Diagnosis and multi-modality treatment of adult pulmonary plastoma: Analysis of 18 cases and review of literature

The clinical data of 18 patients with PB from April 1989 to April 2013 was analyzed retrospectively, including 11 men and 7 women, aged 45 and 76 years old (mean 53 years). There were 12 cases of PB occurring in right lung and other cases in left lung. Among them, 3 patients had no symptoms, and 15 patients displayed symptoms of cough, chest pain, asthenia or minor haemoptysis. Overall, 11 patients had a preoperative diagnosis of lung cancer, 7 patients were preoperatively diagnosed as the other diseases, which included lung benign tumor (n=5) and mediastinal mass (n=2). All patients received a radical resection. Six patients received postoperative cisplatin-based chemotherapy, and two patients received postoperative irradiation with the dose of 55 Gy. Histologically, 14 cases of 18 patients had biphasic pulmonary blastoma and four cases had well differentiated fetal adenocarcinoma. A total of 12 patients died in a period of 6-36 months after operation, and 1 case was lost after 2 years of follow up. The median survival time was 19 months. PB is a rare primary lung malignant embryonal neoplasm. Despite its assumed embyonal origin, the tumor has a predilection for adults. A preoperative correct diagnosis is very difficult in spite of modern diagnostic imaging and biopsy techniques. Surgical resection is the main method for diagnosis and treatment. Postoperative chemotherapy or irradiation can help eliminate tumor remnants. Its prognosis is very poor, especially for the biphasic type.

Association between folate intake, serum folate levels and the risk of lung cancer: a systematic review and meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Folate plays a critical role in nucleotide synthesis and DNA methylation, and was considered to be associated with anti-carcinogenesis.</p><p><b>RESULTS</b>from studies that concern the relationship between the folate intake or serum folate levels and lung cancer risk showed no consistency, which requires our further comprehensive meta-analysis.</p><p><b>METHODS</b>Systematic literature search was conducted to identify the relevant studies (published prior to February 2013) according to standard protocol. Estimated effects were calculated under both random-effects and fixed-effects models. Heterogeneity between studies and publication bias were also evaluated.</p><p><b>RESULTS</b>A total of 4390 cases and 6138 controls from 6 case-control studies revealed a significant overall inverse association between folate intake and lung cancer risk (OR = 0.74, 95%CI = 0.65 - 0.84, P < 0.001). Summary of 1438 cases and 2582 controls from 4 case-control studies and 44 cases out of a cohort of 1988 participants suggested a marginal association without significance (OR = 0.78, 95%CI = 0.60 - 1.02, P = 0.075) between high serum folate levels and less lung cancer susceptibility; however, subgroup analysis about population-based case-control studies showed that high serum folate levels significantly associated with the reduced lung cancer risk (OR = 0.76, 95%CI = 0.58 - 1.00, P = 0.048).</p><p><b>CONCLUSION</b>Higher folate intake can be a protective factor against lung cancer risk, and higher serum folate level is probably associated with reduced lung cancer risk in marginal manner, though more studies are warranted to confirm these associations.</p>

Treatment of 336 cases of chest trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To summarize the clinical features, diagnosis and treatment of chest trauma.</p><p><b>METHODS</b>A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011.</p><p><b>RESULTS</b>Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respiratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas.</p><p><b>CONCLUSIONS</b>(1) For patients with severe chest trauma, early emergency treatment is crucial to save life. (2) Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphragmatic injury. In addition, operative timing and method should be well chosen. (3) Pulmonary contusion is one of common complications in chest trauma, for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.</p>

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer

OBJECTIVE@#To explore the clinical characteristics, surgical treatment and prognosis of non-small cell lung cancer (NSCLC) among elderly patients over 80 years.@*METHODS@#The clinical data, surgical methods, perioperative management, postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed.@*RESULTS@#Out of 52 cases, 27 had a long-term smoking history (51.9%) and 44 were with other diseases (84.6%). Lobectomy was done in 32 cases (65.4%), sub-lobectomy in 20 cases (38.5%), including pulmonary wedge resection in 16 cases (30.8%) and lung segment resection in 4 cases (7.7%). The postoperative complication rate was 44.2% (23/52); the complication rate after lobectomy was 62.5% (20/32) and that after sub-lobectomy was 25% (5/20), with significant difference between lobectomy and sub-lobectomy (P0.05).@*CONCLUSIONS@#Octogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex. Strictly adhering to indications, surgery is still an important treatment of NSCLC patients over 80.

