Surgical treatment of severe benign tracheal stenosis.

OBJECTIVE: To present clinical experiences regarding surgical treatment of patients with severe cicatricial tracheal stenosis. PATIENTS AND METHODS: From January 2008 to March 2020, 14 patients underwent tracheal resection and reconstruction under general anesthesia. Nine cases had cervical tracheal stenosis and five cases had thoracic tracheal stenosis. The mean diameter and length of strictured trachea was 0 - 8 mm with a mean of 4.5 ± 2.4 mm and 1 - 3 cm with a mean of 1.67 ± 0.63 cm, respectively. General anesthesia and mechanical ventilation were performed in ten cases and four patients underwent femoral arteriovenous bypass surgery due to severe stenosis. End-to-end anastomosis of trachea was performed in 13 cases and the anastomosis between trachea and cricothyroid membrane was performed in one case. Absorbable and unabsorbable sutures were used for the anterior and posterior anastomoses, respectively. Postoperative neck anteflexion was maintained by a suture between the chin and superior chest wall. The relevant data of the 14 patients were retrospectively reviewed, and the operation time, blood loss, postoperative hospital stay, postoperative complications and follow-up were retrieved. RESULTS: There was no intraoperative death. The length of resected trachea ranged from 1.5 to 4.5 cm with a mean of 1.67 ± 0.63 cm. Operation time ranged from 50 - 450 min with a mean of 142.8 ± 96.6 min and intraoperative hemorrhage ranged from 10 - 300 ml with a mean of 87.8 ± 83.6 ml. Follow-up period ranged from 5 to 43 months with a mean of 17.9 ± 10.6 months. None of the patients had recurrent laryngeal nerve paralysis during postoperative follow-up. Ten cases were discharged uneventfully. Anastomosis stenosis occurred in three cases who received interventional therapies. Bronchopleurocutaneous fistula occurred in one patient after 6 days postoperatively and further treatment was declined. CONCLUSION: The strategies of anesthesia, mechanical ventilation, identification of stenosis lesion, the "hybrid" sutures and postoperative anteflexion are critical to be optimized for successful postoperative recovery.

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor.

BACKGROUND: In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. METHODS: Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. RESULTS: A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. CONCLUSIONS: Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.

Erratum: P130cas is required for TGF-ß1-mediated epithelial-mesenchymal transition in lung cancer.

[This corrects the article DOI: 10.3892/ol.2014.2123.].

Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review.

BACKGROUND: Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). METHODS: Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. RESULTS: The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. CONCLUSION: The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.

Anxiety after Sympathectomy in patients with primary palmar hyperhidrosis may prolong the duration of compensatory hyperhidrosis.

BACKGROUND: Compensatory hyperhidrosis (CH) is a frequent side effect after sympathectomy for the treatment of primary palmar hyperhidrosis. We determined the effects of demographic and clinical factors which may increase the duration of CH (DCH). METHODS: One hundred twenty-two patients who had undergone sympathectomies from 2014 to 2016 were retrospectively reviewed. Anxiety was evaluated using the State and Trait Anxiety Inventory score. Follow-up evaluations continued until CH remitted. A Cox proportional hazards model was used to determine the association between DCH and variables. RESULTS: DCH ranged from 5 to 27 weeks (median, 11.47 weeks). Severe CH (HR = 0.318, 95% CI, 0.136-0.741) and exacerbated anxiety 1 month post-operatively (HR = 0.816, 95% CI, 0.746-0.893) may prolong CH. A positive correlation between post-operative anxiety and DCH was common in patients with moderate or severe CH, and in cases with forearm CH. CONCLUSIONS: Pre- and post-operative anxiety should be evaluated, and anti-anxiety treatment is offered to patients with moderate-to-severe CH to shorten the DCH.

Circulating tumor cells in early stage lung adenocarcinoma: a case series report and literature review.

