Endobronchial ultrasonography in the assessment of centrally located early-stage lung cancer before photodynamic therapy

To evaluate the utility of endobronchial ultrasonography (EBUS) in selecting appropriate candidates with centrally located early-stage lung cancer for photodynamic therapy (PDT) with curative intent, we performed EBUS before PDT in 18 biopsy-proven squamous cell carcinomas (including three carcinoma in situ) that had been considered to be appropriate candidates for PDT by conventional bronchoscopy and high-resolution computed tomography (HR-CT). Nine lesions were diagnosed as intracartilaginous by EBUS and subsequently PDT was performed. Long-term complete remission has been achieved in these patients with a median follow-up term after PDT of 32 months. The remaining nine lesions were diagnosed as extracartilaginous by EBUS and were considered candidates for other therapies such as surgical resection, chemotherapy, and radiotherapy, although two were invisible by HR-CT, three were superficial, and five were < or = 1 cm in diameter on observation by bronchoscopy. The depth of tumor invasion estimated by EBUS was proven to be accurate by histopathologic findings in six specimens after surgical resection. We conclude that EBUS is a useful technique that might be considered in addition to conventional bronchoscopy and HR-CT to improve the efficacy of PDT in patients with centrally located early-stage lung cancer.     

Enhanced Accumulation of Sialyl Lewis X-Carboxymethylpullulan Conjugate in Acute Inflammatory Lesion

Purpose. E-selectin is a cell adhesion molecule that is specifically expressed in the inflammatory vascular endothelium in response to cytokines such as IL-1 and TNF-, and interacts with specific ligands containing sialyl Lewis X (Neu5Ac2-3Gall-4(Fucl-3)GlcNAc-, SLe^x). In order to investigate the ability of E-selectin ligands to target the inflammatory site, the tissue distribution of carboxymethylpullulan (CMPul) modified with SLe^x was studied. Methods. CMPul conjugates with various saccharides containing SLe^x and monovalent SLe^x were intravenously administered to mice with ear edema induced by arachidonic acid, and their distributions to the inflamed ear and other tissues were studied. To determine the microdistributions of these compounds, the inflamed ear was subjected to microautoradiography. Results. After intravenous administration AUC_0-24h of SLe^x-CMPul, which binds to E-selectin, in the inflamed ear was about 300-fold and 2.5-fold higher than that of monovalent SLe^x and CMPul conjugated with other saccharides, which can not serve as ligands for E-selectin. Microautoradiography also revealed SLe^x-CMPul accumulated at the microvessels in the inflammatory lesions. Conclusions. SLe^x-CMPul was found to have the potential to target drugs to the inflammatory lesion.     

Endobronchial ultrasonography in the diagnosis and treatment of relapsing polychondritis with tracheobronchial malacia

Relapsing polychondritis (RP) with tracheobronchial involvement has a poor prognosis, and a delay in diagnosis increases morbidity and mortality; however, the diagnosis is difficult to make. Endobronchial ultrasonography (EBUS) revealed changes in the tracheobronchial cartilage in two patients who met the criteria for RP, and facilitated the diagnosis. In these cases, EBUS revealed a poorly defined bronchial wall structure with two patterns of cartilaginous damage: fragmentation and edema. These cases were successfully treated by the implantation of nitinol stents, the sizes of which were determined by EBUS. EBUS was found to be useful in the diagnosis and treatment of RP.     

Stenting at the flow-limiting segment in tracheobronchial stenosis due to lung cancer

Airway stenting at the wave-speed flow-limiting segment (the choke point) is assessed. We determined prospectively the precise location of the choke point using the flow-volume curve, endobronchial ultrasonography, ultrathin bronchoscopy, and three-dimensional computed tomography scan before and after stenting in 64 patients with extrincic compression due to lung cancer. We noted distinct flow-volume curve patterns specific to the type of stenosis. The tracheal stenosis group indicated fixed narrowing patterns with an expiratory plateau, bronchial stenosis group dynamic collapse patterns with an expiratory flow deterioration (choking), carinal stenosis group combined fixed and dynamic patterns, and extensive stenosis group complex patterns containing elements of all the former. After stenting, almost full-function patterns with significant improvement in PEF were observed in all groups (p < 0.01, p < 0.05, p < 0.001, p < 0.01, respectively). In patients with extensive stenosis, implantation of additional stents was required when the choke points were observed to have migrated to the areas of malacia with cartilage destruction by the tumor. Secondary stenting at migrated choke points resulted in a significant improvement in PEF over the initial stenting (p < 0.01). Stenting at the choke point improved expiratory flow limitation by increasing the cross-sectional area, supporting the weakened airway wall and relieving dyspnea.     

Novel approach for talc pleurodesis by dedicated catheter through flexi-rigid thoracoscope under local anesthesia

For pleurodesis, talc administered by poudrage is usually insufflated blindly from a single port of entry using the standard method with a small-diameter rigid thoracoscope. In order to visually perform talc poudrage from a single port, we introduced a catheter technique through a flexi-rigid thoracoscope. Patients with uncontrolled and symptomatic pleural effusion requiring pleurodesis underwent flexi-rigid thoracoscopy under local anesthesia for talc poudrage. A dedicated catheter with 2.1-mm inner diameter was connected to a talc atomizer and inserted through the working channel of the flexi-rigid thoracoscope to insufflate talc into the pleural cavity under visualization. Nine patients were included in this study. Three patients were >75 years old, and two were Karnofsky performance status 50. Three patients received propofol for sedation and six were not sedated. Mean operative time was 30.8 min for all patients, and 21.3 min for cases without sedation. All procedures were performed easily under clear visualization with no major complications or catheter obstructions. This novel approach for talc pleurodesis using a catheter was well-tolerated and seems feasible for patients with uncontrolled pleural effusion. We consider this technique useful even for difficult cases, such as elderly patients or those with relatively low performance status.     

Intrapleural cisplatin and OK432 therapy for malignant pleural effusion caused by non-small cell lung cancer

OBJECTIVE: To evaluate the efficacy of combined intrapleural therapy with cisplatin, an antineoplastic agent, and OK432, a sclerosing agent, in controlling malignant pleural effusions, when compared with monotherapy with either agent. METHODS: A total of 49 non-small cell lung cancer patients with malignant pleural effusion were randomly assigned to one of three groups: intrapleural cisplatin therapy (n = 17), intrapleural OK432 therapy (n = 17), or both (n = 15). They were compared in terms of success rate, duration of indwelling chest tube and adverse reactions. RESULTS: Rates of pleural effusion recurrence within 180 days following cisplatin, OK432, or combination therapy were 64.7%, 52.9% and 13.3%, respectively, being significantly lower in the combination therapy group (P = 0.01). The mean duration of chest tube drainage was 8.4 days, 5.5 days and 12.9 days, respectively, being significantly longer in the combination therapy group (P < 0.001). All procedures were well tolerated. CONCLUSIONS: Although chest tube drainage took longer because of the time required for multiple administration of the agents, intrapleural combination therapy with cisplatin and OK432 was more effective in controlling malignant pleural effusions due to non-small cell lung cancer than monotherapy with either agent.