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Impact of early or delayed elective resection in complicated diverticulitis

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World Journal of Gastroenterology 2011年第48期17卷 5274-5279页

作者： Kai Bachmann Geeske Krause Tamina Rawnaq Lena Tomkotter Yogesh Vashist Shanly Shahmiri Jakob RIzbicki Maximilian Bockhorn Department of general Visceraland Thoracic Surgery University Medical Center Hamburg-Eppendorf

AIM： To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis. METHODS： The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis （Hinchey classification I - II ） at the Department of surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies. RESULTS： The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher （80% vs 75%）. Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elec- tive resection （9296 ± 694 vs 8423 ± 968 ; P = 0.001）. Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages.

关键词： Complicated diverticulitis Resection of sig-moid Delayed elective resection Early elective resec-tion Socioeconomic effects

Gastroparesis after video-assisted thoracic surgery:A case report

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World Journal of Clinical Cases 2023年第8期11卷 1862-1868页

作者： Hang An Yu-Cun Liu Department of general surgery Peking University First HospitalBeijing 100034China

BACKGROUND Video-assisted thoracic surgery(VATS)lobectomy is a common treatment for patients with early-stage lung *** patients can experience slight gastrointestinal discomfort after lobectomy for a *** is a gastrointestinal disorder that can be severe;it is associated with an increased risk of aspiration pneumonia and impaired postoperative ***,we report a rare case of gastroparesis after VATS *** SUMMARY A 61-year-old man underwent VATS right lower lobectomy uneventfully but had an obstruction of the upper digestive tract 2 d after *** gastroparesis was diagnosed after emergency computed tomography and oral iohexol X-ray *** gastrointestinal decompression and administration of prokinetic drugs,the patient’s gastrointestinal symptoms *** perioperative medication was applied according to the recommended dose and there was no evidence of electrolyte imbalance,intraoperative periesophageal vagal nerve injury was the most likely underlying cause of *** Although gastroparesis is a rare perioperative complication following VATS,clinicians should be on the alert when patients complain about gastrointestinal *** surgeons resect paraesophageal lymph nodes with electrocautery,excessive ambient heat and compression of paraesophageal hematoma might induce vagal nerve dysfunction.

关键词： Gastroparesis Delayed gastrointestinal emptying Video-assisted thoracic surgery Lobectomy thoracic surgery Case report

Cryoanalgesia of intercostal nerves following thoracotomy Clinical trial based on animal experiment

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Neural Regeneration Research 2009年第12期4卷 1083-1087页

作者： Yongfu Ma Yang Liu Jianxin Zuo Department of thoracic surgery the General Hospital of the People's Liberation Army Beijing 100853 China Department of thoracic surgery the Military General Hospital of Beijing PLA Beijing 100700 China

BACKGROUND： Cryoanalgesia at -50 ℃ for 90 seconds yields effective pain relief following thoracotomy. In China, -50 ℃ is a common temperature for intercostal cryoanalgesia following thoracotomy. However, experimental results vary. OBJECTIVE： To explore intercostal nerve pathological changes at -70 ℃ for various freezing times by studying canines, and to evaluate long-term clinical efficacy of intercostal nerve cryoanalgesia for postoperative pain relief based on the animal experiments. DESIGN, TIME AND SETTING： A comparative animal study was performed at the Animal Experimental Center of the general Hospital of the People＇s Liberation Army. Based on results from the animal study, a randomized, controlled, clinical trial was performed at the Department of thoracic surgery of the general Hospital of the People＇s Liberation Army between October 2006 and October 2008. PARTICIPANTS： A total of 120 patients undergoing posterolateral single incision Iobectomy at the Department of thoracic surgery of PLA general Hospital between October 2006 and October 2008 were selected. Nervous system diseases were excluded. METHODS： Animal experiment： 8 anaesthetized, mixed-breed dogs were used. The intercostal nerves （costal bone 6-10） were frozen at -70 ℃ for varying times （30, 60, 90, 120, and 180 seconds）. Clinical study： 120 patients were randomly assigned to 2 groups （n = 60）. In the cryoanalgesia group, the intercostal nerves were frozen prior to chest closure, and 4 costal nerves （1 at incision level, 2 above and below incision, and 1 at drainage tube level） were frozen for 90 seconds at-70 ℃, respectively. Intercostal nerves were not frozen in the control group patients. Dolantin was used to relieve postoperative pain in patients from both groups. MAIN OUTCOME MEASURES： Pathological changes in frozen intercostal nerves were examined at days 1, 10, 30, and 60 following freezing. Following surgery, the degree of postoperative pain in all patients was evaluated by visual analogue

关键词： cryoanalgesia intercostal nerve histology post-thoracotomy pain

Role of diaphragm in pancreaticopleural fistula

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World Journal of Gastroenterology 2011年第32期17卷 3759-3760页

作者： Anestis P Ninos Stephanos K Pierrakakis Consultant general Surgeon Department of Surgery Thriassio General Hospital Consultant general and thoracic Surgeon Head of the Department of Surgery Thriassio General Hospital

A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology . Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.