Combination of single-port thoracoscopy and laparoscopy for the treatment of esophageal carcinoma: report of 6 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the feasibility and early results of radical resection of esophageal carcinoma using single-port thoracoscopy combined with laparoscopy.</p><p><b>METHODS</b>From March 2010 to December 2010, 6 patients with esophageal carcinoma underwent radical resection by single-port thoracoscopy combined with laparoscopy in the General Hospital of People's Liberation Army. With the patients at a supine position, laparoscopy was performed to complete stomach mobilization and abdominal lymph node dissection. Thoracoscopy was then carried out with the patients lying on the left to mobilize the esophagus and dissect thoracic lymph nodes. Finally, the stomach was pulled into the thoracic cavity via the hiatus of the diaphragm to construct a tube-like stomach, which was then anastomosed to the esophagus using the OrVil system.</p><p><b>RESULTS</b>No patient was converted to open surgery during the operation. The total operative time ranged from 200 to 320 min. The mean laparoscopic time was 75(range, 45-90) min, and the mean thoracoscopic time 160(120-240) min. The mean intraoperative blood loss was 220(160-300) ml. The mean lymph node retrieval was 12(9-18). No anastomotic fistula, chylothorax, lung infection were found postoperatively.</p><p><b>CONCLUSION</b>After esophageal resection using single-port thoracoscopic and laparoscopy, reconstruction using OrVil system is safe and feasible.</p>

Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thymectomy is considered the most effective treatment in patients with myasthenia gravis. This study aimed to explore the predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.</p><p><b>METHODS</b>Clinical records of 243 patients with myasthenia gravis who underwent thymectomy were reviewed retrospectively. The following factors were analyzed in relation to the occurrence of myasthenic crisis after thymectomy: gender, age, duration of symptoms, Osserman stage, history of myasthenic crisis, concomitant diseases, preoperative pyridostigmine dose, preoperative steroid therapy, operation approach, operation time, presence of thymoma, major postoperative complications.</p><p><b>RESULTS</b>Forty-four patients experienced postoperative myasthenic crisis during the first month after thymectomy. Univariate analysis revealed that Osserman stage (RR = 0.0976, P = 0.000), history of myasthenic crisis (RR = 0.2309, P = 0.012), preoperative pyridostigmine dose (RR = 0.4349, P = 0.016), thymoma (RR = 0.0606, P = 0.000), and major postoperative complications (RR = 0.1094, P = 0.000) were significantly related to postoperative myasthenic crisis. Multivariate Logistic regression analysis showed that Osserman stage (IIb + III + IV) (RR = 0.0953, P = 0.000), thymoma (RR = 0.0294, P = 0.000), and major postoperative complications (RR = 0.0424, P = 0.000) independently predict postoperative myasthenic crisis.</p><p><b>CONCLUSION</b>Osserman stage (IIb + IIIb + IV), thymoma and major postoperative complications are independent predictors of postoperative myasthenic crisis in patients with myasthenia gravis who underwent thymectomy.</p>

