Surgical management of mediastinal hemangioma: a report of 18 cases / 中华胸心血管外科杂志

Objective To summarize our experience in surgical intervention of patients with mediastinal hemangioma.Methods From January 1994 to August 2017,18 patients underwent surgical treatment were diagnosed with mediastinal hemangioma in our department.There were 9 females and 9 males,with the average age of(50.9 ± 14.0) years.Seven patients were seen with signs and symptoms related to the tumor,and the other 11 patients had no symptom.Three cases were located in the anterior mediastinum,1 case in the middle mediastinum and 14 cases in the posterior mediastinum.All of the cases experienced chest computed tomography(unenhanced or contrast-enhanced CT scan).Most mediastinal hemangiomas manifested as well-marginated masses at CT.Seven hemangiomas showed heterogeneous enhancement at contrast-enhanced CT.Calcifications were demonstrated in 2 patients.Preoperative diagnosis was not confirmed in all patients.Two cases were suspected to be hemangioma preoperatively,other cases were suspected to be thymoma,neurofibroma or malignancy.Eight cases were treated by video-assisted thoracic surgery approach,3 of those converted to thoracotomy due to high risk of hemorrhage.Ten cases experienced traditional thoracotomy.Results Seventeen patients had total excision,but one experienced biopsy because of hemorrhage.There were no operative death and major complications.The average operation time was(105.0 ± 49.6) minutes,and the average blood loss was(111.7 ± 138.9) ml.The postoperative hospital stay was (4.7 ± 3.5) days on average.Follow-up time ranged from 1 to 18 months(median,9.6 months).No recurrence was found in the patients with total excision at the time of follow-up.The patient undergoing biopsy showed no progression of the disease for 12 months.Conclusion Mediastinal hemangiomas were rare tumors,without relatively specific clinical manifestation.Calcification and phleboliths on CT scan were helpful in suggesting the vascular nature of the mass.Preoperative diagnosis of mediastinal hemangioma was usually very difficult.Mediastinal hemangiomas were mainly treated by surgical approach and had good prognosis.

Distribution and clinical significance of EML4-ALK fusion gene in phase Ⅰ lung cancer / 中华胸心血管外科杂志

Objective To detect the mutation frequency of EML4-ALK fusion gene in lung cancer patients, and to inves-tigate the distribution of mutation character for EML4-ALK fusion gene in Ⅰ stage lung cancer patients and clinical features as well as provide a reference for the individual treatment of lung cancer .Methods 256 fresh tumor tissue specimens of lung cancer patients were screened from the specimen bank of our hospital and all the patients had accepted the surgical treatment from February 2013 to December 2014.Total RNA was extracted and then be transcribed into cDNA, the amplification-refrac-tory mutation system(ARMS) was used to detect mutation of EML4-ALK fusion gene.The results according to the positive con-trol, negative control and RNA quality control for EML4-ALK fusion type were analyzed.Results During the 256 patients ofⅠ stage lung cancer, there were 17 patients(6.64%) had mutations in EML4-ALK fusion gene.In lung adenocarcinoma mu-tation rate(16/207, 7.73%) was higher than that of lung squamous cell mutation rate(1/39, 2.56%), lung adeno-squamous mutation rate(0/4, 0) and large cell carcinoma(0/5, 0) of the mutation rate;young lung cancer patients( <63 years) of the mutation rate(14/139, 10.07%) was significantly higher than the high age of lung cancer patients(≥63 years old) mutation rate(3/117, 2.56%), P =0.009.EML4-ALK fusion with tumor invasion and visceral pleura group incidence (9/80, 11. 25%) was significantly higher than that of non-invasive and visceral pleura group incidence rate(8/176, 4.55%), P =0.045.Conclusion The occurence of EML4-ALK fusion correlates with patients’ age as well as whether visceral pleura is in-vaded, type 1 EML4-ALK fusion was detected more in phase I lung cancer patients.

