In recent years, the bronchoscope has undergone remarkable progress. We describe the development and future of the convex scanning type ultrasonic bronchofiberscope and optical coherence tomograpy (OCT). The convex scanning type ultrasonic bronchofiberscope is a new bronchoscope with a convex scanning type ultrasonic probe attached at its tip. This equipment always allows observation in B mode and color Doppler mode, showing the lymph nodes and tumors around a bronchus, while color Doppler mode allows differentiation with vessels. Furthermore, real time ultrasound guide transbronchial aspiration cytology (TBAC) is possible by using a 2.2 mm biopsy forceps channel, and it is expected to be applied to localization diagnosis of a lymph nodes or qualitative diagnosis. OCT is advanced technology in the field of optical measurement, allowing tomographic images with a spatial resolution of 10 μm, which is ten times higher than the resolution of ultrasound. With the development of a narrow OCT probe which can be used under a bronchofiberscope, research has been started toward clinical application in the fields of respirology and gastroenterology. The advanced resolving power of OCT is expected to allow the detection of lesions which were difficult to detect by conventional bronchoscope, and more exact depth diagnosis. In the near future it may become possible to obtain a histological diagnosis by OCT image without performing a biopsy (optical biopsy).

View full abstract

Generally, it is difficult to observe the mucosa of the tracheobronchial wall in the frontal view by a conventional bronchoscope. Since 1998, we have studied about the changes of bronchial mucosa by a high magnification bronchovideoscope (side-viewing type) in order to elucidate fine mucosal changes caused by various respiratory diseases. We have used three prototypes of a high magnification bronchovideoscope, those are named XBF-200HM1, XBF-200HM3 and XBF-240HM5 (Olympus Co. Ltd.) in manufacturing order. XBF-200HM1, the first prototype of high magnification bronchovideoscope, had only side-viewing high magnification system. Therefore, we could not realize precise region in the tracheobronchial tree. In addition, intubation tube was necessary for insertion into the trachea. The image fiberscope for orientation was equipped in the second prototype XBF-200HM3. The operator could easily insert into the trachea and approach to the lesion by using this front-viewing system. In the third prototype XBF-240HM5, the side-viewing magnification system was equipped in front of the front-viewing system. The angle of light axis of sideviewing system was modified so that two images could overlap each other. These technical improvements enabled us to observe the tracheobronchial lesions precisely and repeatedly. The remained problems of XBF-240HM5 are that the external diameter is 6.2 mm and that the observation depth is fixed between 1 and 4 mm. We intend to clarify the fine mucosal changes of respiratory diseases, in directing to our attention to epithelial findings and vascular findings.

View full abstract

Background. Endobronchial Ultrasonography (EBUS) supplies cross sectional images of tracheobronchial wall and peri-bronchial mediastinal structures. We assess usefulness of pre-operative EBUS for determination of depth of tumor invasion. Thirty-seven lesions were registered for this study. Thirty-two in 37 lesions had correct diagnosis in depth of tumor invasion. In other 5 lesions, 3 lesions were carcinoma in situ. One lesion was diagnosed to invade beyond adventitia whereas this lesion wes invaded to adventitia not beyond adventitia histopathologically. The residual one lesion was diagnosed to invade to adventitia whereas this lesion wes invaded to submucosa not beyond cartilage histopathologically. The reason of overdiagnosis of last lesion was impossibility of differential diagnosis between tumor invasion and lymphocyte infiltration.

View full abstract

The fluorescence bronchoscopy has increased the detection rate of superficial early lung cancers that have only subtle changes in mucosa. In our institution, 11 carcinoma in situ and 2 squamous cell carcinomas were detected only by fluorescence bronchoscopy, which were invisible by conventional white light bronchoscopy. If the depth of tumor invasion was intra-cartilaginous by endobronchial ultrasonography (EBUS), indicating that the tumor was contained within the mocosa and/or submucosa, the lesion was selected for a suitable candidate for PDT. Most of the patients treated with PDT demonstrate good prognosis, but some cases show recurrence shortly after successful PDT. These patients showed positive telomerase protein expression in non-cancerous bronchial epithelia before cancer development, while none of patients who achieved long-term CR showed positive telomerase protein in any part of the bronchial epithelia. We propose that telomerase protein expression in bronchial epithelia in situ may become a possible marker of developing lung cancer.

