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Objective To improve the understanding of pulmonary mucormycosis by analyzing the clinical manifestations,imaging features,diagnosis,treatment and prognosis of this disease.Methods The clinical data of eight patients diagnosed as pulmonary mucormycosis by histopathologic examination were retrospectively analyzed.Results Eight patients included six males and two females with age from 36 days to 66 years.Underlying conditions covered diabetes (n =4),renal transplantation (n =3),premature (n =1) and long-term corticosteroid treatment in two cases.Imaging manifestations revealed multiple irregular lumps or nodules in three cases,multiple cavities with thick wall in three cases,diffuse lung infiltrate in one case and lung opacities in one case.The diagnoses of seven patients were confirmed by percutaneous needle lung biopsy and the remaining one was diagnosed with fiberoptic bronchoscopy biopsy.Surgery combined with amphotericin B liposome(60 mg/d for three weeks)was applied to one patient who was cured with no recurrence after a 22 month follow-up.Three cases were given amphotericin B liposome (a newborn with 7mg/d for 62 days,the other two 60 mg/d for 31 days and 70 mg/d for 71 days respectively).All had achieved marked response with follow up from 8 to 29 months,but one patient relapsed and died of recurrent lung mucormycosis.The other three patients were treated with itraconazole 400-200 mg/d from 21 days to 1 year with duration of follow up from 1 month to 20 months.One patient was not evaluable due to missing.Two patients relapsed and one died.Conclusion Pulmonary mucormycosis is difficult to diagnose and treat with a high mortality.Percutaneous tranthoracic lung biopsy is a useful diagnostic method.Amphotericin B liposome or itraconazole may be active against mucus.Early control of causes is essential to improve the prognosis and reduce the recurrence in patients with pulmonary mucormycosis.
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Objective To investigate the clinical value of transumbilical endoscopic thoracic sympathectomy on women patients with palmar hyperhidrosis.Methods A total of 25 consecutive women patients with palmar hyperhidrosis underwent transumblical thoracic sympathectomy with ultra-thin endoscope.The operative data,including duration of operation,intra-operative and postoperative complications were recorded.Results The procedure was performed successfully in all 25 patients with a mean operative time of 64 min(58-113 min).No umbilical hernia,diaphragmatic hernia,Horner's syndrome or hemothorax were observed.Minor pneumothorax was found in postoperative chest X-ray in 3 patients,all of which were completely resolved with conservative treatment.All patients recovered to their normal life at 1 week after discharge.The scar was small and hidden in umbilical with no visible incisions.After a follow-up of 4 to 12 months,all patients' hands sweating symptoms completely disappeared,axillary sweat symptoms completely resolved in 6 patients,significantly improved in 4 and mildly improved in 1.Conclusion Transumbilical thoracic sympathectomy with ultrathin flexible endoscope is a safe and effective option for women patients with severe palmar hyperhidrosis,which provides excellent cosmetic outcomes.
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Objective To compare the clinical efficacy of seretide (50 μg/500 μg salmeterol/fluticasone propionate) with seretide (50 μg/250 μg salmeterol/fluticasone propionate) in single inhaler in the treatment of patients with stable status moderate to severe chronic obstructive pulmonary disease (COPD)Methods Sixty patients with COPD were randomly divided into the treatment and the control groups.Baseline treatments were similar in all patients,patients in the treatment group received seretide (50 μg/500 μg) while the control group received seretide (50 μg/250 μg) inhalation once every 12 hours for 24 weeks Before and after the therapeutic course,tests for lung function in patients of the two groups were conducted and compared with each other.Clinical symptoms and physical signs were graded by questionnaire.Results There was no significant difference on indexes of lung function between the two groups at baseline (P ＞ 0.05).After treatment,the score of clinical symptoms and signs in the treatment group was lower than that in the control group ((4.0 ± 0.5) vs.(4.8 ± 0.3),t =2.63,P ＜ 0.05).Six minutes walking distance was longer in the treatment group than that in the control group ((451.6±22.9) meter vs.(401.2 ±25.4) meter,t =2.51,P ＜0.05).The levels of forced exhaled gas volume 1 (FEV1),FEV1/forced vital capacity (FVC) and FEV1/pred in the treatment group were higher than those in the control group ([FEV1:(2.18 ± 0.38) L vs.(1.78 ± 0.45) L;FEV1/pred:(63.19 ±9.08)％ vs.(57.19 ±9.25)％; FEV1/FVC％:(73.8 ±5.6)％ vs.(67.3 ± 11.5)％ ;P ＜ 0.05).Conclnsion High dosage of seretide had better effect in the treatment of stable moderate and severe COPD,and can obviously improve patients' lung function,clinical symptoms and quality of life.
ABSTRACT
Objective To evaluate the technique of finger palpation in thoracoscopic localization in patients with pulmonary nodules,and to summarize its technical details,especially with exploit of chest computed tomography (CT) facilitating it.Methods 95 patients with total amount of 109 pulmonary nodes 20 mm or smaller in size shown with lung window of CT,were reviewed.They were located subpleurally,with a median depth of 8.2 mm and a median size of 10.0 mm.The value of their depth over their size (D/d value) could be used as the extent of localizing difficulty.Each node had its own radiographic fealures for being localized,which was built preoperatively.Under thoracoscopic vision,nodules were finger-palpated by index finger via the 4th or 5th intercostal space on anterior axillary line,followed by wedgectomy or lobectomy for instant histopathological diagnosis to further decide the final surgical type.The distance between the nodule and the origin of segmental bronchus (L value) were also calculated out,as it might be relevant to the way the nodule could be biopsied.Results All nodules were successfully localized and resected for biopsy goal,105 by wedgectomy,4 by lobectomy.After intraoperative diagnosis was made by the pathologist,VATS lobectomy and lymph node dissection were further performed in 55 patients.L value of 4 cases being biopsied by lobectomy ranged from 18.3 to 30.3 mm,averaging 26.1 mm.Conclusion Finger palpation is viable in any cases of pulmonary nodules.Detailed reference of CT digital information,and enough detachment of mediastinal pleura,can greatly facilitate thoracoscopic localization by finger palpation.Lobectomy or segementectomy is preferable when L value is less than 30 mm.