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disorder was estimated prospectively and correlated with muscle histology and with

lung tumour type in one hundred patients prior to treatment. Enzyme histochemistry was performed on fresh frozen muscle tis- sue obtained from the vastus lateralis under local anaesthetic by needle biopsy.

35 patients had small cell (SCLC) and 65 non-small cell (NSCLC) tumours. Clini- cally 33 patients were myopathic: 18 of these were "cachectic" and 15 "proximal". In the NSCLC group a significantly higher proportion were cachectic (p < 0.05) and in the SCLC group a significantly higher proportion had proximal myopathy (p < 0.05).

99 patients had abnormal muscle histology, 66 were not myopathic clinically. 74 had type II fibre atrophy, 12 had type I and II fibre atrophy, 12 had muscle necrosis, and one had type I atrophy. These histo- chemical findings are at variance with the previous clinico-pathological classifi- cation indicating that the true incidence of neuromuscular disorders in lung carci- noma is very high and cannot be assessed on clinical criteria alone.

The Determination of Hyaluronic Acid in Pleural Fluids by a Simple HPLC Procedure. Hjerpe, A. Department of Pathology II, Ka- rolinska Institute, F42, Huddinge Univer- sity Hospital, S-141 86 Huddinge, Sweden.

To enhance the diagnosis of mesotheli- oma, a simple and sensitive HPLC procedure was optimized for the study of hyaluronic acid (HA) in pleural fluids. Twenty~l of a cell free supernatant was precipitated with 4 volumes of ethanol also containing sodium acatate. Following chondroitinase digestion more than 90% of the HA could be recovered as ~-disaccharides in the subsequent HPLC analysis, the HA derived

-disaccharides showing baseline separa- tion from those chondroitin derived.

This determination was performed on a consecutive material consisting of pleural fluids from 6 patients (20 samples) with known pleural mesothelioma and from 104 patients (154 samples) where this diagno- sis has not yet been established. Among these latter patients slightly increased HA concentrations could be associated with tissue destruction, but the HA derived uronic acid only rarely exceeded 30 ug/ml here. In 4 out of the 6 patients with meso- thelioma the HA concentration was conside- rably higher, the maximum values exceeding 800 ~g/ml. No further information was ob- tained by expressing the HA content as a proportion of the total glycosaminoglycan content.

The determination may therefore be of great help to establish this diagnosis, even though not all mesotheliomas seem to

produce HA. The method is so simple that

it may well be routin®usly used together with a cytological examination of sediment. The num- ber of cases detected during the observation

period is higher than expected, which may in- dicate that mesotheliomas often are misconcie- ved.

Natural Course of Untreated Lung Cancer at Stage I ~n Elderies. _ Mizukami-, Y., Kimula 2, y., Murai 3, y. 1. Re-

spiratory division, Toyama City Hospital, Toy- ama, Japan. 2. Pathology, University of Tsukuba, Ibaraki, Japan. 3. Respiratory division, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.

Natural course of lung cancer without anti- cancer treatment as surgery, radiotherapy and chemotherapy was studied in 34 autopsied el- deries, consisted with 21 adenocarcinoma, I0 epidermoid, 2 small cell and a large cell car- cinoma. The mean age was 80(70-97 y.o). All the cases were found out at stage I and follow- ed up only with general care for infection, nu- tritional state and diseases except for cancer.

Mean survival is 39 months and survival rate on a year, 2,3,4,5 years are 77,65,53,35,24% respectively. Mean survivals in T1 and T2 ca- ses are 48 and 39 months. Mean survivals in adeno- and epidermoid carcinoma are 45 and 34 months. Tumor doubling time was measured in 25 cases and over 200 days were 16 cases (64%). The growth rate correlates with survival period significantly. 19 (56%) cases died of cancer dissemination (cancer death), and 15(44%) cases died of complications. 6 (75%) of 8 five-year- survivors died of cancer since 7(88%) of 8 ca- ses died within a year with complications.

It is concluded that the considerable long survival of the lung cancer in the elderly is obtained even without anticancer therapy. Ca- ses of adenocarcinoma, of long doubling time and small size survive long. Successful general care is the most important factor for long survive.

Correlation of CTwith Fiberoptic Bronchosc0pic Findings Concerning Intrathoracic Lymph Node Metastasis from Lung Cancer. Matsushima, Y., Chung, FM, Takakura, H., Nahai, K., Amemiya, R., Oho, K., Hayata, Y., Hwang, LM. Department of Surgery, Tokyo Medical Colle- ge, Tokyo, Japan.

The role of CT in evaluation of intratho- racic lymph node metastasis in patients with lung cancer has been reported in the literature. However, a correlation of CT-detectable lymph node (LN) with fiberoptic bronchoscopic findings mainly external compression has not yet been reported. For this respect, we studied retro- spectively 70 resected lung cancer cases.

