[Show abstract][Hide abstract] ABSTRACT: Simultaneously occurring Morgagni hernia and paraesophageal hernia is an extremely rare clinical condition with only six case reports in the English-language literature and only two laparoscopic repair reports. We report a 73-year-old woman with both Morgagni hernia and paraesophageal hernia who underwent successful laparoscopic repair of the hernia defects using transabdominal wall suturing. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. This case report reported the concurring Morgagni and paraesophageal hernias and validated the feasibility of laparoscopic repair both hernias simultaneously.
[Show abstract][Hide abstract] ABSTRACT: Microbe-associated molecular pattern (MAMP)-triggered immunity plays critical roles in the basal resistance defense response in plants. Chitin and peptidoglycan (PGN) are major molecular patterns for fungi and bacteria, respectively. Two rice (Oryza sativa) lysin motif-containing proteins, OsLYP4 and OsLYP6, function as receptors that sense bacterial PGN and fungal chitin. These membrane receptors, which lack intracellular kinase domains, likely contain another component for transmembrane immune signal transduction. Here, we demonstrate that the rice LysM receptor-like kinase OsCERK1, a key component of the chitin elicitor signaling pathway, also plays an important role in PGN-triggered immunity in rice. Silencing of OsCERK1 suppressed PGN-induced (and chitin-induced) immunity responses, including reactive oxygen species generation, defense gene expression, and callose deposition, indicating that OsCERK1 is essential for both PGN and chitin signaling initiated by OsLYP4 and OsLYP6. OsLYP4 associated with OsLYP6 and the rice chitin receptor CEBiP in the absence of PGN or chitin, and treatment with PGN or chitin led to their disassociation in vivo. OsCERK1 associated with OsLYP4 or OsLYP6 when induced by PGN but it associated with OsLYP4, OsLYP6, or CEBiP under chitin treatment, suggesting the presence of different patterns of ligand-induced heterooligomeric receptor complexes. Furthermore, the receptor-like cytoplasmic kinase OsRLCK176 functions downstream of OsCERK1 in the PGN and chitin signaling pathways, suggesting that these MAMPs share overlapping intracellular signaling components. Therefore, OsCERK1 plays dual roles in PGN and chitin signaling in rice innate immunity and as an adaptor involved in signal transduction at the plasma membrane in conjunction with OsLYP4 and OsLYP6. This article is protected by copyright. All rights reserved.
The Plant Journal 10/2014; 80(6). DOI:10.1111/tpj.12710 · 5.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To improve the understanding of bronchial Dieulafoy disease by summarizing the clinical and literature reported cases.
The clinical data of 3 patients with bronchial Dieulafoy disease diagnosed by pathology from January 1, 2007 to May 31, 2012 in our hospital was collected and summarized. The data of 19 cases from literature case report regarding bronchial Dieulafoy disease both in Chinese and English were also reviewed through databases including Wanfang Data, National Knowledge Infrastructure, National Center for Biotechnology Information and Ovid Technologics from January 1, 2005 to May 31, 2012. The clinical characteristics, diagnosis and treatment of all the 22 cases were summarized and analyzed.
The average age of the 22 cases with bronchial Dieulafoy disease was (47 ± 15) years, and the preponderance was in male adults (16/22). Right lung (16/22) was more commonly involved than the left lung (4/22), and rarely in both lungs (2/22). Eight cases had smoking history, and 10 cases had underlying diseases such as tuberculosis.Sudden onset of massive hemoptysis was a common manifestation. Massive or lethal hemorrhage was often caused by biopsy injury. The abnormality of bronchial Dieulafoy disease was usually demonstrated as nodular lesions within the lumen of the bronchus.However, It was unable to determine their originating of the anomalous arteries in half of the cases(11/22). Most anomalous arteries confirmed by pathology were branched from bronchial artery (9/22), and rarely from pulmonary artery (2/22). The definitive diagnosis was made by pathological examination.Selective bronchial artery embolization and pulmonary lobectomy were the major therapeutic strategies, but bleeding may relapse after bronchial artery embolization, and lobectomy of the lung was a cure approach.
