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We report 6 cases of spontaneous pneumomediastinum. It is defined not to have clear etiology such as trauma, and is comparatively rare disease developing suddenly. Our patients complained of chest or neck pain, dyspnea and pain when swallowing. They were 3 men and 3 women, who were young and did not have causal disease. Chest X-ray films and computed tomography (CT) scans revealed pneumomediastinum. All of them were treated conservatively and recovered completely within 10 days hospitalization. Spontaneous pneumomediastinum is uncommon and usually benign. Most patients require only conservative treatment. However, since it possibly develops tension pneumothorax, pneumothorax, or mediastinitis, careful observation is recommended never to overlook life-threatening condition. In addition, it is important to distinguish from Boerhaave syndrome, tracheal trauma and so on.

We report a case of metastatic bladder tumor from gastric carcinoma. A 55-year old male patient was referred to our urological clinic with a complaint of frequent urination and voiding pain. He had undergone total gastrectomy for poorly differentiated adenocarcinoma, signet-ring cell type, 9 months earlier. Computed tomographic scan revealed a thick bladder and rectum wall all around. Punch biopsies from vesical and rectal wall revealed metastatic adenocarcinoma, signet-ring cell type. There were no other metastatic sites. Systemic chemotherapy was done with a combination of mitomycin-C, 5-fluorouracil and cytosine arabinoside. This chemotherapy was effective and complete remission was obtained at bladder and rectum. Six months after chemotherapy, peritoneal recurrence developed and he died 9 months after chemotherapy. However no recurrence of bladder tumor was detected. This was a quite rare case of metastatic bladder tumor characterized by good response to systemic chemotherapy.

Experimental combined hormone therapy with tamoxifen, aminoglutethimide and medroxyprogesterone acetate was investigated using three hormone-dependent human breast carcinomas serially transplanted into nude mice. The antitumor effect of combined tamoxifen and aminoglutethimide was better than that of either tamoxifen or aminoglutethimide alone. Since aminoglutethimide significantly reduced the level of estrogen and the uterine weight in normal female mice, the antitumor effect of combined tamoxifen and aminoglutethimide was assumed to be a result of the low estrogen level produced by aminoglutethimide, favoring the competition of tamoxifen with estrogen receptors. There was no additive antitumor effect of the combination of tamoxifen and medroxyprogesterone acetate, although serum medroxyprogesterone acetate levels in nude mice were almost equivalent to those of humans. These results indicate that combination hormone therapy, especially with and aminoglutethimide, might be a promising method for clinical application.

On the assumption that an early breast cancer is tumor under 1.0 centimeter in diameter, sixty five cases of the early disease were picked out from 970 patients who had breast cancer during 20 years from 1961 to 1980. The former were 6.7 percentage among them. Only five cases (7.6%) among patients with such early breast cancer had metastasis in the axillary lymph nodes, except lymph nodes of the level III group. On the other hand, ten year survival after modified radical mastectomy for early breast cancer was 93 percentage. An inquiry of the atrophy of the major pectoral muscles after modified radical mastectomy revealed that it was rather fewer after Auchincloss's mode than after Patey's. In conclusion, the two facts suggested that surgery of Auchincloss's type was the most available for such early breast cancer.