Background and purpose:As a minimally invasive procedure, video-assisted thoracospic surgery for definitive resection of lung cancer is the focus of thoracic surgeons controversy.We studied the application of video-assisted thoracospic surgery and conventional thoracotomy for definitive resection of lung cancer from viewpoint of lymphadenectomy. Methods:From January 2001 to December 2005,549 patients with lung cancer underwent video-assisted thoracospic surgery lobectomy or pneumonectomy with systematic thoracic lymphadenectomy. The total number and average of dissected lymph nodes were recorded. Some studies on VAT and conventional lobectomy or pneumonectomy with systematic thoracic lymphadenectomy for lung cancer were compared.Results:In all 549 cases,7360 lymph nodes were dissected. The average of dissected lymph nodes was 13.41. There were no significant difference between video-assisted thoracospic surgery and conventional thoracotomy.Conclusions:Video-assisted thoracospic surgery should fulfill the same quality of lymphadenectomy WT5"and lung cancer radical resection. WT5"HZ

Objective To report the management of single allograft lung transplantation in 4 cases of COPD. Methods Four COPD cases receiving lung transplantation were analyzed respectively. There was diffuse emphysema in double lung in one case and in the remaining 3 cases severe diffuse emphysema that mixed together partially to be bulla but not to the 1/3 of the thoracic cavity. All the cases received the corpse donor. One case with diffuse emphysema received the single-right lung transplantation, one case received simultaneous single-lung transplantation and lung volume reduction and the remaining 2 cases received LVRS 47 days and 28 days after single-left lung transplantation respectively. The inductive treatment with the daclizumab or antithymocyte globulin (ATG) was done and the rejection was prevented with the Tacrolimus, mycophenolate and prednisone. Results The operations were successful in the 4 cases. One case had the acute rejection 5 days after operation and reco- vered after intensive treatment with Methylprednisolone. Two cases discharged successfully and lived to today and the first case lived more than 2 years. Two cases died 74 days and 77 days after lung transplantation respectively. Conclusion In late stage COPD, single allograft lung transplantation is an effective treatment to the bilateral emphysema patients and the lung volume reduction should be done simultaneously to the patients with the bullae that may be ruptured.

Objective To study the features of pulmonary cryptococcosis and the curative effect of thoracoscopic operation for it. Methods The authors retrospectively analyzed the clinical data of 11 patients with pulmonary cryptococcosis in this hospital between January 1996 and December 2002, consisting of 8 cases of thoracoscopic wedge resection, 2 cases of thoracoscopy-assisted modified posterolateral mini-lobectomy, and 1 case of pulmonary wedge resection. Results Ten patients were preoperatively misdiagnosed. Solitary lesions were found in 8 patients and multiple lesions in both lungs in 3 patients. Complete removal of lesions was achieved in 8 patients and pulmonary biopsy was conducted in 3 patients. Except for 3 cases of wound effusion, there were no other postoperative complications. Follow-up for (38.6?10.8) months (range, 12～72 months) found no pyothorax, bronchopleural fistula, or recurrence of cryptococcosis. Conclusions Pulmonary cryptococcosis usually makes its appearance as a solitary lesion without underlying diseases or symptoms, which is difficult to diagnose preoperatively. Video-assisted thoracoscopic surgery can remove the lesion completely, giving a minimal invasion and rapid recovery.

Objective To summarize the experience of the diagnosis and treatment of pulmonary hamartoma.Methods Bronchoscopic enucleation of tumor was conducted in 1 case of endobrochial hamartoma, while video-assisted thoracoscopic surgery was performed in 42 cases(consisting of 40 cases of pulmonary wedge resection,1 case of lobectomy,and 1 case of bilateral lesion biopsy).Results Pathological examinations revealed hamartoma in all the 43 cases,including 1 case of multiple lesions and 1 case of hamartoma complicated with lung cancer.The diagnostic accordance rate was 11.6%(5/43).Follow-up in 37 cases for 4 months~ 11 years(mean,41.2 months) showed no recurrence or malignant change.Conclusions Pulmonary hamartoma is difficult to be confirmatively diagnosed preoperatively.Endoscopic operations can give an accurate diagnosis and a thorough removal of the lesion,with minimal invasion and rapid recovery.

