ABSTRACT
Objective:To explore the incidence, clinical characteristics and prognosis of invasive pulmonary fungal infection(IPFI)in recipients of lung transplantation(LT)in southern China.Methods:From January 2003 to August 2019, retrospective analysis was performed for 300 recipients of lung transplantation at three hospitals in southern China. There were 254 males and 46 females with an average age of (54.98±14.2)years. Clinical data were collected from medical records, including symptoms and signs, imaging studies, bronchoscopy examination, pathogen separation and culture from deep sputum and bronchoalveolar lavage fluid(BALF), fungal-related laboratory tests and tissue pathology.Results:Among 300 cases, 93(31.0%)had at least one episode of IPFI. The most common pathogen was aspergillosis(60.2%), followed by candida(15 cases, 16.1%)and Pneumocystis jeroveci (13 cases, 14.0%). Kaplan Meier analysis indicated that all-cause mortality was significantly higher in IPFI group than that in non-IPFI(nIPFI)group with one-year mortality of 45.2% vs. 26.7% in IPFI and nIPFI groups respectively( P<0.05). Conclusions:IPFI is prevalent after LT in southern China. And aspergillosis is the most common pathogen and Candida comes the next. The median occurring time for aspergillosis is 6 months after LT. Candida infection occurs earlier at airway anastomosis. A higher incidence of invasive fungal disease(IFD)associated with a lower survival indicates that IPFI has a substantial mortality among recipients after LT. Prophylactic agents should be optimized based upon an epidemiologically likely pathogen.
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Objective Summarize the experience of single port video-assisted thoracoscopic surgery (SPVATS).Evaluate the value of SPVATS for thoracic diseases.Methods 32 patients underwent SPVATS from March 2011 to May 2011,including 28 males and4 females,with an average age of (26.5 ±9.2) years (ranged 18-72 years).There were twenty-seven cases of spontaneous pneumothorax ( including 2 cases of single stage bilateral surgery),three cases of unknown pleural effusion,one case of bilateral pulmonary nodules,and one case of pulmonary metastasis tumor.Results All procedures were successfully accomplished without conversion to conventional multi-port VATS or open approach.There was no major complication or operative death.All procedures were using self-developed specialized surgical instruments and two-incision joint protection.The procedures inluded resection of lung bullae in 27 cases,purulent drainage fiber stripping pleural lavage in 3,parietal pleural biopsy in 1,and pulmonary wedge resection in 1.The operating time ranged from (22.0 ± 9.5 ) min.The average intraoperative blood loss was ( 14.5 ± 8.8 )ml.The mean chest tube duration was (3.1 ± 0.6 ) days.The average postoperative hospital stay was (6.8 ± 1.6 ) days.Conclusion SPVATS is a new approach for treatment of thoracic diseases.This technique is preferred as a minimally invasive and cosmetic procedure with decreased operative time,quickened postoperative recovery,few complications,and satisfactory short-term outcome.
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Objective To investigate the value of video-assisted thoracoscopy in the diagnosis and treatment of pleural effusion with unknown causes.Methods Video-assisted thoracoscopic biopsy or pleurodesis was performed in 45 cases of pleural effusion unexplained by routine examinations from March 2002 to March 2005.Results The diagnosis was clarified in all the 45 cases.There were 3 cases of malignant effusion,38 cases of tuberculous pleurisy,3 cases of nonspecific effusion,and 1 case of idiopathic pleural effusion.No severe surgical complications occurred.Follow-up checkups for 2~36 months found no recurrence.Conclusions Video-assisted thoracoscopy is a safe,effective,and micro-traumatic approach for the diagnosis and treatment of pleural effusion.