A complex implant was prepared using autogenous free jejunum and artificial vascular graft, and the trachea in the cervical region was replaced by this complex implant as a tracheal prosthesis in dogs (n=18). The mucosa was bluntly abraded from the autogenous free jejunum, and the jejunum was adhered to the inner surface of the artificial vascular graft using a fibrin glue containing basic fibroblast growth factor (bFGF). Artificial vascular grafts with low porosity (60 ml/cm2/min/120mmHg) were grafted to group I (n=3) using no bFGF and group II (n=3) using bFGF at 2.5μg/ml. Artificial vascular grafts with high porosity (1200 ml/cm²/ min/120 mmHg) were grafted to group III (n=3) using no bFGF, group IV (n=3) using bFGF at 2.5μg/ml and group V (n=6) using bFGF at 5.0μg/ml. In group I, II, and III, neither regeneration of tracheal mucosal epithelium, nor vascularization was observed. In group V, regeneration of tracheal mucosal epithelium for 5 mm length near the anastomotic line was macroscopically and histologically observed, in addition to marked vascularization around the complex implant. Regeneration of tracheal mucosal epithelium was also observed in group IV, but vascularization was less, as compared with group V.

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From 1986 to 1996, 20 bronchoplastic operations were carried out in patients with lung cancer. In 8 of these, pulmonary arterioplasty (PA-plasty group) was performed, and in other 12 it was not (no PA-plasty group). One patient of PA-plasty group was in p-stage I, 3 in p-stage II, 3 in p-stage IIIA, and 1 in p-stage IIIB. Eight patients of no PA-plasty group were in p-stage I, 1 in p-stage II, and 3 in p-stage IIIA. Bronchoplasty was performed using sleeve resection, and PA-plasty was performed using sleeve resection in 2 patients, and using partial resection in 6 patients. In all cases bronchial and arterial wrapping was not employed. There were no significant differences in intraoperative blood loss or operating time between the two groups. Postoperative complications without troubles of the anastomotic sites occurred in 50 % of the PA-plasty group. But there was no operative or hospital death in either group. The 5-year survival rate of PA-plasty group was 68.5%, and that of no PA-plasty 61.7%. There was no significant difference between the two in the survival rates. Though utmost care must be exercised in the postoperative management of combined bronchoplastic and pulmonary arterioplastic surgery, it is a useful operation to enhance curability as cancer surgery and preserve pulmonary function. It was considered that wrapping for the anastomotic sites was not neccessary.

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A series of 56 patients (63 cases) with primary spontaneous pneumothorax were treated by video-assisted thoracic surgery (VATS). We compared our results and complications with the first half period (June 1992 to August 1994) in 31 cases (group I) with the later half period (September 1994 to December 1996) in 32 cases (group II). Indications for operations, sex distribution, and average age (group I, 27.2±13.0 years ; group II, 23.1±7.8 years) were comparable. Operation time was less in group II (96.7±36.2 min versus 131.5±58.3 min ; p=0. 0167). Postoperative hospital stay was less in group II (8.3±6.4 days versus 12.1±7.0 days ; p= 0.0322). There have been three recurrences of pneumothorax in group I only. The interval between VATS and recurrences was 9, 10, and 16 days and two cases needed reoperation. The cause of recurrence was failure to seek other bullae by VATS. The cause of improvement of complications in group II was progress in the VATS procedure and the management of the preoperative screening by the chest X-ray and CT scan.
VATS for spontaneous pneumothorax has the same good results as thoracotomy and offers the potential benefits of shorter hospital stay and less pain.

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We analyzed retrospectively the clinical outcome of thirty patients with myasthenia gravis (MG) who underwent simple or extended thymectomy during 1977 to 1994 in our hospital. Overall remission rate and palliation rates were 20.0% and 76.7%, respectively. When the clinical outcome of patients was compared in terms of sex, Ossermann's classification, serum level of anti-acethylcholine receptor antibody, the presence or absence of thymoma, and the operative procedures, there were no differences in the clinical outcome of patients according to any of these factors. However, patients who were less than 40 years of age or with duration of illness of less than 12 months showed a significantly more favorable prognosis. These results suggested that surgery should be considered as early as possible for patients with MG.

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A 64-year-old man who had been in good health was admitted to our hospital for treatment of left pneumothorax. Pneumothorax and pneumopericardium were observed with radiograph and CT studies, and complete defect of the left pericardium was diagnosed before operation. Bullae were resected with autosuture, however the defected pericardium was left untouched. The postoperative course was uneventful, and he has had no complaints since the operation.

