Twenty rats were exposed to a high concentration of nitrogen dioxide (50 ppm) during 1 and 3 days. Pathological changes in the central and peripheral airways were assessed semiquantitatively. This study showed that a high concentration of nitrogen dioxide could injure the central airways in rats as well as the peripheral airways, including the terminal and the respiratory bronchioles. Pathological changes in the peripheral airways were more prominent 3 days after exposure although the central airways showed some recovery. These preliminary studies indicated that pathological changes in isolated bronchiolitis seen in adult humans might be derived from the inhalation of toxic gas, with additional different response and recovery to acute injury in central and peripheral airways.

View full abstract

Fucose (Fu) and sialic acid (NANA) occupy terminal positions in the carbohydrate side chain of airway mucus glycoprotein (AMG). In order to clarify changes in the carbohydrate side chain of the AMG in chronic airway disease, and to examine the diagnostic values of Fu and NANA in sputum, we analyzed the Fu and NANA content of whole sputum and purified AMG in mucoid and purulent sputum from patients with chronic airway diseases with AMG of normal subjects as control. The AMG was isolated from the sputum of patients and from bronchial lavage fluid of normal subjects. 1. Results in mucoid sputum 1) The NANA/Fu ratio (M/M) of whole sputum was about 0.400, and correlated significantly with that of the AMG (r=0.845, n=65). A positive correlation was found between Fu or NANA levels, and NANA or Fu levels, dry weight and total protein, in whole sputum. These results indicate that both the Fu and NANA level of whole sputum reflect the amount of AMG, and that the NANA/Fu ratio of whole sputum reflects that of AMG, in mucoid sputum. 2) There was little difference in the NANA/Fu ratio of AMF among patients with chronic bronchitis, diffuse panbronchiolitis and bronchiectasis. On the basis of the NANA/Fu ratio of AMG, mucoid sputum was divided into two groups, Group I with an NANA/Fu ratio lower than that of the AMG of normal subjects and Group II with an NANA/Fu ratio equal to that of AMG of normal subjects. 3) The NANA/Fu ratio of AMG significantly increased to a normal level only in Group I but did not increase in Group II, 8 weeks after oral administration of 1, 500 mg of S-CMC/day. This result indicates that S-CMC normalizes the carbohydrate side chain of AMG. II. Results in purulent sputum In whole sputum, levels of NANA, dry weight, total protein and albumin in purulent sputum were about twice those of mucoid sputum, but there was no significant difference between fucose levels in mucoid and purulent sputum. The NANA/Fu ratio of whole sputum was significantly higher in purulent sputum than in mucoid sputum. NANA level was positively correlated with dry weight and total protein but Fu level was not with these parameters. It was postulated that the NANA/Fu ratio of whole sputum does not always reflect that of AMG, and the NANA level in whole sputum reflects the degree of inflammation in purulent sputum.

View full abstract

Endoscopically, swelling of the mediastinal and hilar lymph nodes is observed as extramural of the adjacent tracheobronchial wall. The correlation of the endoscopically evaluated extramural compression by enlarged lymph nodes with the size detected by CT and the metastasis-positive rate of the dissected lymph nodes was studied in 70 resected primary lung cancer cases. In all patients bronchofiberscopy with an Olympus BF-6C and CT scan with a 2-second scanner GE9800 were performed preoperatively. Endoscopically, extramural compression of the trachea from upper mediastinal nodes nos. 1&acd;6 was recognized in only one case, in which the node size was 5.0cm in largest dimension with metastasis. The mean diameter of the subcarinal node no.7 causing a widened carina was 3.76cm (p<0.001). All cases revealed metastasis. The mean diameter of hilar node no.10 causing endoscopically recognizable compression of the main bronchus was 1.95cm (p<0.02). The metastasis-positive rate of this node was 67%. The mean diameter of the interlobar node no.11 that induced endoscopically recognizable widening of the interlobar bifurcation was 1.81cm (p<0.05). The metastasis-positive rate of this node was 44%.

