Prognosis of surgically treated lung cancer

BACKGROUND AND AIMS: This retrospective study clarifies the prognosis of surgically treated lung cancer in a teaching university hospital. MATERIAL AND METHODS: During a four year period 141 patients were operated for lung cancer in a teaching university hospital. After five years follow up the case records were analysed. The operative and microscopical findings were classified using the AJC pTNM staging system and WHO's histologic classification of lung tumours. There were 120 (85 %) male and 21 (15 %) female. The median age for males was 62 years and females 64 years; range was 29 to 76 years for both sexes. RESULTS AND CONCLUSIONS: The perioperative mortality of all patients was 5,0 %, of 84 patients operated with lobectomy 2.4 %, of 32 patients operated with pneumectomy 15,6 %, and of 25 patients operated with explorative thoracotomy 0 %, respectively. The five year survival of all patients was 33 % including perioperative mortality. The survival was significantly better for 83 patients with stage I disease (49 %) than 17 stage II (6 %), 24 stage IIIa (20.8 %), and 17 stage IIIb or IV disease (0 %). The survival was significantly better after lobectomy (44.1 %) than after pneumectomy (25.0 %) or explorative thoracotomy (8.0 %). Our study shows the good effect of surgery in stage I, and confirms it's usefulness in stage IIIa lung cancer. The histologic types of tumours did not affect survival.     

A case of surgically treated simultaneous bilateral squamous cell carcinoma of the lung

A case of simultaneous, bilateral squamous cell carcinoma of the lung was presented. One located in right basal bronchus had mediastinal lymph node metastasis even though primary lesion was localized within the bronchial wall. So right lower lobectomy with R 2 lymph node dissection was carried out. The left one located in the left basal bronchus was treated using laser preoperatively, which revealed its location and extension. Sequentially S6 segmental sleeve resection was carried out and preserved his residual lung function. Six months later, the third primary lung cancer was found in left B3. We discussed about diagnosis and treatment of the multiple lung cancer and emphasize that bronchoplastic procedures in segmental level is available for treatment of multiple lung cancer.     

Lobectomy for lung cancer in an elderly man on maintenance hemodialysis

An 82-year-old man who had been undergoing hemodialysis for chronic renal failure, 3 times a week for the last 3 years, was admitted to our hospital for the treatment of lung cancer. Under careful perioperative management, we successfully performed a lobectomy. Histological examination revealed well differentiated squamous cell carcinoma and the postoperative staging was pT1N0M0. On postoperative day 1, he was commenced on hemodialysis with nafamostat mesilate instead of heparin sodium, and there was no postoperative bleeding. The patient had an uneventful postoperative course and was discharged 3 weeks after his operation.     

A surgically treated case of capsulated thymoma with thymic cyst

A 56-year-old woman was pointed out an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid mass with a cyst at right anterior mediastinum. Clinical diagnosis was thymoma with cyst, and surgical excision was performed. The histopathological examination of the resected specimen demonstrated that the epithelia of the cyst wall was single cuboidal or squamous cells and contained some foci of thymic tissue. The solid mass was capsulated and predominantly composed of lymphocytes. The pathological diagnosis was a thymoma (predominantly lymphocytic type) with thymic cyst. She is doing well for 10 years postoperatively.     

A case of surgically treated newborn with congenital tracheal stenosis

This is a case report of a newborn with congenital tracheal stenosis which was fortunately healed by surgery. A 2,650 g female infant was born at 39 wk gestation. She began having respiratory difficulty soon after birth. Prompt endotracheal intubation was attempted, but failed. She was transferred to our hospital under assisted ventilation. Chest roentgenogram and bronchoscopy demonstrated segmental narrowing of the trachea about 2 cm distal from the vocal cord. A surgical operation was performed because respiratory management would not be enough to save the infant. Through a transverse collar incision and an upper median sternotomy, a stenotic 7 mm length of the trachea was resected and anastomosed with 5-0 Dexon suture. Postoperative course was uneventful. Histologically, the stenotic segment consisted of hypoplasia of the tracheal cartilage and fibrosis of the membranous portion. Squamous metaplasia was also recognized. There was no other report of tracheal stenosis successfully operated during the period of newborn.     

