[Growth rate analysis of pulmonary metastases in giant cell tumor of bone].

We reviewed six cases with pulmonary metastases in giant cell tumor of bone. The growth rate and the doubling time of pulmonary metastases was measured and compared to the clinical course. The six cases were classified into two each of the following three types: 1) spontaneous remission, 2) continuously slow growing and 3) rapid growing. A favorable factor was a doubling time of more than 80 days in pulmonary metastases. A poor prognosis was indicated by a doubling time of around 30 days. Aggressive primary lesions should be excised widely.

[Treatment of pericardial cyst under thoracoscopy].

Thoracoscopic therapy was carried out on two cases of pericardial cyst. The first patient was a 24-year-old male. An abnormal shadow on a chest X-ray was pointed out at a regular checkup. Thoracoscopy was carried out under the local anesthesia and a thin-walled cyst was discovered. The cyst was punctured and serous fluid was aspirated. Then, several biopsy specimens were obtained from the cyst wall, a pathological diagnosis of the cyst was made as a pericardial cyst. One year after the thoracoscopy, no abnormal shadow is observed on chest X-ray. The second patient was a 26-year-old male. It was also discovered that he had an abnormal shadow on a chest X-ray at a regular medical checkup. Since a solid mass couldn't be completely denied, thoracoscopy was carried out in preparing for thoracotomy under the general anesthesia. The cyst observed between SVC and the azygos vein, and serous fluid was aspirated form the cyst. Following this, the cyst wall was biopsied and opened. Since no cases of malignant pericardial cysts have been reported, an operation is not usually required for these patients. We suggest that thoracoscopy is very useful tool for the final diagnosis and therapy of pericardial cyst because this method is easily carried out under local anesthesia.

[An evaluation of surgical treatment for giant bullae].

We have experienced 67 operative cases of giant emphysematous bullae of the lung. For the bilateral lesions, two stage operation was performed in five cases and one stage operation under median-sternotomy in 12 cases. Twenty six cases were subjected to Naclerio-Langer's method, 25 cases to partial resection or plication and 15 cases to lobectomy. At the earlier period lobectomy was the treatment of choice, but, recently lobectomy was avoided for the conservation of pulmonary function. In terms of the improvement of pulmonary function, there was no difference between Naclerio-Langer's method and partial resection by Autosuture. In conclusion, for the treatment of giant bullae, partial resection by Autosuture is preferable because of improvement of pulmonary function and one stage median-sternotomy for bilateral lesions also are effective.

[Regeneration of the respiratory epithelium].

It is very important to clarify the mechanism of the regeneration of the respiratory epithelium in not only Oto-Naso-Laryngology but also in the field of chest medicine and surgery. Because of the experimental study carried out on dogs, involving the curing process of the tracheal anastomosis site, a scanning electron microscopic study showed that after two weeks, ciliated cells could be seen making a thin layer. It took nine weeks or more till the whole tracheal anastomosis site was completely covered by the ciliated epithelial cells. Having reviewed the experimental papers concerning the regeneration of the respiratory epithelium which have been published since 1953, a conclusion has been reached that after the injury of the respiratory mucosa, the existence of the basement membranes remains were covered by the migration of the traditional epithelium from the margin of the wound and four weeks later, the wound was covered by the normal epithelium. It has been stated up until now that the differentiation of the epithelium was covered from basement cells, but in fact, it seems to occur from the secretory cells. This has been demonstrated by the culture process of the respiratory epithelium. From these facts, the cultured respiratory epithelium cells are very important in elucidating carcinogenesis.

[Trans-sternal bilateral thoracotomy for bilateral lung lesions].

