Filter cigarette smoking and lung cancer risk; a hospital-based case--control study in Japan.

Recent changes in the histology of lung cancer, namely a relative increase of adenocarcinoma compared to squamous cell carcinoma, might be due to a temporal shift from nonfilter to filter cigarettes. To investigate the association between type of cigarette and lung cancer by histological type, we conducted a case-control study in Japan, comprising 356 histologically confirmed lung cancer cases and 162 controls of male current smokers, who provided complete smoking histories. Overall, logistic regression analysis after controlling for age and prefecture revealed decreased risk, as shown by adjusted odds ratios, for both squamous cell carcinoma and adenocarcinoma among lifelong filter-exclusive smokers as compared to nonfilter or mixed smokers. This decrease was greater for squamous cell carcinoma than for adenocarcinoma. Among men under 54 years, filter-exclusive smokers displayed increased risk of adenocarcinoma, but decreased risk of squamous cell carcinoma. The recent shift in histology from squamous cell carcinoma to adenocarcinoma, particularly among younger smokers, might be due to changes in cigarette type. However, among subjects aged 65 years or more, no differences in histological type appeared related to type of cigarette smoked, implying that other factors are associated with increases in adenocarcinoma among older Japanese population.

Prognosis of resected non-small cell lung cancer patients with carcinomatous pleuritis of minimal disease.

OBJECTIVE: The purpose of this study was to clarify the prognosis of resected non-small cell lung cancer (NSCLC) patients with carcinomatous pleuritis of minimal disease which might be considered as the next advanced stage of positive pleural lavage cytology. METHOD: The data were collected from a questionnaire survey on the survival of the patients with carcinomatous pleuritis found at thoracotomy from 1985 to December 1994 which was conducted by the Japan Clinical Oncology Group (JCOG). RESULTS: Out of 227 patients with carcinomatous pleuritis found at thoracotomy who had available information on a survival, 100 patients who underwent a resection of the primary tumor had carcinomatous pleuritis of minimal disease defined based on the criteria of the Japan Lung Cancer Society. The mean malignant fluid volume (+/-S.E.) was 37.1 (6.3) ml and the mean number of pleural disseminated nodules was 5.6 (0.9). A lobectomy was performed in 79 patients, a pneumonectomy in 11 and a limited resection in ten. The 3- and 5-year survival rates were 31.8 and 22.8%, respectively. CONCLUSIONS: The prognosis of resected NSCLC patients with carcinomatous pleuritis of minimal disease was unexpectedly good. This indicates that no fine line may exist between positive pleural lavage cytology findings and the aforementioned lesion.

The prognosis of patients with non-small cell lung cancer found to have carcinomatous pleuritis at thoracotomy.

Non-small cell lung cancer with carcinomatous pleuritis is considered to be a contraindication of surgical resection. The objective of this study was to clarify the prognosis of patients with non-small cell lung cancer in whom carcinomatous pleuritis was found at thoracotomy. A questionnaire survey on the survival of patients with carcinomatous pleuritis found at thoracotomy between January 1985 and December 1994 was conducted by the Japan Clinical Oncology Group. According to the data collected from 21 hospitals, 8813 patients with non-small cell lung cancer underwent thoracotomy, 284 (3.2%) of whom were found to have carcinomatous pleuritis. Information on survival was available for 227 of these patients, 34 (15%) of whom underwent thoracotomy alone without resection, whereas 193 (85%) underwent surgical resection. Of the 193 resected patients, 155 had no macroscopical residual tumor apart from the carcinomatous pleuritis. The 5-year survival rate was 14%. According to a univariate analysis, female sex, the presence of adenocarcinoma, a tumor size of less than 3.0 cm, no clinical lymph node metastasis, and no macroscopical residual tumor had a significantly favorable impact on survival. A multivariate analysis revealed that the extent of clinical lymph node metastasis (P = 0.006), histology (P = 0.028), and the absence or presence of a macroscopic residual tumor after the operation (P = 0.045) were predominant prognostic factors. The 5-year survival rate of 83 patients with three positive variables was 24%. The prognosis of patients with adenocarcinoma found to have carcinomatous pleuritis at thoracotomy was not necessarily unfavorable if there was no clinically detected lymph node metastasis and no residual tumor apart from the carcinomatous pleuritis.

