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難治性肺炎を主症状とする, 食道憩室を伴った成人の先天性食道気管支瘻の3例を外科治療を中心に検討した.症例は72歳女性 (症例1), 58歳女性 (症例2), および49歳男性 (症例3) である.病悩期間は1年ないし12年であった.症例2, 3は幼少時より飲水後むせることがあった.また症例3は23歳時に難治性肺炎のため右中葉切除術および右下葉部分切除術を受けた.手術は, 症例1では瘻管・食道憩室切除術のみを施行したが, 症例2, 3では, 右下葉あるいは右残存肺の合併切除術を追加した.術中所見ではいずれの症例も瘻管周囲に炎症所見はなく, 組織学的所見でも瘻管に正常食道粘膜や筋層を認めたため先天性食道気管支瘻と判断した.術後経過は3例とも順調で, 肺炎は再発しなかった.本疾患の外科治療は瘻管切除術と抗生物質の投与で治療可能であるため, 肺切除術は必ずしも行わなくてもよいと考えられた.

胸部X線写真上, 急速に異常陰影が出現増大し気管支壁及び肺静脈に浸潤した肺硬化性血管腫の1例を経験した.症例は48歳女性.血痰を主訴に入院した.入院2ヵ月前の胸部X線写真では右上肺野に淡く不明瞭な小陰影を認めるのみであったが, 入院2ヵ月後には境界明瞭な3cm×4cmの楕円形陰影を認めるようになった.悪性腫瘍を否定しえない為, 右肺上葉切除を行った.病理所見より, 気管支壁及び肺静脈に浸潤した肺硬化性血管腫と診断された。肺硬化性血管腫は, 一般に良性腫瘍と考えられているが, 本症例は臨床経過及び病理所見より悪性度の低い悪性腫瘍と考えるべきだと思われた.肺硬化性血管腫が疑われる場合は, 経過観察のみを行うのでなく, 積極的に切除を行う必要があると考えられた.

肺気腫症例に対し胸腔鏡下の炭酸ガスレーザー照射が有効であるかどうかを検討した.4例の肺気腫症例に対し胸腔鏡下に炭酸ガスレーザー照射を行い, 手術前後の呼吸機能および運動機能を比較検討した.術前右心カテーテル検査では肺高血圧症が全例に認められた.術中の肉眼的所見では照射により気腫化部分の縮小が認められた.全例とも2日目に胸腔ドレーンを抜管でき, 術後40日以内に退院した.術後合併症は皆無であり, 胸腔鏡下炭酸ガスレーザー照射は安全に施行できた.手術前後の胸部X線写真およびCTの比較では1例に気腫化部分の明らかな縮小を認めた。1秒量は術前0.35±0.11に比し術後0.42±0.21とやや増加し, 2例では運動機能の改善と自覚症状の改善を見た.他の2例では自覚症状に変化を認めなかった.胸腔鏡下炭酸ガスレーザー照射は一部の肺気腫症例に対して有効であった.

A 57-year-old man was admitted with burning pain and swelling of his left arm. A chest X-ray film showed a tumor shadow in the apex of the left lung, squamous cell carcinoma was diagnosed by bronchoscopy and brush biopsy. A sweat test showed a significant decrease in sweating in the distribution from the stellate ganglion through T3 on the left. The amplitude of the pulse in his left index finger was 4 times that on the right. Our diagnosis was reflex sympathetic dystrophy (RSD). After preoperative irradiation to the tumor (30 Gy), left upper lobectomy was performed followed by left sympathetic ganglionectomy from the lower stellate ganglion through T3. The burning pain and edema of the left arm disappeared. We conclude that sympathetic ganglionectomy is very efficient in patients with RSD due to lung cancer.

