Treatment of ulcerative endobronchial tuberculosis and bronchial stenosis with aerosolized streptomycin and steroids.

OBJECTIVES: Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree. It has been reported that aerosolized therapy with streptomycin and steroids is useful for EBTB; however, the effectiveness of this therapy for bronchial stenosis has yet to be clarified. This study was undertaken to determine the effectiveness of aerosol therapy in the treatment of bronchial stenosis due to EBTB. DESIGN: An observational, historical, controlled comparative study. Retrospective analysis of 27 patients treated with conventional therapy, and prospective analysis of 30 patients treated with aerosol therapy. METHOD AND PATIENTS: Flexible bronchoscopy was performed at least twice in 57 patients with ulcerative EBTB, in whom the degree of bronchial stenosis between the first and last bronchoscopic examinations was estimated. Bronchial stenosis was graded as minimal, mild, moderate, severe or obstructive, and the follow-up of bronchial stenosis assessed as aggravation, no change or improvement. RESULTS: Conventional therapies led to aggravation in 13 patients, no change in 13 patients, and improvement in one patient. Aerosol therapy led to no change in 27 patients, and improvement in three patients. No patients developed aggravation. The differences between the therapeutic groups were significant. CONCLUSION: Aerosol therapy helps to prevent progressively severe bronchial stenosis due to EBTB.

Thoracoscopic lung biopsy for diffuse infiltrative lung disease.

Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We have performed thoracoscopic lung biopsy for 17 patients with diffuse infiltrative lung disease, in Kurume University Hospital. There were 13 females and 4 males with a mean age of 48 years (range: 19-71 years). Thoracoscopic surgical biopsy was performed in the right lung in 12 and in the left lung in 5. Adequate lung tissue from each case was obtained for pathological examination. The mean surgical biopsy time was 49 min (range: 25-72 min) and bleeding was negligible. The mean duration for chest tube drainage was 2.6 days. No postoperative complication such as prolonged air leakage occurred. A specific diagnosis from the biopsy was achieved in 13 (76.4%) of the 17 cases. In only 6 (35.2%) of the 17 cases, the pathological diagnosis was the same as that from the thoracoscopic biopsy. In these 6 cases, the same diagnosis was obtained only in those with idiopathic interstitial pneumonitis or diffuse panbronchitis. Thoracoscopic lung biopsy was safe and useful for diagnosis for diffuse infiltrative lung disease.

Giant cell interstitial pneumonia in two hard metal workers: the role of bronchoalveolar lavage in diagnosis.

Two cases of hard metal lung disease and pathological findings of giant cell interstitial pneumonia are reported. The cases worked in different factories manufacturing hard metal parts from tungsten carbide and cobalt. Pathological specimens were obtained by percutaneous thoracoscopy and transbronchial lung biopsy. X-ray microanalysis detected only tungsten carbide in the lung specimen of one case. Bronchoalveolar lavage showed diagnostic bizarre macrophages in the lavage fluid.

Prognostic significance of febrile episodes in lung cancer patients receiving chemotherapy.

The prognostic significance of neutropenic fever in lung cancer patients receiving chemotherapy with or without radiotherapy was investigated. Male patients and patients with squamous cell lung cancer had a higher incidence of febrile episodes than female patients and patients with other cell types, but the differences were not significant. Patients with a poor performance status had a significantly higher incidence of febrile episodes. An indwelling central venous catheter was an important risk factor for febrile episodes, indicating that bacteremia was one of the major causes of fever. The median survival time of the patients who developed febrile episodes during chemotherapy was significantly shorter than that of patients without fever (6.1 vs 12.0 months), whether or not cases of early death within 3 months were excluded (8.9 vs 13.1 months). The prevention of infectious complications during anticancer treatment by the use of rh G-CSF and the early initiation of antimicrobial chemotherapy, although the results are inconclusive, may be worthwhile.

[Chronic pulmonary paracoccidioidomyosis in a Japanese Adult].

We encountered a case of chronic pulmonary paracoccidiodomycosis in Japan. A 53-year-old Japanese man, who had worked in Brazil from 1964 to 1969. Came to our hospital because of abnormal shadows on a screening chest roentgenogram. In 1989, he had been treated with fluconazole for mucocutaneous-lymphangitic paracoccidioidomycosis with oral ulceration and neak hymphadenitis. Chest roentgenograms and computed tomograms showed diffuse small nodular and emphysematous shadows. Microscopical examination of specimens obtained by transbronchial lung biopsy showed no abnormality. He was treated with oral fluconazole, and the abnormal radiographic shadows regressed. We believe that this was the first case of chronic pulmonary paracoccidiodomycosis in Japan.

Diffuse panbronchiolitis--a thin-section CT scoring system.

The usefulness of thin-section computed tomography (CT) in the identification of the specific and clinically relevant pathologic changes in airway disease has been well documented. However, this approach has not been used for objective evaluation in patients with diffuse panbronchiolitis. Therefore attempts were made to use it in patients with diffuse panbronchiolitis. The study group included 12 men and 10 women, 17 to 69 years of age (mean, 47 years) with diffuse panbronchiolitis. All patients were evaluated by thin-section CT and pulmonary function testing. The CT score was calculated by a modified score criteria. The correlations between the CT score and the pulmonary function parameters were assessed by Pearson's linear regression analysis. Bronchiolar inflammation and airway-ectasia were present in all 22 patients. Periairway thickening was present in 17 patients. Pus plugging was present in 18 patients. Two patients had bullae formation, and 6 had air-trapping. Pulmonary collapse or consolidation was evident in 6 patients. The CT score demonstrated a significant negative correlation with FEV1% (r = -3.267, p = .0230), %VC (r = -4.658, p = .0018), and arterial blood oxygen concentration (r = -1.009, p = .0381). The thin-section CT findings in patients with diffuse panbronchiolitis closely resembled those in patients with cystic fibrosis, previously described. Furthermore, a CT scoring system is useful for objective evaluation of lung disease severity in patients with diffuse panbronchiolitis.