We carried out clinical investigations on transbronchial bacteriological culture studies using the flexible fiberoptic bronchoschope to compare culture of throat swabs taken just before examination of bronchoscopy and culture of bronchial lavage fluid. There were two groups, one was the non-infectious disease group (n=34) and the other was the pulmonary infection group (n=23). In approximately half of the non-infection group, bronchial lavage fluid contained contamination by bacteria isolated from the throat swab i. e. oropharyngeal flora. In the non-infection group, bacteria in bronchial lavage fluid that were different from those isolated from the throat swab were recognized in only one case and consisted of only one kind of bacterium. In the infection group these were 11 cases and 9 kinds. In the infection group, it is probable that bacteria found only in bronchial lavage fluid and not isolated from the throat swab were the causative organisms. We concluded that throat swab culture obtained just before bronchoscopy was useful in transbronchial bacteriological culture studies using flexible fiberoptic bronchoscopy for pulmonary infectious diseases.

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Bronchial artery embolization (BAE) is a well-accepted method technique to control hemoptysis. In recent years, superselective embolization with a coaxial microcatheter system has been reported as a way to avoid spinal injury. Between April 1994 and July 1997, superselective BAE using gelatin sponge and metallic coils as occlusive material was performed in 41 patients. They included 27 men and 14 women aged 31-76 years (average 58.3). Immediate control of hemoptysis was achieved in 37 of 41 patients (90.4%) by BAE. On longterm follow period (average 36.1 month) of 35 patients with immediate successful BAE, 5 patients (14.3%) had bloody sputum but not hemoptysis. 8 patients (23.9%) had hemoptysis and underwent embolization therapy again.

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To assess the clinical features of endobronchial tuberculosis due to lymph node perforation (EBTBLN), we investigated the clinical records of eight patients (1 man and 7 women) retrospectively, who were diagnosed as EBTBLN by bronchoscopic findings from June 1992 to November 1998. All patients were over 65 years old, and two patients had a past history of tuberculosis without chemotherapy. The chief complaints on admission of 7 patients were persistent cough and sputum (bloody sputum). The findings of chest X-ray, including CT, on admission varied greatly with consolidation, infiltration or atelectatic shadows, which were lobular, segmental or of minimum extent, and lower lung field tuberculosis was also seen. However no lymphadenopathy could be detected. The locations of the perforating lymph nodes were as follows : right upper lobe bronchus in 4, left upper lobe bronchus in 1, right truncus intermedius in 2 and left basal bronchus in 1. The bronchoscopic findings were also in the varied : frankly perforating lymph nodes, depositions of black carbonized material in the epithelium, or typical bronchial ulcer formation. The mechanisms of EBTBLN are thought as the reactivation of tuberculous lymphadenitis and perforation into the bronchial lumen. The essential points of early diagnosis are sputum examination of tuberculous bacilli and detailed imaging examinations of the airway, and bronchoscopy is nessesary for the diagnosis of endobronchial tuberculosis.

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A 79-year-old man complained of cough and dyspnea. He had undergone resection of inguinal liposarcoma 3 months previously. Chest X ray revealed an abnormal mass shadow and chest CT showed a hilar mass extending to the lower trachea. Bronchoscopic findings showed that the tumor was a polypoid lesion in the right main bronchus, wedged completely into the right upper lobe bronchus. He underwent a right upper lobectomy and a partial resection of the right middle lobe. The surgical specimen revealed that the tumor extended into the right main bronchus. Most endobronchial metastases from non-pulmonary tumors are from carcinoma. This is a rare case of liposarcoma metastatic to the lung with endobronchial extension.

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A 31-year-old woman with a past history of bronchial asthma presented with cough. She was admitted because of exacerbation of cough. Bronchoscopy after admission showed redness and engorged vessels in the bronchi. A virus infection was suspected because bronchial biopsy revealed syncytial cytomegaly of the bronchial epithelium. Based upon the significant elevation of serum parainfluenza virus 3 antibody titer, it was confirmed that parainfluenza virus 3 caused the acute exacerbation of asthma.

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A 68-year-old man was admitted because of massive hemoptysis due to non-tuberculous mycobacterial infection in the right lung. Angiographs showed vascular hyperplasia in the peripheral regions, of the right bronchial artery and lateral thoracic artery, which were extensively embolized. After BAE, he suffered repeated acute dyspnea with metabolic acidosis. Systemic hypercoagulopathy and vasoconstriction related to BAE seemed to trigger the condition. His cardiac hypofunction and systemic severe arteriosclerosis may clarify the pathogenesis. BAE has been established as an effective and safe procedure for the management of massive or recurrent hemoptysis. Our experience, however, suggests the importance of extensive evaluation of cardiac and vascular condition prior to BAE, especially when the procedure is to be performed in an aged patient.

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A large defect in the esophagotracheal wall was caused by complete perforation of an esophageal stent into the trachea in a 67-year-old man with esophageal cancer in whom esophagotracheal fistula appeared after chemoradiotherapy. An esophageal stent had been placed to seal the fistula 3 months previously. The patient visited our department with severe symptoms of sputa, cough, dyspnea, high fever and dysphagia. Bronchoscopic examination showed the complete perforation of the esophageal stent into the trachea. After extubation of the perforated stent using a rigid bronchoscope, the wall defected was 8.0 cm in length. Double stent insertion was then performed, using a Dynamic stent for the trachea and a covered Ultraflex for the esophagus. After the double stenting, the patient was capable of semi-solid food intake, and his aspiration pneumonia improved. Double stenting is an useful modality for occlusion of esophagotracheal large fistulas and can improve the quality of life of the patient.

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A 58-year-old male suffered dyspnea and cough. The patient had been exposed to glass dust in his work place. Chest X-ray did not reveal any abnormal findings. However, thoracic computed tomography revealed infiltration in the right S^6 area. Endoscopic findings suggested mild inflammation. On bronchial biopsy of the right B^6 area, glass dust foreign bodies were detected. One year later, additional examination showed that glass dust foreign bodies remained in the bronchial tissue. Respiratory tract foreign bodies are induced by swallowing in most cases. However, if the substance is powdered as reported for this patient, inhalation may also induce respiratory tract foreign bodies. Glass is rare as a foreign body in the respiratory tract. In this patient, foreign bodies were histologically demonstrated.

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