A new current dipole tracing method from EEG which is very useful in research of human brain activity in the space station.

The space station is available from 2004 for scientific research including human physiology and medicine. In that instance, non-invasive research of human brain in the microgravity condition was highly required. The present newly developed dipole tracing method fits this research purpose, by determining current source in the brain from EEG activity. EEG is also very helpful to monitor the conditions of subjects in various hazard cases. We strongly recommend to use this apparatus in the space station.

[Three cases of primary lung cancer unexpectedly discovered during the operation of pneumothorax].

It is well known that emphysematous bulla is thought to be often associated with lung cancer. However, it is very rare that lung cancer predisposing to pneumothorax as initial manifestation. We performed surgical operations of four hundred and one cases of spontaneous pneumothorax, and discovered three cases of lung cancer during the operation. However, these three cases occupied the 30% of the patients with pneumothorax who were older than 65 years. The two of them were adenocarcinomas which were situated in the wall of bullae, but did not perforated the bullous wall. The other one was squamous cell carcinoma which was apart from the bullous lesion. This shows that we should always be careful of the associated lung cancer when we care elderly patients with pneumothorax.

[A case of liposarcoma associated with chronic tuberculous empyema].

A case was 77-year-old male with left back pain who had received artificial pneumothorax therapy 40 years ago due to lung tuberculosis. He had a spindle shaped mass in his left chest wall which had connection to the chronic tuberculous cavity. Because malignant cell was not detected by biopsy, it was therapied as tuberculous abscess. Then the mass grew rapidly into 20 cm in diameter. Although surgical operation was carried out, it was impossible to remove it all. After the surgery, the pathological findings was liposarcoma. In spite of the radiotherapy, the patient died 4 months after the surgery. We should always keep in mind the early diagnosis of malignant tumor associated with chronic tuberculous empyema.

[A case report of relapsed esophageal cancer with tracheal stenosis treated with expandable metallic stent placement].

A 63-year-old male who suffered from relapsed esophageal cancer in the thoracic lymphonode causing severe tracheal stenosis, was treated by expandable metallic stent (EMS) placement. Dyspnea has disappeared immediately after EMS placement and the patient has been free from dyspnea until his death. EMS has been very effective for the therapy of tracheal stenosis by esophageal cancer.

[A case of bronchogenic cyst in the subdiaphragmatic region].

A 62-year-old male who had gallbladder stone was admitted because of an abnormality in abdominal CT. Abdominal CT revealed the mass lesion with smooth margin under the diaphragmatic area, whose density was higher than that of water. Both MRI T1-weighted and T2-weighted images showed a relatively high intensity. On ultrasonography, the lesion was consisted of a thin wall. On the basis of these imaging modalities, the diagnosis was considered to be cyst. The mass was resected via posterior extraperitoneal approach, and its histologic diagnosis was bronchogenic cyst containing turbid fluid. Subdiaphragmatic bronchogenic cyst is rarely reported. The characteristic findings of MRI and ultrasonography was useful for the diagnosis of a cyst with turbid contents.

[Nine cases of spontaneous hemopneumothorax with massive bleeding].

We experienced nine cases of spontaneous hemopneumothorax. All the patients were male and six of those had received emergent operations because of massive intrathoracic bleeding. In six of the nine cases we found the bleeding from the ruptured string like tissues between parietal pleura and the apex of the upper lobe. Those string like tissues contained vessels and were suspected to have ruptured when the lung collapsed. In other three cases the bleeding was controlled conservatively but operations were performed because of continuous air leakage and the bleeding were found from the bullous apical tissues of the lung adhered to the thoracic wall. Histopathologically those bullous tissues and string like tissues were revealed grannuromatous and chronic pleuritis rich in microvessels. Early thoracotomy for spontaneous hemopneumothorax was recommended in case of massive intrathoracic bleeding.

[Two cases of empyema treated with rectus abdominis myocutaneous flap and muscle flap].

A rectus abdominis myocutaneous flap (RAM flap) has often been useful in breast reconstructions after the surgical therapy for breast cancer, or in other plastic surgeries. However, there have been few reports concerning about its applications for intrathoracic diseases. In this paper, we report two cases of recurrent empyema treated with RAM flap and muscle flap from rectus abdominis. One case is 75-year-old male with right-empyema and bronchial fistula after the thoracoplasty due to lung tuberculosis. The bronchial fistula was successfully closed with muscle flap from the right rectus abdominis. The other is 33-year-old male with left empyema and cutaneous fistula after the hemothorax due to traffic accident. He contracted with MRSA in his thoracic cavity. We resected the fistula and reconstructed his left chest wall with left RAM flap. The muscle flap from rectus abdominis or RAM flap has been very effective for the therapy of bronchial fistula after lung tuberculosis, and for the reconstruction of chest wall.