Objective To investigate the clinical features and gene mutation of a newborn with neonatal-onset ornithine transcarbamylase deficiency (OTCD) and report the multidisciplinary perinatal management of the mother with late-onset OTCD.Methods The clinical features,biochemical data and the treatment of a newborn boy with OTCD and his mother admitted by Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in April,2013,were collected.The ornithine transcarbamylase (OTC) gene in the family was analyzed.Results Serum ammonium in the male newborn gradually increased to 1 020 μ mol/L at 48 h after birth.His blood amino acids level and urine organic acid level showed a pattern indicative of OTCD [blood arginine (97.43 μ mol/L,reference 1.00-25.00 μ mol/L),citrulline (27.43 μ mol/L,reference 4.00-30.00 μ mol/L),ornithine (161.66 μ mol/L,reference 10.00-120.00 μ mol/L) and methionine (70.45 μ mol/L,reference 10.00-50.00 μ mol/L); urine uracil (67.11 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (1 372.66 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol Crea)].DNA studies revealed a c.583G ＞ A (G195R) homozygous mutation of the OTC gene.His mother was heterozygous for OTCD and developed acute hyperammonemia during pregnancy.Her blood showed a normal-leveled arginine (8.44 μ mol/L,reference 1.50-25.00 μ mol/L),a normal-leveled citrulline(8.41 μ mol/L,reference 7.00-35.00 μ mol/L),an elevated glutamate(279.15 μ mol/L,reference 45.00-200.00 μ mol/L).Her urine uracil (51.55 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (38.75 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol) were elevated.Successful management of her prenatal and postpartum blood ammonia level was achieved after administration of pharmacologic nitrogen scavengers and protein limitation.DNA studies revealed a c.583G ＞ A (G195R) heterozygous mutation in the newborn's mother and grandmother.Conclusions General management on pregnant OTCD women is effective.Male newborn patients often have a poor prognosis.

Objective To evaluate the clinical effects of endobronchial ultrasound - transbronchial needle aspiration (EBUS-TBNA) in the evaluation of staging of lung cancer.Methods Between July 2008 to March 2010,the first 128 patients selected by CT or PET/CT scanning with lung cancer in whom metastatic carcinoma in the hilar and/or mediastinal lymph nodes underwent EBUS-TBNA and were clinically followed up.There were 102 males and 26 femals with the age of 37 - 85 years,average 60.1 years.Review the performance in check and the result of biopsy.Results From 128 patients of mean age 60.1 years ( range 37 - 85 ),189 lymph nodes were punctured.The mean diameter of the nodes was 12.3 mm and the range was 6-16 mm.There were no procedural complications.Accuracy,sensitivity,and specificity for EBUS-TBNA were 98.53％,98.50％,and 100％,respectively.Conclusion EBUS-TBNA allows real-time visualization of mediastinal and hilar lymph nodes,allowing sampling safely and efficiently.It has great potential for diagnosis of staging of lung cancer.

Objective To investigate the expression of FGFR4 in lung adenocarcinoma tissue and its association with the prognosis of lung adenocarcinoma. Methods The expression FGFR4 in 128 lung adenocarcinoma tissue and the normal lung tissue was detected by the immunohistochemistry SP method.The relationship between the expression of FGFR4 in lung adenocarcinoma and the prognosis of lung adenocarcinoma was analyzed. Results The expression of FGFR4 protein in lung adenocarcinoma was significantly lower than that in the tumor-adjacent normal lung tissue (P<0.05). Expression of FGFR4 protein was not significantly assocoated with gender, age, smoking status, serum CEA levels and tumor location (P > 0.05), but was significantly and positively correlated with the degree of tumor differentiation and T stage, N stage and the clinical TNM stage of lung adenocarcinoma (P < 0.05).Kaplan-Meier survival test showed that the postoperative survival time in the high expression group of FGFR4 was significantly longer than that in the low FGFR4 expression group (P < 0.05). Conclusion The expression of FGFR4 protein in lung adenocarcinoma was significantly lower than that in the tumor-adjacent normal lung tissue. Postoperative survival time in the high FGFR4expression group was significantly longer than that in the low FGFR4 expression group.

