To assess the clinical significance of bronchoscopic findings of airway burn, we examined the serial bronchoscopic findings of airway burn cases by scoring redness and swelling of the airway wall. Redness and swelling scores were divided into 4 degrees for quantification. The total score counting redness and swelling scores showed a peak on the 3rd day and was high on the 2nd and 6th days. The score remained high for the 7 days of the observation period. We compared the scores of cases with and without pulmonary intubation. The former was progressed similarly as the total score, but the latter was not so changed. The score of cases with carbonized deposit in the airway as significantly higher on the 3rd day than on the 1st day. We also compared the scores of cases with and without carbonized deposit. The former showed higher scores than the latter at both the 3rd and 5th days. Comparison was made of the scores of cases with and without pulmonary complications (e.g. pneumonia, atelectasis, asthma, pulmonary edema) after admission. The score was higher in the former particularly on the 2nd day. The above findings suggest that grasping the bronchoscopic findings on the 2nd day is as important as diagnosis and treatment by bronchoscopy immediately after injury in the diagnosis and management of burn patients.

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We defined the normal appearance of lobar bronchi on CT and we analyzed CT scans of 107 cases with almost normal chest findings. CT images were obtained at 10mm intervals and 10mm thickness at end-inspiration. The images from a standard point in the carina to the upper lobe bronchi were examined. Using the last slice of the upper lobe bronchi as the standard point, slices were examined up to the middle lobe bronchi and superior segmental bronchi of the lower lobe (B^6). From the standard point of the carina to the right upper lobe bronchi, two slices were seen in 76 cases (71.0%) and to the left upper lobe bronchi four slices were seen in 51 cases (47.7%). From the upper to the middle lobe bronchi, three slices were seen in 75 cases (70.1%). From the upper lobe bronchi, to the right B^6 three slices were observed in 62 cases (57.9%) and to the left B^6 one slice was observed in 99 cases (92.5%). The branching patterns of lobar bronchi are useful to diagnose bronchial anomalies and intrabronchial lesions. They may also be helpful for preoperative examination or bronchoscopy.

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We compared specimens of spontaneous and hypertonic saline-induced sputum from 6 patients with mild sinobronchial syndrome (SBS) and 6 patients with bronchial asthma (BA). Eosinophils were found in the sputum of most asthmatics. Moreover, induced sputum contained more eosinophils and less neutrophils than spontaneous sputum. The ratio of degenerated cells was higher in spontaneous sputum than induced sputum. We concluded that sputum induction by hypertonic saline is useful even in subjects with sputum production.

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Bronchography using iotrolan as a contrast medium was attempted to evaluate its effectiveness. Thirty-two patients (ranging in age from 31 to 80, average : 63.0 years old) including 15 patients with lung cancer were studied. Bronchography examination was performed following bronchoscopic examination of the respiratory tract under topical anesthesia on a fluoroscope monitoring table. Iotrolan (Isovist 300) was used as the contrast medium and a BF-1T20 was used as the bronchoscope. Radiography was performed under concomitant observation by fluoroscopy a total of 36 times on 32 patients. A 5.5 Fr balloon catheter (balloon), which is used in contrast radiography and for drainage of the pancreatic duct and bile duct, was employed for selective bronchography a total of 28 times. When a balloon was not used for bronchography, severe tussis was noted in 88% cases and although the procedure was still useful in the diagnosis of a lesion in 0-2nd order bronchi, a clear image could not be obtained. When balloon selective bronchography of the 1st to 3rd order bronchi was performed, tussis was rarely noted and a clear image of the peripheral lesions was obtained. Tussis was noted only when the contrast medium refluxed to the larynx because the balloon had not been inflated sufficiently. This observation suggests that iotrolan itself is not a potent bronchial stimulant. The major factor causing tussis was suggested to be the reflux of the contrast medium to the larynx. The dose of iotrolan used in balloon selective bronchography was 6-20m1 (average : 10.8±4.6ml). No notable side effect was observed after the examination. Balloon selective bronchography using iotrolan is a useful respiratory examination and can be widely applied clinically.

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Expandable metallic stents (EMS) were employed in cases of neoplastic tracheobronchial stenosis and the subsequent quality of life (QOL) of the patients and incidence of complications were evaluated. All 8 patients, 7 with primary lung cancer and 1 with tracheal invasion due to recurrent esophageal carcinoma, had received chemotherapy and/or radiotherapy prior to EMS placement because they were inoperable. We first performed tracheal intubation under local anesthesia and then placed Gianturco type EMS at the site of their stenotic lesions via flexible bronchoscopy under fluoroscopic guidance. We found that 1) dyspnea (Hugh-Jones IV or more) in 3 cases remarkably decreased immediately after EMS placement, 2) chemotherapy and/or radiotherapy were safely performed in 6 cases with the tracheobronchial tree remaining open after placement, 3) there were few life-threatening complications except one case of EMS migration out of his body with mild hemosputum, 4) Pseudomonas aeruginosa and Klebsiella pneumoniae from areas surrounding EMS in relatively long-term survivors were found, 5) EMS placement should contribute to the QOL of patients with neoplastic tracheobronchial stenosis if EMS can be successfully employed in selected patients.

