Thirty-eight cases of multiple primary cancer involving the lung were experienced in our hospital during the period from January 1962 to May 1987. The incidence rate of multiple primary cancer was 5.0% of all hospitalized cases of primary lung cancer. In thirty-six cases of double primary cancer, twenty-seven cases were metachronous, only two of which were cases of prior lung cancer. There were three cases of triple primary cancer. Stomach cancer was most frequently associated with lung cancer.
The 5-year survival rate of all multiple primary cancer was 27.1%. The 5-year survival rate of the cases detected by mass X-ray survey or by X-ray examination during follow-up was 47.8%, which was better than that of the cases detected by symptoms.
In the follow-up of malignant diseases, more attention should be paid to the possibility of a second primary cancer because earlier diagnosis and aggressive treatment may prolong survival.

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Forty-five lung cancer patients who manifested spinal cord compression caused by metastases to the spine were studied.Thirty-three of patients were male, 12 female and their ages ranged from 36 to 81 years (median 59).Their carcinomas were classified as follows: adenocarcinoma (19), small cell (11), large cell (9), squamous cell (5) and unknown (1). Bonescintigrams showed, spinal metastases in the cervical region in 2 patients, the cervicothoracic region in 6, the thoracic region in 15, the thoracolumbar region in 5 and the lumbar region in 17.A total of 36 patients underwent local treatment, i.e.radiotherapy and/or laminectomy, while 9 did not because of their poor general condition.Before treatment, 14 patients were ambulatory, 22 were not.After local treatment, 13 of the former group had retained motor function as opposed to only 2 of the latter group.
The median survival time for the entire group of 36 patients who were treated with radiotherapy and/or laminectomy, with or without the addition of glucocorticoids, was 7 weeks. The 8 patients who showed post-treatment neurological improvement survived longer (24 weeks) than those who did not (7 weeks, p=0.032).The 16 patients who were ambulatory after treatment survived longer (17 weeks) than those who were not (6 weeks), but with little significance (p=0.124).In contrast, the length of the survival time was not dependent on the histological type (10 weeks in patients with non-small cell carcinoma versus 7 weeks in those with small cell carcinoma), pre-treatment neurological findings (8 weeks in patients who were ambulatory versus 7 weeks in patients who were not ambulatory) nor on the type of local therapy (8 weeks in patients treated surgically versus 8 weeks in those treated non-surgically).
Although the available literature reports poor results in the treatment of spinal cord compression due to metastases from lung cancer, post-treatment motor function could be more frequently maintained and the survival time could be prolonged if the patients were adequately treated before becoming incapacitated.

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Cardiac tamponade caused by cancerous pericarditis is life threatening and requires immediate treatment. The control of pericarditis has great influence on the prognosis of the patient with cancerous pericarditis.
We tried local treatment of cisplatin (CDDP) on 5 cases of cancerous pericarditis. The subjects consisted of 2 small cell carcinomas, 2 adenocarcinomas and 1 adenoid cystic carcinoma. As for the primary site, 4 cases were lung cancer and 1 case was gastric cancer.
CDDP (25mg-100mg) was administered into the pericardium through an echo-guided catheter. The treatment was clinically effective in five cases.
As a side effect, arrythmia was observed in 1 case. Pharmacokinetics revealed a low level of CDDP in serum, and a high level of free type CDDP in pericardial effusion.
It was concluded that local treatment of CDDP is effective for cancerous pericarditis.

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Small cell lung carcinoma (SCLC) has been shown to be extremely responsive to chemotherapy and radiotherapy, but such responses are often short in duration and long-term survival (5 years or more) is rarely seen. Of 144 patients with SCLC treated by chemotherapy with or without radiotherapy from January 1975 to December 1982 at the National Kinki Chuo hospital for Chest Diseases, 7 patients survived over 5 years-3 males and 4 females. All of these had limited disease and received combination chemotherapy as well as radiotherapy. Among them there were no cases of recurrence after receiving appropriate treatment. It is considered that achieving CR status early with combined modality therapy, including combination chemotherapy and radiotherapy is important to obtain long term survival.

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Eight cases of multiple primary lung cancers were experienced during a period of 12 years from January, 1975 to May, 1987, six of which were metachronous and two wer synchronous. Of the six metachronous cases, five underwent operation for the second tumors. In a unilateral synchronous case, both tumors were resected simultaneously, but in a bilateral synchronous case tumors were resected separately. In the seven operated cases, six had limited operation because of their poor respiratory function, and they had no complications.
It is possible to carry out surgical treatment in patients with multiple primary lung cancers when the respiratory function is accurately known and the operation method is chosen accordingly. In such cases, a favorable prognosis can be expected.

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The Nutritional status of 24 patients with lung cancer and 60 healthy subjects was studied. A decrease in anthropometric parameters and in visceral proteins such as Alb, Tf, PA, RBP, suggested a high incidence of protein energy malnutrition (PEM) in lung cancer patient. Plasma amino acids analysis showed, that the Fischer ratio (BCAA/AAA) was reduced, which may suggest the existence of an imbalance of plasma amino acids in patients with lung cancer.
A subgroup with reduced delayed-type hypersensitivity reaction was shown to be more malnourished than those with normal delayed-type hypersensitivity reaction. NK cell activity, which has been shown to play an important role in the defense mechanism against tumor, correlated significantly with visceral proteins and the Fischer ratio. These findings may suggest the relationship between malnutrition and cell-mediated immunity in patients with lung cancer.