View full abstract

We report on the successful placement of silicone stents using a MITSFIB (Miyazawa Ikeda Triple Sheath Flexi-rigid Interventional Bronchoscope). These are sterile, disposable sheaths. The widest of these is used for initial insertion into the trachea to maintain air-flow, the second sheath is utilized for the loading of the folded silicone stent. The narrowest sheath is used to deploy the stent and for visual confirmation of correct positioning of the stent. This performed via flexible bronchoscope through this tube. This technique allows for stenting to be performed even when rigid bronchoscopes are impossible to insert, i.e., neck injuries or laryngectomy. In our opinion, this method requires the physician having had suitable training in the use of a rigid bronchoscope.

View full abstract

Background. At the moment, several models of stent exist that are used in the patients with benign and malignant airway stenosis, in order to improve symptoms and to maintain a satisfactory patent airway. Purpose. We reviewed our cases of stent and other reports of airway stent therapy, and discussed which type of stent should be inserted in the different types of airway stenosis. Methods. We inserted various types of airways stents to 50 patients who had inoperable central stenosis with important symptoms of respiratory difficulty. With respect to the cause of the stenosis, 2 patients were by benign disease, while the rest was by malignant disease. Thirty-three patients were placed with metal stents (modified Gianturco Z stent: 19; Spiral Z stent: 14; and Ultraflex stent: 4) and the rest of the 17 patients were placed with silicone stents (Dumon stent: 15; Dynamic stent: 1; and Montgomery silicone T tube: 1). Results. All the patients had an immediate relief of dyspnea after the stent placement. Complications after the metal stent placement were migration, mild hemorrhage and granulation tissue formation, with a complication rate of 16%. With silicone stent, the rate of complications was 59%, with mucus retention, displacement, granulation tissue formation, hemorrhage, laryngeal edema and laryngeal pain. However silicon stent's complications were not so serious in comparison with the complications of metal stent. About the patient's prognosis, both patients with benign stenoses survived to over of 10 years after the stent insertion. The average survival time of the patients with malignant stenoses were about 198 days, although 6 patients managed to survive over one year. Of this 6 patients, 4 had the diagnostic of lung cancer, and were treated with combined radiotherapy and chemotherapy after the stent's placement. A lethal hemoptysis occurred in 5 patients between 2 and 10 months after stenting. These five patients were treated with metallic stent placement and radiotherapy. Conclusion. All the types of stents that we used were well tolerated and showed to be very effective in the treatment of the airway stenosis our long-term observation. In our study the stent of Dumon was safer than metal stent, also can be removed and repositioned. For that reason we considered that Dumon's stent is the first choice of treatment as much in both benign and malignant airway stenosis rather than metal stent.

View full abstract

Purpose. To evaluate the feasibility and efficacy of the spiral Z stent in multi-institutional prospective study. Patients and Methods. Patients who have dyspnea from malignant airway stenosis and are candidate for airway stents insertion were treated with Spiral Z stents, with local anesthesia in 25 cases and with general anesthesia in 16 cases. Results. Sixty spiral Z stents were placed to trachea to bronchi for 41 patients with few complications. The degree of airway stenosis and the WHO dyspnea index were improved significantly up to 2-3 months after insertion of this stents. Conclusion. Spiral Z stent is safety and effective for relieve symptoms of the patients with malignant airway stenosis.

View full abstract

Stent placement has been widely performed in these days, but indication of this procedure is not clearly shown. In our hospital, we decided the indication as follows, 1) A patient with severe stenosis of central airway presenting dyspnea and flow limitation on flow-volume curve. 2) Prognosis shall be prolonged by stent placement. But what factors are to affect the patient's prognosis is unknown. We made a retrospective study on our 40 patients with central airway stenosis treated by air way stents. These patients include 24 lung cancer, 11 esophageal cancer, 3 thyroid cancer, 1 malignant thymoma, 1 malignant melanoma. Their age is ranged 42 to 83, and 32 male and 8 female. Their survival was compared using Kaplan-Meier method according to age, performance status after stent placement, additional therapy. As a result, the survival is significantly better in patients in good performance status (1 or 2), and patients undergone additional therapy (chemotherapy or radiotherapy). And 39 in 40 patients was treated with silicone stent. Only 3 patients was treated with metallic stent. Besides metallic stent was used combined with silicone stent in 2 cases. Silicone stent is bio-compatible and removable, and we think silicone stent should be first choice and metallic stent should be used only in cases that we can't use silicone stent.