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A case of rounded atelectasis in a 77-year-old male is reported. Chest X-ray revealed a semiround tumor shadow in the right lower lung field. Chest X-ray tomography and chest CT revealed pleural thickening and comet tail sign. Rounded atelectasis was suspected most strongly, but lung cancer could not be denied by the images. At surgery, rounded atelectasis was diagnosed histopathologically. There was no change in the tumor shadow on chest X-ray about one year after surgery. 3D images obtained from helical scan CT and MRI were obtained, and the image characteristics are discussed.

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We performed a chest wall reconstruction using titanium mesh plate after resection of the anterior chest wall in a patient with a recurrent desmoid. We want to emphasize this surgical method, especially its technique and materials.
The size of the chest wall defect was 120×200 mm, and we used 78×225×0.5mm Titanium Mesh SheetR which was sandwiched by Marlex mesh sheets. The posterior margin of the chest wall defect was the polypropylene mesh that had been used at the previous surgery. The titanium mesh plate was fixed to the ribs with stainless steel wires, and Marlex mesh sheets were sutured to the edge of the defect and the polypropylene mesh. Finally, the titanium mesh plate was covered with the chest wall muscles.
The postoperative course was uneventful, the patient suffered no pain, and the wound was in good condition with no accumulation of fluid. There was no deformity, or flail chest. Titanium Mesh Sheet did not obstruct the view of the underlying lung on roentgenogram and computed tomographies.
In conclusion, the titanium mesh sheet seems to be an excellent prosthetic material for chest wall reconstruction.

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We report a re-operated case of locally recurrent desmoid tumor in the chest wall. A 51-year -old woman, who had been operated on for a tumor in the right supraclavicular fossa three years before, complained of warmth and pain in her right arm and was admitted to our hospital. As the recurrence of the previous tumor, re-operation was performed. A mass, 78 g in weight, was excised en bloc with a previous artificial vessel. The right subclavian artery was rereconstructed using another artificial vessel. Pathological examinations revealed the findings of recurrence of extra-abdominal desmoid tumor. The principle of treatment of locally recurrent desmoid tumors in the chest wall is also considered to be aggressive wide resection.

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A 59-year-old man had received a right nephrectomy for renal cell carcinoma of the clear cell type in September, 1984. He developed multiple lung metastases and underwent bilateral partial lung resection at another hospital in December, 1994. He had been given Interferon α (IFN α) since then. He was referred to our department for further treatment in April, 1995 at which find a mass, consistent with the left interlobar lymph node was found on the chest CT scan. He noticed hemosputum in March, 1996 and the mass was found to have increased in size despite continued IFN α treatment for ten months. He had massive hemoptysis before scheduled bronchoscopy and emergency BAE was performed.
Three days later, the left pneumonectomy with clearance of mediastinal lymph nodes was performed. The pathological section of the tumor revealed metastasis of renal cell carcinoma. It was considered that the interlobar lymph node metastasis gradually enlarged encroaching on the bronchus resulting in massive hemoptysis in this case. Lymph node dissection is necessary in the case with lymph node metastasis, though minimal lung resection is usually indicated for pulmonary metastasis of renal cell carcinoma for preservation of pulmonary function.

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We experienced three cases of Paragonimiasis including one resected cse. All patients were male. A 55-year-old man was admitted to our hospital on March, 1st, 1996 because of hemo-sputum. Chest X-P film revealed a nodular shadow and cavity in the right upper lung field. He was suspected of pulmonary tuberculosis, so received anti-TB drugs for 6 months. 12 months later, the nodular shadow increased in size, causing stenosis of bronchus on chest computed tomography. The pre-operative findings did not lead to a definitive diagnosis, and lung cancer could not be excluded. He underwent right upper lobectomy on March, 18th, 1997. Intra-operative pathological diagnosis was Paragonimiasis. He was treated with praziquantel for 2 days at a daily dosage of 40 mg/kg.
A 45-year-old man presented with hemosputum, pleural effusion and nodular shadow on chest X-P. Pleuritis carcinomatosa could not be excluded.
A 13-year-old male suffered from abdominal pain, high-grade fever and leukocytosis (eosinophilia 13 %). In both cases, eggs of Paragonimiasis were found in their sputa. They were treated with oral administration of bithionol (40 mg/kg every 15 days). After completion of the therapy, their clinical signs disappeared.
All patients had ingested uncooked fresh wild boars captured by them-selves. In Japan, Paragonimiasis is recently rarely reported, but it is important to have this disease in mind when a patient has a history of eating wild boar meat.

