[Successful surgical ligation and transection of racemose hemangioma of bronchial artery].

We report two cases of bilateral racemose hemangioma in patients with hemoptysis. Case 1 was a 62-year-old woman who visited a local clinic complaining of hemoptysis. Bronchoscopy revealed multiple pulsating tumorous lesions and she was referred to our department. Chest Multidetector CT (MDCT) disclosed bilateral enlarged and convoluted, abnormal bronchial arteries and primary racemose hemangioma was diagnosed. Bronchial artery embolization was selected, but not conducted because of concern regarding the arteriovenous shunt and escape into the greater circulation. In combination with thoracoscopic mini-thoracotomy, ligation and separation of the bronchial artery were performed. Case 2 was a 68-year-old man who was transferred to our department with a chief complaint of hemoptysis. MDCT revealed bilateral bronchiectasis and a convoluted and enlarged, abnormal bronchial artery along the mediastinum. He was diagnosed as having secondary racemose hemangioma. First, bronchial artery embolization was conducted, but hemostasis was difficult, thus surgical ligation was conducted. In both cases, MDCT was effective for diagnosis and surgical ligation is very important as a therapeutic option for racemose hemangioma.

[The investigation of isoflurane therapy for status asthmaticus patients].

Status asthmaticus is defined as an attack of bronchial asthma that resists conventional treatment and continues for more than 24 hours. We report here about patients with status asthmaticus who were successfully treated with isoflurane inhalation. Of the 19 patients who were transferred to the intensive care unit (ICU) and underwent mechanical ventilation from January 1996 to May 2001, eleven patients who were first treated by isoflurane inhalation were targeted in this study. Their improvement was assessed 6 and 24 hours after anesthesia compared with their condition before anesthesia. The tidal volume, pH, and PaCO2 improved within 6 hours after anesthesia. For the next step, among the patients who were transferred to the critical care center soon after an attack of bronchial asthma and underwent mechanical ventilation, 8 patients who were treated by isoflurane inhalation anesthesia (Group I) and another 4 patients who were not treated by isoflurane (Group NI) were compared to assess the usefulness of isoflurane inhalation therapy. The patients in Group I stayed in the ICU and underwent mechanical ventilation for a shorter period. These patients had hypotension and liver dysfunction after the inhalation anesthesia, but these symptoms were improved by decreasing the concentration of isoflurane. Isoflurane inhalation therapy seemed useful for intractable status asthmaticus, and earlier introduction of this therapy is expected to achieve a greater therapeutic effect.

[A case of endobronchial mucormycosis with peculiar bronchoscopic findings].

Small cell lung cancer was diagnosed in a 54-year-old man in 1997. He had received 5 cycles of systemic chemotherapy and thoracic irradiation since 1997, and a favorable response had been achieved. In August 2001, pro-GRP was again elevated, and he was readmitted. Bronchoscopic findings revealed a white dendritic endobronchial mass on a cheese-like plug obstructing the left upper bronchus division. Numerous mucor hyphe and cancer cells were detected by transbronchial biopsy, and a fungal culture disclosed mucor. Although no antifungal drug was administered, the bronchial lesion disappeared after removal with biopsy forceps and 2 cycles of systemic anticancer chemotherapy. Endobronchial involvement of mucormycosis is rare and this case is unique because of the peculiar bronchoscopic finding with the endobronchial lesion.