View full abstract

In general, co-operation of anesthesiologists with bronchoscopists in the operating theater is rare because there are only several bronchoascopists in hospital. As it is difficult for the bronchoscopists to perform bronchoscopy lor diagnosis and treatment of airway troubles occurring in the operating theater, which should be managed promptly, anesthesiologists should do. Therefore, bronchoscopic system must be substantially equipped. In addition, anesthesiologists should be familiar with the bronchoscopy system. Not often but important co-operation of anesthesiologists with bronchoscopists in the operating theater is general anesthesia for airway stenting and bronchoscopic laser surgery for obstructive airway tumor. These operations are accompanied with several high risks such as firing and bleeding in the airway, and the patient's condition is often poor. Therefore, we anesthesiologists and bronchoscopists should always have tight comminucations during the operation.

View full abstract

Background. Airway is a tubular lumen from the nasal cavity to bronchus. Commonly, otolaryngologists treat the upper airway and the lower airway is treated by bronchoendoscopists. A relationship between bronchoendoscopits and otolaryngologists appears to be very important because of the treatments with the airway. Objective. Getting through cases consulted from bronchoendoscopists to the department of otolaryngology, the requirement of a relationship between bronchoendoscopits and otolaryngologists was reviewed here. Subjects. Six patients consulted to the Department of Otolaryngology in past 5 years, Tokyo Metropolitan Ohtsuka Hospital from bronchoendoscopits were entered into this review. The diagnoses were nonspecific granuloma of the larynx in 3 cases, hemangioma of the larynx in 1 case, laryngeal papilloma in 1 case, and granular cell tumor of the larynx in 1 case. All patients underwent bronchoendoscopy and were unexpectedly diagnosed as laryngeal disease without lower airway lesion. Results. The laryngeal lesion of all patients arose in the posterior glottis or supraglottic area. Accordingly, all patients suffered no dysphonia, but were suspected as lower airway disease at first. Conclusions. Bronchoendscopy is certainly performed through the upper airway. Although otolaryngologists cannot observe the lower airway, bronchoendoscopists can observe the upper airway and happen to find a laryngeal lesion. As a result, a relationship between bronchoendoscopits and otolaryngologists is important from now on. (JJSB. 2003:25:649-65 1)

View full abstract

We emergency physicians do perform the bronchoscopy in critically ill patients in whom respiratory and circulatory status tend to be unstable in the Intensive Care Unit or Emergency Center. The bronchoscopy is an indispensable life-saving procedure for emergency respiratory care. Therefore, the bronchoscopy procedures should be performed by physicians who are skilled and trained in the use of this versatile instrument with close monitoring. The respiratory bronchoscopist usually does perform the bronchoscopic examination for diagnostic and therapeutic purposes of various pulmonary diseases. With trained personnel including emergency physicians and respiratory bronchoscopists available to provide optimal bronchoscopic procedure results in significant benefits for the severley ill patients.

View full abstract

The purpose of this study is to determine capability of the newly developed micro-computed tomography (micro-CT) system for imaging of the micro structures of normal preexising lung, the fundamental elements of broncho-pulmonary physiology. The basic components of the micro-CT system consist of a microfocus X-ray source, a specimen manipulator, and an image intensifier detector coupled to charge-coupled device (CCD) camera. Threedimensional (3D) image reconstruction was performed slice by slice. A standard fan-beam convolution and backprojection algorithm was used to reconstruct the center plane intersecting the X-ray source. The preprocessing of the 3-D image reconstruction included the correction of the geometrical distortions and the shading artifact introduced by the image intensifier. The main advances of the system is to obtain a high resolution minimal 5μm. In this work we report on preliminary studies carried out with the micro CT for imaging surgically resected, inflated and fixed lung specimens of a normal lung. We compared the CT images with soft X-ray images and stereomicroscopic findings of the specimens. Experimental results reveal ultra fine structures of lung tissues, such as alveolar walls, interlobular septa, and bronchioles. From the results, the micro CT system is expected to have interesting potentials for experimental and clinical investigations.

