[Mature teratoma in the posterior mediastinum showing the fatty density on the chest computed tomography].

We reported a case of posterior mediastinal mature teratoma. A 16-year-old woman was referred for further investigation of a left paravertebral mass detected on chest roentgenogram. The defined mass was located above the diaphragm and showed homogeneous fat density on computed tomography (CT) and hypersignal intensity on both T1 weighted images and T2 weighted images on magnetic resonance imaging (MRI). Radiologically, there was a mimicking foci of calcification. The mass was histologically diagnosed as mature teratoma.

[Postoperative penicillin-resistant streptococcus pneumonia in lung cancer patient].

A 78-year-old man underwent a left lower sleeve lobectomy and lymph node dissection for lung cancer. His postoperative course had been uneventful until postoperative day (POD) 3, but severe dyspnea occurred suddenly and the chest X-p showed infiltration shadow on POD 3. Streptococcus pneumonia antigen in the urine was elevated, suggesting pneumonia caused by Streptococcus pneumonia. The patient was treated with double dose of imipenem/cilastatin sodium and supported with a mechanical ventilator in an intensive care unit. Although the patient recovered from penicillin resistant Streptococcus pneumonia, he was suffered from Klebsiella sepsis and expired on the POD 26.

[Video-assisted thoracoscopic surgery for ligation of anomalous systemic arterial supply to pulmonary sequestration].

A 52-year old female with anomalous systemic arterial supply to pulmonary sequestration was reported. The patient was admitted because of an abnormal lung shadow on chest X-ray film. Computed tomography (CT) showed an anomalous systemic arterial supply to pulmonary sequestration of the left lower lung without lung infection. Video-assisted thoracoscopic surgery for ligation of the anomalous systemic artery was performed. Postoperative course has been uneventful for 14 months after surgery. Blood supply increased to the left lower lung by 3-dimensional CT after surgery. The ligation of anomalous systemic arterial is enough for this disease.

[Mediastinal recurrence of breast cancer suspecting mediastinal fibrosis].

A 63-year-old female, who had undergone a modified radical mastectomy for breast cancer at the age of 45, was suffered from trachyphonia due to left recurrent nerve paralysis at the age of 53. She presented left phrenic nerve paralysis and dysphagia at the age of 61. Computed tomography (CT) revealed mediastinal fibrosis, stenosis of esophagus and superior vena cava, and slight lymph nodes swelling. Video-assisted thoracoscopic mediastinal biopsy was performed and the mediastinal fibrosis was diagnosed as recurrence of breast cancer 17 years after the breast cancer operation. She underwent mediastinal radiation and chemotherapy for mediastinal recurrence and stenting for esophageal stenosis.

Five cases of asymptomatic spontaneous pneumothorax.

Asymptomatic spontaneous pneumothorax (ASPT) is an uncommon condition. Between January 1, 1989 and December 31, 1997, 269 patients were admitted to our department with spontaneous pneumothorax. Of the 269 patients, 5 had no symptoms at the time of discovery. Their ages ranged from 15 to 61 years (mean, 37.8 years), and all of them were male. Of the 5 patients with no complaints, 2 had bilateral metachronous pneumothoraces and 3 had hemilateral pneumothorax. All of these ASPTs were revealed by chest roentgenographs taken during medical examinations or follow-up studies relating to other diseases. The mean value of body mass index (BMI) was 19.96 +/- 1.4 (range 18.7 - 22.1). Two of the 5 patients underwent bilateral partial lung resection. Histopathological examination of the resected specimens showed elastofibrosis, scar formation, and an interruption of the elastic fiber of the pleura. In these 5 cases, clinical courses were uneventful, and relapse of the pneumothorax did not occur. Clinical physicians should be aware of the possibility of asymptomatic pneumothorax, as well as the optimal radiographic techniques for revealing small pneumothoraces.

[Surgical problem of lung cancer with coexisting acute pulmonary tuberculosis].

