Complications of chest wall around malignant tumors: differences based on reconstruction strategy.

BACKGROUND: Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy. METHODS: Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated. RESULTS: Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05-111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693-0.957; p = 0.0126). CONCLUSIONS: Surgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0.

Introduction: Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. Methods: A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Results: Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Discussion: Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

Factor analysis-based relationship analysis between geographical factors and value of FEV1. 0% in aged Chinese males / 第二军医大学学报

Objective: To provide a scientific basis for establishing a standard reference value of FEV1. 0% for aged Chinese males. Methods: The reference values of FEV1. 0% of 4 342 healthy aged Chinese males were collected from hospitals, research units, and higher institutions of 72 counties or cities. Correlation analysis, factor analysis and GIS software were used to investigate the relationship between the reference values of FEV1. 0% with six geographical factors. Results: It was found that the reference values of FEV1. 0% in aged Chinese males were significantly associated with geographical factors. Factor analysis and regression analysis yielded a regression equation as: y = 79.279 8 + 0.000 901 5X1 -0. 001 931 4X2 + 0. 001 966 8X 3 - 0.002 615X4+0.001 293 4X5+0.001 650 3X 6 ±1.032 8. The fitting degree between the predicted and the measured values was high. With the aid of geostatistical analysis module of GIS spatial analysis and Kriging interpolation method, we interpolated the geographical distribution map of the reference value of FEV1. 0% in aged Chinese males. Conclusion: The regression equation can be used to accurately calculate the reference value of FEV1. 0% for aged Chinese males, if the geographical values for an area are available. The reference value of FEV1. 0% can also be obtained by the geography Trend-surface distribution map of an area.

Decrease in Low Attenuation Area(LAA) of the Lungs on High Resolution Computed Tomography(HRCT) by Long-term Spa Therapy in Patients with Asthma / 日本温泉気候物理医学会雑誌

Characteristics of low attenuation area (LAA) of the lungs on HRCT were studied in 132 patients with asthma, and long-term spa therapy on the LAA of the lungs was observed in 5 patients with asthma, whose me an %LAA was more than 30%.<br>1. The morphology of LAA of the lungs on HRCT observed in asthma was different from that in pulmonary emphysema. 2. The LAA of the lungs in asthma was closely related to residual volume (RV). 3. The mean %LAA value significantly decreased from 33.5% before spa therapy to 24.5% at 24 months after beginning of the therapy. CT number also significantly increased after long-term spa therapy. 4. %FEV1.0 value significantly improved from 52.1% before spa therapy to 72.1% at 24 months after spa therapy. The RV value also decreased by spa therapy, however, the decrease was not significant. These results suggest that LAA of the lungs in asthma is associated with hyperinflation, and the LAA of the lungs decreases after long-term spa therapy.

The Serum Alpha-antitrypsin Concentration of Coal Workers' Pneumoconiosis Patients / 대한산업의학회지

This study was performed to investigate associations between serum alpha(1)-antitrypsin(AAT) concentration and radiological categories of coal workers' pneumoconlosis(CWP), between AAT concentration and pulmonary complications such as tuberculosis and emphysema, and to study associations between AAT concentration and FEV(1.0)% in CWP patients, We classified 254 CWP patients in D Hospital into categories of small opacity profusion. And we selected 86 subjects by with or without emphysematous finding in each categories by proportional stratified sampling method. Semm AAT concentrations were quantkated by single radial immunodiffusion method, and the findings of chest radiographs were evaluated by radilogist. The results were as follows: 1. Serum AAT concentrations were not significantly different among groups of radiological categories of small opacities. 2. Complication of emphysema was associated with smoking habits sigmficantlyl(chi square=12.16, p<0,01). And AAT concentraLion was higher in smokers and ex-smokers than in non-smokers. Serum AAT concentration was significantly higher in the cases with emphysema than in the cdses without emphybema{p<0.01). 3. Serum AAT concentration of the group with active pulmonary tuberculosis was significantly higher than with inactive or without: pulmonary tuberculosis group(p<0.1). 4. Serum AAT concentration of the group with low FEV(1.0)% was significantly higher than with high or normal group(p<0.05).