Safety and feasibility of intrathoracic modified overlap esophagojejunostomy in laparoscopic radical resection of Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

Objective: The study aimed to investigate the safety and feasibility of intrathoracic modified overlap method in laparoscopic radical resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Methods: A descriptive case series study was conducted. The clinical data of 27 patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic total gastrectomy and intrathoracic modified overlap esophagojejunostomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were retrospectively analyzed. The intrathoracic modified overlap esophagojejunostomy was performed as follows: (1) The Roux-en-Y loop was made; (2) The jejunum side was prepared extraperitoneal for overlap anastomosis; (3) The esophagus side was prepared intraperitoneal for overlap anastomosis; (4) The overlap esophagojejunostomy was performed; (5) The common outlet was closed after confirmation of anastomosis integrity without bleeding; (6) A thoracic drainage tube was inserted into the thoracic hole with the diaphragm incision closed. The intraoperative and postoperative results were reviewed. Results: All 27 patients were successfully operated, without mortality or conversion to laparotomy. The operative time, digestive tract reconstruction time and esophageal-jejunal anastomosis time were (327.5±102.0) minute, 50 (28-62) minute and (29.0±7.4) minute, respectively. The blood loss was 100 (20-150) ml. The postoperative time to flatus and postoperative hospital stay were (4.7±3.7) days and 9(6-73) days, respectively. Three patients (11.1%) developed postoperative grade III complications according to the Clavien-Dindo classification, including 1 case of anastomotic fistula with empyema, 1 case of pleural effusion and 1 case of pancreatic fistula, all of whom were cured by puncture drainage and anti-infective therapy. Conclusions: The intrathoracic modified overlap esophagojejunostomy is safe and feasible in laparoscopic radical resection of Siewert type II AEG.

Reinterventions after damage control surgery / Reintervención en cirugía de control de daños

Abstract Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality.

Resumen El control de daños es uno de los pilares de la cirugía de trauma. Sin embargo, la reintervención aún genera controversias en cuanto a quién, cuándo y cómo debe realizarse. El presente artículo presenta las recomendaciones del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali, Colombia, respecto a las reintervenciones después de una cirugía de control de daños. Se recomienda el empaquetamiento como la estrategia de control de sangrado y se debe desempaquetar en un lapso entre 48 y 72 horas. La anastomosis diferida debe ser la opción de reparo en las lesiones intestinales. La reintervención vascular en los pacientes manejados con shunt vascular debe ser antes de las 24 horas para dar el manejo definitivo. En un lapso de 8 días se debe intentar realizar el cierre de la pared abdominal o torácica. Estas estrategias buscan disminuir la frecuencia de complicaciones y de morbimortalidad.

Analysis of influencing factors of recurrent spontaneous pneumothorax in adolescents after closed thoracic drainage / 中国基层医药

Objective To explore the influencing factors of recurrent spontaneous pneumothorax after thoracic closed drainage in adolescents.Methods From January 2010 to May 2018,62 young patients with spontaneous pneumothorax treated in School Hospital of Zhejiang Ocean University and referral to superior hospital were selected . The patients were followed up by telephone or clinic for 24 months after discharge,and their general information and recurrence were collected.Logistic regression multivariate analysis was used to investigate the influencing factors of recurrent spontaneous pneumothorax after thoracic closed drainage in adolescents .Results Sixty－two patients were followed up,15 patients with recurrence,and the recurrence rate was 24.19%.Univariate analysis showed that age over 20[recurrence and non －recurrence ≤20 years old 11 cases (73.33%),11 cases (23.40%);＞20 years old 4 cases (26.67%),36 cases (76.59%)],body mass over 19.6kg／m2 [ recurrence and non －recurrence BMI ≤19.6 10 cases (66.67%),18 cases (38.30%);BMI＞19.6 5 cases (33.33%),29 cases (61.70%)],smoking [recurrence and non －recurrence smoking 12 cases ( 80.00%), 14 cases ( 29.79%); non －smoking 3 cases (20.00%),33 cases (70.21%)],degree of pneumobula lesions [recurrence and non －recurrence mildly 3 cases (20.00%),19 cases (40.43%);medium 5 cases (33.33%),20 cases (42.55%);severe 7 cases (46.67%), 8 cases ( 17.02%)], pneumothorax [ recurrence and non －recurrence a little 2 cases ( 13.33%), 20 cases (46.81%);massive 13 cases (86.67%),27 cases (53.19%)] and diameter of pneumobula over 1cm[ recurrence and non －recurrence ≤1cm 5 cases (33.33%),28 cases (61.70%);＞1cm 10 cases (66.67%),18 cases (38.29%)] were associated with recurrence after closed thoracic drainage (χ2 ＝11.857,5.192,9.325,13.522, 9.824,6.823,all P＜0.05).The results of logistic multivariate regression analysis showed that age (OR:1.224;95%CI:0.958－12.142),BMI(OR:3.463;95% CI:0.824－9.024),smoking(OR:5.000;95% CI:1.534－9.852), degree of pneumobulus lesions ( OR:12.041;95% CI:6.032 －12.174) and pneumothorax (OR:2.465;95% CI:1.627－4.684) were the influencing factors for recurrence after primary spontaneous pneumothorax drainage in adolescents (all P＜0.05).Conclusion Younger than 20 years of age,smoking,pneumobulous lesions and large pneumothorax are risk factors for recurrence after primary spontaneous pneumothorax drainage .

