Video-assisted thoracic surgery for thymoma: long-term follow-up results and prognostic factors-single-center experience of 150 cases.

BACKGROUND: The use of video-assisted thoracic surgery (VATS) in the treatment of thymoma is becoming more and more common. The aim of this study was to evaluate safety and effectiveness of thoracoscopic treatment of thymoma and, more importantly, to report long-term follow-up results of a large single-center cohort. METHODS: A retrospective review of a prospective database was performed. In total, 150 patients who underwent VATS resection for thymoma at Peking University People's Hospital from April 2001 to November 2014 were retrospectively reviewed. RESULTS: Average operation time was 140.1±54.2 min, median blood loss was 50 mL (range, 10-700 mL), median post-operative drainage time was 3 days (range, 1-11 days), and median length of post-op stay was 5 days (range, 2-20 days); 134 patients (89.3%) were followed up successfully. Median follow-up was 59.5 months (range, 2-187 months). Five- and 10-year recurrence free survival (RFS) rates of entire group were 96.5% and 94.4%, respectively; 5- and 10-year RFS rates for Masaoka stages I + II were 98.1% and 98.1%, respectively; 5- and 6-year RFS rates for Masaoka stage III were 90% and 60%, respectively. One case of recurrence in five Masaoka stage IV patients was observed, and 4-year RFS was 80%. Multivariable analysis indicated that recurrence tended to occur in Masaoka stages III + IV patients (P=0.037, HR =12.69, 95% CI: 1.17-138.22) and older patients had a lower risk of recurrence (P=0.029, HR =0.87, 95% CI: 0.77-0.99). Myasthenia gravis (MG) presented in 44 patients (29.3%), of which 36 patients (81.8%) were followed up. Nine patients achieved complete remission, and 19 patients had symptom improvement after surgery. Overall response rate of MG was 77.8% (28/36). CONCLUSIONS: VATS was a safe and effective procedure for treatment of thymomas with satisfactory prognosis. MG with thymoma treated by VATS had comparable neurological outcome to that associated with the trans-sternal approach.

Change of CMTM7 expression, a potential tumor suppressor, is associated with poor clinical outcome in human non-small cell lung cancer.

BACKGROUND: CKLF-like MARVEL transmembrane domain-containing 7 (CMTM7) located at 3p22.3, is a frequent deletion site and a tumor suppressor gene (TSG) locus in many cancer, which suggests CMTM7 may be a potential TSG. The aim of this study was to investigate the correlations of CMTM7 expression and survival rate in patients with non-smallcell lung cancer (NSCLC). METHODS: Surgical specimens of 180 cases with pathologically confirmed NSCLC were grouped into 18 tissue microarray slides. CMTM7 expression in these specimens were detected by immunohistochemistry staining and representative cases were confirmed by Western blotting. Univariate and multivariate analyses were performed to identify the association of CMTM7 expression with pathological features and survival of patients with NSCLC. RESULTS: A total of 78.9% of the 180 patients had variations of CMTM7 protein expression, either up-regulated or down-regulated. Univariate analysis showed that the patients' survival rate after surgery was highly correlated with CMTM7 expression (P = 0.0091). In addition, prognostic factors were examined by multivariate Cox regression analysis, and results suggested that CMTM7 expression was a unique prognostic factor in NSCLC survival. CONCLUSIONS: The CMTM7 expression may be related to survival of patients with NSCLC and a unique prognostic factor. CMTM7 may play an important role in NSCLC development.

Tolerability and toxicity of adjuvant cisplatin and gemcitabine for treating non-small cell lung cancer.

