Objective To investigate the biodistribution and positron emission tomography (PET) imaging of 3′-deoxy-3′-~ 18 F-fluorothymidine (~ 18 F-FLT) in a murine model of pulmonary carcinoma, and to evaluate the use of ~ 18 F-FLT as a new PET tracer for diagnosis of pulmonary malignant tumor. Methods 40 T739 mice bearing the pulmonary adenocarcinoma were randomly divided into five groups according to different tracers and time after their injection (n=8/group). The biodistribution of mice for ~ 18 F-FLT was measured with well-gamma detector at 30min, 60min, 90min, 120min after injection via the tail veins. The biodistribution of mice for ~ 18 F-FDG was examined at 60min after injection as controls. In addition, the PET imaging of mice was performed using two tracers. Results In the biodistribution study of ~ 18 F-FLT, considerable radioactive uptake in tumor was observed, and high radioactivity was showed in the kidney and spleen. The T/NT ratios of tumor/blood, tumor/muscle and tumor/lung was all above 2.0. The tumor PET images with ~ 18 F-FLT were clear, as well. Conclusions The uptake of ~ 18 F-FLT in pulmonary adenocarcinoma is higher than that in normal tissues, thus the pulmonary neoplasm could be identified accurately with PET imaging. Our preliminary study of ~ 18 F-FLT in lung carcinoma xenografts is satisfactory, and it provides a basis for further clinical study.

To investigate the relationship between partial esophagectomy with staple anastomosis for carcinoma and gastroesophageal reflux (GER). The pressure in the esophagus and intrathoracic stomach was measured with SG-Ⅱ computer manometer in 45 patients. Twenty-four-hour esophageal pH monitoring, endoscopy and pathological examination were performed in 20 patients. Resting pressure above the esophago-gastric anastomosis was higher than that under the esophago-gastric anastomosis. Twenty-four-hour pH monitoring revealed that GER occurred. Abnormal findings were observed in 80% of patients by endoscopic and pathological examinations. The results showed that GER existed in the patients after esophagectomy and esophagogastrostomy for esophageal cancer. The occurrence of GER with stapling anastomosis were similar to that with manual anastomosis. The occurrence of GER was not related with the length of postoperative period. Sleeping in semirecumbent position was an effective method to prevent GER for postoperative patients. Twenty-four-hour pH monitoring was a reliable method for detecting GER.

Objective With the development in optics and video systems, video assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of esophageal lesions has come to clinical use. The experience with the method in 12 patients admitted to the surgical department of the General Hospital of PLA from Oct.1993 to Sept.2001 was summarized. Methods Of the 12 patients (male 10, female 2) with the age ranging from 34 to 63, 10 were suffering from malignant tumors (9 squamous carcinoma, 1 adenoid cysticcarcinoma) with 5 in TNM stage 1, and 5 in stage 2, and 2 were having benign tumors (1 esophageal leiomyoma, 1 esophageal cyst). In 7 patients with malignant tumors, esophagectomy was performed through the right thorasic cavity followed by asophagogastrostomy in the neck, and in 3 patients the anastomosis was done in the right thoracic cavity. A left thoracoscopic extirpation of esophageal leiomyoma and esophageal cyst was performed in patients with benign tumors. Thoracotomy was necessary in 3 patients. All patients were ventilated with a double lumen endotracheal tube, so that only the ipsilateral lung collapsed. Results There was no operative mortality in the group. Mean time for freeing the esophagus through thoracoscope was 70 minutes, and mean overall operation time was 252 minutes. 7 enlarged mediastinal lympha nodes were excised. The mean postoperative drainage volume was 180ml/24h and the mean duration of drainage tube was 2 days. The patients were discharged from the hospitals 9～13 days after the operation. Two postoperative complications occurred, one presented as left recurrent laryngeal nerve injury and the other as incision infection. Conservative therapy was given and recovery was uneventful. Conclusions As a minimally invasive surgical technique, VATS was a feasible and effective option in the treatment of esophageal lesions. Complications of VATS were similar to that of conventional open chest surgery. There is still controversy with regard to esophageal resection with VATS for malignant tumors, therefore further investigation is necessary.

Objective To evaluate the value of intraoperative ultrasonography (IUS) in detecting the lymph nodes in mediastinum and hilum during lung cancer surgery. Methods Lymph nodes were detected in every part of the mediastinum and hilum by IUS in 33 cases with lung cancer during surgery. The number, size and location of lymph nodes were recorded, and the metastasis to lymph nodes was predicted by the sonographic features and geometric measurement respectively. Mediastinum was explored and lymph nodes resection was performed in each case, and each resected lymph node was sent for pathological examination. Results The sensitivity of IUS in detecting lymph nodes in mediastinum and hilum was 83.6% (163/195) and the positive predictive value was 97.0%(165/168). The result of detecting lymph nodes with IUS was influenced by their location and size. The sensitivity, specificity and accuracy of IUS in diagnosing lymphatic metastasis with respect to geometric measurement were 70.3%, 71.7%, 71.2%, respectively, and were 85.7%, 75.0%, 83.3%, respectively, with respect to sonographic features. Conclusions IUS was an effective method for lung cancer surgery in detecting mediastinum lymph nodes.