Bronchial Dieulafoy disease should be differentiated in patients with massive and unexplained hemoptysis.It takes a very high risk for biopsy, which rarely needs to be implemented. Bronchial arteriography and selective bronchial artery embolization should be promptly carried out to avoid life-threatening hemoptysis.Lobectomy could be an alternative choice for a cure.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 08/2013; 36(8):577-580.
[Show abstract][Hide abstract] ABSTRACT: Background:
The feasibility of completing a lobectomy by completely video-assisted thoracoscopic surgery (cVATS) in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the lobectomies that used thoracotomy vs. cVATS, we determined the appropriateness of the minimally invasive cVATS approach in the management of bronchiectasis.
Between June 2001 and October 2010, 60 patients with bronchiectasis underwent surgery, of which 56 lobectomies were performed. All lobectomies were carried out by either thoracotomy or cVATS approach. Pulmonary vessels and bronchi were manipulated by ligation or stapler in the thoracotomy group, while they were dissected by endo-cutters in the cVATS group.
There were 21 patients in the thoracotomy group and 35 patients in the cVATS group. Two cVATS patients (5.7%) converted. The difference in operation time, chest tube duration, lengths of hospitalization, and morbidity were not significantly different between the two groups (P > 0.05). The blood loss was less in the cVATS group (P = 0.015). A total of 52.4% and 62.9% of patients were postoperatively asymptomatic in the thoracotomy and cVATS groups respectively, and symptomatic improvement was obtained in 38.1% patients by thoracotomy vs. 31.4% patients by cVATS.
cVATS lobectomy is safe and effective for the management of bronchiectasis, especially for the patients with localized lesions.
Chinese medical journal 03/2013; 126(5):875-878. DOI:10.3760/cma.j.issn.0366-6999.20121796 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Plant innate immunity relies on successful detection of trespassing pathogens through recognizing their microbe-associated molecular patterns (MAMPs) by pattern recognition receptors (PRRs) at the cell surface. We recently reported two rice lysin motif (LysM)-containing proteins, OsLYP4 and OsLYP6, as dual functional PRRs sensing bacterial peptidoglycan (PGN) and fungal chitin. Here we further demonstrated the important roles of OsLYP4 and OsLYP6 in rice defense signaling, as silencing of either LYP impaired the defense marker gene activation induced by either bacterial pathogen Xanthomonas oryzaecola or fungal pathogen Magnaporthe oryzae. Moreover, we found that OsLYP4 and OsLYP6 could form homo- and hetero-dimers, and could interact with CEBiP, suggesting an unexpected complexity of chitin perception in rice.
[Show abstract][Hide abstract] ABSTRACT: Plant innate immunity relies on successful detection of microbe-associated molecular patterns (MAMPs) of invading microbes via pattern recognition receptors (PRRs) at the plant cell surface. Here, we report two homologous rice (Oryza sativa) lysin motif-containing proteins, LYP4 and LYP6, as dual functional PRRs sensing bacterial peptidoglycan (PGN) and fungal chitin. Live cell imaging and microsomal fractionation consistently revealed the plasma membrane localization of these proteins in rice cells. Transcription of these two genes could be induced rapidly upon exposure to bacterial pathogens or diverse MAMPs. Both proteins selectively bound PGN and chitin but not lipopolysaccharide (LPS) in vitro. Accordingly, silencing of either LYP specifically impaired PGN- or chitin- but not LPS-induced defense responses in rice, including reactive oxygen species generation, defense gene activation, and callose deposition, leading to compromised resistance against bacterial pathogen Xanthomonas oryzae and fungal pathogen Magnaporthe oryzae. Interestingly, pretreatment with excess PGN dramatically attenuated the alkalinization response of rice cells to chitin but not to flagellin; vice versa, pretreatment with chitin attenuated the response to PGN, suggesting that PGN and chitin engage overlapping perception components in rice. Collectively, our data support the notion that LYP4 and LYP6 are promiscuous PRRs for PGN and chitin in rice innate immunity.
The Plant Cell 08/2012; 24(8):3406-19. DOI:10.1105/tpc.112.102475 · 9.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of isolated mediastinal lesions.
A retrospective study was conducted of 73 consecutive patients with isolated mediastinal lesions of unknown origin without parenchymal lung abnormalities, who underwent EBUS-TBNA from September 2009 to April 2011. The patients who were nondiagnostic with EBUS-TBNA subsequently underwent surgical biopsies and a minimum of 6 months'clinical and radiologic follow-up.
