[Recurrence after bullectomy by video-assisted thoracic surgery for spontaneous pneumothorax in younger ages].

We reported 2 cases of recurrent pneumothorax after thoracoscopic bullectomy. The patients are 19-year-old and 21-year-old men. The distensible bullae without macroscopic emphysematous change were found at initial surgery in both patients. They experienced the recurrence at 21 months and 25 months respectively. Interestingly, small bullae along the overall length of the previous stapled line were found in both cases. Histological examination of the resected lungs at the 1st and 2nd operation disclosed microscopic emphysema in the macroscopically normal lung tissue. Pathologic findings suggest that new bullous lesions developed from the microscopic emphysematous lesion around the stapled line. Distortion of lung tissue by stapling is likely to be the cause of new bullous formation. Reinforcement around stapled line covered with absorbable material might be necessary at the initial surgery to prevent recurrence in younger patients.

Familial hyperparathyroidism associated with jaw fibroma: case report and literature review.

A 53-year-old female suffering from renal stones and hypercalcaemia was diagnosed as having primary hyperparathyroidism caused by hyperplasia of the parathyroid glands. She underwent total parathyroidectomy and implantation of parathyroid tissue. After one year, she underwent surgery for a jaw tumour. The pathological findings indicated it to be a cementifying fibroma. Jackson et al. (1990) reported the familial association of hyperparathyroidism with jaw tumours, and they suggested that this condition represents a new clinical syndrome. We believe that our case belongs to this syndrome.

[Two cases of thyroid cancer resected with trachea].

We described two patients of thyroid cancer with tracheal invasion. A 54-aged female visited our hospital with complaint of the neck pain. Echography showed a tumor in the right lobe of the thyroid. In operation the thyroid tumor invaded the trachea and right recurrent nerve. A 24-aged male visited our hospital with complaint of a mass of the left side neck. Echography showed a tumor in the left lobe of the thyroid. In operation the thyroid tumor invaded the trachea, lymph node and left recurrent nerve. In these two cases we could find thyroid tumors invaded into the trachea by echography. We re-evaluated the utility of echography.

Thyroid nodules in female uremic patients on maintenance hemodialysis.

We investigated the incidence of thyroid nodules in female uremic patients on maintenance hemodialysis using a high-frequency sonographic scanner. In 47 (21.0%) of the 224 female normal controls and 33 (55.0%) of the 60 female patients, thyroid nodules were detected. The difference in these incidences between controls and patients was significant. There were no differences in age, duration of hemodialysis, the level of blood urea nitrogen, parathyroid hormone or thyroid stimulating hormone between the patients with thyroid nodules and those without nodules. Although there is a correlation between uremia and the development of thyroid nodules, the details of the underlying mechanism of their association remain unclear.

Diagnosis and surgical treatment of small papillary carcinomas of the thyroid gland.

The preoperative and pathological findings of 38 cases of small papillary carcinoma of the thyroid gland measuring < or = 10 mm in diameter and 74 cases of large papillary carcinoma measuring more than 10 mm were compared. In the small carcinoma cases, the sensitivity of palpation, ultrasonography, and fine-needle aspiration biopsy (FNAB) was higher than that of computed tomography and soft tissue roentgenography of the neck. Therefore, palpation, US, and FNAB should be instituted as reliable diagnostic methods, but other examinations seem unsuitable as methods for preoperative qualitative diagnosis. No definite correlation was found between the intraglandular dissemination and the size of the carcinoma, and the frequency of metastasis was relatively high even in the small carcinoma cases. If the patient elects to undergo surgery, subtotal thyroidectomy with lymph node dissection should be performed for small thyroid carcinomas as well as large carcinomas.

Immunohistochemical study of estrogen receptor and estradiol on papillary thyroid carcinoma in young patients.

We have immunohistochemically examined estrogen receptors (ER) and estradiol (E2) on papillary thyroid carcinoma in young females under the age of 25 years. The 10 young females in this study were compared with 64 females 30 years of age or older who underwent surgery for treatment of papillary thyroid carcinoma. We did not find any significant difference in the incidences of positive staining for E2 between the two groups. Of the specimens obtained from the young patients, 80% (8/10) showed positive staining for ER; this was significantly higher (P < 0.01) than that observed in patients 30 years of age or older (25%). We think that, especially in youth, estrogen may play an important role as a promoting factor. This indication needs further study.

Immunohistochemical study of estrogen receptors and the responsiveness to estrogen in papillary thyroid carcinoma.

