Concerning the early detection of the peripheral lung cancer, the problems werediscussed about the limitation of the detectable size and the interval of periodicalchest X-ray examination.
The volume doubling time of the peripheral lung cancer was measured in 44 cases to know the differences of the growth rate by histological types. Adenocarcinomawas divided into two sub-groups; alveolar-septum lining type which consisted ofpulmoalveolar and papillary adenocarcinomas, and alveolar-space filling type whichconsisted of tubular and acinar adenocarcinomas.
The volume doubling times in each histological type were from 149 to 1, 430 days (mean: 93 days) in squamous cell carcinomas; from 27 to 130 days (mean: 71 days) (mean: 121 days) in alveolar-space filling adenocarcinomas; from 52 to 184 days (mean: 93 days) in squamous cell carcinomas; from 27 to 130 days (mean: 7.1 days) in large cell undifferentiated carcinomas and from 28 to 56 days (mean: 43 days) in small cell undifferentiated carcinomas.
The diameter of the shadow of the cancer at detection were measured in 33cases which were periodically checked by chest X-ray before detection with theinterval of less than 12 months. Although the alveolar-septum lining adenocarcinomahad the slowest growth rate and had an opportunity of being detected in smallersize, 11 of 12 cases were more than 1.5 cm in diameter at detection. On the other hand, 9 of 21 cases of the other types were 1.5cm or less in diameterat detection, even though they had rather faster growth rate. The minimum diameterat detection was 1.0cm in alveolar-septum lining adenocarcinoma and 0.6cm in theother histological types. This is indicating that the minimum limitation of the detectablediameter is larger in the alveolar-septum lining adenocarcinoma than in the other types.
The duration of time for cancers to grow from 0.5cm to 2.0cm, which wascalculated from the volume doubling times, was more than 5.4 months for undifferentiated carcinomas, more than 10.4 months for squamous cell carcinomas, more than 12.4 months for alveolar-space filling adenocarcinomas and more than30 months for alveolar-septum lining adenocarcinomas. Therefore, it was concludedthat the interval of the periodical chest X-ray examinations should be 6 months fordetecting almost all of the peripheral lung cancers within less than 2.0 cm in diameter.
Since the minimum limitation of the detectable diameter is larger in the alveolarseptum lining adenocarcinomas than in the other types, a careful attention is requiredfor the detection of this type, althoug the growth rate is extemely slow in this type.

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A cell line (DL-1) from a mongrel lung cancer, induced experimentally byintrabronchial application of 20-methylcholanthrene was established in vitro andmaintained in continuous growth for about two years. The materials used forexplantation was a metastatic adenoacanthomatic paratracheal lymph node. The cultured cells grew attached to a glass surface in layered heaps and posessedthe characteristics of poorly differentiated cancer cells from their ultrastructure anda tumor which grew in a hamster's cheek pouch after transplantion of 15th generationcells. The cultured cells were transplanted to 15 allogeneic mongrels using manydifferent methods and amounts of cells. But we could not succeed in transplantingthe cultured cells.

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The present study was designed to clinically evaluate the joint use of perfusionlung scintigraphy and tumor scintigraphy with ¹⁹⁷HgCl₂ in the diagnosis of lungcancer. These procedures were performed in 129 patients including 84 cases ofprimary lung cancer. Seventy nine cases out of 84 primary lung cancers (95.2%) had an abnormal perfusion lung scintigram. A marked impairment in pulmonarycapillary flow in the patients presenting with hilar bronchogenic carcinoma, pleuritiscarcinomatosa and atelectasis. Eighty cases of 84 primary lung cancers (96.4%) exhibited discernible selective uptake of ¹⁹⁷HgCl₂. ¹⁹⁷HgCl₂ scintigraphy was usefulin detecting primary focus in the lung cancer with atelectasis and/or pleural effusionand metastatic foci in the mediastinum and hilar region. Combination of the twoprocedures made isotope diagnosis of lung cancer more reliable and eliminated thedisadvantages of both methods which thus complement each other favourably.