Analysis of influencing factors of recurrent spontaneous pneumothorax in adolescents after closed thoracic drainage / 中国基层医药

Objective@#To explore the influencing factors of recurrent spontaneous pneumothorax after thoracic closed drainage in adolescents.@*Methods@#From January 2010 to May 2018, 62 young patients with spontaneous pneumothorax treated in School Hospital of Zhejiang Ocean University and referral to superior hospital were selected.The patients were followed up by telephone or clinic for 24 months after discharge, and their general information and recurrence were collected.Logistic regression multivariate analysis was used to investigate the influencing factors of recurrent spontaneous pneumothorax after thoracic closed drainage in adolescents.@*Results@#Sixty-two patients were followed up, 15 patients with recurrence, and the recurrence rate was 24.19%.Univariate analysis showed that age over 20[recurrence and non-recurrence ≤20 years old 11 cases (73.33%), 11 cases (23.40%); >20 years old 4 cases (26.67%), 36 cases (76.59%)], body mass over 19.6kg/m2[recurrence and non-recurrence BMI ≤19.6 10 cases (66.67%), 18 cases (38.30%); BMI>19.6 5 cases (33.33%), 29 cases (61.70%)], smoking[recurrence and non-recurrence smoking 12 cases (80.00%), 14 cases (29.79%); non-smoking 3 cases (20.00%), 33 cases (70.21%)], degree of pneumobula lesions[recurrence and non-recurrence mildly 3 cases (20.00%), 19 cases (40.43%); medium 5 cases (33.33%), 20 cases (42.55%); severe 7 cases (46.67%), 8 cases (17.02%)], pneumothorax[recurrence and non-recurrence a little 2 cases (13.33%), 20 cases (46.81%); massive 13 cases (86.67%), 27 cases (53.19%)] and diameter of pneumobula over 1cm[recurrence and non-recurrence ≤1cm 5 cases (33.33%), 28 cases (61.70%); >1cm 10 cases (66.67%), 18 cases (38.29%)] were associated with recurrence after closed thoracic drainage (χ2=11.857, 5.192, 9.325, 13.522, 9.824, 6.823, all P<0.05). The results of logistic multivariate regression analysis showed that age(OR: 1.224; 95% CI: 0.958-12.142), BMI(OR: 3.463; 95% CI: 0.824-9.024), smoking(OR: 5.000; 95% CI: 1.534-9.852), degree of pneumobulus lesions(OR: 12.041; 95% CI: 6.032-12.174) and pneumothorax(OR: 2.465; 95% CI: 1.627-4.684) were the influencing factors for recurrence after primary spontaneous pneumothorax drainage in adolescents (all P<0.05).@*Conclusion@#Younger than 20 years of age, smoking, pneumobulous lesions and large pneumothorax are risk factors for recurrence after primary spontaneous pneumothorax drainage.

