Biomedical subjects

T Shirakusa

Publications and source records attributed to T Shirakusa.

At least 73 records · Page 4Linked to original sources

PubMed1999

Transgastrostomal endoscopic surgery for early gastric carcinoma and submucosal tumor.

BACKGROUND: Laparoscopic intraluminal surgery of the stomach is now widely used for a lesion on the posterior wall. However, this procedure has some technical limitation related to the intricate introduction of the surgical instruments into the gastric lumen. In this article, we report our newly developed technique of transgastrostomal endoscopic surgery that overcomes this limitation and is also suitable for full-thickness gastric wall resection of a lesion in the wall. METHODS: After making a 4-cm-long temporary gastrostomy, a Buess-type endoscope is inserted into the gastric lumen through the gastrostomy. The operation is performed inside the gastric lumen under video camera guidance using electrocautery, scissors, and forceps. After resection, the wound in the mucosa or the wound after full-thickness resection is endoluminally sutured. Mucosal resection was performed in six cases of early gastric carcinoma, two cases of atypical epithelium, and one case of ectopic pancreas. Full-thickness wall resection was performed in four cases of a leiomyoma. RESULTS: In all 13 cases, the lesion could be precisely located by the video camera. All lesions were then resected endoluminally. The mean duration of the operation was 148 min. The postoperative course in all cases was uneventful. CONCLUSIONS: Transgastrostomal endoscopic surgery is minimally invasive and an efficient tissue-preserving technique for the removal of early gastric carcinoma or submucosal tumor.

Adult↗

PubMed1999

Discrimination of double primary lung cancer from intrapulmonary metastasis by p53 gene mutation.

When multiple synchronous lung tumours are identified, discrimination of multicentric lung cancers from intrapulmonary metastases by clinical findings is often difficult. We used genetic alterations in p53 gene as a discrimination marker of double primary lung cancers from single lung cancer with intrapulmonary metastasis. Twenty of 861 patients with primary lung cancer who underwent lung resection were selected as subjects because they showed synchronous double solid tumours of the same histological type in the unilateral lung without distant metastases. In addition, they had been diagnosed as lung carcinoma with intrapulmonary metastasis by clinical and histological findings. DNAs were extracted from paraffin-embedded tissue of paired tumours from these 20 patients. Exons 5-9 of the p53 gene were examined for genetic alterations in the tumours by polymerase chain reaction, single-strand conformation polymorphism analysis and subsequent DNA sequencing analysis. Three different patterns in the distribution of p53 mutations in double lung tumours were observed: [A] mutation in only one of the tumours (four cases), [B] different mutations in the tumours (two cases), and [C] same mutation in both tumours (one case). The cases of [A] or [B] patterns could be classified as double primary lung cancers, while the case of the [C] pattern was suggested to be lung cancer with intrapulmonary metastasis. These results suggested that the multicentric cancers were more frequent than the intrapulmonary metastatic cancers in double cancer cases.

Adenocarcinoma↗

PubMed1999

Low-grade metaplastic carcinoma of the thymus.

AIMS: Five cases of a characteristic low-grade thymic epithelial tumour are described that we suggest calling metaplastic carcinoma of the thymus. METHODS AND RESULTS: The patients' ages ranged from 44 to 71 (mean 56.2) years. Four of the patients were male. Three of five tumours showed invasion into mediastinal fat or pleura but, otherwise, all were well circumscribed. No metastases were present. Histologically, the tumours showed a biphasic pattern with solid carcinomatous areas merging gradually with a spindle cell component. Lymphocytes were rare. Cytological atypia and mitotic activity were variable in the solid areas, but slight or absent in the spindle cell component. On immunohistochemistry, the tumours showed expression of cytokeratin, vimentin and/or epithelial membrane antigen, both in the carcinomatous and spindle cell components. In two cases, actin expression was also present in both components. In one case, chromogranin, S100 protein, glial fibrillary acidic protein and neuron-specific enolase were expressed in at least some cells of both components. None of the patients had myasthenia gravis. All patients are alive without evidence of recurrence or metastasis. CONCLUSION: Metaplastic carcinoma of the thymus is a distinct clinicopathological entity that should be distinguished from the usually benign medullary thymomas and from the clinically aggressive carcinosarcomas and sarcomatoid carcinomas.

