75

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