View full abstract

Bronchoscopy with curettage was carried out after bronchoscopy on 19 cases who were highly suspected of tuberculoma on chest X-ray. However, Mycobacterium tuberculosis was detected in only 2 cases by curette and 5 cases by bronchial lavage after currettage. In 12 other cases, tuberculoma was confirmed by surgical resection in 3 cases and a definitive diagnosis was not obtained in 9 cases. Compared with peripheral lung cancer, few positive results are obtained in tuberculoma. It was suggested that positive or negative biopsy results depend on which part of the coin lesion was scratched by curette. It was speculated that the center of the coin lesion and its surrounding, respectively, should be sampled for cases of tuberculoma and cancer.

View full abstract

A total of 1, 871 fiberoptic bronchoscopy procedures were performed for diagnostic or therapeutic purposes in 1984 and 667 bacteriological studies on bronchoalveolar lavage fluid (BALF), including smear tests and cultures for mycobacteria, were undertaken. These studies revealed a total of 60 cases of 'positive' results for mycobacteria. We further checked and analyzed all these cases of mycobacteria-positive results, and compared the results with each individual's clinical state, chest X-ray film, bronchoscopic findings, sputum bacteriology and fiberoptic bronchoscope (8 types) used. After excluding those cases which appeared convincingly to be mycobacterial tuberculosis bacteriologically, then there remained a noticeably uneven distribution in the other cases. Fiberoptic bronchoscope #6 provided a greater incidence of mycobacteria-positive results than did any other. The biopsy channel duct of fiberoptic bronchoscope #6 was carefully investigated and proven to be contaminated with a large and remarkable proliferation of mycobacteria. All 'positive' results on bacteriological studies for mycobacteria in BALF must therefore be evaluated most carefully. Much attention must accordingly be given to the avoidance of nosocomial infection via the fiberoptic bronchoscope. In order to avoid this hazard, we have developed a fiberoptic bronchoscope with a new design, in which the light-guide fibers, the image fiber bundles and the manipulation wires are all embedded within the sealed body of the fiberoptic bronchoscope and then a disposable biopsy channel duct is attached to this supporting body to prevent the otherwise reasonable and easy interpatient transfer of contaminating infection.

View full abstract

A statistical survey of tracheobronchoplasty was undertaken through a questionnaire distributed to 959 institutes or hospitals in Japan. Of these, 1562 cases, 578 tracheoplasty and 944 bronchoplasty, were experienced from 1954 to 1984. The number of cases showed a steep increase from 1974 to 1975 becoming more than 200 a year. Lung cancer was the most common, i.e. 58.8% of cases of tracheobronchoplasty. Among 16 types of sutures, dexon, tevdek, nylon, prolene and vicryl were used in more than 90% of cases. Interrupted suture through the whole layer of the wall was the most frequent method of anastomosis. The type of operation could be classified into 57 modes. In these, bronchial anastomosis was most frequent (62.1%), followed by tracheal anastomosis and tracheobronchial anastomosis. Complications were encountered in 16.9% of all cases, 22.3% of which resulted in death. The main complication was anastomotic stricture, dehiscence and recurrent nerve palsy, (90.1% in total). The frequency of complication was analyzed in items of disease, sutures, method of anastomoses and operative modes. These factors are possibly related to the occurrence of complications. The rate of complications has remained at about 13% for the past 10 years. This result emphasizes the necessity of recognition of the correct technique for anastomosis.

View full abstract

Mongrel dogs weighing 20kg to 30kg were used for experiments of tracheal reconstruction with autogenous aortic grafts. The reconstructive methods were divided into the four types : 1) patch procedure for defects involving 1/3 of the circumference of 6-7 tracheal rings (Group A), 2) patch procedure for defects involving 1/2 of the circumference of 3-4 tracheal rings (Group B), 3) patch procedure for defects involving 3/4 of the circumference of 3-4 tracheal rings (Group C), 4) circular procedure for resection of 2 tracheal rings (Group D). The animals were followed up by bronchoscopy at intervals of one or two weeks. The animals were sacrificed at various intervals. The reconstructed portions of the trachea were examined grossly as well as by light and scanning electron microscopy. For Groups A and B, the aortic graft was successful with long-term survival. The aortic grafts were epithelialized by 30 to 40 days postoperatively and almost completely ciliated by about 6 months after surgery. Subepithelial connective tissue with blood vessels was one of the most important for the complete epithelization and ciliation. In Groups C and D, the graft failed with an average survival of 33 days and 21 days respectively. We conclude that partial defects in the trachea could conceivably be managed by autogenous aortic patching.

