Pleurodesis is a minimally invasive technique that is effective in preventing postoperative recurrences of pneumothorax when added to VATS bullectomy. Additional pleurodesis has no disadvantages vs bullectomy alone in terms of worsening postoperative chest pain or pulmonary function.

VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence.

A surgical case of teratoma with malignant transformation (TMT) of the mediastinum in a 66-year-old man is reported. The unilocular, cystic, mediastinal mass, which had been seen in a chest radiograph 7 years earlier, was extirpated. The mass was histologically revealed to be a mature cystic teratoma containing skin and respiratory epithelial tissues, with some areas of well-differentiated adenocarcinoma. Surgical cases of TMT in the mediastinum, which have not received any preoperative chemotherapy or radiation therapy, are rare. By reviewing the previous literature on TMT in various organs, the authors distinguished two types of TMT, chemotherapy- or radiotherapy-induced TMT and naturally occurring TMT. The pathogenesis of these two types are discussed.

Changes in respiratory muscle strength after lung resection were examined concerning age and procedures of thoracotomy. Maximum inspiratory (MIP) and expiratory (MEP) mouth pressure were measured before operation and 1, 2, 4, and 12 weeks after operation in 81 patients undergoing lung resection. In 48 patients undergoing pneumonectomy, lobectomy, or segmentectomy, patients older than 70 showed a significantly lower MIP and MEP before operation and throughout the postoperative period compared to younger ones (P < 0.01). Furthermore, the older patients showed a significantly lower percentage of postoperative MIP and MEP 4 weeks after operation than the younger ones (P < 0.01). In 31 patients undergoing lung wedge resection, patients undergoing limited thoracotomy (LT) and video-assisted thoracic surgery (VATS) showed significantly higher percentages of postoperative MIP and MEP than those undergoing posterolateral thoracotomy (PLT) 1 and 2 weeks after operation (P < 0.01 or 0.05). But there was no significant difference in the values between LT and VATS. We concluded that (1) elderly patients suffered respiratory muscle weakness before and after operation and their postoperative recovery of respiratory muscle strength was slower than in younger patients, and (2) VATS and LT resulted in more rapid recovery of respiratory muscle strength than PLT, but the difference between VATS and LT was not significant.

Serum levels of protein 1 (P1), a Clara cell secretory protein, were studied in 942 healthy subjects in relation to sex, age, and smoking habits and in 117 patients with bacterial pneumonia in relation to prognosis. P1 values in bacterial pneumonia patients at disease onset were compared with those in 234 healthy control subjects matched by sex and age. P1 values in healthy males were highest in those 30 to 39 yr of age and highest in healthy females > or = 70 yr of age but lowest in those 30 to 49 yr of age. P1 values in healthy males were significantly higher than those in females in the 30- to 39-yr age group (p < 0.05). Male smokers showed higher P1 values than nonsmokers, but without a significant difference. P1 values in patients with pneumonia were significantly lower than in control subjects (p < 0.0001). P1 values were significantly lower in patients treated with a respirator than in in patients treated without a respirator (p < 0.05). In 59 patients, whose P1 values could be followed up until the outcome of pneumonia, all 37 recovered patients showed significantly increased P1 values after recovery (p < 0.001), and all 22 who died of their illness showed significantly decreased P1 values just before death (p < 0.01). We thus conclude that P1 serum levels were significantly affected by sex and by the degree of seriousness in bacterial pneumonia.