EBUS-TBNA achieved definitive diagnoses in 60 patients of the 73 patients (82.2%, 60/73). Malignancies were diagnosed in 23 patients and benignancies in 37. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing malignant mediastinal lesions were 95.8%(23/24), 100%(49/49) and 98.6%(72/73), respectively. EBUS was well tolerated by all of the patients with no complications.
EBUS-TBNA of isolated mediastinal lesions is a minimally invasive and safe diagnostic technique with high yield.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 02/2012; 44(1):147-50.
[Show abstract][Hide abstract] ABSTRACT: Completely video-assisted thoracoscopic lobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC). At present, the indication for this procedure is stage Ia and Ib peripheral lung cancer (≤ 5 cm); however, for larger tumors, it remains controversial whether this surgical technique is comparable to open lobectomy. This study aimed to evaluate the safety, completeness, and efficacy of thoracoscopic lobectomy, and to compare this technique with open lobectomy for the treatment of non-small-cell lung cancer when the tumor's diameter was greater than 5 cm.
From May 2001 to April 2011, 802 patients underwent a lobectomy for treatment of non-small-cell lung cancer at our center. In 133 patients, the tumor was > 5 cm. There were 98 men and 35 women, median age 63 years (range: 29 - 81 years). We divided the patients into two groups, group V (completely video-assisted thoracoscopic surgery), and group T (open lobectomy), and evaluated the two groups for age, gender, tumor size, pathological type, location, duration of surgery, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence.
There were 46 cases in group V and 87 cases in group T. Age, gender, tumor size, location, pathological type and stage were similar between the two groups. Group V had shorter operative duration ((186.5 ± 62.8) minutes vs. (256.7 ± 67.5) minutes, P < 0.001) and reduced bleeding ((218.5 ± 174.6) ml vs. (556.9 ± 187.2) ml, P < 0.001). There were no significant differences between the two groups in complications, lymph node dissection, time of drainage and hospitalization. The recurrence between the two groups was equivalent (2.4% vs. 3.8%, P = 0.670). The overall survival at 1, 2 and 3 years was 95.1%, 81.6% and 69.6% for group V and 88.3%, 78.8% and 64.0% for group T. Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P = 0.129).
Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety, completeness, and efficacy, but had a shorter operative duration, and reduced bleeding. This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm.
Chinese medical journal 02/2012; 125(3):434-9. DOI:10.3760/cma.j.issn.0366-6999.2012.03.006 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the safty, thoroughness and efficacy of the video-assisted thoracoscopic surgery compared with open thoracotomy, in treatment of patients with the preoperative staging of lymph node negative and postoperative pathological mediastinal lymph node positive (cN0-pN2) locally advanced non-small cell lung cancer(NSCLC).
We performed a retrospective review of 616 patients who underwent either VATS lobectomy or open thoracotomy from July 2000 to December 2009. Of which 386 patients were diagnosed with preoperative staging of lymph node negative(cN0) non-small cell lung cancer. Of the 386 patients 76 were diagnosed with postoperative pathological mediastinal lymph node positive (pN2). Twenty-nine patients were operated by video-assisted thoracoscopic surgery (VATS group), 47 patients were operated by open thoracotomy(T group).The patients' preoperative and intraoperative conditions, postoperative survival and recurrence, etc. were compared.
The two groups were similar in age, gender distribution, pulmonary function, preoperative complications and the preoperative clinical stage. VATS group was slightly lower than T group in operation time, and blood loss. The station number of mediastinal lymph nodes dissection was (3.3±1.1) vs. (3.3±1.3), P=0.959; the number of lymph nodes dissected (12.7±8.9) vs. (10.5±7.2),P=0.260; positive lymph nodes / lymph nodes dissection 28.7% vs. 32.5%, P=0.592; the postoperative proportion of single-station N2 55.2% vs. 66.0%(P=0.189) in VATS group and T group, respectively. One, three-year disease-free survival rates after operation in VATS and T group were 82.6% vs.69.2%(P=0.088) and 49.3% vs. 51.3% respectively(P=0.996); one, three-year overall survival rates were 84.9% vs. 71.2%(P=0.149) and 64.0% vs. 42.7% (P=0.121). Both groups had the similar pattern of recurrence, most of which were distant metastases.
