Establishment of Thoracic Surgical Difficulty Assessment Scale based on Delphi method / 中南大学学报(医学版)

Objective: The difficulty of surgery, which is related to surgical safety, has only been mentioned as a subjective perception for a long time. There are few studies to quantitatively and systematically evaluate the difficulty of thoracic surgery. This study aims to establish a quantitative evaluation index system for thoracic surgical difficulty, and to evaluate its reliability and validity.Methods: During the 2 national thoracic surgery academic conferences, the factors that may affect the difficulty of thoracic surgery were evaluated by the thoracic surgeons via semi open questionnaires, and then the evaluation item pool of thoracic surgery difficulty was established. The importance of each indicator in the evaluation item pool was graded by 2 rounds of Delphi method. The average score, full score rate and coefficient of variation of each index were calculated, and the composite index method was used to decide whether to delete the indicator. Finally, the difficulty evaluation scale of thoracic surgery was constructed. The surgical data of patients with thoracic tumors were collected. The scale was used to evaluate the difficulty of thoracic surgery for lung, esophageal, and mediastinal tumors. The reliability and validity of the scale were evaluated by the commonly used difficulty evaluation indexes: Operation time, intraoperative estimated blood loss, Visual Analog Scale (VAS), side injury rate, and blood transfusion rate as standards. Results:A total of 230 questionnaires were distributed in the 2 rounds of survey, and 149 valid questionnaires were collected after eliminating duplicate questionnaires. Through 2 rounds of Delphi consultation with 20 experts, the difficulty evaluation indexes were scored and screened, and the difficulty evaluation scale of thoracic surgery was established. It included 5 main indexes (surgical decision-making, operation space, separation interface, reconstruction method, and surgical materials) and 16 secondary indexes [American Society of Anesthesiologists (ASA) classification, surgical trauma, operator experience, space size, space depth, space source, space adjacent, interface content, anatomical gap, visual field, interface size, reconstruction complexity, reconstruction scope, autologous materials, artificial biomaterials and instruments]. After weighting, the total score of Thoracic Surgery Difficulty Evaluation Scale was from 1 to 3. A Score at 1 standed for simplicity, and score at 3 standed for difficulty. Further data were collected for 127 cases of thoracic tumor surgery. The difficulty scores of surgery for lung, esophageal, and mediastinal tumor were 1.69±0.26, 1.86±0.18, and 1.56±0.31, respectively, and the Cronbach ' sαcoefficients of the scale in 3 tumor surgeries were 0.993, 0.974, and 0.989, repectively, and the Spearman Brown coefficients were 0.996, 0.984, and 0.996, respectively. The Spearman correlation coefficients of operation difficulty score with operation time, estimated blood loss, and VAS were 0.360 and 0.634, 0.632 and 0.578, 0.696 and 0.875, respectively (all P<0.05). The incidence of postoperative complications in the difficult operation group (difficulty score >1.85) was higher than that in the non-difficult operation group (P=0.02).Conclusion: The quantitative Thoracic Surgical Difficulty Assessment Scale has been successfully established, which shows good reliability and validity in thoracic tumor surgery. The Thoracic Surgical Difficulty Assessment Scale has broad application prospects in reducing the difficulty of the surgery, controlling surgical complications, and training surgeons.

A modified approach of port-access lymphadectomy for locally advanced non-small cell lung cancer: A single center experience / 中南大学学报(医学版)

Objective: Systematic nodal dissection (SND) is an important component of locally advanced non-small cell lung cancer (NSCLC), but modification of this procedure is rarely reported. In this paper, we reported a modified technique of systematic mediastinal lymph node dissection (MLND) of operable lung cancer by video-assisted thoracic surgery (VATS). Parallel upward dissection (the PUD technique) was named due to this modification and the efficacy of the PUD technique was evaluated as well.Methods: We summarized the tips of the PUD technique and its version was updated in surgical aspect. The design and procedure sequence of the PUD technique were introduced in detail as well as its pros and cons. A retrospective study was performed on 998 cases of locally advanced NSCLC which accepted the PUD procedure in Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, from 2012 to 2020. The perioperative mortality and the incidence of general and serious complications (such as recurrent laryngeal nerve injury, bronchopleural fistula) were analyzed. Results: All the 998 cases were operated successfully with the PUD technique and few post-operation complications were found. There was no perioperative mortality and severe complication such as recurrent laryngeal nerve injury and bronchopleural fistula. Conclusion:The PUD technique is safe and convenient and it can be a good supplement to the existing surgical techniques for locally advanced lung cancer.

