Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology and activated alveolar macrophages and neutrophils play important roles in its pathogenesis. Interleukin-8 (IL-8) is thought to be released by activated mononuclear phagocytes and exhibits potent chemotactic activity for neutrophils. We examined the levels of IL-8 in bronchoalveolar lavage fluid (BALF) from the patients with IPF (n=12) and control subjects (n=5). The level of IL-8 in patients with IPF was 59.4±51.2pg/ml BALF which was significantly higher than that in the controls (3.02±0.99pg/ml BALF; p<0.05). A close correlation was found between the level of IL-8 and BALF neutrophil content, whether expressed as a percentage (r=0.86; p<0.01) or cells per milliliter BALF (r=0.62; p<0.05). The level of IL-8 showed a positive correlation with alveolar-arterial oxygen difference (A-aDO_2), (r=0.586; p<0.05) and negative correlation with PaO_2 (r=0.753; p<0.01). These findings suggest that IL-8 plays an important role in the pathogenesis of IPF and that IL-8 content in BALF may be a useful parameter of its severity.

View full abstract

We prospectively studied whether early high dose methylprednisolone (MPS) therapy in patients with severe pneumonia would improve or prevent acute respiratory distress syndrome(ARDS). Emergency broncho-alveolar lavage was performed in all patients to make a proper diagnosis of acute respiratory failure. Patients received 500mg/body intravenous MPS, days 1 to 3, and 250mg/body, days 4 to 6 along with intravenous fluids and antibiotics. Plasma and BAL fluid levels of tumor necrosis factor alpha(TNF-α), interleukin(IL)-1β, 6, 8, and platelet derived growth factor(PDGF) were measured by the enzyme-linked immunoabsorbent assay method on day 1, and 1 to 2 weeks later. Twelve patients were admitted to our hospital between February 1996 and June 1997. Of the 12 patients, 11 had underlying diseases. The mean age was 64±9 years. Mean PaO_2/FiO_2 on admission was 182±68 Torr. Ten patients underwent BAL while they were receiving mechanical ventilation. The causes of pneumonia were bacteria in 11 patients (sepsis 2), P. carinii and cytomegalovirus in 2, and P. carinii in 1. Trends over time for plasma (n=9) and BAL fluid (n=8) TNFα, IL-1β, IL-6, IL-8, PDGF were measured in the acute and subacute phases, and the levels were as follows : plasma TNFα, 107±188 vs 55±107pg/ml(p=0.068) ; plasma IL-1β, 16±22 vs 3±3(p=0.345) ; plasma IL-6, 422±242 vs 36±26(p=0.043) ; plasma IL-8, 1399±3111 vs 79±78(p=0.043) ; plasma PDGF, 988±867 vs 1696±962(p=0.345) ; BAL TNFα, 194±372 vs 19±10pg/ml(p=0.204) ; BAL IL-1β, 48±63 vs 10±7(p=0.154) ; BAI IL-6, 337±279 vs 10±5(p=0.064) ; BAL IL-8, 3820±5459 vs 352±243(p=0.025) ; BAL PDGF, 32±38 vs 48±30(p=0.239). Plasma levels of IL-6, IL-8 and BAL fluid levels of IL-8 were significantly higher in the acute phase than in the subactue phase. Ten of 12 patients (83%) recovered from ARDS and 9 patients (75%) survived. Our findings indicate that early high dose MPS might improve survival rates in patients with ARDS caused by severe pneumonia.

View full abstract

Pleural involvement of interlobar fissure by a tumor is one of the most important factors in the clinical diagnosis of lung cancer. A positive finding of incomplete interlobar fissure of the lung influences not only the surgical procedure but also the prognosis. The aim of this retrospective study was to investigate the usefulness of thin-section computed tomography(CT) compared with conventional CT in the detection of pleural invasion of the interlobar fissure by lung cancer or incomplete interlobar fissure, and the results of surgery, according to the involvement of the pleural surface. We reviewed 90 patients whose tumors were adjacent to the interlobar fissure of the lung through conventional CT scans and subsequent thoracotomy. A comparison of diagnoses based on the findings of thin-section CT and pathologic examination showed that thin-section CT was 94% accurate for pleural invasion of the interlobar fissure, and 100% for incomplete interlobar fissure. Conventional CT, however, was only 63% accurate for pleural invasion of the interlobar fissure and 31% for incomplete interlobar fissure. This leads us to conclude that thin-section CT is helpful in the accurate evaluation of pleural invasion of the interlobar fissure and in the findings of incomplete interlobar fissure in lung cancer for patients in whom tumors are adjacent to the interlobar fissure on conventional CT findings.