Aged↗

PubMed1999

Expression of steroid receptors, Ki-67, and epidermal growth factor receptor in tamoxifen-treated endometrium.

Endometrial specimens of 34 (25 premenopausal and 9 postmenopausal) breast cancer patients receiving tamoxifen were immunohistochemically examined using estrogen receptor (ER), progesterone receptor (PR), Ki-67, and epidermal growth factor receptor (EGFR) antibodies. Proliferative (n = 6), secretory (n = 9), and postmenopausal (n = 6) endometria served as controls. The ER and PR expressions of the glandular cells in tamoxifen-treated patients did not differ from those of the glandular cells in the control women regardless of menopausal status. The Ki-67 index of glandular cells in tamoxifen-induced amenorrheic women was found to be lower than that of the proliferative glandular cells in the control women (p < 0.03), whereas the Ki-67 index of glandular cells in the tamoxifen-treated postmenopausal patients was higher than that of the glandular cells in the control women (p < 0.02). No EGFR overexpression was found in the glandular cells of the tamoxifen-treated premenopausal patients, but expression of EGFR was high in glandular cells of the tamoxifen-treated postmenopausal patients associated with a high Ki-67 index. In competition with ovarian estrogen secretion, tamoxifen may have an antiestrogenic effect on the endometrium, but tamoxifen probably has an estrogenic effect in the absence of ovarian estrogen secretion. This estrogenic effect of tamoxifen may be associated with an EGFR autocrine system.

Adult↗

PubMed1999

Low rate of apoptosis and overexpression of bcl-2 in Epstein-Barr virus-associated gastric carcinoma.

AIMS: Epstein-Barr virus (EBV) has been demonstrated in about 10% of gastric carcinomas. However, the pathogenetic role of EBV in gastric carcinoma is uncertain. We compared the rate of apoptotic cell death, cell proliferation and the expression of apoptosis-related proteins in gastric carcinomas with or without EBV. METHODS AND RESULTS: Epstein-Barr virus was detected in 40 gastric carcinomas by EBV-encoded small RNA-1 in-situ hybridization. Apoptotic cell death, MIB-1, p53, bcl-2 and bcl-x were examined by the terminal deoxynucleotidyl-mediated dUTP-nick end labelling method and immunohistochemistry. We also included 40 age-, sex- and disease stage-matched EBV-negative cases as a control. The number of apoptotic cells was significantly lower in EBV-positive (20 +/- 15. 1/1000 cells) and bcl-2-positive (17 +/- 12.9/1000 cells) tumours than in EBV-negative (43 +/- 37.1) and bcl-2-negative tumours (38 +/- 32.1, P < 0.001, P < 0.001, respectively). bcl-2 immunostaining was significantly higher in EBV-positive tumours (24 cases) than in EBV-negative tumours (12 cases, P < 0.05). There was no significant difference in bcl-x and p53 expression between EBV-positive and -negative tumours. The number of MIB-1-positive cells in EBV-positive tumours (237 +/- 161/1000) was significantly lower than in EBV-negative tumours (480 +/- 208/1000 cells, P < 0.001). CONCLUSIONS: A low rate of apoptosis and high bcl-2 expression were recognized in EBV-positive gastric carcinomas, suggesting that bcl-2 protein is the main inhibitor of apoptosis in EBV-positive carcinomas. In addition, the low apoptotic and proliferative activities may reflect a low biological activity in EBV-positive gastric carcinomas.

Adult↗

PubMed1999

Clonality of primary pulmonary lymphoproliferative disorders; using in situ hybridization and polymerase chain reaction for immunoglobulin.

Primary pulmonary lymphoproliferative disorders (PLDs) are histologically divided into a neoplastic state of high and low grade malignant lymphoma (ML), and a reactive state of follicular bronchitis/bronchiolitis (FB) and lymphoid interstitial pneumonia (LIP). We reviewed 19 cases with PLDs, including 4 cases each of high and low grade B cell ML, 6 FB cases, and 5 cases of LIP. To clarify the clonality of the proliferating cells, we performed an immunohistochemical examination (IHC), in situ hybridization (ISH) for the immunoglobulin light chain and a polymerase chain reaction (PCR) analysis of the immunoglobulin heavy chain gene using DNA obtained from paraffin sections. In addition, a Southern blot analysis was also performed in 6 cases using fresh materials. In IHC, all ML were positive for L26 (CD20), while the monoclonality of the kappa light chain was observed in only one high grade case. However, using ISH we could detect the clonality in three of four high grade ML cases and in one of four low grade ML cases. In FB and LIP, no clonality of immunoglobulin by ISH was observed. In a PCR analysis for the immunoglobulin heavy chain gene, we could detect one or two prominent bands in all 8 cases of high and low grade ML. On the other hand, in all cases of FB and LIP, we could only detect either an oligoclonal or polyclonal population. In summary, the presence of monoclonality of ISH and/or PCR for the immunoglobulin heavy chain gene were limited in the neoplastic state, but not in the reactive state.