[Thoracoscopic enucleation for sclerosing hemangioma of the lung--a case report].

A 30-year-old female with sclerosing hemangioma of the lung (SHL) was managed by thoracoscopic enucleation. Under the left lateral decubitus position, four small skin incisions were made. The tumor, approximately 2.5 cm in diameter, was just under the pleura at the right S5, and was clearly demarcated without adhesions to mediastinal pleura. Because the tumor located near the hilum, a partial resection by intrathoracic Endo-GIA could not be performed. So the tumor was enucleated bluntly with an electrode knife being tugged by a tractive thread. After it was diagnosed as SHL by intraoperative imprint cytology, the stump was closed with running suture of 3-0 nylon. The patient was discharged on the 10th postoperative day without complication. No recurrence was found during a follow-up period of six months after the operation. Immunohistochemical findings suggested that the tumor cells were derived from type II pneumocytes. Thoracoscopic surgery appears to be a good indication for SHL which commonly occurs in young or middle-aged women and which is difficult to be diagnosed preoperatively. Thoracoscopic enucleation is considered to be a one of the safe methods especially for SHL which can not be resected by Endo-GIA.

[Prediction and the results of postoperative performance status in patients with giant bulla--prospective study of 47 patients].

The discriminant function (Z) for predicting postoperative performance status in patients with giant bulla was addressed in our previous paper. In the present study, patients with dyspnea were classified into Group 1 or Group 2 based on preoperative function, Group 1 showing continuous improvement in dyspnea and Group 2 unchanged or worsened condition after bullectomy. Of the 47 patients in this study, 28 had dyspnea of grade 2 or more, 19 revealing no symptoms prebullectomy. The group predictions for the 28 patients were compared with the postoperative status in dyspnea for over four years following surgery. The predicted grouping in 26 of the 28 (93%) agreed with the postoperative status but in two it did not: one was familial bullous emphysema the other had repeated episodes of pneumonia, both of which were predicted for Group 1. All 19 patients without preoperative dyspnea were studied their symptoms and lung functions before and after bullectomy. After surgery, none showed dyspnea and significant changes of functions. As to preoperative pulmonary function, patients with FEV1.0% of more than 60% and delta N2 of less than 2% were improved, the prediction agreeing with the actual results. Fourteen patients with FEV1.0% of less than 55% showed high delta N2. When delta N2 exceeded 3.5%, deterioration of dyspnea was observed following surgery. Bullectomy is indicated in patients with low pulmonary function, by preoperative FEV1.0% and delta N2.

[A case of tuberculous mesenteric lymphadenitis and peritonitis with symptoms of acute abdomen].

Both of tuberculous mesenteric lymphadenitis and tuberculous peritonitis are now rather rare in parallel with the decrease of the incidence of tuberculosis as a whole. Here, we report a case of tuberculous mesenteric lymphadenitis complicated with tuberculous peritonitis. A 28-year-old man was admitted to our hospital with pulmonary tuberculosis. Antituberculous chemotherapy was started and his chest X-ray findings were improved. After 11 weeks of the treatment, high fever of 39.0 degrees C developed suddenly and he complained right lower abdominal pain. During laparotomy performed on suspicion of acute appendicitis, swelling of mesenteric lymph-nodes, numerous miliary tubercles on mesentery and turbid ascites were noticed. Diagnoses of tuberculous mesenteric lymphadenitis and tuberculous peritonitis were confirmed by bacteriological and histological examinations of lymph-nodes and tubercles. Ileocecal resection was performed and clinical course after the surgery was favourable.

[Omental pedicle flap for chronic empyema].

