Transthoracic Needle Biopsy for Lung Cancer

In the diagnosis of lung cancer, some lesions defy our routinemethods of sputum cytology and transbronchial lung biopsy, orcytology by using the bronchofiberscope; or under some circumstances,neither cytology nor histology by means of the bronchofiberscopecan possibly be applied. To obtain a definite diagnosis of suchcases the biopsy needle, 0.4 mm in diameter and 125 mm in length,has been developed. Since September 1969, transthoracic needlebiopsy has been performed on 276 thoracic lesions, consistingof 86 of lung cancer, 71 of metastatic lung tumors, 10 of malignantmediastinal tumors, and 109 of benign lesions, resulting ina positive diagnosis for all of the 86 lesions of lung cancer,of which 74 (86.0%) were of the peripheral type, and nine wereless than 2 cm. The complications following biopsy were 29 instancesof bloody sputum (10.5%) and 25 of pneumothorax (9.1%). Thoracicdrainage was used for eight patients but no tumor implantationwas observed, nor did any of the complications prove serious.From these results it is considered that transthoracic needlebiopsy, with its high degree of diagnostic accuracy, painlessnessand safety to the patient, simplicity and low cost may be ofgreat value in the diagnosis of lung cancer, especially of theperipheral type.     

Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer

The presence of perinodal cancer invasion in specimens obtainedfrom the mediastinum during curative surgery on 49 patientswith metastasis-bearing mediastinal nodes was determined andevaluated with special reference to its prognostic significance. When an en-bloc dissection technique for the mediastinal lymphnodes and fatty tissue surrounding the nodes during surgerywas used, lymphatic vessel invasion in fatty tissue other thana breach in the capsule of a lymph node by cancer could be seen.A breach in the node capsule and lymphatic vessel invasion aredesignated as "extranodal invasion" in this paper. A breach in the capsule was seen in 16 cases, lymphatic vesselinvasion in 12 and both a breach in the capsule and lymphaticvessel invasion in 4. In 17 cases there was only intranodalcancer metastasis. The 5-yr survival rate was 37.5% and 17.7%for patients with and without extranodal invasion, respectively.However, extranodal invasion did not seem to be a distinctiveprognostic factor.     

Testicular tumor in Down syndrome

A 33-year-old male patient with Down syndrome, who stayed in a welfare institution, visited our hospital due to left testicular enlargement. He was diagnosed as having a left testicular tumor and underwent radical inguinal orchiectomy. Preoperatively, serum level of beta-human chorionic gonadotrophin (beta-HCG) increased to 0.9 ng/mL (normal range <0.2 ng/mL). For the last 2 years after orchiectomy, the serum level of beta-HCG remained normal. Histopathological examination of specimen revealed a typical seminoma. It is currently thought that risk of developing leukemia in patients with Down syndrome is 20- to 30-fold higher than that in normal subjects. Furthermore, the incidence of testicular cancer as a complication other than leukemia is expected to increase because of the increasing postpubertal population with Down syndrome.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.     

A Case of Colon Cancer Metastasizing to the Spleen

A case of colon cancer metastasizing to the spleen is reported.The patient was a 43-year-old man who was laparotomized underthe diagnosis of colon cancer. The tumor of the transverse colonshowed a small ulcer and polypoid projections. Poorly differentiatedadenocarcinoma was noted in the mucosa. Marked tumor metastasiswas found in the parenchyma of the spleen and the peripancreatic,portohepatic, mesenteric and periaortic lymph nodes. The literatureon the incidence and mechanism of metastasis to the spleen wasreviewed, and mtastasis to the spleen was found to be not infrequentat a late or advanced stage of cancer.     