Evaluation of biological characteristics of lung cancer by the human 28 kDa vitamin D-dependent calcium binding protein, calbindin-D28k.

We evaluated the biological characteristics of lung cancer by measuring their contents of human 28 kDa vitamin D-dependent calcium binding protein (calbindin-D). Calbindin-D concentrations were determined in tumor tissue and normal lung tissue extracts from patients with lung cancer by enzyme immunoassay. The percentage of high calbindin-D containing tissues in small cell lung cancer (SCLC) was significantly higher than that in non-small cell lung cancer (NSCLC) and the calbindin-D concentration was low in normal lung extracts. In addition, most of the NSCLC which had a significantly high level of calbindin-D were at the advanced cancer stage with lymph node metastasis. Calbindin-D concentrations were also determined in lung cancer cell lines. The percentage of high calbindin-D containing cell lines was high in classic type SCLC, followed in order by variant type SCLC and NSCLC. In addition, in order to examine the usefulness of calbindin-D as a marker of neuroendocrine properties of lung cancer, we compared the sensitivity and specificity of calbindin-D for distinguishing classic from variant type SCLC with neuron-specific enolase (NSE) and aromatic L-amino acid decarboxylase (AADC) by relative operating characteristic curves. The diagnostic accuracy of AADC was the highest of the three and that of calbindin-D was as high as that of NSE. These findings suggest calbindin-D to be related to the neuroendocrine properties of lung cancer.

Characteristics of the two newly established cell lines of human pulmonary adenocarcinoma and their sensitivity to anticancer agents.

Two adenocarcinoma cell lines were established from metastatic lymph node of lung cancer patients. The cell lines were named NUTLC-1 and NUTLC-3. They were found to have the following biological characterization and sensitivity to anticancer agents by comparison with clinical effect of the drugs on each donor patient: 1) By chromosomal analysis, the tumor cells of two cell lines were human-origin cells. Number of chromosomes of these cell lines ranged from 67 to 77 in NUTLC-1 cells and from 61 to 66 in NUTLC-3 cells, with the modal numbers of 73 and 64, respectively. 2) The tumor cells of the two cell lines were heterotransplanted subcutaneously into nude mice, but, no natural distant metastasis was observed 2 months after transplantation. 3) Sensitivity to anticancer agents on NUTLC-1 and NUTLC-3 cells differed individually according to methylthiazol tetrazorium (bromide) (MTT) colorimetric assay. NUTLC-1 cells were sensitive to Mitomycin C (MMC) and Adriamycin (ADM), and insensitive to Cisplatinum (CDDP), 5-Fluorouracil (5-FU) and Etoposide (VP-16). Antitumor effect of CDDP and 5-FU on recurrent tumor of donor patient was not observed clinically. NUTLC-3 cells were sensitive to CDDP, MMC and ADM, and insensitive to 5-FU and VP-16. Sensitivity to CDDP and MMC on NUTLC-3 cells also correlated to clinical effect of the drugs on the donor patient. From these results, it appears that these new cell lines are useful materials for studies on lung cancer.

[A case of intrathoracic dumb-bell ganglioneuroma and a surgical approach using spinal evoked potentials (SEP)].

A successfully treated case of a seven-year-old girl with a left intrathoracic Dumb-bell ganglioneuroma is reported. The tumor was 10 cm in diameter. Preoperative angiography revealed that the location of tumor was very close to the Adamkiewicz artery. In order to prevent the artery from damaging, spinal evoked potentials (SEP) was used during the surgery and was very useful for monitoring the spinal cord. Although SEP has often been employed in spine surgery, the literature on the use of it for posterior mediastinal tumor is scarce. It is considered that SEP is very useful for not damaging the feeding artery to the spinal cord, and for preventing the postoperative neurologic complications.

[A clinical study of transfer of cefminox and piperacillin into pulmonary tissue].

