We reviewed our experience with 5 cases of acute eosinophilic pneumonia(AEP). The patients presented with an acute febrile illness, severe hypoxemia, diffuse pulmonary infiltrates on chest X-ray, and an elevation of eosinophils in the peripheral blood and bronchoalveolar lavage(BAL)fluid. Two of the 5 cases were young patients who had recently begun smoking. Beginning to smoke may be one of the causes of AEP. Patients improved rapidly after institution of corticosteroid therapy. BAL offers a safe and reliable means of detecting eosinophilic pulmonary involvement in AEP. It also can be used to judge response to corticosteroids.

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A surgical case of carinal reconstruction for adenoid cystic carcinoma was reported. The 70-year-old man complaining of bloody sputum, as adenoid cystic carcinoma was found to extend from the inferior margin of the 4th tracheal ring to the right upper bronchus. Airway stenosis was treated by cautery with Nd-YAG laser. After right sleeve upper lobectomy and wedge carinal resection was performed, the wedge-shaped defect of the trachea was closed, maintaining the diameter, and end to side telescopic anastomosis was carried out. The residual tumor was well controlled with postoperative irradiation(60Gy). Three years after the procedure there is no stenosis or granulation at the anastomose.

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A 60-year-old man was admitted, with suspected lung carcinoma based on sputum cytology(class D). The bronchoscopic examination revealed a smooth-surfaced polypoid lesion proximal to the orifice of left B^4. The biopsy specimens showed squamous metaplasia with moderate atypia. Circumferential resection of the lingular bronchus and reconstruction of the upper lobe bronchus and lingular bronchus was performed. The resected specimen was histopathologically diagnosed as an inflammatory bronchial polyp. Five months later, endoscopic examination showed that the left B^4 was slightly stenotic and left B^5 was opened.

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We report a 24-year-old man who had tracheostomy with mental retardation. He had a brain contusion caused by a traffic accident in November 1994. After surgery for brain contusion, he needed respiratory care with mechanical ventilation for two months via tracheostomy. After 12 months of hospitalization, simple closure of the tracheostomy was performed and he was discharged. However, since he soon complained of dyspnea again, tracheostomy was performed again. Afterward, closure of the tracheostoma was attempted several times during several years, all surgical procedures were unsuccessful because dyspnea reoccurred after surgery. Anotherattempt using a rotation skin also failed. He was referred to our hospital in August 1999. His condition was stable, but neurological examination revealed paraplegia(Th1 and below). CT, 3D-CT and fiberoptic bronchoscopy showed a defect of tracheal cartilage at the site of tracheostomy and fibrotic stricture of the membranous portion. The 3D-reconstructed images revealed that the airway stenosis was due to elevation of the membranous portion. Therefore we thought that both resection of the stenotic portion and end-to-end tracheal anastomosis were necessary. Because of mental retardation and a past history of convulsion attacks, difficulties were foreseen in the postoperative course. To overcome poor conditions, we constructed a gastrostomy before operation. We also planned continuous sedation and mechanical ventilation after surgery to keep his wound stabilized. Tracheoplasty was performed on November 15, 1999. Through a collar incision, a 3.5 cm-segment of trachea, including the stoma and the stenotic portion was resected. After mobilization of the thoracic trachea, end-to-end anastomosis with 4-0 PDS II knotted suture was done. Laryngeal release was not performed. He was maintained on mechanical ventilation(CPAP, PEEP 5 cm H_2O)for one week and chin flexion was maintained. His postoperative course was uneventful and he was discharged on January 16, 2000.

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A 55-year-old man was followed up after left upper lobectomy due to lung adenocarcinoma. One year and nine months later, chest CT showed abnormal shadows in the bilateral lung fields and mediastinal lymph nodes. Two courses of chemotherapy were administered. Three months after the chemotherapy, chest X-ray showed atelectasis of the left lung. Chest tomography revealed the complete obstruction of the left main bronchus caused by a tumor. To improve the difficulty in the breathing, we reduced the tumor by means of Argon Plasma Laser and then the Covered Wallstent was inserted into the left main bronchus under general anesthesia. After the stenting, the atelectasis was improved. The Covered Wallstent was very effective for the severe stenosis caused by surrounding tumor growth, and tumor invasion of the stent was prevented. This form of stent is also indicated in case of bronchial deformity after surgery.