Comparison of POSSUM, P-POSSUM and Thoracoscore in forecast of the postoperative mortality in thoracic surgery patients / 中华胸心血管外科杂志

Objective To evaluate and compare the applicability and accuracy of POSSUM , P-POSSUM and Thora-coscore in predicting the postoperative mortality of thoracic surgery patients .Methods We collected the clinical data of 1 450 thoracic surgery patients during March 2012 to August 2013 in the Second Xiangya Hospital.We used the 3 kinds of risk sco-ring system to calculate the predicted postoperative mortality in these patients .Then we used H-L test and the area under the ROC curve to evaluate and compare their degrees of compliance and validities of identification independently .Results Within 1 450 cases,20 patients (1.4%) died in 30 days after surgery, POSSUM overestimated the mortality (3.84%,P0.05.The area under the ROC curve of POSSUM, P-POSSUM ( two kinds of death prediction formula ) and Thoracoscore to predict postoperative mortality in all thoracic surgery patients was 0.774,0.777,0.777 and 0.831 independently, P <0.05; the area under the ROC curve to predict postoperative mortality in patients after lung surgery was 0.755,0.771,0.771,0.849 independently, P<0.05; the area under the ROC curve to predict postoperative mortality of patients with esophageal surgery was 0.640,0.650,0. 650,0.764 independently, only Thoracoscore P<0.05;the area under the ROC curve to predict postoperative mortality of pa-tients with mediastinal and other surgical was 1.000,1.000,1.000,0.854 independently, only Thoracoscore P<0.05.Con-clusion Thoracoscore scoring system is the most suitable risk scoring system to predict postoperative mortality in thoracic sur-gery patients with high predictive accuracy and good identification validity .

A case of autologous pericardium patch in treatment of aortoesophageal fistula / 中南大学学报(医学版)

Aortoesophageal fistula (AEF) is a rare but fatal complication caused by foreign body ingestion. Aortic replacement and endovascular stent graft are the common repair surgeries. The materials to repair an aortic defect in AEF are typically homograft or allograft, but the use of an autologous pericardium patch is rarely reported. Here we reported a patient with AEF and severe mediastinal infection induced by chicken bone ingestion. In this case, the autologous pericardium patch was used as the repair material.

Experimental study on novel hybrid artificial trachea transplantation / 生物医学工程学杂志

We developed and designed a new type of artificial trachea. The basic structure of the artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings on both sides. Dualmesh was sutured on titanium rings. This experimentation follows the replacement of trachea in dogs with a combined artificial trachea to investigate the feasibility of this type of prosthesis. Sixteen dogs were implanted with the combined artificial trachea after resection of 5 cm of cervical trachea. The 5 cm-long trachea of dogs on the necks were resected and the reconstruction of the defect of the trachea was performed with trachea prosthesis. According to the method of trachea reconstruction, the models were divided into 2 groups, artificial trachea implantation group (the control group, n = 8) and group of artificial trachea implantation with growth factor (the experimental group, n = 8). Then computer tomography scan (CT), bronchoscope and pathologic examination were conducted periodically to observe the healing state of the hybrid artificial trachea. None of the dogs died during operation of cervical segmental trachea construction. But four dogs in the control group died of apnea in succession because artificial trachea was displaced and the lumen was obstructed, while 2 dogs died in the experimental group. In the first month there was granulation around anastomosis with slight stenosis. The rest of dogs were well alive until they were sacrificed 14 months later. The mean survival time of the experimental group was longer than that of the control group. The rate of infection, anastomotic dehiscence, severe stenosis and accidental death in the experimental group were lower than the control group (P < 0.05). Artificial trachea was encapsulated by fibrous tissue and no mucous membrane was seen in the lumen of the artificial trachea. The artificial trachea can be used to reconstruction of the defect of the trachea with long-term survival of the animals. The unique design of artificial trachea reduces stenosis around anastomosis effectively but infections and split or displacement of the artificial trachea are still major problems affecting long-term survival of the animals. Application of growth factors to a certain extent promotes tissue healing by changing the local environment.

