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2003 Volume 25 Issue 7 Pages
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2003 Volume 25 Issue 7 Pages
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Article type: Appendix
2003 Volume 25 Issue 7 Pages
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2003 Volume 25 Issue 7 Pages
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Article type: Index
2003 Volume 25 Issue 7 Pages
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Article type: Index
2003 Volume 25 Issue 7 Pages
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[in Japanese]
Article type: Article
2003 Volume 25 Issue 7 Pages
493-494
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[in Japanese]
Article type: Article
2003 Volume 25 Issue 7 Pages
495-496
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Keisuke Miwa, Shinzo Takamori, Akihiro Hayashi, Mari Fukunaga, Kazuo S ...
Article type: Article
2003 Volume 25 Issue 7 Pages
497-502
Published: November 25, 2003
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Airway stent therapy is a palliative measure for patients with inoperable malignant airway stenoses. However, it is an important method to avoid dyspnea and maintaining quality of life. Although various stents have been developed, the selection among them has been controversial. Purpose. Our management procedure for patients with severe malignant airway stenoses are described. Case 1. A 56-year-old man with recurrent esophageal cancer complained of a dyspnea due to severe stenosis of the lower trachea. The patient's respiratory status was improved by placement of Dumon Y stent into the trachea after laser ablation. Case 2. A 60-year-old woman with invasion to the left main bronchus of esophageal cancer complained of a dyspnea due to left lung atelectasis. The patient's respiratory status and left lung atelectasis were improved by placement of Ultraflex stent into the left main bronchus after balloon dilatation. Results. Both patients received stent placement safely and improved much in respiratory symptoms. Conclusion. We select the Dumon stent first and the Ultraflex stent second.
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Hiroyuki Izumi, Katsuo Kojima, Takehiko Shimoyama, Hideki Akamatsu
Article type: Article
2003 Volume 25 Issue 7 Pages
503-507
Published: November 25, 2003
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Dilation of the airway by means of stenting is a standard strategy for airway stenosis. The Dumon stent, a typical stent made of silicone, is usually inserted through a rigid bronchoscope, however that technique is unable to be performed in patients with permanent tracheal stomas. We need to consider the best way to manage stent insertion for those patients. Cases. We encountered two cases of tracheal stenosis with permanent tracheal stoma after surgery for hypopharyngeal carcinoma, and directly inserted Dumon stents into their tracheas. Patients were maintained with spontaneous respiration under intaravenous and inhalation anesthesia. Dumon stents were folded and directly held with Kelly forceps matched with the curve of the trachea. The stents were inserted through the portion of stenosis using video-fluoroscopy. Stentings were performed promptly and safely in both cases and their dyspnea improved distinctly after operation. Conclusion. Insertion of Dumon stent for patients with permanent tracheal stoma was performed easily using curved Kelly forceps. Grasping of the folded stent by Kelly forceps is the key point of the technique.
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Takuji Fujinaga, Tatsuo Fukuse, Hiromi Wada
Article type: Article
2003 Volume 25 Issue 7 Pages
508-512
Published: November 25, 2003
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The constriction and deformation of the central airway can easily cause suffocation with bleeding or secretion, and patients feel severe dyspnea. Purpose. Discussion of the indications, technical methods and problems in central airway stenting. Results. If a radical operation is impossible and improvement by other therapies takes excessive time, stenting is indicated. Stenting into the central airway can bring about a dramatic improvement. The most serious complication during stenting is respiratory failure, and PCPS can reduce the risk. Conclusion. In the two cases presented, stenting into the central airway resulted in dramatic improvement. To avoid the risk of respiratory failure, adequate support such as PCPS should be prepared before stenting.
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Eiji Monma, Shigemi Ishikawa, Tatsuo Yamamoto, Masataka Onizuka, Yuzur ...
Article type: Article
2003 Volume 25 Issue 7 Pages
513-519
Published: November 25, 2003
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Patients with major airway obstruction require rapid palliation of their symptoms by means of a simple technique. Bronchoscopic electrocautery is the application of high-frequency electrical current to the tracheobronchial tree. Electrocautery has been widely used in gastroenterology, and now an insulated video bronchoscope makes its use possible in the narrow endobronchial space. Purpose. To evaluate the efficacy of bronchoscopic electrocautery, the treated cases in our institute were reviewed. Methods. An electrical surgical loop to snare pedunculated polyps or hot biopsy forceps through the bronchoscopic channel were used with current of 20-40 watts until sufficient blanching of the tumor surface became apparent. These procedures were carried out in combination with mechanical tumor removal. Results. We performed 14 procedures in 6 patients since 1999. All the procedures except one were performed under local anesthesia. Four patients had endobronchial granuloma which developed after tracheostomy, one hamartoma in the right B^4, and one endobronchial metastatic lesion from colon cancer. All the procedures were performed safely without any complications. None of the lesions recurred except the metastatic lesion for which repeated procedures were performed every 2 months during a one-year period. Conclusion . Bronchoscopic electrocautery is a simple, safe and inexpensive alternative to achieve immediate debulking of endobronchial obstructive lesions reducing danger of hemorrhage.
