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Objectives: Pharyngolaryngectomy with total esophagectomy (PLTE) is associated with high morbidity and mortality rates. Cervical tracheostomy (CT) is the first choice of tracheostomy, whereas anterior mediastinal tracheostomy (AMT) is sometimes required due to tumor extension or insufficient blood supply to the tracheal tip. However, the differences in the outcomes between CT and AMT after PLTE remain unclear. Methods: We retrospectively reviewed 67 patients who underwent PLTE and compared the clinical features and postoperative complications between patients with CT and AMT. The characteristics and the outcomes were compared between the groups stratified by the causes of AMT. Results: Of the 67 patients, 42 (62.7%) patients underwent PLTE with CT (CT group), whereas 25 (37.3%) underwent PLTE with AMT (AMT group). The AMT group included more cervicothoracic esophageal cancers and had showed an advanced T stage compared to the CT group (P <.01 and.01, respectively). The incidences of pneumonia and surgical site infection (SSI) were more frequent in the AMT group than in the CT group (P =.03 and.01, respectively). Surgery-related mortality was only observed in the AMT group. In the AMT group, 17 (68.0%) and 8 (32.0%) patients underwent AMT because of tumor extension and insufficient supply to the tracheal tip. The latter cases underwent transthoracic esophagectomy more frequently than former cases (P =.03). Conclusion: AMT after PLTE had more postoperative complications and mortality than CT. In cases that may need AMT, a transhiatal approach is preferable over transthoracic esophagectomy to avoid fatal complications when oncologically permissive. [ABSTRACT FROM AUTHOR]

Background: Flexible fiber‐optic laryngo‐tracheo‐bronchoscopy has become widely performed in infants and neonates since the introduction of thin flexible fiberscopes. Laryngomalacia is the most common airway disease in infants causing stridor. Pharyngomalacia, termed pharyngeal occlusion during inspiration, was the second most common airway disease found in our hospital in patients that underwent laryngo‐tracheo‐bronchoscopy, but the incidence, patient characteristics, and natural course have not been reported in large numbers in Japan. Methods: A retrospective review was performed of medical records on patients admitted to our neonatal intensive care unit during the neonatal period diagnosed with pharyngomalacia between April 2009 and November 2018. Patient characteristics, concurrent airway diseases, comorbidities, and treatment were reviewed. Results: Forty‐eight patients were diagnosed with pharyngomalacia. The median gestational age was 37.1 weeks, and the median birthweight was 2,552 g. Patients were diagnosed at a median age of 29 days, and cure was achieved at a median age of 4 months. Twenty‐eight patients had concurrent airway diseases, laryngomalacia being the most common. Continuous positive airway pressure or high flow nasal cannula was used in 34 patients. Conclusions: In patients with pharyngomalacia, half were born preterm, and more than half had concurrent airway diseases. The onset and diagnosis were made within the first month of life in more than half of the patients, and resolution was seen mostly within the first 6 months of life. Whenever a patient is suspected of having an airway disease, the pharyngeal space should be carefully observed to diagnose pharyngomalacia. [ABSTRACT FROM AUTHOR]

Objective: Tracheal reconstruction is a rare surgical procedure and the actual incidence of or indications for this procedure have not been thoroughly elucidated. We performed the nationwide database analysis to clarify the real-world situation of laryngotracheal surgery requiring cervical tracheal reconstruction.Methods: Patients who underwent surgical treatment for laryngotracheal stenosis or defect from 2008 to 2016 were identified from the Diagnosis Procedure Combination inpatient database, collected from 270 acute care hospitals in Japan. Patients were divided into two groups based on presence/absence of malignancy, and T-tube or tracheotomy dependence at 6 months after surgery was compared between the two groups.Results: One hundred and thirty-four patients (75 males) were identified. The median age at surgery was 65.5 years. The most common indication for surgery was malignancy (n = 60, 44.8%), followed by iatrogenic (n = 25, 18.6%), trauma (n = 6, 4.5%), malformation of the larynx and trachea (n = 6, 4.5%), and chronic inflammatory disease (n = 4, 2.8%). Thyroid cancer was the most common malignancy (n = 38). Thirty patients (22.4%) failed to decannulate within 6 months and malignancy was associated with a lower dependence on T-tube or tracheotomy at 6 months after surgery (adjusted odds ratio: 0.25, 95% confidence interval: 0.08-0.79).Conclusion: A Japanese health insurance claims database provided a useful overview of the clinical features and outcomes of patients who underwent cervical tracheal reconstruction surgery for laryngotracheal stenosis or defect. [ABSTRACT FROM AUTHOR]