View full abstract

In 25 cases out of 30 cases with metastatic airway tumor, good results were obtained by aggressive treatment with Nd-YAG laser vaporization. In the 5 cases who did not show improvement of symptoms, evaluation of the extent of tumor invasion was mistaken. Concerning indications of Nd-YAG laser treatment, good effect can be expected in cases with obstructive metastatic airway tumors located in parts of the airway with large lumens such as the trachea, carina or main bronchi. However in cases located in airway with cartilage, tumor extending more than two cartilage rings are contraindications for this procedure. Nd-YAG laser treatment can improve ventilation in cases of obstructing metastatic airway tumors, allowing them to receive irradiation or chemotherapy, thereby prolonging their life span and improving their life quality. However difficulties to determine the extent of the length of tumor obstruction or the condition of distal bronchi make selection of the indications of Nd-YAG laser treatment difficult. Until this problem is solved it is therefore unavoidable that the procedure will be performed in some cases that hindsight will reveal to have been contraindications.

View full abstract

A 31 year-old female was admitted with cough and sputum. X-ray film of the chest revealed several calcifications in bilateral hilar regions and atelectasis of the right middle lobe. One of these calcifications was confirmed to be present in lumen of the right middle lobe bronchus by tomography and computed tomography of the chest. Bronchoscopic examination disclosed the presence of a tumor which completely obstructed the middle lobe orifice. Though cytologic examination of sputum suggested adenocarcinoma of the lung, microscopic examination of several specimens of the tumor showed only nonspecific inflammatory change. The final diagnosis of broncholithiasis was made by lobectomy of both middle and lower lobe. Reexamination of the sputum specimen by a light microscope in the polarization mode, crystalloid materials were well visualized. The present method would be useful for the diagnosis of broncholithiasis.

View full abstract

An intramural, round and hard tumor in left B^3 was detected bronchoscopically in a 65 year-old man suffering from pneumonia. No definitive histological diagnosis was obtained preoperatively. The patient underwent left upper lobectomy. Histological examination revealed the tumor to be covered with ciliated columnar epithelium and was composed of cartilage, bone, bone marrow, adipose tissue and myxoid connective tissue. The lesion was diagnosed as endobronchial hamartoma. In Japan, only twenty endobronchial hamartomas including our case, have been reported in the literature.

View full abstract

A 70 year-old male was admitted with a chief complaint of bloody sputum. A chest X ray film showed an ill-defined tumor shadow in the middle lung field. Bronchofiberscopy and bronchography revealed the displacement of the both upper lobe bronchi, namely right B^1 branched from the trachea and left B^<1+2> branched from the left main bronchus. A tumor could be observed in right B^3b and biopsy of the tumor revealed squamous cell carcinoma. Pulmonary arteriography revealed a right anomalous artery, considered to be A^1a branching from the apex of the bifurcation of the main right and left pulmonary arteries. This suggested the importance of pre-operative examination of the pulmonary artery. We performed right upper and middle bilobectomy. Without pulmonary arteriography resection would have been extremely dangerous due to the presence of the anomalous artery.

View full abstract

A 45 year-old male patient was admitted with severe tracheal stenosis, due to invasion of poorly differentiated adenocarcinoma of the lung. As a semi-emergency procedure, he underwent insertion of a silicone tracheal T-tube through tracheotomy fenestration. After insertion of a T-tube, 60 Gy radiatiotherapy with was performed, followed by combination chemotherapy with Cis-platinum, Mitomycin C, Adriamycin and 5-Fluorouracil. Although the radiotherapy showed only slight effectiveness, the chemotherapy was so effective that the size of the tumor decreased and the stenotic portion widened. Sixty-eight days after insertion, the T-tube was removed and the tracheal stoma was replaced by a cuff button like cannula. After the course of treatment, the lung function remarkably improved compared to before the insertion of the T-tube. He was discharged with only minor symptoms on December 7, 1985. However, cough, dyspnea, superior vena cava syndrome and respiratory failure reappeared again from the beginning of February, 1986, so the patient was treated conservatively until he expired on May 4, 1986.

View full abstract