In a study of depression of immunity after lung lobectomy, the number and condition of immune competent cells and adrenal hormones were examined. Blood samples were drawn on the preoperative day and on the 12 hour after surgery and on the 2nd, 7th, 14th and 21st postoperative days from 15 patients followed by lobectomy and lymphnode dissection for lung cancer.
The absolute number of lymphocytes was signficantly decreased on the 12 hour after surgery and returned to the preoperative level by the 7th postoperative day. The percentages of CD4⁺, CD4⁺2H4^- (helper T cell), CD4⁺2H4+ (suppressor inducer T cell) and CD4⁺4B4⁺ (helper inducer T cell) lymphocytes were significantly decreased on the 12 hours after surgery and returned to the preoperative levels by the 2nd day. The percentages of CD8⁺, CD8⁺CD11⁺ (suppressor T cell), CD8⁺CD11^- (cytotoxic T cell) and CD8^-CD11⁺ (natural killer T cell) lymphocytes were unchanged. Lymphocyte responses to PHA and natural killer cell activity were significantly suppressed on the 12 hour after surgery and returned to preoperative levels by the 7th postoperative day, but natural killer cell activity was significantly suppressed again on the 14th and 21st post operative days. The serum cortisol and adrenalin levels were significantly elevated on the 12 hour after surgery and then returned to normal limits.
It is considered that the suppression of immunity after surgery is a reaction to maintain physiological homeostasis ; however, it is disadvantageous for cancer patients from view point of possible enhancement of metastasis and progress of the disease. Therefore, the operation should be performed because the patient derived maximum benefit from the reduction of stress during and after the operation.

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The effect of the intrapleural administration of distilled water was compared with that of carboplatin (CBDCA) used for the destruction of scattered cancer cells during surgery for lung cancer. Samples were collected from eight lung cancer patients who received CBDCA (450 mg), and the pharmacokinetics were studied. The mean total serum platinum level 2 and 4 hours after instillation was 4.5 ug/ml and 2.0 ug/ml, respectively. The mean concentration of platinum in the mediastinal lymph nodes was 1.0 ug/g (wet). The sensitivity to CBDCA of seven lines of lung cancer cells was tested, and the IC₅₀ was found to be 50 ug/ml. Five resected cancer tissues and five cell lines were soaked in distilled water for 5 minutes, and in most of them more than 90 % of the cells were killed within 3 days. The intrapleural administration for 5 minutes of distilled water did not increase postoperative complications or affect serum electrolytes. It is concluded that intrapleural distilled water for 5 minutes can be used during surgery instead of carboplatin for the destruction of scattered lung cancer cells.

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We review our clinical experience with muscle flaps in thoracic surgery. Over the past 6 years, we have employed transposition of a muscle flap, either alone or in combination with synthetic materials, in 10 patients (7 males, 3 females, aged 42-63 year old, average 55 year old). Muscle flaps were implanted in infected cavities in 7 patients (2 thoracic empyema, 2 cold abscess of the chest wall, 1 pericostal tuberculosis, 1 mediastinitis, 1 costal chondritis) and used to reconstruct the chest-wall in 3 (1 recurrent breast cancer, 2 chest-wall tumors). All of the wounds closed primarily with no significant complications.
Our experience suggests that muscle flap transposition is reliable and useful for chestwall reconstruction and for closure of infected cavities in both intrathoracic spaces and the chest wall.

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A 52-year-old female was admitted to our hospital because of hemoptysis. Chest X-rays showed a thick walled cavity in the left upper lung field, and aspergillus fumigatus was found in all sputum specimens. So the diagnosis was pulmonary aspergillosis (intrapulmonary type). A left upper lobectomy with pre and post antifungul drug therapy resulted in cure.
In our hospital 11 patients with pulmonary aspergillosis were treated surgically during the past three years. In 7 the disease was intrapulmonary and in 4 it was extrapulmonary (empyema). In 5 of the former we performed complete resection without leaving any aspergillus, but the other two developed aspergillus pneumonia and aspergillus empyema. In the latter group (empyema) curative resection with complete removal of aspergillus was possible in only two patients. In the other two some aspergillus persisted to the operation was unsuccessful. In the treatment of pulmonary aspergillosis we conclude that we should consider operation first only to reduce the amount of aspergillus in the intrapulmonary type. The indications for operation in the extrapulmonary type need careful consideration.

