Objective To investigate the regularity of intrapulnonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma.To provide a basis for more accurate determination of N stage and indication for pulmonary segmental resection.Methods A prospective study was performed from March 2014 to December 2015.103 cases of cT1 N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection in the thoracic surgery department of China-Japan Friendship Hospital.Intrapulmonary lobar and segmental lymph nodes were dissected and sorted carefully then sent to the pathological department with the corresponding lung specimen and other lymph nodes.Statistical analysis was carried out considering size of the lesion,imaging features,serum CEA levels,pathological subtypes and so on.Results In total 103 cases,pN0 was confirmed in 82 cases,pN1 in 15 cases,pN1 + N2 in 5 cases,and skipping-pN2 in 1 case.14 cases(93.3％) in pN1 group were detected with station 12-14 lymph node metastasis,while only 5 cases (33.3％) were detected with station 12-14 LSNs metastasis.4 cases(66.7％) in pN2 group were detected with station 12-14 lymph node metastasis,while only 1 case(16.7％) with station 13 and station 7 lymph node metastasis.If LSNs were not detected,the false negative rate of N staging could be as high as 6.1％ (5/82),The rate of missed diagnosis of lymph node metastasis might be 30％ (6/20) to N1 stations alone.41.2％ (7/17)cases with metastasis to the adjacent LSNs had been proved with metastasis to the isolated LSNs.The metastasis rate of the isolated LSNs was significantly lower(P =0.049) in pure GGNs compared with those part-solid/solid nodules.Invasive adenocarcinoma had higher metastasis rate of isolated LSNs,compared with preinvasive lesions or minimally invasive adenocarcinomas,with no statistical difference between groups (P =0.055).No significant difference in isolated LSNs metastasis rate was found between groups with different serum CEA levels(P =0.251) or tumor size(P =0.197).Conclusion Dissection of intrapulmonary lobar and segmental lymph nodes might facilitate a more accurate N stage,reduce the false negative rate of lymph node metastasis,and provide basis for more accurate assessment of prognosis and postoperative adjuvant treatment.The sampling area of lymph nodes during segmental resection should include the adjacent LSNs of the target segment.The isolated LSNs metastasis rate of cT1N0M0 stage lung adenocarcinoma with pureGGN as imaging feature is relative low,which might be suitable for segmentectomy when meeting other criteria.

OBJECTIVETo explore the relationship between abnormal expressions of positive cell cycle control factors and thyroid carcinoma occurrence and progression, and assess the value of these factors in evaluating tumor cell proliferation activity and the prognosis of the patients.

METHODSImmunohistochemical SP method was used to detect the expressions of MCM7, CDK2 and Ki-67 proteins in 50 cases of thyroid carcinoma, 30 cases of thyroid adenoma, 30 cases of nodular goiter and 20 cases of normal thyroid gland tissues.

RESULTSThe positive rates of MCM7, CDK2 and Ki-67 expressions in thyroid carcinoma were 100% (50/50), 80.00% (40/50) and 84.00% (42/50), significantly higher than the rates in thyroid adenoma, nodular goiter and normal thyroid tissue (P<0.01). In thyroid carcinoma tissues, positive correlations were observed between the expressions of MCM7 and CDK2 proteins (r=0.637, P<0.01), MCM7 and Ki-67 proteins (r=0.633, P<0.01), and CDK2 and Ki-67 proteins (r=0.862, P<0.01).

CONCLUSIONThe high expressions of MCM7, CDK2 and Ki-67 protein may contribute to the development of thyroid carcinoma, and their combined examination may serve as useful index for early diagnosis and prognostic evaluation of thyroid carcinoma. MCM7 is superior to Ki-67 in the evaluation of the thyroid tumor cell proliferation activity.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cyclin-Dependent Kinase 2 ; metabolism ; Female ; Humans ; Ki-67 Antigen ; metabolism ; Male ; Middle Aged ; Minichromosome Maintenance Complex Component 7 ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology ; Young Adult

BACKGROUND AND OBJECTIVEApproximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC) are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent, yet due to many reasons, 5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of being be cured through an operation, who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.