With respect to the safety,thoroughness and recent effect, VATS is not inferior to open thoracotomy in the treatment of cN0-pN2 non-small cell lung cancer.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 12/2011; 43(6):861-5.
[Show abstract][Hide abstract] ABSTRACT: To discuss the feasibility of the completely video-assisted thoracoscopic lobectomy for non-small-cell lung cancer (NSCLC) patients whose tumor size was greater than 5 cm.
From May 2001 to May 2010, 564 patients with NSCLC received lobectomy in our center, of whom, 114 had tumors whose diameters were larger than 5 centimeters (79 males and 35 females, their median age was 63.6 years, ranging from 29 to 81 years). We divided all the patients into two groups, group V (video-assisted thoracoscopic surgery) and group T (Thoracotomy). We compared all the factors, such as age, gender, tumor size, pathological type, location, operation time, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence between the two groups.
There were 72 cases of lobectomy, 18 cases of composite lobectomy and 24 cases of pneumectomy in all the patients. All of the procedures were carried out safely with no serious complications except for two prioperative deaths resulting from respiratory failure (in group T). There were 34 cases in group V and 80 cases in group T. Age, gender, tumor size, tumor location, pathological type and stage were similar between the two groups. The operation time of group V was significantly shorter than that of group T [(208.2±57.0) min vs. (256.4±70.3) min, P=0.001]. The blood loss of group V was much less than that of group T[(269.1±176.2) mL vs. (591.9±169.7) mL, P<0.001].There were no differences between the two groups, such as complications (13.3% vs. 21.3%, P=0.232), lymph node dissection stages (5.0±2.2 vs. 5.1±1.1, P=0.885) and numbers (18.5±9.6 vs. 19.2±9.1, P=0.714), time of drainage[(8.6± 3.9 d) vs. (9.0±5.0) d,P=0.693] and hospitalization (11.7±6.8) d vs. (12.8±7.1) d,P=0.431].The local recurrence between the two groups was equivalent(3.5% vs. 4.2%, P=0.857).The estimated overall survival at the end of 1, 2 and 3 years was 90.0%, 76.9% and 65.9% for group V and 80.3%, 62.9% and 55.3% for group T, respectively. Kaplan-Meier survival curves showed that there was no significant difference between the two groups (P=0.163).
Completely video-assisted thoracoscopic lobectomy is a safe and feasible procedure for a part of non-small-cell lung cancer patients whose tumor size is greater than 5 cm.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 12/2011; 43(6):866-72.
[Show abstract][Hide abstract] ABSTRACT: Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities.
We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People's Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out.
Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed.
Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.
Chinese medical journal 12/2011; 124(23):3988-92. DOI:10.3760/cma.j.issn.0366-6999.2011.23.026 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical factors affecting the definite pathological diagnosis of solitary pulmonary nodules (SPN) with multivariate Logistic regression analysis, and to build the clinical prediction model to estimate the probability of malignancy.
A retrospective cohort study in our institution included 371 patients (197 males and 174 females) with definite pathological diagnosis of solitary pulmonary nodules from Jan 2000 to Sep 2009 (group A). Clinical data included age, gender, course of disease, symptoms, history and quantity of smoking history, history of tumor, family history of tumor, site, diameter, calcification, speculation, border, lobulation, traction of pleural, vascular convergence sign, and cavity. The independent predictors of malignancy were estimated with multivariate analysis, then the clinical prediction model was built. Other 62 SPN patients (group B) with definite pathological diagnosis in our institute from Oct 2009 to Mar 2010, were used to validate value of this clinical prediction model.
53.1% of the nodules were malignant, and 46.9% were benign in goup A. Logistic regression analysis showed that seven clinical characteristics [age of patient (OR: 1.073), diameter (OR: 1.966), border (OR: 0.245), calcification (OR: 0.199), spiculation (OR: 2.088) and the family history of tumor (OR: 3.550)] were independent predictors of malignancy in patients with SPN (P<0.05). The cut-off value was 0.463. The sensitivity in group B was 92.5%, specificity 81.8%, positive predictive value 90.2%, and negative predictive value 85.7%. The area under the ROC curve for our model was 0.888±0.054.