Objective: Surgical airway management is one of the most effective techniques for safe airway management. Within the training programs relating to knowledge and skills required by otorhinolaryngologists, tracheostomy and postoperative management are important items that must be fully understood by airway surgeons. We performed a nationwide survey to identify problems within tracheostomy and postoperative management in Japan in order to establish practical and safe guidelines for surgical airway management., Methods: We conducted a questionnaire survey of the current status of tracheostomy and postoperative management at core institution of otorhinolaryngology training programs in Japan., Results: Responses were obtained from all 101 core training institutions in Japan. Tracheostomy was performed in the operating room at 61.4% of institutions and in the ICU at 26.7%. 89.1% of them performed surgical tracheostomy (ST) in all cases. Even in the remaining 10.9%, percutaneous dilatational tracheostomy (PDT) was performed in less than 10% of cases. The primary surgeon was an otorhinolaryngology resident at 89.1% of institutions. The method of securing the tube immediately after surgery was by securing it with an attached cord at 48.5% of institutions, by suturing to the skin at 25.7%, and using a Velcro band at 24.8%. The first tube change after tracheostomy was performed on the seventh postoperative day at 81.2% of institutions. 87.1% had more than one person performing the first tube change. The tracheostomy postoperative complications within the past year were as follows: tracheostomal granulation: 89.1%; subcutaneous and/or mediastinal emphysema: 62.4%; tube stenosis: 55.4%; accidental tube removal: 50.5%; incorrect tube insertion or misplacement: 15.8%; hemorrhage from tracheal foramen requiring hemostasis in the operating room: 14.9%; pneumothorax: 4.0%; tracheo-innominate arterial fistula: 2.0%; and tracheoesophageal fistula: 1.0%. The method for educating otorhinolaryngology residents about tracheostomy was on-the-job training at 98.0% of institutions., Conclusions: For airway management in otorhinolaryngology training programs, after learning the basics of ST, PDT should also be well understood. Furthermore, in order to create safe educational programs for intraoperative and postoperative management, it is necessary to train otorhinolaryngologists with accurate knowledge and skills, and to strengthen collaboration with multiple professions in their leadership roles as airway surgeons., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023. Published by Elsevier B.V.)

Tracheobronchial foreign bodies (TFBs) are pediatric airway emergencies frequently seen. We aimed to examine the changes in the clinical characteristics of pediatric TFB patients in a single institution within the past 36 years. We retrospectively reviewed the data of 85 patients aged 0-10 years with TFBs lodged in the trachea or bronchus admitted at the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital between 1986 and 2021. We also compared the characteristics, diagnostic methods, and treatments of the previous 64 cases (1986-2005) with those of the recent 21 cases (2006-2021). The number of TFB patients decreased later in this study (3.2 vs. 1.3 patients per year). The proportion of TFB patients aged > 3 years was significantly higher in the later period (6.3% vs. 23.8%, p = 0.038). Peanut was the most common cause of TFBs in both periods, and the overall incidence of peanut aspiration significantly decreased in the later period (68.8% vs. 38.1%, p = 0.019). No patient had an undetected TFB for more than 1 month after the onset of symptoms in the later period. Foreign body extraction using rigid bronchoscopy was performed in all patients earlier, whereas flexible bronchoscopy was used in 14.3% later. Our study revealed a recent trend in the clinical characteristics of pediatric TFB patients in a single institution in Northeast Japan. The prevention and treatment of pediatric TFBs should be considered following the recent trends.