Adult↗

PubMed1999

[Resection and reconstruction of the great vessels for lung cancer and mediastinal tumor].

Between January 1994 and December 1997, 17 patients with lung cancer and 5 patients with mediastinal tumor underwent extensive resection and reconstruction of the great vessels. In patients with lung cancer, the aorta was resected under cardiopulmonary bypass in 4 patients, the superior vena cava in 12, and the left main pulmonary artery with combined resection of the left atrium in 1 and the aorta in 1. In five patients who underwent resection of the superior vena cava, subcarinal resection and reconstruction were also performed. Three patients died within 30 days after surgery. Six patients died of cancer between 3 months and 2 years after surgery. Two patients who underwent aortic resection for node negative lung cancer have survived more than 3 years after surgery. Six patients have survived between 6 months and 2 years after surgery. The histologic type of mediastinal tumor was thymic cancer in 3 patients, invasive thymoma in 1 and malignant lymphoma in 1. In patients who underwent resection of the superior vena cava for mediastinal tumor, bilateral brachiocephalic vein reconstruction was performed in 4 patients and the left brachiocephalic vein reconstruction in 1. One patient underwent resection of the right atrium. The patient with invasive thymoma has survived for more than 3 years. Two of 3 patients with thymic cancer died within 2 years. When complete resection is achieved with combined resection of the great vessels, survival may be anticipated in patients with N0 lung cancer or in those with invasive thymoma.

Adult↗

PubMed1999

Fas and nicotinic acetylcholine receptor in human myasthenic thymus--immunohistochemical study.

We studied the immunohistochemical localization of Fas and nicotinic acetylcholine receptor (nAChR) in the human thymus with myasthenia gravis (MG). Thymuses were obtained from thirteen patients with MG, (thymic hyperplasia 8; thymoma 5) and six normal controls. Antibodies against Fas, nAChR protein isolated from fetal calf thymus (nAChR-FCT), CD3, CD4, and CD8 were used. In both hyperplastic thymus and controls, Fas antigen was found in medullary epithelial cells especially in those around Hassall's corpuscle, in subcapsular epithelial cells, and partially in the cortex. There were no apparent differences between myasthenic thymus and the controls. In the thymic medulla the anti-nAChR-FCT antibody showed a similar staining pattern to the antibody against Fas. The nAChR and the Fas were suggested to be present in the same cell. Then six thymomas were double immunostained with antibodies against Fas and nAChR-FCT. A part of neoplastic epithelial cells were double positive for both Fas and nAChR. The present results show the first observation on the colocalization of the Fas and nAChR in thymic epithelial cells. These antigens were supposed to work on triggering mechanism of autoimmunity in MG.

Adolescent↗

PubMed1999

Dye-enhanced selective laser ablation for surgical mucosectomy.

The diode laser operates at a wavelength of 805 nm; indocyanine green (ICG) has a maximum energy absorption of a wavelength of approximately 800 nm. The effect of the diode laser as a laser knife can be significantly enhanced with an injection of ICG. In the present study, this dye-enhanced photothermal effect was investigated in the field of surgical endoscopy. A 9-cm2 region of the canine gastric mucosa was removed by the laser after injection of 5 ml of ICG solution at a concentration of 0.5 mg/mL into the submucosal space. The diode laser was used at a power output of 10 watts. The canine stomach was removed 10 days after the operation to investigate the site histologically. Clinical application using transanal endoscopic microsurgery (TEM) was employed using a dye-enhanced laser in five patients with a rectal adenoma. The pathological changes in the canine gastric wall resected 10 days after the operation showed that the low-power laser enhanced by ICG produced less fibrosis in the submucosal space than electrocautery. Mucosal resection using a dye-enhanced laser was easily performed in these five patients. It was concluded that this easy removal of the mucosa by a dye-enhanced laser was due to its ability to produce hemostasis of the vessels and its excellent tissue-cutting effect.