Surgical treatment of bronchial stricture due to endobronchial tuberculosis: results in 81 consecutive cases / 中华胸心血管外科杂志

Objective Severe bronchial stricture due to endobronchial tuberculosis is often accompanied by complex complication,such as obstructiv pneumonia,destroyed lung and bronchiectasis.Its treatment is very diffucult.The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis.Methods Reviewed the clinico-pathological records documenting the surgical outcomes in 81 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 1990 and December 2010.There were 29 male and 52 female.Mean age was(36 ± 12) years (ranged 16-66 years).The three most common reasons of surgery were bronchial stricture accompanied by pulmonary atelectasis,destroyed lung and bronchiectasis(76 cases,93.8％).79 cases had elective operation,whereas one patients required emergency surgery.Pueumonectomy in 51,lobectomy in 16,sleeve resection in 11,segmental resection in 2,and exploratory thoracotomy in 1.If frozen pathological examination showed that endobronchial tuberculosis remained in the bronchial stump,it was covered with muscle flaps,including intercostal muscle flap in 6 cases,latissimus dorsi muscle flap in 5 cases,serratus anterior muscle flap in 5 cases.The mean operative time was 3.2 h (range between 2 h and 5.5 h) and the blood loss averaged 546 ml (range between 100ml and 4 000 ml).The post operative hospital stay averaged(12 ±8)days.Results No intraoperative or early postoperative death occurred.Nine patients developed complications,including BPF in 2,pulmonary infection in 2,empyema in 1,hemorragic shock in 1,hemothorax in 1,incision infection in 1,chylothorax in 1.All 9 cases recovered well after treatment.Pathological examination showed that tuberculosis bronchial remained in the brinchial stump in 13 cases.Neither BPF nor empyema occurred in all the 13 cases.Multivariate analysis revealed that destroyed lung was significant risk factor of postoperative complication.There were 3 late deaths.Five year survival rate was 96.2％.Conclusion Surgical treatment is still the recommeded treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its excellent results.It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed into destroyed lung.

Ventilation with cooled carbon monoxide protects non-heart-beating donor rat lungs against worm ischemic injury / 中华器官移植杂志

Objective Lungs from non-heart-beating donors for transplantation require protection against warm ischemic damage.This study investigated the preservative effect of Ventilation with cooled carbon monoxide during warm ischemia in non-heart-beating donor rat lungs.Method 18 rats were divided into a CO group (n =6),which received ventilation with low-dose carbon monoxide at normal temperature during a 4-hour warm ischemic period; a Control group (n =6),which received no ventilation at normal temperature; a cooling CO group (n =6),which received ventilation with cooled carbon monoxide.PaO2,Myeloperoxidase (MPO) activity,Bronchoalveolar lavage (BAL) neutrophil count and the wet-to-dry (W/D) lung weight ratio were recorded in every group.Quantitative real-time RT-PCR was used to analysis the expression of IL-1β and caspase 3 mRNA in graft lung tissures.Result Endobronchial temperatures and lung surface temperatures in the Cooling CO group were lower than those in the corresponding Control group and CO group (P＜ 0.01).Lower wet/dry lung weight ratio,MPO activity,BAL neutrophil count,expression of IL-1β and caspase 3 mRNA in graft lung tissures were seen in the Cooling group compared with the Control group and CO group (P＜0.05).Conclusion Ventilation with cooled carbon monoxise can decrease lung temperature and improve the protecting effect on non-heart-beating donor rat lungs againt worm ischemic injury by inhibiting the expression of proimflammatory factor IL-1β and apoptosis-associated gene caspase 3.

A clinical model to estimate risk factor of early BPF after pneumonectomy for NSCLC / 中华胸心血管外科杂志

Objective To evaluate prognostic factors for early bronchopleural fistula after pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after pneumonectomy for NSCLC.

