Application of cortical bone trajectory screw in elderly patients with lumbar tuberculosis / 中国骨伤

OBJECTIVE@#To explore the clinical effect of cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft for lumbar tuberculosis in elderly.@*METHODS@#The clinical data of 22 patients with lumbar tuberculosis treated by cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft from February 2015 to December 2016 were retrospectively analyzed. There were 13 males and 9 females with an average age of (73.3±7.1) years old. The pre-operative Frankel grading showed that 2 cases were grade B, 5 cases were grade C, 6 were grade D, and 9 were grade E. Pre- and post-operative kyphosis Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate(ESR) and the Frankel grade were analyzed, the conditions of complication, stability of internal plants, graft fusion were observed.@*RESULTS@#All 22 patients were follow-up for 12 to 24 months with an average of (18.7±4.6) years. Two patients with contralateral psoas major muscle abscess enlarged at 3 months after operation and were cured by drainage under the guidance of type-B ultrasonic. Other 20 cases got primary healing without sinus formation and recurrence of spinal tuberculosis. At the final follow-up, the Frankel grading showed that 3 cases was grade C, 5 cases were grade D, and 14 cases were grade E. The Cobb angle, visual analogue scale (VAS), ESR were respectively decreased from preoperative(17.68±3.86)°, (6.95±2.26) points, (47.14±20.85)mm/h to (4.77±2.47)°, (2.18±1.59) points, (16.77±11.42) mm/h at final follow-up. X-ray and CT scan showed bone union for 3 to 8 months after operation, with a mean time of(4.9±1.2) months.@*CONCLUSIONS@#It is effective method to treat lumbar tuberculosis with cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft.

Early cardiovascular complications post lung transplantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the early cardiovascular complications of patients underwent lung transplantation.</p><p><b>METHODS</b>The clinical records of 73 patients who underwent lung transplantation in Wuxi People's Hospital from September 2002 to September of 2010 were retrospectively analyzed. All patients were transferred to intensive care unit (ICU) after lung transplantation, received invasive monitoring (PICCO), mechanical ventilation, immunosuppressive therapy and measures to prevent ischemic reperfusion injury. The early cardiovascular complications after lung transplantation up to discharge from hospital were observed.</p><p><b>RESULTS</b>The postoperative mortality was 20.5% (15/73) within 30 days after surgery. Five patients died of cardiovascular reasons including 2 cases of pulmonary embolism and 3 cases of ventricular fibrillation. Cardiovascular complications during the early post-operation period included: paroxysmal atrial fibrillation (19 cases, 26.0%) and persist atrial fibrillation (1 case, 1.4%); atrial fibrillation and atrial flutter in 3 cases and persistent atrial flutter in 1 patient; ventricular fibrillation (3 cases, 4.1%); paroxysmal supraventricular tachycardia (3 cases, 4.1%); ventricular tachycardia (2 cases, 2.7%); bundle branch block (8 cases, 11.0%); intraventricular block(4 cases, 5.5%); left ventricular heart failure(4 cases, 5.5%), right heart failure(6 cases, 8.2%); pulmonary embolism (2 cases, 2.7%), deep venous thrombosis (1 case, 1.4%).</p><p><b>CONCLUSIONS</b>Atrial fibrillation is the most common cardiovascular complication post lung transplantation. Pulmonary embolism and ventricular fibrillation are not common but related with high mortality rate post lung transplantation.</p>

Lung transplantation for silicosis: a report of 5 cases / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis.</p><p><b>METHODS</b>Lung transplantations (LTx) were performed for five end-stage silicosis in our hospital who were diagnosed in accordance with recommendations of the local Prophylactic Therapeutic Institution for Occupational Diseases. The chest roentgenogram and high resolution CT showed somewhat pulmonary interstitial fibrosis, pulmonary emphysema and massive opacities. The mean pulmonary artery pressure (mPAP) was > 30mmHg, NYHA III or IV. Two patients received thoracic surgery prior to LTx, one patient was ventilator-dependent. One patient received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support. Four patients received single lung transplantation (SLT), 3 under ECMO support.</p><p><b>RESULTS</b>Patient five died of multiple organ failure on postoperative day 8, the remaining four patients were discharged from hospital. During follow up, patient three died of severe infection 7 month postoperatively, the remaining three patients were alive for 5 years, 3 years and 2 years respectively, and lived good quality of life, especially with lower mPAP and improved lung function. Although our patients suffered low-grade chronic rejection with the manifestation of bronchiolitis obliterative syndrome (BOS).</p><p><b>CONCLUSION</b>Lung transplantation is a viable option for patients with end-stage silicosis, providing acceptable quality of life and survival. Both SLT and BSLT are satisfactory approach for end-stage silicosis,and long-term survival requires further investigations.</p>

Comparing the therapeutic effect of lung transplantation with the therapeutic effect of whole lung lavage for the patients with end-stage pneumoconiosis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effects of lung transplantation (LTx) and whole lung lavage (WLL) for patients with end-stage pneumoconiosis.</p><p><b>METHODS</b>From June 2002 to February 2011, 5 cases with end-stage pneumoconiosis were treated with LTx and 12 cases with end-stage pneumoconiosis were treated with WLL. The clinical symptoms, pulmonary functions, pulmonary artery pressures, blood gas analysis, imagings of chest and survival status were retrospectively analyzed.</p><p><b>RESULTS</b>In LTx group, the clinical symptoms (cough, sense of suppression in the chest), pulmonary functions and blood gas indicators were improved, pulmonary artery pressures decreased to normal levels, the imaging of chest showed that the implanted lung inflated well and was with clear lung markings. But the contralateral lungs without treatment appeared the progression of disease in the imaging of chest. In WLL group, the clinical symptoms in a half year after treatment were improved but the symptomatic relief rate declined with time, the pulmonary functions in half year after treatment were improved but decreased after 2 years, the pulmonary artery hypertension enhanced generally, as compared with that prior to WLL. The disease progression in the chest imaging examination was not found in a half year after WLL, but appeared in 1 ∼ 2 years after WLL. During following-up. the mean survival times in LTx and WLL groups were 40.5 and 21.4 months, respectively. In LTx group, one patient died of multiple organ dysfunctions (MODS) caused by primary graft dysfunction (PGD), one case died of severe infection in seven months after LTx. Up to now, other 3 cases have survived for 65, 41 and 29 months, respectively. In WLL group, 3 cases died of pulmonary infection, 2 cases died of respiratory failure, one case died of heart failure and one case died of encephalon vascular accident, the mean survival time of these 7 patients was (19.0 ± 8.7) months. So far other 5 cases have survived for 7, 9, 13, 18 and 26 months, respectively.</p><p><b>CONCLUSION</b>LTx has greater risk of death during preoperative period, but patients after LTx may have long survival times with good quality of life. The clinical symptoms and pulmonary functions of patients can be improved temporarily after WLL, but the survival time of WLL is inferior to that of LTx.</p>

Single-lung transplantation for end-stage emphysema / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate operative technique, patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema.</p><p><b>METHODS</b>A 56-year-old patient with end-stage emphysema underwent left-lung transplantation on September 28, 2002. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by LPD solution with a cold ischemic time of 260 minutes. Cardiopulmonary bypass was not performed.</p><p><b>RESULTS</b>The patient weaned from a ventilator at the 93th hour after operation. Immunosuppressants included cyclosporine, mycophenolate mofetil and corticosteroid. Acute rejection occurred on the ninth day after operation and was cured by bolus methylprednisolone given intravenously. Lung function was improved significantly and the patient was discharged from the hospital on the 47th day after operation.</p><p><b>CONCLUSION</b>Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.</p>