PURPOSE: The study aimed to monitor circulating tumor cells (CTCs) in early stage lung adenocarcinoma patients. RESULTS: CTCs were characterized and classified to epithelial (E-) CTCs, mesenchymal (M-) CTCs and epithelial- mesenchymal (E&M-) CTCs, as per epithelial-mesenchymal transition(EMT) biomarkers. CTCs could not be found in healthy controls. However, in cohort A, CTCs were found in 17 (17/18) cases. Detection rate of E-CTCs was lower (5/18) compared with M-CTC (10/18) or E&M-CTC (14/18). Highly abundant M-CTCs were prone to being in the tumors > 2 cm. In cohorts A and B, CTCs count increased significantly in all patients with tumor progression (7/7). Higher CTCs level or change range could be found postoperatively in the patients with tumor progression, as compared with patients with disease free survival (P < 0.01). Additionally, CTCs detected by CanPatrolTM could be validated by CytoploRare or Pep@MNPs. MATERIALS AND METHODS: We included four cohorts of patients and 20 healthy controls. In cohort A, CTCs were detected by a newly established approach, i.e., CanPatrolTM, prior to anesthesia and monitored after operation longitudinally. In cohort B, CTCs were not assessed prior to operation, but were longitudinally detected after operation. For validation, we detected FOLR(+)-CTCs by using CytoploRare and EPCAM(+)-CTCs by using Pep@MNPs prior to operation, in cohorts C and D, respectively. CONCLUSION: CTCs can be detected in early stage lung adenocarcinoma, even in adenocarcinoma in situ, and CTCs detection can effectively monitor tumor progression. The distinguishing of biomarkers of highly invasive and aggressive CTCs warrants further robust study.

Optimization of Chest Tube Management to Expedite Rehabilitation of Lung Cancer Patients After Video-Assisted Thoracic Surgery: A Meta-Analysis and Systematic Review.

BACKGROUND: The aim of this meta-analysis and systematic review of published evidence was to optimize chest tube management for fast-track rehabilitation of lung cancer patients after video-assisted thoracic surgery (VATS). METHODS: The PubMed, Web of Science, and EMBASE databases were searched to identify all studies that addressed the issue of chest tube management after VATS for lung cancer. Finally, 35 articles were included for analysis, i.e., 29 randomized controlled trials and 6 clinical trials. RESULTS: After synthesis of the published evidence, the following protocol for chest tube drainage was formulated: (1) after VATS lung wedge resection, chest tube drainage can be omitted in selected cases; (2) normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use of a digital monitoring system is recommended; (4) in case of increasing pneumothorax or severe air leakage supported by digital recording system, the tube should be placed with active suction; and (5) the chest tube can be removed within 48 h postoperatively when air leakage is resolved and fluid drainage is <400 mL/day. CONCLUSIONS: Further multicenter studies are warranted based on the variations of body sizes among different ethnicities.

P130cas is required for TGF-ß1-mediated epithelial-mesenchymal transition in lung cancer.

In lung cancer A549 cells, the present study evaluated the associations between p130cas expression and the activation of p38 or Smad2, which are components of two of the main signaling pathways of transforming growth factor-ß1 (TGF-ß1), i.e., epithelial-mesenchymal transition (EMT) and apoptosis, respectively. TGF-ß1-induced EMT was investigated by inspecting cell shape and cell migration, and by testing E-Cadherin, N-Cadherin and Vimentin biomarkers in p130cas-RNA interference (RNAi)-A549 cells. The changes in TGF-ß1-induced apoptosis, i.e., cleaved Caspase-3 levels, were additionally analyzed following p130cas-RNAi. p130cas-knockdown decreased the phosphorylated (p)-p38 expression level, and blockaded the TGF-ß1-induced activation of p-p38 in the A549 cells. p130cas-knockdown arrested cell migration and impaired TGF-ß1-induced EMT in the A549 cells, characterized by changes in cell morphology and biomarker levels. However, p130cas-knockdown had no impact on the activation of Smad2 and the cleavage of Caspase-3. These results indicate that p130cas is a novel molecular 'rheostat' that alters the function of the TGF-ß1 signaling pathway from tumor suppression to tumor promotion in lung cancer cells. The underlying mechanism warrants further study.

BCAR1 protein plays important roles in carcinogenesis and predicts poor prognosis in non-small-cell lung cancer.

