OBJECTIVE:To evaluate the hemostatic effect of Reptilase on bleeding after pneumonectomy.METHODS:324cases of lung cancer were randomly divided into2groups and the volume of postoperative thoracic drainage in Reptilase group and control group was measured at24h,48h and72h after operation.RESULTS:The drainage volume in Reptilase group was much lower than that in control group.CONCLUSION:Reptilase can reduce the volume of thoracic drainage after thoracic surgery.

After decades of development, thymus minimally invasive surgery has derived a variety of surgical methods. In selected cases, it can achieve equivalent therapeutic effect as open surgery. Because mediastinal disease is rare compared with other chest diseases, there is a lack of large-scale comparative study among different surgical methods, and the choice of surgical approaches is mostly based on the experience and habit of the operator. The purpose of this review is to discuss the evolution of minimally invasive thymus surgery, summarize several kinds of minimally invasive thymus surgery approaches that are widely used in and abroad, and analyze the integration and improvement strategies of minimally invasive thymus surgery in China.

Sternal tumors are uncommon, mostly malignant.Radical resection can offer a definitive cure of these tumors. Improvement of skeletal and soft tissue reconstruction have made coverage of sternal defects reliable .

Objective To discuss the cause,prevention,treatment of airway anastomosis stenosis after lung transplantation.Methods From Jan.2003 to Sep.2005,8 homogeneity variant single lung transplantations were performed successfully at our hospital.All the cases were subjected to a running suture on the membranous wall and single stitches on the anterior cartilaginous part.Among the 11 cases,9 were still alive well. In 4 patients having aspergillus infection after operation,2 patients suffered from bronchial anastomosis stenosis.Results There were bronchial anastomosis stenosises in the 2 patients one month and 7 months after transplantation, respectively.All of them were cured by stenting.Conclusions Airway anastomosis stenosis was associated with bronchial ischemia,aspergillus infection,suture technique and so on.The stenting was positively effective for airway anastomosis stenosis.

Objective To summarize the initial outcome of single lung transplantation in the treatment of endstage pulmonary disease.Methods From Jan.2003 to June 2005,11 cases were subjected to single lung transplantation consecutively at our hospital.Of the 11 patients with end-stage pulmonary diseases,7 underwent the right single lung transplantation,and 4 the left procedure.Among them,2 patients received single lung transplantations by the same donor.Results Of the 11 patients,6 cases have been alive for more than 1 year(including 3 cases been alive for more than 2 years).Three cases have been alive for more than 6 months.Lung function examination was done 2 months after lung transplantation.Nine patients showed normal PaO_(2) values(more than 80 mm Hg) with an average improvement of(37.6%),and 8 obtained an average improvement of(165.2%) in FEV_1.One case died of bleeding intra-operatively.One case died of chylothorax at 3rd month post-operatively.The incidence of acute rejection was(1.2) averagely in this group.As to other complications,aspergillosis occurred in 4 cases,severe lung infection in 2 cases,reperfusion-injury-induced pulmonary edema in 1 case at 36th h postoperatively,and upper alimentary canal hemorrhage in 1 case at 7th day.Chronic rejection occurred in 1 case at first year postoperatively.Conclusions Single lung transplantation is effective in treating end-stage pulmonary disease.The incidence of complication was higher after lung transplantation.Effective prevention and management should be emphasized.

Objective To discuss the causes, prophylaxis, and treatment of the complications of mediastinoscopy. Methods Mediastinoscopy was performed in 262 consecutive patients from September 1981 to November 2005 in this hospital. Of them, 12 patients experienced preoperative or postoperative complications. Results During the operation, massive hemorrhage from branches of the innominate artery occurred in 1 patient. After the extension of cervical incision, the bleeding was stopped by pressure tamponade for 2 hours. Wound infection happened in 5 patients. One patient was clarified as having pulmonary tuberculosis, with enlargement and necrosis of mediastinal lymph nodes that led to the diabrosis of biopsy passage. The wound infection was cured by cut-open, drainage, and dressing changes. Wound infection in another 4 patients healed after dressing changes. Hoarseness of voice developed in 2 patients and spontaneously subsided at 1 and 3 postoperative months respectively. Two patients with abnormal electrocardiogram were treated with cedilanid. Pneumothorax was found in 2 patients and spontaneously healed at 4~6 days after operation. Conclusions Complications of mediastinoscopy can be avoided in experienced hands, on the basis of proficiency of mediastinal anatomy and careful surgical manipulation.

