[Application of cortical bone trajectory screw in elderly patients with lumbar tuberculosis].

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].

OBJECTIVE: To observe the early cardiovascular complications of patients underwent lung transplantation. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.

HLA-A and HLA-B gene polymorphism and idiopathic pulmonary fibrosis in a Han Chinese population.

UNLABELLED: Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse interstitial lung disease with poor prognosis of unknown etiology that leading ultimately to death. Predisposing factors are thought to have environmental and genetic inputs. OBJECTIVE: We investigated the relationship between HLA-A, B gene polymorphism and idiopathic pulmonary fibrosis (IPF) in a Han Chinese population. PATIENTS AND METHODS: The gene frequency of 36 patients with IPF was detected using a PCR-SSP grouping method. These values were compared with those a Bone Marrow Bank (Shanghai, China) of healthy subjects of identical racial origin as the patient group. RESULTS: The gene frequency of HLA-A*3 (3.5%), HLA-B*14 (1.4%), -B*15 (10.2%), and -B*40 (5.0%)of the IPF group increased significantly (Pc < 0.05) compared with that in the control group HLA-A*3 (1.0%), HLA-B*14 (0.1%) and -B*15 (1.1%) and -B*40 (0.8%). Investigation of the link between the HLA-A and -B gene showed the gene frequency of HLA-A2B15 to be 5.0% as well as -A2B40 (4.3%), -A11B15 (5.0%), -A24B48 (2.8%) and -A30B40 (2.8%), which were significantly higher than those of the control group (Pc < 0.05). CONCLUSION: These data suggest that the gene frequency of HLA-A*3, HLA-B*14, -B*15, -B*40, and the linked gene frequency of HLA-A2B15, -A2B40, -A11B15, -A24B58, -A30B40 is associated with IPF pathogenesis.

EphB4 gene polymorphism and protein expression in non-small-cell lung cancer.

The objective of this study was to identify new diagnostic, prognostic or therapeutic molecules for non-small- cell lung cancer (NSCLC). We investigated the expression of EphB4, a tyrosine kinase receptor which has been shown to act as a tumor promoter in other cancers. Using immunohistochemistry, we visualized EphB4 expression in 28 samples of NSCLC and 12 samples of adjacent normal tissues. Additionally, we assessed a single-nucleotide polymorphism in EphB4 to determine its effect on protein expression. The correlation of both genotype and protein expression with disease severity was determined. EphB4 was expressed in 53.6% of patients with lung cancer, a significant increase compared to control lung samples (0.0%, P<0.05). Furthermore, EphB4 expression was correlated with differentiation, lymph node metastasis and TNM stage of tumors (P<0.05). Additionally, the polymorphism in EphB4 at rs314310 appeared to correspond to protein expression and disease susceptibility. While the frequencies of CC, CA and AA genotypes were not different between lung cancer patients and healthy controls, the frequencies of C and A alleles were significantly different between these groups (P<0.05). Further analysis showed that the positive rate of EphB4 expression in patients with the AA genotype was significantly higher compared to that in patients with other genotypes (P<0.05). Overexpression of EphB4 plays a role in the occurrence and development of NSCLC, and the polymorphism at rs314310 may predispose individuals to this disease.

Lung transplantation for end-stage silicosis.

OBJECTIVE: To evaluate whether lung transplantation conferred acceptable survival compared with conventional treatment for end-stage silicosis. METHODS: We retrospectively analyzed data for five consecutive patients with silicosis between September 2002 and December 2010, four underwent single lung transplantation and one bilateral lung transplantation. RESULTS: There was no perioperative mortality. Extracorporeal membrane oxygenation was required in four patients, three underwent single lung transplantation and one received bilateral lung transplantation, three of them were successfully weaned. One developed primary graft dysfunction 2 days after transplant and died of multiple organ failure on postoperative day 8. The remaining four patients were discharged from hospital. During follow-up, one recipient died of severe infection 7 months after transplant. All remaining patients returned to work and had a good quality of life after 5, 3 and 2 years, respectively. CONCLUSIONS: Lung transplantation offers effective therapy for patients with end-stage silicosis.

[Comparing the therapeutic effect of lung transplantation with the therapeutic effect of whole lung lavage for the patients with end-stage pneumoconiosis].

OBJECTIVE: To explore the therapeutic effects of lung transplantation (LTx) and whole lung lavage (WLL) for patients with end-stage pneumoconiosis. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Lung transplantation for silicosis: a report of 5 cases].

OBJECTIVE: To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Successful treatment of multi-drug resistant tuberculosis by double lung transplantation.

A 24-year-old man suffering from end-stage, multi-drug, resistant tuberculosis and right heart failure underwent bilateral, single-lung transplantation with extracorporeal membrane oxygenator support. He was successfully weaned and discharged from the hospital 30 days later. Sputum cultures have been negative for tuberculosis since discharge, and for almost 2 years thereafter. Anti-tuberculosis medication was discontinued 4 months postoperatively.