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Selective bronchial arteriography was performed using a new double lumen catheter which was equipped with a shepherd's crook in the outer catheter and straight inner catheter. In 5 cases of 6 cases examined, the inner catheter was successfully inserted into the proper bronchial artery, avoiding the other branches. Four cases with primary lung cancer were treated with 40 mg of cisplatinum (BAI) and more than 25% reduction in tumor size was seen in 2 cases. A case with hemoptysis was successfully treated with gelatin sponge (BAE) through this catheter. Thus, selective bronchial arteriography using this catheter may provide the following advantages: 1) increase of therapeutic effects on BAE and BAI 2) prevention of complications such as spinal injury and esophageal ulcer.

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The effect of chest irradiation on pulmonary function was studied in 16 patients with lung cancer and one with malignant thymoma. Radiation pneumonitis was detected by chest radiography in 15 cases (88%), 35 days (average) after the completion of radiation therapy. In these cases the radiation field included the lungs, and the hilar and mediastinal regions. No radiation pneumonitis occurred in the other two patients, receiving only lung field irradiation.
Various pulmonary functions were measured in all patients following radiation therapy. Inspiratory reserve volume, inspiratory capacity and diffusing capacity were significantly reduced 1 month and 3 months after the completion of radiotherapy. Furthermore, reduction of vital capacity was found 3 months after treatment.
It may be concluded that pulmonary function tests are not useful in predicting the onset of radiation pneumonitis, as chest radiography revealed inflammatory changes before the reduction of pulmonary function was detected.

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A rare case of Lambert-Eaton myasthenic syndrome (LES) associated with pulmonary adenocarcinoma was reported.
A 58-year-old male was admitted to our hospital because of fatigue in the extremities. The electromyogram showed the typical pattern of LES. During the course of examination, atumor was found in the right middle lobe of the lung. After resection of the tumor, markedimprovement was seen in the symptoms and the electromyogram. Histologically, the tumorwas poorly differentiated adenocarcinoma, and neither immunohistochemical nor ultrastructural examinations showed neuroendocrine differentiation. To the best of our knowledge, this is only the fourth case of LES with pulmonary adenocarcinoma to be reported in Japan.

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A 74-year-old asymptomatic male was admitted because of abnormal chest X-ray findings. Chest films showed a tumor shadow in the left lower lung field. The tumor which obstructed the basal bronchus, was recognized by bronchofiberscopy. Left lower lobectomy was carried out. The tumor, 8×3×2.5 cm, extended from B⁹⁺¹⁰ into the lumen of basal bronchus, which was occluded. Invasion to lung parenchyma was not recognized. Microscopical examination of tumor cells showed abundant granular, eosinophilic cytoplasm, and round nucleis. In the cytoplasm of some tumor cells grimelius stain revealed many argyrophilic granules, but their contents were not defined by immunochemical methods. Electron microscopy showed mitochondrial hyperplasia and a few small dense core granules. Judging from these characteristic histological findings, this tumor was diagnosed as a rare case of oncocytomatous carcinoid.

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A 73 year-old male developed hyponatremia repeatedly following treatment with cyclophosphamide and vincristine for an oat-cell carcinoma of the lung. The osmolarities and sodium levels of serum and urine at 24 hours after administration of cyclophosphamide was measured. The results were consistent with a diagnosis of SIADH induced by cyclophosphamide. The possibility of an ectopic-ADH producing tumor was ruled out by clinical findings of the patient.

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A 50 year-old male, in whom a mass shadow had been pointed out on chest X-ray, was admitted. The mass was suspected to be fibroma based on the bronchoscopic biopsy results. However, because of its rapid growth, it was clinically suspected to be malignant and right upper lobectomy was performed. The tumor was 4.5×4.0×4.0 cm in size. It was histopathologically diagnosed as fibrosarcoma and after 2 years postoperative observation, was diagnosed as primary pulmonary fibrosarcoma. We also reviewed 23 cases reported in the Japanese literature and discussed various clinical aspects of primary pulmonary fibrosarcoma.

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An extremely rare case of primary pulmonary osteogenic sarcoma was reported. The patient was a 70-year-old man. Chest X-ray and CT films displayed a tumor in the right lower lung field (S8). CT-guided needle aspiration biopsy (CT·NAB) revealed malignant cells, and he underwent a right middle and lower lobectomy of the lung and 7th and 8th rib resection. Histological diagnosis of the tumor revealed osteogenic sarcoma of the lung with no lymph node metastasis and no invasion to ribs or parietal pleura. After 8 months, he suffered recurrence in the CT·NAB needle tract and died.

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In normal bronchial branching, regular branching into similarly sized branches is the standard pattern. Smaller irregular branches fill the empty spaces between regular branches and are called daughter branches. Alveoli in the hilar region comprise the peripheral area containing daughter branches from a subsegmental or one more divisional peripheral bronchi. Sometimes abnormal shadows are observed in this area. Heretofore only a few reports have mentioned these shadows.
In order to evaluate the usefulness of the various radiologic methods of examining localized shadows in the pulmonary hilar region, two cases of primary lung cancer, one with metastatic lung cancer and the other with carcinoid, and one case of hamartoma were examined.
Bronchography was useful for the evaluation of the spatial relationship between the mass and bronchi. Bronchial arteriography was helpful in the evaluation of the benign tumor.
Inflated-fixed lungs prepared according to Heitzman's method in the two casesof lung cancer clearly showed the tumor together with the surrounding bronchi and vessels

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