Experiencia en trasplante pulmonar pediátrico en Chile / Experience with pediatric lung transplantation in Chile

El trasplante de pulmón (TP) es una opción para pacientes pediátricos con enfermedades pulmonares terminales. OBJETIVO: Evaluar resultados y sobrevida de pacientes pediátricos trasplantados de pulmón. MÉTODOS: Análisis retrospectivo de registros clínicos de pacientes TP ≤ 15 años de Clínica Las Condes. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post trasplante, complicaciones precoces y tardías y sobrevida. RESULTADOS: Nueve pacientes < 15 años de edad se han trasplantado. La edad promedio fue 12,7 años. La principal indicación fue fibrosis quística (7 pacientes). El IMC promedio fue de 17,6 y todos estaban con oxígeno domiciliario. El 77% utilizó soporte extracorpóreo intraoperatorio. Las principales complicaciones precoces fueron hemorragia y la disfunción primaria de injerto mientras que las tardías fueron principalmente las infecciones y la disfunción crónica de injerto. Cuatro pacientes han fallecido y la sobrevida a dos años fue de 85%. El trasplante les permitió una reinserción escolar y 3 lograron completar estudios universitarios. CONCLUSIÓN: El trasplante pulmonar es una alternativa para niños con enfermedades pulmonares avanzadas mejorando su sobrevida y calidad de vida.

Lung transplantation (TP) is a treatment option in children with terminal lung diseases. OBJECTIVE: To evaluate the results and survival of pediatrics lung transplant patients. METHODS: Retrospective analysis of clinical records of lung transplantation of patients ≤ 15 years from Clínica Las Condes, Santiago, Chile. Demographic data, type of transplant, baseline and post transplant lung function, early and late complications and survival rate were analyzed. RESULTS: Nine patients ≤ 15 years-old were transplanted. The average age at transplant was 12.7 years. The main indication was cystic fibrosis (7 patients). The average BMI was 17.6 and all the patients were with home oxygen therapy. 77% used extracorporeal intraoperative support. Average baseline FEV1 was 25.2% with progressive improvement in FEV1 of 77% in the first year. The main early complications were hemorrhage and primary graft dysfunction, while late complications were infections and chronic graft dysfunction. Four patients have died and the estimated 2 years survival was 85%. They achieved school reinsertion and three managed to complete university studies. CONCLUSION: Lung transplantation is an alternative for children with advanced lung diseases improving their survival and quality of life.

Efficacy of Transcutaneous Electronic Nerve Stimulation in Postoperative Analgesia After Pulmonary Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of the study was to identify the analgesic efficacy and safety of transcutaneous electronic nerve stimulation in postoperative pain after pulmonary surgery. DESIGN: Electronic databases (PubMed, Embase, Web of Science, and CENTRAL) were systematically searched from their inception to June 2019. The continuous variables were pooled as the weighted mean difference with correlated 95% confidence interval. Results were recognized as significant when a P value is less than 0.05. Subgroup analyses, sensitivity analyses, and quality assessment were performed. RESULTS: Altogether, 10 studies were included. The pooled results indicated that transcutaneous electronic nerve stimulation group conferred lower pain intensity score on the first postoperative day (weighted mean difference = -0.93, 95% confidence interval = -1.56 to -0.30, P = 0.004), postoperative day 2 (weighted mean difference = -1.00, 95% confidence interval = -1.64 to -0.35, P = 0.002), postoperative day 3 (weighted mean difference = -0.92, 95% confidence interval = -1.76 to -0.09, P = 0.03), postoperative day 4 (weighted mean difference = -0.90, 95% confidence interval = -1.24 to -0.56, P < 0.001), and postoperative day 5 (weighted mean difference = -1.39, 95% confidence interval = -2.20 to -0.57, P < 0.001) compared with the placebo transcutaneous electronic nerve stimulation group. No publication bias was found. No significant discovery was obtained in sensitivity analyses. CONCLUSIONS: Transcutaneous electronic nerve stimulation might be an effective supplementary analgesic regimen in multimodal analgesia to decrease pain intensity after pulmonary surgery.

[Application of Electromagnetic Navigation Bronchoscopic Biopsy Combined with 
Massage Staining in Diagnosis and Treatment of Peripheral Pulmonary Lesion].

BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL). METHODS: The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old. RESULTS: The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure. CONCLUSIONS: The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.