[Causes of early death after lung transplant: analysis of 30 cases].

OBJECTIVE: To investigate the causes of early death after lung transplant and its prevention and management. METHODS: Lung transplantation was performed on 30 patients, 12 with chronic obstructive pulmonary disease, 10 with pulmonary fibrosis, 3 with Eisenmenger's syndrome, 3 with bronchiectasis, 1 with pneumosilicosis, and 1 with pulmonary vascular leiomyoma, 24 males and 6 females, aged 48 +/- 13 (15 - 72), 23 undergoing single lung transplantation, 3 undergoing right single lung transplantation following ventricular septal defect repair with CPB, 3 undergoing bilateral sequential lung transplantation without CPB, and 1 case undergoing bilateral sequential lung transplantation with CPB, during the period September 2002 to December 2005. All the patients received invasive monitoring, mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in ICU after operation. RESULTS: Six cases died in the early period with the causes of death (n = 3), primary graft dysfunction (PGD) (n = 1), acute rejection (n = 1), and pulmonary infarction (n = 1). CONCLUSION: Infection, PGD, acute rejection and pulmonary infarction represent the most frequent causes of early death after lung transplantation.

[Lung and heart-lung transplantation for Eisenmenger syndrome: report of 5 cases].

OBJECTIVE: To discuss the operative indications and peri-operational management of single lung transplantation (SLT) and heart-lung transplantation (HLT) for patients suffering from Eisenmenger's syndrome (ES). METHODS: From September.2002 to March.2006, four ES patients, 1 males and 3 females, aged 16 approximately 19, 2 with atrial septal defect and 2 with ventricular septal defect, underwent single right lung transplantation, and one patients, male, aged 43, who suffered heart failure secondary to an interventional occlusion for atrial septal defect underwent cardiac repair and HLT. RESULTS: Two patients, including the patient who received HLT and one, female, aged 15, who received SHT died of he died primary graft dysfunction on the 23rd day and 20th day post-operationally respectively. While the other 3 recipients kept a normal life for 5, 8, and 22 months respectively after operation with apparently decreased pulmonary artery pressure and improved cardiac-pulmonary functions. CONCLUSION: Lung transplantation companies with cardiac repair is effective in the therapy of ES. Donor-recipient matching in size, proper removal and protection of the donor lung, and appropriate postoperational management are the key procedures for those patients to survive.

[Single-lung transplantation for end-stage pulmonary parenchymal diseases with pulmonary hypertension].

OBJECTIVE: To observe the outcome of single-lung transplantation (SLT) for end-stage pulmonary parenchymal diseases in combination with pulmonary hypertension (PH). METHODS: From September 2002 to November 2005, there were 22 lung transplantation recipients, suffering from emphysema (10/22), pulmonary fibrosis (10/22), pneumosilicosis (1/22) and vascular leiomyoma (1/22), and all of them were complicated with pulmonary hypertension to different extent. Operative techniques: 10 patients received left-lung transplantations, and 12 patients received right-lung transplantation. In all the patients echocardiography (ECHO) was performed before transplantation, and arterial blood was collected to determine oxygenation index (PaO(2)/FiO(2)). RESULTS: The systolic pulmonary artery pressure (Ppa, syst) was monitored by Swan-Gans catheterization one week post-transplantation, and it was found to have decreased significantly [from (50.00+/-13.00) mm Hg (1 mm Hg=0.133 kPa) to (39.5+/-7.36) mm Hg,P<0.05]. Simultaneously, PaO(2)/FiO(2) was improved [from (241.26+/-79.54) mm Hg to (348.23+/-99.31) mm Hg, P<0.05]. CONCLUSION: Single lung transplantation is an efficient way to deal with end-stage pulmonary parenchymal disease combined with pulmonary hypertension.

[Lung transplantation for pulmonary fibrosis: report of 10 cases].

OBJECTIVE: To discuss the operative technique, patient selection and perioperative management of lung transplantation for pulmonary fibrosis. METHODS: From September 2002 to December 2005, 31 cases of lung transplantations were performed in our hospital. There were 10 cases receiving single lung transplantation for pulmonary fibrosis, among them 2 received right lung transplantation with cardio pulmonary bypass, and one received contralateral lung transplantation-a left donor lung implanted in the recipient's right thorax. RESULTS: The in-hospital mortality was 10.0% (1/10). Nine patients were discharged from hospital, while one patient died of severe infection on the 137th postoperative day. During follow-up, one patient died of infection 9 months and another patient died of an accident 25 months after the operation. The 7 other patients were alive with improved lung functions. CONCLUSION: Lung transplantation is effective in improving the survival of selected patients with idiopathic pulmonary fibrosis.

[Perioperative care in lung transplantation: report of 18 cases].

