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Objective To investigate the best operative approach in the treatment of myasthenia gravis (MG) by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery (VATS). Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time, postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb's movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time,and incisional infection in VATS group [(77.5 ± 18.0) ml, ( 100.8 ± 11.8) ml,( 2.3 ± 0.5 ) d, 0 ] were superior to those in trans-sternal group[ (97.4 ± 14.3 ) ml, ( 175.8 ± 18.3 ) ml, ( 3.1 ±0.7 ) d, 6.2% ( 2/32 ) ] and median stemotomy group [ ( 130.1 ± 24.0) ml, ( 379.0 ± 45.6 ) ml, (4.2 ± 0.6) d,13.8% (9/65)] (P ＜0.05),and median sternotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb's movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group (P ＜0.05).Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is more advantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for primary hospitals without advanced technology and equipments.
RESUMEN
<p><b>OBJECTIVE</b>To investigate the relationship between the expression of glucose regulated protein 94 (GRP94) at the level of mRNA and protein in vivo and in human lung cancer.</p><p><b>METHODS</b>RT-PCR, immunohistochemistry and/or Western blot were used in 54 cases of lung cancer tissues and corresponding normal lung tissues.</p><p><b>RESULTS</b>There was a significant overexpression of GRP94 mRNA and protein in lung cancer tissues as compared with lung normal tissues. In lung cancer tissue, the relative level of GRP94 mRNA as evaluated by RT-PCR was 3.48 +/- 2.06, the level of GRP94 protein as evaluated by immunohistochemistry was + + to + + +, and by Western blot was 256.7 +/- 80.6. In lung normal tissue, the relative level of GRP94 mRNA was 2.01 +/- 1.83, the level of GRP94 protein was + to + + and 108.1 +/- 42.3. The differences in expression of GRP94 between the two tissues were significant (P < 0.05). Furthermore, the over-expression of GRP94 in the lung cancer tissues was correlated to grade of differentiation and stage of tumors. There was stronger expression in poor-differentiated tumors than in mild-to-high differentiated tumors (P < 0.05). There was also a stronger expression in stage III than in stage I and II tumors (P < 0.05). No statistically significant difference was found among various pathological types of tumors.</p><p><b>CONCLUSION</b>GRP94 was related with the occurrence, differentiation and progress of human lung cancer. Ascertaining the levels of GRP94 mRNA and protein may be valuable in evaluating the grade of differentiation and clinical stage of human lung cancer.</p>