The wound healing effect of absorbed mesh [polyglycolic acid mesh (PGAM)] on bronchial stump was examined by using piglets. The piglets were divided into two experimental groups. In group A, the bronchial stumps were closed by interrupted sutures. In group B, the bronchial stumps were closed by interruted sutures added to Beriplast P, OK-432 and PGAM. We studied the macroscopic findings, histological findings, leakage pressure, and the amount of hydroxyproline.
In groups B, collagen fiber production was rapid, the leakage pressure was great, and the amount of hydroxyproline was large. In the two groups, all parameters were the same on the 21st postoperative day. These results suggest that PGAM was effective in accelerating bronchial stump healing. It is concluded that bronchopleural fistulas originating in the early stage may be prevented by methods employing PGAM.

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The treatment of metastatic seedings of lung cancer has not been fully investigated. To more fully research this treatment method, a chemosensitivity test of anticancer drugs diluted with distilled water using resected lung cancer tissues was performed. The resulting solution was given to a group of patients. Lung cancer tissue from 30 patients was divided into 3 mm square cubes and exposed for an hour to CDDP, VP-16 or CBDCA diluted with distilled water. The anticancer drug sensitivity was evaluatd using MTT colorimetric assay. The results showed that all three drugs proved to be more effective after dilution with distilled water. Of the three solutions, CBDCA 2 mg/ml was the most effective. Based on this reslt, we twice intrapleurall administered CBDCA 450 mg diluted with 100 ml of distilled water to four patients with metastatic seedings of lung cancer. The pleuritis carcinomatosa was well controlled with three patients, with light side effects. From our results, we concluded that a treatment of CBDCA diluted with distilled water might be more effective than a panpleuropneumonectomy in treating patients with metastaic seedings of lung cancer.

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Six patients who had been undergone thoracotomy on one side conventionally and on the other side received video-assisted thoracoscopic surgery were examined with respect to the clinical results of each procedure. A comparison of the two procedures in one sample test showed that postoperative hospital stay was significantly shorter in video-assisted thoracoscopic surgery than in thoracotomy. And the intraoperative blood loss, the CRP level on the first postoperative day, the amount of analgesics used in the postoperative period, and the pain score on the visual analogue scale were significantly less in video-assisted thoracoscopic surgery than in thoracotomy. We conclude that there are some advantages of video-assisted thoracoscopic surgery over thoracotomy in one sample test.

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The authors examined the usefulness of ¹³³Xe dynamic single-photon emission computed tomography (SPECT) in identifying areas to be resected by reduction surgery in patients with non-bullous emphysema. METHODS : Eighteen patients with advanced symptomatic emphysema with and without obvious bullae (bullous type, n=10 and non-bullous type, n=8) were examined using ¹³³Xe SPECT. After a 6-min inhalation of 133Xe gas, equilibrium and subsequent wash-out SPECT images were acquired every 30 sec for 6-7 min during spontaneous breathing. The patients were treated with unilateral thoracoscopic resection directed to he abnormal ¹³³Xe retention portions as well as to obvious bullae. RESULTS : All patients demonstrated marked, heterogeneous ¹³³Xe retention on the wash-out images. In the patients with obvious bullae, dynamic SPECT showed abnormal ¹³³Xe retention corresponding to bullae. The patients in the non-bullous type group, who did not have abnormal radiolucencies on chest X-ray CT, also showed abnormal retention with dynamic SPECT. Significant postoperative improvement in objective measures of pulmonary function was observed in both groups. CONCLUSIONS : ¹³³Xe SPECT is useful in identifying regional ventilatory abnormalities in non-bullous emphysema. Unilateral thoracoscopic volume reduction directed to the abnormal ¹³³Xe retention portions is an effec tivetreatment for non-bullous emphysema.

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On the pre- and post- operative clinical manegement of thymectomized patients, immunosuppressive therapy by alternate-day administration of prednisolone (PSL) before thymectomy seems to got higher safety than the usual preoperative administration of aniti-cholineesterase (anti-ChE). But, postoperative respiratory care is still important problem.
100 postoperative patients with generalized myasthenia gravis combined alternate-day administration of PSL from January 1979 to March 1996 were analysed retrospectively. As a result, prediction model of postoperative respiratory failure was proposed by logistic regres-sion.
The three factors-reoperative medication (p <0.0001), %FVC (p=0.0001), preoperative clinical severity (p<0.0001) -was most important in postoperative respiratory failure. The prediction model was calculated from the five factors which added two factors-sex and history of crisis-. This model achieved a sensitivity of 80.0%, a specificity of 97.7% and an accuracy of 96.0%.
This logistic model may be clinically useful for the prediction of postoperative respiratory care after thymectomy combined PSL alternative-day in MG.