Adenoma↗

PubMed1998

High levels of hepatocyte growth factor/scatter factor in diffuse-type bronchioloalveolar cell carcinoma.

BACKGROUND: Hepatocyte growth factor/scatter factor (HGF/SF) is a potent mitogen for various neoplastic cells, including neoplastic bronchial epithelia. METHODS: Immunoreactive hepatocyte growth factor/scatter factor (HGF/SF) was measured in extracts prepared from 129 nonsmall cell lung carcinoma (NSCLC) specimens, using an enzyme-linked immunosorbent assay. These specimens represented 5 cases of solitary/localized bronchioloalveolar cell carcinoma (BAC), 4 cases of diffuse/infiltrative BAC, 90 cases of non-BAC adenocarcinoma, 25 cases of squamous cell carcinoma, and 5 cases of large cell carcinoma. RESULTS: The mean concentration of immunoreactive HGF/SF was more than 19-fold higher in tissue extracts from diffuse-type BAG (265.0 +/- 110.2 ng/100 mg protein) than in those from solitary-type BAC (13.9 +/- 15.9, P < 0.005), non-BAC adenocarcinoma (13.8 +/- 14.9, P < 0.001), squamous cell carcinoma (13.2 +/- 14.4, P < 0.001), or large cell carcinoma (11.2 +/- 6.5, P < 0.005). When immunohistochemical staining for HGF/SF was performed, intense HGF/SF staining was uniformly observed in diffuse-type BAC tumor cells, but not in solitary-type BAC. CONCLUSIONS: Although BAC is included as a subtype of adenocarcinoma in the World Health Organization classification, diffuse-type BAC should be considered a distinct biologic entity, at least in terms of HGF/SF expression, from solitary-type BAC or non-BAC adenocarcinoma. In addition, the solitary and diffuse forms of BAC are known to be associated with different prognoses; for the latter, the prognosis is much poorer than for the former. The results of this study may at least partly explain this difference in prognosis.

Adenocarcinoma↗

PubMed1998

Expression of four CEA family antigens (CEA, NCA, BGP and CGM2) in normal and cancerous gastric epithelial cells: up-regulation of BGP and CGM2 in carcinomas.

Four human carcinoembryonic antigen (CEA) family members, CEA (CD66e), non-specific cross-reacting antigen (NCA, CD66c), biliary glycoprotein (BGP, CD66a) and CEA gene-family member 2 (CGM2), are expressed in normal mucosal epithelia of the colon. Expression of BGP and CGM2 has recently been demonstrated to be down-regulated in colorectal adenocarcinomas. We have now investigated the expression of the 4 CEA family antigens in gastric adenocarcinoma and carcinoma cell lines in comparison with adjacent normal gastric mucosa. The transcripts of the CEA, NCA and BGP genes evaluated by reverse transcription-polymerase chain reaction were detectable at various levels in all the gastric adenocarcinoma cell lines tested, while CGM2 mRNA was detectable in the cell lines of poorly differentiated but not of well-differentiated carcinomas. The levels of CEA mRNA in normal gastric mucosa were variable but mostly increased in adenocarcinomas. The sparse expression of NCA observed in the normal tissues was markedly up-regulated in the carcinomas. In contrast to previous findings on normal and cancerous colonic tissues, the transcripts of CGM2 were totally undetectable and those of BGP were recognized only marginally, if at all, in normal gastric mucosa, while both messages were detected at significant levels in most of the gastric adenocarcinomas. This was confirmed by in situ hybridization. Our findings indicate that expression of the CEA family antigens, particularly that of BGP and CGM2, is differently regulated in epithelial cells of the colon and the stomach.

Adenocarcinoma↗

PubMed1998

Plasma thrombospondin levels in patients with colorectal carcinoma.