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Jun Araki, Toshiro Oda, Hiroyuki Minami, Seiji Nagashima, Sadahiro Asa ...
Article type: Article
2003 Volume 25 Issue 7 Pages
520-529
Published: November 25, 2003
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Stenting for severe airway stenosis always involves risk of death due to asphyxia. Safe placement of the stent in airway is essential. Purpose. In order to evaluate the usefulness of percutaneous cardiopulmonary support (PCPS) in stenting, we analyzed results in 10 patients who received placement of airway stents using the system. Methods. Between August 1998 and April 2003, 27 patients had stent placement for severe airway senosis. In 10 patients with life-threatening stenosis, we performed PCPS during stenting. Methods of cannulation for PCPS were veno-arterial bypass in 2 patients and veno-venous bypass in 8 patients. We evaluated SpO_2, blood pressure, PO_2, PCO_2, ACT, during the stenting procedure. Results. PCPS maintained good levels of SpO_2, blood pressure, PO_2 and PCO_2. The veno-venous bypass method yielded more stable data than veno-arterial bypass. Moreover, veno-venous bypass did not require suturing of the vessel after removal of the catheters, and facilitated catheterization. Conclusion. PCPS is useful for safe stenting. PCPS with a veno-venous bypass is more advantageous for stent insertion than PCPS with a venoarterial bypass.
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Masanori Nishikawa, Nobumasa Kakemizu, Mayumi Okamura, Yuichiro Sato, ...
Article type: Article
2003 Volume 25 Issue 7 Pages
530-537
Published: November 25, 2003
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Background. Endobronchial electrocautery using a polypectomy snare could be a useful tool for treating patients with airway obstructing polypoid tumors. Bronchoscopic polypectomy is a simple and inexpensive technique in both a plliative and curative treatment setting. Cases and Results. We performed bronchial polypectomies using a flexible bronchoscope and a polypectomy snare with local or general anesthesia in 8 patients with respiratory distress due to airway obstructing polypoid tumors. Bronchial polypectomies were performed with satisfactory results in 7 of 8 patients. One patient experienced an episode of significant bleeding, which was treated with laser coagulation. Four patients underwent subsequent anti-cancer therapy. One patient with endobronchial chondromatous hamartoma that was resected successfully, was healthy 28 months later. Conclusion. Endobronchial polypectomy through a flexible bronchoscope may be a useful palliative and curative technique in patients with polypoid tumors accessible with a snare.
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Hiroshi Okitsu, Kou Uyama, Hirokazu Takechi, Hisatugu Ishikura, Suguru ...
Article type: Article
2003 Volume 25 Issue 7 Pages
538-542
Published: November 25, 2003
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Case. A 52-year-old man who complained severe cough and stridor had undergone right upper lobectomy for Aspergilloma at age 43, and had stenosis in the right main bronchus caused by a deformation and granulation tissue that developed after operation. He was treated by endoscopic Nd-YAG laser treatment and insertion of an expandable metallic stent (EMS) and progressed. Bronchial stenosis caused by granulation appeared in the EMS indwelling portion occured at age 48, and insertion of EMS was performed again at another hospital. Chest CT and bronchoscopic examination showed a severe stenosis in the right main bronchus due to granulation tissue at the indwelling portion of the EMS. Under rigid bronchoscopy, we were able to remove one EMS by grasping forceps. We performed additional endoscopic Nd-YAG laser treatment for the granulation tissue, and observed the peripheral respiratory tract. Subsequent evaluation after 20 months revealed no recurrence. Conclusion. To treat granulation tissue causing bronchial stenosis due to the insertion of an EMS, the removal of the EMS by rigid bronchoscopy and endoscopic Nd-YAG laser treatment were useful.
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Koji Kanoh, Nobuoki Kohno
Article type: Article
2003 Volume 25 Issue 7 Pages
543-547
Published: November 25, 2003
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Case. The patient was a 50-year-old man with a mass lesion in the right lower lobe on a chest roentgenogram. The solid mass with an air bronchogram was 4 cm in diameter on a computed tomography image of the chest. Bronchoscopy was performed. In addition to cytology using a curette and a standard brush through the right B^7, the bifurcation between the right B^7 and the basal bronchus was penetrated using a needle brush because the lesion could not be observed in the bronchial lumen. Result. A diagnosis of small cell carcinoma was achieved only by the needle brush. Conclusion. The needle brush was a useful tool to diagnose the extrabronchial lesion.