Tracheal sleeve pneumonectomy for bronchogenic carcinoma invading the carina / 中华胸心血管外科杂志

ObjectiveBronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management.Aim of this paper is to examine complications and long-term survival of our personal series and those reported in literature.MethodsBetween 1985 and 2010,48 patients underwent carinal resection:a right tracheal sleeve pneumoneetomy was performed in 47 patients and a left tracheal sleeve pneumonectomy in 1 patient.The anastomosis was performed with aid of high-frequency jet ventilation or introfield tube ventilation.ResultsOverall morbidity and mortality rate was 25％ and 6.3％ respectively,and there was no death in operation.5-yearsurvival rate of patients with squamous and adenocarcinoma was 27.3％ and 12.5％,respectively,P =0.04.The overall 5-year survival rate was 24.3％.Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival:52％,13％ and 0,respectively).Multivariate analysis showed that nodal status was the only independent prognostic factor( P =0.006 ).ConclusionWith careful selection of patients and meticulous surgical technique,Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity,proriding good long-term results.

Surgical repair of early bronchopleural fistula after pulmonary resection / 中华胸心血管外科杂志

Objective Bronchopleural fistula (BPF) is a common but potentially lethal complication after pulmonary resection.Currently,there is still controversy over the appropriate management strategy for BPF,especially when pleural space contamination develops.The purpose of this study was to evaluate the efficacy and safety of surgical repair fistulas combined with pedicled muscle flaps coverage in patients with early BPF after pulmonary resection based on our experience with 23 cases.Methods The clinical data for 23 patients who underwent surgical repair of early BPF from January 1999 to December 2010 at our hospital were reviewed.Thirteen patients had undergone a prior pneumonectomy and 10 patients had undergone a prior lobectomy.BPF occurred from postoperative day 5 to40 (mean postoperative day 21 ).Nine patients had a contaminated pleural space.After BPF was clearly diagnosed,prompt closed pleural drainage was instituted,followed by surgical repair of BPF.Four patients underwent a direct suture repair of fistula,ten patients underwent stump revision and suture closure,seven patients underwent stump revision and bronchoplasty or carina plasty,and a pedicled muscle flap was sewn to the edges of the fistula in two patients.The stump was covered with various muscle flaps,including interostal muscle flap in five cases,latissimus dorsi muscle flap in ten cases,serratus anterior muscle flap in six cases,and erector spinae muscle flap in two cases.Postoperatively,the pleural space was routinely irrigated and drained.Results No intraoperative or early postoperative death occurred.Four patients developed severs complications,including respiratory failure in two cases,pulmonary embolism in one case,and empyema in one case.All four cases recovered well after treatment.The mean duration of hospitalization was 33 days (range 8 - 120 days ).Surgical repair of BPF was successful in 21 cases (91.3％) but failed for 2 patients..BPF recurrence developed in only one patient two years postoperatively due to stump recurrence.He died of extensive metastatic disease 2 years after BPF recurrence.Conclusion Excellent results can be achieved by early surgical repair combined with stump pedicled muscle flaps coverage in patients with BPF who can tolerate reoperation,even if they have a contaminaled pleural space.

Lung transplantation in 42 cases:an 8-year experience in a single center / 中华胸心血管外科杂志

Objective To evaluate the complications and prognostic factors of lung transplantation performed in a single center.Methods A rettospective analysis of demographic and outcome data of lung transplantation was performed.Survival analyses were performed using Kaplan-Meier estimation.Results Between January 2003 and April 2011,42 lung transplant procedures were performed.Overall survival rate at 1,3,and 5 years were 89％,59％ and 38％,respectively.1,3,and 5 years survival in patients with COPD was 83％,66％ and 45％,respectively,which were better than other primary end stage lung diseases ( 78％,17％ and 17％,respectively,P =0.013).Postoperative complications included pulmonary bacterium infection in 8 patients (20％),fungal infection in 12 (30％),and airway complications in4 (9.5％).35％ of patients had at least 1 episode of acute rejections within the first year,and 22.5％ of patients had BOS.2 patients underwent single lung retransplantation.Conclusion In this single center study,patients with COPD may have a good long-term survival.The most common postoperative complications were pulmonary infection and airway complication.