BACKGROUND: Epidemiologic data suggested that the differentiated thyroid carcinoma was affected by sex hormones, especially estrogen. METHODS: The authors have immunohistochemically studied estrogen receptors (ER) in papillary thyroid carcinoma in women. Two anti-ER monoclonal antibodies, D5 and H222, were used. The authors then investigated the responsiveness to estrogen of thyroid neoplasms using primary culture of surgically resected thyroid tissues. The proliferative activity of cultured cells was measured by the bromodeoxyuridine (BrdU) labeling index (LI). RESULTS: Twenty-six percent of the specimens (18/70) showed positive staining with D5, but only 5.6% of the specimens (2/36) showed positive staining with H222. The BrdU LI of ER-positive papillary thyroid carcinoma increased with the addition of estradiol. CONCLUSIONS: These findings indicate that estrogen may affect the proliferation of ER-positive papillary thyroid carcinoma.

Incidence of ultrasonographically-detected thyroid nodules in healthy adults.

We studied the incidence of thyroid nodules in healthy adults, who had no history of thyroid disease, in Tokushima, Japan, where goiter is not considered endemic. Examination was performed by palpation and using a 10-MHz real-time sonographic scanner. Palpable thyroid nodules were present in two (0.9%) of 227 men and in four (1.8%) of 224 women. On the other hand, nodules were detected by ultrasonography in 42 men (18.5%) and 47 women (21.0%). There was no significant difference in the incidence detected by ultrasonography between men and women in any of the age groups, except in men above 60 years old. It is concluded that thyroid nodules are not an uncommon disorder even in men. Since, clinically, the incidence of nodularity appears to be higher in women than in men, there may be difference between men and women in the development of nodules until they become clinically detectable.

The characteristics of interval breast cancer in mass screening.

To investigate the characteristics of interval breast cancer in mass screening, comparisons were made of the following three groups: interval group (21 interval breast cancer cases), mass screening group (87 breast cancer cases detected by mass screening) and outpatient group (266 breast cancer cases diagnosed at outpatient clinics). There were no differences among the three groups in terms of the case distribution by age or obesity, but significant differences in the case distribution according to nodal involvement and tumor size. Histological grading of the malignancy of the primary tumors disclosed that the incidence of breast cancer showing frequent mitoses was high in the interval group compared to the mass screening and outpatient groups. The 7-year cumulative disease-free survival rate was 75.3% in the interval group, 90.0% in the mass screening group and 83.1% in the outpatient group. The mean tumor size of the interval cases at the time of mass screening, back-calculated on the basis of the estimated tumor doubling time, was 1.5 cm in diameter, smaller than that of the mass screening group. It is surmised that interval breast cancer is characterized by marked proliferation of the tumor cells and has a poorer prognosis than the other group cases. These findings might be due to the marked proliferation of interval breast cancer rather than because of cases having been overlooked at the time of the last screening.

[A comparative analysis of interval breast cancer with breast cancer detected by mass screening or in outpatient clinics].

To investigate the characteristics and the prognosis of interval breast cancer, 21 interval cases were reviewed and compared with a total of 87 patients with breast cancer detected by mass screening and 266 found in outpatient clinics on the basis of the clinicopathological features. The postoperative cumulative 7-year disease-free rates were 61.1%, 81.4% and 69.0% in the interval cases, mass screening cases and outpatient clinic cases, respectively. The percentage of cases showing frequent mitoses in cancer cells was statistically higher for interval cancer than for the other breast cancers. The average tumor size of the interval cases calculated from the speculated tumor doubling times, was 1.51 cm. It is surmised that interval breast cancer is characterized by a marked proliferation of tumor cells and has a poorer prognosis than the other breast cancers. This might be due to the marked proliferation of interval breast cancer rather than under-counting because there were no malignant findings at the time of the last screening.

Thyroid carcinoma in patients with secondary hyperparathyroidism.

There have been few reports of coexistence of secondary hyperparathyroidism (2 degrees HPT) and thyroid carcinoma. Eleven consecutive patients with 2 degrees HPT who underwent parathyroidectomy were analyzed. They consisted of six males and five females, whose age ranged from 34 to 55 years. None of the patients had a history of irradiation of the head or neck. Associated thyroid nodules were also present in seven patients (64%): four patients with benign nodules, and three patients with papillary carcinomas, and one with papillary carcinoma and two follicular adenomas. This incidence of thyroid carcinoma in the patient group with 2 degrees HPT (36%) was significantly higher than that of the autopsy group in the same geographical area (11%). The level of carboxyl-terminal parathyroid hormone in the patients with thyroid carcinoma was higher than that in the patients without thyroid carcinoma (P less than 0.05). The importance of searching for possible thyroid cancer in patients with 2 degrees HPT should be emphasized.

A rare case of fibroadenoma in a tubular adenoma of the breast.