Surgical treatment of special thoracic solitary fibrous tumors / 中国肿瘤临床

Objective:To summarize the surgical treatment experience of thoracic solitary fibrous tumors(SFTs),especially some spe-cial SFTs.Methods:Patients with SFTs in our department between January 2009 and May 2017 were recruited in this study and the clinical characteristics were summarized.Results:Twenty-one patients(11 men and 10 women)with an average age of 48.3 years were included.Tumor sizes ranged from 3 to 30 cm and 13 patients(61.9%)harbored pleural tumors,while 8 patients harbored tu-mors from other special thoracic sites (including 1 case of trachea SFT and 1 case of pulmonary SFT). Surgical treatment was per-formed in 19 patients,17 of whom underwent complete tumor resection and two patients underwent palliative resection.One patient did not undergo surgery and was lost to follow-up,and another patient who did not undergo surgery died because of a heart attack af-ter discharge.The 19 patients who underwent surgery were followed up for 1-96 months,3 patients of whom underwent reoperation for tumor recurrence at 12,26,and 72 months after surgery,respectively,while the remaining patients had no recurrence.Seven pa-tients(33.3%)were confirmed with malignancy after operation or biopsy.Conclusions:Thoracic SFTs are mainly from the pleura and the surgical results are favorable.Resection after recurrence can achieve favorable results.

Clinical effects of two different drainage patterns after thoracoscopic lobectomy / 中国基层医药

Objective To analyze the clinical effect of two different drainage methods after video-assisted thoracoscopic(VATS) lobectomy,and to explore the safety,reliability and practicability of clinical application of thoracic drainage tube in Department of Thoracic Surgery.Methods 1 120 cases who underwent VATS lobectomy were selected.According to different drainage methods,they were divided into two groups.560 cases in the observation group received 16-18 silicone elastic drainage,560 patients in the control group received 28-30 traditional silicone chest tube drainage.After drainage,drainage time,residual pleural fluid volume,pain score,catheter site infection rate,the incidence of pneumothorax after extubation,postoperative incidence rate of pulmonary atelectasis were compared between the two groups.Results The postoperative pleural flow of the observation group was (816 ±176) mL,which was less than (1 580 ± 204) mL of the control group,the difference was statistically significant (P =0.006).The drainage days [(5.01 ± 0.57) d],the pleural fluid volume [(2.1 ± 0.6) cm],the catheter site infection rate (0.017％),extubation pneumothorax rate (0.017％),incidence rate of postoperative atelectasis (0.16％) in the observation group were lower than those in the control group [(8.45 ± 1.24) d,(4.3 ± 0.9) cm,0.031％,0.053 ％,0.031％],the differences were statistically significant (all P ＜ 0.05).The NRS pain score between the two groups had statistically significant difference (x2 =16.24,P ＜ 0.001).Conclusion Curative effect of thin tubedrainage after VATS lung resection is safe and reliable,and can reduce the patients' postoperative pain discomfort caused by drainage tube and related complications,it is worthy of clinical popularization and application.

The application of negative pressure ball in patients with thoracoscopic lobectomy / 中国实用护理杂志

Objective To observe the negative pressure ball aplication effect of thoracoscopic loectomy in patients.Methods 50 cases of patients with lung resection operation were divided into conventional group (water-sealed drainage bottle) and improved group (negative pressure ball) by random digital table method,and each group had 25 cases.The effect of nursing care and the satisfaction degree of patients were compared between the two groups.Results After different methods of nursing,the postoperative bed time in the improved group was (12.0±0.8) hours,hospitalization time was (8.0±1.5) days,which were significantly lower than (48.0±2.5) hours,(12.0±2.0) days in the conventional group.The difference was statistically significant (t=2.401,2.302,P＜ 0.05);The satisfaction of patients in the improvement group was 92.0％ (23/25) which was significantly higher than 72.0％ (18/25) of the control group,and the difference was statistically significant (x2=4.920,P＜ 0.05).Conclusions Negative pressure ball in thoracoscopic lobectomy patients after application can significantly improve the effect of clinical nursing and patient satisfaction,worthy of promotion and application in clinical work.

Four-tube strategy for the treatment of thoracic cavity fistula following esophagus carcinoma resection / 医学研究生学报

Objective Thoracic cavity fistula following esophagus carcinoma resection is a serious complication with a high mortality.This study aims at a better therapy for thoracic cavity fistula following esophagus carcinoma resection by summarizing the ex-perience with the four-tube strategy ( jejunal fistula tube, stomach tube, chest drainage tube, and nasal fistula tube) in the treatment of the complication. Methods We retrospectively analyzed the clinical data about 62 cases of thoracic cavity fistula following esopha-gus carcinoma resection, 35 treated with the four-tube strategy ( treatment group) and the other 27 with the three-tube ( stomach tube, chest drainage tube, and nasal fistula tube) method ( control group) .We compared the hospital days, wound healing time, mortality, and incidence of anastomotic stenosis at 6 months after operation between the two groups of patients. Results Compared with the controls, the treatment group showed remarkable decreases in the hospital days (P0.05 ) . Conclusion Compared with the three-tube method, the four-tube strategy has the advantages of shorter healing time and lower mortali-ty, and therefore is preferable for the treatment of thoracic cavity fis-tula following esophagus carcinoma resection.

