[Value of endobronchial ultrasound-transbronchial needle aspiration biopsy for diagnosis of PET-CT positive mediastinal lymph nodes].

OBJECTIVE: To evaluate the clinical value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) biopsy for diagnosis of PET-CT positive mediastinal lymph nodes. METHODS: One hundred and twenty-six patients with lung cancer undergoing both PET-CT scanning and EBUS-TBNA biopsy in the First Affiliated Hospital of Guanzhou Medical College from July 2008 to August 2010 were included in this study. There were 89 male and 37 female patients with a mean age of 56.3 years (range 34 to 81 years). (18)FDG-PET was considered positive in mediastinal nodes if the PET-CT reported hypermetabolic activity consistent with malignant disease (standardized uptake value > 2.5). All of the patients were clinically followed up. RESULTS: Among the 126 patients, 185 stations of lymph nodes were punctured. The mean diameter of the nodes was 13.6 mm and the range was 6 - 23 mm. There were no procedural complications. The diagnostic accuracy, sensitivity, and specificity of EBUS-TBNA were 95.7%, 95.7%, and 100%, respectively. CONCLUSIONS: EBUS-TBNA is a minimally invasive, highly effective and accurate, practical and safe procedure for diagnosis of PET-CT positive mediastinal lymph nodes.

[The analysis on the misdiagnosis of solitary fibrous tumor of the pleura].

OBJECTIVE: To report the characteristics of solitary fibrous tumor of the pleura (SFTP), and to analyze the factors associated with the misdiagnosis of this disease. METHODS: A retrospective review of the clinical records of 21 cases of SFTP in our hospital from June 2000 to September 2008 was conducted. The follow-up data were also reviewed. RESULTS: The preoperative diagnosis was pleural mesothelioma in 7 cases, neurogenic tumor in 6, lung cancer in 4, SFTP in 2, hilar lymph node tuberculosis in 1 and inflammatory granuloma in 1 case. All the cases underwent radical resection, and postoperative pathology and immunohistochemical study were performed, and the diagnosis of benign solitary fibrous tumor of the pleura was confirmed. Follow-up periods ranged from 3 months to 8 years (median, 43 months). Two cases were lost, and the remaining 19 cases reported no recurrence or metastasis. CONCLUSION: The recognition of the clinical characteristics of pleural solitary fibrous tumor is essential for improving the diagnosis of this uncommon disease.

[Injection of activated carbon nanoparticles for guiding lymphadenectomy during minimal invasive surgery in lung cancer].

OBJECTIVE: To evaluate the clinical value of activated carbon nanoparticles for guiding lymphadenectomy in lung cancer. METHODS: Fourty-two lung cancer patients were divided into two groups: the control group (22 cases) and experiment group (20 cases) who received activated carbon nanoparticles injection around the tumor either by endoscopic injection or intraoperative subserosal injection. The number of dissected lymph node, black-stained lymph node, positive lymph node and the side effect of the procedure were analyzed, respectively. RESULTS: No severe complication was observed in the experiment group. The operative time was not prolonged significantly in the experiment group either. However, the number of average lymph nodes dissected in the experiment group (25.5) was significantly more than that in the control group (14.6) (P <0.01). CONCLUSION: Local injection of activated carbon nanoparticles around the tumor during surgical exploration is effective, safe and easy to do for guiding lymphadenectomy in lung cancer patient.

[Treatment and timing of re-operation for postoperative recurrence of spontaneous pneumothorax].

OBJECTIVE: To investigate the treatment for postoperative recurrence of spontaneous pneumothorax, the feasibility of re-operation, indications and the results. METHOD: The clinical and follow-up data of 28 cases of postoperative recurrence from 485 patients who underwent operations for spontaneous pneumothorax from Jan, 1994 to Jan, 2005 were retrospectively reviewed. RESULTS: One case was observed without any invasive therapy, 12 cases underwent closed pleural drainage and 15 cases received reoperation. All of the patients had the lungs reexpanded sufficiently, with comorbidities in 2 cases, one of which was pleural effusion, the other was prolonged leakage after surgery. No death occurred. The operation time was 80 - 315 (115 +/- 43) min, and the bleeding volume was 50 - 350 (115 +/- 54) ml. The time of chest tube drainage was 1 - 7 (4 +/- 2) d, and the time of hospital stay was 7 - 18 (11 +/- 5) d. The follow-up of the 28 cases ranged from 1 to 107 months (median 55.4) without recurrence. CONCLUSIONS: The findings on lung high rate CT (HRCT) are the most important factors in deciding treatments of postoperative recurrence of pneumothorax. If it is the first recurrence, and there is no evident bullae on HRCT, conservative therapy should be considered, especially for the recurrence within two years postoperation. If the first recurrence occurs after surgery, especially within 2 years, and the bullae is invisible on HRCT, adhesion is the choice without significant adverse effect. If the recurrence occurred twice and more, bullae is found on HRCT, adhesion hampered lung reexpansion, or pleural drainage alone could not work, re-operation should be performed.

[Bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for central lung cancer: a report of 139 cases].

OBJECTIVE: To evaluate the efficacy and practicability between bronchial sleeve resection or reconstruction of the pulmonary artery by video-assisted thoracic small incision and routine posterolateral incision for lung cancer. METHODS: The clinic data was analyzed retrospectively, including 139 cases in our hospital underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung cancer from January 1995 to July 2007 and 99 cases in the HUAXI Hospital of SICHUAN University underwent routine posterolateral incision from April 2000 to December 2005. All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve resection or reconstruction of the pulmonary artery. RESULTS: All patients were done operation successfully with no perioperative mortality and no occurrence of anastomosis stenosis as well as fistula. The median survival period of video-assisted thoracic small incision patients and the posterolateral incision patients were 63.17 months and 42.00 months, respectively (P > 0.05). There was no sign of reperfusion injury in the reconstruction of the pulmonary artery patients. The small incisions' length was from 8 to 13 cm and the mean length was 10 cm. The routine posterolateral incisions' mean length was 30 cm. Compared to the patients underwent the routine posterolateral incision, patients underwent the operation of video assisted thoracic small incision had less operation time, less chest tube time, less hospitalization time and less postoperative shoulder joint dysfunction. CONCLUSIONS: The bronchial sleeve resection and reconstruction of the pulmonary artery by video-assisted thoracic small incision surgery for lung cancer can finish the same work as the traditional thoracic lateral incision with less trauma and recovery time.

[The management of the contralateral lungs in four cases with single allograft lung transplantation].

OBJECTIVE: To report the management of the contralateral lungs in 4 cases with single allograft lung transplantation. METHODS: Four cases receiving lung transplantation were analyzed respectively. One presented with bilateral multiple lung cysts and three with chronic obstructive pulmonary disease (COPD) with bilateral bullae. In the case with bilateral multiple cysts, the contralateral lung remained untreated after operation. For the contralateral lungs in the three cases with COPD, one remained untreated, one received lung volume reduction surgery (LVRS) immediately after lung transplantation, and one received LVRS 47 days after lung transplantation. RESULTS: Three patients recovered after operation, and 2 of them survived more than 18 months. One patient with delayed contralateral LVRS died 74 days after lung transplantation. CONCLUSIONS: For advanced stage COPD with bilateral bullae, contralateral LVRS may be performed immediately after single lung transplantation. In patient with bilateral cysts only, the resection of the contralateral cysts may be avoided if there is no severe infection.

[Single lung transplantation for emphysema: analysis of 6 cases].

OBJECTIVE: To review the experience with the management of single lung transplantation for emphysema. METHODS: Between January 2003 and August 2006, single lung transplantation was performed in 6 patients for emphysema with cold low potassium solution flushing. A triple-drug regimen was adopted using steroids, mycophenolate mofetil and tacrolimus as the maintenance immunosuppressants. Chest radiograph score, oxygenation index, and pulmonary arterial pressure of the patients in early after the transplantation were reviewed. RESULTS: All the 6 patients survived for over 30 days after the operation, and 4 of them remained alive with good quality-of-life. Four patients recovered from acute rejection successfully after methylprednisolone pulse therapy for 3 days. One patient underwent reoperation for hemorrhage in the thoracic cavity and finally recovered; spontaneous pneumothorax of the autologous lungs occurred in two patients, who underwent reoperation but finally died 74 days and 77 days after the transplantation, respectively. CONCLUSION: Single lung transplantation is effective for end-stage emphysema. Carefully selected recipients and comprehensive design of the surgical procedures are critical to successful lung transplantation.