OBJECTIVE: Our previous study suggested the potential clinical implications of BCAR1 in non-small-cell lung cancer (NSCLC) (Mol Diagn Ther. 2011. 15(1): 31-40). Herein, we aim to evaluate the predictive power of BCAR1 as a marker for poor prognosis in NSCLC cases, verify the carcinogenic roles of BCAR1 in the A549 lung adenocarcinoma cell line, and testify to the BCAR1/phospho-p38 axis. METHODS: Between January 2006 and June 2010, there were a total of 182 patients with NSCLC (151 cases with available follow up data, and 31 cases lost to follow-up due to the invalid contact information). We inspected BCAR1, phospho-BCAR1(Tyr410), phospho-p38(Thr180/Tyr182) and p38 expression in NSCLC tissues and matched adjacent normal tissues by immunoblotting and IHC. After BCAR1 -RNA interference in A549 cells, we inspected the protein expression (BCAR1, phospho-BCAR1, phospho-p38 and p38) and performed cell biology experiments (cell growth, migration and cycle). RESULTS: BCAR1 was overexpressed in NSCLC tissues (177/182) and cell lines (A549 and Calu-3). However, it was not detected in the normal adjacent tissue in 161 of the 182 cases. Higher BCAR1 levels were strongly associated with more poorly differentiated NSCLC and predicted poorer prognosis. BCAR1 knockdown caused cell growth arrest, cell migration inhibition and cell cycle arrest of A549 cells. Overexpression of BCAR1 was associated with activation of p38 in NSCLC cases, and BCAR1 knockdown caused reduction of phospho-p38 levels in A549 cells. CONCLUSION: Overexpression of BCAR1 is a predictor of poor prognosis in NSCLC and plays important carcinogenic roles in carcinogenesis, probably via activation of p38 MAPK. However, further investigations are required immediately.

Surgical strategy for tubercular abscess in the chest wall: experience of 120 cases.

OBJECTIVES: We aim to optimize surgical strategy to decrease relapse of tubercular abscess in the chest wall (TACW). METHODS: The records of 120 patients who underwent surgical treatment for TACW from May 2005 to March 2011 were retrospectively reviewed. We conducted the following surgical treatment as '6C + A' by abbreviating the first alphabet of each step: (i) careful exploration of the abscess; (ii) complete resection; (iii) cavity washing using sodium bicarbonate solution; (iv) coverage using muscle flap; (v) continuous suction and drainage; (vi) compression dressing and (vii) anti-tuberculosis medication. RESULTS: One hundred and thirteen cases were discharged for rehabilitation with the first stage wound healing (113/120). Four cases postoperatively suffered from subcutaneous fistula which was healed after dressing changes for 1-2 months. Three patients with an abscess relapse underwent the second operation 2 months after the first operation. Follow-ups ranged from 2 months to 6 years and demonstrated no recurrence. CONCLUSIONS: We deem the surgical procedures '6C + A' effective to obviate relapse of TACW.

Clinical value of assaying tumor supplied group of factor/tumor specific growth factor in patients with solitary pulmonary nodule.

OBJECTIVE: This pilot study was designed to evaluate the clinical value of assaying tumor supplied group of factor/tumor specific growth factor (TSGF) in solitary pulmonary nodule (SPN). PATIENTS AND METHODS: The study was conducted from March 2007 to September 2010 and included 33 patients with SPN and 28 healthy volunteers. TSGF was assayed in preoperative serum, intraoperative pleural lavage fluid (IPLF), and postoperative serum. RESULTS: At operation, 20 patients were diagnosed with malignancy and 13 patients were diagnosed with nonmalignancy and placed in group A and group B, respectively. In group A, pathologic staging demonstrated 8 patients (group A1) with stage T1N0M0, 7 patients (group A2) with stage T1N1M0 and 53 patients (group A) with stage T1N2M0 disease. In group B, 8 patients were diagnosed with tuberculoma (group B1) and 5 patients were diagnosed with inflammatory pseudotumor (group B2). Before operation, levels of TSGF in peripheral blood were significantly higher in group A compared with group B and the control group (98.8 ± 29.9 vs. 62.1 ± 24.9 and 50.1 ± 17.9, Student-Newman-Keuls test; P < .05). The percentage of patients with positive serum TSGF results was significantly higher in group A than in group B or the control group (90.0% vs. 30.8% and 17.9%, χ(2) test; P < .05). With respect to the diagnostic value of serum TSGF in malignant SPN, we found sensitivity to be 90%, specificity to be 69.2%, positive forecast rate to be 74.5%, negative forecast rate to be 87.4%, and accurate diagnosed rate to be 79.5%. The TSGF level in IPLF in group A was significantly higher than that in group B (132.2 ± 51.9 vs. 84.6 ± 12.6, Student t test, P < .05). Additionally, TSGF in group A2 and group A3 was significantly higher compared with group A1 (162.2 ± 52.3 and 176.4 ± 17.8 vs. 100.2 ± 35.8, Student-Newman-Keuls test; P < .05). Postoperative serum TSGF in the patients diagnosed with lung cancer decreased significantly after operation. TSGF returned to a normal threshold level (71 U/mL) in the sixth month postoperatively. In addition, there was no appreciable change in the patients in group B. CONCLUSION: Serum TSGF is conducive to discriminating between benign and malignant features of SPN. Additionally, investigation of IPLF TSGF can potentially offer a new approach to predict the existence of lymph node metastases.