Purpose: Bath-related deaths occur frequently in Japan, and many of these deaths are diagnosed as death from disease without autopsy in the current Japanese death-investigation system. Therefore, we aimed to examine the postmortem computed tomography (PMCT) findings of bath-related deaths to determine if PMCT can differentiate between real cases of drowning and sudden deaths not related to drowning.Methods: Bath-related deaths were sampled from all autopsies conducted at the Tokyo Medical Examiner's Office from September 2015 to August 2016. A total of 90 bath-related deaths (77 drowning cases and 13 non-drowning cases) and 50 controls (sudden cardiac deaths non-related to bathing) were included in this study. We investigated factors contributing to drowning and measured PMCT parameters (presence/density of fluid in the maxillary sinus/trachea, distance between the lungs, lung patterns [ground glass opacities, consolidation], position of the right diaphragmatic dome, density in the right atrium, stomach volume, and density of the gastric/duodenal contents).Results: The analysis of the factors contributing to drowning showed that alcohol intoxication was the most frequent (n=25), followed by cardiac pathology (n=22), and psychotropic drug intoxication (n=6). Radiological evaluation showed that measurements of all parameters differed significantly between the drowning group and the controls. In addition, significant differences were observed between drowning and non-drowning cases in three radiological parameters (i.e., distance between lungs, stomach volume, and density of gastric contents).Conclusions: Majority of bath-related deaths in this study showed signs of drowning at autopsy, and we observed a range of factors that contributed to drowning. By using several radiological parameters (e.g., the distance between the lungs, stomach volume, and the density of the gastric contents), PMCT for the investigation of bath-related deaths might indicate that drowning as opposed to other factors unrelated to drowning (e.g., sudden cardiac death) was the cause of death. This might allow for calculation of accurate mortality statistics on bath-related deaths. [ABSTRACT FROM AUTHOR]

Background: Aldehyde dehydrogenases (ALDHs) play a major role in detoxification of aldehydes. High expression of ALDHs is a marker for stem cells of many organs including the lungs. A common polymorphism in ALDH2 gene (ALDH2*2) results in inactivation of the enzyme and is associated with alcohol flushing syndrome and increased risk for cardiovascular and Alzheimer's diseases and some cancers. The effect of this ALDH2 polymorphism on the lung and its stem cells has not been thoroughly examined.Methods: We examined the association between the ALDH2*2 allele and lung function parameters in a population of healthy individuals. We also examined its association with the incidence of asthma and COPD in patient cohorts. We used the in vitro colony forming assay to detect the effect of the polymorphism on lung epithelial stem cells from both primary human surgical samples and Aldh2*2 transgenic (Tg) and Aldh2 -/- mice. Response to acute and chronic lung injuries was compared between wild type (WT), Aldh2*2 Tg and Aldh2 -/- mice.Results: In humans, the ALDH2*2 allele was associated with lower FEV1/FVC in the general population, but not with the development of asthma or COPD. Both the bronchial and lung epithelium carrying the ALDH2*2 allele showed a tendency for lower colony forming efficiency (CFE) compared to ALDH2 allele. In mice, the tracheal epithelial thickness, nuclear density, and number of basal stem cells were significantly lower in Aldh2 -/- and Aldh2*2 Tg adult mice than in WT. Electron microscopy showed significantly increased number of morphologically abnormal mitochondria in the trachea of Aldh2 -/- mice. Aldh2 -/- tracheal and lung cells showed higher ROS levels and fewer functional mitochondria than those from WT mice. No significant differences were detected when tracheal and lung epithelial stem cells were examined for their in vitro CFE. When exposed to chronic cigarette smoke, Aldh2*2 Tg mice were resistant to emphysema development, whereas influenza infection caused more epithelial damage in Aldh2 -/- mice than in WT mice.Conclusions: ALDH2 polymorphism has several subtle effects on the lungs, some of which are similar to changes observed during normal aging, suggesting a "premature lung aging" effect. [ABSTRACT FROM AUTHOR]

Background: Videolaryngoscopes may not be as effective in small children as they are in older children and in adults. The size 1 blade is commercially available for the McGRATH®MAC videolaryngoscope (Covidien, Medtronic, Tokyo, Japan), but its efficacy in comparison with a Macintosh laryngoscope blade 1 is not known., Aim: The main aim of this study was to assess the efficacy of McGrath®MAC blade 1 in comparison with a conventional Macintosh laryngoscope blade 1, in children aged less than 24 months., Methods: Thirty-eight children aged less than 24 months were randomly allocated to one of two groups, and tracheal intubation was attempted using either a direct laryngoscope with a Macintosh blade 1 or a videolaryngoscope with a McGRATH®MAC blade 1. In another 12 children aged 2-4 years, the same comparisons were made with blade 2. The primary outcome measure was time to tracheal intubation using a size 1 blade., Results: Tracheal intubation took significantly longer with a McGRATH®MAC blade 1 (median (interquartile range): 38.0 (31.8-43.5) s) than with the Macintosh blade 1(27.4 (25.9-29.2) s) (p < 0.0001; median difference (95% CI for the median difference): 10.6 (6.4-14.0) s), mainly due to difficulty in advancing a tube into the trachea. No significant difference was observed for the size 2., Conclusions: In small children without predicted difficult airways, time to intubate the trachea was significantly longer for a McGRATH®MAC blade 1 than a Macintosh blade 1., Clinical Trial Registration: jRCT1032220366., (© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Conclusions: Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents. Objectives: This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID. Methods: This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications. Results: Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed. [ABSTRACT FROM AUTHOR]

