We examined the influence of repeated exposure to cigarette smoke on airway responsiveness to inhaled histamine in guinea pigs. Animals were divided into three groups : a group exposed to 1 cigarette per day for 2 weeks, a group exposed to 20 cigarettes per day for 2 weeks and a control group which was not exposed to cigarette smoke. Increased airway reactivity was seen in both low and high level of smoke exposure groups compared to the control group 24 hr after the last smoke exposure. Then, we investigated whether the increased airway reactivity caused by repeated exposure to cigarette smoke could increase more immediately after cigarette smoke or not. Although bronchial reactivity after acute cigarette smoke in the group exposed repeatedly to cigarette smoke was significantly greater than that in the control group, the degree of bronchoconstriction immediately after smoking in the former group was smaller than in the latter group. We concluded that repeated exposure to cigarette smoke increased nonspecific airway reactivity but decreased the degree of bronchoconstriction related to smoking. These findings suggest that smoking may be an important factor contributing to the development of chronic airway obstruction by enhancing bronchial reactivity in smokers.

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Normal human alveolar macrophages (AM) were previously found to suppress the expression of lymphokine-activated killer (LAK) activity by blood lymphocytes in response to IL-2. The present study was undertaken to examine whether AM obtained by bronchoalveolar lavage (BAL) in the lungs of patients with pulmonary sarcoidosis affect the responses of lymphocytes in the blood and BAL fluid (BALF), assessed as the proliferative responses to IL-2 and LAK activity against Daudi cells. BALF lymphocytes of healthy donors did not generate LAK activity in response to IL-2. Lymphocytes purified from the blood and BALF of patients with active sarcoidosis proliferated and generated LAK activity in response to IL-2. A significant correlation was found in sarcoidosis patients between the percentage of lymphocytes in BALF and their LAK activity induced by IL-2. AM of sarcoidosis patients suppressed the responses of BAL lymphocytes to IL-2. These results suggest that AM may be important in down-regulating the local responsiveness of lymphocytes to IL-2 in the pathogenesis of pulmonary sarcoidosis.

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To show how explanations in the informed consent process were recorded in bronchoscopic examination cases, medical records of 119 that underwent bronchoscopy in the Department of Pulmonary Medicine of our institution during the one-year period from April 1991 to March 1992, were reviewed. The records and their contents (objective, procedure, risks, alternatives) were studied. There were explanation records in 75 cases (63.0%). In the records of 35 cases (29.4%), all objectives, the procedure and risks were recorded. Items recorded were different between cases. Recorded rates of explanation of informed consent before bronchoscopy were not enough to archive and maintain quality informed consent, and to manage risks. Explanation and recording items need to be standardized.

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The efficacy and safety of sedation with intravenous administration of diazepam and pethidine hydrochloride were prospectively evaluated in 20 consecutive patients undergoing fiberoptic bronchoscopy. Patients were premedicated with atropine sulfate and hydroxydine. After topical anesthesia with lidocaine, diazepam and pethidine hydrochloride were administered intravenously with different doses according to age. Those under 65 received 10mg diazepam and 35mg pethidine hydrochloride, those aged between 66 and 75 received 5mg and 35mg respectively and those aged 76 and over received 5mg/0mg. After recovery patients recorded their degree of comfort, memory, and the acceptability of the procedure. Over 90% of the patients had amnesia and all the patients answered that the examination was comfortable. All except one, who had severe cough after bronchoscopy, had no objection to re-examination. Elevation of the heart rate and the respiratory rate were observed during the examination, although arterial oxygen saturation and blood pressure were stable. No arrhythmia or respiratory suppression was found. We conclude that this sedative method for fiberoptic bronchoscopy is not painful but comfortable for the patients and safe even for elderly patients.

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Continuous oxygen flow delivered through a nasal cannula has several disadvantages including irritation of the nasal mucosa and ill appearance. More importantly, some patients cannot receive sufficient PaO_2 through the nasal cannula. Transtracheal oxygen therapy (TTO) is a method of delivering oxygen directly into the trachea and is employed in patients who have problems using a nasal cannula. We have employed TTO for 16 patients with COPD receiving long-term oxygen therapy. TTO increases PaO_2 and reduces the oxygen flow rate required. Other benefits of TTO were a decrease in the respiratory rate and a reduction in the dyspnea for patients who had been receiving TTO for more than one year. TTO not only circumvented the leading disadvantages of nasal delivery but also decreased the work of breathing and increased the quality of life for the patients. TTO is accordingly becoming an important technique in long-term oxygen therapy.