BACKGROUND: The combination of cisplatin and vinorelbine is an evidence-supported regimen for adjuvant chemotherapy for treating non-small cell lung cancer (NSCLC). But this doublet has considerable toxicity and unfavorable tolerability, and results in poor compliance. The cisplatin and gemcitabine regimen is one of the most active and well-tolerated regimens against advanced NSCLC, but its toxicity and tolerability has not been adequately evaluated in the adjuvant setting. METHODS: From a lung cancer database we retrospectively reviewed NSCLC patients receiving adjuvant chemotherapy of cisplatin (75 mg/m(2)) and gemcitabine (1250 mg/m(2)) between January 2005 and December 2011. Postoperative demographics, compliance to adjuvant therapy and toxicity were retrieved from medical records. RESULTS: A total of 132 patients met the criteria and were included in the study, 96 were male (72.7%) and 36 were female (27.3%). Median age was 60.5 years old, range 29 - 75 years, and 41.7% of patients were ≥ 65 years old. Overall, 68.2% patients received all four planned cycles, and the cumulative dose delivered for gemcitabine was 8333 mg (83.3% of the planned dose) and cisplatin 248 mg (82.7% of the planned dose). There were no treatment-related deaths. Grade 3/4 neutropenia developed in 47 patients (35.6%) and was the predominant hematologic toxicity. Common grade 3/4 non-hematologic toxicities were nausea/vomiting (22.0%), infection (12.3%), and febrile neutropenia (11.4%). CONCLUSION: Cisplatin and gemcitabine are feasible for use in the adjuvant setting with a favorable toxicity profile and superior tolerability compared with published data on cisplatin and vinorelbine.

Completely thoracoscopic lobectomy for the surgical management of bronchiectasis.

BACKGROUND: The feasibility of completing a lobectomy by completely video-assisted thoracoscopic surgery (cVATS) in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the lobectomies that used thoracotomy vs. cVATS, we determined the appropriateness of the minimally invasive cVATS approach in the management of bronchiectasis. METHODS: Between June 2001 and October 2010, 60 patients with bronchiectasis underwent surgery, of which 56 lobectomies were performed. All lobectomies were carried out by either thoracotomy or cVATS approach. Pulmonary vessels and bronchi were manipulated by ligation or stapler in the thoracotomy group, while they were dissected by endo-cutters in the cVATS group. RESULTS: There were 21 patients in the thoracotomy group and 35 patients in the cVATS group. Two cVATS patients (5.7%) converted. The difference in operation time, chest tube duration, lengths of hospitalization, and morbidity were not significantly different between the two groups (P > 0.05). The blood loss was less in the cVATS group (P = 0.015). A total of 52.4% and 62.9% of patients were postoperatively asymptomatic in the thoracotomy and cVATS groups respectively, and symptomatic improvement was obtained in 38.1% patients by thoracotomy vs. 31.4% patients by cVATS. CONCLUSION: cVATS lobectomy is safe and effective for the management of bronchiectasis, especially for the patients with localized lesions.

Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm: a retrospective study.

BACKGROUND: Completely video-assisted thoracoscopic lobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC). At present, the indication for this procedure is stage Ia and Ib peripheral lung cancer (≤ 5 cm); however, for larger tumors, it remains controversial whether this surgical technique is comparable to open lobectomy. This study aimed to evaluate the safety, completeness, and efficacy of thoracoscopic lobectomy, and to compare this technique with open lobectomy for the treatment of non-small-cell lung cancer when the tumor's diameter was greater than 5 cm. METHODS: From May 2001 to April 2011, 802 patients underwent a lobectomy for treatment of non-small-cell lung cancer at our center. In 133 patients, the tumor was > 5 cm. There were 98 men and 35 women, median age 63 years (range: 29 - 81 years). We divided the patients into two groups, group V (completely video-assisted thoracoscopic surgery), and group T (open lobectomy), and evaluated the two groups for age, gender, tumor size, pathological type, location, duration of surgery, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence. RESULTS: There were 46 cases in group V and 87 cases in group T. Age, gender, tumor size, location, pathological type and stage were similar between the two groups. Group V had shorter operative duration ((186.5 ± 62.8) minutes vs. (256.7 ± 67.5) minutes, P < 0.001) and reduced bleeding ((218.5 ± 174.6) ml vs. (556.9 ± 187.2) ml, P < 0.001). There were no significant differences between the two groups in complications, lymph node dissection, time of drainage and hospitalization. The recurrence between the two groups was equivalent (2.4% vs. 3.8%, P = 0.670). The overall survival at 1, 2 and 3 years was 95.1%, 81.6% and 69.6% for group V and 88.3%, 78.8% and 64.0% for group T. Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P = 0.129). CONCLUSIONS: Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety, completeness, and efficacy, but had a shorter operative duration, and reduced bleeding. This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm.

[Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of isolated mediastinal lesions].

