Adolescent ; Adult ; Bacterial Infections ; Female ; Humans ; Infection ; Male ; Middle Aged ; Neck ; Young Adult

Objective: To compare the clinical value of video-mediastinoscopy (VM) and standard mediastinoscopy(SM) in diagnosis of thoracic diseases. Methods: The clinical data of 100 patients with mediastinoscopy were studied retrospectively. Of them, 54 patients underwent VM, and 46 patients underwent SM. The operative parameters including operating time, complications and post-operative hospital stay, the diagnosis accuracy of undifferentiated mediastinal diseases and the accuracy of perioperative staging of lung cancer were compared. Results: The average operating time in VM group was (53.9?17.2) mins, which was less than that in SM group (69.4?24.7)mins (t=2.05,P

1.0 cm) by radiographic examinations, video-mediastinoscopy showed positive results in 30 cases, and negative in 14 cases, in which the surgical exploration found no evidence of metastasis to mediastinal lymph nodes. No postoperative complications and mortality were observed. Conclusions Video-mediastinoscopy offers clear operation field, high resolution, convenient application, safety and reliability. We suggest that it be adopted as a routine method in the diagnosis of mediastinal tumor and the staging of lung cancer.

Objective To evaluate the value of mediastinoscopy in the diagnosis of undifferentiated mediastinal diseases. Methods A total of 35 mediastinoscopies were performed for patients with undifferentiated mediastinal disease from November 1999 to February 2002 and suspicious tissues at peritracheal,retrosternal,subcarinal,or bilateral hilar areas were obtaiued for pathological examination. Results Thirty four of 35 patients with undetermined mediastinal diseases had definite pathologic diagnosis.The diagnosis accuracy was 97%(34/35).Of the 34 patients,18 were diagnosed as malignant accounting for 52.9%.Sixteen of the 34 were diagnosed as benign,accounting for 47.1%.The diagnostic consistency of preoperation and postoperation was 47.1%(16/34).The misdiagnosis of preoperation was 52.9%(18/34).In this series,the benigns were apt to lead to misdiagnosis.10 of 16 patients with benign disease were diagnoscd as initially malignancies,representing 62.5%.In the entire group one patient had complications (2.9%).Yet no perioperative death occurred. Conclusions Mediastinoscopy is a valuable procedure which helps mede a correct diagnosis of mediastinal diseases.Given its safety and usefulness It is suggested that mediastinoscopy should be used routinely in the diagnosis of undifferentiated mediastinal diseases.

Objective To evaluate the role of mediastinoscopy with biopsy on right trachea-bronchial lymph node (R4) in the diagnosis and pathologic staging of lung cancer. Methods From November 1999 to May 2004, sixty-six patients with lung cancer (47 right and 19 left) received mediastinoscopic biopsy on R4 lymph node. 17 patients were preoperative diagnosed and 49 suspected have lung cancer. The approach included cervical mediastinoscopy in 62 cases, parasternal mediastinoscopy in 1 and cervical combined with parasternal mediastinoscopy in 3. Results In total 66 patients, R4 lymph node positive was found in 49 cases, including 38 patients with right lung cancer and 11 with left lung cancer. The metastasis rate in small cell lung cancer, adenocarcinoma and squamous cell carcinoma were 100%, 82.2% and 52%, respectively. For 49 preoperatively suspected lung cancer patients, malignant tumor was confirmed by mediastinoscopy with biopsy in 40 and open thoracic surgery in 9. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusion R4 lymph node is one of the most common and important site for the tumor metastasis in lung cancer. Mediastinoscopy with biopsy on R4 lymph node has incomparable advantages in diagnosis and staging lung cancer over other examinations and biopsy on other sites of lymph nodes.

Objective To evaluate the efficacy and value of mediastinoscopy in the diagnosis of superior vena cava obstruction syndrome (SVCOS). Methods 12 patients with SVCOS underwent mediastinoscopy. This group consists of 9 males and 3 females aged 16 to 71 years. 7 cervical mediastinoscopies and 5 parasternal mediastinoscopies were performed. Results In eleven patients, definite pathological diagnosis was obtained, included: primary lung cancer in 8, lymphoma in 3 and invasive thymoma in 1. There were no operative morbidity and mortality. Only in 1 patient with lymphoma the symptom got worse after cervical mediastinoscopy and soon released by chemotherapy. Conclusion Mediastinoscopy is an effective method in the diagnosis of SVCOS.It can be considered as a routine procedure if other methods failed.