We have used the omental pedicle flap (OPF) method to treat 10 patients with chronic empyema secondary to pulmonary tuberculosis. Since 1987 they included 9 men and one woman ranging from 48 to 70 years in age. Two patients were required re-operation because of residual bronchopleural fistulas, and the additional procedures (muscle plombage and thoracoplasty) performed in order to close residual dead space produced more severe thoracic deformity and pulmonary dysfunction. In our first successful case, complete thoracoplasty combined with the OPF method also produced pulmonary dysfunction. On the other hand, thoracic deformity was avoided in 3 other patients and 4 patients without thoracoplasty showed better pulmonary function postoperatively. A comparison of the re-operated patients with the successful cases highlighted two important points regarding the OPF method. One is the need for firm fixation of the OPF to a fistula. We usually place a muscular pedicle flap over the OPF, and add limited thoracoplasty as necessary. The other important point is the control of infection. Open window thoracostomy before the OPF method is effective in patients with active infection. The OPF method is an effective radical operation for severe empyema even when residual dead space is present, and it can also be applied to patients with poor pulmonary function.

Case-control study for lung cancer and cigarette smoking in Osaka, Japan: comparison with the results from Western Europe.

In order to clarify the relation between cigarette smoking and lung cancer, a case-control study was conducted. The case series consisted of 1,376 lung cancer patients (1,082 males and 294 females) who were newly diagnosed and admitted to eight hospitals in Osaka during 1986-88. Smoking histories were compared with those of 2,230 controls (1,141 males and 1,089 females) admitted to the same hospitals during the same period without established smoking-related diseases. Odds ratios of current smoker versus nonsmoker were 18.1, 1.9, 21.4, and 3.8 for squamous, adeno, small, and large cell carcinoma, respectively, for males, and 9.7, 1.3, 12.1, 3.7, respectively, for females. Compared to the results from previous studies in Japan, the magnitude of the odds ratios for squamous and small cell carcinoma is approaching the level of Western Europe in the late 1970s. Population attributable risk of exsmokers has also been increasing to the level of Western Europe. Among male current smokers, smoking intensity, such as number of cigarettes per day or fraction smoked per cigarette, seemed to have a slightly greater influence on squamous cell carcinoma than adenocarcinoma, while factors associated with the spread of cigarette smoke, such as inhalation, seemed to have greater influence on adenocarcinoma. The difference in the distribution of these smoking characteristics between Japan and Western Europe could not fully explain the difference in lung cancer incidence and distribution of histologic types between the two areas.

[Squamous papillomatosis of the left main bronchus and trachea: a case report].

A 49-year-old female complaining of dyspnea at exercise was admitted. Bronchoscopic examination revealed that the left main bronchus was almost obstructed by a tumor. A sleeve resection of the left main bronchus was performed. Histological examination confirmed that the tumor was squamous papilloma. After one year and eight months, bronchofiber examination disclosed papilloma in the trachea. Therefore, papilloma was treated with endoscopic methods, including Nd-YAG laser. The patient has survived for 11 years since first treatment.

Epidural migration of hemostatic agents as a cause of postthoracotomy paraplegia. Report of two cases.

Paraplegia secondary to pulmonary surgery occurred in two patients because of epidural migration of hemostatic agents. Computerized tomography following myelography revealed the lesion clearly. Both patients achieved satisfactory neurological recovery through prompt diagnosis and treatment.

Characterization of D-aspartic acid uptake by rat hippocampal slices and effect of ischemic conditions.

The cellular uptake of D-aspartic acid (D-Asp) as a model compound for glutamic acid transport was studied in rat hippocampal slices. D-Asp is accumulated by both Na(+)-dependent and Na(+)-independent processes in hippocampal slices, and both processes are dependent on temperature. The Na(+)-dependent uptake is assumed to be high in affinity (apparent Km = 0.17 mM), but low in capacity, whereas the Na(+)-independent uptake is much lower in affinity (Km = 2.86 mM), but higher in capacity. L-Aspartic acid, L-glutamic acid, dihydrokainic acid, and threo-3-hydroxy-DL-aspartic acid markedly inhibited the uptake of D-Asp with Na+ in the medium, whereas D-glutamic acid, glycine, and L-lysine had no significant effect. The Na(+)-dependent uptake of D-Asp was significantly reduced under "hypoglycemic," "anoxic," and "ischemic" conditions, whereas the Na(+)-independent uptake was unaffected. Metabolic inhibitors such as NaCN and ICH2COOH significantly inhibited the Na(+)-dependent uptake, but not the Na(+)-independent uptake. These results suggest that the Na(+)-dependent component of D-Asp transport in rat hippocampal cells is inactivated under ischemic conditions, whereas the Na(+)-independent component is unaffected.

