Several non-surgical and minimally invasive bronchoscopic interventions, such as bronchoscopic lung volume reduction (BLVR) techniques, have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR... more
Several non-surgical and minimally invasive bronchoscopic interventions, such as bronchoscopic lung volume reduction (BLVR) techniques, have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR has been studied for treatment in severe COPD patients with emphysema. BLVR with one-way endobronchial valves is reported to be effective for patients with a heterogeneous emphysema distribution and without inter-lobar collateral ventilation. For the patients with collateral ventilation, and for the patients with homogeneous emphysema, BLVR with lung volume reduction coil has shown promising results. Targeted lung denervation(TLD) is a novel bronchoscopic intervention based on ablation of parasympathetic nerves surrounding the main bronchi. TLD seems to be effective for COPD with chronic bronchitis phenotype. This review gives a general overview of BLVR with one-way valve and lung volume reduction coil, and TLD.
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Autofluorescence imaging (AFI) is a technique for detecting early‐stage lung cancer by amplifying the difference in autofluorescence of the bronchial mucosa. However, there are few reports detailing its other applications. Here, we report... more
Autofluorescence imaging (AFI) is a technique for detecting early‐stage lung cancer by amplifying the difference in autofluorescence of the bronchial mucosa. However, there are few reports detailing its other applications. Here, we report the case of a 54‐year‐old woman with stage IVa esophageal cancer who completed chemoradiation therapy, but developed a bronchoesophageal fistula at the left main bronchus and underwent fasting treatment. Computed tomography confirmed that the fistula had closed; however, she subsequently developed aspiration pneumonia and underwent bronchoscopy for confirmation. Although it was difficult to identify the site of the pinhole bronchoesophageal fistula under white light, AFI could easily identify the fistula and digestive mucus in light magenta. AFI may therefore be worth considering for the detection of pinhole bronchoesophageal fistulas.
Background: In central airway stenosis, stenting leads to an increase in bronchial patency and to the active distribution of ventilation. However, an improvement in blood flow and gas exchange has not yet been understood. The purpose of... more
Background: In central airway stenosis, stenting leads to an increase in bronchial patency and to the active distribution of ventilation. However, an improvement in blood flow and gas exchange has not yet been understood. The purpose of this study is to evaluate the distribution of pulmonary blood flow using computed tomography (CT) and perfusion scintigraphy. Methods: We assessed lung perfusion in 8 patients with bronchial stenosis. CT and perfusion scintigraphy were performed before and after interventional bronchoscopy. We measured the cross-sectional area (CSA) of less than 5 mm 2 (CSAl5), 10 mm 2 (CSAl10), and 100 mm 2 (CSAl100) by computed tomography. The scintigraphic lung image was divided into the right and left lung. The distribution of lung perfusion was calculated to express the mean counts for the respective lungs as a percentage of the total counts in both lungs. Results: In patients with bronchial stenosis, perfusion was reduced at the obstructed area. After intervent...
Next‐generation sequencing (NGS) enables the diagnosis of large numbers of gene aberrations during one examination, and precision medicine has been developed for patients with advanced non–small cell lung cancer (NSCLC). However,... more
Next‐generation sequencing (NGS) enables the diagnosis of large numbers of gene aberrations during one examination, and precision medicine has been developed for patients with advanced non–small cell lung cancer (NSCLC). However, peripheral lung lesions account for the majority of advanced lung cancers, especially lung adenocarcinoma. In these cases, it is difficult to obtain tissue samples which contain sufficient tumor cells by transbronchial biopsy (TBB) with forceps. Even when the target lesions are quite small, bronchial brushing can obtain enough tumor cells by endobronchial ultrasonography using guide sheath (EBUS‐GS). In this study, we investigate the suitability of bronchial brushing cytology specimens obtained by EBUS‐GS‐TBB to evaluate the correlation between the success rate of NGS and extracted DNA/RNA yields according to biopsy method. We prospectively collected 222 tumor samples obtained from patients with advanced lung cancer. All patients were enrolled in a prospective nationwide genomic screening project for lung cancer (LC‐SCRUM‐Japan/Asia). Genomic data were obtained from the clinico‐genomic database of LC‐SCRUM‐Japan/Asia. The extraction yields of DNA/RNA from samples obtained by EBUS‐GS‐TBB were relatively low compared with tissue samples. The success rate of DNA sequencing for EBUS‐GS‐TBB was 97.9%, with no significant differences between biopsy methods. The success rate of RNA sequencing for EBUS‐GS‐TBB was 80.4%, which was relatively low compared with surgical biopsy samples (P = 0.069). However, some rare oncogenic driver aberrations were detected from these specimens. This study demonstrated that cytology samples obtained by transbronchial brushing with EBUS‐GS‐TBB were suitable for NGS analysis.
