Mediastinal Fibrosis and Superior Vena Cava Syndrome

Superior vena cava syndrome is a clear sign for clinicians of infiltrative mediastinal involvement, usually caused by neoplasms in this location, and it is an indicator of poor prognosis. However, other diseases of benign origin can also cause these alterations. We present the case of a 34-year-old patient who debuted with symptoms of superior vena cava syndrome due to idiopathic mediastinal fibrosis, which presented a torpid evolution and few therapeutic alternatives.     

Congenital lobar emphysema: Differential diagnosis and therapeutic approach

Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors’ experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h–12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift‐herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow‐up duration of all patients was 26.8 ± 29.24 months (range, 1–89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax.     

Subcutaneous emphysema: A least common presentation of foreign body bronchus

Foreign bodies in air way are common days occurrence in Otolaryngologic practice but widespread subcutaneous emphysema extending form scalp to scrotum is a rare entity in foreign body bronchus. As rarity is, a novelty hence reported.     

宣肺通窍止咳汤治疗慢性支气管炎肺气肿随机平行对照研究

[目的]观察宣肺通窍止咳汤治疗慢性支气管炎肺气肿疗效。[方法]使用随机平行对照方法,将80例住院患者按双盲法随机分为两组,对照组40例常规西药治疗,治疗组40例宣肺通窍止咳汤(细辛6g,小麦15g,石膏10g,麻黄12g,半夏10g,厚朴10g,杏仁10g,五味子10g,甘草6g),水煎服,1剂/d,分2次服用。连续治疗10d为1疗程。观测临床症状、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组治愈16例,有效22例,无效2例,总有效率95.00%。对照组治愈4例,有效27例,无效9例,总有效率77.50%。治疗组疗效优于对照组(P<0.05)。[结论]宣肺通窍止咳汤治疗慢性支气管炎肺气肿疗效满意。     

螺旋CT多平面成像扫描技术在纵膈肿瘤诊断中的应用

目的:分析螺旋CT多平面成像在纵膈肿瘤患者诊断及治疗中的作用。方法:回顾性分析经病理或临床手术确诊的45例纵膈肿瘤患者的资料,所有患者均接受螺旋CT进行增强肿瘤容积扫描,经图像处理后,分析纵膈肿瘤多平面CT图像。结果:经螺旋CT进行多平面成像,可以对纵膈肿瘤跟邻近各个组织器官间的关系、肿瘤的范围、肿瘤的长度等进行全面显示。45例纵膈肿瘤患者中,良性纵膈肿瘤27例,其中包括神经源性肿瘤、胸腺肿瘤、甲状腺肿瘤、畸胎瘤以及气管囊肿肿瘤等。通过多层螺旋CT扫描,其平面图像方位全面,显示的肿瘤具有清晰轮廓和规则形态,肿瘤跟肺部、心脏以及大血管、胸壁等组织有缝隙,主要由脂肪成分组成。另外,还能清晰显示纵膈内肿瘤的分区位置;5例为恶性肿瘤,其肿瘤成像没有明确的边界和规则形态,肿瘤跟肺部、心脏以及大血管、胸壁等组织黏连在一起,有的灌铸状紧密围绕,彼此间的脂肪缝隙消失;其余13例患者为淋巴瘤,在肺门以及纵膈中出现较多肿块。结论:螺旋CT多平面成像能有效用于纵隔肿瘤的诊治,其能多平面反应肿瘤图像,有助于观察纵膈肿瘤的生长情况及其对周围组织的侵犯情况,以便选择手术及相关化疗等治疗方案,促进患者早日康复。     

泛素在肺气肿小鼠骨骼肌中的表达和意义

目的 探讨泛素在肺气肿小鼠模型骨骼肌中的基因和蛋白水平变化及与骨骼肌细胞凋亡的关系.方法 采用单纯熏香烟法制作肺气肿小鼠模型,运用TUNEL法检测骨骼肌细胞凋亡,逆转录-聚合酶链反应(RT-PCR)和免疫组化技术检测上述组织泛素的基因及蛋白水平,结果以光度比值和平均光密度值表示.结果 肺气肿小鼠骨骼肌细胞凋亡增加,骨骼肌泛素的基因及蛋白水平分别为0.48±0.02,0.23±0.05,与正常组骨骼肌泛素的基因水平0.17+0.01和蛋白水平0.14±0.01相比,差异均有统计学意义(t=6.223、4.093,均P＜0.05).结论 肺气肿小鼠骨骼肌细胞的凋亡增加可能与泛素表达水平增加有关.     

Hyperpolarized 129Xe lung MRI in spontaneously breathing mice with respiratory gated fast imaging and its application to pulmonary functional imaging

In the present study, a balanced steady-state free precession pulse sequence combined with compressed sensing was applied to hyperpolarized (129) Xe lung imaging in spontaneously breathing mice. With the aid of fast imaging techniques, the temporal resolution was markedly improved in the resulting images. Using these protocols and respiratory gating, (129) Xe lung images in end-inspiratory and end-expiratory phases were obtained successfully. The application of these techniques for pulmonary functional imaging made it possible to simultaneously evaluate regional ventilation and gas exchange in the same animal. A comparative study between healthy and elastase-induced mouse models of emphysema showed abnormal ventilation as well as gas exchange in elastase-treated mice.     

Endobronchial ultrasound-guided transbronchial needle biopsy for diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancy

Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.