Objective To discuss the technical points and clinical effects of thoracic reconstruction after resection of the sternal tumnors with autogenous rib graft and pedicle oinental flap. Method A retrospective study was made on 12 patients,who underwent resection of sternal tumors and thoracic reconstruction with autogenous rib graft and pedicle omental flap between January 2004 and March 2010. The tumor involved the manubrium in 4 patients and the sternal body in 8 patients. Results All operations of 12 patients were succeed with no perioperative mortality or severe complications. Incisions healed by primary intention healing,and no paradoxical breathing was found. The postoperative period was uneventful.Conclusion It's an effective way to treat sternal tumors by the resection and thoracic reconstruction with autogenous rib graft and pedicle omental flap.

BACKGROUNDLung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer.

METHODSOne hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically.

RESULTSOf all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours.

CONCLUSIONSThe nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

BACKGROUNDInflammatory myofibroblastic tumor (IMT) is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department.

METHODSFrom January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years' follow-up was completed in all patients.

RESULTSThese 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up.

CONCLUSIONSHistopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.

BACKGROUNDRecent researches have manifested that down-regulation of KAI1 relates to metastasis in various tumors, but its association with non-small cell lung cancer (NSCLC) and the mechanism for its down-regulation are not clear. The aim of this study is to investigate the expression of KAI1 in NSCLC and its relationship with clinicopathological characteristics and mutant P53 protein.

METHODSThe expression of KAI1/CD82 and mutant P53 protein was detected in 48 cases of NSCLC tissues by Western blot, and KAI1 mRNA was detected by RT-PCR method, with 20 cases of pulmonary benign disease tissues and normal lung tissues as control..

RESULTSThe positive rate of KAI1 mRNA was 52% in lung cancer group and 90% in control group, respectively (P < 0.01), KAI1/CD82 was 48% and 85% respectively (P < 0.01), and mutant P53 protein was 65% and 5% respectively (P < 0.01). The positive rate of KAI1 mRNA, KAI1/CD82 and mutant P53 protein closely related to the tumor stages, cell differentiation and lymph node metastasis status (P < 0.05 or P < 0.01). The expression of KAI1/CD82 highly related to KAI1 mRNA (P < 0.01) and mutant P53 protein (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05).

CONCLUSIONSThe down-regulation of KAI1 may relate to carcinogenesis, development and metastasis of NSCLC. Its reduction may occur mainly at transcriptional level and correlate with p53 in NSCLC. KAI1 and p53 might be helpful to predict the potential metastasis of NSCLC.

BACKGROUNDLymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung.

METHODSA total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed.

RESULTSLymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation.

CONCLUSIONSLymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.