ObjectiveTo observe the effects of lung resection surgery on left heart hemodynamics in elderly patients, and explore its correlation with postoperative arrhythmia.Methods The 16 elderly patients (age≥75 years) receiving lung resection surgery were selected. At the same time, 21 patients (age＜60 years) were selected as controls. The hemodynamic parameters of each patient were recorded at the time of preoperative (T1), surgery completion (T2) and first day after surgery (T3). For patients with arrhythmia during three days after operation, the parameters would be recorded before and after arrhythmia. Results There were no significant changes in heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac stroke volume ( SV),acceleration index (ACI), systemic vascular resistance (SVR) at T2 and T3 compared with T1 for both the two groups (P＞0. 05). Only the central venous pressure (CVP) increased at T2 compared with that at T1 [elderly group: (7.58±0.45) cm H2O vs. (5.92±0. 51) cm H2O, t=2.641, P＜0.01; control group: (7.49±0.34) cm H2O vs. (6.23±0.47) cm H2O, t=1.982, P＜0.05], while the CVP recovered to the preoperative level at T3. The incidence of arrhythmia was significantly higher in elderly group than in control group (31.3% vs. 14.3%, x2 = 4.26, P＜0.05), but there were no significant changes in the parameters before and after arrhythmia compared with those before surgery (P ＞ 0. 05 ).Conclusions The effects of pulmonary resection surgery on left heart hemodynamics in elderly patients can be avoided through full assessment preoperatively, heart-lung protection intraoperatively, as well as the correctly and timely clinical treatment and intensive care postoperatively. Pulmonary resection surgery has no effect on left heart hemodynamics even for patients with postoperative arrhythmia.

Objective: To investigate the protective effects of different storage solutions on the ultrastructure and integrity of rabbit endothelial cells, and their effects on endothelin 1 secretion. Methods: Femoral artery segments were harvested from 16 adult rabbits, which were then stored separately in four different storage solutions. The solutions was: (1) verapamil nitroglycerin solution (VG); (2) heparinized papaverine autologous blood (PB); (3) papaverine solution (PS); (4) Ringer's solution (Ringer). The ultrastructure of the endothelial cells,the covering percentage of endothelium monolayer and the level of endothelin 1 secretion were evaluated. Results: The covering percentage of endothelium monolayer was significantly higher in VG [(69?10)%] and PB[(71?9)%] compared with that in Ringer [(55?11)%] (P0.05). The endothelial ultrastructure was more seriously damaged in PS than that in VG and in PB through TEM. The level of endothelin 1 secreting was similar significantly increased only in PB [(116.781?22.387) pg/ml] compared with that in Ringer (P

Objective To compare the safety , surgery effects , pain scores of the close-distance-two-port video-assisted lobectomy and systematic dissection of the mediastinal nodes , and single-port video-assisted thora-coscopic surgery (VATS). Methods Between October 2012 and January 2015 in Peking University First Hospi-tal and Beijing Hospital , 269 patients who were going to be performed lobectomy and systematic lymph node dissection, were gathered and 205 patients were included in this study finally. Of the total, 122 patients were performed close-distance-two-port VATS , and 83 patients underwent single-port VATS. The clinical data were gathered, and statistically analyzed. Result In both groups, no severe postoperative complications or death oc-curred. No significant differences existed between the two groups in terms of intraoperative blood loss , duration and volume of chest tube drainage , postoperative pain score , hospital stay after surgery and hospitalization ex-penses (P > 0.05) but the data about operating time, number of dissected lymph nodes, complications(subcuta-neous emphysema , air-leak from the port of drainage tube and poor wound healing ) were significantly different (P < 0.05). Conclusions Compared with the single-port VATS, the method of close-distance-two-port video-as-sistant lobectomy and systematic dissection of the mediastinal nodes is safe and practicable with definite thera-peutic effect, less operation difficulty and complications.

Objective To analyze the mid- and long-term results after coronary artery bypass graft surgery (CABG), to evaluate the accuracy of multi-detector CT coronary angiography (MDCT) on the graft patency status and to compare the patency for different grafts. Methods One hundred and one cases underwent CABG from June 1992 to March 2008 were followed up by searching the database of MDCT (42 cases) and selective coronary angiography (SCA, 59 cases). The mean following up period was (66.79 ±44.27) months. Three hundreds and 10 grafts including 115 arterial and 195 venous were analyzed.A comparison of the patency rate between the arterial and venous grafts was also carried out. At the mean time, 2 groups were divided according to the paft lesions( patency of not). Uunivariate analysis and Logistic regression analysis were made for statistics. Results At the follow-up of (53.93 ± 36.80) months, the patent rate of LIMA, RA, SV and CV examined by MDCT was 94.7%, 92.0%, 85.9% and 60.0%, respectively. The patent rate for MDCT patients with angina was 83.5%, and 95.2% for angina-free group ( P = 0.046). At the follow-up of (75.95 ±47.09) months, the patent rate of LIMA, RA, SV and CV examined by SCA was 87.1%, 81.0%, 53.6% and 57. 1%, respectively. In SCA patients the patent rate was 62.0% for angina group and 100% for angina-free group ( P = 0.025 ). According to logistic regression analysis, only the postoperative period was statistically related to the graft lesion. Conclusion MDCT could find out the occlusions and obvious stenoses of the grafts after CABG. It might be served as a noninvasive method to evaluate the grafts patency postoperatively. The mid- and long-term patency of arterial grafts is better than venous grafts. Graft lesion is an important factor leading to postoperative recurrent angina pectoris. The severity of the graft lesion has a close relation to the lenth of postoperative period.

