Table of Content

30 March 2013, Volume 2 Issue 1

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Original Articles

Clinical evaluation of CT-guided percutaneous radiofrequency ablation for the treatment of pulmonary malignancies located in unusual regions

LIU Bao-dong, LIU Lei, HU Mu, QIAN Kun, LI Yuan-bo, WANG Ruo-tian, ZHI Xiu-yi

Journal of Tuberculosis and Lung Health. 2013, 2(1):  7-10. 

Abstract ( 310 )   PDF (700KB) ( 640 )   Save

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Objective To evaluate the feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of pulmonary malignancies located in unusual regions.Methods Among 450 patients conducted CT-guided RFA in the Department of Thoracic Surgery in Xuanwu Hospital from July 2007 to December 2012, 100 cases with lung cancers located in unusual regions (mainly located within 1cm of diaphragmatic surface,hilum,side of superior vena cava,side of pulmonary trunk,side of aorta and side of heart) were enrolled in this study. All patients was performed CT-guided percutaneous RFA under local anesthesia.The time used for puncturing and putting the needles to the scheduled sites were recorded.The complications related the puncturing were observed.Results For all patients,the procedure of puncture and needle placement was completed in 5-10 minutes without any severe complications occurred. In patients with minor complications occurred, 9 (9.0%) had pneumothorax (among whom 2 (2.0%) cases needed closed drainage of pleural cavity), 3 cases (3.0%) had hemoptysis and 3 cases (3.0%) had pulmonary hemorrhage. 9 cases with pneumothorax recovered and left hospital, among whom 7 cases had been operated suction without closed drainage of pleural cavity. Three cases of hemoptysis recovered by hemostasis and radiofrequency ablation. Three cases with pulmonary hemorrhage improved 2 to 3 days after operation.Conclusion The result of this study indicates that CT-guided percutaneous RFA under local anesthesia is a feasible and a safe technique for the treatment of pulmonary malignancies located in unusual regions.

Therapeutic evaluation for radiofrequency ablation (RFA) combination with gefitinib for advanced lung adenocarcinoma

WANG Zhi-hong^*, LI Lu, LIN Yi, SHAO Zhuang,SONG Xiao-yong, ZHOU Jun-jun

Journal of Tuberculosis and Lung Health. 2013, 2(1):  11-13. 

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Objective To observe the clinical efficacy of cluster electrode radiofrequency ablation (RFA) combination with gefitinib for advanced lung adenocarcinoma.Methods Thirty-six patients with advanced lung adenocarcinoma of stage ⅢA and stage Ⅳ were treated with RFA and gefitinib combination therapy(referred to as the “treatment group”), while 33 patients were treated with only RFA(referred to as the “group”) as control. The efficacy, life quality and side effect of both groups were compared using χ² test.Results The response rate of combination therapy group was 66.7%(24/36), which is higher than that of RFA therapy group, with 30.3%(10/33) (χ²=9.07,P<0.05). There were 75.0%(24/36)patients of combination therapy group who had good quality of life, while in RFA therapy group, the proportion was 48.5%(16/33)(χ²=5.24,P<0.05). The side effects of patients were pain, diarrhea and fever.Conclusion The RFA and gefitinib combination therapy can improve the therapeutic efficacy in patients with advanced lung adenocarcinoma.

The early image follow-up of CT scan after treatment with radiofrequency ablation of 226 cases lung malignant neoplasm

HU Mu, LIU Lei, QIAN Kun, CHEN Dong-hong, LIU Bao-dong, ZHI Xiu-yi

Journal of Tuberculosis and Lung Health. 2013, 2(1):  14-18. 