METHODS165 out of 173 patients with N2 NSCLC were treated with surgery in our department from January 1999 to May 2003, among whom 130 were male, 43 female and the sex ratio was 3:1, average age 53, ranging from 29 to 79. The database covers the patients' complete medical history including the information of their age, sex, location and size of tumor, date of operation, surgical methods, histologic diagnosis, clinical stage, post-operative TNM stage, neoadjuvant treatment and chemoradiotherapy. The methods of clinical stage verification include chest X-ray, chest CT, PET, mediastinoscopy, bronchoscope (+?), brain CT or MRI, abdominal B ultrasound (or CT), and bone ECT. The pathological classification was based on the international standard for lung cancer (UICC 1997). Survival time was analyzed from the operation date to May 2008 with the aid of SPSS (Statistical Package for the Social Sciences) program. Kaplan-Meier survival analysis, Log-rank test and Cox multiplicity were adopted respectively to obtain patients' survival curve, survival rate and the impact possible factors may have on their survival rate.

RESULTSThe median survival time was 22 months, with 3-year survival rate reaching 28.1% and 5-year survival rate reaching 19.0%. Age, sex, different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-year survival rate. In all N2 subtypes, 5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P < 0.01), reaching 30.4% and 27.3% respectively. 5-year survival rate for single station lymph node metastasis were 27.8%, much higher compared with 9.3% for multiple stations (P < 0.001). Induction therapy which downstages proven N2 in 73.3% patients gains them the opportunity of surgery. The 5-year survival rate were 23.6% and 13.0% for patients who had complete resection and those who had incomplete resection (P < 0.001). Patients who underwent lobectomy (23.2%) have higher survival rate, less incidence rate of complication and mortality rate, compared with pneumonectomy (14.8%) (P < 0.01). T4 patients has a 5-year survival rate as low as 11.1%, much less than T1 (31.5%) and T2 (24.3%) patients (P = 0.01). It is noted through Cox analysis that completeness of resection, number of positive lymph node stations and primary T status have significant correlativity with 5-year survival rate.

CONCLUSIONIt is suggested that surgery (lobectomy preferentially) is the best solution for T1 and T2 with primary tumor have not invaded pleura or the distance to carina of trachea no less than 2 cm, unexpected N2 discovered at thoractomy when a complete resection can be applied, and proven N2 discovered during preoperative work-up and is down-staged after induction therapy. Surgical treatment is the best option, lobectomy should be prioritized in operational methods since ise rate of complication and morality are lower than that of pneumonectomy. Patients' survival time will not benefit from surgery if they are with lymph nodes metastasis of multiple stations (Bulky N2 included) and T4 which can be partially removed. Neoadjuvant chemotherapy increases long-term survival rate of those with N2 proven prior to surgery. However, postoperative radiotherapy decreases local recurrence rate but does not contribute to patients' long-term survival rate.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; complications ; mortality ; surgery ; Female ; Humans ; Lung Neoplasms ; complications ; mortality ; surgery ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Survival Analysis ; Thoracic Surgical Procedures ; methods ; Treatment Outcome

The present case report was designed to summarize the clinical experience of operative technique. lung preservation, lung perfusion, and perioperative management. Of 7 cases who underwent allogenic single lung transplantation (LT), 3 were idiopathic pulmonary fibrosis, 2 were chronic obstructive pulmonary disease, 1 was silicosis, emphysema, and bulla, and I was tuberculosis in both sides and presented with destroyed lung in one side. All donors were already brain death. Donor lungs were well preserved utilizing Euro-Colins liquid or low-potassium dextran solution. Donors and recipients were matched in blood type. Of 7 cases selected,5 received single right lung transplantation, and 2 received single left LT. End-to-end anastomosis was performed for pulmonary branches and pulmonary arteries. while atrium-to-atrium anastomosis was performed for pulmonary vein. Antibiotics and immunosuppressants were routinely used prior to and subsequent to LT. Following LT, heart and lung function, usage of antibiotics, and adjustment of immunosuppressant were monitored. Stomal complications regarding bronchus and pulmonary artery and vein did not appear in any patient. Five cases survived for about 2 months, one for approximately 1 year, and one for nearly 2 years. Four cases died of multi-organ failure caused by pulmonary infection, and one of severe pulmonary hemorrhage caused by aspergillus sydowi infection. Rejection occurred in 6 cases. One case sufiered from rejection three times. Selection of indication, selection and preservafton of donor lung, LT operation and pre-and post-operative management of LT have acquired satisfactory achievements. High mortality occurred in patients with preoperative poor cardiac and pulmonary functions and postoperative severe infections accompany with application of immunosuppressant.