Clinical Observation of Oxaliplatin Combined with Thymosin in the Treatment of Lung Cancer with Malig-nant Pleural Effusion / 中国药房

OBJECTIVE:To observe the efficacy and safety of oxaliplatin combined with thymosin in the treatment of lung can-cer with malignant pleural effusion. METHODS:120 lung cancer patients with malignant pleural effusion were randomly divided in-to control group(60 cases)and observation group(60 cases). All patients received chest microtubules drainage,then thoracic cavi-ty drug infusion after clean effusion drainage verified by B ultrasound,10 mg Loratadine tablet was orally given before going to bed 1 d before drug infusion,for 1 week;25 mg Promethazine hydrochloride injection was intramuscularly injected 30 min before drug infusion for allergy prevention,20 mg metoclopramide for gastrointestinal reaction prevention,10 mg dexamethasone and 10 ml 2% lidocaine,adding into 10 ml 0.9%Sodium chloride solution,injected to thoracic cavity by drainage tube to prevent and re-lief chest pain,fever,and other pleural reaction symptoms. Based on it,control group was injected 100 mg/m2 Oxaliplatin for injec-tion to thoracic cavity by drainage tube. Observation group was additionally given 300 mg Thymosin injection,to thoracic cavity by drainage tube. Pleural effusion was drained after 2 d. Once every week in 2 groups,4-week was regarded as 1 coure,and it lasted 2 courses. Clinical efficacy,clinical benefit rate,and serum T lymphocyte subsets(CD3+,CD4+,CD8+),inflammatory cytokines lev-els [interleukin(IL)-6,tumor necrosis factor(TNF)-α)] before and after treatment in 2 groups were observed,survival status and the incidence of toxicity reactions were followed-up. RESULTS:The objective response rate,disease control rate,clinical benefit rate,survival rate in observation group were significantly higher than control group,the incidence of toxicity reactions was signifi-cantly lower than control group,the differences were statistically significant(P0.05). CONCLUSIONS:Oxaliplatin combined with thymosin can improve efficacy in the treatment of lung cancer with malignant pleural effusion,prolong survival period,improve survival quality and reduce the incidence of toxicity reactions.

Single pore video-assisted thoracoscopic surgery for patients with acute pyothorax / 局解手术学杂志

Objective To explore the curative effect of the single pore video-assisted thoracoscopic surgery and thoracic closed drainage for patients with acute pyothorax by comparing the advantage and disadvantage of two methods.Methods The clinical data of 65 patients with acute pyothorax in our hospital from January 2012 to June 2015 were retrospectively analyzed.Of which 30 patients underwent single pore video-assisted thoracoscopic surgery were as observation group,35 cases received thoracic closed drainage were as the control group.The cura-tive effect of two methods for acute pyothorax was compared by analyzing the result data of two groups.Results The postoperative chest tube indwelling time,length of hospital stay,postoperative antibiotics of observation group were significantly less than those of the control group,the difference was statistically significant(P<0.05).And the incidence of postoperative complications,the proportion of the chronic pyothorax and secondary tube rate of observation group were lower than those of the control group,the difference was statistically significant(P<0.05). Conclusion The single pore video-assisted thoracoscopic surgery is safe and effective for treatment of acute pyothorax, which is worth promoting.

Observation of the use of percutaneous tracheostomy tube for closed drainage of pneumothorax in intensive care unit / 中华危重病急救医学

Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.

