Summary Nebulisation chemotherapy, a chemotherapeutic method for the treatment of lung cancer that involves the administration of anticancer agents through the inhalation of nebulised aerosols, has been found to be highly effective (Tatsumura et al., 1983a,b). We confirmed that 5-FU administered by this method accumulates in the trachea, bronchi and regional lymph nodes of patients treated before surgery, along with 5-FU metabolites, FUR and FUdR, indicating that 5-FU is directly incorporated and metabolised in the respiratory tract. Parallel result were obtained using mongrel dogs. The 5-FU levels in other organs, such as the heart and liver, were found to be extremely low. Only a trace of 5-FU was found in the serum of both the patients and the dogs. We further investigated the anti-tumour effect of this therapy in ten selected patients and observed a satisfactory anti-tumour response of 60.0%. These results, along with our previous finding that the retention time of isotope tracers inhaled as aerosol is considerably longer in tumour tissues than in normal parts (Tatsumura et al., 1983a) al., 1983a,b). The present study further supports the therapeutic value of this method and presents some data which help explain how this therapy works. Materials and methodsAdministration and analysis of 5-FU in mongrel dogs The concentrations of 5-FU and its metabolites, FUR and FUdR, in the tissues and sera were measured using a recently developed, high-performance liquid chromatographic (HPLC) method (Masuike et al., 1985).Eighteen mongrel dogs weighing 15.5-16.5 kg were used in the experiment. All dogs were anaesthetised with ketamine hydrochloride (Ketalar) (10-20 mg kg-') and atropine sulfate (0.03-0.04 mg kg-'). They were then intubated, mechanically ventilated, and given supplementary oxygen. Anaesthesia was maintained by an intravenous administration of pentobarbital (5-10 mg kg-'). The inhalant was prepared by mixing 5-FU (50 mg kg-') with expectorant, was nebulised by an ultrasonic nebuliser, and was then sent into the respiratory apparatus. Oxygen was supplied to the circuit at a rate of 2 1/min and ventilation was carried out at 100-150 ml min-' at 20 times/min. This circuit carried the aerosol to the bronchial trees at the alveolar level.Cardiac arrest was induced by an intravenous injection of KCI after each procedure. Tissue samples were collected after

To assess the extent of tumor invasion in lung cancer, my colleagues and I routinely use preoperative transesophageal ultrasonic endoscopy and intraoperative ultrasonography in addition to preoperative roentgenography, computed tomographic scanning, and other standard procedures. Both transesophageal ultrasonic endoscopy and intraoperative ultrasonography allow for a real-time assessment of the extent to which the lung cancer has invaded adjacent organs and are useful in determining the operability and safety margin of the involved organ or organs. We found intraoperative ultrasonography to be more accurate than transesophageal ultrasonic endoscopy, because intraoperative ultrasonography can be done at any time during the operation, as needed, and the probe can be directly applied to the desired location from a variety of angles. In contrast, when transesophageal ultrasonic endoscopy is used, the presence of air in the lung tissue can interfere with an accurate evaluation of some aspects of the tumor. Our results indicate that the sensitivity of transesophageal ultrasonic endoscopy and intraoperative ultrasonography is 68.4% and 100%, respectively, and the specificity is 81.3% for transesophageal ultrasonic endoscopy and 95.5% for intraoperative ultrasonography.

Gastrointestinal disorders often occur during systemic chemotherapy. In an attempt to prevent these side-effects, ursodeoxycholic acid was administered during the systemic chemotherapy. This compound significantly alleviated the side-effects, as assessed by an increase in appetite, total serum protein level and body weight. However, in patients with a deficiency in pancreatic exocrine secretion and/or obstructive jaundice due to metastasis to common bile duct, the effects were nil.

A new surgical approach to apical segment lung diseases, including carcinomas and inflammatory diseases A new surgical approach to lung cancer and inflammatory pulmonary diseases has been developed. This approach focuses on diseases located in the apical segments of the lung and showing invasion or severe adhesion to the apical thoracic waD or to vital organs near the thoracic dome (including superior sulcus tumors). The conventional posterolateral approach leaves the surgeon "blind" because it forces the surgeon to perform the operation looking up through a tube from the bottom. This limited view makes accurate assessment of the surrounding vital organs involved in these diseases almost impossible and also increases the risk of injury to adjacent vital organs. The incision in this new approach allows extensive retraction of the scapula to provide easier access to the posterior chest waD. Because the incision curves upward anteriorly, rather than downward as usual, it gives excellent exposure of the apical anterior thoracic region. In the few cases in which we have used this approach, we have found that the surgical field is in plain view and that the operation is consequently safer and easier. So far we have not encountered any complications, and we can recommend this approach with confidence. (J

No abstract