Lung cancer risk among exsmokers.

Lung cancer risk among exsmokers according to years since cessation of smoking was assessed by means of a case-control study. The case series consisted of 1,052 lung cancer patients who were newly diagnosed and admitted to eight hospitals in Osaka in 1986-88. Smoking histories were compared with those of 1,111 controls admitted to the same hospitals during the same period without any diagnosis of smoking-related disease. The odds ratio of lung cancer for exsmokers compared to current smokers was estimated to be 0.90, 0.50, 0.51, 0.59, 0.48 and 0.29, for 1-4, 5-9, 10-14, 15-19, 20-24 and greater than or equal to 25 years after cessation of smoking, respectively. Risk reduction appeared to be greater for those who smoked less than the 1200 cigarette index, compared to those who smoked more. In classification according to histologic type, small cell and large cell carcinoma showed a rapid decrease compared to adenocarcinoma, while squamous cell carcinoma showed an intermediate pattern. Quantitative estimates for reduction of lung cancer risk among exsmokers can be used for projecting lung cancer incidence in the future, by assuming future trends of smoking prevalence, as well as for health education among individual smokers.

Mediastinal lymph node metastases from nonsmall cell bronchogenic carcinoma: reevaluation with CT.

We evaluated the sensitivity of CT for detecting mediastinal lymph node metastases in patients with nonsmall cell bronchogenic carcinoma. Computed tomography of 208 cases of surgically proven bronchogenic carcinoma from three institutes was evaluated retrospectively using specific diagnostic criteria. These consisted of two size thresholds for specific mediastinal node regions: 13 mm short transverse diameter for nodes in the subcarinal, precarinal, and tracheobronchial regions and 10 mm for other regions. Based on these criteria, the overall sensitivity of CT was 69%, specificity 94%, and accuracy 86% for detection of metastasis. In cases of adenocarcinoma, sensitivity was 61%, specificity 93%, and accuracy 81%, and in those of squamous cell carcinoma the respective values were 86, 94, and 92%. Comparison between the results using the present criteria with the former criterion of 10 mm short transverse diameter for all mediastinal nodes revealed that the number of false-positive cases decreased markedly. We conclude that more accurate CT evaluation of mediastinal lymph node metastasis in nonsmall cell bronchogenic carcinoma can be achieved with specific size criteria for specific mediastinal regions.

[Familial spontaneous pneumothorax in three siblings including identical twins].

Two identical twin brothers and their sister who suffered from spontaneous pneumothorax (ages at onset, 18, 22 and 20 years) were admitted to our hospital. Their symptoms and clinical courses were similar and all three were finally treated by thoracotomy. No other members of their family had any history of spontaneous pneumothorax. None of these cases presented any abnormal level of serum ACE or alpha 1-antitrypsin. In order to establish the monozygosity of the brothers more accurately, we examined restriction fragment length polymorphisms (RFLPs) which were shown as the band patterns of hypervariable minisatellite regions in human genomes. However there have been few reports of spontaneous pneumothorax in identical twins, but the onset of the disease tends to be the same as in our cases, suggesting a genetical background of spontaneous pneumothorax.

[A case of chemotherapy induced necrosis of primary mediastinal germ cell tumor].

A 17 year old male with mediastinal yolk sac tumor is herein reported. His chief complaint was anterior chest pain. Chest X-ray and chest CT indicated a 8 cm diameter mass in the anterior mediastinum. Laboratory analysis revealed 2,578 ng/ml for AFP and 54% for LDH I. HCG and CEA values were normal. Yolk sac tumor was cytologically suspected on needle aspiration specimen. Combined chemotherapy with CDDP, VP16, and PEP brought the AFP and LDH 1 values down to 10 ng/ml and 27%, respectively. The diameter of the mass decreased to 6 cm. The mass was removed together with the thymus and the right upper lobe of the lung. A post operative histological examination of the mass revealed total necrosis. Nine months after the initiation of the therapy, his AFP level was within normal limits. The patient is doing well.