Abstract ( 377 )   PDF (1982KB) ( 1081 )   Save

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Objective The purpose of this study is to describe and analyze the CT appearance of lung neoplasms after treatment with radiofrequency ablation (RFA).Methods The imaging of 233 pulmonary lessions treated by RFA in 226 patients with thoracicneoplasms were followed up. Two hundred and one neoplasms were primary lung cancer and 25 were metastases. The mean pretreatment neoplasm size was (4.36±2.45)cm (range, 1.00-10.60cm). The mean time of follow-up was 13.61 months (range, 1-30months). Imaging findings on CT were evaluated by three radiologists and thoracic surgeons by consensus.Results The most common finding immediately after treatment was peripheral ground-glass opacity surrounding the treated neoplasm, seen in 215 patients (95.13%,215/226). This lesion rapidly resolved by the end of the first month. 127 tumors (56.19%,127/226) developed bubble lucencies after ablation. Cavitation was seen in 51 tumors (22.57%,51/226) on follow-up CT and was more common in the bigger neoplasms. Malignant pleural effusions were usually seen after 3 months. One hundred and twenty-one tumors (65.05%,121/186) enlarged from pretreatment CT scans with follow-up imaging at 1 month. At 3 and 6 months after RFA, 66 cases (46.15%,66/143) and 57 cases (50.89%,57/112) tumors decreased in size. Then the percentage became to drop.Conclusion Conclusion peripheral ground-glass opacity, cavitation, and bubble lucencies are common findings on CT after RFA. Cavitation was more common in bigger neoplasms. Many treated neoplasms increased in size from baseline within 1 month. At 6 month, they decreased in size most obviously. Enlargement of a treated tumor after 6 months is regarded as tumor progression. CT scan is one of the effective methods to evaluate the lung neoplasm after RFA.

Clinical application of radiofrequency ablation for non-small cell lung cancer

HUANG Nai-xiang,CHEN Su,SHENG Dong-sheng

Journal of Tuberculosis and Lung Health. 2013, 2(1):  19-21. 

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Objective To evaluate the therapeutic effect and application value of radiofrequency ablation (RAF) for advanced non-small cell lung cancer (NSCLC).Methods From April 2004 to December 2012 1373 patients with NSCLC were treated by RAF. The early treatment results, median survival time and 1-5 year survival rates were observed.Results The effective rate (CR+PR+NC/CR+PR+NC+PD)was 92.15%(1139/1236). 672 cases survived over one year and the 1 year survival rate was 54.37% (672/1236). Two hundred and one cases survived over 2 years and the 2 year survival rate was 40.52% (201/496). Eighty-seven cases survived over three years and the 3 year survival rate was 15.10%(87/576). Twenty-two cases survived over 5 years and the 5 year survival rate was 9.61% (22/229).Conclusion The early and mid-term effects of RAF on non-small cell lung cancer is satisfactory.

Diagnostic value of T lymphocyte spot assay on tuberculosis

ZHANG Yi-wen^*,WANG Qing, SHI Qing-ming, WANG Dong-ping, CHEN Yan

Journal of Tuberculosis and Lung Health. 2013, 2(1):  22-24. 

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Objective To find a way with higher sensitivity and specificity for the diagnosis of tuberculosis (TB).Methods A total of 110 patients were enrolled in this study.The sensitivity and specificity of a T lymphocyte spot assay (T-SPOT.TB) were evaluated in the diagnosis of TB.One hundred and four patients were examined with PPD skin test.Results Of 66 TB patients, 56 were positive with T-SPOT. TB testing, its sensitivity was 84.85%. Forty two of 61 TB cases were PPD positive, its sensitivity was 68.85%. The difference between these two methods have statistical significance(χ²=7.76,P<0.05). Of 44 patients with non-TB diseases, 39 were negative with T-SPOT. TB test, its specificity was 88.64%. Forty three of 44 non-TB cases were examined with PPD skin test, 31 cases were PPD negative, its specificity was 72.09%. Their difference is statistically significant (χ²=4.72,P<0.05). The positive predictive values of T-SPOT.TB assay and PPD skin test were 91.80%(56/61)and 76.36%(42/55), respectively. The sensitivity and specificity of T-SPOT.TB testing were significantly superior to that of PPD skin test.Conclusion T-SPOT.TB assay had higher clinical value on diagnosis of TB.

Comparison of clinical features of TB patients in local and floating population registered from 2008 to 2012 in Panyu Guangzhou

GUO Wan-ru^*,ZHOU Lin,HE Chao-wen,LAO Luo-bin

Journal of Tuberculosis and Lung Health. 2013, 2(1):  25-29. 