Effect of Combined Acupuncture Anesthesia on Surgical Dosage and Serum IL-4, IL-10 of Pneumonectomy Patients.

OBJECTIVE: To analyse the effects of combined acupuncture anesthesia on surgical dosage and serum interleukin-4 (IL-4), interleukin-10 (IL-10) of pneumonectomy patients. STUDY DESIGN: A randomised controlled trial (RCT). PLACE AND DURATION OF STUDY: Lanzhou University Second Hospital, Lanzhou, China, from January 2016 to November 2017. METHODOLOGY: A total of 110 patients undergoing pneumonectomy were randomly divided into group A and group B, with 55 cases in each group. Group A was treated with combined 2Hz acupuncture anesthesia, while group B was treated with combined 2Hz/100Hz acupuncture anesthesia. The additional propofol, fentanyl dosage, and changes in heart rate and systolic blood pressure 5 min before and during extubation were compared between the two groups. The serum IL-4 and IL-10 levels were measured 10 minutes after skin incision and 24 hours after surgery using ELISA. Pain was rated by visual analogue scale (VAS) at 24 hours after surgery. RESULTS: There was no statistically significant difference between group A and group B in the intraoperative additional propofol and fentanyl dosags (p=0.541 and 0.719, respectively). There is no statistical difference in heart rate and systolic blood pressure between group A and group B at 5 minutes before and during extubation (p=0.151, 0.660 and 0.734, 0.528, respectively). There is no statistical difference between group A and group B in serum IL-4 and IL-10 levels 10 minutes after surgical incision (p=0.916 and 0.841, respectively). However, serum IL-4 and IL-2 levels in group A are statistically lower than that of group B at 24 hours after surgery (all p<0.001). The VAS score at 24 hours after surgery in group A was 2.44 ±0.71 points, which was significantly lower than that of group B (3.82 ±0.77 points, p<0.001). CONCLUSION: Combined 2 Hz, 2 Hz/100 Hz acupuncture anesthesia need few anesthetic dosages of propofol and fentanyl to stabilise the patient's blood pressure and heart rate when intubated under general anesthesia; but combined 2 Hz acupuncture anesthesia can reduce IL-4 and IL-10 levels during surgery stress to a greater extent than the latter, and can effectively lower patients' serum IL-4, IL-10 expression after surgery.

[The role of the respiratory and relaxation training in the treatment of the patients after the surgical treatment of non-specific pulmonary diseases].

The present study included 62 patients who had undergone the surgical intervention for the treatment of non-specific pulmonary diseases. All the patients were subjected to the psychological and spirometric examination. The study has demonstrated the relationship between the characteristics of the external respiration function on the one hand and the ability to handle stress, the levels of anxiety, tension, emotional instability and hypochondriacal mood on the other hand. It was shown that the respiratory and relaxation training improves the effectiveness of the treatment of the patients presenting with such symptoms due to the correction of their psychological status and optimization of the external respiration function. The highest effectiveness of the respiratory and relaxation training was documented in the patients suffering moderate neurotic disorders.

Surgical Outcomes in a Large, Clinical, Low-Dose Computed Tomographic Lung Cancer Screening Program.

BACKGROUND: Lung cancer screening with low-dose computed tomography is proven to reduce lung cancer mortality among high-risk patients. However, critics raise concern over the potential for unnecessary surgical procedures performed for benign disease as a result of screening. We reviewed our outcomes in a large clinical lung cancer screening program to assess the number of surgical procedures done for benign disease, as we believe this is an important quality metric. METHODS: We retrospectively reviewed our surgical outcomes of consecutive patients who underwent low-dose computed tomography lung cancer screening from January 2012 through June 2014 using a prospectively collected database. All patients met the National Comprehensive Cancer Network lung cancer screening guidelines high-risk criteria. RESULTS: There were 1,654 screened patients during the study interval with clinical follow-up at Lahey Hospital & Medical Center. Twenty-five of the 1,654 (1.5%) had surgery. Five of 25 had non-lung cancer diagnoses: 2 hamartomas, 2 necrotizing granulomas, and 1 breast cancer metastasis. The incidence of surgery for non-lung cancer diagnosis was 0.30% (5 of 1,654), and the incidence of surgery for benign disease was 0.24% (4 of 1,654). Twenty of 25 had lung cancer, 18 early stage and 2 late stage. There were no surgery-related deaths, and there was 1 major surgical complication (4%) at 30 days. CONCLUSIONS: The incidence of surgical intervention for non-lung cancer diagnosis was low (0.30%) and is comparable to the rate reported in the National Lung Screening Trial (0.62%). Surgical intervention for benign disease was rare (0.24%) in our experience.