Prognosis and staging of non small ceil lung cancer that extends across the fissure into adjacent Iobe / 中华胸心血管外科杂志

Objective To determine the prognosis and staging non small cell lung cancer (NSCLC) that extends across the fissure into adjacent lobe after surgery.Methods 3752 patients with histopathologically confirmed non small cell lung cancer (NSCLC) received surgical reeessetion from January,1997 to April,2007.Among them,163 patients have a tumor invasion beyond fissure.After matching by pathologic TNM staging (7th),326 patients whose tumor defined in a single lobe were eligible for analysis.Results Histopatholngic staging of matched patients was I a:10 patiens(6.1％ ),I b:79 patients (48.5％),Ⅱa:5 patients (3.1％ ),111:44 patients (27.0％) and Ⅲa:25 patients( 15.3％ ).5 years survival in patients with stage 1 tumors crossing the interlobar fissure was 51％,while in patients not cross the interlobar fissure was 63％ ( P ＜0.05 ).There was no difference in survival for tumors stage Ⅱa and above with regard to importance of interlobar extension.The T2 tumor extending across a lung fissure had a reduction in survival compared with T2 tumor not cross the lung fissure and similar to the T3 tumor without the fissure invasion.Conclusion Our results suggest that TNM staging should be modified for tumor extends the fissure into adjacent lobe.

Comparison of stage Ⅰ bronchioloalveolar carcinoma and adenocarcinoma of the lung: clinical charteristics, recurrences, and survival / 中华胸心血管外科杂志

Objective To compare the clinic characteristics, recurrences and prognosis in patients with stage Ⅰ bronchioloalveolar carcinoma (BAC) and adenocarcinoma of the lung. Methods The data of 56 patients with stage Ⅰ BAC and 169 patients with stage Ⅰ adenocarcinoma were analyzed retrospectively. Results The overall 1-, 3-, 5- year survival rates were 94.7%, 83.5% and 61.2%, respectively. Compared with adenocarcinoma of the lung, BAC showed a better survival rate(x2 =6.36, P =0.012). After surgery patients with BAC were prone to develop intrathoracic recurrence, and adenocarcinoma was equal between intrathoracic recurrence and extrathoracic metastasis. The rate of intrathoracic recurrence and extrathoracic metastasis between BAC and adenocarcinoma was significantly different (14/16 vs. 27/59, x2 =8.85, P=0.004). In both group, preoperative asymptomatic patients had better survival rate(x2 = 7.28, P = 0.007; x2 = 6.07, P = 0. 014). Univariate analysis indicated that sex, age(< 60 years and ≥60 years), location of tumor and smoking history did not significantly influence survival in patients with stage Ⅰ BAC or adenocarcinoma (P > 0.05). Conclusion The prognosis of stage Ⅰ BAC is superior to that of stage Ⅰ adenocarcinoma. BAC is prone to develop intrathoracic recurrence, and adenocarcinoma is equal between intrathoracic recurrence and extrathoracic metastasis. Early diagnosis of lung cancer could improve long-term survival.

Simultaneous lung volume reduction surgery in the treatment of lung volume mismatch after single lung transplantation / 中华器官移植杂志