View full abstract

Background and Method. Analysis of the flow-volume curve can define the nature of airway stenosis. Stenting at the flow-limiting segment (the choke point: CP) is assessed. We determined the precise location of the CP using the flow-volume curve, pre and post-stenting in patients with extrinsic compression due to lung cancer. Results. We demonstrated distinct serial flow-volume curve patterns specific to the type of stenosis. In tracheal stenosis, marked reduction of expiratory flow with a plateau indicated fixed stenosis. In bronchial stenosis, expiratory flow with choking indicated dynamic stenosis. In extensive stenosis, severe reduction of expiratory flow indicated complex stenosis. After placement of a Dumon Y-stent at the CP, additional Ultraflex stents at migrated CPs due to malacia with destruction of the cartilage were required. Post-stenting, almost full-function patterns were observed. Conclusions. Stenting at the CPs improved expiratory flow limitation by increasing the cross-sectional area, and supporting weakened airway-wall.

View full abstract

The narrow-diameter video-thoracoscopy under local anesthesia has been spreading rapidly. Indication and endoscopists of this examination are different among institutions in this country. In the early stage of introduction of thoracoscopy in our hospital, the thoracic surgeons and the pulmonary physicians jointly examined the patients who could not get a definite diagnosis based on the examination of the pleural effusion samples. Now, our indication of thoracoscopy under local anesthesia has arranged for all cases with unilateral pleural and requiring treatement of the tube thoracostomy. And the respiratory physicians does all the examination. This thesis report to make clarify the indication for this examination by investigating the patients who underwent thoracoscopy under local anesthesia in our hospital. Patients who underwent narrow-diameter video-thoracoscopy (LTF: 240) under local anesthesia in this hospital endoscope room were divided into two groups of the first period and the latter period. We investigated primary diseases of the pleurisy, the period that we needed by a thoracoscopy, the definite diagnosis rate between two groups. The cases of 28 patients in the first period (from March, 2000 to April, 2002) and 22 patients in the latter period (from May to December, 2002) were qualified for the indication of this study. Underlying pleurisy primary disease were malignant tumor in 12 patients (42%) in the first period and 9 (41%) in the latter period. The average period from the first medical examination of pleuritis to the tube thoracostomy was 15.4 and 8.5 days, respectively. While that from admission to the tube thoracostomy was 10.5 and 5.6 days, respectively. The definite diagnosis rate was 24/28 (86%) in the first period and 17/22 (77%) in the latter period. In the latter period, the case that a diagnosis was possible only in pleural effusion cytological diagnosis was 6 examples (27%), other 16 examples did not take a cytological diagnosis in pleural effusion. No safety problems were observed in any patients both in the first and the latter periods. More early diagnosis of pleuritis becomes possible by implementation of thoracoscopy under local anesthesia by pulmonary physicians without waiting for the results of analysis of pleural effusion samples.

View full abstract

Medical thoracoscopy is used for the diagnosis of the pleural diseases, and there are many reports about usefulness of this method. Current situations of medical thoracoscopy for pleural diseases in Fujigaoka Hospital was examined this time. The diagnostic rates were 87.3% and 64.7% of the carcinomatous pleurisy by lung cancer and another organ cancer, respectively. In addition, they were 92.9% and 78.9%, when the diagnosis by pleural fluid cytology and macroscopic view of pleural space were added. Similarly, diagnostic rate of the tuberculous pleurisy was 89.6%. Tuberculous pleurisy featured many white small nodules, while papillary tumors of the size inequality were recognized in the carcinomatous pleurisy under the macroscopic view classification of this method. When the relationship between success of pleurodesis and macroscopic view of carcinomatous pleurisy was examined, it was found that there were many unsuccessful cases of pleurodesis in which small nodules occurred disseminatedly. Medical thracoscopy is a useful method for the diagnosis of pleural diseases with the high diagnostic rate, and pulmonologists can relatively perform it easily. So we strongly desire this method widely spread in Japan.