Clinical analysis of modified technique for pectus bar removal after Nuss procedure / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of modified technique for removing Nuss bar after Nuss procedure.@*METHODS@#We reviewed 186 patients undergoing bar removal after repair of pectus excavatum with Nuss procedure at our institution from December 2008 to February 2012. All patients had unilateral incision (metallic stabilizers have been used on one side in all patients). Under general anesthesia with single lumen tracheal tube or laryngeal mask, with the patient lying down in supine position, the bar was pulled out along the thoracic wall without overturning or straightening.@*RESULTS@#Totally 132 patients (71.0%) had the bar removed 2 years after the Nuss procedure, 1 (0.5%) removed within 1 year and 53 (28.5%) removed over 2 and half years. The operation time for bar removal was 9-20 (13.1 ± 3.4) min, and the operative blood loss was 3-20 (5.2 ± 2.7) mL. There was no hemorrhage. Three patients (1.6%) developed mild pneumothorax and none showed infection of incision after the operation. All patients were discharged 1 day after the surgery and followed up for 4-48 (21.4 ± 6.8) months. Recurrence was found in the one who which had the bar removed within 1 year (0.5%).@*CONCLUSION@#With modified procedures, Nuss bar can be easily and safely removed 2 years or longer after the Nuss operation. After removing the metallic stabilizer, the bar should be turned and then pulled out along the original surgical incision without bending or turning.

BMPs and cancer / 中南大学学报(医学版)

Bone morphogenetic proteins (BMPs) were first studied as growth factors or morphogens of the transforming growth factor-beta super family. These growth molecules, originally associated with bone and cartilage development, are now known to play important roles in morphogenesis and homeostasis in many other tissues. Recently, signiifcant contributions of BMPs, their receptors, and interacting molecules have been linked to carcinogenesis and tumor progression. BMPs can sometimes play a role as a tumor suppressor. This article explains the composition and biological characteristics of BMPs, and investigates their new roles in the pathogenesis of cancer.

Non-thoracoscopic and thoracoscopic modified Nuss procedure for correction of pectus excavatum / 中南大学学报(医学版)

Objective:To summarize the curative effect, safety and experience of non-thoracoscopic modiifed Nuss procedure for correction of pectus excavatum (PE). Methods:From January 2007 to December 2011, 267 cases of PE patients were selected in our hospital. Among them 85 were treated by thoracoscopic minimally invasive modified Nuss Procedure and 182 by non-thoracoscopic procedure. The operation time, blood loss during operation, length of postoperative hospital stay and effect of treatment were compared retrospectively. Results:All the 267 patients finished the repair procedure smoothly. The non-thoracoscopic group had advantage in terms of operative time (22.5 min vs 35.1 min, P0.05). hTere were no deaths. Conclusion:Non-thoracoscopic minimally invasive modified Nuss procedure is as safe and effective as thoracoscopic Nuss procedure. With advantages of simpliifed operation procedure and shorter operation time, it is easier in practice.

Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for patients with primary palmar hyperhidrosis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficiency of video-assisted thoracoscopic surgery for primary palm hyperhidrosis by T4 sympathicotomy plus bypass fiber resection, and to describe our experience regarding the prevention of related postoperative complications.@*METHODS@#Clinical data for 32 cases of primary palmar hyperhidrosis in patients who underwent bilateral video-assisted thoracoscopic sympathictomy plus bypass fiber resection from October 2008 to June 2011 were analyzed retrospectively.@*RESULTS@#The operation was performed successfully on all patients, and their palmar hyperhidrosis was completely alleviated after operation. No severe, surgery-related, postoperative complications occurred.@*CONCLUSION@#Video-assisted thoracoscopic sympathictomy is an effective, safe and minimally invasive procedure for primary palmar hyperhidrosis.

