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Background: Hemoptysis can cause a life-threatening condition and often needs to be treated urgently. Recently, interventional devices and techniques such as CT angiography were made dramatically an improvement, therefore, we could have performed super selective BAE (ssBAE) which was thinner peripheral artery embolization. Objectives: We conducted a prospective observational study under the hypothesis that elective ssBAE may lead to attributing to the improvement of the hemostasis effect compared to the emergency BAE. [Methods] From June 2016, mild to moderate hemoptysis patients were eligible for this study. Super selective catheterization of abnormal arteries using microcatheters was performed using gelatin sponge. This study was approved by the Committee on Clinical Investigation for National Center for Global Health and Medicine (NCGM-G-002309-00). Results: The cases that we were able to observe the condition of hemoptysis after 1 year were 29 patients (14 males) and they were performed 32 sessions of BAE procedures. The overall efficacy of BAE for control of hemoptysis was 87.5% (n = 32) after one month, 87.1% (n = 31) after three months, and 86.2% (n = 29) after one years. Three cases were unfortunately recurrent hemosputum or hemoptysis within 28 days. Conclusions: The elective ssBAE approach was highly effective to avoid recurrent mild to moderate hemoptysis but especially, chronic inflammatory condition like pulmonary aspergillosis or refractory chronic lower respiratory tract infection with bronchiectasis was too difficult to control only BAE.

Pleuroscopy under local anesthesia is performed by physicians in case with unexplained pleural effusion. There are limits to the bending angle and image resolution of conventional fiberscopes. Olympus Corporation and 4 Japanese institutions, including our hospital, developed a new pleuroscope for use under local anesthesia. Compared to the conventional pleuroscope (LTF-260; Olympus, Japan), the new pleuroscope (LTF-Y0032; Olympus, Japan) comes with an improved bending angle from 160 degrees to 180 degrees, and the internal diameter from 2.8mm to 3.0mm. The quality of images has also been improved. We evaluated the new pleuroscope clinically. The study population comprised 30 patients with pleural effusion of unknown etiology at our hospital, who underwent pleuroscopy using the new pleuroscope from December 2016 to January 2019. The patients included 21 men and 9 women (median age, 76 years) with 18 right and 12 left pleural effusions. In the final diagnosis, there were 17 cases of malignant disease (10 cases of pleural metastasis of lung cancer, 4 cases of malignant pleural mesothelioma, 3 cases of malignant lymphoma), and 13 cases of benign disease (4 cases of pyothorax, 4 cases of nonspecific pleurisy, 2 cases of tuberculous pleurisy, 2 cases of asbestos-related pleurisy and 1 case of IgG4-related disease). In one case of mesothelioma, the lesion was confined to a part of the pleura that cannot be observed with conventional pleuroscope, but it could be visualized by bending the new pleuroscope by 180 degrees. The new pleuroscope has an improved bending angle, image quality and channel inner diameter. The improved bending angle is likely to minimize the blind spot, improving the diagnostic rate.

RATIONALE: Anti-aminoacyl transfer RNA synthetases (ARS) antibodies are a group of myositis specific autoantibodies. It also is frequently found in patients with complicating interstitial pneumonia. However, the clinical characteristics in these patients with anti-ARS antibody were not yet fully elucidated. METHODS: We retrospectively investigated clinical symptoms, radiological findings, treatments, and its outcome in 30 patients with anti-ARS antibody-positive interstitial pneumonia (ARS-IP) in our institution. The radiological patterns of interstitial pneumonia were evaluated with thin-sliced HRCT by two specialists. Anti-ARS antibodies were evaluated using RNA immunoprecipitation assey and anti-synthetase ELISA kit (BML, Japan). RESULTS: Mean age was 59.4 years (28-82), 60.0% were female. Nine patients were with anti-Jo-1, 7 with anti-EJ, 4 with anti-PL-12, 3 with anti-PL-7, 2 with anti- OJ, and 5 with unknown or anti-KS. Seven cases were diagnosed as having ARS-IP with dermatomyositis (DM), and 7 with polymyositis. There were no differences in the demographic features, laboratory data, HRCT findings, between ARS-IP with myositis and without. ARS-IP with myositis recurs more often than without myositis (p=0.019). Serum creatinine kinase (CK) levels were elevated in 13 patients. Patient achieved good responses to initial corticosteroid and immunosuppressant. Mean observation time was 64.9 months (4 months- 138 months). CONCLUSIONS: Most of the patients with interstitial pneumonia associated with anti-ARS antibodies showed remarkable responses to the therapy and favorable outcome.