View full abstract

The efficacy and safety of the uncovered Ultraflex nitinol stent were tested. Between October 1997 and April 1998, we carried out a prospective multicenter study. Ultraflex stents were inserted in 20 patients with inoperable malignant airway stenoses by flexible and/or rigid bronchoscopy. Thirty-five stents were implanted in the trachea in 20%, the left main bronchus in 37%, the right main bronchus in 11%, the truncus intermedius in 20%, and lobar bronchi in 12%. Significant improvements were observed in obstruction of airway diameter (before vs after, 87% vs 19% ; p<0.001). Immediate relief of dyspnea was achieved in 90% of patients. The dyspnea index improved significantly after treatment (p<0.001). The main complications were tumor ingrowth (20%) and misplacement (15%). Nd-YAG laser resection and mechanical coring out using the bevel of the rigid scope were necessary in cases of tumor ingrowth. Removal and reposition were possible in case of misplacement. There were no problems with the migration and retained secretions, thus ultraflex stents should be considered feasible. This stent is well suited for stenting of curvilinear and/or long stenoses with varying diameters owing to its excellent flexibility and biocompatibility.

View full abstract

We placed Dumon Y stents in 3 cases with malignant carinal stenosis. First the stent is placed into the lower trachea. It is safe to push the stent to the carina by alligator forceps after insertion of rigid videoscope into the right main bronchus through the right arm of the stent and a bronchofiberscope into the left main bronchus through the left arm.

View full abstract

A 73-year-old man was referred to our hospital because of an abnormal shadow on a chest X-ray film. Thoracic computed tomography disclosed a mass in the right hilus with encasement of the right upper lobe bronchus. Mediastinal lymphadenopathy was also present. A bronchoscopy revealed a large submucosal tumor extending from the right main bronchus to the right upper lobe bronchus, with polypoid lesions in the upper lobe bronchus. Endobronchial tumor biopsy revealed histologically monotonous proliferation of atypical lymphoid cells. Immunohistochemical studies showed positive staining for only κ light chain. Amyloid deposition was also found in the submucosal tissue of the bronchus. Immunoelectrophoresis revealed the M-protein of IgG-κ type in the serum. Bone marrow examination revealed no abnormality. Skeletal survey demonstrated solitary osteolytic tumor in the temporal bone. Based on these findings, we supposed that this case was pulmonary plasmacytoma with cranial bone metastasis. This appears to be the first reported case of pulmonary plasmacytoma diagnosed by endobronchial tumor biopsy. The patient received chemotherapy and subsequently radiation therapy, but with unsatisfactory response of the mass lesion.

View full abstract

A 43-year-old man was admitted to our hospital because of an abnormal shadow on a chest radiograph. The patient had been working in a beer factory for 4 years. He often used diatomaceous earth to filter beer without wearing mask. A photomicrograph of a lung specimen did not permit a definitive diagnosis of pneumoconiosis because the biopsy specimens were too small. An electron micrograph showed pin-like particles in alveolar macrophages. Electron dispersive X-ray analysis of the particles revealed a high content of silica and aluminum, which are the main components of diatomaceous earth. This case was diagnosed as diatomaceous earth pneumoconiosis. Careful follow-up is required owing to the risk of exacerbation.