Optimization of sympathectomy to treat palmar hyperhidrosis: the systematic review and meta-analysis of studies published during the past decade.

OBJECTIVE: The systemic review and meta-analysis of the studies published during the past 10 years was designed to optimize the surgical procedures of video-assisted thoracoscopic sympathectomy (VTS) to treat palmar hyperhidrosis (PH). METHODS: Citations from 2000 to 2010 were included regarding the following aspects: selection of ganglia level for VTS, comparison of different techniques for VTS, evaluating clinical efficacy of intraoperative intrapleural analgesia, and postoperative intrapleural drainage. Major clinical outcomes are defined as: cases with postoperative resolution of symptoms, total cases with postoperative compensatory hyperhidrosis (CH), cases with severe or moderate CH, satisfied cases, evaluation of postoperative pain, and postoperative pneumothorax. RESULTS: Systemic review indicates that T3 and T3-4 sympathectomy had the "best" clinical efficacy. Meta-analysis suggests that efficacious rates of PH are nearly similar compared with multiple and single ganglia sympathectomy (100 vs. 95.6%). However, single-ganglia sympathectomy can render a lower risk of total CH compared with multiple-ganglia block. Risk of moderate/severe CH has a similar trend. Additionally, single-ganglia sympathectomy is more potent to satisfy patients postoperatively. One randomized, controlled trial (RCT) that compared different techniques for VTS indicated that the overall success rate of the operation was 95% and the differences were not statistically significant. Two RCTs indicated that there were significant differences between trial group (intraoperative intercostal nerve blocks using bupivacaine) and control group regarding the attenuation of postoperative pain. One RCT suggested that there was no significant difference with or without pleural drainage regarding the incidence of postoperative residual pneumothorax. CONCLUSIONS: T3 sympathectomy is supposed to be recommended for the treatment of PH regardless of using various techniques. Intraoperative intrapleural analgesia using bupivacaine or bupivacaine plus epinephrine is effective to prevent postoperative pain. Pleural drainage after VTS should be abandoned.

Prevention of early delayed gastric emptying after high-level esophagogastrostomy by "pyloric digital fracture".

OBJECTIVE: This study was designed to evaluate the clinical efficacy of pyloric digital fracture for the prevention of early delayed gastric emptying (DGE) after high-level esophagogastrostomy. METHODS: From January 2004 to March 2009, we sequentially enrolled 78 patients after esophagogastrostomy: 48 patients with pyloric digital fracture (DF group) and 30 patients without any drainage procedure (non-DF group). Intraoperative manometric study was performed in 48 patients of the DF group. Postoperative evaluation was performed, including symptomatic questionnaire, radiographic study, and gastric scintigraphy. RESULTS: Intraoperative manometric study revealed that basal pyloric pressure and peak pressure of pylorus in phase III of the migrating motor complex increased significantly after gastric conduit was made and anastomosed, but decreased appreciably following digital fracture. Compared with the peak pressure of IPPW before digital fracture (88.52 ± 19.88 mmHg), it appreciably decreased following digital fracture (40.45 ± 13.52 mmHg). Occurrences of IPPW (in 10 min) and duration time of each occurrence (s) had similar trends for before and after digital fracture (11.5 ± 4.5 vs. 5.0 ± 3.5 and 7.0 ± 2.0 vs. 3.0 ± 1.0, respectively). Postoperative evaluation demonstrated that early DGE occurred in four patients in the non-DF group (13.3%), and there was no DGE patient in the DF group. There was significant difference regarding gastric scores between the DF group and the non-DF group (10.5 ± 3.4 vs. 16.7 ± 3.8, t = 2.8271, P < 0.05). Gastric scintigraphy revealed that either semi-emptying-time or percent of retention at 4 h of the DF group was significantly lower than that of the non-DF group. CONCLUSION: Pyloric digital fracture can prevent early DGE after high-level esophagogastrostomy efficaciously and conveniently.