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We report a case of congenital bronchial atresia in a 15-year-old male who visited our hospital for further examination of an abnormal shadow on chest X-ray. Chest X-ray showed hyperlucency in the right upper lung field and mediastinal shift to the left. Chest CT revealed overinflation of the right S^2 with hyperlucency and narrowing of pulmonary vessels. Fiberoptic bronchoscopy showed obstruction of the right B^2 with edematous change of bronchial mucosa and bronchography revealed atresia of the right B^2. ^<99m>Tc MAA pulmonary perfusion scintigraphy showed poor perfusion in the right upper lung field and pulmonary arteriography revealed remarkable reduction of blood flow in the right S^2. The patient was diagnosed as congenital bronchial atresia based on the evidence of these clinical features. No increase in hyperlucent area was found when a comparison was made with the chest X-ray film at age 6.

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A 57-year-old man was admitted complaining of low grade fever and exertional dyspnea. The patient had suffered from systemic extranodal lymphoid hyperplasias for the previous 8 years. Chest X-ray films showed multiple nodules in bilateral lung fields and enlarged hilar lymph nodes. Bronchoscopic findings showed remarkable development of the capillary vessels and multiple submucosal polypoid changes in the trachea, and the submucosal layer was markedly swollen in the left main bronchus. The immunophenotype of the transbronchial biopsy specimens indicated B cell lymphoma. Molecular genetic and cytogenetic studies in this case revealed it to be neoplastic and of mucosa-associated lymphoid tissue (MALT) origin. These findings suggested that at least a part of primary malignant lymphomas of the lung arise from MALT.

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A 59-year-old male without any history of pulmonary disease developed hemoptysis. A chest X-ray film on addmission showed consolidation shadow with minute calcification of left upper lung field. Bronchofiberscopy revealed only bleeding in left B^<1+2>. Bronchial artery angiography demonstrated vascularization and increase of capillary plexus in left S^<1+2> supplied from upper branch of left bronchial artery. These findings suggested that chronic inflammation had been present in this area. We performed bronchial artery embolization using of Spongel^[○!R] to control the hemoptysis. After embolization the bloodsupply to the capillary plexus was distinctly decreased and hemoptysis resolved. Bronchofiberscopy one week later showed white-yellow broncholiths in left B^<1+2>. We successfully removed the broncholiths using basket type grasping-forceps through a bronchofiberscope without bleeding. Infrared spectrum analysis revealed that these broncholiths were mainly composed of calcium phosphate. It has recentry been suggested that calcium phosphate-rich broncholith was caused by calcification of mucus in bronchus. This case report suggests that bronchial artery embolization is useful in case of bronchoscopic removal of broncholiths without bleeding when the broncholiths are caused by calcification of mucus associated with bronchial arterial vascularization.

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A 52-year-old man complained of severe dyspnea due to tracheal stricture 6 months after thermal inhalation injury. After Nd-YAG laser therapy, an intratracheal stent was inserted to the stenotic site of trachea. His respiration improved. This case suggests that Nd-YAG laser therapy was effective for treatment of tracheal stricture due to thermal inhalation injury, but further close follow-up by bronchoscopy is needed.

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Diverticulum of the trachea is relatively rare. This report describes a case with tracheal diverticula and squamous cell carcinoma of early stage. A 64-year-old male was admitted with cough and laryngeal discomfort. When he had gone to an another hospital because of increase of productive cough on June 1994, no abnormal shadow was detected on his plain chest X-ray film. His smoking index was approximately 800. When he came to our hospital on September, on chest tomogram and CT-scan showed multiple air-density free spaces to the right of the trachea. Bronchofiberscopy showed several small holes on the right wall of the trachea, which were confirmed by bronchography. On a diagnosis of multiple tracheal diverticula in addition to early stage squamous cell carcinoma of the left basal bronchus surgery was performed. After resecting diverticula, the trachea was sutured with 3-0 Maxon and covered with a thymus as a reinforcement. This case was considered as an acquired tracheal diverticula. Tracheal diverticulum is relatively rare, which only 25 cases reported in Japan. This is an extremely rare case no other case had multiple diverticula.

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