BACKGROUND: Thrombospondin in a 450-kilodalton glycoprotein, first described as a secretion product of thrombin-stimulated platelets. In a recent study, thrombospondin was discovered not only to accelerate platelet aggregation and to promote construction of the extracellular matrix but also to be involved in the progression of malignant tumors. In another study, plasma thrombospondin was reported to be elevated in patients with colorectal carcinoma with hepatic metastasis. Moreover, venous invasion in colorectal carcinoma is well known to be involved profoundly in organ metastasis. METHODS: Blood samples from patients with colorectal carcinoma were collected preoperatively by venipuncture using ice-chilled tubes, and immediately centrifuged at 4 degrees C. The plasma was aspirated and frozen until the concentration of thrombospondin was measured using a competitive enzyme-linked immunoadsorbent assay. The degree of venous invasion in each case was evaluated pathologically using resected specimens to examine for any correlation with the plasma thrombospondin level. RESULTS: The plasma thrombospondin level was significantly higher in those patients with malignant venous invasion than in those patients with no venous invasion, according to Dukes staging. There was a direct correlation between the plasma thrombospondin level and the degree of venous invasion. CONCLUSIONS: Venous invasion by colorectal carcinoma was found to play an important role in the elevation of the plasma thrombospondin level. Alternatively, a high concentration of thrombospondin may support metastasis and progression of this malignancy.

Aged↗

PubMed1998

Detection of chromogranin A mRNA in small cell lung carcinoma using a new, highly sensitive in situ hybridization method with a non-radioisotope oligonucleotide probe.

BACKGROUND: Immunoreactivity for chromogranin A (Cg A) is associated with the presence of neurosecretory granules in tumor cells, but immunohistochemical staining for Cg A may be absent in small cell lung carcinoma (SCLC), which has only a few secretory granules. Localization of Cg A mRNA is a useful indicator of the site of synthesis of a particular protein and possibly the rate of synthesis, and it is not dependent on posttranslation events within the cells. However, it is difficult to detect the low levels of mRNA copies using the standard non-radioisotope (RI) oligonucleotide probe. METHODS: The authors analyzed Cg A mRNA in 20 cases of SCLC in formalin fixed, paraffin embedded tissue using a new, highly sensitive in situ hybridization method that was developed from the maximized immunohistochemistry (ImmunoMax) method. They also investigated Cg A mRNA in nonsmall cell lung carcinoma (NSCLC), including ten cases each of adenocarcinoma and squamous cell carcinoma of the lung. RESULTS: All examined SCLC tissues showed a positive reaction for Cg mRNA. No NSCLC specimens showed any positive reaction for Cg A mRNA. CONCLUSIONS: The detection of Cg A mRNA using the new, highly sensitive in situ hybridization method with a non-RI oligonucleotide probe can be used to characterize neuroendocrine differentiation of lung tumors even when the Cg A protein is not detected by immunohistochemistry. The authors believe this is a first step toward better diagnosis and treatment for patients with SCLC.

Adult↗

PubMed1998

The number of lymph node metastases influences survival in esophageal cancer.

BACKGROUND AND OBJECTIVES: Lymph node involvement adversely affects the survival of patients with esophageal cancer. We retrospectively investigated whether the number of involved lymph nodes and the degree of lymph node dissection affect survival. PATIENTS AND METHODS: Eighty-eight patients underwent surgical resection and reconstruction for T -T3 thoracic esophageal squamous cell carcinoma. Patients were classified into three groups: group 1, 32 patients without lymph node involvement; group 2, 26 patients with 1 to 3 positive nodes; and group 3, 30 patients with > or = 4 involved lymph nodes. RESULTS: The 3-year and 5-year survival rates were 34.8% and 30.0% in group 1, 30.0% and 22.7% in group 2, and 14.8% and 0% in group 3, respectively. The mean survival time (MST) X +/- SD of the patients in group 3 (453.06+/-74.5 days) was significantly shorter than in group 1 (450.1+/-450.5, P = 0.0005) and group 2 (937.3+/-1317.9, P = 0.0295). For patients in groups 1 and 2, the MST for three-field lymph node dissection (1136.9+/-1476.4 days) was longer than for two-field lymph node dissection (1007.4+/-1476.4 days, P = 0.0355). However, in group 3, there was no survival advantage to three-field lymph node dissection. CONCLUSION: We conclude that the survival in patients with thoracic esophageal cancer involving four or more nodes, is poorer than in patients with lesser involvement. Three-field lymph node dissection does contribute to prolonged survival in patients with node-negative disease or fewer than four positive nodes.

