Using a thermodilution method, we investigated the influence of lobectomy on right ventricular function and respiratory function. In group A (pre-RVEF≤0.4, n=5), RVEF and RV-Emax rose immediately after lobectomy (RVEF : 0.35±0.04→0.39±0.11 ; RV-Emax : 0.33± 0.06→0.37±0.06 mmHg/ml/m²). But in group B (pre-RVEF>0.4, n=5), RVEF and RV-Emax fell immediately after bobectomy (RVEF : 0.49±0.15→0.48±0.04 ; RV-Emax : 0.66±0.11→0. 44±0.09 mmHg/ml/m²). With the passage of time, in both groups there was a tendency for RVEF and RV-Emax to decrease, but in group A (except in 2 patients with atrial fibrillation after lobectomy) RVEF and RV-Emax rose again after one month. There was a correlation (coefficient 0.60) between pre-operative %VC and RVEF. After the changes in physiological conditions due to lobectomy or pneumonectomy, in hearts which retain full innervation inner catecholamine are mobilized and the function of the right ventricle changes spontaneously.

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During the past 10 years, ten patients with pulmonary aspergillosis were treated surgically in our institute. Surgical interventions were necessary because of the repeated hemoptysis resistance to the antifungal treatment in 8, and the suspicious diagnosis of the lung cancer in 2. Although seven patients underwent pulmonary resections (Lobectomy in 4, segmentectomy in 2, partial resection under the thoracoscopy in 1), these procedures were not applicable in 3 patients due to the extended intrapleural disease and the poor patient condition. The muscle plombage and the thoracoplasty following the carvernotomy in 2, and the omental flap plombage following cavernotomy in the other were conducted in substitution for the pulmonary resection. Postoperative complications were encountered in 3 patients : bleeding, bronchial stenosis, bronchopleural fistula. All patients are alive without any relapse of the disease at 9 to 110 months after surgery.
It was concluded that the combination of different surgical procedures other than the pulmonary resection can cause a favorable result in the treatment of widely extended pulmonary or intrapleural aspergillosis, while segmentectomy or lobectomy can be applied successfully for the disease with limited extension.

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Between 1982 and 1992, 315 patients with non-small-cell lung cancer (NSCLS) underwent surgery in our service. Of them 102 were of pathological stage I proved by a complete preoperative work-up which included mediastino-hilar lymph-node dissection.
We studied T factors, histological type, lymphatic and venous infiltration, and expression of E-cadherin (ECD) in formalin-fixed paraffin-embedded surgical specimens from all 102 patients. The overall 5-year-survival rate was 73.1%. In T1 disease it was 87.0% and in T2 54.9% (p<.05), and in Ly (-) disease it was 90.0% and in ly (+) it was 61.1% (p<.05). ECD expression in the 77 patients evaluated was preserved in all. 32 surviving patients (100 %), and reduced in the 45 patients whose five year survival ratio was 62.1% (p=.0028).
Of the patients with T2 disease 20 had reduced ECD and 50.1%, but all 32 patients with T1/ 2 disease preserved ECD survived 100%.
Thus ECD expression seems to be one of the best prognostic factors for stage I NSCLC.

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We treated 14 patients with lobectomy and pulmonary angioplasty for stage III primary lung cancer from 1985 to April 1995. In this paper, we consider the indications for the lobectomy/ pulmonary angioplasty for lung cancer. During same period, 19 patients with primary lung cancer were treated with pneumonectomy. We assessed the merits and indications for lobectomy/pulmonary angioplasty and compared it with pneumonectomy in respect to operation time, volume of blood lost, respiratory examination results before and after operation, and outcome. The volume of Blood lost during lobectomy/angioplasty was 856±348.1ml and the operation time was 306±77 minutes. The figures for pneumonectomy were 1146±1258 m/ and 252.7±5. 61 minutes respectively. Thus lobectomy and angioplasty caused much less bleeding. Before and one month after surgery, lobectomy/pulmonary angioplasty patients had significantly greater vital capacity and forced expiratory volume than did the pneumonectomy patients.
The 5-year survival rate of the pneumonectomy patients was 18.4% and that of the lobectomy/pulmonary angioplasty patient was 0%. These results show that pulmonary angioplasty preserves respiratory function after lobectomy, but the prognosis of lobectomy/ pulmonary angioplasty is worse than that of pneumonectomy in patients with stage III primary lung cancer.