Quality of life of long-term survivors of surgically treated lung cancer

Quality of life (QOL) of long-term survivors (more than 3 years after surgery) of primary non-small cell lung cancer was studied. QOL was analyzed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 30-Item version 3.0 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Sixty of 91 patients (66%) participated in this study 87 +/- 5 (38-172) months postoperatively. In QLQ-C30, calculated scores of physical (84.0 +/- 2.4), role (81.3 +/- 3.6), cognitive (79.7 +/- 2.6), emotional (86.8 +/- 1.9), and social (91.0 +/- 1.9) functioning, and global QOL (72.6 +/- 2.9) were obtained. Calculated HADS A (anxiety) was 3.3 +/- 0.3 and HADS D (depression) was 4.0 +/- 0.4. Postoperative follow-up duration was correlated with financial impact only. QOL of long-term survivors was influenced by gender histology, marital status, employment status, and academic carrier.     

低肺功能肺癌病人术后呼吸衰竭原因分析

目的　回顾性分析总结 181例手术治疗的低肺功能肺癌病人中 2 3例发生呼吸衰竭的原因和治疗经验。方法　应用SPSS统计软件中的二项分类Logistic回归分析及卡方检验 ( χ2 )进行统计分析和比较。结果　切除组 177例低肺功能病人中发生呼吸衰竭 2 3例 ( 13 0 %)。术后因严重肺部感染而发生呼吸衰竭 18例 ( 78 3 %)。因呼吸衰竭所致死亡 12例 ,住院死亡率为 5 2 2 %( 12 2 3例 )。经二项分类Logistic回归分析发现 ,术后呼吸衰竭发生与否依次与术后并发症多少、肺功能障碍程度、手术切除范围、术前是否使用抗生素、术前有无开胸手术史等高度相关。其危险系数 (OR)依次分别为 :11 2 3、2 79、2 41、2 0 5、1 80。其中前 3项影响最显著 (P <0 0 5 )。结论　低肺功能肺癌病人发生术后呼吸衰竭的高危因素有术后并发症多少、肺功能障碍程度、手术切除范围和术前开胸手术史及心肺病史。呼吸道感染是术后诱发呼吸衰竭的主要原因。     

外科肝癌病人生存质量研究

目的　调查肝癌病人生存质量情况和影响因素。方法　采用消化病生存质量指数(GLQI指数 )前瞻性地测定 36例肝癌病人在术前至术后 2年内不同时期的生存质量值。结果　术前平均GLQI指数为 (10 6± 13)分 ,术后 2～ 10周GLQI指数明显下降 (P <0 .0 5～ 0 .0 1) ,第 4个月接近术前水平 (P >0 .0 5 ) ,第 9个月达 (115± 11)分 ,超过术前水平 (P =0 .0 2 )。在术后较早期 ,老年组较非老年组、术前肝功能ChildB级组较A级组、联合肝段和半肝切除较肝段切除组生存质量降幅更大 (P <0 0 5 )。肿瘤复发病人生存质量持续下降 (P <0 .0 5～ 0 .0 0 1)。结论　生存质量测定可有效地用于肝癌病人的健康和疗效评估。肿瘤复发、肝功能障碍、年龄和手术创伤是影响生存质量的主要因素     

右旋糖酐铁治疗24例长期透析患者不宁腿综合征

不安腿综合征（RKS）是终末期肾脏疾病（ESRD）患者在长期接受透析治疗中的常见症状，表现为肢体感觉异常、不自主运动，休息时加重和失眠。我们通过安慰剂对照试验研究，一次性大剂量静脉使用右旋糖酐铁治疗RLS取得了较好效果。     

Challenges in blood pressure measurement in patients treated with maintenance hemodialysis

The association between blood pressure and cardiovascular outcomes in patients undergoing hemodialysis remains controversial. This may relate in part to the technique and device used and the timing of the blood pressure measurement in relation to the hemodialysis procedure. Emerging evidence indicates that standardized hemodialysis unit blood pressure measurements or measurements obtained at home, either by the patient or using an ambulatory blood pressure monitor, may offer advantages over routine hemodialysis unit blood pressure measurements for determining cardiovascular risk and treatment. This review discusses the available evidence and implications for clinicians and clinical trials.