0. 05). Creatinine clearance improved significantly in group C from a mean value of (90?23)ml/min preoperatively to (139?46)ml/min during operation (P

OBJECTIVETo evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation.

METHODSFrom June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA were performed. Preoperatively, the radial-ulnar collateral circulation was evaluated with the modified Allen's test, color Doppler ultrasound and noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperatively and postoperatively.

RESULTSOne patient (1.7%) died of serious cardiac arrhythmia on the fourth postoperative day. There were no arterial graft harvest related complications. Before harvesting, the ulnar artery blood flow was 30.78 +/- 9.71 ml/min, and it increased to 43.36 +/- 13.98 ml/min (40.87% increase, P < 0.01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow postoperatively (P > 0.05), but the systolic/diastolic flow ratio markedly decreased from 8.57 +/- 3.98 ml/min to 3.41 +/- 4.87 ml/min (P < 0.01).

CONCLUSIONSArterial grafts can be safely used for coronary bypass revascularization with good results. The ulnar artery blood flow can increase compensatively after RA harvesting. The diastolic blood flow of grafted IMA markedly increased postoperatively. Color Doppler ultrasound was very helpful both in evaluating the radial-ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).

Adult ; Aged ; Coronary Artery Bypass ; methods ; Coronary Circulation ; Humans ; Mammary Arteries ; transplantation ; Middle Aged ; Radial Artery ; transplantation

Background and objective Video-assisted thoracoscopic surgery (VATS) is the representative thoracic minimally invasive surgery. Compared with traditional open surgery (TOS), VATS has an advantage of less invasiveness, quicker recovery and milder postoperative pain. The aim of this study is to compare the influences of VATS and conventional thoracotomic lobectomy on thyroid hormones in treatment for non-small cell lung cancer (NSCLC). Method From Oct. 2010 to Aug. 2012, 44 consecutive patients with NSCLC were recruited and divided into two groups: VATS group (25 patients) and TOS group (19 patients). All the patients were drawn blood to measure the plasma levels of free T3, free T4, reverse T3 and TSH on the morning of the day before surgery, the postoperative day (POD)1, POD2, POD3 and POD7. We described the perioperative variation trend of the thyroid hormones and compared the differences between VATS group and TOS group. Results There were no differences of thyroid hormone levels between the two groups before surgery. After surgery, the levels of FT3 and TSH were first dropped, then elevated and reached the lowest level on POD3 and POD1 separately. On POD7, they regained the before-surgery levels in VATS group while FT3 level was still significantly lower in TOS group (P=0.032). The FT4 and rT3 levels were first elevated, and then dropped after surgery. They both reached the peak concentrations on POD2, and rT3 levels of TOS group were significantly higher than those of VATS group on POD1, POD2 and POD3 (P<0.05). The changes of FT3 and rT3 levels were beyond normal ranges while changes of FT4 and TSH levels were within normal ranges.When variation trend of all the thyroid hormones were compared between the two groups, only rT3 level was found to have significant statistical differences (F=7.557, P=0.009). Conclusion All NSCLC patients after lobectomy have Euthyroid sick syndrome (ESS). Compared with traditional thoracotomy, VATS surgery has smaller influence on perioperative thyroid hormones and demonstrates a weaker acute stress reaction, which can benefit postoperative recovery of NSCLC patients.