BCG Immunotherapy as an Adjuvant to Surgery in Lung Cancer: A Randomized Prospective Clinical Trial

A protocol was drawn up and a prospective randomized study wascarried out to test the effectiveness of BCG on lung cancer.BCG obtained from the Japan BCG Institute was used. A dose of5.4 mg or 2–4 x 10⁸ viable organisms was administeredinto the arm by the tine technique. Administration of BCG wascarried out once before surgery and four times after surgery.Surgery consisted basically of radical lobectomy or pneumonectomywith complete mediastinal lymphadenectomy. The survival rate in the BCG administered group was significantly(P < 0.05) more than in the control group. Further, whenonly the cases that were treated strictly in accordance withthe protocol were taken into consideration, the effectivenessof BCG was even more significant (P < 0.02). The period ofobservation of these cases was from a minimum of 10 months toa maximum of 28 months. On the basis of these results, it can be said that BCG is beneficialin the treatment of lung cancer.     

医学生环境意识的调查分析

目的 了解医学生的环境意识现状,提出相应教育对策.方法 采用非概率抽样方法,对161例医学生关于环境问题的认识、态度和行为进行了调查和分析.结果 被调查者对环境问题较为关心;广播电视是其获得环境知识的最主要途径;医学生采取的环境保护措施主要为不乱扔垃圾和节约能源.结论 医学生对环境问题比较关心,但获得环境保护知识途径有限,自觉参与行动的意识和能力不足,提出相应对策.     

A Clinico-Pathological Study of Surgical Treatment for Small Cell Carcinoma of the Lung

Thirty-seven patients with histologically confirmed small cellcarcinoma (SCLC), who underwent surgical resection at the NationalCancer Center Hospital between 1963 and 1983, were reviewed.They were divided into two groups, 25 patients who were operatedon between 1963 to 1979 and 12 who were operated on between1980 and 1983. When these two groups were compared, a significantdifference in 5-year survival was found (8% vs 50%). An accumulationof various factors including adjuvant chemotherapy was consideredto contribute to the improvement in survival. After carefullyanalyzing these factors, we have come to the conclusion thatadjuvant chemotherapy was the most important factor among them.An additional six patients with SCLC, who were operated on in1984 and 1985, were also studied. They were either those whowere given an adequate dose of combination chemotherapy beforesurgical resection or those whose local carcinoma which recurredafter complete response was achieved by chemotherapy and/orchest radiation was surgically removed. In two cases, a tumor-likemass which was clearly visible on X-ray film- and in the surgeon'shand at the time of thoracotomy revealed a histo pathological"cure." In another two cases, tissue diagnosis of SCLC whichwas obtained without thoracotomy before chemotherapy and/orradiation was started was reported as NSCLC after the resectedspecimen was histo-pathologically examined. In both of them,the cancer tissue was made up of NSCLC of small cell type. Adiscrepancy between clinical TNM after treatment and pathologicalTNM was noted in two cases. Microinvasion and micrometastases,which were the reasons for the discrepancy, are considered tobe a core of eventual recur rence following induction of completeresponse.     

Mental health of visually and hearing impaired students from the viewpoint of the University Personality Inventory

Tsukuba College of Technology is the first national university established as an institute of higher education for the visually and hearing impaired. We have been systematically conducting a University Personality Inventory (UPI) survey on our students since 1989 to understand their mental health. In this study, we compared the UPI scores of the new students of Tsukuba College of Technology in 1993 and 1994 with unimpaired students from the University of Tsukuba (control group), but found no significant difference in the UPI scores of the visually impaired and the control group. However, we noticed a significant difference in the average UPI scores between the hearing impaired and the control group. The visually impaired group were divided into four subgroups, UPI scores descended in order from degree 1 (total blindness), to degrees 2 and 3 (amblyopia), to degree 4 (visual acuity 0.3). The UPI scores of the degree 4 subgroup were significantly lower than those of the control group. An investigation of the items for which the check rate was at least 50% showed that the visually impaired students had a variety of psychological problems, most of which seemed to concern depression or anxiety as did the normal control group. The number of affirmative responses increased with low visual acuity. The only one belonging to the `lie' scale item was observed in the group of hearing impaired students. Thus, comparing these three groups from the viewpoint of mental health, we noticed the hearing impaired group was slightly different from the other two groups, but the visually impaired group was similar to the normal control group.