Objective: To treat the senile severe emphysema by single lung transplantation. Methods: The candidate was a 63-year-old male patient who had suffered from severe dispnea for more than 23 years and experienced an advancing exacerbation during the last 3 years. He showed very poor lung function and other related clinical date the pre-operative clinical examination: FEV 1 was 0。64L (24%), PaO 2 was 45 mm?Hg, PaCO 2 was 36。3 mm?Hg, pulmonary artery pressure is 38 mm?Hg, 6MMT was 59 m and dispnea staging was 4. An allograft left lung transplantation was performed under general anesthesia in January 9th, 2003. Three immunosuppressors were given to the recipient orally after the operation. Results: 6 months after lung transplantation, the recipient showed a significant clinical relief and lung function improvement: FEV 1 is 1.20L (40%), PaO 2 is 92 mm?Hg and 6MMT is 227 m. Conclusion: The single lung transplantation is efficient in treating the end-staged emphysema.

Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postopearative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphotericin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphotericin B prevent fungal infection during the early postoperative period of lung transplantation.

Objective To summarize the initial outcome on the treatment of severe pulmonary emphysema by single lung transplantation . Methods Between January 2003 and September 2004, 6 single lung transplantations were conducted consecutively at our hospital. Of the 6 patients with severe pulmonary emphysema, 4 underwent the right single lung transplantation, and 2 the left procedure. All 6 patients were males with a mean age of 54.2 years (range: 51 - 63 years) , and suffered from severe dyspnea (Grade Ⅳ of the Hugh-Jones dyspnea scale) for 5 to 23 years before operation. Preoperative lung function showed an average FEV1 of (0.69?0.36)L[(23.3?12.9)% of the predicted], PaO2 of (62.5?6.5) mm Hg, PaCO2 of (41.4?14.9) mmHg, 6 MMT of(51.5?18) m and a mean pulmonary arterial pressure (PAP) of (30?6) mm Hg. All patients were treated postoperatively with conventional temate immunosuppression regimen.Results All 6 patients remain alive and pulmonary function were very well with post-operation survival of 24, 19, 14, 10, 9, 4 months, respectively. When assessed at 2 months after lung transplantation surgery, all 6 patients showed normal PaO2 values (more than 80 mm Hg) with an average improvement of 37.6 % , and 5 FEVi were improved significantly (165.2%) in 5 patients. The incidence of acute rejection was 1.2 averagely in this group. As to other complications, aspergillosis occurred in 4 cases, severe lung infection in 2, reperfusion pulmonary edema in 1 at 36th hour postoperatively, and upper alimentary canal hemorrhage in 1 on 7th day. Conclusion Single lung transplantation is effective in treating end-stage pulmonary emphysema.

Septic arthritis of the sternoclavicular joint(SCJ) is a rare condition and accounts for 0.5％-1.0％ of septic arthritis.SCJ infections often require surgical intervention.Diabetes mellitus,rheumatoid arthritis,intravenous drug use,intraarticular injection and immunosuppressive disorders are predisposing factors.Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteriologies.Early diagnosis of SCJ infection requires a high index of suspicion and a confirmatory CT or MRI scan.The characteristic imaging features include intramedullary and soft tissue gas,sequestra,soft tissue swelling and destruction or widening of joint space.Management strategies have ranged from conservative antibiotic therapy to en-bloc resection of the sternoclavicular joint with or without ipsilateral pectoralis major muscle transposition.The shoulder function in most patients were well preserved.