View full abstract

Purpose. We analyzed the surgical invasiveness of Video-assisted thoracic surgery (VATS) lobectomy for lung cancer, Patients and methods. We operated on 67 patients with non-small cell lung cancer who underwent VATS lobectomy (VL group) between August, 1996 and September, 2002. We compared the surgical invasive parameters with 53 patients who underwent lobectomy by conventional thoracotomy as a historical control group (CO group). Results. Eight patients in VL group converted to conventional thoracotomy due to the lymph node metastasis, adhesion of lung and thoracic cavity, positive lavage cytology, and the others. Intra-operative blood loss and the number of the patients who needed blood transfusion during their peri-operative periods in VL group were significitntly less than those in CO group (blood loss: 148 ±138 vs. 360±295g, P<0.01, transfusion: 0/59 vs. 5/53, p<0.05). Chest tube duration (3.0±2.3 vs. 3.9±1.9 days), ICU stay (1.5±1.1 vs. 3.0±1.4days). and post-operative hospital stay (13.5±4.2 vs. 16.6 ±5.5davs) in VL group were significantly shorter than those in CO group (P<0.05). Visual analog scale (VAS) on 7th post-operative day in VL group was significantly lower than that in CO group (2.7±4.6 vs. 19.0±14.6 mm, P<0.05). Although there were no significant difference in serum IL-6 and IL-8 between the both group, the maximum of white blood count (WBC) and C-reactive protein (CRP) in VL group were significantly lower than those in CO group (WBC:10900±2730 vs. 12100±3210/mm^3, P<0.05, CRP:9.58±3.19 vs. 13.2±6.5,P<0.01).The morbidity rate in VL group was significantly lower than that in CO group (23.7% vs. 50.9%, P<0.01). We experienced no operative death in VL group. Conclusion. We conclude that VATS lobectomy for non-small cell lung cancer patients is less invasive and safety procedure with less blood loss and minimal pain, that led them earlier discharge from the hospital.

View full abstract

[in Japanese]

View full abstract

Background and Objectives. Recently induction therapy for N2 non-small cell lung cancer has been considered to be standard strategy. However diagnosis for N2 using only the cervical mediastinoscopy is incomplete.This is because the #5, the #6, the both #8 and the both #9 lymph nodes can not be reached by this technique alone. Using both thoracoscopy and mediastinoscopy, we can diagnose not only these lymph nodes but also the pleural disseminations, the invasions to adjacent organs, or the intrapulmonary metastases. The efficacy and the safety of this method were assessed from our preliminary experiences. Patients and Methods. Ten patients underwent the technique until now. The indication was pre-treatment staging in 4 cases and restaging after induction therapy in 6 cases. The examination was performed under general anesthesia using the spiral-wire tube and the bronchial blocker with occlusion balloon for pne-lung ventilation. Results. Among 4 patients of ore-treatment staging, surgery was indicated in only one case. Induction therapy was carried out in one case due to the N2 and non-surgical treatments were carried out in 2 cases due to the T4. Among 6 patients of restaging after induction therapy, surgery was indicated in 4 cases. However, 2 patients didn't undergo surgery because of the persistent N2 or the PM2. Summary. Accurate staging could be done using simultaneous method of video-mediastionoscopy and video-thoracoscopy without serious complications in our preliminary experiences. Further study using larger number of patients is mandated.

View full abstract

Objective. We report our experience with mediastinoscopy. Methods. Between 1994 and 2002, 54 patients underwent mediastinoscopy. From 1998, all patients underwent video- mediastinoscopy. Indications for mediastinoscopy were staging and confirmation of histology of lung cancer in 43 patients and confirmation of histology of other diseases in 11 patients. Results. Diagnoses were lung cancer in 44 patients, sardoidosis in 4, metastatic cancer in 3, malignant lymphoma, bronchogenic cyst, reactive lymphadenopathy in each 1. In lung cancer patients, N0/N1/N2/N3 was respectively 4 patients/1/26/13. Four patients with NO and 4 patients with N2 underwent surgery. Two operative complications occurred: a transient left recurrent nerve palsy and a bronchial injury. Conclusions. 1. Mediastinoscopy was a useful method in staging of lung cancer, confirmation of histology of enlarged mediastinal lymph nodes. 2. Video-mediastinoscopy was effective in nodal assessment of mediastinum and was useful in teaching, improving manifestation, and techniques for biopsy.