(Material and Method) from March 1983 to December 1984, 70 resected lung cancer cases in which CT scan had been done with a 2-second scanner GE9800 with contiguous 1 cm slices were studied. In all patients bronahofibersco-

py with an Olympus B6C was also performed. The

76

nomenclature of the intrathoracic LN is based on the nomenclature of the Japanese

Joint Committee. (Results) Among these pa- tients LN were detected on CT films of 33 cases (sq. cell ca. 14, adenoca. 15, large cell ca. l, small cell ca. 2, adeno- ca. mixed with sq. cell ca. l) Endoscopi- cally external compression sign from nodes number 1 to 6. was not recognized unless they were swollen more than 5 cm in dia- meter. 80% of subcarinal nodes which indu- ced external compression as widening of carina were over 3 cm in diameter. 80% of nodes number i0 or ii which induced external compression or widening of the bifurcation were over 1.6 cm in diameter.

Comparison Among Stage, I l istology and Surgery in a Lung Cancer Selected Group. Fiacchi, M., Bini, A., Di Gaetano, P., Artuso, S., Sette, P. Chirurgia Toracica Universita di Bologna, Italia.

Clinical, pathological, surgical in- formation and follow-up data on 263 lung cancer patients surgically treated in the Thoracic Surgery Unit of Bologna Univer- sity from 1979 to 1984, are collected in a computer library. We have so evaluated relations among histology, tumor seat, stage (according to the A.J.C. Staging System), therapy and survival. The tumors include 152 squamous carcinomas (58%), 58 adenocarcinomas (22%), 8 bronchioloalve- olar adenocarcinoma (2%), 23 large cell un- differentiated carcinomas (9%), 23 oat cell undifferentiated carcinomas (9L). There have been 179 patients (68%) resec- ted, with lobeetomy 88(49%), with pneumo- nectomy 59 (33%), with intrapericardial pneumonectomy 12 (7%), with sleeve-resec- tion 9 (5%) (sleeve-lobectomies 5 and sleeve-pneumonectomies 4), with segmental resection 5 (3%); in 6 patients (3%) we have also reseeted a share of chest wall. In 84 patients (32%), the thoracotomy was only explorative. About survival of the resected patients, a bad prognostic signi- ficance have the presence of lymph node metastases (N=I/2), more than the tumor size. When lymph node metastases are absent (N=0), the 5 year probability of survival is egual in all the histologic types of lung cancer except, of course, oat cell undifferentiated carcinoma.

An Automated Decision Support System for Diagnosis and Treatment of S o l i t a w Pulmo- nary Nodules. Kunstaetter, R., Kreisman, H., Cohen, C., Frank, H., Wolkove, N. The Sir Mortimer B. Davis Jewish General Hospital & McGill University, Montreal, Canada.

Despite recent diagnostic and therapeu- tic advances, management of patients (pts)

with ~clih~ty pulmonary nodules remains

a difficult problem. Particularly in older pts and those with underlying cardiorespiratory

disease, the risks of intervention may equal or exceed its benefits. Often, the physician must empirically choose between surgery, transtho- racic needle biopsy, and expectant management, without access to quentitative outcome data or the formal techniques to apply such data to an individual pt.

We have developed a Bayesian decision-ana- lytic model for pts with a solitary pulmonary nodule. The model incorporates age, sex, smok- ing history and multiple indices of cardiore- spiratory status. The programs form a decision support system which may be used to derive the probability ( .:';,'; "~" ','I a~.,lignan, , '~,.,

i ,~ks of biopsy and surgery, the ~uns±tlvity and specificity of biopsy, the probability of a nodule being resectable (if malignant), and the morbidity-adjusted life expectancy of a given pt for each management option. The model allows the physician using the program to sub-

stitute his own predicted values (probability of malignancy etc) for the particular pt(s) being evaluated. By using the technique of sensitivity analysis, he may determine whether this new value changes the choice of procedure (surgery vs biopsy vs expectant management) in a particular pt.

These results may be of assistance in mana- ging pts with solitary pulmonary nodules and provide a better understanding of the factors involved in this clinical decision making pro- cess.

Simple and Safe Procedure To Control of Ma- l i ~ m n t Per icardia l EfFusion in l,ung Cancer Pa t i en t s ; Tube Drainage Through Stmmal Burr H o l e .

Mitsui, K., Akaogi, g., gndo, K., Sohara, Y., Murayama, F., Onizuka, M., Nakagawa, H., Suzu-

ki, Y., Maeta, H., Hori, M. Department of Sur- gery, Institute of Clinical Medicine, Universi- ty of Tsukuba, Ibaraki, Japan.

Cardiac tamponade caused with massive malig- nant pericardial effusion is one of serious and hazardous complications in lung cancer pts. We

deviced a simple and safe procedure for mana- ge this condition with tube drainage through small sternal burr hole by a trephine under local anesthesia.

We have treated 28 lung caneer pts with car.- diac tamponade by this method. The most valu- able method for diagnosis was UCG. The histo- logical types were 16 adenocarcinomas, 4 squa-

mous cell carcinomas, 5 small cell carcinomas and 3 large cell carcinomas. The perieardial effusion was dark bloody in 18 pts and cyto- logically positive in 20 pts, to whom cytotox- ic drug was infused into the pericardial cavi- ty for 3 to 5 days. Cytological positive to ne- gative change occurred in 5 of 17 pts. Peri- cardial invasion was histologically proved in only 4 of 21 biopsies. Just after drainage,

their hemodynamic status was dramatically