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The activities of hexokinase (HK), lactate dehydrogenase (LDH), citrate synthase (CS) and 3-hydroxyacyl-CoA-dehydrogenase (HAD) were measured in the costal diaphragm (DI) and in the latissimus dorsi (LD), a non respiratory muscle, of 21 middle aged men: 10 normal subjects and 11 patients with moderate chronic obstructive pulmonary disease (COPD). In the normal subjects, all the enzymatic activities were significantly higher in the diaphragm (p less than 0.01) than in the latissimus dorsi, the mean increase ranging from 61 to 118%. Chronic obstructive pulmonary disease failed to cause any further increase in enzymatic activities in the DI; on the contrary, a significant decrease of HK and LDH (30%, p less than 0.01) was observed. Enzymatic activities of LD were unaffected by COPD. These data show that the metabolic enzymatic activities in the diaphragm of normal middle aged subjects is similar to that of the vastus lateralis of highly trained young athletes, suggesting that DI is a highly trained muscle in normal man.

The authors report a series of 63 cases, all operated, of bronchial cancer associated with upper airway cancer. The laryngeal portion of the upper airways was the site of cancer in 50% of cases. The two cancers occurred synchronously in 13% and at different times in 87% of cases. Operative mortality was 3%. Post-operative complications were dominated by bronchopulmonary congestion. Long-term survival was similar to that in series of operated bronchial cancer alone and was 70% at one year and 30% at five years. These results should lead to all isolated pulmonary lesions being considered as second primary cancers with early surgical resection being proposed.

The majority of the 82 cases of tubal choriocarcinoma reported in the published literature followed malignant transformation of a tubal ectopic pregnancy. The case presented was not related to ectopic pregnancy but was apparently the result of malignant changes in migrating trophoblastic elements during previous pregnancies not arriving at full term. The patient had two abortions by aspiration and had been on oral contraceptives ever since. Fifteen or so of the cases of extra-uterine choriocarcinoma published in the literature appear to have resulted from the same aetiopathogenic mechanism.

The authors report the case of a road accident which resulted in rupture of the middle lobe bronchus. There was an associated lesion of the pulmonary artery. Treatment was conservative after primary evaluation of the right pulmonary artery at its origin. Vascular trauma associated with rupture of the main bronchi is rare. The prevalence is greater in the case of rupture of the more distal lobar bronchi. It is important to be aware of this possibility, and the pulmonary artery must be inspected before such lesions are treated surgically.

A series of 52 hydatid cysts of the liver is reported. It is emphasized that diagnosis should be easily done with simple explorations as liver scan, echography, immunologic tests. As far as treatment is concerned the possibility of anaphylactic accidents during operation must be kept in mind. To avoid as much as possible postoperative complications special attention must be taken in the choice of the operative technic. In young, unilocular cysts hydatidectomy should be performed. In old cysts complete resection of both cyst and adjacent hepatic parenchyma (pericystectomy) gives the best results.

Secretory granules containing 6-8 nm fine filaments are described in mucous cells of human bronchial glands. In contrast with the strongly marked classical mucous granules, filamentary granules exhibit weak positivity with Thiéry's method providing an easy characterization. Exocytosis in glandular lumen are often observed. These undescribed filaments may probably represent an usual component of fibrillar matrix in bronchial mucus.

The authors report the case of a round, peripheral radiographic opacity ("coin lesion" of English-language authors) which after surgical excision was found to be an intrapulmonary lymph node. In an anatomical study on the lymphatic drainage of pulmonary segments in adults, a similar lesion was found among 483 injected segments. A review of the literature yielded 27 similar cases which are described in detail. These lymph nodes are probably more frequent than is generally believed, as shown by an experimental radiolymphographic study. Such clinical findings will no doubt be rendered more numerous by the improved sensitivity of new medical imaging techniques. Despite hypotheses put forward by the authors, the presence of these lymph nodes, which seem to be acquired by the adult lung, has not yet been explained.