The trans-sternal bilateral thoracotomy had been used widely in the early days of cardiac surgery, but since the 1960's the median sternotomy has played a great part in open heart surgery. Recently, the simultaneous bilateral thoracotomy has been used for bilateral lung lesions such as bilateral giant bullae, bilateral pneumothoraces and bilateral metastatic lung tumors. Since 1965 we have performed 6 operations using trans-sternal bilateral thoracotomy for several bilateral lung lesions. The diseases which led to the use of the trans-sternal bilateral thoracotomy technique were 2 cases of bilateral simultaneous pneumothoraces and 4 cases of bilateral lung metastatic tumors. The ages of the patients ranged from 17 to 45 years old. The operative blood loss was between 100 and 810 gm. No case showed postoperative respiratory distress or severe thoracic pain. It would like to be pointed out that the trans-sternal bilateral thoracotomy is the most ideal approach for the multiple bilateral lung metastatic lesions which often invade the chest wall or diaphragm.

[Establishment and characterization of a new human germ cell tumor strain (NOC-Ts) in culture].

We have derived and characterized a new cell line from a teratoma with a embryonal carcinoma and seminoma. The medium used for the cell culture was Eagle's MEM synthetic culture medium (Gibco Inc.) supplemented with 10% new calf serum (Tissue plus, Mitsubishi Kasei Co.). Subcultures were performed on 3 to 4 days basis at 1:2 split by the use of 0.25% trypsin solution. The morphology of obtained cells was a epithelial-like shape and the cell grew in a monolayered sheet with about 30-32 hrs of population doubling time. The model chromosome number of this cell line was 73 including one large submetacentric marker chromosome. The temperature sensitivity and the tumorigenicity of this cell were tested in this experiment.

[Establishment and characterization of human cancer cell line (NOC-S) derived from a progressive lung cancer].

The results of the transplantation out of a progressive lung cancer tissue with leukocytosis showed that tumors were grown in nude mice at about 70 days after direct transplantation. A tumor was removed from the nude mouse for attempt at establishment of cell line in vitro. The medium used for the cell culture was MEM synthetic culture medium (Gibco Inc.) supplemented with 10% new borne bovine serum. Subcultures were performed on 5 to 6 days basis at 1:2 split by the use of 0.25% trypsin solution. The morphology of obtained cells was a spindle-like shape and the cell grew in a monolayered sheet with about 32 to 36 hr of population-doubling time. The modal chromosome number of this cell line was 44 including one large submetacentric and one minute marker chromosome. Cell lines were tested for tumorigenicity with an inoculum of five million cells in nude mice. This cell lines produced tumors with high rate. The tumor has been maintained in nude mice through serial passages over a period of one year. The temperature sensitivity and the colony stimulating factor-producing of this cells will be discussed.

[A case of thymolipoma on the cervicomediastinal area].

Thymolipoma is a very rare mediastinal tumor. We reported a case of 52-year-old female with thymolipoma which was located in the cervicomediastinal area. The chest X-ray film revealed an abnormal shadow in the superior mediastinum. Computed Tomography (CT) clearly showed the existence of a large mass in the left side of the trachea. The angiogram showed that there was a stenosis on the left brachiocephalic vein. On June 13, 1988, median sternotomy was performed. A large tumor, about 5.5 x 13 x 5.5 cm, was found arising from the left cervical area. This tumor was excised completely and thymolipoma was diagnosed histopathologically. The post-operative course was very satisfactory.

[Surgical treatment of bilateral spontaneous pneumothorax].

88 cases of bacterial spontaneous pneumothorax, 20 cases, occurred same time and 68 cases, occurred different time, were treated in our Department of Thoracic Surgery from 1975 to July 1987, and represented 16.6% of all cases of spontaneous pneumothorax. The characteristics of bilateral spontaneous pneumothorax, occurred same time, were as follows; 1) frequent in teens, 2) often occurred with history of unilateral spontaneous pneumothorax, 3) slightly collapsed. For the treatment of bilateral spontaneous pneumothorax, occurred same time, bilateral thoracotomy was necessary. The characteristics of bilateral spontaneous pneumothorax, occurred different time, were as follows; 1) frequent in the twenties, 2) often occurred the other side after unilateral thoracotomy within a year. For the treatment of bilateral spontaneous pneumothorax, occurred different time, if the patient is under 20 thoracotomy must be carried out, but if the patient is over 20 at the side of pneumothorax must be operated.