Objective To investigate the effectiveness and safety of simultaneous lung volume reduction surgery in the treatment of lung volume mismatch after single lung transplantation. Methods Twenty-four single lung transplantations were performed on 20 male and 4 female patients, with a mean age of 54. 6 ± 12. 2 years (ranging from 28 to 75 years). Indications for transplantation included end-stage chronic obstructive lung disease (COPD) in 14 cases, COPD combined with upper lobe lung destruction in 1 case, COPD combined with pneumoconiosis in 1 case, end-stage interstitial pulmonary fibrosis in 6 cases, lymphangioleiomyomatosis (LAM) in 1 case, and post-transplantation bronchiolitis obliterans syndrom (BOS) in 1 case. Sixteen cases had right-side and 8 cases had left-side lung transplantation. Lung volume reduction surgeries were performed through open thoracotomy. Graft lung volume reduction was carried out through the same incision as transplantation, and native lung volume reduction through a small anterior lateral incision contralaterally. Patients were divided into lung volume reduction group (group Ⅰ) and control group (group Ⅱ). There were 8 cases in group Ⅰ,including 5 graft lung, 2 native lung, and 1 graft and native lung volume reduction surgeries. In group Ⅱ, there were 16 cases that had no further treatment for lung volume mismatch. Differences in various clinical parameters between the two groups were compared. Results Two out of 14 (14.3%) patients with COPD accepted lung volume reduction, which was significantly lower than that in patients with other diseases (6 out of 10, 60%, P＜0. 05). Post-transplantation chest X-ray showed that 50.0% and 25% of patients had an undeflected mediastinum in group Ⅰ and group Ⅱ, respectively (P＜0. 05).None of the other clinical parameters had significant difference between the two groups (P＞0.05).But a tendency of increase in mechanical ventilation, chest tube drainage time, air leak time, volume of chest drainage, and a tendency of decrease in times and volume of thoracentesis could be observed in group Ⅰ. Lung function test was not performed on 8 cases after transplantation. Sixteen cases (4 in group Ⅰ, 12 in group Ⅱ) had complete lung function data. There was no significant difference in FEV1 improvement after lung transplantation between the two groups (P＞0. 05). Conclusion Simultaneous graft or native lung volume reduction surgery is a safe and effective way of ameliorating lung volume mismatch after single lung transplantation, probably by improving ventilation-perfusion ratio.

Clinical characteristics and prognosis analysis of pulmonary carcinosarcoma (a report of 48 cases) / 中国肺癌杂志

<p><b>BACKGROUND</b>Pulmonary carcinosarcoma (PCS) is a rare pulmonary mixed malignant tumor. The aim of this study is to explore the clinical characteristics and prognosis of 48 patients with PCS.</p><p><b>METHODS</b>The data of 48 patients with PCS from 1986 to 2004 were analysed retrospectively. Then their prognostic factors were analysed statistically.</p><p><b>RESULTS</b>PCS occurred usually in males over 50 years old, often in the right lungs. The clinical and radiographic characteristics of PCS were similar to primary non-small cell lung cancer. Its diagnosis was mainly verified by postoperative pathologic findings and immunohistochemical staining. The 1-, 3- and 5-year survival rate was 77.1%, 49.5% and 22.7% respectively. The multivariate prognosis analysis and Chi-square test showed that TNM stage was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>TNM stage is an independent prognostic factor for PCS, so it is necessary to operate surgically in early stage to prolong the survival time of patients.</p>

Clinical analysis of 15 patients with pulmonary malignant fibrous histiocytoma / 中国肺癌杂志

<p><b>BACKGROUND</b>Pulmonary malignant fibrous histiocytoma (MFH) is very rare and it is worthy to study the clinical characteristics, treatment method and prognosis of primary pulmonary MFH.</p><p><b>METHODS</b>Fifteen patients with primary pulmonary MFH were reviewed retrospectively.</p><p><b>RESULTS</b>There were 10 males and 5 females. Their ages were 56.2 years±14.0 years (20-72 years). MFH mainly manifested as cough, hemoptysis, fever, chest pain and breathlessness. The diameters of tumors were 8.3 cm±8.0 cm, ranged from 0.3 to 35 cm. All the patients received surgical operations, including 5 pneumonect-omy, 8 lobectomy and 2 exploration. The overall 1-, 3-and 5-year survival rate of 15 patients was 56.2%, 24.1% and 16.7% respectively. Incomplete surgical excision of tumor significantly influenced survival.</p><p><b>CONCLUSIONS</b>Pulmonary MFH is a high-grade malignant tumor with poor prognosis, and surgery is the main treatment method.</p>