Objective To investigate a novel therapeutic strategy in the treatment of lung cancer with diffuse pleural metastasis accompanied by malignant pleural effusion. Methods From December 1978 to February 2003, 55 patients of carcinoma of lung with pleural metastasis underwent the comprehensive therapy characterized by pleuropneumonectomy. A follow-up of all the patients after hospital discharge was conducted. Results Death due to complications was found in 2 out of the 55 patients, but remission and significant improvement of symptoms were found in the rest. A follow-up period ranging from 1 to 25 years revealed that 48 patients survived for 5-40 months (median survival time: 14 months), and 5 patients were still living and well. Conclusion Strict control of the surgical indications and radical removal of the malignant tumor can improve the quality of life and prolong the survival time of patients, even there is already metastasis to the pleura.

Objective To evaluate the accuracy of intraoperative ultrasonography (IUS) in judging the relationship between central bronchogenic carcinoma and pulmonary vessels and in predicting the resectability of the tumor. Methods Intraoperative ultrasonograpy(IUS) and preoperative CT scanning were performed in 30 patients of central bronchogenic carcinoma. The relationship between vessel and tumor as assessed by IUS and preoperative CT were quantified and scored with a ranging from 0-4 respectively, and then the resectability of the tumor and optimal surgical method were predicted according to the scores. Results The accuracy of CT and IUS to determine tumor-vessel relationship was 72.3%(141/195) and 81.0%(171/211), respectively (P=0.037). The sensitivity of CT and IUS in predicting the resectability of tumor was 91.3%(21/23) and 95.6%(22/23), respectively, the specificity was 28.6%(2/7) and 57.1%(4/7), respectively, and the accuracy was 76.7%(23/30) and 86.7%(26/30), respectively. The accuracy of CT and IUS in predicting surgical strategy was 53.3%(16/30) and 63.3%(19/30), respectively(P=0.432). Conclusion IUS is a useful method in predicting the resectability of centrally located bronchogenic carcinoma.

Objective To study the killing effect of hypocrellins B-photodynamic therapy (HB-PDT) for lung cancer cell line A549, to compare with that of hematoporphyrin derivative-photodynamic therapy (HpD -PDT), in order to define the superiority of HB-PDT in the therapy of lung cancer. Methods Lung cancer cell line A549 was used in the study. The cells were incubated in vitro with HB or HpD dissolved in DMEM in different concentrations, and then irradiated by copper vapor laser with mixed wavelength light under saturated light dose. Cell survival rate was respectively measured by MTT assay after 24 hours' incubation. According to cell survival curves after being cultured with different photosensitizers in different concentrations, the equation of each cell survival curve was plotted. Finally IC 50 (50% inhibition concentration) of each photosensitizer was derived. Results The results showed that HB-PDT had a strong killing effect on lung cancer cell. The IC 50 of HB was 33.82ng/ml for lung cancer cell, while the IC 50 of HpD was 1 316.88ng/ml, which was 38.94 fold of that of HB. Conclusions HB was a more effective photosensitizer than the photosensitizer HpD. HB-PDT had strong photodynamic killing effect on lung cancer cell line.

Objective To summarize the experiences in diagnosis and treatment of thymoma in 120 cases. Methods 120 patients with thymoma were operated on, and the diagnosis was confirmed pathologically, from January 1994 to December 2003 in our department. According to Masaoka clinical and pathological classification, 54 cases were stage Ⅰ, 32 were stage Ⅱ, 22 were stage Ⅲ, 12 were stage Ⅳ. In 42 cases there were symptoms of myasthenia gravis. Result Total excision was performed in 112 cases and partial excision in 8 cases. When the tumor was beyond stage Ⅱ, postoperative radiotherapy was given. Recurrence occurred in 5 patients 1-7 years after operation. Conclusions Surgical resection is currently the main therapeutic method for tumor of the thymus. The preferred surgical approach was excision of thymoma and removal of perithymic fat in the anterior mediastinum through a median sternotomy. Thymoma is a potentially malignant disease, and the patients with the tumor beyond stage Ⅰ must undergo postoperative radiotherapy. Local recurrence of the tumor should be surgically excised.

Forty patients with pulmonary sclerosing hemangioma treated from 1971 to 1999 in General itospital of PLA were analyzed retrospectively for clinical and pathological features,and image characteristics. The results showed that 60%(24 of 40) of patients were middle aged or elderly women,and 40% (16 of 40) of patients had symptoms.On chest radiography,the tumor presented as a round or nearly round nodule or mass with sharp and smooth margin in 37 cases(92 5%).All patients received operation without complication or mortality.Immunohistochemical findings indicated that the tumor cells were positive for neuroendocrine markers,and neurosecretory granules were found in tumor cells by electron microscopy.There was no recurrence or metastasis at the follow up. It suggested that pulmonary sclerosing hemangioma is a benign neuroendocrine tumor that has a good prognosis if it is treated by operation.

Of the 49 patients(male 43, female 6) collected from October 1983 to April 2000, 46 were malignancy with 29 in TNM stage I, 15 in stage II, and 2 in stage Ⅲa. Age ranged from 10～68. Upper lobectomy with sleeve resection was performed in 43 cases(14 in left lung, 29 in right lung) and right upper lobectomy with wedge bronchoplasty in 2 cases, left upper lobectomy with bronchoplasty and angioplasty in 2 cases , left lower lobectomy with sleeve resection in 2 cases. There was no mortality in our group and all patients recovered well. No such major complications as bronchial anastomotic fistula or stenosis occurred. The 1,5 and 10 year survival rates of malignant cases were 93.0%, 48.1% and 8.3% respectively. The results suggested that the operation plan for malignant lung diseases should be made individually. However, instead of a total pneumonectomy, a sleeve lobectomy is sometimes preferabe for the sake of the safety in those with poor cardiopulmonary function to save the lung capacity as much as possible.