Contusão pulmonar e pneumotórax traumático em cão – relato de caso / Pulmonary contusion and traumatic pneumothorax in a dog - case report

Foi atendida no hospital veterinário da Universidade Federal do Rio Grande do Sul (HCV-UFRGS) uma cadela, com seis meses, atropelada havia 12 horas que apresentava dispneia grave e sangramento na cavidade oral. Ao exame físico apresentou-se hipocorada, hipotérmica e com leve dor à palpação abdominal e torácica. Foi estabilizada através de oxigenioterapia (por colocação de sonda nasal, com fluxo direto de oxigênio a um litro por minuto) e analgesia (morfina, 0,5mg/kg, por via subcutânea). Realizou-se em seguida exame radiográfico de tórax, nas posições laterolateral direito e dorsoventral, que evidenciou opacificação homogênea da região periférica, com visibilização de fissuras interlobares bilateralmente, compatível com efusão pleural, além de opacificação de padrão alveolar, sugestivo de contusão pulmonar.

Resultados de una encuesta sobre tratamiento de la cifosis torácica causada por enfermedad de Scheuermann / Resultados de uma pesquisa sobre o tratamento da cifose torácica de Scheuermann / Results of a survey on the treatment of thoracic Scheuermann´s kyphosis

OBJETIVO: Conocer que parámetros se deben considerar para encarar el tratamiento de la cifosis torácica causada por la enfermedad de Scheuermann. MÉTODO: Se realizó una recolección de informaciones consistente en aplicar un cuestionario a 25 informantes calificados, colegas de diferentes países de Íbero/Latinoamérica miembros de SILACO (Sociedad Íbero/Latinoamericana de Columna) y se analizaron los resultados de las mismas. RESULTADOS: Como tratamiento ortopédico, la mayoría se inclinó por el uso del corsé de Milwaukee, indicado en pacientes prepúberes y pospúberes con curvas mayores de 60º y en curvas de menos de 60º si tienen dolor. El tiempo de uso: 22 hrs por día, su mantenimiento hasta llegar a Risser 4 o 5. Se observó una tasa de abandono de 48% al plan terapéutico. En lo referente a tratamiento quirúrgico, las indicaciones surgen: por localización de la deformidad, el valor angular, dolor, edad y estética. La extensión del área a fusionar fue determinada con los espinogramas y radiografías dinámicas. Se eligió la vía posterior como vía de abordaje con barras y tornillos, y en algunos casos la combinación con ganchos. Se evaluaron los resultados del tratamiento quirúrgico (de acuerdo a la opinión del médico), que fueron catalogados como buenos en un 64%. CONCLUSIONES: Se realizó una encuesta de opinión sobre el tratamiento de la cifosis torácica causada por enfermedad de Scheuermann .y se analizaron 25 formularios de respuestas de calificados cirujanos de columna, de diferentes países de Ibero/Latinoamérica miembros de SILACO. La encuesta ha permitido establecer normas de conducta terapéuticas (ortopédicas y quirúrgicas) para el tratamiento de esta afección.

OBJETIVO: Obter os parâmetros a serem considerados para realizar o tratamento da cifose torácica de Scheuermann. MÉTODOS: Os dados foram obtidos por meio de um questionário que foi respondido por 25 membros da SILACO (Sociedad Ibero-Latino-americana de Columna) e análise dos resultados das respostas. RESULTADOS: Como tratamento ortopédico, a maioria optou pelo uso do colete de Milwaukee indicado para pacientes pré-púberes e pós-púberes com curvas maiores que 60° e curvas de menos de 60° acompanhadas de dor. O tempo de uso diário do colete foi de 22 horas até atingir Risser 4 ou 5. A taxa de abandono do plano terapêutico foi de 48%. Em relação ao tratamento cirúrgico, a maioria afirmou que as indicações estão relacionadas com localização da deformidade, valor angular, dor, idade e a estética. A extensão da área da artrodese foi determinada por meio de radiografias totais de coluna e dinâmicas. A abordagem posterior foi escolhida como a via de acesso preferida, utilizando-se hastes, parafusos e associação com ganchos. CONCLUSÃO: Realizamos uma pesquisa sobre o tratamento da cifose torácica decorrente de doença Scheuermann. Analisamos 25 formulários de resposta de cirurgiões de coluna qualificados de diferentes países membros da SILACO. A pesquisa permitiu estabelecer normas de conduta terapêutica (ortopédicas e cirúrgicas) para tratamento dessa afecção.

