[Video-assisted bedside pleuroscopy under local anesthesia: use of a rigid cystoureteroscope in patients with undiagnosed pleural effusion].

Up to 20% of pleural effusions remain undiagnosed despite history-taking, physical examination, thoracentesis, and percutaneous closed pleural biopsy. The next diagnostic procedure used is often thoracoscopy under general anesthesia in an operating room. We report a technique for beside pleuroscopy and pleural biopsy that can be done without assistance of surgeons. We performed video-assisted pleuroscopy with a rigid cysto-ureteroscope in seven patients with pleural effusion that remained undiagnosed despite extensive clinical evaluation. A sterile 19.8 Fr. rigid cysto-ureteroscope was placed into the pleural space under local anesthesia. Pneumothorax was induced to enhance visualization of the surfaces. Forceps-biopsy specimens were taken of suspicious lesions on the parietal pleural. In three patients the pleural surface appeared smooth and in two the parietal pleural surface was studded. A localized coin-like lesion was seen in one patient, and extensive fibrinogenic adhesions and diffuse opacity of the parietal pleura was seen in another. Using this bedside procedure, we diagnosed pleural tuberculosis in three patients and pleural metastases of adenocarcinoma in one. When done under local anesthesia with a rigid cyst-ureteroscopy, video-assisted pleuroscopy can be a safe and useful diagnostic aid in patients with undiagnosed pleural effusion.

Effect of 'bakumondo-to', a Chinese-Japanese herbal medicine, on cultured and dispersed salivary gland cells.

'Bakumondo-to', a Chinese-Japanese herbal medicine, has been used for patients with xerostomia in Japan. Although the efficacy of this medicine for xerostomia has been reported, the pharmacological basis was only partially understood. The aim of this study was to clarify the direct effect of Bakumondo-to on salivary gland cells using isolated and cultured cells. In the physiological experiment using the fluorescent dye fura-2, Bakumondo-to showed no direct effect on isolated parotid gland cells. On the other hand, Bakumondo-to, when applied to cultured salivary gland cells, showed enhancement effects on cell proliferation. After inspection by transmission electron microscopy, we concluded that Bakumondo-to did not show an increase in the number of secretion granules but did increase the mean size of secretion granules in parotid gland cells. These mechanisms, together with other in vivo effecters, may contribute to clinical efficacy.