View full abstract

Background. Mediastinal lymph node involvement diagnosis has been increasingly recognized important in the accurate staging and management of lung cancer. Objective. We evaluated the feasibility of video-assisted mediastinoscopic lymph node biopsy using Ultra-retractor^<[○!R]> (Ethicon Endo-Surgery) in primary lung cancer patients with positron emission tomography (PET)-positive mediastinal nodes. Patients and Methods. Primary lung cancer patients were administered 300 MBq of radioactive FDG. Radioactive distribution data was accumulated 60 minutes later. Transverse and sagittal images were reconstructed with a slice-thickness of 7.5 mm and interpreted by a single radiologist. Patients with PET-positive lymph nodes underwent mediastinoscopic lymph node biopsy using Ultra-retractor^<[○!R]> and 5-mm oblique video-thoracoscope. Results. From January 2001 through December 2002, 10 eligible patients underwent Ultra-retractor^<[○!R]> mediastinoscopic biopsy. There were 7 men and 3 women, with ages ranging from 47 to 79 (median: 69) years. Computed tomography showed suspicious metastatic mediastinal nodes in 8 patients. Biopsy took 35 to 65 minutes, with the average 46 minutes. There were no morbidity or mortality associated with the biopsy procedure. Positive mediastinal nodes were found in 4 patients: 2 in the pretracheal, one in the tracheobronchial, and one in the subcarinal nodes. Six patients were negative, and 5 of them underwent lobectomy and systematic node dissection. Two patients were positive for intrapulmonary nodes. One patient received radiotherapy for T4 disease. Conclusions. PET findings were correct for positive mediastinal nodes only in 40% of the patients. Mediastinal lymph node biopsy remains indispensable in correct node involvement diagnosis. Video-assisted mediastinoscopic node biopsy with Ultra-retractor^<[○!R]> was safe and sampled as far as subcarinal nodes.

View full abstract

Background/Purpose. Bronchial occlusion using EWS (Endoscopic Watanabe Spigot) is reported to be a useful therapy for intractable pneumothorax and pulmonary fistula. We improved the original method with the grasping forceps to the method with the guidewire and guide-catheter (i.e., push & slide method), and treated intractable pneumothorax and pulmonary fistula. We furthermore carried out a pilot study on clinical efficacy of bronchoscopic lung volume reduction by this method in six patients with severe emphysema. Method. [Push & slide method] First, insert the guidewire to the target segmental bronchus with a flexible bronchoscope under the fluoroscopic image. Next, pass through the end of the guidewire in the center of EWS. Finally, push and slide EWS with the guide-catheter into the target bronchus. Result. Fourteen patients with intractable pneumothorax, six patients with pulmonary fistula, and six patients with severe emphysema were treated. We could easily occlude the target bronchus by push & slide method for a short time. A total of 123 spigots was placed by 44 procedures. Thirteen spigots (10.6%) were migrated. Exacerbation of dyspnea occurred in four patients with intractable pneumothorax, and pneumothorax and pneumonia occurred in one patient, respectively. No other serious complications occurred. The air leakage was finally stopped in 17/20 cases. Pleurodesis was performed in 13/17 cases and recurrence of pneumothorax was occurred in three cases of the group without pleurodesis. After bronchoscopic lung volume reduction in five patients with severe emphysema, dyspnea slightly improved in four patients. The average percent predicted vital capacity (%VC) increased from 74.7% to 82.6% (difference 10.8%, p<0.05) and the average percent predicted forced expiratory volume in 1 s (%FEV_1) increased from 27.1% to 32.4% (difference 18.8% ,p<0.05). CT scans after bronchial occlusion showed no regional volume loss of the lung in all patients. Conclusions. Bronchial occlusion using EWS seemed to be an extremely useful in the treatment of intractable pneumothorax and pulmonary fistula. We considered that our improved method (push & slide method) was safe and reliable. It suggested that bronchoscopic lung volume reduction using EWS might be a new treatment of end stage emphysema.