Adult↗

PubMed1998

Clinical use of a front lifting hood rectoscope tube for transanal endoscopic microsurgery.

BACKGROUND: Transanal endoscopic microsurgery (TEM), a procedure developed by Buess et al. requires a specially designed surgical rectoscope system, and adequate training for its operation is mandatory. In order to simplify the performance of TEM, and to allow the use of additional surgical instruments and devices, we have developed a new rectoscope tube. METHODS: The forward half of the tube can be opened longitudinally by hand. Our working insert platform is hollowed and includes a channel for an endoscope. The resection procedure can be performed under normal atmospheric pressure. This newly developed rectoscope system has already been employed clinically. TEM was performed using our original forward lifting hood rectoscope tube in 20 patients, including 12 cases of sessile adenoma and eight cases of early carcinoma. RESULTS: The forward hood of the tube was opened to the maximum angle of 25 degrees in eight patients and 15-20 degrees in the other 12 patients. The visible field of the rectal interior was extended in direct proportion to the angle. Through our working insert platform, instruments and devices could be used for either laparoscopic or open surgery. CONCLUSIONS: These modifications have made TEM easier and will therefore make the procedure available to more surgeons.

Aged↗

PubMed1998

Thoracoscopic transdiaphragmatic microwave coagulation therapy for a liver tumor.

BACKGROUND: Microwave coagulation therapy (MCT) for hepatocellular carcinoma, which induces tumor coagulonecrosis, is now recognized as an efficient treatment. However, when a tumor is located just below the top of the diaphragmatic dome, laparotomical MCT requires a large incision, and percutaneous MCT is sometimes impossible. PATIENTS AND METHODS: The patients were four men and two women. There were four cases of hepatocellular carcinoma and two cases of liver metastasis from colorectal cancer. All tumors were located below the top of the diaphragmatic dome. Thoracoscopic transdiaphragmatic MCT (TTMCT) was performed under general anesthesia using an endotracheal double-lumen tube. Identification of the tumor site in the liver was performed using an ultrasonic probe under thoracoscopic observation. After the diaphragm above the tumor was opened, a needle electrode to transmit microwaves was inserted directly into the tumor. Microwave irradiation was repeated to coagulate the entire lesion. After completion of TTMCT, the diaphragm was closed thoracoscopically. RESULTS: TTMCT was successfully administered to cancerous lesions in all six patients. The postoperative course was uneventful, and the average postoperative hospitalization period was 10.5 days. None of the patients has shown any recurrence during a follow-up period of 4-23 months. CONCLUSIONS: TTMCT was performed without any difficulty using the thoracoscopic surgical technique, and its therapeutic outcome was satisfactory. This is effective for tumors located just below the top of the diaphragmatic dome.

Aged↗

PubMed1998

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-wire-reinforced 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.

Adult↗

PubMed1998

Stenting for airway obstruction in the carinal region.

BACKGROUND: Recent progress on airway stents has provided sufficient airway patency for patients with airway obstruction; however, when the stenosis exists in the carinal zone, establishing an excellent airway condition is still troublesome because of the anatomic structure. METHODS: We treated 15 patients with severe tracheobronchial stenosis involving a carinal bifurcation region, using several types of stenting devices (long T-tube, T-Y tube, wire reinforced Y tracheostomal tube, Freitag Dynamic stent [Karl Storz, Tuttlingen, Germany], and covered metallic stent). All patients had advanced inoperable tumors (lung cancer, n = 6; esophageal cancer, n = 3; thyroid cancer, n = 3; mediastinal tumor, n = 3). RESULTS: All but 2 patients had immediate relief of respiratory symptoms. One patient died of respiratory failure caused by pulmonary lymphatic spread 3 days after Dynamic stent insertion. In 1 patient with severe left main bronchial stenosis due to lung cancer, effective palliation was not achieved by insertion of a covered metallic stent because of its insufficient expansion against the stenosis. Mean survival after successful stenting was 4.3 months (range, 1 to 15 months). There were no complications directly attributable to the stents. CONCLUSIONS: As evidenced by the clinical effectiveness, airway stenting for inoperable tumor is valuable in such patients. Choosing a stent that will fully cover the lesion and allow sufficient tolerance against compression is important to successful stenting. Benefits such as ease of phonation and stent maintenance should also be considered.

Bronchial Diseases↗