OBJECTIVE: To evaluate monitoring and cares in the intensive care unit (ICU) after lung transplantation. METHODS: From September 2002 to April 2005, there were 18 cases of lung transplant recipients, who had suffered from emphysema (9 cases), pulmonary fibrosis (5 cases), silicosis (1 cases), bronchiectasis (1 case), pulmonary vascular leiomyoma (1 case), ventricular septal defect and Eisenmenger's syndrome (1 case), respectively. Operative procedures included 9 cases with left lung transplantation, 5 right lung transplantation, 1 case right single lung transplantation and ventricular septal defect repair, and 3 cases bilateral lung transplantations. All the patients received mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in the ICU after operation. Preoperatively, echocardiography (ECHO), artery blood gas,and oxygenation index (partial pressure of oxygen in artery/fraction of inspired oxygen, PaO(2)/FiO(2)) were observed. RESULTS: The average weaning time from the ventilator was (7.39+/-4.89) days. The average ICU stay time was (9.72+/-8.32) days. The systolic pulmonary artery pressure (Ppa, syst) was monitored with Swan-Ganz catheterization 1 week post transplant, and it was found to have decreased significantly from (48.94+/-14.45) mm Hg (1 mm Hg=0.133 kPa) to (39.59+/-7.45) mm Hg (P<0.05). At the same time, oxygenation index was improved from (263.89+/-82.09) mm Hg to (345.56+/-92.18) mm Hg (P<0.05), partial pressure of carbon dioxide in artery (PaCO(2)) was decreased from (63.29+/-22.56) mm Hg to (38.37+/-9.19) mm Hg (P<0.05). In hospital mortality (HM) was 16.7% (3/18 cases), and an early death was due to severe infection on the 30 th postoperative day in 1 patient and acute rejection on the 15 th postoperative day in another patient, and the other patient died due to pulmonary vein embolism on the 36 th day. Fifteen patients recovered quickly and discharged from the hospital. One patient was followed up for 32 months. CONCLUSION: Lung transplantation remains the only hope for many patients with end stage pulmonary disease. It is important that the lung transplant team possesses a working knowledge of the treatment of common complications, the time of these complications mostly likely to occur and how best to treat them when they do arise, to ensure long-term survival and success.

[Single-lung transplantation and contralateral lung volume reduction for emphysema].

OBJECTIVE: To report the operation technique, patient selection and curative effect of single-lung transplantation with contralateral lung volume reduction for a patient with end-stage emphysema. METHODS: A 47-year-old male patient who was dependent on mechanical ventilation because of end-stage emphysema received left-lung transplantation on 20 June, 2003. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by low-potassium dextran solutions (LPD) with a cold ischemic time of 390 minutes. The patient received contralateral lung volume reduction because of subacute native lung hyperinflation on the 7th day after operation. He was received tracheostomy on 15th day after operation and was weaned from ventilator on the 26th day post-operation. Immunosuppression included cyclosporine, mycophenolate mofetil and corticosteroid. The acute rejection occurred on the 9th and 15th days after operation and was cured successfully. RESULTS: The lung function was improved significantly and the patient was discharged from hospital 71 days after operation. CONCLUSIONS: Single-lung transplantation combined with contralateral lung volume reduction for end-stage emphysema is an effective measure for subacute native lung hyperinflation. Further follow-up is required to assess the long term results of this procedure.

[Single-lung transplantation for end-stage emphysema].

OBJECTIVE: To evaluate operative technique, patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema. METHODS: 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. RESULTS: 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. CONCLUSION: Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.

[Video-assisted thoracoscopic surgery for spontaneous pneumothorax].

OBJECTIVE: To explore the operational procedures, indications, and the long-term results of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax. METHODS: One hundred seventy three cases of spontaneous pneumothorax treated with VATS in our hospital between 1995 and 2001 were analyzed. Primary spontaneous pneumothorax (PSP) was found in 157 cases and secondary spontaneous pneumothorax (SSP) in 16 cases. In patients with PSP, pneumothorax occurred for the first time in 65 (41.4%) cases, and recurred at least once in 92 (58.6%) cases. Among them three patients underwent simultaneous bilateral VATS for simultaneous bilateral pneumothorax, and 6 underwent two-stage bilateral VATS. In patients with SSP, 6 had recurrent pneumothorax. RESULTS: According to the Vanderschueren's classification, no abnormality was found in 34 (19.7%) cases, pleuro-pulmonary adhesions in 41 (23.7%) cases and bullae in 98 (56.7%) cases. Pleurodesis and stapling under Endo-cutter were the major operational procedures used in these cases. The median follow-up time was 53 months. The long-term recurrence rate was 1.8%. Complications related to surgery occurred in 3.0% of the cases, which included subcutaneous emphysema, localized pleural effusion and prolonged air leakage. CONCLUSION: VATS is a safe and effective treatment for both initial and recurrent spontaneous pneumothorax, and therefore it is becoming the primary treatment modality for this disease.