[Clinical research of lung resection surgery with microinjection acupuncture and drug anesthesia instead of traditional acupuncture anesthesia].

OBJECTIVE: To explore the feasibility and safety on lung resection surgery with the combined method of microinjection acupuncture (MIA) and intravenous anesthesia instead of compound traditional acupuncture and drug anesthesia (ADA). METHODS: Ninety cases of lung resection surgery were randomized into a general anesthesia group, a MIA group and a ADA group, 30 cases in each one. In the general anesthesia group, before surgery, the intramuscular injection of atropine 0. 5 mg was used; during surgery, the anesthesia induction was followed with intravenous injection of fentanyl citrate, propofol and rocuronium bromide and the dosage was increased accordingly; after surgery, the analgesia pump was applied. In the MIA group, on the basis of general anesthesia, before anesthesia induction, the acupoint catgut embedding was applied to Jiaji (EX-B 2) of T4 , T6 and T, , Feishui (BL 13), Xinshu (BL 15) and Geshu (BL 17) on the affected side and bilateral Quchi (LI 11) and Zusanli (ST 36); after surgery, the analgesia pump was applied. In the ADA group, on the basis of general anesthesia, before! anesthesia induction, electroacupuncture (EA) was applied to Hegu (LI 4), Neiguan (PC 6) , Houxi (SI 3) and Zhigou (TE 6) for 30 min; during surgery, EA and intravenous medication were combined at the same acupoints as those before surgery; after surgery, moxibustion and the analgesia pump were applied in combination for analgesia. In each group, the biological indices were monitored during surgery at 11 time points named T. (before anesthesia I induction), T1 (intubation in general anesthesia induction), T2 (skin incision), T3 (rib exposure in muscular incision) T. (chest open), T, (lung removal), T6 (drainage tube implantation), T7 (chest closure), T (muscular stitching), T, (skin stitching) and T0 (extubation). The actual dosage of anesthetics during surgery and the, dosage of fentanyl citrate in analgesia pump were quantified after surgery. Results (1) In the MIA group and ADA group, the increased dosage of fentanyl citrate was less than that in the general anesthesia group [(1. 23±0. 28) µg . kg-1 . h-1 vs (2. 4±0. 54µg. kg-1 . h-1, (1. 1±0. 38µg . kg-1 . h-1 vs (2. 4±0. 54µg. kg-1 . h-1 , both P<0. 05]. The increased dosage of propofol and rocuronium bromide was not different during surgery among the groups (all P>0. 05). (2) In the MIA group and ADA group, after surgery, the increased dosage of fentanyl citrate was less than that in the general anesthesia group [(11. 0±1. 04)µg/kg vs (15. 4±1. 52µg/kg, (11. 5±1. 38µg/kg vs (15. 4±1. 52µg/kg, both P<0. 05], reducing by 25% in comparison. (3) The differences in heart rate and blood pressure at 11 time points during surgery were not significant among the three groups (all P>0. 05). CONCLUSION: n The combined method of MIA and intravenous anesthesia significantly reduces the dosage of intravenous anesthetics during and after lung resection surgery as compared with ADA, presenting the similar analgesic effect as simple intravenous medication and the good safety. The combined method of MIA and intravenous anesthesia is much

Autologous blood patch for persistent air leak in children.

PURPOSE: Persistent air leak (PAL) is associated with increased morbidity. Standard treatment of PAL includes chemical or mechanical pleurodesis. Long-term impact of these interventions is not known in the pediatric population. Autologous blood patch (ABP) offers a novel treatment option. We report our experience with autologous blood patch to successfully treat PAL in eight children. METHODS: Children with PAL were treated with ABP. A fresh whole blood sample was obtained from each patient and injected via their pre-existing chest tube. Volume of blood injected, time to cessation of air leak, time to chest tube removal, outcomes and complications were reviewed. RESULTS: Eight children aged 2 months to 18 years underwent ABP. Three children had immediate seal of air leak, while two patients sealed after 1 and 2 days. Three patients required a second ABP, after which they had immediate seal of air leak. Chest tubes were removed within 2-3 days in 7 cases. One child developed an asymptomatic pneumothorax and required 8 days for radiographic resolution. CONCLUSION: ABP appears to be a safe and effective treatment option for PAL in children. ABP offers an inexpensive, easy to perform technique and avoids use of toxic chemicals for pleurodesis in pediatric patients.