Conclusion: This new regenerative therapy shows great potential for the treatment of stenosis of the trachea and/or cricoids (STC). Objectives: To estimate the potential of tissue-engineered artificial trachea (AT) for treatment of STC in clinical applications. We previously reported that AT was a useful material for implantation into a tracheal defect after resection of cancer. There are many causes of stenosis of the respiratory tract and STC is particularly difficult to treat. Methods: The AT was a spiral stent composed of Marlex mesh made of polypropylene and covered with collagen sponge made from porcine skin. Three patients with STC were treated by this tissue-engineering method. All of them suffered from STC caused by long endotracheal intubations. They underwent a two-stage operation. In the first operation, after resection of the stenotic regions, the edge of the tracheal cartilage was sutured to the edge of the skin. The tracheal lumen was exposed and a T-shaped cannula was inserted into the large tracheostoma. At 3 weeks to 2 months after the first operation, the trachea and skin were separated. The trimmed AT with venous blood and basic fibroblast growth factor (b-FGF) was then implanted into the cartilage defect. Results: Postoperatively, all patients were able to breathe easily and had no discomfort in their daily activities. Six months after the second operation, we observed enough air space in the trachea and cricoid by computed tomography (CT) imaging and fiber endoscopy. [ABSTRACT FROM AUTHOR]

Objectives: Our previous studies focused on basic research and the clinical applications of an artificial trachea. However, the prefabricated artificial trachea cannot be utilized for pediatric airways, because the tracheal frame needs to expand as the child develops. The purpose of this study was to evaluate the potential of induced pluripotent stem (iPS) cells for the regeneration of the tracheal wall. Methods: We cultured iPS cells in a 3-dimensional (3-D) scaffold in chondrocyte differentiation medium (bioengineered scaffold model), and the results were compared with those in a 3-D scaffold without iPS cells (control scaffold model). The 3-D scaffolds were implanted into tracheal defects in 8 nude rats. After 4 weeks, the regenerated tissue was histologically examined. Results: Implanted iPS cells were confirmed to exist in all 5 rats implanted with bioengineered scaffolds. Cartilage-like tissue was observed in the regenerated tracheal wall in 2 of the 5 rats in the bioengineered scaffold model, but in none of the 3 rats in the control scaffold model. Conclusions: Implanted iPS cells were confirmed to exist in the bioengineered scaffold. Cartilage-like tissue was regenerated in the trachea! defect. This study demonstrated the potential of iPS cells in the regeneration of the trachea! wall. [ABSTRACT FROM AUTHOR]

Background: Appropriate sizes (internal diameters) and insertion depths of uncuffed preformed endotracheal tubes in children with cleft lip and palate, who generally have delayed growth and development in early infancy have not been elucidated. Methods: The sizes and insertion depths of endotracheal tubes in patients who received primary cheiloplasty and/or palatoplasty in relation to age, height, and weight were retrospectively analyzed. Tube sizes were determined using an appropriate air leakage at an airway pressure of 15–20 cmH2O. Tube insertion depths were confirmed by auscultation of bilateral breathing sounds at several tube depths, placing the tip 1.5 cm above the carina. Obtained data sets were compared with previously published studies. Results: The number of cases analyzed was 236 in total. The mean age, height, and weight were 327.4 ± 199.2 days, 69.7 ± 7.5 cm, and 8.2 ± 1.8 kg, respectively (mean ± sd). Neither the tube size nor tube depth in cleft lip and palate children was smaller or shorter than those of normal subjects. Discrepancies between the preformed bend and the tube insertion depth increased as the tube size increased. Conclusions: The current findings suggest that it is reasonable to apply the currently available standards for normal children, e.g. Motoyama’s general guide, to predict the tube size and insertion depth for Japanese cleft lip and palate children, and that the use of the uncuffed preformed endotracheal tube is associated with a risk of endobronchial intubation, which appears to increase with age. [ABSTRACT FROM AUTHOR]

