During the past 30 years, 138 patients with pulmonary metastatic tumors were treated surgically. Their primary lesions were mainly osteosarcoma (26 cases), rectal cancer (25 cases), renal cell carcinoma (15 cases), uterine cancer (11 cases) and breast cancer (8 cases). Sixty-one patients had a solitary metastasis, 23 had unilateral multifocal and 54 had bilateral multifocal metastases. Pneumonectomy was performed in 12 cases, lobectomy in 42, partial resection or segmentectomy in 81 and open thoracotomy in 3. The five-year survival rates were 46.3% in the solitary lesion group, 30.3% in the unilateral multifocal and 16.7% in the bilateral multifocal group. The five-year survival rates were in 10.9% for osteosarcoma, 33% for colo-rectal cancer, 45% for uterine cancer and 0% for breast cancer. Of the 88 patients operated more than 5 years before the survey, 26 survived for more than 5 years, and 13 of them survived for more than 10 years. 10 of these had a solitary pulmonary metastasis and 3 had unilateral multiple metastases.
These results indicate that in selected patients with pulmonary metastatic tumors surgery can provide prolonged survival.

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During the past 15 years, 274 patients (pts) have been operated on for primary lung cancer at Kitasato University Hospital, 204 men and 70 women. The histological diagnosis was adenocarcinoma (Ad) in 135, squamous cell carcinoma (Sq) in 101, small cell carcinoma in 12, large cell carcinoma in 9, adenosquamous carcinoma in 7, adenocystic carcinoma in 2, and others in 8.
Staging was stage I in 117, stage II in 22, stage IIIa in 82 Mb in 26 and stage IV in 24 pts.
The 5-year survival rates were 41.5% in the group of 274 pts, 57% in stage I, 43.8% in stage II, 20.7% in stage III (a+b) and 36.4% in stage IV.
There was no statistically significant difference in the 5-year survival rates between Ad (39.6%) and Sq (46.6%), but among the pts who were classified as stage III (a+b), those with Sq had significantly better 5-year survival rate than those with Ad (Sq : 35.5%; Ad : 10.6%, p< 0. 05).
Pts who underwent lobectomy had a better 5-year survival rate than those who underwent pneumonectomy (lobectomy : 51.6%; pneumonectomy : 20.6%, p<0.001).
Among the pts who had relatively curative resections, those with Sq had significantly better 5-year survival rates than those with Ad (Sq : 43.1%; Ad : 14.2%, p< 0.05).
Age was not a significant prognostic factor, nor did it affect operative mortality.

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We treated 112 patients with stage I lung cancer from 1973 through 1986. The overall 5-year survival rate was 59.5%. In T1N0M0 cases it was significantly better than in T2N0M0 cases (p< O. 05). There was no statistically significant difference in survival rate between patients who had complete dissection of mediastinal lymph node and those without it. The cause of death following resection of stage I lung cancer was mainly distant metastasis to the brain, lung or liver. Adjuvant therapy is recommended to improve the survival rate of patients with stage I lung cancer, especially those in the T2N0M0 classification.

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Both primary lung cancers and associated brain metastases were resected in ten patients : four males and six females aged 44 to 66 years (mean, 51.7 years). Eight patients had solitary and two had multiple brain metastases. Histologically, eight patients had adenocarcinomas and two had large cell carcinomas. After resection of the brain metastasis, eight patients received radiotherapy and/or chemotherapy. There were no operative or hospital deaths. Survival after craniotomy was 6 to 37 months (median, 10 months). Survival at one year was 40%. Only one patient is still alive. Four patients died of systemic metastases, two of intracranial recurrence and three of other diseases. The interval between thoracotomy and crandiotomy was 1 to 29 months (median, 11 months). The disease-free interval correlated positively with survival. After craniotomy all patients clearly had much relief from severe preoperative neurological symtoms.
In conclusion, surgical resection of both primary lung cancer and brain metastasis seems to prolong survival and improve “Quality of Life” of patients, especially those with a solitary brain metastasis and a long disease-free interval.