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Background: Airway involvement in relapsing polychondritis (RP) includes airway inflammation, airway narrowing and malacia. Systemic corticosteroid and immunosuppressive therapy does not always improve airway involvement making pulmonary... more
Background: Airway involvement in relapsing polychondritis (RP) includes airway inflammation, airway narrowing and malacia. Systemic corticosteroid and immunosuppressive therapy does not always improve airway involvement making pulmonary interventions such as balloon dilation and stenting necessary. Impulse oscillometry (IOS) measurements can be safely performed in patients with airway involvement during quiet breathing before and after pulmonary intervention. Objectives: To confirm whether IOS can assess airway involvement in RP. Methods: Fifteen patients diagnosed with RP, based on McAdam9s criteria participated in this study. Airway disease including: airway narrowing, airway wall thickness, calcification and malacia were confirmed by computed tomography (CT). IOS was performed in all patients and respiratory resistance (Rrs) and respiratory reactance (Xrs) were calculated in frequency ranges of 5Hz increments from 5 to 35Hz. Results: Five patients developed into tracheobronchomalacia (TBM). R5-R20 and X5 showed a significant difference between patients with TBM and patients with only airway involvement (AI) (R5-R20:TMB 0.48±0.21kPa/(l/s), AI 0.15±0.27 kPa/(l/s), p Conclusions: IOS was useful in the evaluation of airway involvement in RP and R5-R20 and X5 were practical markers to differentiate patients with TBM.
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Thirteen cases of diffuse alveolar hemorrhage (DAH) were encountered in our Hospital between January 1996 and October 2001. Eight patients were men and five were women, their mean age being 59.5 +/- 19.2 years (range, 18-88 years). Three... more
Thirteen cases of diffuse alveolar hemorrhage (DAH) were encountered in our Hospital between January 1996 and October 2001. Eight patients were men and five were women, their mean age being 59.5 +/- 19.2 years (range, 18-88 years). Three patients had systemic lupus erythematosus (SLE), three (23%) had polyarteritis nodosa (including microscopic PN), one (7.7%) had allergic granulomatous angitis, one (7.7%) had Goodpasture syndrome, one (7.7%) had MPO-ANCA-associated vasculitis, one (7.7%) had Behçet's disease, one (7.7%) had chronic heart failure caused by mitral stenosis, one (7.7%) had chronic renal failure (etiology unknown), and the last had no particular disorder. Nine episodes (69%) had occurred as complications of primary diseases, four (31%) as the first symptoms of underlying diseases. Prognosis was poor in the former cases but in the latter, the prognosis was relatively favorable.
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Bronchial occlusion with an endobronchial Watanabe spigot (EWS) is effective for the management of persistent pulmonary air leaks; however, an optimal procedure for placing the spigot at the target bronchus remains debatable. The... more
Bronchial occlusion with an endobronchial Watanabe spigot (EWS) is effective for the management of persistent pulmonary air leaks; however, an optimal procedure for placing the spigot at the target bronchus remains debatable. The procedure most currently applied involves grasping the middle of the graspable part of the EWS with grasping forceps (conventional method). In this study, we assess a new technique, the side-grasping method, to maneuver the spigot into the target bronchus by using rotatable biopsy forceps to grasp the edge of the graspable part of the EWS. The aim of this study is to evaluate the effectiveness of this new technique for the simple placement of the EWS. To compare the number of bronchoscopists who were able to place the EWS correctly within 10 minutes, and the time needed to place each spigot for both methods into 4 canine bronchi. More bronchoscopists correctly placed the EWS within 10 minutes using the side-grasping method compared with the conventional met...
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A 79-year-old Japanese woman with no smoking habit was referred to our hospital complaining of anterior chest pain. Chest computed tomography displayed a mass in the right lower lobe with multiple pulmonary nodules in both lungs. Upon... more
A 79-year-old Japanese woman with no smoking habit was referred to our hospital complaining of anterior chest pain. Chest computed tomography displayed a mass in the right lower lobe with multiple pulmonary nodules in both lungs. Upon further examination, we performed ...