OBJECTIVE: To evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of isolated mediastinal lesions. METHODS: A retrospective study was conducted of 73 consecutive patients with isolated mediastinal lesions of unknown origin without parenchymal lung abnormalities, who underwent EBUS-TBNA from September 2009 to April 2011. The patients who were nondiagnostic with EBUS-TBNA subsequently underwent surgical biopsies and a minimum of 6 months'clinical and radiologic follow-up. RESULTS: EBUS-TBNA achieved definitive diagnoses in 60 patients of the 73 patients (82.2%, 60/73). Malignancies were diagnosed in 23 patients and benignancies in 37. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing malignant mediastinal lesions were 95.8%(23/24), 100%(49/49) and 98.6%(72/73), respectively. EBUS was well tolerated by all of the patients with no complications. CONCLUSION: EBUS-TBNA of isolated mediastinal lesions is a minimally invasive and safe diagnostic technique with high yield.

[Preliminary comparison research of thoracoscopy and thoracotomy lobectomy for clinical N0 and post-operatively pathological N2 non-small cell lung cancer].

OBJECTIVE: To evaluate the safty, thoroughness and efficacy of the video-assisted thoracoscopic surgery compared with open thoracotomy, in treatment of patients with the preoperative staging of lymph node negative and postoperative pathological mediastinal lymph node positive (cN0-pN2) locally advanced non-small cell lung cancer(NSCLC). METHODS: We performed a retrospective review of 616 patients who underwent either VATS lobectomy or open thoracotomy from July 2000 to December 2009. Of which 386 patients were diagnosed with preoperative staging of lymph node negative(cN0) non-small cell lung cancer. Of the 386 patients 76 were diagnosed with postoperative pathological mediastinal lymph node positive (pN2). Twenty-nine patients were operated by video-assisted thoracoscopic surgery (VATS group), 47 patients were operated by open thoracotomy(T group).The patients' preoperative and intraoperative conditions, postoperative survival and recurrence, etc. were compared. RESULTS: The two groups were similar in age, gender distribution, pulmonary function, preoperative complications and the preoperative clinical stage. VATS group was slightly lower than T group in operation time, and blood loss. The station number of mediastinal lymph nodes dissection was (3.3±1.1) vs. (3.3±1.3), P=0.959; the number of lymph nodes dissected (12.7±8.9) vs. (10.5±7.2),P=0.260; positive lymph nodes / lymph nodes dissection 28.7% vs. 32.5%, P=0.592; the postoperative proportion of single-station N2 55.2% vs. 66.0%(P=0.189) in VATS group and T group, respectively. One, three-year disease-free survival rates after operation in VATS and T group were 82.6% vs.69.2%(P=0.088) and 49.3% vs. 51.3% respectively(P=0.996); one, three-year overall survival rates were 84.9% vs. 71.2%(P=0.149) and 64.0% vs. 42.7% (P=0.121). Both groups had the similar pattern of recurrence, most of which were distant metastases. CONCLUSION: With respect to the safety,thoroughness and recent effect, VATS is not inferior to open thoracotomy in the treatment of cN0-pN2 non-small cell lung cancer.

[A retrospective comparative study of the safety, completeness and efficacy of video-assisted thoracoscopic lobectomy versus open lobectomy for non-small-cell lung cancer patients whose tumor size was greater than 5 cm].

OBJECTIVE: To discuss the feasibility of the completely video-assisted thoracoscopic lobectomy for non-small-cell lung cancer (NSCLC) patients whose tumor size was greater than 5 cm. METHODS: From May 2001 to May 2010, 564 patients with NSCLC received lobectomy in our center, of whom, 114 had tumors whose diameters were larger than 5 centimeters (79 males and 35 females, their median age was 63.6 years, ranging from 29 to 81 years). We divided all the patients into two groups, group V (video-assisted thoracoscopic surgery) and group T (Thoracotomy). We compared all the factors, such as age, gender, tumor size, pathological type, location, operation time, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence between the two groups. RESULTS: There were 72 cases of lobectomy, 18 cases of composite lobectomy and 24 cases of pneumectomy in all the patients. All of the procedures were carried out safely with no serious complications except for two prioperative deaths resulting from respiratory failure (in group T). There were 34 cases in group V and 80 cases in group T. Age, gender, tumor size, tumor location, pathological type and stage were similar between the two groups. The operation time of group V was significantly shorter than that of group T [(208.2±57.0) min vs. (256.4±70.3) min, P=0.001]. The blood loss of group V was much less than that of group T[(269.1±176.2) mL vs. (591.9±169.7) mL, P<0.001].There were no differences between the two groups, such as complications (13.3% vs. 21.3%, P=0.232), lymph node dissection stages (5.0±2.2 vs. 5.1±1.1, P=0.885) and numbers (18.5±9.6 vs. 19.2±9.1, P=0.714), time of drainage[(8.6± 3.9 d) vs. (9.0±5.0) d,P=0.693] and hospitalization (11.7±6.8) d vs. (12.8±7.1) d,P=0.431].The local recurrence between the two groups was equivalent(3.5% vs. 4.2%, P=0.857).The estimated overall survival at the end of 1, 2 and 3 years was 90.0%, 76.9% and 65.9% for group V and 80.3%, 62.9% and 55.3% for group T, respectively. Kaplan-Meier survival curves showed that there was no significant difference between the two groups (P=0.163). CONCLUSION: Completely video-assisted thoracoscopic lobectomy is a safe and feasible procedure for a part of non-small-cell lung cancer patients whose tumor size is greater than 5 cm.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions.