Background and objective Vascular endothelial growth factor (VEGF) and matrix metalloprotein-ase-9 (MMP-9) are important factors in angiogenesis. hTese factors function in the angiogenesis of lung cancers. hTe aim of this study is to determine the changes in serum VEGF and MMP-9 atfer patients with NSCLC were subjected to lobectomy. hTe aim of this study is also to compare the differences in the changes observed between video-assisted thoracoscopic surgery (VATS) and traditional open surgery (TOS). Methods A total of 43 consecutive patients with NSCLC were recruited from October 2010 to August 2012. All of these patients underwent lobectomy and systematic mediastinal lymphadenectomy. Blood was drawn from these patients to measure the serum levels of VEGF and MMP-9 in the morning before surgery and on postoperative days1, 2, 3, and 7 (POD1, POD2, POD3, and POD7, respectively). Perioperative variations in serum VEGF and MMP-9 were also observed. Using different surgical options, we divided the patients into two groups:VATS group (25 patients) and TOS group (18 patients). hTe differences in the changes in serum VEGF and MMP-9 were then compared be-tween the two groups. Results Atfer surgery, the serum VEGF and MMP-9 of patients with NSCLC initially increased and subsequently decreased. hTe peak levels were observed on POD2 and POD3, and these levels were signiifcantly higher than the preoperative levels (P=0.031, P=0.020). On POD7, the serum VEGF and MMP-9 remained higher than the preopera-tive levels. In VATS and TOS groups, the serum VEGF and MMP-9 levels also initially increased and subsequently decreased. hTe TOS group showed a more evident variation. However, no signiifcant statistical differences in the changes of VEGF and MMP-9 were found between the two groups (F=2.022, P=0.163;F=1.703, P=0.199). Conclusion Serum VEGF and MMP-9 remarkably increase in TOS group and VATS group. Although the serum level of VEGF an MMP-9 in TOS group were higher than that in VATS group. But no signiifcant difference was observed between VATS and TOS group.

Objective: To summarize the clinical features, diagnosis and treatment of postoperative acute exacerbation of interstitial lung disease (ILD) after pneumonectomy. Methods: The clinical data of 4 patients with postoperative acute exacerbation of ILD after pneumonectomy admitted in Beijing Hospital from October 2014 to November 2015 were retrospectively analyzed and related literatures were reviewed. Results: Four patients were aged 60 to 74 years, including 3 males and 1 female, 2 of whom were idiopathic pulmonary fibrosis and 2 were connective tissue diseases related ILD. Chest high resolution computed tomography (HRCT) showed multiple lobular septal thickening, ground glass opacities, reticular shadow and strip shadow in both lungs. The patients developed acute dyspnea 2 to 3 days after pneumonectomy. In 2 cases, HRCT showed new patchy ground-glass opacities, reticular shadow and strip shadow in both lungs on the basis of preoperative pulmonary fibrosis. The sputum smear and culture showed no pulmonary infection in all 4 cases. Three patients were treated with glucocorticoids and 3 received mechanical ventilation with endotracheal intubation. One patient was successfully treated by early using adequate glucocorticoids, one patient improved after treatment but died after re-exacerbation, and the other two patients died after treatment failed. Conclusions Acute exacerbation of ILD after pneumonectomy often occurs in early postoperative period and it is characterized by progressive dyspnea. Chest CT and respiratory pathogen examination are helpful for early diagnosis. Postoperative acute exacerbation of ILD often lacks effective treatment, requires mechanical ventilation, and the prognosis is poor. Although glucocorticoids may be effective, re-exacerbation should be alert during treatment.

Objective:To evaluate the safety of thymic surgery in patients aged 65 years and over.Methods:A total of 696 patients who underwent thymectomy/thymoma resection in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were collected and divided into two groups according to the age of 65 years old.The preoperative course of disease, MG stage, dosage of pyridostigmine bromide, American College of Anesthesiologists(ASA)score, surgical method, intraoperative bleeding, postoperative drainage, postoperative complications, Clavien-dindo score(CDC), and myasthenic crisis were recorded and statistically analyzed.Results:A total of 696 patients were enrolled, including 364 males and 332 females, aged 15~86 years, with an average age of 49.1 years.There were 309 patients with thymoma, 565 patients with MG, and 178 patients with both.There were 124 cases in the elderly group(≥65 years old)and 572 cases in the non-elderly group(<65 years old). The incidence of thymoma was higher in the elderly group(54.8 % versus 42.1 %, χ2=6.664, P=0.010), while the incidence of MG was lower(67.7 % versus 84.1 %, χ2=17.827, P<0.001). The ASA score of the elderly group was higher than that of the non-elderly group( χ2=52.372, P=0.000), and the preoperative ventilation function FEV1 and FEV1/FVC were also significantly lower than those of the non-elderly group( z=8.187, 4.580, P=0.000 for all). The drainage volume in the first 3 days after operation and postoperative drainage tube time in the elderly group were significantly higher than those in the non-elderly group( P=0.018, P=0.003). The incidence of postoperative myasthenia crisis in the elderly group was higher than that in the non-elderly group( P=0.034). There was no significant difference in the incidence of postoperative complications between the two groups, but after Clavien-dindo classification, the score of the elderly group was higher than that of the non-elderly group( P=0.003). Although the ASA score and Clavien-dindo score of the elderly group were both higher than those of the non-elderly group, there was no correlation between the two. Conclusions:Although the preoperative ASA score and pulmonary function of elderly patients were poorer than those in the non-elderly group, while the incidence of postoperative myasthenia crisis was higher, and the incidence of postoperative complications was not higher, the Clavien-dindo classification, however, was higher in elderly patients than that of the non-elderly group.After careful preoperative evaluation and strengthening perioperative management, most elderly patients can receive thymus surgery safely with acceptable risks.