Diagnosis of chest pain with foregut symptoms in Chinese patients.

AIM: To evaluate the diagnosis of chest pain with foregut symptoms in Chinese patients. METHODS: Esophageal manometric studies, 24-h introesophageal pH monitoring and 24-h electrocardiograms (Holter electrocardiography) were performed in 61 patients with chest pain. RESULTS: Thirty-nine patients were diagnosed with non-specific esophageal motility disorders (29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia). Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux (two patients had concomitant myocardial ischemia), and one patient was diagnosed with nutcracker esophagus. CONCLUSION: The esophageal manometric studies, 24-h intra-esophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain, particularly in patients with foregut symptoms. In cases of esophageal motility disorders, pathological gastroesophageal reflux may be a major cause of chest pain with non-specific esophageal motility disorders. Spasm of the esophageal smooth muscle might affect the heart-coronary smooth muscle, leading to myocardial ischemia.

Functional and menometric study of side-to-side stapled anastomosis and traditional hand-sewn anastomosis in cervical esophagogastrostomy.

OBJECTIVE: In the study, we made the pharyngoesophageal functional assessment and menometric study on the two kinds of anastomosis (traditional hand-sewn anastomosis and side-to-side stapled anastomosis) for the further evaluation and application of cervical esophagogastrostomy. PATIENTS: The study included 17 patients with esophageal squamous cancer from March 2006 to May 2008. Eight patients had undergone total esophagectomy and traditional hand-sewn technique in CEGA. The other nine patients had undergone total esophagectomy and side-to-side stapled technique in CEGA. All the 17 patients were studied for 3 months after the operations. The complete data, such as esophagogastroscopy, barium swallow and manometric studies, were obtained for each participating patient. RESULTS: In the hand-sewn group of eight patients, four patients (50%) reported clinical significant symptoms of cervical dysphagia. Two patients (11.1%) reported clinical significant symptoms of cervical dysphagia in the side-to-side group of nine patients. There is a statistically significant difference between the hand-sewn group of patients (n=8) and the side-to-side group of patients (n=9) with respect to overall mean anastomotic diameters (1.688+/-0.26 cm vs 3.012+/-0.17 cm, p=2.10 x 10(-8)). In the eight patients who underwent hand-sewn technique, there were four symptomatic patients with poor menometric datum, such as anastomotic hypertensive peristaltic activity, confusing inversion of anastomotic and midcervical esophageal pressure, and consequently poor compliance of the pharyngoesophageal segment (pharyngeal shoulder pressure). By contrast, there was only one symptomatic patient with poor menometric data in the nine patients who underwent side-to-side technique. CONCLUSION: The side-to-side stapled technique is conducive to decrease complications of postoperative dysphagia and is helpful for improving pharyngesophageal and anastomotic menometric function. The anastomotic technique deserves more attention and further applications.

Prevention of stricture development after corrosive esophageal burn with a modified esophageal stent in dogs.