View full abstract

We made the first report on bronchial occlusion with silicone. This method provides a surer and longer bronchial blockade than the conventional bronchial occlusion methods. So, As we developed Endobronchial Watanabe Spigot (EWS), a silicone-made bronchial filler. Bronchial occlusion with EWS has been performed on 88 patients in Japan, including 57 cases of intractable pneumothorax, 17 cases of pyothorax with bronchial fistula, 9 cases of pulmonary fistula after surgery, and 5 cases of bronchial fistula with other organs. Bronchial occlusion with EWS was tried in 85 cases and technical success was obtained in 82 (96.5%) cases. Air leakage was stopped in 36 (43.9%) cases and reduced in 31 (37.8%) cases with this procedure. There were no severe complications that related to these procedures. We conclude that bronchial occlusion with EWS provides an efficient bronchial blockade compared to conventional bronchial occlusion methods.

View full abstract

Three patients with non-small cell lung cancer were treated by gene therapy using p53 adenovirus vector (Ad-p53) in Tokyo Medical University Hospital. Case 1: A 68-year old male with c-stage IIIB adenocarcinoma in the right upper lobe was treated with gene therapy combined with chemotherapy of cisplatin (CDDP), because the prior chemotherapy had resulted progressive disease (PD). Two cycles of gene therapy suppressed the tumor growth and the therapeutic results were evaluated as stable disease (SD). Case 2: A 61-year old male with c-stage IIIB squamous cell carcinoma of the right upper lobe bronchus was treated with gene therapy combined with chemotherapy of CDDP for a regrowing tumor after chemo-radiotherapy. The therapeutic effect was evaluated as SD. Case 3: A 62-year old male with c-stage IIIB squamous cell carcinoma in the right upper lobe was treated with Ad-p53 for a relapsed tumor after chemoradiotherapy. The therapeutic effect of 4 cycles of gene therapy was SD. In these 3 patients no serious adverse events concerning administration of the vector were observed. One patient (case 1) has been surviving for 32 months after gene therapy without tumor growth or a distant metastasis.

View full abstract

Purpose. The purpose of this study was to assess the efficacy of endobronchial radiation therapy (EBRT) for the local control of endobronchial carcinoma by the tumor-regression-rate, and survival. Methods. The EBRT using ^<192>Ir-HDR was performed on 34 cases with primary lung cancer. The histological types were: 28 squamous cell carcinoma, four small cell carcinoma, one large cell carcinoma, and one adenoid cystic carcinoma. Assessment of efficacy was performed on each ordinary therapeutic group, early cancer group, surgery-combined group, and symptom control group. EBRT was administered by a dosage of either 15-18 Gy/3 Fr. or 10 Gy/1 Fr. and was combined with external beam radiotherapy of 40-70 Gy, in 31 cases (91%). Results. Bronchoscopic response rate (CR + PR) was 84% in over-all groups. This rate means that EBRT has a good potential to improve local tumor control. Survival rate of the ordinary therapeutic group (27 cases) was estimated at 44.3% in one year, 23.6% in two years, and 5.9% in three years. Mean survival time was 10.8 months. Long cancer-free survival was obtained in an early cancer group (3 cases). This proved the good efficacy of EBRT for the treatment of hilar early squamous cell carcinoma. In two cases of the symptom control group, the hemosputa could not be controlled sufficiently. In another two cases of surgery-combined group, bronchial or tracheal reconstruction procedures, which is troublesome even after the ordinary radiation therapy, was performed successfully. No serious problems were encountered surrounding the wound healing and patients recovered well. They survived a long time without recurrence. Conclusion. EBRT, including the combination of external beam radiation therapy, was useful to control a local growth of the endobronchial carcinoma. EBRT was also effective for the treatment of early squamous cell carcinoma. Surgical resection after the EBRT was well tolerated and contributed to the long survival.