Four patients with coexistent lung cancer and acute pulmonary tuberculosis were operated during recent 5 years. All were males and cigarette smokers (B.I. > 600). Adenocarcinoma were recovered from 3 patients, while the remaining 1 had squamous cell carcinoma. Only 1 curative resection was performed for lung cancer. In most cases, late stage of the disease was alleged to be a factor contributing to the poor prognosis.

[Asymptomatic bilateral spontaneous pneumothorax].

Two surgical cases of bilateral pneumothorax founded at a medical examination were reported. Case 1; A 15-year-old male was admitted to our hospital pointed out left spontaneous pneumothorax without complaints. The interval between the first and the contralateral pneumothorax was 3 weeks. He was treated with a one-stage operation through a bilateral axillary incision. Case 2; A 19-year-old male was admitted to our hospital pointed out left spontaneous pneumothorax without complaints. Surgical operation was performed with a left axillary incision. One year after the treatment, he was pointed out right spontaneous pneumothorax on his chest X-ray film. Partial resection of the right lung was performed with a right axillary incision. Of the 261 pneumothorax patients, 28 had bilateral pneumothorax in our hospital. The majority of these patients had complaints which were chest pain, dyspnea and cough. Of the 28 patients, 2 had no complaints at the time of admission. We conclude that we have to follow up carefully the patients with hemilateral spontaneous pneumothorax.

[Lung resection affects the postoperative arrhythmia and electrocardiographic axis deviation].

After lung lobectomy or pneumonectomy, the mediastinal shift and diaphragmatic elevation are occurred. Because this phenomenon may affect the heart positional change, we studied the electrocardiographic QRS axis in the frontal plane (from leads I and III) and the postoperative arrhythmia. Seventy three patients who had no heart disease including arrhythmia before the surgery were recorded their electrocardiogram (ECG) before their surgery and after their discharge. When the postoperative ECG was recorded, they had no respiratory failure nor cancer recurrence, and their lungs were fully expanded in their thoracic cages. After right upper lobectomy (19 cases), the axis was twisted rightward slightly (2.1 degrees). Right middle lobectomy (2 cases, 9.5 degrees) and right upper and middle lobectomies (3 cases, 7.3 degrees) twisted the heart axes more rightwards. Right lower lobectomy (12 cases, -1.0 degree) and right middle and lower lobectomies (3 cases, -17.7 degrees) contorted their axes leftwards and right pneumonectomy (5 cases, 31.4 degrees) rightwards. The axes were turned rightwards after the left upper lobectomy (18 cases, 2.8 degrees) and the left lower lobectomy (7 cases, 3.9 degrees). Left pneumonectomy (4 cases, -4.0 degrees) twisted the axis leftwards. After the surgery, arrhythmias were recorded in 14 cases and, among these patients, 5 cases were required the oral anti-arrhythmic medication. Most of these cases changed their heart axes after the surgery and it is suggested that the axial deviation may contribute to their postoperative arrhythmia.

[Aortitis syndrome associated with aortic regurgitation and coronary ostial stenosis: a case of successful surgical treatment at the active stage].

A 24-year-old woman with aortic regurgitation and ostial stenosis of coronary artery due to aortitis syndrome was reported. She was admitted to the hospital with anterior chest pain. Retrograde aortogram showed aortic regurgitation and selective coronary angiogram revealed severe ostial stenosis. In spite of steroid therapy, chest pain was not controlled. In spite of the active stage, she underwent aorto-coronary bypass and aortic valve replacement. Intra-aortic balloon pumping (IABP) was necessary to wean from cardio-pulmonary bypass, but she recovered well and no complication was recognized after operation.

[A surgically treated case of capsulated thymoma with thymic cyst].

A 56-year-old woman was pointed out an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid mass with a cyst at right anterior mediastinum. Clinical diagnosis was thymoma with cyst, and surgical excision was performed. The histopathological examination of the resected specimen demonstrated that the epithelia of the cyst wall was single cuboidal or squamous cells and contained some foci of thymic tissue. The solid mass was capsulated and predominantly composed of lymphocytes. The pathological diagnosis was a thymoma (predominantly lymphocytic type) with thymic cyst. She is doing well for 10 years postoperatively.