Age of patient, diameter, border, calcification, spiculation and the family history of tumor are independent predictors of malignancy in patients with SPN. Our prediction model is accurate and sufficient to estimate the malignancy of patients with SPN.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 06/2011; 43(3):450-4.
[Show abstract][Hide abstract] ABSTRACT: Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease that is characterized by diffuse proliferation of abnormal pulmonary lymphatic channels. DPL occurs mostly in children and young adults and often undergoes a progressive clinical course, eventually causing deterioration of the lung. Both the clinical diagnosis and treatment of DPL remain a challenge. Here, we report a case of DPL in a 53-year-old Chinese woman with comprehensive investigations including pulmonary function tests, computer tomography (CT), bronchoscopy and histological examination of the lung biopsy, and review the literature.
Chinese medical journal 03/2011; 124(5):797-800. DOI:10.3760/cma.j.issn.0366-6999.2011.05.033 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The sensitivity and accuracy of white light bronchoscopy (WLB) in airway examination are low. Autofluorescence bronchoscope (AFB) can determine early lesions in bronchial mucosa more sensitively, but it has seldom performed in China. To assess the clinical value of the AFB in airway examination, we compared the sensitivity and specificity of the AFB and WLB in detecting cancer of the airway mucosa.
Between September 2009 and May 2010, bronchoscope examinations using both the AFB and WLB were performed on 136 patients, 95 men and 41 women with a median age of 61.5 years (ranged from 25 to 84 years). There were 46 lesions located in the central airway, 84 in the peripheral lung parenchyma, and 6 in the mediastinal region. All patients received local and general anesthesia and were subsequently examined with the WLB and AFB in tandem. All procedures were completed safely. Abnormal visual findings were recorded, and biopsies of the affected regions were collected for pathologic examination.
Of 241 regions sampled for biopsy, 76 sites contained malignant lesions, whereas 165 sites contained benign lesions. The AFB detected 72 of the 76 malignant lesions, but the WLB detected only 50. The sensitivities of the AFB and WLB were 94.7% and 65.8%, respectively, and the specificities were 57.0% and 83.6%, respectively. The negative predictive values of the AFB and WLB were 95.9% and 84.1%, respectively.
The AFB is more sensitive than the WLB in detecting cancerous lesions in the mucosa, and is an effective airway examination.
Chinese journal of cancer 12/2010; 29(12):1018-22. DOI:10.5732/cjc.010.10298 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate technique aspects of video-assisted thoracoscopic lobectomy for benign diseases.
Retrospective review of 24 patients with benign pulmonary disease underwent thoracoscopic lobectomy from September 2006 to September 2008. One patient had bilateral bronchiectasis received concurrent bilateral lobectomy. The patients included 11 males and 13 females with mean age of 49.0 years. Fifteen cases were diagnosed as benign diseases preoperatively consisted 10 bronchiectasis as the primary indication. The other 9 cases were pulmonary nodules pathologic diagnosed intra-operatively. Inflammation changes including dense plural adhesions, pulmonary artery adhesions and calcified lymph nodes were managed endoscopically.
All 25 thoracoscopic procedures were completely with no conversion to thoracotomy. The mean operation time was (163 +/- 52) min, blood loss was (163 +/- 130) ml. There was no hospital death or major morbidity. Postoperative drainage was (5.8 +/- 2.8) d. No long-term complications were noticed during a mean follow-up of 7.3 months.
Chronic inflammation induced adhesions is the key limiting factor for thoracoscopic lobectomy for benign diseases.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2009; 47(6):454-6.
[Show abstract][Hide abstract] ABSTRACT: To review the technology of completely thoracoscopic lobectomy procedures.
From September 2006 to July 2007, 40 patients (23 male and 17 female) underwent completely thoracoscopic lobectomy. The median age was 59.5-years-old, with a range from 24 to 79-years-old. The lobectomy was completed through 3 incision in the 5th, 8th and 7th intercostal space. The procedures were similar with conventional open lobectomy.