BACKGROUND: Lung transplantation can improve quality of life of patients who get terminal pulmonary disease and also it can help to get better survival.Now it has become one of the best therapeutic methods for terminal pulmonary disease.However,limited donors leave the development of lung transplantation in dilemma.The emergence of living lobar transplantation and cadeveric lobar transplantation let this procedure much easier.OBJECTIVE: To evaluate the clinical probability of bilateral lobar transplantation.METHODS: Sequential bilateral lobar transplantation was performed for one 26 years old cystic fibrosis female.Cardiac pulmonary bypass was used during operation.Anti-rejection(Tacrolimus,mycophenolate,etc)and anti-infection was used postoperatively.RESULTS AND CONCLUSION: The recovery course postoperatively was smooth,and the recipient got out of hospital 7weeks later.Bilateral lobar transplantation could offer satisfied short-term pulmonary function.The long term results should be further evaluated.

OBJECTIVETo Summarize the clinical experience in the treatment of late-stage emphysema by lung volume reduction (LVR) in 5 years.

METHODSWe retrospectively studied the indications, contraindications, operation procedures and complications of LVR in 22 patients.

RESULTSBefore operation, the average FEV(1) was 24.5%, RV 196.8%, and TLC 130.5%; after operation they were 27.8%, 148.8% and 112.5%, respectively. 16 patients needed inhaling oxygen before operation, and 5 after operation. 16 patients finished 6-minute walking test with an average of 198 m, all patients walked much longer with an average of 256 m after operation. 3-degree lung function was observed in 14 patients, and 4-degree before operation in 8 patients; but 2-degree lung function in 5 patients, 3-degree in 13, and 4-degree in 4 after operation.

CONCLUSIONSHeterogeneous type emphysema with clear target area, especially bullous emphysema is the best indication for LVR. Lung function and life quality could be much improved postoperatively. Homogeneous type could also be treated with LVR in highly selected cases. TLCO < 20% is not an absolute contraindication, others standards need further investigation. Video-assistant thoracoscopic surgery (VATS) with subaxillary small incision for LVR is safe, reliable and effective. Application of stapler buttressing with bovine pericardia could decrease air leakage postoperatively.

Aged ; Female ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Pulmonary Emphysema ; surgery ; Retrospective Studies ; Thoracoscopy

BACKGROUND AND OBJECTIVEBecause radical resection for lung cancer invading the initial borderline of different lobes and carina is difficult, we tried to analyse the variables of successful tracheal carinoplasty and bronchovasculoplasty to discover a proper approach for appropriate early and long-term results.

METHODSOf 1 399 lung resections for primary lung cancer performed in our hospital from April 1985 to December 2006, 133 underwent bronchoplastic surgeries, including 15 carinoplasty cases and 118 sleeve lobectomy (SL) cases, and 118 pneumoectomy (PN) cases were compared at the same time.

RESULTSComplications occurred in 18 cases, with no operative related mortality. For all patients, the 1 year, 3 year, and 5 year survival rates were 79.8%, 56.7% and 31.2%, respectively. The 5 year survival rate by cancer stage was 69.2% for Ib, 40.6% for IIb, 19.6% for IIIa, and 16.6% for IIIa (N2).

CONCLUSIONSelection of cases, clearance of lymph nodes, disposal of the bronchus and pulmonary vessel and replacement or restoration of the superior vena cava are the main factors influencing prognosis.

Adult ; Aged ; Carcinoma, Bronchogenic ; mortality ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Survival Rate ; Trachea ; pathology ; surgery ; Treatment Outcome

Objective    To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax (PSP) patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods    The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion (BLPA) between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results    The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% (7/229), and that in patients with recurrent PSP was 2.6% (3/115, P=0.82). Compared with the bullectomy group (5.8%, 7/120), recurrence rate in the BLPA group was lower (1.3%, 3/224, P=0.02). There were no mortalities or significant complications in both groups. There was significant difference in body mass index (P=0.04), intraoperative adhesion (P<0.05), operation duration (P<0.01), number of bullae (P<0.01), and bullae location (P<0.01) between bullectomy and BLPA groups. Postoperative drainage (P<0.01), air leak (P=0.01) and extubation duration (P<0.01) were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group (P<0.01). Conclusion    Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.