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We report a case of a 55-year-old woman with a tracheal stenosis caused by recurrent lung cancer. After balloon dilation under endoscopic control, the Nitinol stent was implanted in the trachea. Dyspnea, stridor and bloody sputum were markedly improved after placement. However, two days after placement, giant granulation tissue was expectorated with coughing. Fortunately, acute airway obstruction did not occur. The Nitinol stent has a variety of excellent properties and is easy to manipulate. Although complications are rate for the Nitinol stent compared to other metallic stents, acute airway obstruction within three days after placement has been reported. To prevent acute airway obstruction due to mucoid impaction, bronchial toilet, nebulization and antibiotics are very important.

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A 49-year-old man had showed an abnormal shadow on a chest X-ray. Bronchofiberscopy revealed a string-like scar lesion in membranous portion of right truncus intermedius. A histopathological diagnosis of benignbronchial neurinoma was made by transbronchial biopsy. Only 13 documented cases have been reported in Japanese literature. Unlike the usual bronchial neurinoma, which grows like a polyp or dumbbell, the tumor extended into the bronchial mucosa, and resembled a string-like scar.

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A 67-year-old man was admitted to our hospital complaining of cough and bloody sputum. The chest radiograph and CT scan disclosed a nodular shadow with a clear margin in the right S^6. The patient was given a diagnosis of pulmonary aspergillosis, because Y-shaped hyphae were detected in the transbronchial lavage fluid and the anti-aspergillus precipitating antibody in serum was positive. Since the nodular shadow was localized in the right S^6, it was resected. The resected lung contained an encapsulated mass consisting of necrotizing brownish tissue. Histological examination revealed a fungus ball in the ectatic bronchus surrounded by inflammatory cell infiltration. This is a rare case of primary pulmonary aspergilloma developing in am otherwise healthy person.

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A 23-year-old man was admitted for detailed examinations of an abnormal shadow in the right middle lung field. Chest CT scan revealed mucoid impaction and surrounding hyperlucency in the right S^3b and S^5 areas. Bronchofiberscopy found no orifices of the right B^3b and B^5. Bronchial atresia was diagnosed. The patient underwent right upper lobe anterior subsegmentectomy and middle lobectomy. This was a rare atypical case of bronchial atresia with two lesion in each lobe.

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A 46-year-old woman was admitted to our hospital, complaining cough and chest pain. She had already suffered lung abscess two times and more since infancy. A cystic mass shadow was detected in S^<10> of the left lung on chest X-ray film and CT scan. Aortography showed that the arterial supply into the mass was provided by branches of the abdominal aorta. Dynamic CT scan infusing a contrast medium into the abdominal aorta showed that the flow returned to the left atrium via a pulmonary vein. Surgery demonstrated that an abnormal mass was separated from a small area of lower lobe by fibrous tissue. Extralobar pulmonary sequestration was diagnozed. In adults, extralobar pulmonary sequestration are almost asymptomatic, but this case had repeated pulmonary infection.

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A 63-year-old woman who suffered from aspiration pneumonia after near-drowning was transferred to our hospital because of increasing cough and bloodysputm. A wide infiltration in the right middle and lower lung field was pointed out on chest X-ray and computed tomography. Immediately upon admission, therapeutic bronchoalveolar lavage(BAL)with a flexible bronchofiberscope was done under general anesthesia, while the patient was treated with antibiotics and steroid hormone. The infiltration improved dramatically after the therapeutic BAL. Because it can remove the contaminating materials from the airway, BAL may be recommended as prophylaxis for aspiration pneumonia after near-drowning.

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Serum KL-6, SP-A and SP-D levels have been reported to be valuable indicators of the disease activity of interstitial pneumonia. We monitored there in a case of pulmonary alveolar proteinosis. A 67-year-old woman who presented with exertional dyspnea was found to have bilateral non-segmental reticular infiltration shadows in the middle and lower lung fields on her chest radiograph. Chest CT scan revealed diffuse ground glass opacities with thickening of the interlobular septum and a peripheral clear zone. Because pulmonary alveolar proteinosis was confirmed confirmed by bronchoalveolar lavage and transbronchial lung biopsy, total bilateral whole lung lavages were performed. The serum KL-6 level decreased after whole lung lavages and correlated with symptoms, opacities on the chest radiograph, and arterial blood gas measurements but the serum SP-A and SP-D level increased transiently after whole lung lavages. The serum KL-6, SP-A and SP-D levels may be useful monitoring markers for pulmonary alveolar proteinosis.

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