View full abstract

Eight years after right lower lobectomy for pulmonary adenocarcinoma (P-T0N0M0), severe hemoptysis occured in a 53-year-old man. On chest roentgenogram, a fungus ball was recognized in the right upper lobe. To control the hemoptysis right upper and middle lobectomy was performed. Histopathological examination revealed several cavities in the right upper lobe. The cavities in S^2 were of the conventional fungus ball type, while two cavities in S^3 were filled with bloody clots and, in the cavity wall, hemorrhage from a ruptured arterial wall was observed. The granulation tissue surrounding the cavity wall displayed hemorrhagic foci from the inside of small blood vessels, which contained some aspergillar hyphae. The entire pleura was thickened, and rupture of small blood vessels, hemorrhage and colonization of aspergillar hyphae were observed throughout. Furthermore, many aspergillar hyphae were found within the pulmonary artery and a few in the pulmonary vein. The causal relationship between the characteristic histopathological features and the hemoptysis in this case was discussed from the point of view of the action of hemolysin and the proteolytic enzymes released by aspergillar hyphae, which have recently been highlighted as pathogenic factors especially in chronic necrotizing pulmonary aspergillosis.

View full abstract

A 63-year-old man was admitted because of exacerbation of dyspnea on exertion(DOE). Arterial blood gas analysis revealed hypoxemia, the chest roentgenogram showed diffuse pulmonary infiltrates and pulmonary artery wedge pressure was higher than 18 mmHg. He was thought to have cardiac failure, and furosemide was administered with only a limited effect. Since a subsequent chest roentgenogram showed a ground glass appearance and hypoxemia increased, acute exacerbation of idiopathic pulmonary fibrosis was diagnosed. Pulse therapy of intravenous methylprednisolone and subsequent oral prednisolone resulted in improvement of hypoxemia and DOE. Three months later, he died of sudden cardiopulmonary arrest. On autopsy, histopathological examination of the lung showed widespread intrabronchiolar foreign bodies, inflammatory nodular lesions around these bronchioles, and honeycombing. From these findings, diffuse aspiration bronchiolitis complicated with idiopathic pulmonary fibrosis was diagnosed.

View full abstract

A 23-year-old man was admitted with chest pain and an abnormal shadow in the right middle lung field. Bronchoscopy revealed a polypoid tumor at the orifice of right B^6 which almost completely obstructed the right B^6a. The histological findings of the polyp indicated inflammatory granulation tissue with necrosis. Both Ziehl-Neelsen stain and fluorescent stains were negative for tuberculosis. A white-coated necrotic ulcerative mucosal lesion was also seen at the base of the polyp. The TBLB specimen of the right S^6a revealed granulation tissue with lymphocyte infiltration, giant cells, and epithelioid granuloma, which was compatible with a diagnosis of tuberculosis. Culture of the bronchial washing specimen was positive for Mycobacterium tuberculosis. The polyp was not recognizable on bronchoscopy performed after administration of anti-tuberculous agents (HRS) for three weeks, which suggested that the polyp might have been related to a tuberculous infection. Although no previous report was found on nonspecific inflammatory endobroncial polyps associated with untreated tuberculosis, tuberculosis may be considered when such polyps are encountered.

View full abstract

CT bronchoscopy, or so-called "virtual bronchoscopy" is a recently developed technique. It is useful for evaluating the morphology of the airways because flexible bronchoscopic examinations are invasive and technically limited. This technique is especially useful for simulation in patients who will undergo a transbronchial examination. We demonstrated the efficacy of interactive VB in the transbronchial-biopsy planning of 2 patients, one with a peripheral lung tumor and one with a mediastinal mass.

View full abstract

Mucosal bridges formed following treatment in cases of lung cancer (2 epidermoid carcinoma and 1 small cell carcinoma) were reported. All mucosal bridges were formed at the segmental bronchus or more proximal bronchi, but biopsy revealed cancer cells in only one case. While, it is considered that mucosal bridge formation is an expression of the healing process in gastrointestinal inflammatory disease, its clinical significance in respiratory diseases is not clarified. Reported cases of mucosal bridge formation in the air way are rare, but it should be possible to detect mucosal bridge easily when fiberoptic bronchoscopy is performed more frequently after the treatment.

View full abstract

A 3-year-old boy in whom early myoclonic epileptic encephalopathy was diagnosed underwent tracheostomy. Three years and ten months later, bleeding through the tracheostomy tube suddenly appeared. Based on postcontrast chest CT findings, he underwent an emergency operation for tracheo-innominate artery fistula. The fistula between the trachea and the right brachiocephalic trunk was closed with interrupted sutures, and the thymus was interposed between these two structures. He had a satisfactory postoperative course.

View full abstract