Diagnosis and treatment of aortic dissection combined with chronic renal failure / 中国医师进修杂志

Objective To evaluate the diagnosis and treatment of aortic dissection combined with chronic renal failure.Methods Ten cases were retrospectively analyzed who were diagnosed as aortic dissection combined with chronic renal failure between January 2012 and December 2014.The history of chronic renal failure was 1-6 years.According to Standford classification,one case was type A dissection and the other nine were type B.Results Seven type B dissection had endovascular stent implantation.Perioperative renal function monitor and hemodialysis was given.The other two patients with type B dissection had conservative treatment.One patient with type A dissection died in the day of diagnosis.Follow-up data showed seven patients with stent implantation were in good condition and two others with conservative treatment died due to dissection rupture three and eight months after diagnosis respectively.Conclusions The mortality of aortic dissection combined with chronic renal failure is high.For Standford B dissection,endovascular stent implantation is a reliable treatment method.

Diagnostic and therapeutic strategy of traumatic pulmonary pseudocyst / 中国医师进修杂志

Objective To evaluate the diagnostic and therapeutic strategy of traumatic pulmonary pseudocyst (TPP).Methods Fifteen patients who were diagnosed and treated as TPP between January 2000 and November 2011 were studied retrospectively.Results Nonpenetrating chest trauma was the underlying cause in all cases.A typical sign shown on chest radiograph was a thin-walled cavitary lesion in 9 patients,6 patients accompanied by traumatic wet lung,with or without an air-fluid level.Serial radiological images of CT showed high resolution of the above lesions.Single TPP lesion occurred in 9 patients,and multiple TPP lesions in 6 patients.The size of the lesions was 5 -75 (32 ± 17) mm.The pseudocyst was located in the left lung in 5 patients(33％),located in the right lung in 7 patients (47％),located in bilateral lung in 3 patients (20％).All TPP patients were treated conservatively with no occurrence of complications.Conclusions TPP is an uncommon benign lesion secondary to thoracic trauma.CT scan is an optimal option for diagnosis and evaluation of TPP.Uncomplicated cases can take conservative treatment.For complicated patients,theraneutic strategy should be made individually.

Relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung / 中国肺癌杂志

<p><b>BACKGROUND</b>Lymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung.</p><p><b>METHODS</b>A total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed.</p><p><b>RESULTS</b>Lymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation.</p><p><b>CONCLUSIONS</b>Lymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.</p>

A clinicopathological study of 14 cases of pulmonary inflammatory myofibroblastic tumor / 中国肺癌杂志

<p><b>BACKGROUND</b>Inflammatory myofibroblastic tumor (IMT) is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department.</p><p><b>METHODS</b>From January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years' follow-up was completed in all patients.</p><p><b>RESULTS</b>These 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up.</p><p><b>CONCLUSIONS</b>Histopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.</p>

Pathogen spectrum and correlative factors of nosocomial infection in patients with lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Lung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer.</p><p><b>METHODS</b>One hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically.</p><p><b>RESULTS</b>Of all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours.</p><p><b>CONCLUSIONS</b>The nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.</p>