Validating the surgical indication value of the LTB-S classification system for drug resistant tuberculosis.

BACKGROUND: Currently there is no guideline based on preoperative clinical parameters for assessing the prognosis of the adjunctive surgery for drug-resistant tuberculosis. METHODS: We retrospectively analyzed 138 patients who had undergone surgical resection as a treatment for drug- resistant tuberculosis after 24 months. Four clinical parameters on lesion type, treatment history, body physiological status, and surgery approach were evaluated. Categorical preoperative clinical parameters were analyzed by ordinal logistic regression model when considering postoperative complications as outcomes ordered in terms of severity. Statistically significant parameters were then combined in a single classification system for predicting the outcomes of the adjunctive surgery. FINDINGS: Diffused, progressive bilateral lesions, or active/progressive extra pulmonary tuberculosis (L3), and history of less than 2 months treatment before surgery (T3) were the strongest predicative parameters for postoperative complications and for surgery failure. Classification systems based on the four parameters were found to have a statistically significant effect on postoperative complications and postoperative efficacy. 24- month follow up indicated a high cure rate (above 95.5%) among patients without T3, L3, or severe physiological complications (B3). INTERPRETATION: A classification system based on objective clinical parameters showed predicative value for the prognosis of the adjunctive surgery and could guide management of drug-resistant Tuberculosis.

Individualized Comprehensive Therapy for the Lung Cancer Patients with HIV Infection / 中国肺癌杂志

BACKGROUND@#To observe clinical features, clinical stagings, types ofpathology, treatment options and clinical effects of patients suffer from HIV infection combined with lung cancer, and also to provide guidance for individualized comprehensive treatment of HIV combined with lung cancer.@*METHODS@#Through the retrospective analysis of 53 cases of HIV merger of lung cancer patients admitted in our department, 47 cases of non-small cell lung cancer (NSCLC), 6 cases of small cell lung cancer (SCLC), 24 cases accepted surgery combined chemotherapy, 22 patients with simple chemotherapy, 7 cases give up treatment; 28 cases are in stages I-III, 25 cases are in stage IV; 24 patients received combined chemotherapy in 28 patients with stages I-III, 2 cases gave up treatment, 2 cases with severe chronic obstructive pulmonary disease (COPD) could not tolerate chemotherapy plus surgery. According to the situation of patients before highly active anti-retroviral therapy (HAART) treatment, patients who received HAART before treatment were divided into observation group (n=27), patients who did not receive HAART were divided into control group (n=19). The survival and the independent influencing factors between the two groups were analyzed.@*RESULTS@#Among the 53 HIV infected cases a toal of 46 patients received treatment among 53 cases of treatment in patients with lung cancer merger of HIV, there are no differences of 1 year survival rate, 2 years survival rate between observation group and control group; patients in I-III phase 1 year survival rate was 76.0%, 2 years survival rate was 60.0%. Patients in IV phase 1 year survival rate was 13.6%, 2 years survival rate was 0%. 24 patients with surgery combined chemotherapy 1 year survival rate was 83.3%, 2 years survival rate was 62.5%; 22 cases treated with simple chemotherapy 1 year survival rate was 18.0%, 2 years survival rate was 0%.@*CONCLUSIONS@#HIV merger in patients with lung cancer can improve the patients survival rate after different individualized comprehensive treatment, early surgery with combined chemotherapy has remarkable effect.

Mini-thoracotomy focus cleaning for cavitary pulmonary tuberculosis or pulmonary tuberculoma: A report of 18 cases / 中国微创外科杂志

Objective To investigate the effects and feasibility of mini-thoracotomy focus cleaning in the management of cavitary pulmonary tuberculosis or pulmonary tuberculoma. Methods The mini-thoracotomy approach was adopted in patients with cavitary pulmonary tuberculosis or pulmonary tuberculoma who had undergone long-term anti-tuberculosis therapy or needed a re-treatment.Eight patients with chronic fibro-cavitative pulmonary tuberculosis and 10 patients with pulmonary tuberculoma underwent focus cleaning, irrigation, and folding suture. Results All the 18 patients were cured clinically, with their sputum findings turning negative for bacteria and pulmonary shadows subsiding. No operative complications occurred. Follow-up for 1～4 years found no recurrence. Conclusions Focus cleaning is an effective surgical alternative for pulmonary tuberculosis after proper selection of cases. The procedure is minimally invasive and patient's pulmonary function can be protected to the greatest possible advantage.