Objective To evaluate the efficacy of retroperitoneoscopic adrenalectomy for pheochromocytoma.Methods From January 2000 to October 2006,a total of 16 patients(aged from 32 to 65 with a mean of 42 years) with pheochromocytoma received retroperitoneoscopic adrenalectomy in our hospital.Among the cases,6 had the tumor on the right side,and 10 on the left.The size of the tumors ranged from 2.5 to 4.6 cm in diameter(mean,3.1 cm).Results The mean preoperative preparation time in this series was 11 days(range,6 to 28).The retroperitoneoscopic adrenalectomy was completed in all but one of the patients,who were converted to open surgery because of extensive adhesion of the tumor to surrounding tissues and massive bleeding.The mean operation time was 110 minutes(90 to 170),and the mean blood loss was 135 ml(80 to 650).Three cases,who had normal blood pressure and thus received no noradrenalin immediately after the surgery,was given noradrenalin emergently 4,6,or 56 hours later owing to a sudden drop of systolic pressure(from 135 mm Hg to 80 mm Hg in 2,and from 140 mm Hg to 85 mm Hg in 1).Postoperative examination showed benign pheochromocytoma in 15 of the cases,and low-grade malignant pheochromocytoma with local invasion of the capsule in the patient who was converted to open surgery.The mean postoperative hospital stay was 12 days(9 to 20).The patients were followed up for 3 to 24 months(mean,13),during which only one received antihypertensive drugs;the others restored normal blood pressure spontaneously.No patient had abnormal levels of 24-hour urine noradrenalin,adrenalin,and catecholamine.Conclusions Retroperitoneoscopic surgery is an effective and minimally invasive treatment for patients with adrenal pheochromocytoma.The patients have a few complications and recover quickly after the operation.Preoperative preparation and postoperative treatment are important for the outcomes of the disease.

Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma.Methods Clinical data of 49 patients with esophageal leiomyoma from September 1996 to February 2009 treated by video-assisted thoracoscopic enucleation were reviewed retrospectively.Three or four trocars were used during the operation.The procedure of the surgery was similar to that of open thoracoscopic enucleation.Results In the 49 patients,video-assisted thoracoscopic leiomyoma enucleation was successfully completed in 42 cases.The other 7 patients were converted to open thoracotomy because of the following reasons:dense pleural adhesion in 2,location failure of small tumor(

Objective To study the self-identity and security of patients with obsessive-compulsive disorder (OCD) Methods According to the Chinese Classification of Mental Disorder,Third Edition,63 inpatients and outpatients with OCD and 61 healthy controls were recruited to investigate with self-identity scale(SIS),security questionnaire (SQ),Yale-brown obsessive compulsive scale (Y-BOCS),and self-made questionnaire.Results Compared with controls,patients had lower self-identity (50.81 ± 7.52 vs 55.10 ± 6.86,P ＜ 0.01)and security(50.09 ± 11.65 vs 58.87 ± 10.22,P ＜ 0.01)than healthy controls.Female patients had lower self-identity (48.31 ±7.68 vs 52.57 ±6.98,P＜0.05) than male patients.There were correlation between self-identity and Y-BOCS (r =-0.404,P ＜ 0.01),security and Y-BOCS (r =-0.314,P ＜ 0.05),self-identity and course of disease (r =-0.284,P ＜ 0.05),security and course of disease (r =-0.259,P ＜ 0.05) self-identity and security (r =0.698,P＜ 0.01) Conclusion OCD patients have lower self-identity and security.The self-identity and security reduce with the symptoms getting worse.Low self-identity and security maybe characteristic of OCD patients.

Objective To compare safety,completeness and long-term results between lobectomy by video-assisted thoracoscopic surgery(VATS) and thoracotomy for clinical stage Ⅰ / Ⅱ non-small cell lung cancer(NSCLC).Methods Between July 2010 and December 2011,673 patients with clinical stage Ⅰ / Ⅱ NSCLC from 11 hospitals underwent pulmonary lobectomy(425 VATS,248 thoracotomy).Patients were matched by propensity score matoh method to create two comparable groups,402 patients remained eligible for analysis,with 201 patients in each group.Perioperative variables and follow-up results were compared between the two groups.Results Patients characteristics were comparable between the two groups,except for a slight lower preoperative FEV1,FEV1％ and FEV1/FVC in the VATS group (P ＜ 0.05).There was one postoperative death in each group.There was no significant difference in operative time,mediastinal lymph nodes stations/numbers dissected and postoperative drainage time between the two groups.The operative blood loss was lower in the VATS group(P ＜ 0.001),the mean hospital stay was shorter in the VATS group(P ＜ 0.001).Postoperative pneumonia/pulmonary atelectasis rate was lower in the VATS group than in the thoracotomy group (5.1％ vs.10.4％,P ＜ 0.05).Median follow-up time was 20 months in both groups.One-year and two-year recurrence-free survival was 90％ vs.88％ and 80％ vs.70％,respectively(P =0.163).One-year and two-year overall survival were 96％ vs.95％ and 88％ vs.85％,respectively(P =0.226).Conclusion For clinical stage Ⅰ / Ⅱ NSCLC,VATS lobectomy is a feasible procedure with shorter hospital stay and less complications,while its surgical and oncologic outcome is comparable to that of thoracotomy lobectomy.