Positron emission tomography with special tracers in pulmonary abnormalities / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of positron emission tomography (PET) with (11)C-choline (CH), (11)C-methionine (MET), (18)F-fluorothymidine (FLT), and (11)C-acetate (AC) in diagnosis of pulmonary abnormalities and the features of pulmonary abnormalities in PET.</p><p><b>METHODS</b>From June 2002 to June 2007, 100 patients with pulmonary nodules or masses confirmed by CT scans received PET with special tracers. Fifty-eight patients received CH-PET, 16 patients received MET-PET, 22 patients received FLT-PET, 4 patients received AC-PET. PET data was analyzed by visual method and semiquantitative method with standard uptake value (SUV). Diagnoses were compared with pathology and follow-up survey.</p><p><b>RESULTS</b>For identification of pulmonary neoplasms with CH-PET, the sensitivity, specificity and accuracy were 84.2% (32/38), 57.9% (11/19) and 75.4% (43/57). In cancer cases, SUV had no correlation with tumor size or age. For identification of pulmonary neoplasms with MET-PET, the sensitivity, specificity and accuracy were 6/7, 6/9 and 75.0% (12/16). In cancer cases, SUV had not correlation with tumor size or age. For identification of pulmonary neoplasms with FLT-PET, the sensitivity, specificity and accuracy were 85.7% (12/14), 2/8 and 63.6% (14/22). In cancer cases, SUV had not correlation with tumor size or age. In AC-PET, only 1 case of pulmonary metastasis of kidney clear cell carcinoma showed acetate avid. Two squamous cell carcinoma and 1 adenocarcinoma didn't appear abnormal in AC-PET.</p><p><b>CONCLUSION</b>CH, MET, FLT, AC are valuable in diagnosing but also lead to false positive and false negative.</p>

Clinical pathological study on nodal micrometastases of non-small-cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the practicability of detecting the micrometastases in lymph nodes of no-small-cell lung cancer (NSCLC) by means of the immunohistochemical (IHC) staining.</p><p><b>METHODS</b>The lymph node samples were taken from the patients with NSCLC during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6 approximately 10 serial sections were chosen, each 5 microm thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin (HE), and the other serial sections were used for the IHC staining examination with the monoclonal antibody against cytokeratin 19.</p><p><b>RESULTS</b>The paraffin embedded sections of 195 regional lymph nodes from 25 patients with NSCLC were examined by HE staining. Thirty lymph nodes in 9 patients revealed gross nodal metastases, and none of lymph node in 25 patients showed micrometastatic tumor cells. Frozen tissue sections from 135 regional lymph nodes that were staged as free of metastases by HE staining were screened by IHC staining. Thirty-one lymph nodes in 9 patients showed micrometastatic tumor cells. Five of sixteen patients staged as PN(0) had hilum lymph nodal micrometastases, versus four of nine patients with stage PN(1) had mediastinal lymph nodal micrometastases. There was a significant difference between two groups (chi(2)=52.900, P=0.0193).</p><p><b>CONCLUSIONS</b>Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of patients with NSCLC, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes of NSCLC, and its assessment of nodal micrometastases can provide a refinement of TNM stage for partial patients with stage I to II NSCLC.</p>

Fluorodeoxyglucose-positron emission tomography in carcinoma of the esophagogastric junction / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) in carcinoma of the esophagogastric junction.</p><p><b>METHODS</b>From December 1998 to April 2002, 27 patients were imaged with FDG-PET and FDG avid masses in the esophagogastric junction were found in every patient. FDG-PET data was analyzed by visual method and standardized uptake value (SUV). FDG-PET results were compared with pathological results and follow-up survey.</p><p><b>RESULTS</b>16 carcinomas of the esophagogastric junction and 11 non-specific FDG-avid masses of normal stomach were all considered malignant by visual method. Maximum and mean Standard uptake value (SUV) of cancer were 6.71 +/- 2.75 and 5.46 +/- 2.31, respectively; SUVmax and SUVmean of non-specific FDG avid mass were 2.99 +/- 0.67 and 2.38 +/- 0.51 respectively; SUV of cancer was higher than that of non-specific FDG avid mass (Z = -4.171, Z = -4.195, P < 0.01).</p><p><b>CONCLUSIONS</b>FDG-PET has limited value in differentiating carcinoma of the esophagogastric junction from non-specific FDG avid mass of normal stomach.</p>