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Takeaki Hiratsuka, Toshihiko Ihi, Yuka Kyoraku, Kenshi Kumamoto
Article type: Article
2003 Volume 25 Issue 7 Pages
548-552
Published: November 25, 2003
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Background. Gold sodium thiomalate and bucillamine are common anti-rheumatic drugs. We report two cases with rheumatoid arthritis who developed drug-induced pneumonitis during combined treatment with gold sodium thiomalate and bucillamine. Cases. In the first case diagnosed as bucillamine-induced pneumonitis, bilateral diffuse ground-glass opacities on chest computed tomography (CT) and high level of serum surfactant protein A (SP-A) were observed. After discontinuation of the drugs, the radiographic findings resolved rapidly. In the second case diagnosed as gold-induced pneumonitis, bilateral high density shadows along the bronchovascular bundles on chest CT and high levels of serum KL-6 and surfactant protein D (SP-D) were observed. After discontinuation of the drugs but continued administration of prednisolone, the radiographic findings improved gradually. Significant reductions in the serum level of KL-6, SP-A, and SP-D were observed in both cases after improvement of pneumonitis. Conclusion. Characteristic chest CT finding, i.e. ground-glass opacities in bucillamine-induced pneumonitis and high density shadows along the bronchovascular bundles in gold-induced pneumonitis, were observed in our cases. The serum levels of KL-6, SP-A, and SP-D may be useful markers of disease activity in patients with drug-induced pneumonitis.
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Seiji Mega, Kazumi Itoi
Article type: Article
2003 Volume 25 Issue 7 Pages
553-557
Published: November 25, 2003
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Background. Tracheobronchopathia osteochondroplastica (TBOC) is a relatively rare benign disease characterized by ectopic and multiple submucosal cartilaginous and/or bony nodules lining the trachea and/or the bronchi. To date, about 370 cases of this disease have been reported in the world literature, while in Japan over 130 cases have been reported. Case. A 71-year-old man had been scheduled to undergo surgery for prostate carcinoma. However the operation had to be suspended because of difficulty in intubation. Subsequently, tracheobronchopathia osteochondroplastica was diagnosed. Conclusion. TBOC is often accompanied by malignant tumors in particular lung cancer. Including the present case, 133 TBOC cases have been reported in Japan from 1938 until 2003, 28 of which were accompanied by malignant neoplasms, 14 of which were lung cancer. Clinical features were briefly reviewed. We reviewed 133 cases in the Japanese literature.
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Akihiro Tsujita, Shoji Ohno, Shinya Harigae, Masashi Bando, Katsuhisa ...
Article type: Article
2003 Volume 25 Issue 7 Pages
558-563
Published: November 25, 2003
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Case. A 41-year-old woman underwent hysterectomy on a diagnosis of uterine myoma in another hospital at the age of 37. She was admitted to our hospital because of cough and bloody sputum. Fiberoptic bronchoscopy was performed because her chest X-ray film revealed multiple nodules in both lungs. A white and soft polypoid tumor arose from the left lower bronchus. The biopsied specimen revealed malignant cells with spindle-shaped nuclei. A diagnosis of leiomyosarcoma was confirmed by immunohistochemical examinations. It was confirmed as a metastatic tumor by re-evaluation of histology of the previous hysterectomy specimen. Enucleation of the tumor in the right lung and left lower lobectomy were performed. Although her symptoms were relieved after the operation, she died of metastatic disease, 3 years after resection of the metastatic lesion. Conclusion. In uterine leiomyosarcoma, endobronchial metastasis is relatively rare.
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Shigeki Sugiyama, Keizo Inagaki, Yoshikazu Naka
Article type: Article
2003 Volume 25 Issue 7 Pages
564-566
Published: November 25, 2003
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Background. During transoral bronchoscopic examination under local anesthesia, we do not use any premedication for oral secretions. We encountered a patient with oral secretions that increased without atropine sulfate for premedication. The side effects of atropine sulfate are known to include glaucoma and incontinence in elderly patients. Purpose. We should not give atropine sulfate to elderly patients due to the risk of glaucoma and incontinence. For continuous suctioning of oral secretions, we insert a disposable dental suction tube to the oral cavity. Methods. In 32 cases, time-sequence changes in percutaneous oxgen saturation, pulse rate and blood pressure were measured during bronchoscopic procedures without atropine sulfate and a disposable dental suction tube was inserted. Supplemental oxygen was administrated transnasally at a now rate of 3 l/min. Results and Conclusions. There was no significant difference in the time required for measurement with a dental suction tube to continuously vacuum oral secretions. The disposable dental suction tube was highly effective during transoral bronchoscopic procedures even when atropin sulfate wasnot given as a premedication.
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Taeko Shirakawa
Article type: Article
2003 Volume 25 Issue 7 Pages
567-574
Published: November 25, 2003
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[in Japanese]
Article type: Article
2003 Volume 25 Issue 7 Pages
575-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
576-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
576-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
576-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
576-577
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
577-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
577-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
577-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
577-578
Published: November 25, 2003
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
2003 Volume 25 Issue 7 Pages
578-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
578-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
578-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2003 Volume 25 Issue 7 Pages
578-579
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
579-
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Article type: Article
2003 Volume 25 Issue 7 Pages
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2003 Volume 25 Issue 7 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2003 Volume 25 Issue 7 Pages
579-580
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Article type: Article
2003 Volume 25 Issue 7 Pages
580-
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Article type: Article
2003 Volume 25 Issue 7 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
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Article type: Article
2003 Volume 25 Issue 7 Pages
580-581
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2003 Volume 25 Issue 7 Pages
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2003 Volume 25 Issue 7 Pages
581-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 25 Issue 7 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
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2003 Volume 25 Issue 7 Pages
581-582
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