Objective To summarize the preliminary effectiveness of surgical treatment of Erdheim-Chester disease (ECD), so as to improve the understanding of the disease by orthopedic surgeons. Methods The clinical data of 9 patients with ECD between December 2012 and October 2017 were retrospectively analysed. There were 6 males and 3 females with an median age of 42 years (range, 8-61 years). The disease duration was 4-59 months (mean, 39 months). There were 2 cases of multiple lesions, including 1 case involving soft tissue of the buttocks and bilateral tibia, 1 case involving the sinus, skull base, and proximal right tibia; 7 cases with single lesion, including 3 cases of right femoral neck, 1 case of proximal right tibia, 1 case of right humerus, and 2 cases of ribs. Nine patients were diagnosed according to clinical manifestations, imaging examination, and pathological diagnosis. Four patients underwent needle biopsy before operation and 5 patients were diagnosed by postoperative pathology examination. Five cases underwent lesional scraping and internal fixation, 1 case underwent bone scraping and bone grafting, and 3 cases underwent lesion resection. One of the multiple lesions was treated with interferon and hormone. Results Nine patients underwent the surgery safely. There was no fever, wound exudation, infection, etc., and the incisions healed by first intention. All the patients were followed up 4-59 months with an average of 31.4 months. One patient with bilateral tibia and hip soft tissue involvement continued to receive medical treatment, and the tumor was controlled without significant increasing. The remaining 8 patients were examined for X-ray films at 3, 6, and 12 months after surgery, the bone has been fused and the steel plate and intramedullary nail were firmly fixed, and no tumor recurrence was observed. At 1 year after surgery, the pain symptoms of the patients improved and returned to normal life; 3 of them who involving the right femoral neck walked freely, and the quality of life improved significantly. Conclusion ECD patients can achieve the purpose of eliminating lesions and relieving pain after surgical treatment, and the surgical treatment has the advantages of quick relief of pain, improved quality of life, small side effects, and low economic cost when compared with medical treatment.
ObjectiveTo investigate the role of dynamic monitoring procalcitonin (PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia (CAP). MethodsFour hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group (the research group) and a standard guideline group (the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein (CRP)were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. ResultsThe hospitalization time [(9.6±1.7)days vs. (10.9±1.6)days],hospitalization cost [(6 957.11±1 009.46) yuan vs. (8 011.35±1 049.77) yuan],chest CT examination rate (56.96% vs. 89.40%),the application time of antibiotics [(16.5±2.3)days vs. (20.0±1.2)days],and the rate of required antibiotics upgrade (6.96% vs. 11.06%) in the research group were all significantly lower than the control group (P<0.05). There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics (14.78% vs. 15.20%),the rate of transfer into ICU (2.61% vs. 3.69%) or the mortality (1.74% vs. 2.30%)(P>0.05). ConclusionOn the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.
Cardiopulmonary resuscitation (CPR) is a very important treatment after cardiac arrest. The optimal treatment strategy of CPR is uncertain. With the accumulation of clinical medical evidence, the CPR treatment recommendations have been changed. This article will review the current hot issues and progress, including the pathophysiological mechanisms of CPR, how to achieve high-quality chest compression, how to achieve CPR quality monitoring, how to achieve optimal CPR for different individuals and how to use antiarrhythmic drugs.
Proper management of chest drainage after pulmonary lobectomy is a topic that every thoracic surgeon must face up to. Reasonable chest drainage plays a critical role in postoperative normal physiological recovery. However， there are still controversies and discrepancies in many aspects of chest drainage management after pulmonary lobectomy. In this review，we focus on five aspects of chest drainage management after pulmonary lobectomy，including the choice of chest drainage system，single or double chest tubes，suction or not，treatment of persistent air leak，and removal of chest tube.
