Koei Ando

Y-shaped tracheobronchial stent for carinal and distal tracheal stenosis.

A Y-shaped tracheo-bronchial tube was designed and used for two patients with carinal stenosis following a lower tracheal resection in one case and a malignant tracheal fistula in the other. The tube consisted of three parts including a Y-shaped, thin-walled, soft silicone stent; a spiral-wirereinforced main tube; and a curved tracheostomy tube. The stent was inserted easily and comfortably through the tracheostomy under fiberoptic bronchoscopic guidance with minimal local anesthesia. The positioning stability of the tube was excellent because of the carina-shaped structure of the tube end. Resistance to compression was satisfactory due to the embedded spiral wire. The insertion procedure through the tracheostomy was smooth, even in patients whose respiratory condition was severe or critical. Satisfactory phonational activity was also provided by breathing through the hole on the tube back up to the vocal cord. Bronchoscopic inspection was uncomplicated, and the patients themselves could easily clean the stent. Since palliation of the airway obstruction is the main purpose of such a stent for patients with either severe lower tracheal or carinal stenosis, and because of the difficulty of ordinary stent insertion in this part of the airway, this device appears to offer excellent stability and easy insertion of the stent. In addition, the ease of maintenance and suctioning through the tracheostomal end allows for an excellent quality of life in which the patients are able to return to their homes.

Involucrin in Well-Differentiated Adenocarcinoma of the Lung: Comparison with Adenocarcinomas of Different Organs

Using immunoperoxidase stain for involucrin, 50 well-differentiated adenocarcinomas of the lung were compared with similarly well-differentiated adenocarcinomas of other organs, 30 from the stomach, 30 from the colon, 12 from the pancreas and 12 from the prostate. Thirty (60%) adenocarcinomas of the lung were positive for involucrin; in 24 of 30 cases from 10% to more than 60% of tumor cells were positive and in the remaining 6 cases a few cells were positive. The positive cells included columnar or cuboidal tumor cells as well as some squamoid tumor cells. In contrast, only 4 (4.8%) of 84 tumors in the other organs were involucrin positive. Most of the involucrin positive foci of these four cases seemed to show squamous differentiation. These findings suggest that pulmonary adenocarcinoma is more prone to show squamous differentiation, compared with gastric, colonic, pancreatic and prostatic adenocarcinomas. The result may be applied for the differential diagnosis between primary and metastatic well-differentiated adenocarcinomas in the lung.

Malignant fibrous histiocytoma in the thoracic region —A clinico-pathologic investigation

Seven cases of malignant fibrous histiocytoma (MFH); 3 originating in the thoracic region, one which was considered to arise from the lung parenchyma, and 4 which were metastatic to the lungs, are presented herein. Six of these patients underwent surgical excision and analysis under light and electron microscopy revealed the lesions of MFH to be composed of two cell types; a fibroblast-like cell and a histiocyte-like cell. The latter showed histologically characteristic growth in a so-called storiform pattern. In all patients adjuvant chemotherapy was performed, although in only one patient did it prove temporarily effective. Despite the fact that the prognosis of MFH in the thoracic region is poor, the suggested therapy for longer survival is resection with postoperative combination chemotherapy including the use of sensitive anticancerous agents.