BACKGROUND: Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities. METHODS: We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People's Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out. RESULTS: Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed. CONCLUSION: Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.

Comparison of the autofluorescence bronchoscope and the white light bronchoscope in airway examination.

BACKGROUND AND OBJECTIVE: The sensitivity and accuracy of white light bronchoscopy (WLB) in airway examination are low. Autofluorescence bronchoscope (AFB) can determine early lesions in bronchial mucosa more sensitively, but it has seldom performed in China. To assess the clinical value of the AFB in airway examination, we compared the sensitivity and specificity of the AFB and WLB in detecting cancer of the airway mucosa. METHODS: Between September 2009 and May 2010, bronchoscope examinations using both the AFB and WLB were performed on 136 patients, 95 men and 41 women with a median age of 61.5 years (ranged from 25 to 84 years). There were 46 lesions located in the central airway, 84 in the peripheral lung parenchyma, and 6 in the mediastinal region. All patients received local and general anesthesia and were subsequently examined with the WLB and AFB in tandem. All procedures were completed safely. Abnormal visual findings were recorded, and biopsies of the affected regions were collected for pathologic examination. RESULTS: Of 241 regions sampled for biopsy, 76 sites contained malignant lesions, whereas 165 sites contained benign lesions. The AFB detected 72 of the 76 malignant lesions, but the WLB detected only 50. The sensitivities of the AFB and WLB were 94.7% and 65.8%, respectively, and the specificities were 57.0% and 83.6%, respectively. The negative predictive values of the AFB and WLB were 95.9% and 84.1%, respectively. CONCLUSIONS: The AFB is more sensitive than the WLB in detecting cancerous lesions in the mucosa, and is an effective airway examination.

[Video-assisted thoracoscopic lobectomy for benign pulmonary diseases].

OBJECTIVE: To evaluate technique aspects of video-assisted thoracoscopic lobectomy for benign diseases. METHODS: Retrospective review of 24 patients with benign pulmonary disease underwent thoracoscopic lobectomy from September 2006 to September 2008. One patient had bilateral bronchiectasis received concurrent bilateral lobectomy. The patients included 11 males and 13 females with mean age of 49.0 years. Fifteen cases were diagnosed as benign diseases preoperatively consisted 10 bronchiectasis as the primary indication. The other 9 cases were pulmonary nodules pathologic diagnosed intra-operatively. Inflammation changes including dense plural adhesions, pulmonary artery adhesions and calcified lymph nodes were managed endoscopically. RESULTS: All 25 thoracoscopic procedures were completely with no conversion to thoracotomy. The mean operation time was (163 +/- 52) min, blood loss was (163 +/- 130) ml. There was no hospital death or major morbidity. Postoperative drainage was (5.8 +/- 2.8) d. No long-term complications were noticed during a mean follow-up of 7.3 months. CONCLUSION: Chronic inflammation induced adhesions is the key limiting factor for thoracoscopic lobectomy for benign diseases.

[Clinical analysis of thoracoscopic lobectomy: a report of 40 cases].