Tracheal and carinal resection and reconstruction in the treatment of lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Tracheal and carinal resection and reconstruction is an important way in treatment of lung cancer invading trachea and carina. The aim of this study is to summarize the method and effect of tracheal and carinal resection and reconstruction in treatment of lung cancer.</p><p><b>METHODS</b>Seventy-three patients with lung cancer who underwent tracheal and carinal resection and reconstruction were retrospectively analyzed. There were 22 cases for right pneumonectomy and carinal resection, 14 cases for right pneumonectomy and tracheobronchoplastic procedure, 12 cases for right sleeve pneumonectomy, 15 cases for tracheobronchoplastic procedure plus right upper lobectomy, 2 cases for left sleeve pneumonectomy and 8 cases for left pneumonectomy and tracheobronchoplastic procedure.</p><p><b>RESULTS</b>Four cases received palliative operation. Four patients (5.48%) died in the perioperative period. The 1-, 3-and 5-year survival rate was 75.3%, 63.0% and 23.3% respectively.</p><p><b>CONCLUSIONS</b>Careful preoperative assessment, skillful operation and appropriate postoperative treatment are helpful to improve the outcome of tracheal and carinal resection and reconstruction for lung cancer.</p>

Immunohistochemical analysis of P14ARF protein expression in non-small cell lung cancer: its prognostic significance / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate immunoexpression of P14ARF protein in non-small cell lung cancer (NSCLC) and to evaluate the prognostic significance.</p><p><b>METHODS</b>Thirty-nine tumor specimens were immunohistochemically examined with FL-132 antibody against P14ARF protein.</p><p><b>RESULTS</b>P14 nuclei immunoexpression was found in 25 tumor specimens (64.1%). The patients in stage I and II had a much higher P14 expression rate than the patients in stage III and IV [78.0%(18/23) vs 43.8%(7/16) P =0.043]. The P14 expression rate in patients with and without metastasis was 78.3%(18/23) and 43.8%(7/16) respectively (P=0.043). The mean survival time of patients without P14-immunopositive staining was significantly shorter than that of patients with P14-immunopositive staining (17 months vs 45 months, P=0.023 5).</p><p><b>CONCLUSIONS</b>Patients with the expression of P14ARF protein have a better prognosis. Detection of P14ARF protein in lung cancer tissues may be helpful to predict the prognosis of NSCLC.</p>

A clinicopathologic study on neoadjuvant chemotherapy in the treatment of non-small-cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To explore the clinicopathological changes of non-small cell lung cancer tissues after neoadjuvant chemotherapy with MVP (MMC+VDS+DDP) regimen and its concordance with clinical evaluation, and to study the clinical value of neoadjuvant chemotherapy.</p><p><b>METHODS</b>A total of 84 patients with NSCLC were randomized into combinated therapy group (42 cases) and surgical group (42 cases). The combinated therapy group were given MVP regimen for 2 cycles before operation and 2-4 cycles after operation, however, the surgical group only received surgical treatment. The efficacy of preoperative chemotherapy were determined by pathologic examination under light microscope and electron microscope and clinical evaluation.</p><p><b>RESULTS</b>Combinated therapy group showed various degrees of degeneration and necrosis of tumor cells, which was not found in surgical group. The overall response rate of neoadjuvant chemotherapy was 59.5% (25/42) by both pathological and clinical evaluation. The coincidence ratio of the two evaluation methods was 71.4% (Kappa value=0.407,P < 0.01). Between the two groups, there was a significant difference in total survival rate (P=0.047). And further analysis showed that survival rate was remarkably different in patients with stage III between the two groups (P=0.037), but not in those with stage I and II (P > 0.05).</p><p><b>CONCLUSIONS</b>Degeneration and necrosis with fibrosis are the main pathological phenotypes of the primary lesion after induction chemotherapy, which can be showed by clinical evaluation to chemotherapy efficacy. The preoperative and postoperative adjuvant chemotherapy may be benefical to patients with stage-III NSCLC.</p>