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A 19-month-old female was admitted to our hospital for treatment of recurrent pneumonia with the chief complaints of productive cough and high temperature. Administration of antibiotics induced remission of pneumonia, with multiple cystic lung disease then revealed. Left lower lobectomy was performed for prevention of pneumonia, reexpansion of intact lung and confirmation of the diagnosis. The resected lung was occupied by multiple cysts with a thin wall measuring less than 30 mm in diameter. Histological examination showed multiple cysts lined by ciliated tall columnar or cuboidal cells and filled with foamy cells, so congenital cystic adenomatoid malformation was diagnosed. But because of repeated pneumonia many lymphoid follicles were scattered. The postoperative course was uneventful, and pneumonia has not recurred.

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A giant bulla in the right upper field and abnormal mass in the right hilus were pointed out on the chest X-ray of a 43-year-old man. Close examination showed an adenocarcionma originating in the right upper lobe which invaded a 2 cm portion of the trachea and 1 cm of the left main bronchus. The cancer also involved the right pulmonary artery and esophagus. The patient was treated with three courses of induction chemotherapy (CDDP+VDS) and radiotherapy (26 Gy). Extreme reduction was seen in the size of the tumor. Right sleeve pneumonectomy with mediastinal lymph node dissection and partial resection of the left atrium, superior vena cava and esophagus was performed with end to end anastomosis of the trachea and left main bronchus through a posterolateral approach.
The right side of the anastomosis showed a small granulation 3 weeks after operation but no other complication was observed. The resected specimen showed no tumor cell at the cutsurface of the trachea and the left main bronchus and fibrotic change in mediastinal lymph nodes. Then the pathological stage was T2N1MO-II. Relapse of cancer was seen in the esophagus at 1 year and 6 months after operation. Chemoradiotherapy reduced it for a while but the patient died at 2 years and 10 months after surgery.
Aggressive induction therapy may lead to curative resection in some T4N2 cases of lung cancer invading the trachea and other organs.

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A 69-year-old man was admitted to our hospital with a 10-year history of shortness of breath on exertion. A CT scan remarkable diffuse bullous emphysema of both lungs. The bulla and bilateral emphysematous legions were resected by linear stapler under thoracoscopy.
Air leakage persisted for 2 postoperative days, but the postoperative course was uneventful.
At 3 months postoperatively pulmonary function and blood gas examination revealed an improvement of dyspnea.
This procedure can be an effective treatment of diffuse bullous emphysema to achieve benefit at one operation, with a minimum of morbidity. We recommend this procedure which we called thoracoscopic bilateral partial resection of the lung for severe pulmonary emphysema.

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Localized mesotheliomas of the pleura are relatively rare tumors. Their clinical characters are various and their malignant potential is still obscure. Frequently they are found without symptoms. A 53-year-old woman was pointed out as having an abnormal shadow on chest X-ray film, and introduced to our department. Preoperative possible diagnosis was benign localized mesothelioma of the parietal pleura or a neurogenic tumor, for which we planned a thoracoscopic resection. Unexpectedly, the tumor as found to originate from visceral pleura, and we performed thoracoscopic resection safely using ENDO-GIA. Pathological diagnosis was confirmed as benign mesothelioma of the pleura. This patient has been followed for 1 year and 5 months, so far. She is doing well but we must continue to monitor her condition carefully.

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A 44-year-old man was admitted to another hospital he cause an abnormal shadow on a chest X ray film. The patient was diagnosed as having a maligant tumor using the needle biopsy following CT scan. He was admitted to our hospital for operation. CT scan and MRI showed dislocation of the left subclavian artery and vein but no invasion by the tumor. The tumor was surgically removed, and the pathological diagnosis was myxoid type liposarcoma. The patient had no additional therapy and remains free of disease one year and four months after the operation.

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Hemangiomas of the mediastinum are very rare, acounting for only 0.5 % or less of all mediastinal tumors. Fewer than 50 cases have been reported in Japan. They are asymptomatic in more than half of the patients, and usually chest X-ray, CT scan, and angiography do not help in the preoperative diagnosis. We presented a case of mediastinal hemangioma suspected preoperatively.
An abnormal shadow on the chest X-ray film in a medical check-up was pointed out in a 60-year-old female. CT scan revealed a right upper anterior mediastinal tumor but did not aid in the final diagnosis. MRI demonstrated the morphology of the vascular tumor as a hyperintense mass in Ti and T2 weighted image and early inhomogenous enhancement after administration of Gd-DPTA. Through a median sternotomy, the tumor was extirpated completely and confirmed to be a cavernous hemangioma histologically.
In this case MRI was excellent in evaluating the nature of the vascular tumor.