Serum concentrations of cefminox (CMNX) and piperacillin (PIPC) and their transfer into pulmonary tissue during surgery were serially studied following 1-hour intravenous instillation of 1 g of CMNX or PIPC immediately before thoracotomy, and the following results were obtained. Maximum serum concentrations of CMNX and PIPC were observed 1 hour after the commencement of administration, and their levels gradually decreased thereafter. The mean peak level of CMNX was 72.21 micrograms/ml, and T 1/2 was 1.62 hours. The mean peak level of PIPC was 43.26 micrograms/ml, and T 1/2 was 1.54 hours. In the pulmonary tissue, mean concentrations of CMNX in the normal pulmonary (alveolar) tissue were 28.80, 26.50 and 17.80 micrograms/g at 2.5, 3 and 4 hours, respectively, after the commencement of administration, and the corresponding levels for bronchiolar tissue were 19.6, 18.40 and 20.53 micrograms/g, respectively. The mean concentrations of PIPC in the normal pulmonary (alveolar) tissue were 18.97, 7.34 and 5.0 micrograms/g at 2, 3 and 4 hours, respectively, after the commencement of administration, and the corresponding levels for bronchiolar tissue were 7.2, 9.20 and less than 0.2 micrograms/g, respectively. PIPC also showed favorable transfer into the hilar lymph node tissue and obstructive pneumonitic lesions. The transfer of both drugs into pulmonary tissue suggests that both drugs are useful for the treatment of respiratory infectious diseases and the prevention of postoperative infections.

[An immunohistochemical study on three aldolase isozymes in human lung cancer].

We investigated three aldolase isozymes (aldolase A, B, and C) in human lung cancer by using an indirect peroxidase labeled antibody method. We used 27 tissue samples obtained at surgical operations which were fixed in periodate-lysine-4% paraformaldehyde (PLP) solution, and embedded in optimum cutting temperature (OCT) compound. They were 11 adenocarcinomas, 9 squamous cell carcinomas, 3 large cell carcinomas, 3 small cell carcinomas, and 1 adenosquamous carcinoma. Aldolase A and C expressed intensely positive stainings in the cytoplasm of cancer cells compared with normal lung tissues, and its positivities were 81% respectively. However, Aldolase B showed almost negative staining, and its positivities were only 41%. These rates had no relation to the histological types or pathological stages of lung cancers, and suggested that human lung cancer contained increased levels of aldolase A, and C.

Transfer of beta-lactam preparations created in Japan to lung tissue and the drug selection for chemotherapy of respiratory tract infections.

Intraoperative transfer of eight beta-lactam preparations to lung tissues was investigated by one-gram one-hour intravenous drip infusion immediately prior to operation. The Japanese drugs used were piperacillin, cefotiam, ceftizoxime, cefuzonam, latamoxef, flomoxef, cefotetan and cefbuperazone. The serum peak level was highest with cefotetan, 104.1 micrograms/ml, followed by cefbuperazone, latamoxef, ceftizoxime, cefotiam, piperacillin, flomoxef and cefuzonam, in decreasing order. Except for cefuzonam, there was a correlation between the serum peak level and the human serum protein binding rate (r = 0.89). There was a correlation (r = 0.98) between the Cmax of normal lung tissue (alveoli) level and the serum peak level (Cmax), but no correlation between the former and the human serum protein binding rate. The tumour level was lower than that in normal lung tissue (alveoli), but the tissue level at the obstructive pneumonia area was higher. The Cmax of bronchiolar tissue level was highest with cefuzonam, followed by latamoxef. There was no correlation between the Cmax of bronchiolar tissue level and the serum peak level, human serum protein binding rate or the Cmax of lung tissue (alveoli) level. It is therefore presumed that the drug level in tissue of the acute pneumonia area can be determined from the serum peak level of the respective drug. An appropriate drug for chemotherapy may be selected from beta-lactam preparations which are effective against main causative organisms in acute respiratory tract infections. Cefuzonam and latamoxef are especially useful for chemotherapy in patients with acute bronchiolitis.

[A case report of mediastinal paraganglioma and a review of the literature in Japan].

Paraganglioma is a tumor arising from the extra-adrenal paraganglion system and is rarely observed in the mediastinum. The authors experienced a case of nonfunctioning paraganglioma of the upper posterior mediastinum. The patient was a 40-year-old female in whom abnormal shadows were noted in chest X-ray films taken in March, 1989. She was examined at our hospital with a diagnosis of mediastinal tumor in June of the same year. CT of the chest revealed a tumor in the upper posterior mediastinum and it was shown to be hypervascular by a DSA study. Urinary hormone levels were normal. The tumor was resected in May, 1990. The tumor, measuring 6.8 X 4.0 X 3.5 cm, was encapsulated, appeared dark red and had relatively clear borders. A histopathologic diagnosis of paraganglioma was made. The patient remains disease-free at present, 6 months after operation. Problems concerning diagnosis and treatment of mediastinal paraganglioma were evaluated with a review of cases reported in Japan.

Immunochemical and immunohistochemical studies on three aldolase isozymes in human lung cancer.