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The single-stage omental pedicle flap closure method was successful in three out of eight patients with chronic empyema between September 1987 and August 1988. In this procedure, an omental pedicle flap, supplied by the right gastroepiploic artery, is made and transposed into the cureted and irrigated empyema space by fixing it to the bronchopleural fistula. Thoracoplasty is added if a residual dead space is present.
The omental pedicle flap nourished by the right gastroepiploic artery is large enough and long enough to reach all areas in the thoracic cavity in most persons.
The omentum has angiogenesis, immunological competence and absorptive capacity and is effective in the treatment of chronic empyema with bronchopleural fistula.

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Pedicled omental grafts were used successfully in 2 cases. A 66-year-old male who had had a left pneumonectomy for primary lung cancer 13 months earlier suffered from cough and dyspnea. A bronchopleural fistula was found on bronchoscopy. A pedicled omental graft was placed in the pleural cavity through a retrosternal route and fixed over the bronchopleural fistula. He is asymptomatic 8 months after the operation.
A 59-year-old female had a right upper and middle lobectomy combined with resection of the chest wall for primary lung cancer. Reconstruction of the chest wall was performed with Marlex mesh as the prosthetic material. A pedicled omental graft was placed on the Marlex mesh through a percutaneous route and covered with a fullthickness skin graft. She is doing well 7 months after the operation.

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The mean transdiaphragmatic venous pressure difference (P_TDV=P_IVC-P_RA) was determined at right cardiac catheterization and compared with values of pulmonary function parameters in 90 cases. The maximum value of P_TDV was 9.0 mmHg, and the mean and its standard deviation were 1. 9±1. 7 mmHg. While the mean pulmonary arterial pressure (P_PA) was found to be significantly correlated with FVC, FEV_1.0, D_LCO, among the pulmonary function parameters (r=-.28, -. 28 and-. 27 respectively), P_TDV was significantly correlation with FVC, FRC and RV (r =-. 32, -36 and-.41 respectively). P_PA +P_TDV was correlated with FVC to a significantly higher degree (r =-. 40) than with the aforementioned two indices. These results were interpreted as suggesting that intrathoracic pressure might be involved in the abovementioned relationships. This would seem to point to the necessity of correcting intrathoracic vascular pressure measurement for intrathoracic pressure under clinical circumstances associated with a reduced pulmonary compliance such as pulmonary parenchymal lesions or a condition after pulmonary resection. P_TVD, which can be measured with ease, would serve this purpose well as a convenient-to-use index.

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The levels of endotoxin in blood were measured before and after thoracotomy by two methods : Limulus Colorimetric Test (LCT) and Endotoxin Specific Test (EST). The blood endotoxin level measured by EST did not increase after thoracotomy. The blood endotoxin level measured by LCT was always higher than that measured by EST. We conclude that EST is necessary to diagnose endotoxemia and that LCT overestimates the levels of endotoxin because of a false positive response by non-specific lysate activating substance. There was a positive correlation between the blood endotoxin level measured by LCT and the duration of surgery. We conclude that an increased endotoxin level demonstrated by LCT indicates a reduction in the clearance activity of the reticuloendothelial system.

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Thymic epithelial cells of cortex and medulla were studied by histological, morphometric, and immunohistochemical analysis. Epithelial cells in the cortex had large round nuclei with fine chromatin and conspicuous nucleoli. Those in the medulla had oval to spindle-shaped nuclei with irregular margins, coarse chromatin, and inconspicuous nucleoli. The nuclear area of epithelial cells in the cortex was significantly larger than in the medulla. Immunohistochemical studies showed that the epithelial cell in the outer cortex contained Leu7 and keratin, while those in the inner cortex and in the medulla contained keratin but no Leu7. These results show that the epithelial cells of the cortex and medulla differ histologically, morphometrically, and immunohistochemically.

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Malignant fibrous histiocytoma originating from the mediastinum was found in a 59-year-old man with Superior Vena Cava (SVC) syndrome, chest pain and dyspnea. A chest roentgenogram showed a circumscribed mediastinal mass in the right upper lung.
Mediastinitis was suspected and an emergency operation was performed.
A cyst-like mass occupied the mediastinum. The mass was so densely adherent to the aorta, trachea and SVC that it could not be dissected. As much as possible was resected and the SVC was replaced with a Gore-texgraft.
Microscopically, leiomyosarcoma of SVC origin was suspected.
But the mass was proved by electronmicroscopy to be MFH.