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With the recent advance in surgery, the incidence of postsurgical pulmonarycomplications have been markedly reduced, however the acute collapse of the lungdue to air-way block by excess bronchial secretions after the surgery still remains animportant field in surgical complications.
Subsequently the collapsed lung leads to increased pulmonary vascular resistanceand/or unevenness of ventilation and perfusion, which are clinically manifested bytachypnes; tachycardia, arryhunia and so on. Sucking out excess secretions in theair way is the first and fational choice for the treatment of such complications. Thebronchofiberscope has been used in 33 cases for this therapeutic purpose. The casestreated with flexible bronchofiberscope are analysed and summarized as below.
1 The cases were selected because of tachypnea, dyspnea, tachycardia, arrthymia, cyanosis, etc. All of these symptoms were thought to be caused by the retention of excess bronchial secretions after the surgery. They were clinically improvedafter the therapeutic bronchofiberscopy.
2 31 out of 33 cases revealed no atelectasis on the chest x-ray film.
3 The mechanical stimulation of the air-way from this treatment produced acough reflex, which eventually improved ventilatory function of the cases.

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Bronchographic findings of lung cancer were studied in relation to the histologicaltypes. According to the order of the bronchus where the tumor existed, lung cancerwas divided into two groups; 1. hilar type (proximal to the third order bronchus) and 2. peripheral type (distal to the fourth order bronchus). In the hilar type, bronchofiberscopic findings were also discussed especially in relation to the histologicaltypes.
1) hilar type Bronchographic findings showed no remarkable characteristic features, while bronchofiberscopic findings showed some reasonable features in relation to thehistological types.
2) peripheral type
a. Squamous cell carcinoma in 27 cases: The bronchogram showed irregular orclear cut obstruction and adjacent to the foci the bronchi were dislocated bythe mass and irregular margins were demonstrated.
b. Adenocarcinoma in 27 cases: Tapered obstruction was characteristic andaround the foci, frequently at the periphery of the lung, the bronchi wereretracted toward the mass, showing converging appearance.
c. Poorly differentiated and large cell carcinoma in 23 cases: The bronchogramshowed almost the same findings as in squamous cell carcinoma, althoughmarked dislocation of the bronchi and loss of arborization were characteristicfeatures in these cases.
d. In contrast to carcinoma, chronic pneumonia showed constriction of theproximal bronchi, bronchiectasis and loss of arborization.
Histological analysis of the bronchographic findings of lung cancer may also beof great advantage to differentiate the disease from inflamatory lesions. Even selectivebronchography by Metras catheter method has often failed to identify early peripherallung cancer. Consequently, an approach to a new method should be devised forevaluating the lesions in the higher order of the bronchus.

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In order to investigate the trend of death from cancer, the author tried to estimatethe instantaneous death rate (hazard function) from the life table of 1827 patientswith lung cancer according to clinical stage (Japan Lung Cancer Society). (1966)
The data was collected by the Lung Cancer Task Force Japan Joint Comitteeon TNM Classification in 1967, 68 and 69.
The result of the present study showed approximately that the hazard functionswere not motone, which increases initially to a maximum and then decreases to zerowith time.
Since a log-normal and a multi-hit distributions have a non-monotone hazardfunction, these theoretical distributions would probably fit the above data.
But, the log-normal distribution is difficult to distinguish from the multi-hitdistribution by means of graphic method.

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To correctly grasp the immune response of the tumor host is exceedinglyimportant in administering immunotherapy. Using cells of a cell line we establishedfrom a primary human lung cancer tumor (adenocarbionma), we conducted autologouscolony inhibition tests of the peripheral lymphocytes of the same patient beforeand after BCG inoculation in conjunction with T, B-cell subpopulation and PPDtests, as non-specific tests. Results of colony inhibition tests showed significantdifferences before and after BCG administration, decreasing as the disease progressed, becoming-9% immediately prior to death. PPD also turned positive with administration of BCG, but this reaction also diminished gradually. T-cell changes werelow in general and no definite tendencies could be observed.
The results of this study show that even in advanced cases the immune responseis increased through BCG inoculation.

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