AIM: To investigate the protective effect of ulinastatin on rats with hemorrhagic shock. METHODS: A prospective, controlled animal study was designed. The model of hemorrhagic shock in rats was produced by Chaudry method. After 60 min, rats were resuscitated by transfusion of shed blood and normal saline, but a half of them were treated with ulinastatin. At different time points after reperfusion, the levels of tumor necrosis factor-alpha (TNF-?), interleukin-6 (IL-6), malondialdehyde (MDA) and superoxide dismutase (SOD) in serum were detected. RESULTS: The levels of TNF-?, IL-6 and MDA significantly increased and the activity of SOD decreased. In the ulinastatin-treated groups, the blood pressure and heart rate were obviously improved; the levels of TNF-?, IL-6 and MDA significantly decreased and the activity of SOD had little change after hemorrhagic shock and reperfusion. CONCLUSION: Ulinastatin has a protection effect on rats with hemorrhagic shock by suppressing the production of inflammatory factors and reducing oxidative damage.

Objective To investigate the therapeutic effect of single stage cavernostomy and myoplasty on the aspergillus thoracic empyema. Method Four patients suffering from aspergillus thoracic empyema were treated with single stage cavernostomy and myoplasty. They got the inflammation of aspergillus after the operation for tuberculosis in 2, bronchiectasis in 1 and lung cyst in 1. They were performed rib resection, cavernostomy, closure of the bronchial openings and total/partial obliteration of the cavity with a muscle flap as a single stage technique. Pectoralis major muscle was used for the myoplasty in 1, latissimus dorsi in 1 and intercostal muscle in 2. All patients were given the therapy of nutritional support, local pressure dressing and oral anti-fungus drugs. Result Two patients got the primary healing, the chest tube were pulled out 2 days later and they were discharged 12 days after the operation. One patient′s cavity became little and there was pus drained from the chest tube, he cured after prolonged draining and washed with the anti-fungus drugs. One patient dead for pneumonia 67 days after the operation. Conclusion Cavernostomy and myoplasty as a single stage technique is safe and reliable in the management of patients with aspergillus thoracic empyema.

ObjectiveTo evaluate CT and MRI findings of the intrathoracic ganglioneuroma and to improve its diagnosis and differential diagnosis ability.MethodsClinical,CT( n = 14),MRI (n = 6) and pathology manifestations of 20 patients with the intrathoracic ganglioneuroma were retrospectively analyzed.All 20 cases had chest CT and MRI plain scanning and multiphase enhance scanning before operation.ResultsSeventeen of 20 lesions were located in posterior mediastinum,2 in pleura side and 1 in right thorax cavity.The CT value of the plain scans ranged from 20 to 40 HU ( mean 30.5 HU),Tubercle calcification were detected in four masses,one case with fat density was showed on CT scanning.After injecting contrast media,CT value ranged from 0 to 12 HU (mean 6.2 HU) in artery phase,ranging from 10 to 20 HU ( mean 14.3 HU) in delay phase.Five of 6 cases of MRI signals were homogeneously low intensity on T1 WI,1 case with fat signal was imhomogeneously low intensity on T1WI.Six cases were imhomogeneously high intensity on T2WI.A whorled appearance was visualized in one tumor on T2WI.The post-contrast enhancement MR images was slight enhancement imhomogeneously in artery phase and gradual increasing enhancement in delay phase.ConclusionOn CT and MR imaging,no enhancement or slight enhancement in artery phase and gradual increasing enhancement in delay phase are characteristic manifestations of ganglioneuroma in the thorax.