[Needlescopic thoracic sympathectomy for palmar hyperhidrosis].

OBJECTIVE: To evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis. METHODS: From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded. RESULTS: Sympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment. CONCLUSION: Needlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.

[A clinicopathological study of 14 cases of pulmonary inflammatory myofibroblastic tumor].

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department. METHODS: From January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years' follow-up was completed in all patients. RESULTS: These 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up. CONCLUSIONS: Histopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.

[Relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung].

BACKGROUND: Lymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung. METHODS: A total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed. RESULTS: Lymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation. CONCLUSIONS: Lymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.

[Expression of KAI1 gene in non-small cell lung cancer and its relationship with P53].

BACKGROUND: Recent researches have manifested that down-regulation of KAI1 relates to metastasis in various tumors, but its association with non-small cell lung cancer (NSCLC) and the mechanism for its down-regulation are not clear. The aim of this study is to investigate the expression of KAI1 in NSCLC and its relationship with clinicopathological characteristics and mutant P53 protein. METHODS: The expression of KAI1/CD82 and mutant P53 protein was detected in 48 cases of NSCLC tissues by Western blot, and KAI1 mRNA was detected by RT-PCR method, with 20 cases of pulmonary benign disease tissues and normal lung tissues as control.. RESULTS: The positive rate of KAI1 mRNA was 52% in lung cancer group and 90% in control group, respectively (P < 0.01), KAI1/CD82 was 48% and 85% respectively (P < 0.01), and mutant P53 protein was 65% and 5% respectively (P < 0.01). The positive rate of KAI1 mRNA, KAI1/CD82 and mutant P53 protein closely related to the tumor stages, cell differentiation and lymph node metastasis status (P < 0.05 or P < 0.01). The expression of KAI1/CD82 highly related to KAI1 mRNA (P < 0.01) and mutant P53 protein (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05). CONCLUSIONS: The down-regulation of KAI1 may relate to carcinogenesis, development and metastasis of NSCLC. Its reduction may occur mainly at transcriptional level and correlate with p53 in NSCLC. KAI1 and p53 might be helpful to predict the potential metastasis of NSCLC.

[Pathogen spectrum and correlative factors of nosocomial infection in patients with lung cancer].

BACKGROUND: Lung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer. METHODS: One hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically. RESULTS: Of all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum ß-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. CONCLUSIONS: The nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

Resection of a large benign pharyngo-oesophageal submucous mesenchymoma via laterocervical approach.

Two rare cases of benign submucosal pharyngo-oesophageal mesenchymoma are presented in this paper. One patient was treated by tumour removal via a combined thoracic and laterocervical approach and the other by resection through a laterocervical approach. The paper discusses the pathology and diagnosis of benign mesenchymomas. The authors suggest that for large tumours located in the pharynx and extending down the oesophagus without adhesion to the oesophageal wall, the laterocervical approach can avoid complications associated with the thoracic approach. The new technique caused less tissue damage and provided a quicker recovery and shorter hospitalization.