ObjectiveTo explore the necessity of routine X-ray examination after lung surgery based on patient symptom burden. MethodsA retrospective study was conducted on the patients who underwent thoracoscopic lung resection at the Department of Thoracic Surgery of Guangdong Provincial People's Hospital from March 2020 to April 2023. The routine chest X-ray examination results and symptom burden of postoperative patients were analyzed. Symptom burden was evaluated using the Perioperative Symptom Assessment Lung inventory. Results A total of 2 101 patients were collected, including 915 males and 1 100 femals, with a median age of 56 years. Among patients who underwent routine postoperative chest X-ray, only 1.0% patients accepted intervention. Among patients who had chest X-ray after chest tube removal, only 0.5% of them needed intervention. Among patients who had chest X-ray one month after discharge, only 1.3% of them required intervention. The intervention group had significantly worse shortness of breath (3 points vs. 2 points, P=0.015), pain (2 points vs. 1 point, P=0.039), and disturbed sleep (3 points vs. 2 points, P=0.036) compared with the normal group. Conclusion Very few routine postoperative chest X-ray examinations change patients’ management, and patients who need extra-intervention tended to have more severe symptom burden after surgery.
ObjectiveTo analyze the clinical characteristics of patients with amyopathic dermatomyositis with organizing pneumonia (ADM-OP).MethodsThe clinical data of 8 patients hospitalized with ADM-OP from June 2014 to June 2018 were retrospectively reviewed and simultaneously compared with those of 8 patients of cryptogenic organizing pneumonia (COP).ResultsThe incidence of skin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies in the ADM-OP patients were 87.5%, 87.5% 75.0% and 87.5% respectively. Gender, smoking, respiratory symptoms and signs, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and treatment strategy were no statistical difference between ADM-OP and COP patients, but the onset age and Chest CT fibrosis scores (CTFS) on admission existed differences. After treatment for 3 months, CTFS, rate of change and forced vital capacity (FVC) existed differences. After treatment for 6 months, CTFS, rate of change, FVC and diffusing capacity of the lung for carbon monoxide existed differences.ConclusionsSkin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies are more common in ADM-OP patients. Their response to treatment is good but the improvement rates in CTFS and pulmonary function are slower than those of COP patients.
Chest wall surgery used to be a subspecialty of traditional thoracic surgery, which has an ancient history of research and clinical practice. It has gradually become an independent professional field in recent years. With the change of concept and the progress of interdisciplines, we have deepened our understanding of related diseases, and the treatment of chest wall surgical diseases has also acquired new characteristics. This article reviews the progress in the treatment of chest wall surgical diseases including chest wall trauma, chest wall deformity, chest wall tumor, chest wall infection and chest wall defect from the perspective of chest wall surgery.
ObjectiveTo compare clinical results between single and double chest tube applications after lung cancer resection, and explore the role of single chest tube in postoperative fast track recovery. MethodNinety-three patients with lung cancer who underwent lobectomy between March and December of 2009 in West China Hospital of Sichuan University were included in this study. All the patients were divided into a single-tube group including 46 patients (39 males and 7 females) with their age of 58.4±9.5 years, and a double-tube group including 47 patients (32 males and 15 females) with their age of 58.2±9.0 years. Drainage amount, duration, postoperative hospital stay, and incidences of pneumothorax and pleural effusion after removal of chest tubes were compared between the 2 groups. ResultsThe percentage of patients undergoing complete video-assisted thoracic surgery (VATS) of the double-tube group was significantly higher than that of the single-tube group, and the percentage of patients undergoing thoracotomy of the double-tube group was significantly lower than that of the single-tube group (P < 0.05). Drainage amount of the double-tube group was significantly larger than that of the single-tube group (824.4±612.5 ml vs. 510.7±406.7 ml, P < 0.05). There was no statistical difference in drainage duration, postoperative hospital stay, the incidences of subcutaneous emphysema, pneumothorax, pleural effusion or re-insertion of chest drain between the 2 groups (P > 0.05). ConclusionClinical results of single chest tube is better than or equivalent to those of double chest tubes after lung cancer resection, and drainage duration of single chest tube application might be shorter.
Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Regardless of the cause of the chest wall defect, especially the extensive chest wall defect, if it cannot be effectively repaired and reconstructed, it may cause physiological and pathological changes such as chest wall softening, respiratory abnormalities and mediastinal oscillations. The main factors affecting the repair and reconstruction of the chest wall are the choice of reconstruction methods and materials. With the increasing understanding of chest wall defects, advances in reconstructive surgery techniques and the development of reconstructed materials, it has become possible to reconstruct many extensive chest wall defects that were previously impossible to complete. This article reviews the characteristics of chest wall defects, methods of repair, and current status and progress of reconstructed materials.