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Objective By comparing the clinical features of pulmonary tuberculosis (PTB) and TB pleurisy patients among local and floating population registered from 2008 to 2012 in Panyu Guangzhou to identify the difference between the two groups, and provide the basis for formulation of targeted control measures.Methods We collected the data of 8031 PTB and TB pleurisy patients from all levels TB institutions of Guangzhou, among them 3931 are local patients and 4100 are from floating population. According to the requirement of TB special report of ‘China Disease Control Information System’, patient’s information were checked and validated monthly, excel table were downloaded, and converted into the Foxpro data table. The chi-square test was used for categorical data statistics and t test for measurement data. α=0.05 is used as standard to determine if the difference is statistically significant.Results For local patients, the male to female ratio was 2.27∶1(2730/1201); primarily middle-aged and young, and above 60 years old were also not rare, the median age was 37.41 years old; farmers, others, workers and students patients constituted larger proportion, they occupied 34.09%(1340/3931), 20.96%(824/3931), 19.59%(770/3931), 10.68%(420/3931) respectively; patients were mainly previously untreated (92.50%,3630/3931) and secondary PTB(96.11%,3778/3931), 25.38%(998/3931) of patients had cavity and 49.22%(1935/3931) was smear positive; Most patients are found through referral and passive identification, the treatment delay rate was 52.66%(2070/3931), the average number of days from symptom onset to seeking care was 76.39d, to TB diagnosis confirmation was 105.75d. For patients of floating population, the male to female ratio was 1.92∶1(2696/1404); primarily middle-aged and young, and above 60 years old were rare, the median age was 29.03 years old; workers, others and unemployed patients constituted larger proportion, they occupied 73.46%(3012/4100),17.39%(713/4100)and 4.88%(200/4100) respectively; patients were mainly previously untreated (97.22%,3986/4100) and secondary PTB(93.76%,3844/4100), less patients had cavity (17.05%,699/4100) or smear positive(28.80%, 1181/4100); Most patients are found through referral and physical examination, the treatment delay rate was 48.46%(1987/4100), the average number of days from symptom onset to seeking care was 51.55d, to TB diagnosis confirmation was 63.17d. Comparing the two groups, there was statistically significant difference in sex ratio,average age, the age structure, the occupational structure, sputum smear-positive rate, new and retreatment ratio, constituent of disease type, proportion of patients with cavity, constituent of ways of case detection, proportion of treatment delay, the average number of days from symptom onset to seeking care, proportion of TB diagnosis delay, the average number of days from symptom onset to TB diagnosis confirmation, the statistical values were 12.48, 26.27, 890.52, 1440.73, 352.38, 92.65, 31.13, 83.74, 1422.02, 14.12, 3.27, 13.91, 4.66 respectively(the average age, the average number of days from symptom onset to seeking care, the average number of days from symptom onset to TB diagnosis confirmation using t test, other using χ² test),P<0.05.Conclusion The two groups were significantly different in gender, age, occupation, disease type, new treatment and retreatment ratio, whether infectious, with cavity or not, seeking care delay, days from symptom onset to seeking care, diagnosis delay, days from symptom onset to TB diagnosis confirmation. Local and floating population patients all have their own features, therefore it is necessary to take the different and more focused control measures.
   

Clinical and etiological analysis of severe sepsis induced by pneumonia

PENG Chun-hong, YANG Xiu-lin, ZHANG Qian, L Xia, GUO Jiang-fu, WEN Ming-xiang

Journal of Tuberculosis and Lung Health. 2013, 2(1):  30-33. 

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Objective To analyze the clinical and etiological characteristics of sepsis induced by pneumonia and to evaluate antibiotic susceptibility of the pathogens.Methods A prospective study was conducted on sepsis patients induced by pneumonia in ICU of People’s Hospital of Guizhou Province. The sputum and blood samples were collected for culture and bacteria were isolated and identified using conventional methods and the antimicrobial susceptibility against bacteria by Kirby-Bauer method was tested.Results There were 110 patients with 88 strains of isolated pathogenic bacteria. The most common pathogen was Klebsiella pneumonia (34.1%,30/88),the second and the third were Pseudomonas aeruginosa (28.4%,25/88) and Escherichia coli (15.9%,14/88),respectively. In severe sepsis with pneumonia, Klebsiella pneumonia was the most isolated pathogens and Staphylococcus aureus was the major isolated gram positive coccus pathogen. The resistant rate of isolates from severe sepsis with pneumonia patients were 11.53%(6/52), 11.53%(6/52),9.61%(5/52) to ceftazidime,cefotaxime sodium and ceftriaxone respectively, which were significantly higher than isolates from sepsis(P<0.05).Conclusion Gram negative bacteria plays an important role in severe sepsis induced by pneumonia, and the degree of drug resistance to antibiotics from sepsis are higher than those isolated from severe sepsis.