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In patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator.... more
In patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator. The airflow asynchrony is reflected by the difference in the left and right lung sound development at tidal breathing. To investigate the usefulness of left and right lung asynchrony due to unilateral bronchial obstruction as a physiological indicator for interventional bronchoscopy. Fifty cases with central airway obstruction were classified into three groups: tracheal, bronchial and extensive obstruction. The gap index was defined as the absolute value of the average of gaps between the left and right lung sound intensity peaks for a 12-second duration. Before interventional bronchoscopy, the gap index was significantly higher in the bronchial (p<0.05) and extensive obstruction groups (p<0.05) than in the tracheal group. The gap index in ca...
Research Interests: Engineering, Physics, Chemistry, Biology, Medicine, and 12 moreMultidisciplinary, Humans, Female, Male, Lung, PLoS one, Aged, Middle Aged, Adult, Trachea, Bronchoscopy, and Airway Obstruction
Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for approaching the lesion adjacent to extrapulmonary bronchus. We started to use wedge insertion of a convex endobronchial... more
Endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for approaching the lesion adjacent to extrapulmonary bronchus. We started to use wedge insertion of a convex endobronchial ultrasound bronchoscope into bronchi narrower than the diameter of the bronchoscope itself to perform EBUS-TBNA. Our objective was to investigate the bronchus in which EBUS-TBNA was possible and safe. In this prospective study, we examined 15 lesions that were adjacent to lobar, segmental, or subsegmental bronchi narrower than the 6.9 mm external diameter of the convex scope. The cross-sectional area and maximum, minimum, and mean internal diameters of the airway lumen adjacent to the lesion were calculated using the measurement software. We investigated the airway branch in which EBUS-TBNA was possible, the narrowest airway diameter adjacent to the lesion for which insertion and diagnosis could be performed, the feasibility of puncture, and techniques for ...
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Vibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults. VRI images of 106 healthy subjects (33.7±9.6 years,... more
Vibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults. VRI images of 106 healthy subjects (33.7±9.6 years, 52 male and 54 female), including 67 nonsmokers and 39 asymptomatic smokers, were recorded. The regional intensity of vibrations was assessed using quantitative lung data (QLD), and VRI dynamic images by rater assessment, left and right lung asynchrony (gap index), and regional lung asynchrony (asynchrony score). A dominance of total left lung QLD was observed in all subjects, and this phenomenon was more prominent in female subjects. However, there was no significant difference between the total left and total right lung QLD in smokers. Rater assessments showed that 81.1% of all subjects had a normal final assessment. Male subjects had a significantly higher percentage of good or normal assessments for all image scores, except dynamic image scorin...
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: Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a 22-gauge needle has emerged as an accurate, minimally invasive, and safe technique for accessing undiagnosed mediastinal adenopathy,... more
: Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a 22-gauge needle has emerged as an accurate, minimally invasive, and safe technique for accessing undiagnosed mediastinal adenopathy, particularly in patients with lung cancer, the small sample size obtained by a conventional needle may limit the accuracy of the result. : We evaluated the safety and efficacy of obtaining specimens using 21-gauge needles, comparing diagnostic yield with conventional 22-gauge needles. : Participants consisted of 56 consecutive patients with mediastinal lesions referred to our institution for diagnostic EBUS-TBNA. The 21-gauge needle group (21 G) included 24 patients with 6 nonmalignancies and the 22-gauge needle group (22 G) included 32 patients with 9 nonmalignancies. Final diagnosis was based on cytology, histology, surgical results, appropriate clinical pictures on examination, and/or clinical follow-up. : Comparing 21 G and 22 G, inadequate material rates were 0% versus 3.1% in cytology, and 4.2% versus 18.8% in histology, respectively. Accuracy in cytology, histology, and combined cytology and/or histology were 91.7% versus 65.6% (P=0.02), 95.8% versus 81.3% (P=0.11), and 100% versus 84.4% (P=0.04), respectively. After limiting cases to suspected malignancies, sensitivity in cytology, histology, and combined cytology and/or histology were 88.9% versus 52.2% (P=0.01), 100% versus 82.6% (P=0.09), and 100% versus 87.0% (P=0.17), respectively. : Increasing sample volume using a 21-gauge needle rather than a 22-gauge needle might improve diagnostic yield in EBUS-TBNA. This study revealed the benefits of using a 21-gauge needle for cytological and histologic diagnostic yields.