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Bronchial explant culture using an serum free medium was carried out on polystyrene dishes coated with different extracellular substrates. The NHBEC outgrowth area was then measured, and the effects of the extracellular substrates were compared. Experiment 1 : four types of collagen ; type I, type II, type III, and type IV, were compared. The outgrowth area (cm²) of type I, type II, type III, and type IV was 24, 17, 25, and 28, respectively, in donor 1, with type IV>type II (P<0.05); 12, 11, 14, and 16, respectively, in donor 2, with type IV>type I-type II (P<0.05); 26, 19, 19, and 28, respectively, in donor 3, with no significant differences : 24, 17, 17, and 28, respectively, in donor 4, with type IV>type II-type III (P<0.05); and 16, 17, 15, and 23, respectively, in donor 5, with type IV>type I-type II-type III. Experiment 2 : observations were focused on type IV which was the most effective type in Experiment 1. Three groups were prepared by coating type IV with laminin (LM) [group L], fibronectin (Fn) [group F], and LM and FN [group LF], and then compared with Group C using only type IV. The outgrowth area (cm²) of C, L, F, and LF, respectively was 13, 16, 17, and 20 with LF> C (P <0.05) in donor 6 ; 20, 23, 20, and 32, with LF> F-C (P<0.05) in donor 7 ; 16, 22, 23, and 28, with LF>C (P< 0.05) in donor 8 ; 19, 20, 19, and 29, with LF> L-F-C (P<0.05) in donor 9 ; and 17, 32, 23, and 28, with LF> F-C (P<0.05) in donor 10. The above-mentioned results showed that coating with LM, FN added to type IV had an effective action on the proliferation of NHBEC, suggested that NHBEC may be a useful substrate for coating the lumen of the artificial trachea.

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The changes in right ventricular function before and after pulmonary resection were investigated by means of cardiac pool scintigraphy. Furthermore, operative tolerability based on both right ventricular function and resection criteria of pulmonary function was investigated. Thirty cases were enrolled in this study. One third ejection fraction (1/3 EF), time to peak ejection rate (TPE) as the postoperative contractility parameters and one third filling fraction (1/3 FF), time to peak filling rate (TPF) as the expandability parameters showed significant changes. The cardiac output (CO) was however maintained by a compensatory increase in heart rate.
When the cases were divided into two groups, i. e., one with decreased performance status (PS) after the operation and one with normal post-operative PS, a significant decrease of the ejection fraction (EF) and the 1/3 EF was found in the former group.
In this group, among the pre-operative parameters, CO and percent delta ejection fraction (%dEF) were lowered.
In addition, resection index (RI) obtained by the pre-operative pulmonary function was also lowered in this group.
The values of the cases of this group were all smaller than 0.45.
In conclusion, much attention should be paid to cases with RI smaller than 0.45 and with low preoperative CO and %dEF.

