Objective. Four patients with bronchomalacia or cicatric stenosis who were treated with stent were reported. All of the 4 patients suffered restenosis after stent placement Case 1. A 48 years old male was suffered of bronchomalacia after carinal resection for lung cancer. While the metallic stent could dilate the stenosis temporally, he suffered fatal granulation stenosis at the metallic stent 12 months after the stent placement. Case 2. A 56 years old female with cicatric stenosis of trachea due to tuberculosis was treated with Dumon stent. Four months after the stent placement, granulation stenosis was occurred at the peripheral edge of the stent. While another longer Dumon stent was replaced at the stenosis, granulation stenosis at both edge of the stent was occurred, necessitating removal of the stent. Nine years after removal of the stent, the patient is well without restenosis. Case 3. A 27 years old male with cicatric stenosis of the left main bronchus due to tuberculosis was treated with Dumon stent. Three months after the stent placement, granulation stenosis was occurred at both edge of the stent, necessitating removal of the stent. Nine years after removal of the stent, the patient is well without restenosis. Case 4. A 67 years old male with cicatric stenosis at the anastomosis after right upper sleeve lobectomy for lung cancer was treated with Dumon stent. Six weeks after the stent placement, granulation stenosis was occurred at the central edge of the stent. Conclusion. While it is already known that the metallic stent is out of indication for tracheobronchial stenosis due to cicatrie stenosis, a Dumon stent could also cause the granulation stenosis at the edge of the stent, due to the pressure of stent for tracheobronchus.(JJSRE. 2007;29:7-13)

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Mitomycin C is an anti-tumor agent that acts as an alkylating agent cross-linking DNA and thereby inhibits DNA synthesis. It has been proven to be a potent inhibitor of human fibroblasts and was primarily used in ophthalmology successfully for many years. Preliminary results using mitomycin C for laryngotrachial stenosis have shown promise in recent clinical trials. However, topical therapy with mitomycin C for tracheobronchial stenosis has not been reported previously in Japan. In this study on topical therapy with mitomycin C obtained relief from dyspnea in all 5 patients, with minimal complications. Therefore, further clinical trials and extended follow-up studies are needed to prove its efficacy and safety for tracheobronchial stenosis. (JJSRE. 2007;29:14-19)

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The original purpose of airway stents is to maintain the lumen by dilating sites of stenosis. However, stents can also be modified for applications in standard surgical treatments. For example, in cases of airway reconstruction for infiltration of thyroid cancer into the trachea in which extensive airway resection is necessary, the application of internal stents enables patch graft reconstruction and eliminates the need for segmental resection, thus reducing operative stress and risks. Following this procedure, patients require only outpatient visits during the course of the development cicatricial formation. In cases of infiltration of esophageal and lung cancer into the airway, the use of stents improves dyspnea caused by airway stenosis and dysphagia caused by tracheoesophageal fistula, and thus enables subsequent radiation therapy and chemotherapy. Patients who underwent these treatments demonstrated a survival advantage of 3 months while maintaining their QOL. In addition, the use of a Y-shaped silicone stent in which one end was modified and closed enables maintenance of the airway of healthy lungs by inhibiting the spread of tumors from the main bronchi into the trachea, and promotes granulation in cases of post-pneumonectomy bronchial stump fistula by reducing air fistula. In cases of stenosis caused by tumor infiltration or compression from outside of the airway wall, stent diameter must be selected on a millimeter scale in order to ensure airway maintenance without excessive dilatation. Bronchoscopic ultrasound enables measurements of the internal diameter of the dilated airway in addition to observations of the structure of the tracheal wall and the condition of areas surrounding the airway, and is thus essential for preventing granulation, perforation, and migration of stents. (JJSRE. 2007;29:30-37)

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Background. Allergic bronchopulmonary aspergillosis by (ABPA) is a hypersensitivity disorder caused by Aspergillus, and Aspergillus fumigatus is the major cause of ABPA. Case. A 76-year-old woman was admitted to our hospital with cough and exertional dyspnea. Chest X-ray film and computed tomography revealed bilateral infiltrative shadow accompanied by peripheral fine nodular opacities. This patient also had peripheral eosinophilia, increased serum levels of IgE-RAST against Aspergillus fumigatus, a positive immediate skin reaction against Aspergillus fumigatus, and a positive test for antibodies against Aspergillus fumigatus. Bronchofiberscopy demonstrated mucoid impaction. Since Aspergillus terreus was observed from a plug extracted by bronchofiberscopy and from sputum, ABPA caused by Aspergillus terreus was suspected. Mycobacterium avium-intracellulare complex was also detected from a plug extracted by bronchofiberscopy and from sputum. Administration of oral and inhalational corticosteroid, (3-stimulator, and oral itraconazole induced improvement of symptoms and the abnormal laboratory findings. Conclusion. We reported a case of ABPA caused by Aspergillus terreus.(JJSRE. 2007;29:41-45)

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Background. We report a case of inflammatory myofibroblastic tumor occurring as a polypoid endobronchial lesion. Case. In a 36-year-old man, chest X-ray film revealed an abnormal shadow in the right upper lung field. Chest computed tomography (CT) scan showed a 2-cm nodule in the right upper lobe (S^2) suggesting that the right B^2_bb bronchus was obstructed by the mass. Bronchoscopy revealed a polypoid mass obstructing most of the orifice of the right B^2_b bronchus. The right upper lobectomy was performed and a final diagnosis of inflammatory myofibroblastic tumor was established. Conclusion.The radiologic differential diagnosis of inflammatory myofibroblastic tumor covers a broad area because typical lesions may be characterized as a solitary pulmonary mass. However, inflammatory myofibroblastic tumor should be included in the differential diagnosis when a polypoid endotracheal/endobronchial mass is seen.(JJSRE. 2007;29:46-49)

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Background. There are few reports of foreign body aspiration in a healthy adult; we add one with the case of a man who had only mild symptoms due to a long-standing aspirated foreign body. Case. A 46 year-old man was referred to our hospital on the suspicion of foreign body aspiration. His past history was unremarkable except for the loss of metallic false teeth while sleeping, roughly two months previously. The patient had thought the teeth were lost in his bedding. At admission, he had only mild chest discomfort. His chest X-ray and computed tomogram showed a foreign body, which was found in the right lower lobe bronchus on bronchoscopic examination and easily removed with forceps. The dental bridge was about 2.5 cm in length. After extraction, bronchoscopic examination showed granulation tissue and hyperplasia in the right lower bronchus, but no stenosis. The patient was asymptomatic after the procedure. Conclusion. When there is a possible foreign body aspiration in a healthy adult, diagnosis may require chest X-ray and CT, with extraction by bronchoscopy. (JJSRE. 2007;29:50-53)

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Background. Drug-induced eosinophilic pneumonia can be caused by many medicines. We report a case of drug-induced eosinophilic pneumonia with wandering infiltrate induced by medicines used in the treatment of an upper respiratory infection. Case. A 68-year-old man had been treated with amoxicillin and Pelex granules for an upper respiratory infection. He then had a high fever and exertional dyspnea. A chest radiograph demonstrated infiltrative shadows wandering from the left upper lung field to the right lower lung field. Bronchoalveolar lavage findings indicated 25% eosinophils. We reached a diagnosis of drug-induced eosinophilic pneumonia because of the lymphocyte stimulation test for both medicines. After treatment with steroids, the clinical symptoms and radiographic infiltrates disappeared. Conclusion. We should consider that therapeutic preparations for upper respiratory infection can lead to eosinophilic pneumonia. (JJSRE. 2007;29:54-57)

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