Analysis on clinical characteristics of 75 paitents of elderly pulmonary tuberculosis complicated with fungi infection

CHEN En-tai,HE Qing,SU Li-fang,LI Jin-sheng

Journal of Tuberculosis and Lung Health. 2013, 2(1):  34-37. 

Abstract ( 357 )   PDF (702KB) ( 978 )   Save

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Objective To study clinical characteristics and methods of diagnosis of elderly pulmonary tuberculosis with fungi infection.Methods Seventy-five paitents with elderly pulmonary tuberculosis complicated with fungi infection from 2008 to 2011 in Hospital for Chronic Diseases of Gaozhou were enrolled, including 48 male and 27 female patients, with aged 61-81 years old,and the average age was(71.5±10.5) years old.All patients had a long history of using antibiotic therapy and basis diseases.Results of clinical characteristics,the radiographic manifestations on lung lesions, using antibiotic therapy, fungus culture and drug-resistance were analyzed.ResultsThe common fungal pathogen was Candida albicans 68.0%(51/75),Glabrata 10.7%(8/75), C.tropicalis 6.7%(5/75) and Candida krusei 5.3%(4/75) in elderly patients with elderly pulmonary tuberculosis complicated with fungi infection. The resistant rates were low in Candida albicans. Ten(13.3%,10/75) patients had less than 1 field lesion, 13(17.3%,13/75) patients had 2 lung fields lesion,52(69.3%,52/75) patients had more than 3 lung fields lesion. The patients with pulmonary tuberculosis complicated with fibrosis were easily infected by fungi 78.7%(59/75). The overall clinical cure rate was 88.0%(66/75),the improvement rate was 9.3%(7/75),the death rate was 2.7%(2/75) after treatment.Conclusion The lung lesion areas were quite extensive with destroyed lobes or lung segments. The incidence of fungi infection will be higher with the increasing of lung lesion areas. We should take efforts to reduce the rate of fungi infection and resistance rate, which will be contribute to tuberculosis control and reduce death rate.

The clinical analysis of 48 youth cases of lung cancer first misdiagnosed as tuberculosis

GUO Shuai,L Yan,YU Xue-yan,HOU Dai-lun

Journal of Tuberculosis and Lung Health. 2013, 2(1):  38-40. 

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Objective To study the misdiagnosis reasons of lung cancer in young patients,and raise the awareness of the youth lung cancer and provide a reference for clinical diagnosis and treatment.Methods A retrospective analysis of clinical data of 48 patients younger than 40 years old who had been histologically confirmed as lung cancer and used to be misdiagnosed as tuberculosis initially by Shandong Chest Hospital from 2006 to 2012.Results Twenty-three cases were confirmed by fiberoptic bronchoscopy biopsy, 15 cases by CT-guided percutaneous needle biopsy, 5 by thoracoscopic biopsy, 2 by lymph node biopsy, 2 by pleural effusion cytology and 1 by sputum cytology.Conclusion Youth lung cancer is easily misdiagnosed as tuberculosis, and should be paid more attention. We should make the diagnosis in conjunction with the symptoms, imaging, fiberoptic bronchoscopy and percuta-neous needle biopsy, superficial lymph node biopsy.

Observation of efficacy for tuberculous otitis media with different antituberculous drugs ear dropping combination with nursing intervention

GUO Li-xia, GAO Cui-nan, JIAN Yi-luan, SU Xiao-min

Journal of Tuberculosis and Lung Health. 2013, 2(1):  41-44. 

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Objective To investigate the efficacy of tuberculous otitis media treated with different antituberculous drugs dropping and douching combination with nursing intervention.Methods Twenty-seven cases with tuberculous otitis media in our hospital during the Mar,2005 to the Feb, 2012 were divided randomly into 2 groups by different antituberculous drugs ear dropping and douching combination with nursing interventions, meanwhile all patients received antituberculous drugs treatment. Fifteen patients were treated with the isoniazid and rifampin ear dropping and douching in group A and 12 cases were treated with the ofloxacin ear dropping and douching in group B. Clinical efficacy were compared between groups. We adopted EpiData 3.0 software to establish database,and ana-lyzed the data with SPSS 13.0 software. Efficacy was evaluated on the basis of dry ear time, tympanic membrane closure and whether need to operate or not at the end of ear dropping and douching. The data were analyzed using four exact probability test table and the difference was statistically significant with P<0.05.Results After 2 months of treatment, there were 13 cases with dry ear in group A and 1 cases in group B. The others were ear dry in group A and group B at the 3rd month(χ²=16.3836,P＜0.05). At the end of treatment, there were 0 case required mastoid surgery in group A and 4 cases in group B(χ²=5.8696,P＜0.05). There were 6 cases with tym-panic membrane closure while 9 cases with tympanic membrane perforation in group A. But there were 0 case with tympanic membrane closure while 12 cases with tympanic membrane perforation in group B. The difference was significant statistically(χ²=6.1714,P＜0.05). Followed up for 1 year, none of 27 patients recurred.Conclusion Nursing interventions combination with antituberculous drugs ear dropping and douching are effective for tuberculous otitis media in 2 groups. According to the dry ear time, tympanic membrane closure and whether need to ope-rate, group A shows better curative effect than group B. Therefore, it is recommended that the isoniazid and rifampin ear drops in the treatment of tuberculous otitis media should be prior to application.