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A 77-year-old male was admitted because of dyspnea and an abnormal chest X-ray. He had been followed for giant bulla in the left lung for 3 years. On admission, his chest roentgenogram revealed a giant bulla occupying one half of the left lung and a tumor shadow in the right upper lung field. Pulmonary function tests, including %VC, FEV ₁₀ and unilateral pulmonary artery occlusion test, demonstrated the impaired left pulmonary function.
Bronchial biopsy of the orifice of S¹ a confirmed the diagnosis of well-differentiated squamous cell carcinoma. Simultaneous operation for bilateral lung disease was successfully performed a combination of Naclerio-Langer bullectomy with a stapling device, fibrin glue for the giant emphysematous bulla in the left lower lobe and right upper lobectomy for the lung cancer (t₁n₁m₀ p-stage II) through a median sternotomy.
Surgical indications and operative techniques for giant bulla and lung cancer are discussed.

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A 43-year-old man was brought to our hospital because of acute dyspnea. He had been treated with ventilation through a tracheostomy tube for one month after accidental inhalation of wood chips. Chest x-ray film and bronchoscopy revealed stenosis of the thoracic trachea. Emergency operation was performed through a median sternotomy. Four rings of stenotic trachea were resected and reconstructed at the level of the aortic arch. The anastomosis was successful and the postoperative course was uneventful.
Microscopic examination of the resected specimen revealed granulation and scar tissue with pathological cartilage formation. Wood chips were buried in the granulation tissue. The wood chips and assisted ventilation through tracheostomy apparently caused an inflammatory reaction which led to the stenosis.

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A patient with extrinsic pulmonary arterial stenosis due to compression by a bronchogenic cyst is presented. CT examination showed a cyst with a thin wall located just beneath the bifurcation of the trachea, and a homogenous round mass with a CT number of 33. Pulmonary angiograms revealed stenosis of the right main pulmonary artery accompanied by a systolic pressure gradient of 20 mmHg. The tumor contained 140 ml of opaque black fluid, which contained of numerous necrotic substances, polymorphonuclear leukocytes and ciliated epithelial cells. Histologically, the cyst was lined by damaged ciliated epithelium, and beneath the epithelium was edematous tissue infiltrated by numerous inflammatory cells. These findings suggested that acute inflammation of the cyst induced increased pressure in the cyst and compression of the pulmonary artery.

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A 50-year-old woman was found to have an abnormal shadow on a routine chest x-ray. Right middle lobe syndrome was diagnosed 15 years ago. Since then the abnormal shadow had been noted several times on routine examinations. Chest CT scans revealed a tumor adjacent to the thymus; the CT number was-97-103, indicating fatty tissue. The shape of the tumor changed in chest x-rays taken in the decubitus position. Internal mammary arteriograms revealed that the tumor was supplied by the thymic artery. The preoperative diagnosis was thymolipoma.

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An anterior mediastinal tumor containing suture thread was suspected histologically of being an old hematoma.
A 53-year-old male was found to have an abnormal shadow in the right chest field on a routine examination. He had had a right middle lobectomy for pulmonary tuberculosis 32 years previously. A block resection of the mass was carried out for the anterior mediastinal tumor. The tumor measured 6. 5 × 4. 5 ×3. 2 cm, and had a fibrous capsule surrounding a necrotic and hemorrhagic mass. Histological examination of the specimen revealed an old hematoma containing suture thread with calcification. There was no evidence of inflammation, tuberculosis or neoplasm.
We considered that the tumor might be the result of chronic bleeding of unknown etiology, related to the former operation.

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Chronic pyothorax with bronchopleural fistula and thoracic malignant lymphoma was successfully treated by omental pedicle flap and chest wall muscles. A 61-year-old man who had had an episode of pulmonary tuberculosis treated with artificial pneumothorax 37 years ago was admitted with chronic empyema. After tube drainage, open thoracotomy was performed. A soft tumor on the empyema cavity wall was biopsied and found to be a B cell malignant lymphoma. Following after the tumor had disappeared (CR) the chemotherapy (VEPA-B), muscle and omental flap closure of the empyema space and thoracoplasty were performed. The omental flap was pulled into the empyema cavity and fixed over the bronchopleural fistula. The patient is alive eight months after surgery.

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