OBJECTIVE: To review the technology of completely thoracoscopic lobectomy procedures. METHODS: From September 2006 to July 2007, 40 patients (23 male and 17 female) underwent completely thoracoscopic lobectomy. The median age was 59.5-years-old, with a range from 24 to 79-years-old. The lobectomy was completed through 3 incision in the 5th, 8th and 7th intercostal space. The procedures were similar with conventional open lobectomy. RESULTS: All procedure were carried out safely, including lung cancer (n = 34), lymphoma(n = 1), pulmonary cyst (n = 1), middle lobe syndrome (n = 1) , bronchiectasis (n = 2) and renal carcinoma metastasis to lung (n = 1). There were no operative mortality or serious complications. There was one patient opposed to open thoracotomy because of the mediastinal lymph nodes metastasis. The average surgical duration was 206 min (range from 60 to 300 min). The average blood loss was 221 ml (range from 100 to 400 ml) with no blood transfusion required. The average length of stay was 8.9 d. No recurrence and metastasis was observed in a follow-up range from 1 to 10 months except one patient with adenocarcinoma occurred metastasis of tumor 3 months postoperation. CONCLUSION: The completely thoracoscopic lobectomy is a safe and feasible surgical procedure compared with conventional open lobectomy for selected patients.

[Value of mediastinoscopy in the diagnosis of stage I thoracic sarcoidosis].

OBJECTIVE: To determine the current role of mediastinoscopy in the diagnosis and differential diagnosis of stage I thoracic sarcoidosis. METHODS: The clinical data of 60 patients with a presumptive diagnosis of stage I thoracic sarcoidosis underwent mediastinoscopy from November 1999 to June 2007 were analyzed retrospectively. All the patients had hilum of lung and/or mediastinal lymphadenopathy with normal lung parenchyma on thoracic CT scan. Typical stage I sarcoidosis was defined as presence of bilateral hilum of lung lymphadenopathy with/without mediastinal lymphadenopathy. RESULTS: All the patients had definitive pathologic diagnosis. Among the 33 patients with typical presentation of stage I sarcoidosis, 32 patients were confirmed by pathology. One patient was reactive lymph node. Among the 27 patients with atypical patterns on CT, 17 patients were confirmed by pathology. No postoperative complication and mortality occurred. CONCLUSION: For the patient with a presumptive diagnosis of typical stage I thoracic sarcoidosis after clinical and radiological evaluation, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.

[Study of growth inhibition of lung cancer cells by siRNA targeting mutant K-ras gene in vitro and in vivo].

OBJECTIVE: To study the inhibitory effect of mutant K-ras gene depletion by small interfering RNA on the growth of lung cancer cell line-H441 cells in vitro and in vivo. METHODS: One pair of 63 bp reverse repeated sequence targeting mutant K-ras(V12) mRNA spaced by 9 bp nucleotide were synthesized and inserted into plasmid pSilencer3.1 eukaryotic expression vector. After transient and stable transfection into H441 cells, the mutant K-ras mRNA and protein level were measured by RT-PCR and Western blotting, and the H441 cells proliferation was measured by MTT method, and the apoptosis rate was detected by flow-cytometry. H441 cells treated with pSilencer3.1-K-ras(V12) were transplanted subcutaneously in nude mice and their tumorigenesis ability was observed. RESULTS: The recombinant plasmid pSilencer3.1-K-ras(V12) was successfully constructed by sequencing. The introduction of pSilencer3.1-K-ras(V12) was showed to efficiently and specifically inhibit the expression of K-ras(V12) gene according to the results of RT-PCR and Western blotting (P < 0.01, as compared with controls). The inhibitory effect on cell proliferation was confirmed by MTT test (P < 0.05, as compared with controls). Apoptosis rate of H441 cells treated with pSilencer3.1-K-ras(V12) was significantly higher than that of the control cells (P < 0.01). The test in vivo showed that downregulation of K-ras(V12) expression in H441 cells apparently affected their ability to form tumors in nude mice. CONCLUSIONS: siRNA targeting mutant K-ras mRNA can specifically suppress the expression of mutant K-ras gene in H441 cells, and therefore has a substantially inhibitory effect on cell proliferation in vitro and in vivo, it provides a new method and material to the gene therapy of lung cancer.

[Long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis: 5-year follow-up of 18 cases].