All procedure were carried out safely, including lung cancer (n = 34), lymphoma(n = 1), pulmonary cyst (n = 1), middle lobe syndrome (n = 1) , bronchiectasis (n = 2) and renal carcinoma metastasis to lung (n = 1). There were no operative mortality or serious complications. There was one patient opposed to open thoracotomy because of the mediastinal lymph nodes metastasis. The average surgical duration was 206 min (range from 60 to 300 min). The average blood loss was 221 ml (range from 100 to 400 ml) with no blood transfusion required. The average length of stay was 8.9 d. No recurrence and metastasis was observed in a follow-up range from 1 to 10 months except one patient with adenocarcinoma occurred metastasis of tumor 3 months postoperation.
The completely thoracoscopic lobectomy is a safe and feasible surgical procedure compared with conventional open lobectomy for selected patients.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2008; 46(6):405-7.
[Show abstract][Hide abstract] ABSTRACT: To determine the current role of mediastinoscopy in the diagnosis and differential diagnosis of stage I thoracic sarcoidosis.
The clinical data of 60 patients with a presumptive diagnosis of stage I thoracic sarcoidosis underwent mediastinoscopy from November 1999 to June 2007 were analyzed retrospectively. All the patients had hilum of lung and/or mediastinal lymphadenopathy with normal lung parenchyma on thoracic CT scan. Typical stage I sarcoidosis was defined as presence of bilateral hilum of lung lymphadenopathy with/without mediastinal lymphadenopathy.
All the patients had definitive pathologic diagnosis. Among the 33 patients with typical presentation of stage I sarcoidosis, 32 patients were confirmed by pathology. One patient was reactive lymph node. Among the 27 patients with atypical patterns on CT, 17 patients were confirmed by pathology. No postoperative complication and mortality occurred.
For the patient with a presumptive diagnosis of typical stage I thoracic sarcoidosis after clinical and radiological evaluation, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2008; 46(6):413-5.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis (MG).
Eighteen MG patients, 7 males and 11 females, aged 33.4 +/- 9.4 (19 - 48), underwent video-assisted thoracoscopic thymectomy by the same surgical group from November 2001 to May 2005. Right side access was used in 14 of them, left side approach was used in 2, and bilateral approach in 1 of them. The thymus and fatty tissue in the front mediastinum were resected. The medical records were reviewed and telephone survey was conducted to understand the effects. The mean follow-up time was 26.4 +/- 10.9 months.
VATS was successfully conducted except in 1 case. The bleeding volume was less than 50 ml. The average chest tube drainage time was 2.1 +/- 1.2 days, and the mean hospitalization day was 6.3 +/- 3.1 days. Three of the 18 patients needed temporary mechanical ventilation less than 72 hours, and 2 needed reintubation due to either myasthenic or cholinergic crises. Nine of the 18 patients achieved complete relief (50%) and 6 of them (33.3%) had their symptoms greatly improved, and the symptoms of one case remained stable (5.6%), and the overall effective rate was 83.3%.
Video-assisted thoracoscopic thymectomy is a safe and effective method for treatment of myasthenia gravis with satisfactory long-term outcomes.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect and side effect of T(3) versus T(4) sympathectomy in the surgical management of primary palmar hyperhidrosis through prospective multi-center randomized controlled trial.
From Sep 2004 to Feb 2006, 106 consecutive patients (49 males and 54 females) with primary palmar hyperhidrosis were enrolled in the study and randomly assigned into T(3) or T(4) level sympathectomy groups. 66 patients received T(3) sympathetic chain transection and 37 patients received T(4) sympathetic chain transection. The two groups were comparable in all other parameters.
All procedures were carried out successfully without severe morbidity or mortality. After a mean follow-up period of 8.6 months, both groups remained satisfactory in palmar sweating control. The T(4) group had more moisture hands compared with the T(3) branch (54.1% vs 15.2%, P < 0.01), but this didn't compromise the patients' satisfactory. The patients in T(4) group showed significantly less dry hand problems than the patients in the T(3) group (5.4% vs. 25.8%, P < 0.05), and so did compensatory sweating (21.6% vs. 45.6%, P < 0.05).
The procedure of T(3) or T(4) sympathectomy, both transecting the sympathetic chain in one single position in relatively lower segment, are comparatively effective in the treatment of primary palmar hyperhidrosis, but T(4) sympathectomy shows less side effect.