[Influence of acupuncture-drug compound anesthesia with different frequency electroacupuncture on immune function in patients undergoing pneumonectomy].

OBJECTIVE: To explore different frequency electroacupuncture in acupuncture-drug compound anesthesia on analgesic effect and immune function in the pulmonary resection patients in order to recommend the best electroacupuncture frequency in acupuncture-drug compound anesthesia. METHODS: One hundred and sixty-three patients scheduled for pneumonectomy were randomly divided into group A (n = 31), B (n = 34), C (n = 32), D (n = 34) and E (n = 32). Houxi (SI 3), Zhigou (TE 6), Neiguan (PC 6) and Hegu (LI 4) were selected in the five groups. Group A was treated with sham acupuncture by pasting needles without needle bodies at acupoints and electroacupuncture at the needle handle, and group B with 2 Hz electroacupuncture, and group C with 2 Hz/ 100 Hz electroacupuncture, and group D with 100 Hz electroacupuncture, and group E with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation, and general anesthesia was produced in all the groups followed by 30 min electrical stimulation and the stimulation was lasted till the end of operation. The dosages of the anesthetics and the changes of surface antigen of leukomonocyte (CD3+ , CD4+ , CD8+ and CD4+/CD8+) and natural killer (NK) cell were observed at 1 day before surgery, intraoperative and 1 day after surgery. RESULTS: In comparison with group A, the dosages of Propofol in group B and D were decreased, Fentanyl in group B, D and E were decreased. CD3+ and CD4+ in 5 groups increased at first and then decreased over time (all P < 0.01), and group E and C could inhibit the decrease of CD3+ and CD4+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and D could inhibit the decrease of CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD4+/CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and C could inhibit the decrease of CD4+/CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). NK cells of 5 groups were increased gradually in different times (all P < 0.01), with the similar regulation of NK cells (all P > 0.05). CONCLUSION: Acupuncture-drug compound anesthesia with 2 Hz and 100 Hz electroacupuncture together with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation have the best analgesic effect, and 2 Hz/100 Hz transcetaneous acupoints electrical stimulation and 2 Hz/100 Hz electroacupuncture have the best regulation of immune function. Acupuncture-drug compound anesthesia with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation is recommended for that it can not only decrease the dosages of the anesthetics, but also significantly improve the immunosuppression in patients undergoing pneumonectomy.

Animal models and medical countermeasures development for radiation-induced lung damage: report from an NIAID Workshop.

Since 9/11, there have been concerns that terrorists may detonate a radiological or nuclear device in an American city. Aside from several decorporation and blocking agents for use against internal radionuclide contamination, there are currently no medications within the Strategic National Stockpile that are approved to treat the immediate or delayed complications resulting from accidental exposure to radiation. Although the majority of research attention has focused on developing countermeasures that target the bone marrow and gastrointestinal tract, since they represent the most acutely radiosensitive organs, individuals who survive early radiation syndromes will likely suffer late effects in the months that follow. Of particular concern are the delayed effects seen in the lung that play a major role in late mortality seen in radiation-exposed patients and accident victims. To address these concerns, the National Institute of Allergy and Infectious Diseases convened a workshop to discuss pulmonary model development, mechanisms of radiation-induced lung injury, targets for medical countermeasures development, and end points to evaluate treatment efficacy. Other topics covered included guidance on the challenges of developing and licensing drugs and treatments specific to a radiation lung damage indication. This report reviews the data presented, as well as key points from the ensuing discussion.

Local anaesthetic thoracoscopy for intractable pneumothorax in a high-risk patient.

The management of high-operative-risk patients with a pneumothorax is complicated. The case of a 79-year old man with an intractable secondary pneumothorax, who had taken oral steroids to control asthma, is presented. Since the patient could not tolerate general anaesthesia because of poor cardiac function, thoracoscopic surgery was performed under local anaesthesia. A successful lung fistula closure was achieved and the continuous air leakage disappeared immediately after the surgery.

Vitamin D deficiency in lung transplant patients: is it important?