Five patients with invasive thymomas and postoperative associated diseases were studied clinically and histologically three had myasthenia gravis (MG), one had a skin rash, interstitial pneumonia and hypogammaglobulinemia, and one had pure red cell aplasia (PRCA) and hypogammaglobulinemia. Total tumor resection was performed in four patients, and partial resection in one, who had massive pleural dissemination. Thymectomy was performed in the patient with preoperative PRCA, right pneumonectomy in one patient, and right upper lobectomy in one. The epithelial cells in four of the tumors were polygonal, and there were spindle-shaped in the patient with preoperative PRCA. Metastasis and/or local regrowth of the thymomas occurred in two patients, one of whom received chemotherapy. MG was treated with prednisolone and/or azathiopurine, and PRCA was treated with prednisolone and protein anabolic hormone. One patient died of brain metastasis, and three of complications. Only one patient is still alive.In conclusion, metastasis or recurrence of thymoma is likely to be the cause of postoperative associated diseases, and treatment of metastasis or recurrence may be helpful in the management of associated diseases.

Thymomas, especially epithelial component were cultured, and differentiation between invasive and noninvasive thymoma was attempted.Materials were obtained at operations and were immediately minced. A portion was digested with 500-1000 u/mlof dispase, 0.25% trypsin or 0.05% collagenase and the remainder was placed in plastic tissue culture dishes, some of which were coated with type I collagen. Culture media were Dulbecco's modified MEM, Ham's F12 or Medium 199. These were supplemented with 10-20% fetal bovine serum, and some as the following additives were tested : 0.5 mg of ATP, 5ug/ml of dibutyryl cyclic AMP, 5 half-maximal units of IL-2, 0.05 u/ml of Insulin, 5 ng/ml of EGF, 10 ng/ml of phorbol 12-myristate 13-acetate, 10-9 M of chorela toxin, 2.5 mg/ml of methylprednisolone, autologous peripheral blood lymphocytes.Tissues were obtained from 9 patients with invasive and 7 with noninvasive thymoma. None of them was established and no additives promoted cell proliferation under the conditions described in this paper. Primary cultures from the invasive thymomas grew well and many epithelial cells were easily obtained. Tumor cells were dissociated easily by proteases or by physical forces. On the contrary, few or no tumor cells were obtained in the noninvasive cases. The growth of mesenchymal cells was always more dense in the noninvasive than in the invasive cases. Microscopic findings in the invasive cases were : dense cytoplasm and thick margin of nucleus, large nucleus, 1 or 2 clearly visible large nucleoli, sharply defined cell borders.Although we cannot necessarily distinguish between invasive and noninvasive thymoma from these results alone, this method may become a useful tool in the diagnosis of thymoma.

48-and 96-hour lung preservation were conducted using simple cooling method in dogs. The effect of buffer action of solutions to the lung preservation was examined.Phosphate buffered solutions with 2% of low molecular weight dextran (Ep1Ep3) were prepared with the change of pH by altering the ratio of H2PO4-and HPO42-. In Ep4, K2HPO4 was added for considering its availability to the heart-lung preservation. As to the electrolyte composition, all solutions were prepared as the extracellular fluid. For preservation, heart-lung bloc of the donor was used. After completion of the preservation, left lung was removed from the heart-lung bloc and transplanted to the recipient orthotopically. Recipient was immunosuppressed using 100 mg/day of azathioprine and 100 mg/day of methylprednisolone for 7 days after transplantation, thereafter each drug was decreased to 50 mg/day in dosage. Serial chest X-ray films were taken after transplantation. Contralateral pulmonary artery ligation was conducted on 11th day postoperatively in the successful cases.4 out of 4 (100%) were successful transplants after 48-hour preservation using Ep3 solution with the pH resembling to the physiological pH at 37°C. In 96-hour preservation, 3 out of 4 were successful cases, however, they did not give satisfactory results on chest X-ray films, contralateral pulmonary artery ligation and histologic findings comparing to successful cases in 48-hour preservation group. Further improvement in preservation solution is considered to be needed for 96-hour lung preservation.From this experiment, we concluded that our method of lung preservation using Ep3 solution may be reliable for 48-hour lung preservation in human lung transplantation.