View full abstract

With the progress of interventional bronchology, improvement of both fiberoptic bronchoscope and its image recording systems is remarkable. However, it must be said that the kind of tools using for endobronchial treatment through the channel of bronchoscope is insufficient in comparison with them for gastrointestinal endoscopes which cannot be referred to as enough. Usually, when removing endobronchial tumors several methods as following are considered. 1) Gnawing by biopsy forceps, 2) Cutting by high-frequency electrosurgical snaring, 3) Ablation by Nd-YAG laser or argon plasma coagulation, 4) Excavation by tip of rigid endoscope, etc. Although full use of these methods was made throughout of the procedure of endobronchial stent placement therapy, it took a long time during the dilatation of bronchial lumen which was nearly obstructed by the tumor. We felt the necessity of devising a certain new method. Then we devised a new endobronchial high-frequency electrosurgical scissors forceps. which fulfills the conditions that it can be easily operated through the channel of fiberoptic bronchoscope, it can control the bleeding, and it can remove comparative large quantities of endobronchial mass. While observing the lesion closely through the fiberoptic bronchoscone, basal part of tumor is cut by scissors forceps, bleeding points are coagulated by high-frequency electrocautery, and both function can be perfomed at the same time. Some improvement was added to the original trial product, and it became a clinically usable stage.

View full abstract

Since 1996, we have used intravenous midazolam sedation for bronchoscopy and abandoned atropine premedication. We reviewed our experience and assessed the efficacy and safety of our methods. We studied 905 consecutive patients who underwent beonchoscopy from April 1999 to December 2002. Patients were given no premedication. The procedure consisted of; 1) indwelling intravenous catheter and 4% lidocaine spray. 2) Oxygen was supplied at 2l/min by nasal cannula. Oxygen saturation, pulse wave and possible arrhythmia were monitored with pulse oxymeter. 3) Administration of midazolam by slow injection; 0.07 mg/kg (≦59 years), 0.06 mg/kg (60-69), 0.05 mg/kg (70-79), 0.04 mg/kg (80≦). No reverse with flumazenil was done in principle. All bronchoscopies except 3 patients were completed. Those 3 patients were not sedated adequately. There was no termination of procedure due to respiratory depression and without atropine premedication. Awake from sedation was smooth and no problem with outpatients. In Germany rigid bronchoscopy and occasional flexible fiberscopy were performed under general anesthesia with propofol and fentanyl by management of anesthesiologist. Although bronchoscopy under general anesthesia is ideal, we recommend intravenous midazolam sedation for bronchoscopy through our experiences concerning with Japanese medical circumstances.

View full abstract

From the results of Questionnaire survey by the Japanese Society for Bronchology in 2000 (229 hospitals), frequent complications during bronchoscopy were reported as pneumothorax, infection, and the third was asthma exacerbation (19.9%). Out of 1270 bronchoscopic examinations for diagnosis in recent three years 37 examinations (3%) were patients with asthma. In the 37 events, only one patient, who had not receive regular use of inhaled corticosteroid, suffered asthma exacerbation during this process. The important two points for safe examination were 1) good asthma control by inhaled corticosteroid and 2) short time examination by expert bronchologist. Saturation oxygen monitoring should be done during the examination, and nasal oxygen supply should be prepared. In cases of mild or moderate stable asthmatic patients, pre-medication of regular or double dose of inhaled corticosteroid or inhaled longacting β2 agonist on the day of examination, and of inhaled short-acting β2 agonist before 15 minutes were recommended. And in patients with unstable asthma, drip infusion of steroid, i.e. 40-125 mg of methylprednisolone and theophylline on the day of examination would be recommended.

View full abstract

Background. The ministry of health, labor, and welfare made the plan to install electronic medical record (EMR) system in 60% of the major hospitals by 2006. Routine practices of bronchoscopy will be involved into the new electronic system. Methods. The information system developed by the endoscope company is connected to the primary hospital system via web server system (intra-hospital). We designed the view screens on which doctors order broncoscopy, input information of execution, and edit reports. Results. EMR system went into operation June, 2003 at Tokyo Metropolitan Fuchu Hospital. EMR forces doctors to fill out the information which is necessary to perform bronchoscopy on the order view. We can edit more accurate reports on the display in comparison to paper-based repots. We present the experience of introduction of EMR and some problems from the point of view of bronchospists. Conclusion. Standardizations of bronchosopic findings, medical terms, and information are needed for inter-hospital networks, and the development of evidence-based medicine.

View full abstract