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Pneumothorax, defined as the presence of air in the pleural space, is usually classified as spontaneous or traumatic; it is unusual for pneumothorax to be categorized as being acute or chronic. Even if conservative treatment is chosen, the pneumothorax is cured when air in the pleural space dissolves into the venous blood. A 50-years-old Japanese man with no prior medical history was referred to our department with a right pneumothorax and two rightsided pulmonary nodules on chest X-ray and CT. The chest radiographs of past mass screening which was taken four years ago showed right pneumothorax and right-sided pulmonary nodules. From then, all chest radiograph and chest computed tomography showed right pneumothorax and pulmonary nodules. But he underwent no medical interventions. We designed to perform an operation for a treatment of right pneumothorax and the diagnosis of pulmonary tumors. We underwent right upper lobectomy and pleural decortication under video assisted thoracic surgery. We obtained pathological diagnosis of inflammatory pseudotumor and surrounding atelectasis. He was cured from pneumothorax and pulmonary tumors. A unique case of spontaneous pneumothorax presenting with a pleural air space that was confirmed by chest radiographs and computed tomography examinations over a 4-year period is reported.

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We investigated the potential donors from cases without lung procurement in spite of considering procurement as the donor. We reviewed 207 cases considered for lung procurement. Donors were divided into 2 groups according to whether or not their lungs were harvested: 50 did and 157 did not. We investigated their age, gender, donor management periods, blood pressure, heart rate, P/F ratio, PCO2, HCO3, positive end-expiratory pressure (PEEP), respiratory rate, abnormal findings in the chest X-ray, blood chemistries, sputum culture, and intravenous administration of steroid. Univariable or multivariable logistic regression analysis was used to predict lung harvesting by various factors. Univariable logistic regression analysis revealed maximum heart rate (HR) and respiratory rate (RR), maximum, minimum, and average P/F ratio, and abnormal findings in the chest X-ray, to be predictors to perform transplant. The maximum HR and RR of the non-harvest group are higher than those of the harvest group. Multivariable logistic regression analysis revealed average P/F ratio only to be a predictor to transplant. We divided the non-harvest group into 2 groups according to whether or not their P/F ratio was >300: 55 did (P/F 300 group) and 102 did not (P/F 299 group). Between P/F 299 group and the harvest group, univariable logistic regression analysis revealed maximum HR, maximum and minimum RR, maximum PEEP, maximum, minimum, and average P/F ratio, and abnormal findings in the chest X-ray to be predictors to transplant. Maximum HR, PEEP, and maximum and minimum RR of the P/F 299 group are higher than those of the harvest group. Maximum, minimum, and average P/F ratio of the P/F 299 group are lower than those of the harvest group. The average PCO2 of P/F 299 group is higher than that of the harvest group. The rate of abnormal findings in the chest X-ray of the P/F 299 group is higher than that of the harvest group. Multivariable logistic regression analysis revealed average P/F ratio only to be a predictor to transplant. There were no predictors between the P/F 300 group and the harvest group in both univariable and multivariable logistic regression analyses. Furthermore, there were no different factors between the P/F 300 group and the harvest group. Our study showed that 35.5% of the non-harvest group had a P/F ratio of >300 and had no difference compared with the harvest group. Our data suggest that potential donors existed in the non-harvest group and increased the number of lung procurement to 27.3% from 13.0% of all donors.

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We had surgically treated varicose veins in 554 legs of 386 patients as of June 30, 2000. Varicose veins of the stem or segment type without skin changes were treated with sclerotherapy combined with high ligation, while a part of secondary varicose veins and the reticular or web type were treated with sclerotherapy alone. This paper describes our methods for day surgery for this condition. The most important therapeutic consideration in the surgical procedure is achieving sufficient venous collapse to prevent the occurrence of intravenous thrombus. In our 386 patients, a massive intravenous thrombus that was resected occurred in one limb (0.1%). Postoperative bleeding also occurred in one limb (0.1%) of a patient with severe liver cirrhosis.

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An unusual case of coexisting malignant lymphoma and adenocarcinoma of the stomach is described. A 61-year-old man with weight loss, malaise, and tarry stool demonstrated diffuse lymphoma, large-cell type, and two early gastric carcinomas. Each of the two early carcinomas collided with malignant lymphoma, respectively. Two histologically different tumors were precisely diagnosed preoperatively in this case. Frequent endoscopy with biopsies from various sites of the lesion is important in achieving a correct diagnosis.

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Cold lability of pyruvate, orthophosphate dikinase was investigated using a homogeneous, purified enzyme preparation from maize (Zea mays L. var. Golden Cross Bantam T51) leaves. Its stability was markedly reduced below about 10 C and the rate of cold inactivation followed first order kinetics at a concentration lower than about 0.1 milligram of enzyme per milliliter. Cold inactivation was little affected by pH in the range which gives good stability for the enzyme at warm temperatures and the enzyme activity was protected strongly by inclusion of substrates (pyruvate and phosphoenolpyruvate) and polyols such as sucrose, sorbitol, and glycerol. Loss of catalytic activity was accompanied by an apparent dissociation of a tetrameric form of the enzyme (9S form) into a new, more slowly sedimenting (5.1S) component. Inclusion of pyruvate at 4 mM in the cold-treated enzyme had no effect on the sedimentation value. A sharp change in activation energy of the dikinase-catalyzed reaction was observed near 12 C and its break point appears to be close to the generally accepted critical low temperature limit for the growth of maize plants.

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