OBJECTIVE: To evaluate the long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis (MG). METHODS: Eighteen MG patients, 7 males and 11 females, aged 33.4 +/- 9.4 (19 - 48), underwent video-assisted thoracoscopic thymectomy by the same surgical group from November 2001 to May 2005. Right side access was used in 14 of them, left side approach was used in 2, and bilateral approach in 1 of them. The thymus and fatty tissue in the front mediastinum were resected. The medical records were reviewed and telephone survey was conducted to understand the effects. The mean follow-up time was 26.4 +/- 10.9 months. RESULTS: VATS was successfully conducted except in 1 case. The bleeding volume was less than 50 ml. The average chest tube drainage time was 2.1 +/- 1.2 days, and the mean hospitalization day was 6.3 +/- 3.1 days. Three of the 18 patients needed temporary mechanical ventilation less than 72 hours, and 2 needed reintubation due to either myasthenic or cholinergic crises. Nine of the 18 patients achieved complete relief (50%) and 6 of them (33.3%) had their symptoms greatly improved, and the symptoms of one case remained stable (5.6%), and the overall effective rate was 83.3%. CONCLUSION: Video-assisted thoracoscopic thymectomy is a safe and effective method for treatment of myasthenia gravis with satisfactory long-term outcomes.

[A comparison of T3 sympathectomy versus T4 sympathectomy in the treatment of primary palmer hyperhidrosis].

OBJECTIVE: To evaluate the effect and side effect of T(3) versus T(4) sympathectomy in the surgical management of primary palmar hyperhidrosis through prospective multi-center randomized controlled trial. METHODS: From Sep 2004 to Feb 2006, 106 consecutive patients (49 males and 54 females) with primary palmar hyperhidrosis were enrolled in the study and randomly assigned into T(3) or T(4) level sympathectomy groups. 66 patients received T(3) sympathetic chain transection and 37 patients received T(4) sympathetic chain transection. The two groups were comparable in all other parameters. RESULTS: All procedures were carried out successfully without severe morbidity or mortality. After a mean follow-up period of 8.6 months, both groups remained satisfactory in palmar sweating control. The T(4) group had more moisture hands compared with the T(3) branch (54.1% vs 15.2%, P < 0.01), but this didn't compromise the patients' satisfactory. The patients in T(4) group showed significantly less dry hand problems than the patients in the T(3) group (5.4% vs. 25.8%, P < 0.05), and so did compensatory sweating (21.6% vs. 45.6%, P < 0.05). CONCLUSION: The procedure of T(3) or T(4) sympathectomy, both transecting the sympathetic chain in one single position in relatively lower segment, are comparatively effective in the treatment of primary palmar hyperhidrosis, but T(4) sympathectomy shows less side effect.

[Video-assisted thoracoscopic extended thymectomy for myasthenia gravis: analysis of 107 cases].

OBJECTIVE: To evaluate the results of video-assisted thoracoscopic extended thymectomy for myasthenia gravis. METHODS: We retrospectively reviewed data from 107 patients received thoracoscopic extended thymectomy from June 1995 to June 2004. All patients had confirmed diagnosis of myasthenia gravis by clinical manifestation and electromyogram. Thoracoscopic extended thymectomy as well as dissection of all fatty tissue anterior to the pericardium was performed. RESULTS: During a follow-up of 1-98 months, symptom was significantly improved in 83% of patients, including 34 patients experienced complete remission. There was no postoperative mortality. CONCLUSION: Favorable results of video-assisted thoracoscopic extended thymectomy can be achieved in patients with myasthenia gravis. The technique is safe and minimally invasive.

[Craniofacial hyperhidrosis treated by video-assisted thoracoscopic sympathectomy].

OBJECTIVE: To investigate the feasibility, safety and prospect application value of video-assisted thoracoscopic sympathectomy utilized in the treatment of craniofacial hyperhidrosis. METHODS: Eighteen patients with craniofacial hyperhidrosis underwent sympathectomy from January 2003 to December 2004, including 10 cases combined with palmar hyperhidrosis. There were 17 males and 1 females with a mean age of 36.5 years (ranges, 25-42). Sympathetic chain was transected just below the stellate ganglion in pure craniofacial hyperhidrosis. Additional T(3) sympathectomy was performed in those patients combined with palmar hyperhidrosis. RESULTS: There were no surgical complication or surgical mortality cases. Seventeen patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms, but one had partial remission due to thoracic adhesion and false location of the ganglions. The effective rate was 97% (35/36). No recurrent symptoms occurred after a mean of 8.3 months of follow-up. No relapse occurred. Fifteen patients (83%) developed compensatory sweating of the trunk and lower limbs. Six patients (33%) presented palmar dry (severe hypohidrosis) and they all can tolerate the condition. All patients were satisfied with the outcomes of their operations. CONCLUSION: The initial results show that thoracoscopic sympathectomy is a safe and effective method for the treatment of craniofacial hyperhidrosis.