OBJECTIVE: To determine which parameters should be considered to address the treatment of thoracic Scheuermann kyphosis. METHOD: A survey information with a questionnaire applied to 25 informants, colleagues from different countries of Ibero-Latin American members of SILACO (Sociedad Ibero-Latinoamericana de Columna) and to analyze the results. RESULTS: Regarding to the orthopedic treatment the majority tended towards the use of Milwaukee brace for pre-pubertal and post-pubertal patients with curves greater than 60º and in curves of less than 60º if they had pain. Time of use: Twenty two hours per day until reaching Risser of 4 or 5. The rejection rate of the therapeutic plan was 48%. Regarding surgical treatment, the majority established that the indications are related to the location of the deformity, the angular value, pain, age and aesthetics. The extension of the area to be fused was determined by the total column and dynamic X-rays. Posterior approach was chosen to access; rod and screws, and in some cases the combination with hooks. CONCLUSION: We conducted a survey about the treatment of thoracic kyphosis due to Scheuermann disease and analyzed 25 response forms of qualified spine surgeons from different countries that are SILACO members. The survey has allowed to establish standards of management (orthopedic and surgical) for the treatment of this condition.

Thoracic Splenosis: A Case Report and the Importance of Clinical History

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.

Nursing care of patients using ultrasound-guided microwave coagulation therapy with artificial pleural effusion for liver carcinoma in the hepatic dome / 中华护理杂志

Objective To discuss the key points of nursing care for patients using ultrasound-guided microwave coagulation therapy with artificial pleural effusion for liver carcinoma in the hepatic dome.Methods The preoperative and postoperative data of 34 patients who were hospitalized in our hospital from June 2004 to February 2009 were reviewed.Results All the patients finished the treatment successfully.Slightly chest distress was the most frequently complication correlated to artificial pleural effusion,mostly disappeared in 3-7 days.Only 3 patients suffered from dyspnea and a decrease of SpO_2 in the second day after the treatment.The symptoms were relieved after a drainage of pleural.The common side effects of microwave coagulation therapy were found as fever,pain during deep respiration and liver dysfunction,which were relieved after symptomatic treatment and nursing care.No severe complication was found.Conclusions Adequate preoperative preparation,proper intraoperative cooperation,close postoperative observation and nursing are the key points to decrease complications.

Treating thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube / 介入放射学杂志

Objective To explore the feasibility and value of treating esophageal thoracic fistula with covered esophageal stent through nasal esophagus drainage tube. Methods Seven patients with esophageal thoracic cavity fistula were enrolled and treated by 5F pigtail side-holes catheter inserting into thoracic cavity for drainage and then again through nasal esophagus and fistula, placing a covered stent in the esophagus to occlude the orifice of the fistula. The abscess cavities were washed and radiographied periodically through drainage tubes. Results The insertion of the drainage tube and the placement of covered stent were all successful. The drainage tubes were placed in abscess cavities for 12-22 days, average 15 days. The radiography through drainage tubes showed that the abscess cavities disappeared or shrank obviously with control of hydropneumothorax before the drainage tubes being pulled out. The esophagogram after withdrawal of the drainage tubes notified that the fistulae were occluded satisfactorily with stents expanded fully without displacement and stenosis. Conclusions Treating esophageal thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube is feasible and safe with clinical efficiency.

Intrathoracic malignant peripheral nerve sheath tumor in von Recklinghausen's disease

Malignant peripheral nerve sheath tumor (MPNST) is defined as any malignant tumor arising from or differentiating toward the cells of the peripheral nerve sheath. MPNST accounts for about 5-10% of all soft tissue tumors and is often associated with neurofibromatosis type I (NF-1, von Recklinghausen's disease). It is one of the malignant tumors associated with von Recklinghausen's disease. Its common site is the lower and upper extremities, trunk, head and neck. But intrathoracic manifestations are very rare. We report a case of a 40 year-old man with multiple neurofibromatosis who was presented with an intrathoracic malignant peripheral nerve sheath tumor

Clinical Observation of Using Highdose of Reptilase During Intracardiac Surgery Under Extracorporeal Circulation / 中国药房

OBJECTIVE:To observe the amount of thoracic cavity drainage24h after using highdose reptilase during in?tracardiac surgery.METHODS:32patients undergoing operation were randomly divided into group R(reptilase group,n=17)and group C(control group,n=15).In group R,reptilase2KU was injected before opening the thoracic cavity,reptilase1KU was added to prefilling fluid of extracorporeal circulation machine and reptilase2KU was intravenoulsy dripped after stopping machine until the end of operation.RESULTS:Compared with group C,the amount of thoracic cavity drainage reduced by35%(P