Application of laminated anastomosis with absorbable suture in cervical esophagogastrostomy / 中南大学学报(医学版)

OBJECTIVE@#To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy, and to reduce the incidence of cervical esophagogastric anastomotic stricture.@*METHODS@#A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010. Among them, 96 cases were treated with traditional full layer interrupted varus suture (varus group) and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture (laminated group). Esophageal angiography was performed in 1 week, 1 month, and 3 months after the operation. The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively. The area of anastomatic stoma was calculated. The degree of stenosis was assessed according to the patients' dysphagia symptom.@*RESULTS@#There was no operative deaths, no serious pulmonary complications and chylothorax, no sever esophageal reflux in all patients. The ratio of cervical esophagogastric anastomotic leakage was 2.1% (2/96) in the varus group. No anastomotic leakage in the laminated group. Compared with the varus group, the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points (P<0.01). The incidence of obstruction in the laminated group was decreased significantly (P<0.01) in 1 month or in 3 months after operation compared with the varus group.@*CONCLUSION@#Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.

Evaluation of resection of local advanced upper lung cancer through median sternotomy / 中南大学学报(医学版)

OBJECTIVE@#To summarize the resection of local advanced upper lung cancer and radical bilateral mediastinal lymph node dissection through a median sternotomy.@*METHODS@#A total of 31 patients with local advanced upper lung cancer underwent lobectomy and radical complete dissection of bilateral superior mediastinal lymph node through a median sternotomy (the sternotomy group). The sternotomy group consisted of 8 females and 23 males, from 35 to 75 years old (average 57 years). Five patients underwent superior vena caval replacement or partial excision, 21 underwent upper sleeve lobectomy, and 6 patients combined with right pulmonary artery sleeve angioplasty or partial resection and reconstruction. Compared with the 30 patients who were operated through posterolateral incision, the surgery time, complications, and prognosis during the same period (the posterolateral incision group) were recorded.@*RESULTS@#There was no perioperative death. The average operation time in the sternotomy group was (170±30)min, while that in the posterolateral incision group was (140±30) min(P>0.05). Postoperative complications comprised atelectasis, cardiac arrhythmia, and pneumonia. In the sternotomy group it was 6.5%(2/31), 16.1%(5/31), and 6.5% (2/31),and that in the posterolateral incision group 3.3%(1/30), 20%(6/30), 10.0%(3/30),respectively. Postoperative pathological findings demonstrated the rate for pN3 disease in the sternotomy group was 29%(9/31), 2 patients died of brain and liver metastasis respectively 10 or 11 months after the operation. The 3 year survival rate of 9 patients with pN3 diagnosed as cN2 preoperatively was 33.3%(3/9). The total survival rate of 1,3 years in the sternotomy group was 90.3%(28/31) and 41.9%(13/31), in the posterolateral incision group 86.6%(26/30) and 40.0%(12/30),respectively(P>0.05).@*CONCLUSION@#Median sternotomy helps to resect local advanced upper lung cancer completely and to dissect bilateral mediastinal lymph node, and it can also provide more complete postoperative lymph node staging with no significant increase in complications.

Expression of Merlin protein in non-small cell lung carcinoma and the clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To determine the expression and clinical significance of Merlin protein in non-small cell lung cancer (NSCLC).@*METHODS@#The expression of Merlin protein in 45 cases of NSCLC and adjacent tissue of NSCLC and normal lung tissue was checked by immunohistochemistry. The relation between the expression of Merlin protein and the multiple factors of pathological type, gender, P-TNM stage, differentiation and lymph node metastasis was analyzed.@*RESULTS@#The expression rates of Merlin protein in NSCLC and normal lung tissue sections were 73.33% and 15.56%, respectively (P0.05).@*CONCLUSION@#Merlin protein might contribute to the initiation of metastasis of NSCLC.

Clinical application of completed video-assisted thoracic surgery lobectomy (with 186 cases report) / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the postsurgery effects of completed video-assisted thoracic surgery (VATS) lobectomy and the indication for non-small cell lung cancer cases (NSCLC).@*METHODS@#Retrospective analysis of 186 patients received completed VATS technique surgery for lobectomy from October 2007 to July 2010.@*RESULTS@#All surgeries (186 cases) were performed successfully, and there was no death and severe postsurgery complications. Among the 186 patients, 1.6%(3/186) were switched to open thoracic operation. Up to now, all patients was alive, and the longest time for return was 31 months. Compared with regular lobectomy, bleeding, time for postoperative drainage and hospital stay were all decreased in completed VAST (P<0.05). In NSCLC cases, the average number of dissected lymph node was 14.5(4-22).@*CONCLUSION@#VATS lobectomy is safe and feasible. It is particularly useful for early stage NSCLC (esp.I-IIb) with proper indication.