[Surgically treated infectious giant bulla].

A 32-year-old man who underwent evaluation for dyspnea and left chest pain proved to have a left pneumothorax and a right giant bulla. After surgery for the left pneumothorax, drug induced liver injury was observed. Seventeen days after surgery, left giant bulla was infected and niveau formation was seen with high fever. After administration of antibiotics, the niveau was disappeared and the body temperature was down, however, drug induced liver injury was caused. After that, again, the niveau formation was noticed in the right bulla. We speculated that adequate drug therapy could not used because of liver injury if the right bulla would be infected one more time. Bullectomy of the right lung was performed. One year after surgery, there were no signs of infection. We usually administer the adequate antibiotics against the infectious giant bulla without surgical therapy because the bulla will be reduced with the infection. However, there is a situation like this case that surgical treatment is required because of the drug induced liver injury.

[A case of esophageal duplication cyst associated with a total left pericardial defect].

Esophageal duplication cyst associated with pericardial defect in a 57-year-old man is reported. Differential diagnosis was very difficult in the preoperative examination. The tumor was a cyst and its wall was a perfect replica of normal esophagus e.g. esophageal duplication, and total left pericardial defect also was found at the operation. There was no malignant or inflammation findings in the excised specimens. The association of esophageal duplication cyst associated with pericardial defect is very rare.

[Evaluation of treatment of lung cancer combined with the disease which has needed a semi-emergency operation].

Six cases of lung cancer combined with the disease which has needed semi-emergency operation, two cases of unstable angina, two of ileus due to colon cancer, one of impending rupture of abdominal aortic aneurysm and one of purulent cholecystitis with cholelithiasis, were discussed. Mean age was 62.0 years (range, 36 to 73); four were male and two were female. Case 1 and 2 were admitted with anterior chest pain, Case 3 with lumbago and abdominal pain, Case 4 and 5 with an abnormal shadow on chest x-ray film and Case 6 with abdominal pain. Of the two with unstable angina, one was operated on with right upper lobectomy during the first months after aorto-coronary bypass. Of the two with colon cancer, one was operated on with right upper lobectomy during about 5 weeks after right hemi-colectomy. Case 3 with abdominal aortic aneurysm operated on with left upper lobectomy during 4 weeks after replacement of abdominal aorta. Case 4 with cholecystitis was operated on with left pneumonectomy during about 3 weeks after cholecystectomy. The postoperative course of 4 cases and the post-chemotherapy condition of 2 cases were uneventful.

[Surgically excised primary mediastinal tumors and cysts: a report of 43 cases].

Forty-three primary mediastinal tumors or cysts were surgically treated in 41 patients during a 10-year period. These tumors consisted of 20 thymic tumors, 10 neurogenic tumors, 5 teratomas, 3 lymphoid tumors, 2 congenital cysts, 2 mediastinal thyroid tumors, and 1 chondroma. There were 16 male and 25 female patients. The mean age was 44 years with a range of 6 to 79 years. Sixteen patients (39%) were symptomatic. There were 20 thymic tumors including 13 thymomas, 5 thymic cysts, and 2 hyperplasia with myastenia. Additional radiation therapy was recommended for all but stage I thymomas. Only 1 of the 10 neurogenic tumors was malignant. Eight teratomas were all cystic and matured. Early operative intervention is mandatory in these cases.

[Leiomyoma of the esophagus shown as a cervical tumor].

A 44-year-old female was admitted to our hospital because of the left cervical tumor. Radiologic examination showed that the tumor was 5 cm in diameter and was inhomogeneous. The tumor was spread to the upper mediastinum. Esophagoscopy showed that the tumor was covered by the normal mucosa. Percutaneous fine needle biopsy did not appear the histopathological diagnosis. The patient underwent surgical resection through the cervical approach and the tumor was located between the mucosal and muscular layers of the esophagus. The tumor was enucleated without any complication. Histopathological diagnosis was leiomyoma. Postoperative course was uneventful. Expecting diagnosis and positive complete resection is recommended for leiomyoma of the esophagus.

