Clinical features and management of pyothorax due to postoperative cervical anastomotic leakage in esophageal cancer surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and managements of pyothorax due to postoperative cervical anastomotic leakage after esophageal cancer surgery.</p><p><b>METHODS</b>From January 2006 to January 2013, 3342 patients with esophageal carcinoma underwent esophagectomy and cervical esophagogastric anastomosis. Of them, 19 patients developed pyothorax following cervical anastomotic leakage and their clinicopathological data were analyzed retrospectively.</p><p><b>RESULTS</b>All the patients underwent a cervical anastomosis via a three-incisional approach (right cervicothoracic mid-abdominal incision, RT group, n=1094) or a two-incisional approach (left cervicothoracic incision, LT group, n=2248). The total number of cervical anastomotic leakage cases was 237, of which 152 cases were in LT group (6.8%), and 85 cases in RT group (7.8%), respectively (P=0.287). The incidence of pyothorax was 2.0% (n=3) in LT group, and 18.8% (n=16) in RT group, respectively (P<0.01). Fourteen cases develop pyothorax within 3 days after operation. The main symptoms were high fever, dyspnea and chest pain. All the pyothorax patients received conservative treatments, including thoracic closed drainage, nasogastric tube placement, jejunal stoma, nutritional support, antibiotics and symptomatic treatment. Sixteen cases were cured, while 3 cases were dead.</p><p><b>CONCLUSIONS</b>The right thoracotomy approach predisposes the cervical anastomotic leakage-associated pyothorax. Sufficient drainage and sufficient nutritional support are critical to the treatment.</p>

Long-term efficacy comparison between goniosynechialysis and combination of phacoemulsification with goniosynechialysis for the management of chronic angle closure glaucoma / 中华实验眼科杂志

Background One of the features of the pathogenesis of primary angle-closure glaucoma(PACG) is anterior synechia of peripheral iris.Goniosynechialysis and combination of phacoemulsification and goniosynechialysis have been applied for the treatment of the disease recently,but the selection of operative types has great impact on clinical efficacy.Objective This study was to investigate the long-term efficacy of goniosynechialysis and combination of phacoemulsification and goniosynechialysis for the management of chronic PACG.Methods A non-randomized clinical controlled trial was designed.This clinical trial complied with Declaration of Helsinki and was approved by Medical Ethic Committee of Nanjing Medical University.Written informed consent was obtained from each patient.One hundred and ten eyes of 110 patients with chronic PACG were assigned to the goniosynechialysis group and combined operative group from March,2008 to February,2011 in Wuxi People's Hospital.180° goniosynechialysis was performed on 34 patients in the goniosynechialysis group,and phacoemulsifieation +intraocular lens (IOL) implantation + goniosynechialysis were carried out in 78 patients of the combination operative group.All the patients were followed-up for 2 years.Vision acuity,intraocular pressure (IOP),anterior chamber depth(ACD),unltrasound biomicroscopy and perimetry were recorded and compared between before and after operation.Results No significant difference was found in vision acuity between preoperation and postoperative 2 years in the goniosynechialysis group ([0.65 ± 0.15] vs.[0.45 ± 0.15]) (t =1.57,P＞0.05),but in the combination operative group,the vision acuity was significantly different between the before and after operation ([0.25±0.15] vs.[0.85 ±0.05]) (t =9.12,P＜0.001).The lOPs at 2 years after operation were (14.2±4.1) mmHgand(13.7±4.8) mmHg,respectively in the goniosynechialysis group and combination operative group and were significantly lower than(47.2 ±6.3) mmHg and(46.9±7.0) mmHg before operation(t =4.95,P＜0.001 ;t=5.03,P＜0.001).The ACD values in the goniosynechialysis group and combination operative group were(3.38±0.02)mm and (3.54±0.03) mm 2 years after operation,which were significantly increased in comparison with (1.33 ±0.24)mm and (1.56±0.37) mm before operation(t=7.65,P＜0.001;t=6.76,P＜0.001).Conclusions Both combination of phacomulsification with goniosynechialysis or 180° goniosynechialysis are effective for the treatment of PACG.Suitable operation should be alternated depending on the indicators of PACG patients.

Expression of PTEN, matrix metaloproteinases 2 and 9 in thymomas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the expression of PTEN, MMP-2 and MMP-9 in thymomas and their correlation with clinical significance.</p><p><b>METHODS</b>Immunohistochemical S-P assay was used to detect the expression of PTEN, MMP-2 and MMP-9 in 45 thymomas and 16 non-neoplastic thymuses.</p><p><b>RESULTS</b>The positive rate of PTEN, MMP-2 and MMP-9 expression in 45 thymomas were 53.5%, 48.9% and 62.2%, respectively. There were significant differences between non-neoplastic thymus and thymomas (P < 0.05). The expression of PTEN, MMP-2 correlated with histological type (P < 0.05) and different clinical stage of the thymoma (P < 0.01). The expression of MMP-9 was not correlated with histological type and different clinical stages of thymoma (P > 0.05).</p><p><b>CONCLUSION</b>PTEN, MMP-2 and MMP-9 may play an important role in the occurrence and development of thymoma. The expression of PTEN and MMP-2 correlates with the malignance and the aggression of thymoma.</p>