We report herein a case of a 31 year old housewife who underwent an excisional biopsy for a well-circumscribed lump in her breast. The lump contained 2 histological patterns, namely, fibroadenoma and tubular adenoma. These patterns had no transitional zone, were distinct and changed abruptly. This case was histologically diagnosed as "a fibroadenoma in tubular adenoma of the breast, benign", with no other such case ever having been reported in Japan. The histological findings of this case, convinced us that tubular adenoma is closely related to fibroadenoma.

Estimated weight of the residual parathyroid gland after parathyroidectomy using plasma levels of the parathyroid hormone.

The possibility of estimating the total weight of the parathyroid glands based on the plasma concentration of the parathyroid hormone (PTH) would be of great help when searching for the parathyroid glands during surgery on patients with secondary hyperparathyroidism. Thus, we studied the relationship between the levels of carboxyl-terminal PTH (C-PTH), midportion PTH (M-PTH) and intact PTH, and the weight of the parathyroid glands resected for secondary hyperparathyroidism. The subjects studied were 11 patients with secondary hyperparathyroidism caused by chronic renal failure. The pre- and post-operative differences in the plasma C-PTH levels and plasma M-PTH levels were significantly correlated with the weight of the resected parathyroid glands (p less than 0.001 for both), but there was no correlation between the differences in the levels of intact PTH and the weight of the resected parathyroid glands. From these relationships we estimated the weight of the residual parathyroid gland after parathyroidectomy using the levels of each PTH. All patients in whom the residual parathyroid gland was estimated to be heavy based on the levels of M-PTH showed recurrence of hyperparathyroidism after the parathyroidectomy. We therefore found that estimation of the weight of the parathyroid glands from the levels of M-PTH is both possible and useful.

Sex hormone receptors in human thyroid tissues.

The behavior of sex hormone receptors was studied in the cytosol of thyroid tissue samples in order to clarify the effects of sex hormones on diseases of the thyroid. Androgen receptor (AR), estrogen receptor (ER), and progesterone receptor (PgR) were assayed using the dextran-coated charcoal (DCC) method and analyzed by the method of Scatchard. Androgen receptor, ER, and PgR were negative in all of the cytosol prepared from normal thyroid tissues. However, the positive rates for the receptors in the neoplastic and nonneoplastic tissues were 22% for AR, 29% for ER, and 18% for PgR. Especially, the incidence of ER was significantly higher in neoplastic lesions than normal tissues. These data suggest that sex hormones, especially estrogen, may play a role in diseases of the thyroid.

[Comparison of the binding nature of mibolerone to androgen receptor of human prostate with that of R1881].

The authors examined the binding nature of mibolerone in cytosols of hypertrophic prostates from 15 patients to androgen receptor using Dextran-charcoal assay, analyzed it by the method of Scatchard, and compared it with that of R1881. The addition of triamcinolone acetonide into the incubation medium induced specific single binding of mibolerone to androgen receptor with high affinity as well as R1881. The receptor contents obtained with mibolerone were higher than those of R1881, and both of them correlated well. The dissociation constants of both ligands showed good correlation and no significant differences. Mibolerone seems to be as suitable a ligand as R1881 for measuring the androgen receptor.

[A clinical study of lobular carcinoma of the breast].

In a review of 549 cases of breast cancer in the last 16 years, 7 cases with lobular carcinoma have been studied. All of the patients appeared well and were without recurrence. Two cases had been lobular carcinomas in situ, one of which had arisen in a small fibroadenoma associated with malignant phyllodes tumor in the opposite breast, and the other had shown multicentric foci of a lobular neoplasm. The remaining 5 cases had been invasive lobular carcinomas. The incidence of lobular carcinoma represented 1.3% (7/549) of all primary breast carcinomas, and had been increasing chronologically. Estrogen and progesterone receptors were positive in 5 eligible cases.

Breast cancer detected by mass screening using physical examination alone.

In Tokushima prefecture, mass screening for breast cancer has been conducted using physical examination alone since 1970. Breast cancer was detected in 116 of 111,571 screened women up until 1984. The detection rate was 0.08 per cent in total examinees, 0.13 per cent in initial examinees, and 0.04 per cent in subsequent examinees. The patients with breast cancer were divided into three groups, i.e., 62 cases detected at initial screening, 28 cases detected at subsequent screenings, and 26 interval cancer cases. 510 patients with breast cancer in the outpatient clinic were serving as controls. The stage classification and nodal involvement were significantly different between the mass screening group and the control group, but not significantly different among the three groups. The interval cases were detected at an early stage. The survival rates were not significantly different between the three groups and the control group. Efforts should be doubled to educate women about the proper method of breast self-examination in order to promote the early detection of breast cancer.