Detection of micrometastasis in lymph nodes of patients with non-small-cell lung cancer: its biological significance / 中国肺癌杂志

<p><b>BACKGROUND</b>To evaluate the biological significance of the lymphnode micrometastasis in non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>Ninety regional lymph nodes indicated to be tumor free by conventional histopathologic methods were taken from 39 patients who underwent pulmonary resection for NSCLC. CK immunohistochemical staining was used to detect the micrometastatic tumor cells in lymph nodes. Expressions of p53, p21(ras) and Ki67 in primary pulmonary lesions were also detected by immunochemical methods.</p><p><b>RESULTS</b>Micrometastasis were found in 26 lymph nodes (28.89%) of 22 patients (56.4%). The proportion of patients with micrometastasis whose primary lesions had the expressions of p53, p21(ras) and Ki67 was higher than those without micrometastasis whose primary lesions had no expressions of p53, p21(ras) and Ki67. The proportion of patients with micrometastasis whose tumor size was more than and less than 3 cm was 55.6% and 58.3% respectively (P=1.000).</p><p><b>CONCLUSIONS</b>Expressions of p53, p21(ras) and Ki67 in primary pulmonary lesions has certain relations with micrometastasis in lymph nodes.</p>

The staging of pulmonary angiography with the multi-slice spiral CT: to evaluate its significance in cancerous invasion of central pulmonary artery in lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To explore the possibility of the staging of pulmonary angiography with multi slice spiral CT (MSCT) and to evaluate its value in making surgical plan for patients with lung cancer.</p><p><b>METHODS</b>MSCT with two-segment injection and three-protocol scan was performed in 73 patients with central type lung cancer. According to the site and degree, the involvement of pulmonary artery was divided into three grades and blindly compared with the surgery and pathology.</p><p><b>RESULTS</b>MSCT in 68 cases (93.15%, 68/73) was successfully performed. The involvement of central pulmonary artery was grade I in 4 cases (5.88%, 4/68), grade II in 9 (13.23%, 9/68), and grade III in 55 (80.88%, 55/68). All patients with grade I underwent lobectomy. There was remarkable difference of lobectomy ratio between grade II and III (Chi-square=64.03, P < 0.005) and also between IIIa and IIIb (Chi-square=68.69, P < 0.005). All patients with grade IIIc were ruled out from surgery.</p><p><b>CONCLUSIONS</b>The staging of pulmonary angiography by MSCT is useful to demonstrate the site and degree of involvement of central pulmonary artery and provides more precise evidence of images for making surgical plan.</p>

Single lung transplantation in treatment of severe emphysema / 中华胸心血管外科杂志

Objective: To treat the senile severe emphysema by single lung transplantation. Methods: The candidate was a 63-year-old male patient who had suffered from severe dispnea for more than 23 years and experienced an advancing exacerbation during the last 3 years. He showed very poor lung function and other related clinical date the pre-operative clinical examination: FEV 1 was 0。64L (24%), PaO 2 was 45 mm?Hg, PaCO 2 was 36。3 mm?Hg, pulmonary artery pressure is 38 mm?Hg, 6MMT was 59 m and dispnea staging was 4. An allograft left lung transplantation was performed under general anesthesia in January 9th, 2003. Three immunosuppressors were given to the recipient orally after the operation. Results: 6 months after lung transplantation, the recipient showed a significant clinical relief and lung function improvement: FEV 1 is 1.20L (40%), PaO 2 is 92 mm?Hg and 6MMT is 227 m. Conclusion: The single lung transplantation is efficient in treating the end-staged emphysema.

Aspergillosis infection in lung transplant recipients (4 cases report and review of the literature) / 中华胸心血管外科杂志

Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postopearative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphotericin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphotericin B prevent fungal infection during the early postoperative period of lung transplantation.