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Objective:To summarize our experience in diagnosis and treatment of patients with pulmonary mucosa-associated lymphoid tissue-derived(MALT) lymphoma and to explore the role of surgery.Methods:We retrospectively analyzed the clinical and follow-up data of 86 patients with pulmonary MALT lymphoma in Shanghai Pulmonary Hospital from January 2000 to December 2018. 86 cases were identified with 44 males and 42 females. The mean age was(56.7±10.6) years old. 38(44.2%) cases had symptoms mainly presenting as cough and sputum at diagnosis. The chest CT scan of the patients showed pulmonary consolidation in 39 cases, nodule/mass shadow in 37 cases, usually with air bronchogram. Only 8(9.3%) cases could be diagnosed by non-surgical approach. 58 cases received complete resection, 10 of which followed chemotherapy. 8 of 17 cases who received incomplete resection accepted chemotherapy. The rest 11 cases who experienced surgical biopsy because of uncertain diagnosis were treated by chemotherapy or radio-chemotherapy or just watch-to-wait.Results:The median follow-up of 83 cases was 64 months, ranged from 24 to 219 months. The estimated 5-year and 10-year OS rates were 95.0% and 76.8%, while 5-year and 10-year PFS were 75.7% and 35.1% respectively. Patients who received complete resectionhad better PFS( P<0.001)but similar OS( P=0.395), compared with those received incomplete resection. There were no significant difference in OS and PFS between patients who received complete resection accepted chemotherapy or not( P>0.05). Conclusion:Pulmonary MALT lymphoma has an indolent nature with an excellent long-term survival. Diagnosis is difficult to be made by non-surgical approach. Surgery plays an important role of treatment of pulmonary MALT lymphoma, due to significant improvement of diagnosis rate and radical treatment of localized disease by complete resection.
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Objective:To explore the sex-based heterogeneity in demographic and pathological trends of lung cancer during the past 30 years.Methods:Patients with primary lung cancer who received surgical treatment in the Department of thoracic surgery, Shanghai Pulmonary Hospital Tongji University from 1989 to 2018 were retrospectively analyzed. The differences between male and female patients in age, smoking history, pathological stage and type were compared. Mann- Kendall trend test was performed for trend analysis. Results:A total of 58 433 patients were included in this study, encompassing 30 729(52.6%) men and 27 , 704(47.4%) women. Compared with male patients, female patients were younger(56.0 years old vs. 59.7 years old), and had a higher proportion of non-smokers(98.3% vs. 52.3%), stage Ⅰ lung cancers(60.6% vs. 49.3%), and adenocarcinoma(93.7% vs. 56.1%, all P-values <0.001). Trend analyses revealed that the proportion of female patients increased year by year, and surpassed males in 2015, with the current ratio of male to female being 1∶1.5. After 2013, the age of onset in females was getting younger, and the average age decreased from 58.7 years old to 54.7 years old( P=0.02). The decrease in the proportion of smoking patients was mainly reflected by male patients(from 68.5% to 31.1%, P<0.01). Stage Ⅰ lung cancers in male and females outnumbered advanced stage in 2012 and 2010, respectively, with a much higher proportion in female patients. Among male patients, adenocarcinoma has replaced squamous cell carcinoma as the most common pathological type since 2012, while in female patients adenocarcinoma remained the most common pathological type of lung cancer, and its proportion continued to increase reaching over 98%. Conclusion:A dramatic change in gender distribution was noticed during the past 30 years. Female patients became the primary population in surgically-treated lung cancers, with a trend of getting younger. The proportion of smokers and squamous cell carcinoma decreased significantly in male patients, and adenocarcinoma has become the most common pathological type of lung cancer. The proportion of stage Ⅰ lung cancers was on a dramatic rise, with the popularization of CT screening for lung cancer.