Background: A dry powder inhaler of KP-496 is currently in clinical development in Japan as an antiasthmatic agent. The aim of this study was to evaluate the in vitro pharmacological profile of KP-496. Methods: The antagonistic activities of KP-496 for leukotriene (LT) D4 and thromboxane (TX) A2 receptors were examined using the LTD4 - and U46619-induced contractions of the isolated guinea pig trachea. The selectivity of KP-496 was examined using various agonist-induced contractions in the isolated guinea pig trachea. Results: KP-496 produced parallel rightward shifts of the LTD4 and U46619 concentration-response curves in a concentration-dependent manner. Schild plot analyses of the antagonistic activities of KP-496 demonstrated that it is a competitive antagonist for LTD4 and TXA2 receptors with pA2 values of 8.64 and 8.23, respectively. The LTD4 antagonistic activity of KP-496 was comparable to that of pranlukast and zafirlukast but was more potent than that of montelukast. The TXA2 antagonistic activity of KP-496 was comparable to that of seratrodast. KP-496 and seratrodast also inhibited the prostaglandin (PG) D2 - and PGF2α-induced contractions of the isolated guinea pig trachea. KP-496 had no effect on the histamine-, acetylcholine-, serotonin- and substance P-induced contractions of the isolated guinea pig trachea. Conclusions: These results indicate that KP-496 is a selective dual antagonist for LTD4 and TXA2 receptors. LTD4 and TXA2 play important roles in asthma, and antagonists for these mediators are being used for the treatment of asthma. Thus, KP-496 is expected to become a novel potent therapeutic agent for asthma. [ABSTRACT FROM AUTHOR]

Tracheal washing fluid was collected from 170 foals at 28 and 35 d old from February to July in a foaling season on horse-breeding farms with sporadic rhodococcosis in Japan and was investigated by quantitative culture. The history of the 170 foals followed up for the next few months. The proportion of R. equi-positive foals at 28 and 35 d old was significantly increased according to the birth month. Furthermore, the mean number of R. equi in the tracheal washing fluid of each month group increased according to their birth month with the rise in outside temperature. During the follow-up observation, 9/30 foals (30.0 %) born in February showed the first clinical signs at 56 ± 8 d old, 21/61 foals (34.4 %) born in March showed the signs at 37 ± 3 d old, 15/49 foals (30.6 %) born in April showed the signs at 39 ± 2 d old, and 7/30 foals (23.3 %) born in May showed signs at 44 ± 3 d old. Two sick foals (6.7 %) born in February, 19 sick foals (31.1 %) born in March, 15 sick foals (30.6 %) born in April, and 6 sick foals (20.0 %) born in May showed a positive culture of R. equi at 28 or 35 d old. The present study revealed that birth month is associated with the initial colonization of R. equi in the trachea of newborn foals on farms with sporadic rhodococcosis in Japan. Therefore, birth month might be a risk factor for developing R. equi pneumonia in foals., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background Anaplastic thyroid cancer (ATC) is a malignant tumor with very poor prognosis. In the Phase 2 study in Japan, the antitumor effect of lenvatinib against ATC has been demonstrated. However, there are few reports on the efficacy and safety of lenvatinib in ATCs in many practical clinical cases. Method: We analyzed 124 ATC patients enrolled in all cases survey that began in May 2015 when lenvatinib was approved for unresectable thyroid cancer in Japan. The observation period per case was 12 months, and the tumor response was evaluated by image findings at 3 months, 6 months, and 12 months after administration of lenvatinib. For safety, frequency and severity of side effects of lenvatinib were evaluated with CTCAE v 4.0. Results: Of the 124 patients, 61.3% were female. The median age was 73 (41-90) years, performance status 0/1/2/3/4 was seen in 38/50/18/13/5 patients, respectively, stage (IVa/IVb/IVc/unknown) was 0/21.8/68.5/8.1%, respectively, the maximum tumor length (less than 10/10-50/50-100/100mm-) was 4.8/32.3/47.6/3.2%. Tumor infiltration in either the carotid artery, jugular vein, trachea or skin were present in 72.6% patients. The initial dose of lenvatinib was 24 mg/day in 70.2% of patients, and the median dose was 15.8 mg/day. The best overall response for CR/PR/SD/PD was 3/44/33/25 cases in a total of 105 evaluable patients. The response rate was 44.8%, and the disease control rate was 76.2%. The survival rate at 1 year after lenvatinib treatment was 18.5%, and factors influencing prognosis were PS 3 or more, liver metastasis, carotid infiltration of tumor. The main side effects (All grade/Grade 3 or more) after administration of lenvatinib were hypertension (69.4/46.8%), proteinuria (29.8/7.3%), palmar-plantar erythrodysesthesia syndrome (25.8/3.2%), and decreased platelet count (22.6/12.9%). Conclusion: The results suggest that lenvatinib demonstrated activity and was well tolerated in ATC patients in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan., Methods: A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed., Results: Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body., Conclusions: Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.