BACKGROUND: Vitamin D deficiency has been reported in different chronic pulmonary diseases like asthma and chronic obstructive pulmonary disease, but little is known in lung transplant recipients. METHODS: Serum 25-hydroxyvitamin D (25-OHD) levels and pulmonary function (forced expiratory volume in 1 sec [FEV(1)] %predicted) were measured in 131 lung transplant patients during their yearly posttransplant check-up hospital stay, and the total number of infections and perivascular/peribronchiolar rejections were assessed from transplantation on. RESULTS: Vitamin D deficiency (<30 ng/mL) occurred in 62 of 131 patients (47.3%), of whom 26 (19.8%) were severely deficient (<20 ng/mL). The FEV(1) was significantly lower in the deficient group compared with the group with normal levels (P=0.019). Moreover, we could find an association between FEV(1) and 25-OHD levels in univariate analysis (P=0.018), which remained significant in multivariate analysis (P=0.012). The same holds true for the association between 25-OHD levels and the peak postoperative FEV(1) (P=0.021 in multivariate analysis). We also identified significantly more patients with moderate to severe B-grade rejections in the deficient group (P=0.0038). CONCLUSION: Vitamin D deficiency is present in 47% of our lung transplant patients and seems independently associated with a lower FEV(1) and more severe B-grade rejections. This study raises the potential need for additional vitamin D treatment in lung transplantation and clearly indicates the role of a randomized placebo-controlled trial with vitamin D supplementation, which is ongoing in our center.

[Observation on the anti-stress effect of acupuncture-assisted anesthesia for puhnlmonary lobectomy patients].

OBJECTIVE: To observe the anti-stress effect of acupuncture-assisted anesthesia in patients undergoing pulmonary lobectomy. METHODS: A randomized, controlled, single-blind clinical trial was conducted in the present study. A total of 48 patients undergoing pulmonary lobectomy were randomized into regular general anesthesia (RGA), general anesthesia combined with 2 Hz electroacupuncture (EA) (GA+2 Hz-EA), general anesthesia combined with 2 Hz/100 Hz EA (GA+2 Hz/100 Hz-EA), and GA + 100 Hz-EA groups (n=12). EA (1-3 mA) was applied to bilateral Houxi (SI 3), Zhigou (SJ 6), Neiguan (PC 6) and Hegu (LI 4) for 30 min, followed by general anesthesia with midazolam (0.05 mg/kg), fentanyl (5 microg/kg), propofol (2 mg/kg), and vecuronium (0.1 mg/kg). The dosages of the anesthetics, heart rate (HR), systolic blood pressure (SBP), and bispectral index (BIS) of electroencephalogam during general anesthesia were recorded. Plasma adrenaline and cortisol concentrations were assayed by radioimmunoassay. RESULTS: In comparison with the RGA group, the dosages of supplementary propofol and fentanyl in both GA + 2 Hz-EA and GA + 100 Hz-EA groups,and that of propofol in the GA+2 Hz/100 Hz-EA group were decreased significantly (P < 0.05, P < 0.01). Compared to the RGA group, both HR and SBP values during trachea extubation in the GA+ 2 Hz/100 Hz-EA and GA + 100 Hz-EA groups were significantly lower (P < 0.01, P < 0.05). No significant differences were found between the GA+2 Hz/100 Hz-EA and RGA groups in the supplementary dose of fentanyl, between the GA+2 Hz-EA and RGA groups in HR and SBP values during trachea extubation, among the 4 groups in HR and SBP values before trachea extubation and in plasma adrenaline and cortisol levels (P > 0.05). CONCLUSION: Acupuncture-assisted anesthesia can decrease the dosage of general anesthetics, and effectively restrain cardiovascular stress reaction during trachea extubation in pulmonery lobectomy patients.

[Intracavity drainage under local anesthesia for giant emphysematous bulla and infected bulla].

We performed a retrospective review of 9 patients who underwent intracavity drainage under local anesthesia for emphysematous bulla and infected bulla between 1996 and 2010. Three patients with giant emphysematous bulla were treated intracavity drainage. Pneumothorax occurred and was treated by chest tube in all cases. Radiographic and symptomatic improvement occurred in all patients. After that, bullectomy was performed safely in 2 patients and intrabullar suction with fibrin glue was performed in 1. There were 6 cases with infected bulla that was not improved by the administration of antibiotics. After intracavity drainage, control of infection was achieved, and all but 1 patient were discharged without drain and complications. Intracavity drainage under local anesthesia is a safe and effective treatment for giant emphysematous bulla and infected bulla.

Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases.