The aldolase isozymes A, B, and C in tumor tissues (63) and sera (104) of patients with lung cancer were determined with an enzyme immunoassay system, compared with normal lung tissues (13), and the sera of normal healthy subjects (100). Tissue aldolase A and C concentrations were enhanced in 83% (52/63) and 51% (32/63) of patients with lung cancer, respectively, regardless of histologic type or stage (P less than 0.01). But aldolase B was not elevated in tissue levels. In the sera of patients with lung cancer, there were no significant elevations of the isozymes. Immunohistochemically aldolase A and C stained more intensely in the cytoplasm of lung cancer cells than those in normal tissues. These results indicate lung cancer cells contain enhanced tissue levels of aldolase A and C.

[A clinical study on pulmonary tissue uptake of flomoxef].

Based on the results of a study on pulmonary tissue uptake of flomoxef (FMOX), a new antibiotic agent, in 45 patients undergoing thoracotomy, the following conclusions were drawn: 1. Immediately preoperative 1 hour-drug infusion of 1 g FMOX led to maximum serum concentration (averaging 42.4 micrograms/ml) 1 hour later, with a half-life of its beta phase of 1.26 hours. 2. Normal lung (alveolar) tissue concentration was Cmax 17.98 micrograms/g with its ratios to serum peak value being 31.8, 27.1, 22.2, 9.4, 5.9 and 5.0% at 1, 2, 3, 4, 5 and 6 hours later, respectively. 3. Bronchiolar tissue concentration was Cmax 31.91 micrograms/g, with its ratios to serum peak value being 27.8, 19.3 and 10.1% at 2, 3 and 4 hours later, respectively, indicating its good bronchiolar intra-tissue transition. The above results suggested the usefulness of FMOX for both the treatment of respiratory infections and the prevention of postoperative infections.

[Surgical indications for small advanced lung cancer: especially from resected cases of peripheral non-small cell lung cancer less than 2 cm in diameter].

During the period from 1978 to 1987, 30 cases of peripheral non-small cell lung cancer with primary lesions less than 2 cm in diameter were resected at our hospital. Histopathologically, these cases consisted of 24 adenocarcinomas, 5 squamous cell carcinomas and one adenosquamous carcinoma. Twenty-one cases were in early stages (p-stage I) and 9 in advanced stages (6 p-stage IIIA, one p-stage IIIB and 2 p-stage IV). Serum levels of CEA in the advanced stages exceeded those in the early stages. However, clinically no cases of the advanced stages are being assessed preoperatively. Thus, for cases of small peripheral lung cancer less than 2 cm, the possibility of advanced stages should be considered and for the complete cure of lung cancer, mediastinal lymph nodes dissection with lobectomy and appropriate adjuvant chemotherapy should be conducted.

[Management of acute empyema with leakage of bronchial anastomosis after right sleeve upper lobectomy--a case report].

Bronchopleural fistula developing empyema after pulmonary resection is a fatal complication. But we have successfully treated this complication after right sleeve upper lobectomy. The patient was a 61-year-old male, who has a squamous cell carcinoma originating in the right upper lobe of the lung in the clinical stage of IIIa. Right sleeve upper lobectomy with pericardiotomy to reduce the tension of bronchial anastomosis and R2a lymph node dissection. The leakage of bronchial anastomosis was complicated on 5th postoperative day and developed aspiration pneumonia of right middle and lower lobe and empyema. Reoperation was done on 7POD and completion pneumonectomy, omentopexy and open window thoracotomy were performed. Then endotracheal tube had been inserted into the left main bronchus and he controlled under respirator. Six weeks after that fistula was cured. Empyema, which caused by methicillin resistant staphylococcus aureus, was cured by open drainage for 2 weeks and closed drainage and irrigation for 14 weeks. He discharged 16 weeks after reoperation.

[The alpha subunits of the GTP-binding proteins, Go and Gi2 in lung cancer].

The alpha subunits of the GTP-binding proteins, Go and Gi2, in sera, tissues, and pleural effusions have been studied, using an enzyme immunoassays system. The Gi alpha concentrations were found increased in the pleural effusions of patients with a small cell lung cancer, as compared to patients with a nonsmall cell lung cancer. Both GTP-binding proteins, however, were not elevated in the sera of patients with a lung cancer. Thus, an evaluation of the amount of Go alpha in the pleural effusion is thought to be a useful tumor marker of small cell lung cancers, elevating the specificity of a combination assay with other markers, NSE or CKBB.

[Two resected cases of pulmonary aspergilloma in acute leukemia].

Remission rate of leukemia has been improved by development of recent antileukemic chemotherapy. But opportunistic infection in secondary immunodeficiency has increased. Especially pulmonary mycoses often occurs and its prognosis is poor. But if patient with leukemia complicates pulmonary mycoses, it should be cured as soon as possible and antileukemic chemotherapy should be continued. We successfully performed surgical treatment for 2 pulmonary aspergillosis, which were complicated in stage of remission induction of acute leukemia.