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A 39-year-old male had café au lait spots of the skin. He had had pneumoplication for multiple emphysematous bullae at 37 years of age. Two years later, chest X-rays revealed a mass shadow originating at the site of the pneumoplication, and fiberscopic lung biopsy showed primary lung carcinoma. Carcinogenesis seems to lead to lung cancer in patients with von Recklinghausen's disease with bullae. Closer follow-up is recommended for patients with von Recklinghausen's disease with emphysematous bullae to find a possible association with lung cancer.

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This is a report of pulmonary squamous cell carcinoma that developed around a bullet lodged in the lung for 47 years.
A 67-year-old man was admitted to our hospital complaining of hemosputum. He was shot in the right thorax during World War II and the bullet had lodged in his right lung. Chest X-rays showed a bullet in the right upper lobe with a tumor shadow around it. Pulmonary squamous cell carcinama was diagnosed by bronchoscopic biopsy. Lobectomy was performed after irradiation and chemotherapy.
Three lesions were found in contact with each other in the resected lobe : a bullet surrounded by fibrous tissue, tuberculosis and squamous cell carcinoma. Since these three lesions had been strongly affected by irradiation, a direct connection between the bullet and the carcinoma could not be proved microscopically. However, it can be considered that the bullet was responsible for the etiology of the carcinoma, as well as the tuberculosis.

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A 26-year-old male consulted a doctor with complaints of cough, fever and right chest pain. Medication ameliorated the symptoms for some time, but he was later admitted to our hospital with recurrent right chest pain. Chest X-ray showed an infiltrative shadow in the right upper lung field. Chest CT scan also demonstrated an infiltrative shadow in which multiple bullae and dilated bronchi were observed in the right S². Bronchoscopic and bronchographic examinations revealed a B² defect. He was therefore diagnosed as having congenital bronchial atresia associated with obstructive pneumonia. Since the infiltrative shadow did not disappear in spite of antibiotic therapy, right upper lobectomy was performed. The resected lung had dilated bronchi containing mucoid material in the hilar region of S², and emphysema associated with obstructive pneumonia. The proximal part of the bronchus had a blind ending.

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The development of a bronchopleural fistula (BPF) after thoracic surgery is a devastating complication for patients who have undergone positive pressure ventilatin. A 73-year-old male patient needed mechanical ventilation with a PEEP because of pneumonia after middle and lower lobectomy for lung cancer. A BPF was found on the 22nd postoperative day. After chest tube placement, an emergency operation was conducted to close the BPF with an omental pedicle.
Unfortunately, high-flow air leakage developed after a few days of mechanical ventilation. A simple method using a balloon catheter was devised to occlude the BPF. The catheter was introduced through the tracheostomy, and the balloon was inflated with 1.5 ml of air at the fistula under fiberbronchoscopic control.
BPF was never a significant problem after insertion of the catheter. Three months after treatment, pneumonia was noted to have subsided. Deflating the balloon did not lead to air leakage from the fistula, and the catheter was removed. Chest X-rays still showed pleural thickening, but no pleural infection, indicating that the BPF had been closed successfully.

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A 57-year-old man, who had had left nephrectomy for renal cell carcinoma eight years previosly, was admitted with bloody sputum and cough as the chief complaints.
Chest X-ray films showed an atelectatic lesion on the mediastinal side of the right lower lung field. Fiberoptic bronchoscopy revealed a tumor that occluded the right lower bronchus. Biopsy specimens demonstrated an angiomatous tumor.
Right lower lobectomy was performed. Resected specimens demonstrated a polypoid tumor about 1.5 cm in diameter located in the rt-sub-superior bronchus. Pathologycal examination showed clear cell carcinoma under the squamous cell epithelium.
Interferon therapy (INF-α) was administared additionally after operation.