BACKGROUND: Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and endotracheal intubation. There are risks to such anesthesia and some operations may not require general anesthesia or intubation. We elected to study the safety and efficacy of VATS utilizing local anesthesia, sedation, and spontaneous ventilation. METHODS: The medical records of all patients undergoing VATS utilizing local anesthesia and sedation at our system's three hospitals between June 1, 2002 and June 1, 2009 were retrospectively reviewed. The authors or residents under supervision performed all procedures. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on age or comorbidity. All procedures were performed in the operating room with patients in full lateral position; no patient had endotracheal intubation or epidural or nerve block analgesia. RESULTS: Three hundred fifty-three patients ranging in age from 21 to 100 years (mean 67 years) underwent 384 VATS operations: pleural biopsy-drainage with or without talc, 244; drainage of empyema, 74; lung biopsy, 40; evacuate hemothorax, 13; pericardial window, 7; drain lung abscess, 2; treat chylothorax, 2; treat pneumothorax, 1; and biopsy mediastinal mass, 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent biopsy for diagnosis; two patients required a subsequent procedure for empyema. There were 10 complications: cerebrovascular accident, 2; atrial fibrillation, 2; persistent air leak, 2; empyema, transient renal failure, transient respiratory failure, and urinary tract infection, 1 each. There were no deaths due to operation; within 30 days 9 patients died from underlying disease and 1 from overanticoagulation. CONCLUSIONS: Video-assisted thoracic surgery utilizing local anesthesia-sedation is well tolerated, safe, and valuable for an increasing number of indications.

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction.

In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

Lung aplasia: anatomy, history, diagnosis and surgical management.

PURPOSE: The aim of the study was to define the details of the history and clarify the cause for respiratory distress, justify the need for surgical correction and suggest a rational operative technique for patients with lung aplasia. METHODS: Our experience with the management of 9 patients with lung aplasia and 1 patient with lung agenesis in the period from 1985 to 2004 is presented. All 10 patients were referred for respiratory distress. A detailed study of clinical symptoms and the data from X-ray, computed tomography (CT), tracheobronchoscopy and digital subtraction angiography (DSA) suggested that all patients had different degrees of mediastinal shift and heart rotation, tracheal kinking and compression of the aortic arch and innominate artery or emphysema of a single lung. Two of the patients required operation. RESULTS: We performed ipsilateral cephalad translocation of the diaphragm which resulted in complete recovery from respiratory distress and a significant improvement in tolerance of physical exercise in both patients. The good results in these patients were followed up for 8 and 2 years, respectively. CONCLUSIONS: We suggest that ipsilateral translocation of the diaphragm could be a useful alternative to unsuccessful symptomatic treatment in patients with lung aplasia.

Impalpable pulmonary nodules with ground-glass opacity: Success for making pathologic sections with preoperative marking by lipiodol.

BACKGROUND: The developments in high-resolution CT scanning have increased the chance of detecting small bronchioloalveolar carcinoma (BAC) or atypical adenomatous hyperplasia (AAH) that appears as a ground-glass opacity (GGO). However, these lesions are not only difficult to localize during surgery, but they are also hard to make pathologic sections of because they are usually impalpable. Here, we report a method of making pathologic sections for impalpable GGO lesions. METHODS: Twenty-nine impalpable GGO lesions < 1 cm in size were marked by 0.4 to 0.5 mL of lipiodol under CT scan before surgery. The lesions were resected under C-arm fluoroscopy. The radiopaque areas marked by lipiodol within the formalin-fixed specimens were cut serially under conventional fluoroscopy for pathologic examinations. RESULTS: The mean (+/- SD) size of the lesions was 0.5 +/- 0.2 cm (range, 0.2 to 1 cm), and the mean depth from the pleural surface was 1.6 +/- 1.4 cm (range, 0.2 to 6 cm). The mean number of sections submitted for pathologic examinations was 2.3 +/- 1.7 per lesion (range, 1 to 7 per lesion). While 11 of the 29 lesions (38%) were invisible even on the cut surface of the specimens, all were demonstrated in hematoxylin-eosin sections. The pathologic diagnosis was BAC in 17 lesions, AAH in 10 lesions, and organized pneumonia in 2 lesions. The use of lipiodol did not affect the pathologic findings. CONCLUSIONS: The use of fluoroscopy to cut sections from resected specimens after preoperative marking with lipiodol was useful for making pathologic sections of impalpable GGOs < 1 cm in size.