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Objective To systematically evaluate the efficacy and safety of Wiltse approach and conven-tional posterior midline approach for single thoracolumbar fracture. Methods Databases including Embase, PubMed,cnki,WanFang Data were searched to collect the related literatures for single thoracolumbar fracture treated with surgery of Wiltse approach and conventional posterior midline approach. The data were collected and evaluated by different reviewers independently and the Meta analysis was conducted by using the RevMan 5.3. Results A total of 6 literatures involving 351 patients were included. The results of Meta-analysis showed that there were significant differences in surgical duration,intraoperative bleeding,postoperative discharge volume, and visual analog score(VAS)(P < 0.000 01). There was no significant difference between the Cobb angle(P =0.69)and the fanterior edge convex height(P=0.46).Conclusions Wiltse approach is superior to conventional posterior midline approach for single thoracolumbar fracture with shorter surgical duration,less intraoperative blood loss,less postoperative discharge and lower incidence of postoperative backache. It reduces spine malformation, maintains height of the fanterior edge convex.Wiltse approach is a safe and feasible surgical technique for treating single thoracolumbar fracture.
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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.
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BACKGROUND:Clinical physicians should pay attention on how to reduce ankle fracture healing wounds, reduce bleeding, improve operating technique, and improve repair effect, especialy for comminuted fracture. It is necessary to understand how to develop a detailed plan before repair, observe specific circumstances of the fracture from multiple angles, and establish three-dimensional images using two-dimensional X-ray films or CT scan. These raise a chalenge for each physician. OBJECTIVE:To explore the application effect of three-dimensional print, minimaly invasive percutaneous screw and locking plate fixation in the repair of ankle fractures. METHODS: A total of 26 cases of fracture of ankle joint were treated from January 2012 to June 2014. There were 9 cases of double ankle fracture, 12 cases of three ankle fractures, and 5 cases of three ankle fractures involved PILON fracture on the lower tibia. They received spiral CT scanning on the ankle joint, and stored in the format of di.com. After processing with minics software, data were converted into STL format, and then input into the three-dimensional printer. Thus, models of ankle joint were made at the ratio of 1:1. The repair scheme was made. After discharge, X-ray films were checked every month to observe the healing condition of fractures. According to Mazur ankle score standard, ankle joint function was assessed. RESULTS AND CONCLUSION: Al 26 cases were folowed up for 6-12 months. The fractures were healed. The healing time was 4-6 months, averagely 5.5 months. The healing was good, without vascular and nerve damage, or plate breakage. In accordance with the Mazur ankle score standard, there were excelent in 11 cases, good in 13 cases with an excelent and good rate of 92%. The operation time was (64±15) minutes, and intraoperative blood loss was (100±15) mL. The incision was healed in stage one. These findings confirm that the simulation training and operation in fracture models of three-dimensional print have smal injuries to patients with ankle fracture. The bleeding was less, the operation was simple, the healing time was short, and the functional recovery was rapid, especialy for comminuted fracture.
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Objective To explore the morphology,cell phenotype and cell function in dendritic cells (DCs) derived from bone marrow after treatment with Sirolimus or Sirolimus combined with sTNFRI-IgGFc gene segment transfection.Method DCs were divided into 5 groups (imDCs,mDCs,Rapa-DCs,sTNFRI-DCs and Rapa-sTNFRI-DCs) according to different interventions.The expresson of MHC-Ⅱ,CD80 and CD86 was detected by flow cytometry.T cell proliferation of the mixed lymphocyte reaction was evaluated by MTT method.The levels of IL-12,IFN-γ and sTNFRI-IgGFc were determined by ELISA.Result On the day 10,the flow cytometry showed that the expression levels of MHC-Ⅱ,CD80 and CD86 on the cell surface in Sirolimus group were significantly higher than the other groups (P＜0.05).The expression level of CD86 in Rapa-sTNFRI group was significantly lower than in imDC group (P＜0.05).MTT results demonstrated that T cell proliferation ability in Sirolimus group,sTNFRI group and Rapa-sTNFRI group were reduced as compared with mDC group (P＜0.05).The ELISA results revealed that the levels of IL-12 and INF-γ in rnDC group were significantly higher than other groups (P＜0.05).The levels of IL-12 and INF-γ in Rapa-sTNFRI group were significantly lower than other groups (P＜0.05).Conclusion Sirolimus combined with modified sTNFRI-IgGFc gene could synergistically inhibit maturation of DCs more effectively than Sirolimus or modified sTNFRI-IgGFc gene used alone.