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A randomized trial was performed to compare the anesthetic effect of intravenous administration of diazepam combined with flumazenil and pethidine with naloxone for sedation in diagnostic bronchoscopy. From October 1993 to April 1994, 57 patients enrolled in this study underwent bronchofiberscopy with biopsy and curetting under fluoroscopy. Patients with respiratory or circulatory failure, or with consciousness disturbance were excluded. They were randomly allocated to two groups ; those who received diazepam combined with its specific antagonist flumazenil (group A), and pethidine hydrochloride combined with its competitive antagonist naloxone hydrochloride (group B), Both groups were also premedicated atropine sulfate and local anesthesia by 4% lidocaine spray. There was no significant difference in the sedation, cooperation, safety, and awakening in both methods. Awakening of patients from sedation was smooth with both methods. The intravenous administration of diazepam or pethidine hydrochloride as anesthesia for diagnostic bronchoscopy were both safe for out patients and elderly patients, and both had enough sedative effect to simplify the procedure.

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A 52-year-old man presented with a chief complaint of cough. Bronchoscopy revealed an endobronchial polypoid mass obstructing the right lower lobe bronchus. Biopsy revealed leiomyoma. Endoscopic Nd-YAG laser therapy was initiated, but was, since the mass originated within the right B^6 bronchus a switch to surgical treatment. Sleeve S^6 segmentecomy was carried out successfully. The postoperative course was uneventful and there is no evidence of tumor recurrence to date. Sleeve segmentectomy may well be considered for benign endobronchial tumors, which are difficult to treat by endoscopic therapy alone, especially in the cases in which such a procedure can significantly preserve lung function.

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This report treats a case of bronchial carcinoid in which a modified bronchoplastic operation for closure of the bronchial stump was necessary because of anomalous bronchus. A 53-year-old female had high fever and cough. Chest X-ray showed atelectasis of the right middle lobe. Bronchoscopy and bronchography revealed obstruction of the right middle bronchial orifice, and displacement of the right upper segmental bronchi. The right segmental bronchi of B^<1+3> and B^<2+3> originated separately from the right main bronchus. Cytology of the right middle bronchial orifice showed bronchial carcinoid. A right middle and lower bilobectomy was performed. The bronchial stump was closed by a modified bronchoplastic procedure using the wall of the truncus intermedius because the tumor invaded the B^<2+3> segmental branch. The patient recovered and was discharged 19 days after surgery although she required suction of sputum by bronchofiberscopy due to stenosis of the anastomosis. The pathologic diagnosis was typical carcinoid. The patient is alive and well 38 months after surgery and stenosis of the anastomosis is improving.

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A 64-year-old woman complaining of an abnormal sensation in the larynx was admitted for treatment of a tracheal pedunculate polyp. She underwent tracheal intubation for mechanical ventilation 4 month previously because of severe hypoxemia and unconsciousness due to infection of old pulmonary tuberculosis. Bronchofiberscopic polypectomy was performed by electoro cautery using a polypectomy snare. The polyp was completely resected without bleeding. Histologically, the polyp was a granuloma lacking the epithelium. The postoperative course was uneventful and she is free of symptoms.

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The chest roentgenogram of a 51-year-old man showed multiple infiltrations in both lung fields with a giant cavity of the left upper lobe and pleural effusion. The results of sputum smear and culture studies were positive for M.tuberculosis. No resistance was proved in vitro for INH, RFP, EB and SM. Three months after starting antituberculous therapy, including RFP, INH, SM and EB, new infiltrative shadows appeared in both lung fields. At the time of their appearance there had been evidence of clinical improvement. Transbronchial lung biopsy specimens from new lesions showed alveolitis with Masson bodies. BALF findings revealed that the percentage of lymphocytes was 54% and the OKT4/8 ratio was 0.3. After treatment with prednisolone the new shadows disappeared. The drug challenge tests to RFP, INH and EB were negative. A case of initial aggravation with interesting pathological findings was reported.

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A 66-year-old woman presented with wheeze and dyspnea. A clinical diagnosis of bronchial asthma with left upper lobar atelectasis was confirmed by chest X-ray films. As medications including steroids were not effective, bronchial toilet and local intrabronchial administration of prednisolone, gentamycin and tyloxapol were performed through bronchofiberscope. Symptoms promptly improved compared with the result of treatment by bronchial toilet following a previous bronchial asthma attack. Transbronchoscopic administration of steroids, antimicrobial agent and surfactant in addition to bronchial toilet may be useful for the treatment of bronchial asthma accompanied by lobar atelectasis.

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