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A 71-year-old man had had a left upper lobectomy due to lung adenocarcinoma. Eight months after lung resection, he complained of anorexia, and abdominal X-P and CT scan showed the intestinal intussuception due to an intestinal tumor. Resection and primary small bowel anastomosis were carried out and the pathological diagnosis of this tumor was leiomyosarcoma. He died of pericardial metastasis of the lung cancer 2 months later. Pathological reexamination of the lung cancer demonstrated a sarcomatous pattern in the primary lung adenocarcinoma, which was also found in the intestinal tumor and in the recur-rence of lung cancer in the anterior mediastinum. Therefore, the intestinal tumor was considered to be a metastasis of an element of the primary lung cancer, which was diagnosed as moderately differentiated adenocarcinoma with sarcomatous variety.

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We performed a mediastinoscopic extended thymectomy using a sternum lifting method on a patient with myasthenia gravis without thymoma. We reported this surgical method, focusing on its technique. The papient was a 42-year old female with myasthenia gravis, II B under Osserman classification.
First, the thymic tissue from the inferior pole of the thyroid gland up to the superior mediastinum was detached by a cervical collar incision. Next, after the entire sternum was elevated using a strip of tape inserted in the longitudinal axial direction, the thymes, including the anterior mediastinal fat tissue, was removed under the mediastinoscope.
The surgical procedure was completed in 5 and a half hours, with a 200cc hemorrhage, and the removed thymus weighed 42g. There was hardly any postoperative pain due to the sternum elevation and mediastinal maneuver.
With this technique, an extended thymectomy which is equivalent to a midline sternotomy approach can be accomplished. Moreover, it is a more safely applicable method to pleurodesis cases and pulmonary insufficiency cases with a dysfunctional ventilation lung.

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We experienced a 16-year-old male with mediastinal germ cell tumor whose serum level of alpha-fetoprotein (AFP) remained decreased during the course of recurrence. In the first operation, a huge tumor with multicystic solid zones occupying almost all of the right thoracic cavity was found. It originated from the anterior mediastinum. Massive pleural effusion was also seen. The serum AFP level was elevated to 5, 490 ng/ml before surgery. Adjuvant modified PVB (CDDP+ VBL +BLM) chemotherapy was carried out after pathological diagnosis of combined teratoma was established.
The serum AFP level then fell and remained normal with no residual disease by chest X-ray, chest CT, and chest MRI. Recurrence rapidly occurred, however, in the right thorax six months after the operation. Serum AFP level was not elevated and remained decreased through out the course of the recurrence. These findings suggest that non-AFP-producing immature tissue played a critical role in forming the rapidly growing recurrent tumor.

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A 46-year-old man visited our department with right flank pain and right hypochondralgia. CT and MRI of the chest revealed a dumbbellshaped tumor of the right posterior mediastinum growing into the vertebral canal through spinal foramens. We performed a one-staged combined approach operation safely. The tumor had originated from the sympathetic nerve tract. The pathological diagnosis was reported to be malignant shcwannoma. One year after the operation, local recurrence and lung metastases took place. Radiation and combination chemotherapy were tried. The recurrent tumors reduced their sizes to one-third in response to these treatments. A reoperation was followingly done through a postero-lateral thoracotomy when all tumors were removed. We should consider a multidisciplinary treatment, even for recurrent and/or metastatic lesions ocurring after initial surgery of a malignant shcwannoma.

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A 54-year-old female had been treated by chemotherapy for essential thrombocythemia and was admitted to our hospital for a middle mediastinal mass detected on chest X-ray and computed tomography (CT) scan. On admission platelet count was 270, 000/mm³ and CEA was 380 ng/ml. The tumor was resected and the histological diagnosis was paraganglioma. The tumor cells were positive for the CEA stain. After surgical therapy, the serum CEA returned to normal range. Only 23 cases of mediastinal paraganglioma are reported in Japan, and this case presenting high serum CEA is the first report in the literature.

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We reported a surgical treatment for middle lobe syndrome in childhood. The patient was a 12-year-old boy having recurrent pneumonitis since the age of 2 years. Various examinations revealed no stenotic or obstructive findings, tumor, or foreign body in his lung, but atelectasis and pneumonitis occurred recurrently. The atelectasis and pneumonitis were localized to the right middle lobe and left lingular segment, and they were thought to be irreversible diseases because of chronic inflammation for a long period. As medical treatment for 2 months was not effective, right middle lobectomy and left lingular segmentectomy were performed.
Resected speciments revealed bronchiectasis, fibrosis and chronic pneumonitis. He has had no recurrence of pneumonitis after operation and has been very well. The operative treatment was thought to be effective for this patient.

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