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.
Surgical management of non-small cell lung cancer (NSCLC) invading chest wall is the combination of pulmonary resection, lymphadenectomy and chest wall resection and reconstruction. Hitherto the surgical procedures include combination of thoracotomy and video-assisted thoracoscopic surgery (VATS), thoracotomy, and VATS. The result of the surgery leads to a defect in the chest wall. Therefore, the requirements of the technique and material are relatively high with no consensual standard. This review describes the definitions, indications, materials, prognostic factors, and recent progress in surgical techniques.
ObjectivesTo systematically review clinical values of multi-slice spiral computed tomography angiography (MSCTA) in diagnosis of chest pain triple (CPT).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were searched to collect diagnostic tests on CPT diagnosed by MSCTA from inception to October 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by Stata 12.0 software. The pooled weighted Sen, Spe, +LR, -LR, and the DOR were calculated, SROC and AUC were drawn.ResultsA total of 11 diagnostic studies were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR, -LR, DOR and AUC of MSCTA for diagnosing CPT were 0.95 (95%CI 0.91 to 0.98), 0.97 (95%CI 0.94 to 0.98), 31.24 (95%CI 15.63 to 62.43), 0.05 (95%CI 0.02 to 0.10), 659.04 (95%CI 236.73 to 1 834.71) and 0.99 (95%CI 0.98 to 1.00), respectively.ConclusionsMSCTA has high sensibility and specificity for diagnosing CPT. Due to limited quantity and quality of the included studies, more high-quality studies are required to verify the above conclusion.
Mediastinal and chest wall tumors contain various benign and malignant tumors. In order to further standardize the whole-course diagnosis and treatment of mediastinal and chest wall tumors, the consensus was formulated through discussion by the expert group. Based on the clinical diagnosis and treatment experience and various prospective and retrospective studies, the consensus was formed.
ObjectiveTo investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. MethodsThis was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared.ResultsThe time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively.ConclusionThe establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
Precise segmentation of lung field is a crucial step in chest radiographic computer-aided diagnosis system. With the development of deep learning, fully convolutional network based models for lung field segmentation have achieved great effect but are poor at accurate identification of the boundary and preserving lung field consistency. To solve this problem, this paper proposed a lung segmentation algorithm based on non-local attention and multi-task learning. Firstly, an encoder-decoder convolutional network based on residual connection was used to extract multi-scale context and predict the boundary of lung. Secondly, a non-local attention mechanism to capture the long-range dependencies between pixels in the boundary regions and global context was proposed to enrich feature of inconsistent region. Thirdly, a multi-task learning to predict lung field based on the enriched feature was conducted. Finally, experiments to evaluate this algorithm were performed on JSRT and Montgomery dataset. The maximum improvement of Dice coefficient and accuracy were 1.99% and 2.27%, respectively, comparing with other representative algorithms. Results show that by enhancing the attention of boundary, this algorithm can improve the accuracy and reduce false segmentation.
ObjectiveTo compare and evaluate the application of two types of chest drainage in patients who had undergone the lung lobe resection.
MethodWe retrospective analyzed the clinical data of 240 patients who underwent left lobe resection. The patients were divided into a single conventional drainage group with single chest drainage tube (normal group) and a single conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) (combination group). There were 140 patients including 86 males and 54 females at mean age of 48.76± 4.92 years in the normal group. There were 100 patients including 58 males and 42 females at mean age of 48.37± 4.56 years in the combination group. We compared the outcomes between the two groups.
ResultThe postoperative pathological results revealed there were 12 patients with tuberculosis (TB), 87 patients with squamous carcinoma, and 41 patients with adenocarcinoma in the normal group; 5 patients with TB, 66 patients with squamous carcinoma, and 29 patients with adenocarcinoma in the combination group. There were statistical differences in postoperative hospital stay (11.35± 2.78 d vs. 9.33± 2.46 d), chest drainage tube indwelling time (6.75± 2.10 d vs. 8.28± 2.10 d), total volume of chest drainage (1 176.07± 384.62 ml vs. 926.50± 22.35 ml) with P values less than 0.001 between the normal group and the combination group. No statistical difference was found between the two groups in complications (P>0.05).
ConclusionSingle conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) has more advantages than single conventional chest drainage tube drainage, and is worth to be applied popularly in clinic.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.
ObjectiveTo investigate the clinical value of pedicled latissimus dorsi Kiss flap in repairing chest wall large skin defect after tumor operation.
MethodsA retrospective analysis was made on the clinical data from 15 cases of chest wall tumors treated between December 2010 and December 2015. There were 2 males and 13 females with an average age of 51.8 years (range, 43-60 years); there were 11 cases of locally advanced breast cancer, 3 cases of fibrosarcoma in chest wall, and 1 case of chest wall radiation ulcer with a median disease duration of 24.1 months (range, 6 months to 8 years). The area of skin defects was 17 cm×12 cm to 20 cm×18 cm after primary tumor resection; the pedicled latissimus dorsi Kiss flap was designed to repair wounds. The flap was a two-lobed flap at a certain angle on the surface of latissimus dorsi based on the thoracodorsal artery, with a size of 17 cm×6 cm to 20 cm×9 cm for each lobe. The donor site was sutured directly.
ResultsFourteen flaps survived with primary healing of wound; delayed healing was observed in 1 flap because of distal necrosis; and healing by first intention was obtained at the donor sites. The follow-up time was from 6 months to 3 years (mean, 21.6 months). The flap had good appearance with no bloated pedicle. The shoulder joint activities were normal. No local recurrence occurred, but distant metastasis in 2 cases. No obvious scar was found at donor sites.
ConclusionThe application of pedicled latissimus dorsi Kiss flap to repair chest wall skin defects after tumor resection has important clinical value, because of the advatages of simple operation, minor donor site damage and rapid postoperative recovery, especially for late stage cancer patients.
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.
