Medical Thoracoscopy Performed Using a Flexible Bronchoscope Inserted through a Chest Tube under Local Anesthesia

Background and Objectives. Many cases of pleural effusion can remain undiagnosed following thoracentesis. We evaluated our own technique for performing thoracoscopy under local anesthesia using a 32 Fr chest tube and a flexible fiberoptic bronchoscope without a rigid thoracoscope for the diagnosis, inspection, and management of patients with pleurisy. Methods. Seven patients with pleural effusion who underwent thoracoscopy under local anesthesia using a 32 Fr chest tube and a flexible fiberoptic bronchoscope were retrospectively studied. Results. Thoracoscopy was safely performed in the diagnosis and management of pleural effusion in all cases. The visualization of the pleura, diaphragm, and lung using this instrumentation was excellent in comparison to that normally obtained during surgical thoracoscopy. A forceps biopsy of the pleura or diaphragm could therefore be easily and effectively performed. Conclusion. This technique is considered to have clinical utility as a diagnostic tool for pleurisy; furthermore, this method is safe, effective and inexpensive, not only for surgeons but also for physicians

Exophiala dermatitidis infection in non-cystic fibrosis bronchiectasis

SummaryA 54-year-old female presented with an exacerbation of right middle lobe bronchiectasis. A bronchoscopic bronchial washing and repeated trials of sputum culture consistently recovered no other infectious agent except Exophiala dermatitidis. Her illness was improved by administrations of intravenous miconazole and nebulized amphotericin B when sputum cultures yielded no fungi, demonstrating a pathogenic role of the fungi. The present case illustrates E. dermatitidis as a pathogenic agent in non-cystic fibrosis bronchiectasis

A Hybrid Lesion of Lung Cancer and Aspergillosis

A 74-year-old man presented with gradual wall thickening of a cystic lung lesion. Serologic tests indicated Aspergillus infection, but neither fungal organisms nor evidence of malignant disease were recovered from repeated sputum collections, a bronchoscopic lung biopsy specimen, or bronchial washings. Treatment with antifungal agents did not result in clinical improvement. Surgical resection of the lesion demonstrated both squamous cell carcinoma and aspergillosis. These distinct disorders share common radiologic manifestations that can present a diagnostic challenge, as in the present case

Overexpression of Chitinase 3-Like 1/YKL-40 in Lung-Specific IL-18-Transgenic Mice, Smokers and COPD

We analyzed the lung mRNA expression profiles of a murine model of COPD developed using a lung-specific IL-18-transgenic mouse. In this transgenic mouse, the expression of 608 genes was found to vary more than 2-fold in comparison with control WT mice, and was clustered into 4 groups. The expression of 140 genes was constitutively increased at all ages, 215 genes increased gradually with aging, 171 genes decreased gradually with aging, and 82 genes decreased temporarily at 9 weeks of age. Interestingly, the levels of mRNA for the chitinase-related genes chitinase 3-like 1 (Chi3l1), Chi3l3, and acidic mammalian chitinase (AMCase) were significantly higher in the lungs of transgenic mice than in control mice. The level of Chi3l1 protein increased significantly with aging in the lungs and sera of IL-18 transgenic, but not WT mice. Previous studies have suggested Chi3l3 and AMCase are IL-13-driven chitinase-like proteins. However, IL-13 gene deletion did not reduce the level of Chi3l1 protein in the lungs of IL-18 transgenic mice. Based on our murine model gene expression data, we analyzed the protein level of YKL-40, the human homolog of Chi3l1, in sera of smokers and COPD patients. Sixteen COPD patients had undergone high resolution computed tomography (HRCT) examination. Emphysema was assessed by using a density mask with a cutoff of −950 Hounsfield units to calculate the low-attenuation area percentage (LAA%). We observed significantly higher serum levels in samples from 28 smokers and 45 COPD patients compared to 30 non-smokers. In COPD patients, there was a significant negative correlation between serum level of YKL-40 and %FEV1. Moreover, there was a significant positive correlation between the serum levels of YKL-40 and LAA% in COPD patients. Thus our results suggest that chitinase-related genes may play an important role in establishing pulmonary inflammation and emphysematous changes in smokers and COPD patients

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

To determine the clinical efficacy of combined vaccination with 23-valent pneumococcal vaccine (PV) and influenza vaccine (IV) against pneumonia and acute exacerbation of chronic lung diseases (CLD), we conducted an open-label, randomized, controlled study among 167 adults with CLD over a 2-year period. Subjects were randomly assigned to a PV + IV group (n = 87) or an IV group (n = 80). The number of patients with CLD experiencing infectious acute exacerbation (P = 0.022), but not pneumonia (P = 0.284), was significantly lower in the PV + IV group compared with the IV group. When these subjects were divided into subgroups, an additive effect of PV with IV in preventing infectious acute exacerbation was significant only in patients with chronic obstructive pulmonary diseases (P = 0.037). In patients with CLD, the Kaplan-Meier survival curves demonstrated a significant difference for infectious acute exacerbation (P = 0.016) between the two groups. An additive effect of PV with IV on infectious acute exacerbation was found during the first year after vaccination (P = 0.019), but not during the second year (P = 0.342), and was associated with serotype-specific immune response in sera of these patients who used PV during the same period

Role of nitric oxide in airway inflammation and hyperresponsiveness in bronchial asthma

Nitric oxide (NO) is produced within the airways and has a variety of actions on the airway function. Nitric oxide is a potent bronchodilator, and NO released from airway epithelial cells and inhibitory nonadrenergic non-cholinergic nerve terminals may attenuate airway hyperresponsiveness. However, a large amount of NO produced by inducible NO synthase may facilitate airway inflammation, which then leads to airway hyperresponsiveness. Although the role of NO remains controversial, the measurement of exhaled NO may well be of value in the clinical management of asthma