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This study compares the outcomes of video-assisted lobectomy and standard lobectomy through open thoracotomy. Forty-six patients with clinical T1N0M0 non-small cell lung cancer were divided into two groups. Twelve patients who were older than 70 years of age underwent video-assisted lobectomy (VATS). Thirty-four patients who were younger than 70 years of age underwent standard lobectomy through an open thoracotomy (OT). There were no differences between the two groups in gender distribution, histology type, tumor grading lymph node metastases, pleural invasion, vascular invasion, or lymphatic vessel invasion. Results : The operation time of the VATS group was significantly longer than that of the OT group (VATS : 5.3 ±-0.2 hours, OT : 4.3 ± 0.1 hours), and the disposable equipment cost of the VATS group was significantly higher than that of the OT group (VATS : 421 ± 48 × 10³yen, OT 48 ± 6 × 10³yen). Postoperative pain was significantly less in the VATS group compared with the OT group 1 week after surgery. The VATS group had less decrease inforced expiratory volume in 1 sec. 3 months following the surgery than the OT group. There were no differences in intraoperative blood loss, number of resected lymph nodes, duration of fever, duration of chest tube drainage, postoperative leukocyte counts and C-reactive protein concentration or length of postoperative hospital stay between the two groups. There was no significant difference in 3-year survival between the two groups (VATS : 83.3%, OT : 97.1%). Conclusion : VATS successfully reduced postoperative pain but increased disposable equipment costs. The prognosis of patients receiving VATS for T1NOMO lung cancer was similar to that of those receiving standard lobectomy through an open thoracotomy. VATS is a reliable procedure for clinical T1N0M0 lung cancer. Additional long-term studies are needed to determine the efficacy of this procedure.

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A 56-year-old woman was admitted to our hospital showing an abnormal left pulmonary hilar shadow on a chest X-ray film.
Further examinations, including a 3D CT scan, led to a diagnosis of anterior mediastinal tumor. The tumor was removed and found to be a localized pleural mesothelioma attached to the visceral pleura with a stalk. It was difficult to preoperatively diagnose whether the tumor was located in the mediastinum or the pleural space. Retrospective opinion was that MRI was more useful than CT scan in defining this tumor.

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A 49-year-old woman was admitted for an investigation of the cause of her dyspnea. Respiratory function tests suggested tracheal obstruction. Chest CT and X-ray films showed a tracheal tumor. The tumor was resected through a median sternotomy. The defect in the tracheal membranous portion was reconstructed with an esophageal tracheoplasty. She is in good health without any complications 2 years and 4 months after surgery. We think benign tracheal tumors of the membranous portion are good candidates for esophageal tracheoplasty.

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Mesothelial cyst is one of the congenital mediastinal cystic lesions. It is essentially a unilocular cyst filled with clear or slightly yellowish thin fluid. It can be classified as a pericardial cyst when it is attached to the pericardium and as a pleural cyst when it is in other mediastinal locations. Mesothelial cyst have a fibrous wall of varying thickness, and microscopic examination of the wall reveals a single or multi layer of mesothelial cells resting on a loose stroma of connective tissue. It is reported that this cyst is frequently located at the cardiophrenic angle. It is difficult to diagnose anterior superior mediastinal cystic lesions preoperatively. So operative treatment is indicated for diagnosis and therapy. Thoracoscopic resection is less invasive than usual thoracotomy and indications are numerous. We successfully performed thoracoscopic complete resection of a mesothelial cyst.

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Volume reduction operation (resection of both upper lobes with a liner stapler and bovine pericardial support of the staple line) is a new surgical approach for patients with severe chronic obstructive pulmonary disease. We used this procedure in a patient with severe bilateral bullous emphysema. The patient is a 62-year-old man who needs supplemental oxygen daily (Hugh-Jones classification, V). Preoperative examination showed a significant decrease in forced expiratory volume (FVC, 2.33 L) and 1 second FVC (0.54 L); he could walk no more than 150 m in 6 minutes. Respiratory function and blood gas data gradually improved after the operation. Six months later, his FVC and 1 second FVC increased to 2.65 L and 1.29 L, respectively. The 6 minute walk test also showed great improvement. He was able to perform his daily activities without supplemental further oxygen. We are no w quite satisfied with the results, but further careful observation of his postoperative course is required.