[A case of mediastinal malignant lymphoma; 16 years follow up after surgery].

A 32-year-old female was admitted to our hospital on September 1976 because of left mediastinal mass shadows on chest roentgenogram. Needle biopsy studies provided no definitive diagnosis, and exploratory operation was carried out through left postero-lateral thoracotomy. Two large masses were seen in the mediastinum and five small tumors were seen on the diaphragm. All of these masses were removed. Histopathological examination of the tumors indicated non-Hodgkin's lymphoma, diffuse small cell type. Radiation therapy was carried out postoperatively, but chemotherapy could not continue because of side effect. Eight years after surgical therapy, recurrence was seen at left parietal pleura, ten years at peritoneum, twelve years at left parietal pleura, thirteen years at upper mediastinal lymph node, 16 years at post-peritoneal space. These tumors disappeared after radiation therapy. She is doing well seventeen years after the surgery.

Graded-index plastic optical fiber composed of methyl methacrylate and vinyl phenylacetate copolymers.

Graded-index plastic optical fiber whose transmission attenuation is 143 dB/km at 651-nm wavelength was fabricated by heat-drawing the corresponding GI preform rod. This rod is prepared by the interfacial-gel copolymerization technique of methyl methacrylate (MMA) and vinyl phenylacetate (VPAc). The total scattering loss of the GI preform rod is ~60 dB/km at 633 nm. The graded-index profiles of the optical fibers are almost the same as those of the corresponding preforms with cladding sheaths. The index distributions of their core regions are quadratic against the distance from the center axis. The numerical aperture estimated from the index difference is ~0.20.

[A surgically treated case with lung cancer on maintenance hemodialysis].

Maintenance hemodialysis for chronic renal failure has spread all over the country, and the number of patients in whom surgical indications are considered to concomitant diseases has been increasing. A 76-year-old male was admitted due to lung cancer on maintenance hemodialysis. The chest roentgenogram showed a 2.5 cm sized coin lesion in the right middle lung field. Preoperative examinations, chest tomography, chest CT-scanning, bone scintigraphy, bronchofiberscopic biopsy, etc. led to a diagnosis of primary lung cancer (squamous cell carcinoma). Hemodialysis with prescribing nafamostat mesilate (40 mg/hour) was performed the day before the operation and on the first, fourth and sixth postoperative days. There was no postoperative bleeding. The patient has been well for 27 months postoperatively.

Growth inhibitory factor of human alveolar macrophage.

The effect of human lung conditioned medium (HLCM) on the DNA synthesis in cultured human alveolar macrophages (HAM) was evaluated. The medium from human lung cultured for 3 days (3d-HLCM) promoted the DNA synthesis as well as the recombinant human GM-CSF does. On the other hand, that cultured for six days (6d-HLCM) did not promote the DNA synthesis but strongly suppressed GM-CSF induced DNA synthesis in HAM. This growth inhibitory effect was also observed when several macrophage like cell lines were cultured with 6d-HLCM. Partial purification of an inhibitory factor on gel permeation HPLC revealed two distinct peaks of activity with molecular weights of 38 kd and 110 kd.

[Surgical treatment of tuberculous abscess in chest wall].

A case of chest wall tuberculosis with empyema is reported. A 45-year-old woman with a history of right lung pleuritis was admitted to our hospital with right shoulder pain. The chest X-ray film showed abnormal shadow in the right lower lung field. Chest CT revealed right posterior chest wall abscess and localized empyema. Bacterial examination of the chest wall abscess obtained by needle aspiration biopsy disclosed positive acid-fast bacilli. Three months after starting antituberculous therapy with INH, RFP and SM, the chest wall abscess had been increased and abscess drainage was performed. After two months of tube drainage, the abscess was diminished in size and enucleation with primary closure was performed. Antituberculous chemotherapy was continued. One year after surgery, no sign of recurrence was observed and the residual empyema was decreased.