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BACKGROUND:Studies showed that platelet-rich plasma + bone transplantation for repair of bone defects not only can accelerate new bone formation, but also increase bone density. OBJECTIVE:To observe autologous platelet-rich plasma and autologous bone graft for treatment of comminuted fractures, and the efficacy. METHODS:This was a clinical prospective randomized controled study. A total of 42 patients with limb comminuted fracture and bone defects were enroled and randomly assigned to two groups. In the experimental group, 20 patients received treatment with autologous platelet-rich plasma and mixture of autologous ilium and cancelous bone. In the control group, 22 patients underwent plate, screw or intramedulary nail fixation. At 1, 3, 6 and 12 months after surgery, X-ray examination was conducted. Healing conditions, healing speed and functional recovery were compared between the experimental and control groups. RESULTS AND CONCLUSION:The time of bone healing was respectively 12 weeks in the experimental group and 18 weeks in the control group on average, showing significant differences. There were two cases of plate breakage, one case of nonunion reoperation, three cases of delayed fracture healing in the control group. No autologous blood transfusion or other complications appeared in the experimental group. Results suggested that autologous platelet-rich plasma and autologous bone graft for comminuted fractures can facilitate and accelerate bone healing.
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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.
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Objective To study the clinical characteristics of spinal hydatid disease and help to diagnozy and treat the disease. Methods 14 cases with spinal hydatid disease, admitted in our hospital between July 1994 and October 2003, were studied retrospectively. Besides routine examinations, plain X-ray films were performed in all 14 cases, CT in 8 cases and MRI in 13 cases, respectively. 8 cases sufferred serodiagnostic tests for human hydatidosis. All cases underwent operation and the histopathological examination. There were 5 males and 9 females with an average age of 25.8 years(range, 5-53 years) in this series. All 14 cases had the living history in endemic area and the average duration of symptom was 26.7 months(range, 4-120 months). The lesions most frequently involved the thoracic segments, accounting for 35.8%, and then 21.4% in the lumbar, and 28.6% in the lumbosacral segments, cervical segments were the least commonly involved. According to Dew'classification, spinal hydatid cysts located primarily at intradural extramedullary area in 1 case, extradural intraspinal in 2 cases, vertebral in 7 cases, paravertebral in 1 case and combination of various extradural tissues involved in other 3 cases. Results The clinical manifestations were localized back pain or radiating pain, mass and gradually progressive neurological dysfunction. Eight of 14 cases displayed abnormality in X-ray films which showed local, well-defined and irregular erosions with or without surrounding sclerosis or calcifications. CT scans presented multiloculated low density lesions. The MRI characteristics of the lesions were multiloculated cysts, signal intensities of the cyst content were similar to that of CSF. On T1W images the cyst wall appeared iso- or slightly more hypo-intense than the cyst content, T2W images demonstrated a low intensity rim and the hyper-intense cyst content resembling a bunch of grapes. Seven of 8 cases performed the 3-tests serodiagnosis were positive, and 3 cases with positive 3-tests serodiagnosis accepted 8-tests were positive. All the specimens were shown to be Echinococcus Granulosus. Conclusion MRI was the most sensitive diagnostic method and the best method to determinate the site and extent of the cystic lesions. CT and serological examination are useful for diagnosis. The key of avoiding misdiagnosis is to enhance understanding of the disease.
