Photodynamic diagnosis in respiratory tract malignancy using an excimer dye laser system.

Equipment has been developed for the early-stage diagnosis and treatment of cancer using an excimer dye laser. The excimer laser beam is obtained by exciting XeCl. A 405 nm beam tuned by DPS dye is used for tumour localization and a 630 nm beam obtained with a rhodamine B dye is used for treatment. The equipment was applied clinically on the basis of extensive experimental research. Effectiveness for cancer localization was examined in 11 cases: four were early stage (three lung cancer and one vocal cord cancer), four were stage I, two were stage III and one was stage IV. All cases were squamous cell carcinoma except for one case of adenocarcinoma. Fluorescence was recognized in all lesions and the equipment was effective for localization.

[Endoscopic Nd-YAG laser treatment of tracheobronchial lesions].

Eight cases treated with Nd-YAG laser via fiberoptic bronchoscopy were studied. Four of them were primary lung cancer, one was tracheal invasion of thyroid cancer and three were postintubation lesions of trachea. In six cases, Nd-YAG laser treatment was effective for enlargement of the airway lumen and improvement of their symptoms. In the cases of advanced lung cancer, not only local findings of the tumor but also clinical stage and possibility of adjuvant therapy must be considered to apply this procedure. In the cases of postintubation tracheal stenosis (except polypoid lesions), T-tube stenting or surgical reconstruction must be followed after laser treatment. Nd-YAG laser treatment can be useful for the tracheobronchial lesions such as primary tracheal tumors, lung cancer, metastatic tumors, postintubation tracheal stenosis and so on if applied precisely.

[Targeting therapy for lung cancer].

Many approaches have been developed to targeting therapy for lung cancer. The representatives types have included photodynamic therapy (PDT), bronchial arterial infusion of anticancer agent and/or embolization, intensification of the effect of drugs on tumor tissue and drug delivery systems (DDS) using liposomes. In our hospital, 195 lung cancer patients, including those with 56 early stage lesions, have been treated with PDT, and a CR rate of 65.2% was obtained. Bronchial arterial infusion (BAI) for clinical N2, in-operable non-small cell lung cancer patients has prolonged median survival time compared to the patients treated without BAI. Combined modalities of chemotherapy and low power laser (He-Ne Laser) irradiation in the experimental animal model have been shown. This combined therapy may permit enhancement of the antitumor effects of routine chemotherapy by reducing the side effects of the drug. DDS using liposomes may well be a major targeting therapy for lung cancer. In our data, trans-bronchial injection of chemotherapeutic drugs encapsulated with liposomes will be most effective for mediastinal lymph node metastasis of lung cancer.

[A case of traumatic hernia of diaphragm showing prolapse of liver with abnormal lobulation into pleural cavity].

A 48-year-old male was admitted to our hospital in 1988 with injury by a traffic accident, resulting in fracture of the right rib, right clavicle, and pelvic. The patient came to us again with a chief complaint of abdominal pain in May, 1991 when digestive tract gas was observed in the right pleural cavity casting a doubt of diaphragmatic hernia. Chest CT scan and liver scintigraphy disclosed prolapse of the colon into the pleural cavity together with a picture on the diaphragm being supposed as parenchyma of the liver. Operation findings showed prolapses of the colon and the omentum through the opening of diaphragm into the pleural cavity and also exhibited prolapse of hepatic parenchyma, supposedly S4, together with gallbladder into the pleural cavity. The case, which had showed no abnormality in the Chest X-ray film before the injury, was conceivably an extremely rate case of traumatic hernia with the right diaphragm showing; abnormality of hepatic lobulation accompanied by diaphragmatic rupture, and prolapse of the liver with abnormal lobulation.