Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis.

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.     

高效液相色谱法测定人血浆中阿莫西林浓度及药代动力学

高效液相色谱法测定人血浆中阿莫西林浓度及药代动力学谭力周继红罗楠袁倚盛（南京军区南京总医院中心仪器分析科，南京２１０００１）阿莫西林（ａｍｏｘｉｃｉｌｉｎ）为β内酰胺类抗生素，其抗菌谱广，口服受食物影响小，对大多数病人耐受性良好，因而在临床上得以广泛...     

Primary papillary serous cystadenocarcinoma of broad ligament

A rare case of an advanced primary broad ligament carcinoma is discussed, with a review of the literature regarding its incidence, presentation and management. This patient showed a complete response to adjuvant cisplatin-based chemotherapy following panhysterectomy and is presently without any evidence of disease, 15 months after completion of her treatment.     

Video-assisted thoracoscopic management of anterior mediastinal masses

The author reports his personal experience on the management of anterior mediastinal masses using video-assisted thoracoscopic surgery (VATS) at a single institution. From August 1993 to March 1995, 24 patients (14 males and 10 females ranging in age from 9 to 76 years old) with anterior mediastinal masses were diagnosed or treated by VATS. This consisted of 11 biopsies and 13 resections (11 thymectomies and 2 thymic cystectomies). Seven biopsies were performed for primary histological diagnosis (four non-Hodgkin's lymphoma, two metastatic carcinoma, one yolk sac tumor) and four biopsies were performed to detect residual tumors following chemotherapy. Complete thymectomy was accomplished in all 11 cases by examination of the thymic bed and resected specimen. We have reserved this approach for resection of benign masses only. Adequate biopsy for histological diagnosis was obtained in all 11 cases to guide further management. There was no surgical mortality or intraoperative complications. The median postoperative hospital stay for the entire group was 3 days. We conclude that VATS for resection or biopsy of an anterior mediastinal mass is technically feasible and provides an alternative to the conventional approaches in selected patients.     

Video assisted thoracoscopic surgery (VATS) in Asia - its impact and implications

Abstract Background: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects.
Aims: We examined the impact of VATS on our practice and its implications.
Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital.
Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases.
Conclusion: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.     

Fibula osteoseptocutaneous flap for mandible reconstruction

The fibula free flap has become an established flap for mandible reconstruction when vascularized bone is desirable. Recreating mandibular contour, providing soft tissue coverage, and restoring masticatory function are equally important in mandible reconstruction, and these can be provided by the fibula osteoseptocutaneous flap. This article is a summary of the anatomy, indications, and operative technique of the fibula osteoseptocutaneous flap accumulated from 49 consecutive mandible reconstructions. © 1994 Wiley-Liss, Inc.     

Should cervical ultrasonography be a routine staging investigation for lung cancer patients with impalpable cervical lymph nodes?

OBJECTIVES: Detection of cervical N3 lymph nodes is currently not a routine preoperative investigation for lung cancer patients. We designed a study to assess if the frequency and accuracy of detection of metastatic cervical lymph nodes using cervical ultrasonography (US) and fine needle aspiration (FNA) justify their routine use in all lung cancer patients with impalpable cervical lymph nodes. METHODS: Fifty patients with suspected and potentially operable non-small cell lung cancer were enrolled. Patients with palpable cervical lymph nodes were excluded. In addition to routine preoperative investigations, all patients received cervical US to determine the presence of cervical lymph nodes. Nodes suspicious of harboring malignancy according to a specific set of sonographic criteria (which include shape, echogenicity, nodal architecture, and vascular patterns) were subjected to biopsy by ultrasound-guided FNA. RESULTS: Normal cervical lymph nodes were detected by cervical US in 30 patients (60%). Cervical lymph nodes suspicious of harboring malignancy were detected in 10 patients (20%). FNA confirmed cervical nodal metastasis in four of these patients (8%). The TNM staging of two patients (4%) was revised up to stage IIIb as a result, excluding them from further surgery. Cost analysis suggests this technique to be cost-effective when used as a routine preoperative investigation to exclude patients from unnecessary surgical intervention. No mortality or complications were encountered in all patients. CONCLUSIONS: Cervical US and FNA is a safe and cost-effective method of evaluating the status of impalpable cervical lymph nodes in lung cancer patients. Further study is warranted to establish the role of cervical US and FNA in lung cancer staging algorithms.