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A 50-year-old female had an abnormal shadow on a routine chest rentogenogram. Computed tomography suggested a benign tumor in the right upper mediastinum, so we performed thoracoscopic surgery. The tumor was found in the bronchial plexus. After operation she had ulnar nerve palsy, but gradually recovered. The pathological diagnosis was neurofibroma. We think that thoracoscopic surgery is indicated for mediastinal tumors with intrathoracic extension, but it is necessary to consider the histological type and the anatomical position of the tumor.

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The patient was a 27-year old female who complained of dyspnea. CT scan revealed a solid mass in the anterior mediastinal region. The tumor was removed on June 10, 1992, through a longitudinal sternal incision. Histological examination showed massive thymic hyperplasia. Massive thymic hyperplasia is very rare in adults. Dyspnea was alleviated postoperatively.

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A 17-year-old man was admitted to our hospital because of facial edema and an abnormal shadow on a chest X-ray film. A mass was demonstrated in the anterosuperior mediastinum by chest X-ray examination and chest CT scan. A diagnosis of thymoma was made by percutaneous biopsy. It was stage III in Masaoka's classification, so we chose preoperative chemotherapy. The patient received 2 courses of combination chemotherapy consisting of CDDP, ADM, VCR and CPA prior to surgery. The superior vena cava syndrome disappeared and the tumor was markedly reduced in size. The tumor could be removed totally through only a partial resection of the pleura. Histopathological examination revealed mixed thymoma with necrosis and fibrosis throughout the lesion. After surgery the patient received 40 Gy irradiation to the superior mediastinum. In this case invasive thymoma responded so well to combination chemotherapy, including CDDP, that total resection was possible and was well tolerated.

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A 66-year-old woman with history of Sjögren syndrome and primary biliary cirrhosis was admitted to our hospital for an abnormal shadow on chest X-ray film. Chest CT scan revealed a mass shadow sized 6.8 cm × 4.5 cm at the periphery of the left S⁸S⁹. There was no evidence of swelling of the mediastinal lymph nodes. No malignant cells were observed by transbronchial brushing cytology, but left lower lobectomy was performed because malignancy was suspected. Since malignant lymphoma was suspected by rapid pathological examination at operation, dissection of the mediastinal lymph nodes was added. Postoperative pathological examinations revealed proliferation of small or medium sized B type lymphoid cells with monoclonality of the light chain of IgG. There were no metastases in the dissected lymph nodes. She has had no evidence of recurrence for 16 months after operation without chemotherapy.

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A 49-year-old female was admitted because of an abnormal shadow on chest X-ray. Chest CT and pulmonary angiography (DSA) revealed nodular lesions, feeding artery and drainage vein in the right S¹ and the left S⁹. Telangiectasia was found in the lips, tongue and upper breast. These findings were consistent with a diagnosis of Rendu-Osler-Weber disease which was accompanied by pulmonary arteriovenous fistulas (PAVF). Almost without exception, the treatment of choice in such cases is a minimal resection to include entire removal of the fistula. Bilateral thoracotomy was performed in one session, and the fistulas were successfully removed by using CUSA. Recently it is considered that PAVF should be resected at the point of detection, even if there is no symptoms. The children of this patient were also examined and PAVF were detected in them. As this disease is associated with some severe life-threatening complications like brain abscess or rupture of the fistula, it is important to examine not only the patient but also her family for early detection of the disease.

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This paper describes carinoplasty and reconstruction of the superior vena cava in the treatment of advanced lung cancer aided by pre-operative three-dimensional images of helical scanning CT. The purpose of this case report was to evaluate the usefulness of three-dimentional CT images of the trachea and the bronchi before carinoplasty. The patient was a 62-year-old male with squamous cell carcinoma of the lung. The examination showed that the main tumor was in right upper lobe, mediastinal lymphnodes (#3, #4) were enlarged and had invaded the trachea and the superior vena cava. Three-dimensional images of the trachea on helical CT showed disappearance of 2-rings from the carina. Because of these findings carinoplast; and reconstruction of the superior vena cava were performed. At present 10 months after operation, there is no evidence of recurrence.

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