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.

Objective To compare the levels of serum CEA, NSE and CYFRA21-1 of patients with lung cancer and those with benign lung diseases, and to evaluate the clinical differential diagnostic value of combined detection of serum CEA, NSE and CYFRA21-1 in patients with lung cancer. Methods CEA, NSE and CYFRA21-1 were determined with enzyme-linked immunosorbent assay in 122 patients with lung cancer and 37 patients with benign lung diseases. The data was analyzed by t test. Results The serum levels of CEA(12.95?33.04ng/ml), CYFRA21-1(4.87?0.638ng/ml) in patients with lung cancer were significantly higher than that in those with benign lung diseases (1.92?0.84ng/ml and 4.87?0.638ng/ml, respectively)(P0.05). The levels of serum CEA, NSE and CYFRA21-1 were related to types of pathology. The highest levels of CEA, NSE and CYFRA21-1 appeared in adenocarcinoma, small cell carcinoma and squamous cell carcinoma, respectively. The level of serum of NSE (26.05?20.69ng/ml) in patients with small cell carcinoma was significantly higher than that of the patients with benign lung disease, adenocarcinoma (11.26?6.97ng/ml) and squamous cell carcinoma (12.71?7.64ng/ml), respectively (P0.05). Conclusion Combined determination of serum levels of CEA, NSE and CYFRA21-1 is helpful in differential diagnosis of lung cancers.

Objective To review and sum up the clinicopathologic features and surgical therapeutic efficacy of intrathoracic Castleman′s disease (CD). Methods 14 patients with intrathoracic Castleman′s disease, 7 in each sex, aged from 19 to 52, admitted during 1982 to 2005, all underwent surgical treatment, among which 11 with localized type and 3 with multicentric type, were retrospective analyzed on their clinicopathologic features, radiological signs, treatment and prognosis. Results Clinically, 3 patients of localized type were with systematic symptoms; all the patients of multicentric type were with various severity systematic symptoms. Pathological type: 9 cases with hyaline vascular type (HV), 2 cases with Plasma type (PC), and 3 cases with Mixed type (Mix). A different pattern of pathologic alterations existed between HV、PC and Mix types of CD. Radiological features: in localized type of CD, the lesion presented as a solitary soft-tissue mass with a mean diameter of 5.05cm, the mean CT value was 37.39HU. In 3 cases with multicentric type of CD, diffuse mediastinal lymphadenopathy and pleural effusion were observed. All patients survived after surgical resection, long-term survival was achieved in 11 cases with localized type and 2 cases with multicentric type, no recurrence occurred in the 13 patients. Recurrence occurred twice in a patient with multicentric Mix type in the fourth and the ninth year after surgery, respectively, thus the operative treatment followed. Conclusions The diagnosis of CD is based mainly on its histopathological features. The patients with intrathoracic localized type of CD and part of the patients with multicentric type CD could be cured, while part of the patients with multicentric type CD got a poor therapeutic efficacy and unfavorable prognosis even underwent with radiotherapy and integrated treatment.

Objective To investigate the expression of LRP16 gene in lung cancer, and explore its clinicopathological significance. Methods Fresh resected tissues from 54 patients with primary lung cancer were collected and the clinicopathological data were gathered. The expression of LRP16 protein in cancer tissues and the matched normal tissues were determined by Western blotting, and the relationship between LRP16 expression and clinicopathological data was analyzed. It was defined as overexpression when the LRP16 expression of cancer tissues was twice or more higher than that of matched normal tissues. Results The LRP16 was overexpressed in 15 out of 54 patients with lung cancer (27.8%). Among the 23 patients with adencarcinoma, the overexpression of LRP16 was found in 11 cases (47.8%), while in the patients with squamous carcinoma, the overexpression of LRP16 was only found in 4 out of 27 cases (14.8%), and there was a significant difference between the two groups (Pearson test, P=0.0258). Besides, very low expression or non-expression of LRP16 was found in 2 large cell lung cancer and 2 small cell lung cancer. The overexpression rate of LRP16 was 20.0% (2/10) in tumor with diameter less than 3cm and 29.5% (13/44) in tumor with diameter ≥3cm, and there was no significant difference between the two groups (Pearson test, P=0.7224). Conclusions There were significant differences of LRP16 overexpression in cases of adencarcinoma or squamous carcinoma with or without lymphatic metastasis. It is suggested that LRP16 is a tumor-related gene of lung cancer, and may play an important role in molecular staging of lung cancer.

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.

To assess the advantage, disadvantage and feasibility of small thoracotomy incision for intrathoracic operations. In 124 patients minimal thoracotomy incisions (MT) were made for infrathoracic surgery from July 1999 to June 2001. The operative approaches consisted of posterolateral incisions in 82 cases, axillary incisions in 17 cases, and anterolateral incision in 25 cases. The operations included 46 lobectomies, 8 pneumonectomies, 27 wedge resections, 13 mediastinum tumor resections, 13 bullae ligations with pleurodeses, 2 esophagectomy and esophagogastric anastomosis, 1 total gastrectomy and esophagojejunostomy, 9 explorations, and 5 other operations. There was no mortality or serious complication in this group. The patients had a faster recovery with less postoperative pain and better cosmetic result. Minimal thoracotomy incisions are safe and feasible approaches for intrathoracic surgery and worth recommending.

In this paper the authors submitted their experience in application of video assisted thoracic surgery (VATS) in 204 cases at the surgical clinic of the General Hospital of PLA (Oct.1992 Jun.2002). A retrospective analytic study was carried out to assess the value of VATS in terms of the diseases and the surgical anesthesia, operation modes, complications and result. A satisfying result in the group was obtained in each of the cases. There was no operative mortality or morbidity. The mean operation time was 110 minutes, the overall median duration of chest tube drainage was 2 days, and the mean hospitalization time was 9 days. The postoperative recovery was uneventful. As a minimally invasive surgical technique with very low morbidity, VATS is worth considering and has been established as a procedure of choice with exceptional results in various chest diseases. Our experience confirms the safety of VATS in both diagnostic and therapeutic procedures. Due to progress over the past several years, VATS is by now a standard surgical procedure in thoracic surgery, and has become an inseparable part of thoracic surgery. There are differences of opinion with regard to major pulmonary and esophageal resections for cancer, thus further clinical investigation deserves to be carried out.