We conducted a study to assess the precise incidence of anaerobic infections among patients with pulmonary diseases in Japan. To avoid false-negative results of anaerobic cultures, we used percutaneous transtracheal aspiration and subsequent immediate bedside anaerobic inoculation onto a set of plates with appropriately selected culture media. Fifty-six episodes of pulmonary disease occurred in 50 patients; anaerobes were isolated in 20 (36%) of these episodes. Bacteria were recovered in 30 (94%) of 32 episodes not associated with prior antimicrobial therapy, and anaerobes were isolated in 15 (47%) of these 32 episodes. Rates of anaerobic isolation in episodes of pneumonia (7 of 14), lung abscess (3 of 3), and acute exacerbation of chronic lower respiratory tract infection (5 of 15) that were not associated with prior antimicrobial therapy were 50%, 100%, and 33%, respectively.

Incidence of foreign body aspiration in tracheobronchial tree is rare, however the foreign body aspiration can lead to severe illness and even death if not diagnosed and treated promptly. We retrospectively analyzed forty five patients who underwent ventilation bronchoscope under general anesthesia for suspected aspirated foreign bodies in our hospital. In thirty eight patients, foreign body was confirmed in tracheobronchial tree, while in seven patients foreign body was not confirmed with bronchoscope. The thirty eight patients ranged in age from 10 months to 73 years; the peak incidence of foreign body aspiration occurred in children under 3 years of age. Twenty five of thirty eight patients were male. Food or food derivatives were the causative agents in 68% of the patients, with 65% due to a portion of peanut. The foreign body was located in the right and left bronchus with almost equal frequency. The main symptoms were coughing (72%), wheezing (53%), and dyspnea (25%). The radiographic abnormality was seen in eighteen of thirty eight patients. A radio-opaque material was seen in 18%. Children at age 6 years of younger (90%) had been witnessed to choke on identifiable foreign body, but only 40% were diagnosed within 24 hours. Twelve of these children were treated unnecessarily for asthma, pneumonia, or so on. We conclude that it is most important to take history carefully considering the possibility of foreign body aspiration in the patients with coughing, wheezing, or dyspnea.

A statistical study of 41 cases with denture foreign bodies in the air and upper food passages which were treated in our department during the past 21 years was done. (1) Males were more frequently affected. The ratio of male to female was about 2 to 1. (2) Of 41 dentures, 2, 2 and 37 were lodged in the air passages, hypopharynx and esophagus respectively. (3) There were 5 complete mandibular dentures in 41 cases. (4) The causes of the denture foreign bodies were originated to the problem of denture itself in 29 cases, that of the patient himself in 2 cases and both in 10 cases. (5) Of 39 problematic dentures, 16 showed the breakage such as plate fracture and clasp deformity, but the other 23 showed no breakage. In this latter group, poor holding of the denture was ascribed to miss-making or miss-planning. (6) Of 12 patients with problems in their physical function, 5 had suffered from cerebrovascular disease and 3 from geriatric dementia. (7) The denture foreign body in aged patients with physical hypofunction tends to increase in recent years. (8) Of 39 dentures tried to remove by esophagoscopy, 18 were done with difficulty and they were detachable partial dentures with one artificial tooth and 2-arm-clasps lodged at the first and/or second isthmus of the esophagus. Though we have a denture removed successfully at the third trial, we have no case needed external esophagotomy. (9) Duplicated denture models were made in 20 cases prior to the procedure, and we certify that these models play an important role for the safer removal of denture foreign bodies.