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A 69-year-old female was found to have a round lesion in the right lung in 1981. It was diagnosed a benign tumor of the lung by the radiologic examination. In 1996, The tumor increased in size slightly during a 15-year follow-up period. Under general anesthesia, three trocars were inserted through the right intercostal space for operation. Thoracoscopic enucleation of sclerosing hemangioma of the lung was successfully performed. Immunostaining of the tumor revealed positive expression of alpha-smooth muscle actin, cytokeratin, CD68 and vimentine. C-myc, p53, CD34, estrogen receptor and progesterone reseptor were negative. Thoracoscopic enucleation is considered to be indicated for sclerosing hemangioma of the lung during a long term follow-up.

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A 55-year-old woman was admitted as an emergency with multiple injuries sustained in a motor vehicle accident. She suffered a subarachnoideal hemorrage, right multiple rib fractures, right lung contusion and right pelvic fracture.
Seven days after her injury, chest Xp showed right hemothorax and a chest tube was placed. Subsequent chest Xp showed elevation of the right hemidiaphragma.
Magnetic resonance imaging showed herniation of the liver in the right hemithorax.
Twenty one days after her injury, the right diaphragma was repaired successfully using a Video-assisted procedure.

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Combined resection of the aorta were performed under a temporary bypass in 2 patients with advanced lung cancer invading the aorta. Case 1 : A 64-year-old man had large-cell carcinoma of the left-upper lobe invading the descending aorta. Left-upper lobectomy and combined resection of the adventitia of the aorta were performed under a temporary bypass between the left subclavian artery and the descending aorta. Case 2 : A 48-year-old man had adenocarcinoma of the left-lower lobe invading the descending aorta. Left-lower lobectomy combined with tubular resection and reconstruction of the descending aorta were performed under a temporary bypass between the proximal and distal side of the tumor in the descending aorta. Combined resection of the aorta under a simple temporary bypass is a useful technique for controlling lung cancer invading the aorta without assisted circulation.

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A 64-year-old male was admitted to our hospital because of an abnormal chest roentgenogram showing a solitary thin-walled cavity in the left upper lung. Chest CT showed the same finding. A thin-walled cavity in the left lung was 70 mm in diameter, and the wall was 7 mm thick. He had no cough or sputum. As laboratory data demonstrated increased CEA levels, a left upper lobectomy was performed. The tumor was resected and diagnosed as squamous cell carcinoma. Primary lung cancer with thin-walled cavity is rare. The pathogenesis of the thin -walled cavity formation in this case was considered to be caused by central necrosis and check valve mechanism.

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Four operative cases with primary malignant tumor of the trachea are reported. Two had adenoid cystic carcinoma and 2 squamous cell carcinoma. All 4 patients complained of dyspnea. Cough was noted in 2 patients and hemoptysis in the other two. The average duration of symptoms was 13 months. The operative procedures were as follows : tracheal resection with primary end to end anastomosis, 1 ; laryngotracheal resection, 1 ; partial resection and patch closure of the membranous portion of the trachea just above the bifurcation, 1 ; extended carinal resection and direct anastomosis (lowering the tracheal carina), 1. Although microscopic disease at the resection margin was revealed by frozen section assessment in both patients with adenoid cystic carcinoma, further resection of the trachea was not performed. Lymphnode metastasis was observed in 1 of 2 patients with squamous cell carcinoma, but the patient with lymphnode metastasis did not receieve postoperative radiotherapy and died 1.9 years after operation. The other 3 patients, including 2 patients who recieved postoperative radiotherapy, are alive without recurrence from 9 to 14 years after operation. Curative resection should be sought for treatment of primary malignant tumors of the trachea. However it is necessary to take into consideration the properties and the locations of the tumors as well as the patient's condition when the extent of resection or operative procedures are determined.

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We experienced a case of tracheal stenosis due to endotracheal intubation.
A 73-year-old female was treated by endotracheal intubation for acute myocardial infarction, and immediately underwent three coronary arterial bypass graftings (CABG) in November, 1996. The intubation period lasted 9 days. Approximately one month after CABG, she complained of wheeze and dyspnea. At first, she was treated on the suspicion of bronchial asthma, but the symptoms were not improved. Re-intubation was performed, but the tube could not be passed the point approximately 20 cm from the mouth. Bronchofiberscopy was performed, and revealed a circumscribed stenosis of the second tracheal cartilage. The stenosis was limited to one cartilage and the peripheral ring appeared normal. We evaluated this case and found that it was a good indication for surgical treatment. An end-to-end anastomosis after a 3 tracheal ring sleeve resection was performed successfully. She has been followed up for 5 months, with no abnormal findings noted so far.

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