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To assess airway measurements, endobronchial ultrasonography (EBUS) and multidetector, row computed tomography (MDCT) images were compared in patients with tracheal stenosis. Airway stenting was performed on 31 patients, 25 malignant and... more
To assess airway measurements, endobronchial ultrasonography (EBUS) and multidetector, row computed tomography (MDCT) images were compared in patients with tracheal stenosis. Airway stenting was performed on 31 patients, 25 malignant and 6 benign. EBUS and MDCT images were compared before intervention to assess the degree of airway narrowing at 212 sites. Of these, 130 sites were considered normal and 82 abnormal. For malignant stenosis, airway measurements were taken at 160 sites including 112 normal and 48 abnormal. For benign stenosis, airway measurements were taken at 52 sites including 18 normal and 34 abnormal. This technique enables the EBUS probe to measure the distal end to the proximal end of the stenosis whereby the inflated balloon size changes according to the degree of stenosis. The diameter and length of the stenotic sites measured by EBUS and MDCT were nearly equal in all patients. Significant correlation was seen at all 212 sites (r=0.805, P<0.0001), 130 normal (...
A 49-year-old woman presented with continuous cough, progressive dyspnea on exertion, and hoarseness. She had a total colectomy for ulcerative colitis 17 years earlier. Bronchoscopy showed circumferential mucosal erythema. The surface of... more
A 49-year-old woman presented with continuous cough, progressive dyspnea on exertion, and hoarseness. She had a total colectomy for ulcerative colitis 17 years earlier. Bronchoscopy showed circumferential mucosal erythema. The surface of the tracheal mucosa was irregular and bled easily on contact. Endobronchial ultrasonography and magnetic resonance imaging (MRI) showed characteristic findings that suggested that the lesion was located within the tracheal mucosa and submucosa. Endobronchial ultrasonography images showed circumferential thickening of the mucosa, but tracheobronchial cartilage was preserved intact. Moreover, the comparison between tracheal tissues from tracheostomy and colon tissues resected 17 years earlier showed similarities in pathologic findings. These findings suggested that inflammatory bowel disease can cause the tracheobronchial stenosis.
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Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kanagawa 216-8511, Japan Department of Public Health, Fujita Health University School of Medicine, 1-98,... more
Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kanagawa 216-8511, Japan Department of Public Health, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan Department of Internal Medicine, Division of Medical Oncology, Teikyo University School of Medicine, Tokyo 173-8605, Japan Department of Urology, St Marianna University School of Medicine, Kanagawa 216-8511, Japan Seigakuin Schools, Saitama 362-8585, Japan
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... FUNDAMENTAL FREQUENCY MEASURES WITH MORPHEUS OF HUMAN SLEEP ELECTROENCEPHALOGRAPHY(EEG) IN SEVERE SLEEP APNEA WITH EARLY INTERVENTION OF CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) Richard K. Bogan ...
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CLINICAL IMPLICATIONS: This study suggests that the emitted dose of arformoterol inhalation solution 15 g in 2 mL would not be substantially impacted by different breathing patterns during nebuliza-tion. DISCLOSURE: Andrea Bauer, No... more
CLINICAL IMPLICATIONS: This study suggests that the emitted dose of arformoterol inhalation solution 15 g in 2 mL would not be substantially impacted by different breathing patterns during nebuliza-tion. DISCLOSURE: Andrea Bauer, No Product/Research Disclosure In- ...
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Vibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults. VRI images of 106 healthy subjects (33.7±9.6 years,... more
Vibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults. VRI images of 106 healthy subjects (33.7±9.6 years, 52 male and 54 female), including 67 nonsmokers and 39 asymptomatic smokers, were recorded. The regional intensity of vibrations was assessed using quantitative lung data (QLD), and VRI dynamic images by rater assessment, left and right lung asynchrony (gap index), and regional lung asynchrony (asynchrony score). A dominance of total left lung QLD was observed in all subjects, and this phenomenon was more prominent in female subjects. However, there was no significant difference between the total left and total right lung QLD in smokers. Rater assessments showed that 81.1% of all subjects had a normal final assessment. Male subjects had a significantly higher percentage of good or normal assessments for all image scores, except dynamic image scorin...