关键词： Fistula Pleural effusion Pancreatic surgery

HYPERMETHYLATION OF p14^(ARF) PROMOTER REGION AND EXPRESION OF p14^(ARF) GENE PRODUCT IN NON-SMALL CELL LUNG CANCER

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Chinese Journal of Cancer Research 2006年第4期18卷 276-281页

作者：田凯华沈毅罗宜人王明钊刘宏旭赵惠儒张林 Department of general thoracic surgery The Affiliated Hospital of Qingdao University Medical College Dipartment of general thoracic surgery The First Affiliated Hospital China Medical University

Objective： This study was designed to investigate promoter methylation status and protein expression of p14^ARF gene in non-small cell lung cancer, and value the role of p14^ARF promoter methylation in carcinogenesis of non-small cell lung cancer. Methods： Promoter methylation status and protein expression of p14^ARF gene in 40 cases of non-small cell lung cancer were analyzed by methylation specific polymerase china reaction （MSP）, restriction enzyme-related polymerase chain reaction （RE-PCR） and immunohistochemistry （IHC）. Results： The positive rates of p14^ARF promoter methylation in tumor tissues and normal tissues adjacent to cancer were 17.5% （7/40） and 2.5% （1/40） respectively. There were statistically significant differences between them, P〈0.05. The results of RE-PCR were consistent with that of MSP. The expression rate of p14^ARF protein in tumor tissues was significantly lower than that in normal tissues adjacent to cancer, p〈0.01. Promoter methylation status and protein expression of p14^ARF gene in non-small cell lung cancer showed significantly an inverse correlation （r=-0.56, P〈0.01）, and both of them did not relate statistically with the clinicopathologic characteristics of patients such as histological classification, clinical stage, differentiation grade and lymph node involvement. Conclusion： Promoter methylation is a crucial mechanism of inactivation of p14^ARF gene. Promoter methylation of p14^ARF gene might he involved in carcinogenesis of non-small cell lung cancer, and is an early event in development process of non-small cell lung cancer. It might be used as a new target in gene treatments in the future.

关键词： Lung neoplasms Non-small cell lung cancer Tumor suppressor gene p14^ARF Methylation Histopathology

Clinical Significance of the Expression of Inducible Nitric Oxide Synthase in Non-Small Cell Lung Cancer

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Chinese Journal of Cancer Research 2007年第2期19卷 136-140页

作者：杨春鹿王勇赵君张义良 Department of thoracic surgery The First Affiliated Hospital China Medical Univercity Department of thoracic surgery The General Hospital of Benxi Steel Company The Police Hospital of Shenyang City

Objective： To study the expressive characteristics of iNOS to the prognosis NSCLC patients. Methods： The expression in non-small cell lung carcinoma （NSCLC） and it＇s affection of iNOS was detected in 50 NSCLC tissues by Immunohistochemistry technology. Results： There was positive expression in NSCLC （positive rate 38.00%）. The expression of iNOS had a correlation with lymph node metastasis （P〈0.05）. There was no significant difference between positive expression of iNOS and lung cancer histological types, TNM stages, T stages （P〉0.05）. But the data suggested that there was a direct correlation between expression of iNOS and clinical prognosis （P〈0.05）. Conclusion： Positive expression of iNOS was observed in NSCLC, which correlated with postoperative survival time and lymph node metastasis. Although iNOS level had no significant relation with T stage, we find the positive rate in T2 stage was much higher than that in TI stage. The result suggested that positive expression of iNOS was related to bad clinical prognosis because of promoting tumor growth and metastasis.

关键词： NSCLC iNOS Prognosis

MALE BREAST CANCER: A REPORT OF 34 CASES

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Chinese Journal of Cancer Research 2005年第4期17卷 298-300页

作者：吴迪李长远范志民张士福 Department of thoracic surgery First Hospital Jilin University Department of thoracic surgery General Hospital of Daqing Oilfield

Objective： To study the biological characteristics, the therapeutic procedure and the prognosis of male breast cancer. Methods： 34 patients with male breast cancer were retrospectively analyzed, who were diagnosed and treated in the First Hospital of Jilin University between 1980 and March 2005. Results： Clinical TNM stage of the patients were stage Ⅰ, 6 patients, stage Ⅱ, 24 patients and stage Ⅲ, 4 patients＇. Positive lymph nodes were found in 35.3% of the patients. All these patients received modified radical mastectomy. The 5-year survival rate was 65.3%. Postoperation recurrence rate was 11.8%. Conclusions： Patients with male breast cancer should receive surgical treatment, assisted with adjuvant treatment, such as radiotherapy, chemotherapy, endocrine therapy and so on. TNM stage and expression of hormone receptor may be the main factors affecting the prognosis.

