Background. Recently, thoracoscopic pleural biopsies have been widely used for the diagnosis of pleural effusion. We have tried pleural biopsies with thin thoracoscopes, so called needlescopic surgery, for the diagnosis of pleural lesions. Patients and Procedures. Between April 2003 and July 2005,17 patients (14 male, 3 female) underwent pleural biopsies under epidural anesthesia, in the operation room of our hospital. The thin thoracoscopes were inserted into the thoracic cavity under ultrasound guidance. After removing pleural effusion, pleural biopsies were performed. Results. The mean operation time was 61 minutes. Pathological diagnosis were malignant mesothelioma in 4 patients, fibrous pleuritis in 4, carcinoma in 3, malignant lymphoma in 2 and tuberculosis in 1. There were no major complications. All but one, which was found to be malignant lymphoma, was easily diagnosed by frozen section diagnosis during operation. Conclusion. Our diagnostic method using thin thoracoscopes, under epidural anesthesia, is effective and safe.

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Background. During bronchoscopic examination, additional lidocaine is usually administered into the trachea and bronchus by injection through the working channel with a syringe. The bronchoscopic injection itself can induce coughing and is associated with uneven anesthesia in the trachea and bronchus. We designed a novel Bronchoscopic Catheter Spray Device(BCSD) and reported its safety, that it provides uniform anesthesia and the possibility of sputum aspiration. Purpose. We also reported the results of prolonged monitoring of oxygen saturation in blood(SpO_2) and heart rate, carried out a questionnaire investigation of patients and studied the structural advantage of BCSD for iatrogenic contamination. Methods. Patients were randomly separated into two groups, 14 patients with the conventional method(Group I) and 13 patients with the BCSD method(Group II). We performed prolonged monitoring of SpO_2 and heart rate, and examined hypoxia episodes and heart rate elevation. We examined coughing episodes and made a subjective discomfort questionnaire investigation of patients using a ten-stage evaluation classification. Results. The 4% lidocaine doses during examination of Groups I and II were 11.6 ± 4.5 ml and 2.0 ± 0.8 ml, respectively (p<0.01). The <2%SpO_2 degradation counts/h were 19.3 ± 17.6 and 11.6 ± 9.4, respectively. The >6 bpm heart rate elevation counts/h were 26.9 ± 17.5 and 22.4 ± 15.8, respectively. The coughing counts were 62.1 ± 62.5 and 27.2 ± 36.0, respectively. The discomfort questionnaire scores were 6.0 ± 1.8 and 4.2 ± 2.5, respectively (p < 0.05). Conclusions. The BCSD method decreased the lidocaine dose significantly and reduced coughing and discomfort of patients. During BCSD anesthesia, the patient's SpO_2 did not deteriorate because of oxygen administration. Conventional treatment impels saprophytic bacteria back into the forceps channel to the trachea and bronchus. However, we considered that the possibility of iatrogenic contamination was extremely low in BCSD because of the independence of the medication and aspiration routes.

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Background. It is difficult to choose the optimal therapeutic modality for lung cancer in aged patients or those with poor performance status(PS). We report the successful use of bronchial arterial infusion with cisplatin and docetaxel in an elderly patient with poor PS suffering from squamous cell carcinoma of the lung. Case. An 80-year-old man was admitted for investigation of a mass in the hilum of the right lung. The mass obstructed the right main bronchus and was diagnosed as squamous cell carcinoma of the lung, cT3N1M0, stage III A. Initially we infused 60 mg of cisplatin and 40 mg of docetaxel via the right bronchial artery because of the patient's very poor PS(PS4). After BAI therapy, the tumor disappeared completely without major side effects, and the patient's PS and respiratory status improved to PS 1. Therefore we performed radiation therapy after BAI. Six months after BAI, the patient is alive without recurrence. Conclusion. BAI with cisplatin and docetaxel may be an effective therapeutic modality for patients with lung cancer showing poor PS.

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Case. An abnormal shadow of the right upper lobe was discovered on a chest X-ray from a 63-year-old woman at an annual physical check-up. Chest CT scan revealed atelectasis of the right S^3 and a protruding tumor in the right upper lobe bronchus. Bronchoscopy revealed a 1.5 cm tumor at the bifurcation of B^2 and B^3 that easily bled. Biopsy showed bronchial papilloma. Because the tumor was difficult to excise bronchoscopically, we performed a right upper lobectomy. Histological examination revealed a mixed squamous cell and glandular papilloma. Conclusion. Solitary bronchial papilloma is a rare tumor type, and most originate from a central bronchus. Mixed squamous cell and glandular papilloma is especially rare. Bronchoscopic resection and laser ablation have recently been applied in some cases, but surgical resection is considered the most appropriate treatment with respect to curability.

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Background. It is considered that the number of patients with synchronous and metachronous lung double cancer is increasing along with an increase in the incidence of lung cancer and a advances in diagnosis and treatment. Case. The patient was a 58-year-old man. In 1995, he underwent right upper lobectomy and lymph node dissection for adenocarcinoma(stage Ib) at the right lung apex. In May 2005, he visited our hospital complaining of left blepharophimosis and lacrimation. Chest X-ray and CT films showed a mass shadow at the left lung apex, and he was admitted for detailed examinations. Based on findings of examinations such as bronchoscopy, a diagnosis of squamous cell carcinoma, stage IIIb was made. Conclusion. We report this patient with metachronous lung double cancer that developed after a 10-year cancer-free period from the first diagnosis of cancer.

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Background. Bronchial artery embolization(BAE) is widely perfomed when hemoptysis is not controlled during bronchofiberscopic treatment. In most cases of sudden massive hemoptysis, it is difficult to perform BAE immediately. Recently, we encountered a case of lung cancer in whom we controlled bleeding with an endobronchial Watanabe spigot (EWS) which was developed to improve intractable pneumothorax, pulmonary fistula or pyothorax with bronchial fistula. Case. The patient was a 63 year-old man who was given a diagnosis of double lung cancer of left S^8 and S^<1+2>. We performed left lower lobectomy and upper partial resection with mediastinal lymph node dissection. Seven months later, he presented with massive hemoptysis. We performed transbronchial suctioning of the hemorrhage and sprayed dilute epinephrine and thrombin solution to control the continuous massive bleeding in left B^3 for an hour. However, we could not stop the massive bleeding. Therefore, we attempted bronchial occlusion using EWS for left B^3a and the bleeding reduced greatly. Two days later, we performed bronchial artery embolization and confirmed the hemostasis by bronchofiberscopy. Conclusion. EWS can be effective for massive hemoptysis which can not be controlled by the bronchofiberscopy alone.

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Background. The placement of a Montgomery T-tube(T-tube), which is indicated for tracheolaryngeal stenosis, normally requires temporary suspension of mechanical ventilation. However, we developed a novel technique for T-tube stent insertion which permits continuous ventilation. Method. First, the T-tube is mounted on a spiral tube (4 mm in luminal diameter size) through the horizontal limb and distal end of the T-tube and is remodeled into a straight-line shape by a stylette insertion into the spiral tube. Thus prepared, the T-tube is advanced through the stoma until the oral side of the T-tube enters the trachea. Then the stylette is removed, which makes the tube form a T-shape. The spiral tube is extubated gradually under continuous ventilation. Conclusion. Our novel technique is useful method for physicians with little experienced in T-tube placement.

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