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The patient was a 42 year-old male, a heavy smoker. A pulmonary tumor was found which appeared to arise in the right upper lobe periphery. Right upper lobectomy with lymph node dissection was performed. The tumor, growing along the wall of an emphysmatous bulla, was diagnosed as large cell carcinoma of the lung by routine light microscopic examination. No components of squamous cell carcinoma, adenocarcinoma or small cell carcinoma was found, but immunohistochemical stains revealed neuroendocrine features. Stains were positive to antibodies to neuron specific enolase, chromogranin, endocrine granular constituent, vasoactive intestinal polypeptide, CEA, cytokeratin, and vimentine. They were negative to antibodies to epithelial membrane antigen, S-100 protein, Leu-7, neurofilament, somatostatin, substance P, β -endorphine, and calcitonin.
Electron microscopy showed numerous dense-core granules in tumor cells. The final diagnosis was large cell neuroendocrine carcinoma of the lung.

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A 43-year-old male was admitted to our hospital with complaints of swelling of the neck and dysphagia. He had a large mass in the neck. Roentgenograms and CT scans of the neck and the chest revealed a tumor located from the neck to the posterior mediastinum, antero-lateral to the vertebrae and extending to both sides. The hypopharynx, larynx, esophagus and trachea were shifted anteriorly. The density of the tumor was heterogeneous ; that is, multiple highdensity funiculi were seen in the fatty density the CT number of which was 44 HU. We therefore suspected that he had cervicomediastinal liposarcoma, and performed an operation. Because the tumor was encapsulated and nearly noninvasive, extripation of it via a U-shaped collar incision and median sternotomy was performed successfully. The pathological diagnosis was well-differentiated liposarcoma. The patient had no additional therapy and remains free of disease one year and nine months after the operation.

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Our patient, a 41-year-old male, is alive without any signs of tumor 3 years and 11 months after extirpation of a mediastinal lymph node with metastasis of giant cell carcinoma from an unknown primary site. Most cancers of unknown primary origin discovered in metastatic lymph nodes are found in cervical lymph node metastases, not mediastinal ones. In general, the prognosis of cancer of unknown origin is extremely discouraging, and long-term survival is very rare. In our patient, the histology of the metastatic site was giant cell carcinoma and immunohistochemically other neoplasms, such an thymic carcinoma and malignant lymphoma, were denied. Therefore, the metastasis of lung cancer (T0N2M0) might cause the development of the mediastinal tumor, although the primary tumor has not yet been identified.

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We selected sternal turnover procedures with preservation of rectus muscle pedicle for 30 cases with funnel chest.
However, recurrent concavity of the anterior central chest wall occurred in 5 patients after the operation.
Therefore we applied a modified procedure of conventional sternal turnover to the latest 5 cases of funnel chest. and the operative results seemed to be satisfactory. This paper describes the technique of the modified procedure.

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A 38-year-old man was found to have a rounded mass shadow in the right lower lobe on routine chest roentgenography. Brushed cytological specimens obtained by flexible bronchofibersopy revealed no malignant cells ; therefore enucleation of the tumor was performed. Histopathological examination of the resected tumor, including H. E stain, Grimelius stain and immunohistochemical stains for NSE, S-100 protein and Cytokeratin showed pulmonary paraganglioma. Clinicopathological features of the solitary form of pulmonary paraganglioma are discussed on the basis of the 26 cases reported in the world.

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A 26 year-old man underwent resection of a left pulmonary tumor. It was diagnosed as benign clear cell tumor.
Benign clear cell tumors of the lung are rare neoplasms originally described in 1963 by Liebow and Castleman. Only 14 well-documented cases have been reported in the Japanese leterature : six women and eight men with a median age of 40. 9 years. The tumor was in the left lung in ten patients and in the right lung in four. Most diagnoses of benign clear cell tumor were made during thoracotmy. Seven patients underwent lobectomy. Long-term follow-up is important, because there is little information regarding its etiology, and there have been a few reports of metastases.

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