关键词： Male breast cancer Systemic treatments Prognosis

Histological analysis and clinical observation of phrenic nerve cryotherapy following pulmonary resection

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Neural Regeneration Research 2010年第10期5卷 769-773页

作者： Yongfu Ma Yang Liu Xueliang Yang Department of thoracic surgery General Hospital of Chinese PLA Beijing 100853 China Department of thoracic surgery Shanxi Tumor Hospital Taiyuan 030013 Shanxi Province China

BACKGROUND： Residual postoperative pleural spaces （RPPS） are often encountered during pulmonary resection; this could adversely affect the outcome and prolong recovery. Nerve cryotherapy reduces postoperative complications and does not affect neural regeneration. However, it remains unclear whether nerve cryotherapy reduces RPPS occurrence following pulmonary ***： To explore pathological changes in the phrenic nerve following exposure to -50℃ for various freezing times, and to explore the feasibility and efficacy of phrenic nerve cryotherapy following pulmonary resection based on animal experiment ***, TIME AND SETTING： A comparative animal study was conducted at the Animal Experimental Center of general Hospital of Chinese PLA from January to June 2008. Based on results from the animal study, a randomized, controlled, clinical study was initiated at the Department of thoracic surgery of general Hospital of Chinese PLA between July 2008 and July ***： A total of 160 patients undergoing lobectomy were selected at the Department of thoracic surgery of general Hospital of Chinese PLA from July 2008 to July ***： Animal experiment： 27 adult goats were randomly assigned to three groups （n = 9）.The phrenic nerves were frozen at -50 ℃ for 30, 60, and 90 seconds, respectively. Clinical study： 160 patients undergoing lobectomy were randomly assigned to two groups （n = 80）. In the cryoanalgesia group, patients received phrenic nerve cryotherapy; phrenic nerves were frozen above the capsula cordis for 60 seconds at -50 ℃ prior to chest closure. Patients in the control group did not receive *** OUTCOME MEASURES： Pathological changes were observed at days 1, 30, and 60 following phrenic nerve cryotherapy. In the clinical study, RPPS incidence rate was regularly recorded. Respiratory function tests, including measured forced vital capacity and forced expiratory volume in 1 second, were regularly conducted post-surgicall

关键词： lobectomy residual pleural spaces cryotherapy phrenic nerve postoperative complications neural regeneration

A Prospective Randomized Study of Adjuvant Chemotherapy in Completely Resected Stage III-N2 Non Small Cell Lung Cancer

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Chinese Journal of Cancer Research 2007年第3期19卷 189-194页

作者：王思愚区伟林勇斌梁颖叶雄张彬彬杨桦 Department of thoracic surgery

To evaluate the effect of postoperative adjuvant chemotherapy on survival after complete resection of stage III-N2 non-small-cell lung cancer. Methods： From Jan. 1999 to Dec. 2003, one-hundred and fifty patients, who were diagnosed as stage III-N2 non-small cell lung cancer after operation, were randomly devided into chemotherapy group and control group. The former received four cycles of chemotherapy with NVB （25 mg/m^2, D1, D5）/paclitaxel （175 mg/m^2, D1） and Carboplatin （AUC=5, D1）. Results： In chemotherapy group, 75.8% （68/79） of patients had finished the 4 cycles of chemotherapy and no one died of toxic effects of chemotherapy. Twenty-five percent of the patients had grade 3-4 neutropenia and 2% had febrile neutropenia. The median survival for the entire 150 patients was 879 d, with 1-year survival rate of 81%, 2-year survival rate of 59% and 3-year survival rate of 43%. There was no significant difference in median survival between chemotherapy and control group （897 d vs 821 d, P=0.0527）, but there was significant difference in the 1-year and 2-year overall survival （94.71%, 76.28% vs 512 d, P=0.122）, but there was significant difference in the 2-year survival rate between two groups with brain metastases （66.7% vs 37.6% P〈0.05）. The median survival after brain metastasis appeared was 190 days. Conclusion： Postoperative adjuvant chemotherapy does not significantly improve median survival among patients with completely resected stage II-N2 non-small-cell lung cancer, but significantly improves the 1-year and 2-year overall survival. It neither decreases the incidence of brain metastasis but put off the time of brain metastasis.

关键词： Lung cancer Carcinoma Non-small lung cancer Adjuvant chemotherapy surgery