Experimental research of immunophenotype CD133,CD34,CD44 in human lung adenocarcinoma / 中国医师杂志

Objective To validate the possibility of CD133 CD34 CD44 be served as biomarkers in cancer stem cell of human lung adenocarcinoma. Methods Two kinds of culturing methods were performed to generate adhesive tumor cells and floating aggregates, and the differences of expression of CD133 CD34 CD44 between 2 kinds of cultured cells were observed by immunofluorescence. Results Floating aggregates grew more slowly, kept activity for longer period than adhesive cells (72.5% vs 47.5%,P＜0.05). Floating aggregates expressed higher level of CD133, CD34 and CD44 than adhesive cells (68.97%,82.76%,93.10% vs 5.26%,15.79%,5.26%,P＜0.01). Conclusions The combination of CD133, CD34 and CD44 probably can be used as surface markers of cancer stem cells for human lung adenocarcinoma.

LUNX mRNA in regional lymph nodes of non-small cell lung cancer patients by RT-PCR and its clinical significance / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the detection of humen-lung-specific X protein (LUNX) gene in micrometastases of patients with non-small cell lung cancer.@*METHODS@#The expression of LUNX gene in tumor tissue, lung and lymph nodes was detected by reverse transcriptase-polymerase chain reaction(RT-PCR) both in 43 non-small-cell lung cancer patients (the experimental group) and 15 lung benign patients (the control group). LUNX mRNA expression in clinic pathology,stage of cancer cell differentiation, clinic stage, age, sex, smoking history, and 4 lung cancer blood markers (CEA,CA125,NSE, and CYFRA211) were evaluated.@*RESULTS@#The expression of LUNX gene was positive in the 2 groups. LUNX gene expression was positive in 33 of the 87 lymph nodes of the 43 patients in the experimental group (37.93%), and in 2 of the 26 lymph nodes in the control group (7.69%). The LUNX mRNA positive in the lymph nodes was closely related to the pathological type, cancer cell differentiation and clinic stage(r=0.660,0.500,0.460; P=0.011,0.017,0.022, all P0.05).@*CONCLUSION@#The LUNX mRNA expression detected by RT-PCR is more sensitive than by traditional ways. The expression of LUNX gene mRNA in the lymph nodes is a valuable index for the detection of micrometastases in patients with non-small cell lung cancer.

Prognostic factors for thymic epithelial tumor: a retrospective study of 137 cases / 中南大学学报(医学版)

OBJECTIVE@#To analyze the clinic and pathologic data of thymic epithelial tumor (TET) and to explore its prognostic factors.@*METHODS@#From June 1997 to September 2007, 137 patients with TET were surgically treated in our hospital. The data included age, gender, symptoms, histological type, stage and grade, pathological findings, and operation reports. The patients were followed up by telephones and mails. The patients were divided into Masaoka I/II group and III/IV group, and WHO A/AB/B1 group and B2/B3/C group. Kaplan-Meier method, log-rank test, and COX regression model were used to analyze the prognostic factors for TET.@*RESULTS@#Among the 137 patients, 124 (90.5%) received complete resection, 9 (6.6%) incomplete resection, and 4 (2.9%) surgical biopsy. The rate of complete resection was significantly higher in Masaoka stages I/II than that in stages III/IV (P<0.001). The overall 5-year and 10-year survival rate was 71.4å and 50.1å, respectively. Patients in stage I/II had better long-term survival than those in stage III/IV (P<0.001). According to WHO histological classification, the 5-year and 10-year survival rate in patients with Type A/AB/B1 TET was significantly higher than that in patients with Type B2/B3/C TET (P<0.001). The 5-year and 10-year survival rate in patients with complete resection was significantly higher than that in patients with incomplete resection and biopsy (P<0.001).Cox regression analysis showed that the prognosis of patients with TET was related to Masaoka stage, WHO histological classification, extent of resection, and age at operation.@*CONCLUSION@#Masaoka stage, WHO histological classification, extent of resection, and age at operation are important prognostic factors in patients with TET.

