observation because he rejected the operation. To the best of our knowledge, only 30 solitary bronchial papilloma cases have been reported in Japan.

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The patient was a 68-year-old female. Chemotherapy (VEPA) was administred for a malignant lymphoma (non-Hodgkin's lymphoma) which developed in the neck and mediastinum. The tumor showed complete remission, but a tracheoesophageal fistula developed at the site thought to have been invaded by the tumor. To treat this, a Dumon tube (outer diameter : 14mm, length : 60mm) was inserted into the trachea, and this was successful in preventing the development of pneumonia and allowing resumption of oral intake of nutrition. To date, the conventional methods employed for the treatment of tracheoesophageal fistulas that developed in connection with malignant tumors have consisted of creation of an esophageal bypass or intubation of the esophagus. In recent years, however, endotracheal stent intubation methods have been reported. In comparison with the creation of an esophageal bypass, the methods of endoesophageal intubation and endotracheal stent intubation present the advantage of being minimally invasive. Endotracheal stent intubation using a Dumon stent, as performed in the present case, can be effective in the treatment of the patients in whom the trachea is still relatively well preserved above and below the fistula.

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The patient was a 63-year-old man who had been treated for pulmonary tuberculosis by surgicaly creation of a pneumothorax in 1955. In 1988, he developed hemoptysis. He was diagnosed as having tuberculous empyema of the pneumothorax. He received chemotherapy with isonicotinic asid hydrazide and rifampicin for about 1 year. In July 1993, hemoptysis occurred abruptly on coughing and blood subsequently appeared persistently in the phlegm. The patient was admitted on the next day. Imaging studies revealed calcification of pyothorax which had developed after creation of a pneumothorax, and bronchoscopy detected a wedge-shaped bronchial stone at the right B^9 orifice. Transbronchial lithectomy was attempted, but was abandoned when hemorrhage occurred again. Subsequently, the site of bleeding was confirmed by bronchial arteriograpy and embolization was carried out. After this procedure, transbronchial lithectomy was attempted again and was completed successfuly without hemorrhage.

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A 74-year-old man, who had handled coke for 52 years in an electrode mill, presented with exertional dyspnea. Chest X-ray films and CT revealed diffuse interstitial shadows in both lung fields. Restrictive ventilatory impediment (%FVC=59.6%) and hypoxemia (PaO_2=65torr) were observed. Bronchofiberscopy revealed much black pigmentation spots in the bronchial mucosa, and much black dust was seen in BAL fluid. Carbonaceous dusts were once considered to be "inert dust", and pneumoconiosis due to them was treated lightly as "benign pneumoconiosis". However, since there may be some cases, like our case, who develop chronic respiratory failure, more attention should be paid to this kind of pneumoconiosis.

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A 22-year-old woman with bronchial asthma was admitted complaining of cough in May/1993. Chest-X-ray disclosed bilateral hilar lymphadenopathy and diffuse opacities in the left lung. The bronchoscopic findings showed multiple submucosal nodules and granular appearance in nearly all bronchi. She was confirmed to have sarcoidosis by histological findings obtained from bronchial and lung biopsy specimens. We administered inhaled becrometasone for her bronchial asthma and bronchial involvement of sarcoidosis. Her symptoms markedly improved. After 16 weeks the bronchial sarcoid lesions were remarkably decreased and her chest-X-ray showed improvement of the opacities. Inhaled becrometasone is thought to be useful in the treatment of bronchial involvement of sarcoidosis.

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We report a case of tracheobronchial tuberculosis, which was considered to be early exacerbation, during the treatment of mediastinal tuberculous lymphadenitis and describe the course of its endoscopical findings. A 28-year-old man was admitted to our hospital because of general malaise, fever, anterior chest pain and dry cough. A chest X-ray examination revealed a widened right paratracheal region and chest CT scans revealed mediastinal lymphadenopathy. After injection of contrast medium, swollen nodes showed multifocal small areas of low density, enhanced margin and multiple septa. The biopsy specimens of mediastinal nodes revealed caseating granulomas and contained small numbers of acid-fast bacilli. Culture of the lymph node later yielded M.tuberculosis. Mediastinal tuberculous lymphadenitis was diagnosed and treated by SM INH REP. However, the symptoms continued and after three months, bronchoscopic examination revealed three polyp-like lesions around the bifurcation and a similar lesion on the right tracheal wall. The pathological findings of the polyp-like lesion showed caseating granulomas and tracheobronchial tuberculosis was diagnosed. At ten months of treatment, polyp-like lesions had improved and anthracosis was found at the sites of perforation of tuberculous lymph nodes.

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A 48 year-old housewife visited another hospital, complaining of coughing and hoarseness. At the age of 20, she had suffered from pulmonary tuberculosis and received chemotherapy for three years. Subsequently she was asymptomatic for about 25 years. She visited our hospital about seven months after the occurence of the symptoms. Soon after, she started coughing up horseshoe shaped white pieces of tissue and mycobacterium tuberculosis was revealed in her sputum. Bronchoscopy examination showed a marked narrowing of the left main bronchus and small, white, protrusions from the tracheal membrane. A horse-shoe shaped white piece of tissue, which she expectorated immediately before bronchoscopy, was shown pathologically to be bronchial cartilage. The anti-tuberculous treatment caused further narrowing of the left main bronchus, necessitating broncho plasty. This is a rare case of bronchial tuberculosis presenting with expectoration of horse-shoe shaped bronchial cartilage.

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