OBJECTIVE: We sought to test the feasibility and technical ease of a newly designed nitinol-based modified esophageal stent and its effects on preventing postcaustic stricture in mongrel dogs and to try to explain the result at the molecular level. METHODS: Twenty-four dogs were included in this controlled study. Stenosis index (wall thickness/intraluminal diameter), pathologic features, hydroxyproline quantities, esophageal compliance, and biomechanics were compared between the injured but unstented and stented dogs. Transforming growth factor beta1, Sma/Mad (Smad)3, and Smad7 mRNA expression and protein levels in esophageal tissue were detected by means of reverse transcriptase-polymerase chain reaction and Western blotting, respectively. RESULTS: The modified esophageal stent was able to be placed and retrieved successfully and conveniently and was not only intact but there was also no macroscopic esophageal mucosal injury after the stent removal 4 months later. In comparison with the injured but unstented group, esophageal compliance, biomechanics, and the stenosis index were significantly better in the stented group. Histopathologic study revealed that collagen bundles were thinner and its orientation tended toward a regular and parallel pattern. Transforming growth factor beta1 and Smad3 mRNA expression and protein levels increased and Smad7 mRNA expression and protein levels decreased significantly in esophageal tissue in the stented group. These variables showed no statistically significant difference 2 months after stent removal. CONCLUSIONS: The modified esophageal stent might be a promising stent in preventing stricture formation after corrosive esophageal burns clinically.

[Thymectomy for myasthenia gravis by video-assisted thoracoscopic surgery through right anterior-lateral approach].

OBJECTIVE: To evaluate the feasibility and curative effect of thymectomy for myasthenia gravis (MG) by video-assisted thoracoscopic surgery (VATS) through right anterior-lateral approach. METHODS: Fifty-six patients of MG were treated with thoracoscopic thymectomy and mediastinal fat dissection through right anterior-lateral approach from August 2001 to October 2007. The feasibility, safety, complication and remission for MG were retrospectively analyzed. RESULTS: Fifty-five operations were completed by VATS. The mean operative time and blood loss were (96.2 +/- 52.1) min and (68.7 +/- 21.4) ml, respectively. The brachiocephalic vein injury by the electric coagulator occurred in two cases and one of them performed thoracotomy for homeostasis, the other performed ligation. The postoperative pathology showed hyperplasia in 38 cases, atrophy in 5 cases, thymoma in 12 cases and cyst of thymus in 1 case. And the operative complication included one myasthenia crisis (1.8%) at the third day and one death (1.8%) at the eighth day because of postoperative hemorrhage. The average length of stay was (7.9 +/- 2.9) d. All cases were followed up from one to seventy months. Eight (14.3%) of complete remission, 39 cases (69.6%) of partial remission and 7 cases (12.5%) of no change were found. The total effective rate was 83.9%. CONCLUSIONS: Thoracoscopic thymectomy through right anterior lateral approach is technically feasible, safe and minimally invasive. It has a high remission rate for MG.

Lung volume reduction surgery allows esophageal tumor resection in selected esophageal carcinoma with severe emphysema.

BACKGROUND: Esophageal carcinoma patients with coexisting severe emphysema are high risk surgical candidates. We hypothesize that simultaneous unilateral lung volume reduction surgery (LVRS) allows us to offer esophageal tumor resection to patients previously considered inoperable. METHODS: Twenty-one patients with esophageal carcinoma were recruited. All patients had severe emphysema with impaired respiratory function and health-related quality of life (HRQL). Esophageal tumor resection with gastroesophagostomy in the thorax and then unilateral LVRS were performed at the same anesthesia. Dyspnea index, exercise capacity, pulmonary function, and HRQL were assessed at baseline and every three months up to one year postoperatively. RESULTS: There was no perioperative death or significant morbidity. Clinical improvements were observed at 3, 6, and 12 months, in terms of dyspnea index, forced expiratory volume in 1 second, residual volume, partial pressure of oxygen, arterial, partial pressure of carbon dioxide, arterial, 6-minute walking distance, dysphagia, and odynophagia (p < 0.01 or p < 0.05). The Karnofsky Performance Status score improved from baseline 36 +/- 3 to 53 +/- 3 at 3 months, 67 +/- 5 at 6 months, and 63 +/- 8 at 12 months (p < 0.01). Significant improvement was seen in all the Short-Form 36-item Health Survey HRQL domains at 3 months (p < 0.01 or p < 0.05). These improvements remained significant for up to 6 months, and for up to 12 months for physical functioning and general health. The Psychosocial Adjustment to Illness Scale score and all the scales were improved after surgery (p < 0.01). CONCLUSIONS: Our study shows that in selected patients with esophageal carcinoma who suffer from severe emphysema, simultaneous unilateral LVRS renders esophageal tumor resection safe and effective. Also, these patients may experience early improvement in pulmonary function and HRQL.