The animal experiment for acute superior vena cava obstruction / 中华胸心血管外科杂志

Objective To investigat the safe time of SVC interruption in New Zealand rabbits, and help to find the safe time ofSVC interruption in chnical operation. Methods 25 New-Zealand rabbits were separated into 3 groups randomly. Bi-SVC was cross-clamped for one hour, two hours in animal models. The femoral artery or SVC pressures were monitored. The control group (sham op-eration group, 5) were opened chest both sides and monitored femoral artery pressure and SVC pressure for 2 hours. Samples of cere-brum, cerebellum and medulla of rabbits immediately post-operation were studied for water content, light and electric microscopies.The tiny change of brain cells in brain mantle, hippocampus and thalamencephal were observed under electron microscope. Results(1) The SVC pressure of rabbits varied regularly in occlusion groups, which displayed as "upgrade-degression- upgrade again-retain".(2) There was no obvious difference in water content of brain between the one hour group and the control group, both of which weremuch lower than two hours group. (3) The brain tissues were almost in normal construction in one hour group, but encephaledema wasobserved in two hours group. The pathological change of cony brain cells was light and reversible in one hour group. However, in twohours group, necrosis of neuron ceils in brain could be observed, which was irreversible. Concerto The animal model of acuteSVC obstruction was built successfully. Interruption of the SVC for 1 hour was proved safe, with longer interruption of SVC 2 hours,obvious encephaledema and necrosis of neuron cells can be observed.

Augmentation of Neovascularization by Implantation of Autologous Bone Marrow Mononuclear Cells in a Rat Ischemic Limb Model / 中国医师杂志

Objective To investigate the effect of autologous bone marrow mononuclear cells (BM-MNCs) implantation on neovascularization in rat model of hind limb ischemia, and explore its mechanism. Methods Rat BM-MNCs were isolated from tibia and femur using density gradient centrifugation. A rat model of ischemic hind limb was made by the ligation of the right femoral artery and its branches in imbred Wistar rats. BM-MNCs were injected into 7 points of the ischemic muscles (20?l/point). The levels of VEGF, bFGF and IL-1? in the ischemic musles at the third, 7th and 14th days after ligation were measured by ELISA. Micro-vessel density (MVD) in the ischemic mulsles was evaluated at the second and 4th weeks after ligation. Results The levels of bFGF and IL-1? in the implantation group were significantly higher than those in the control group. The MVD of ischemic mulsles in the implantation group was also significantly higher than that in the control group at the second and 4th weeks after treatment. Conclusion The implantation of autologous BM-MNCs could induce neovascularization in a rat ischemic hind limb, and bFGF and IL-1? secreted by BM-MNCs might play a role in the neovascularization.

Reconstruction Of Superior Vena Cave and Its Branches in the Treatment of Malignant Mediastinal or Pulmonary Tumors Through Anterior Mediastinotomy / 中国医师杂志

Objective To explore the operative method for reconstruction of superior vena cave (SVC) and its branches in the treatment of patients with malignant mediastinal or pulmonary tumors through anterior mediastinotomy. Methods From 2001 to 2004 year, 22 patients with malignant mediastinal tumor or lung cancer received the resection of tumors and the reconstruction of the superior vena cave and its branches through anterior mediastinotomy. The operative efficacy was followed up in all patients. Results There was neither severe operative complications nor operative death in this group of patients, and 2 patients died of tumor recurrence in one year of post-operation, while others survived till now. Only one artificial graft occlusion occurred one month after operation. Conclusion The complete resection of malignant mediastinal or pulmonary tumors and the reconstruction of superior vena cave and its branches through anterior mediastinotomy is simple and reliable, and can remarkably improve the survival time of the short-term and long-term of the patients with malignant mediastinal or pulmonary tumor invading SVC.

Postoperative Psychosis Following Open-Heart Surgery / 中国医师杂志

Objective To study the etiology, pathogenesis, prophylaxis and management measures for psychosis after open-heart surgery.Methods Four thousand one hundred and six cases of patients with open-heart surgery were observed. The patients with psychosis complications were diagnosed and treated by psychiatrist.Results Thirty-eight cases of the patients had psychosis complications,the incidence of which was 0 93%. Most of the patients with postcardiotomy psychosis were adults. The symptoms of postcardiotomy psychosis were manic state, compression state, schizophrenia-like state and neurosis reaction. The prognosis of the patients was good.Conclusion Postcardiotomy psychosis may be viewed as having a multivariant etiology encompassing physiologic factors, environmental factors and psychological factors. Comprehensive prevention measures should be taken.