Analysis of 52 chronic bronchitis patients with pulmonary tuberculosis

XIE Yu-qin, WEN Jie-ran, XIE Li-lan, WU Jia-wen, LUO Yu-juan, LI Jie

Journal of Tuberculosis and Lung Health. 2013, 2(1):  45-47. 

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Objective To explore clinical characteristics of chronic bronchitis patients with pulmonary tuberculosis in order to reduce misdiagnosis and improve the diagnosis and treatment.Methods The clinical manifestation of 52 chronic bronchitis patients with pulmonary tuberculosis from 2009 to 2011 were analyzed.Results 88.5%(46/52)of the patients had no tuberculosis symptoms.There was no significant difference in the chest X-ray manifestations between chronic bronchitis patients with tuberculosis and simple pulmonary tuberculosis, which lesions located in the tip or combined with posterior segment of lower lobe, basal segment accounting for 61.5%(32/52).Conclusion It is possible to be misdiagnosed due to atypical symptoms of the chronic bronchitis associated with pulmonary tuberculosis, so X-ray or CT should be taken as routine examination for early diagnosis and treatment.

Clinical analysis of 15 cases of nasopharyngeal tuberculosis

HU Zhi-min^*,WANG Fei,ZHAN Zhi-hua

Journal of Tuberculosis and Lung Health. 2013, 2(1):  48-51. 

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Objective To analyze the clinical characteristics of patients with nasopharyngeal tuberculosis.Methods A retrospective analysis was made on clinical manifestations, test results, misdiagnosis, treatment and outcome of 15 cases of biopsy confirmed nasopharyngeal tuberculosis registered in Wuhan Medical Care Center from 2003 to 2012.Results Two cases of 15 showed low fever and night sweat. Six cases showed enlargement of neck lymph nodes, among them, two showed initial neck mass. Fourteen cases had purified protein derivative tuberculin (PPD) positive result, 10 strong positive and 1 negative. One case had Mycobactcrium tuberculosis sputum culture positive result and 14 were negative. Thirteen cases of 15 had different degrees of misdiagnosis, 10 cases were misdiagnosed as nasopharyngeal carcinoma, 2 cases were misdiagnosed as nasopharyngitis, 1 case were misdiagnosed as sleep apnea hypopnea syndrome (SAHS). Through the standard and systematic anti-tuberculosis treatment, the clinical symptoms of all patients were relieved.Conclusion The clinical manifestation of nasopharyngeal tuberculosis is untypical and it is easily misdiagnosed.Doctors should raise awareness of nasopharyngeal tuberculosis and do pathological examination early and repeatedly for early treatment.

Study on the application of self-care management model in pulmonary tuberculosis patients among floating population

GAO Yan-bo^*, GAO Cui-nan, XU Zhuo-wei, LIAN Yong-e, QIU Li-fen

Journal of Tuberculosis and Lung Health. 2013, 2(1):  52-54. 

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Objective To explore the effect of the self-care management model in the treatment of patients with tuberculosis among floating population.Methods We use the self-care capacity measurement scale (ESCA) to measure the self-care ability of 53 patients before and after the intervention, t test is used for statistical analysis and P<0.05 is considered statistically significant.Results After the intervention, in terms of the self-care ability,the concept of self-care, the self-care motivation, the self-care knowledge, and whether response is passive, the ave-rage scores of the 53 patients increased from 116.82±19.23 ,44.40±8.09,37.81±9.64,18.69±3.90,16.71±4.66 to 138.25±15.48 ,51.46±6.72,45.85±6.09,22.81±2.53,19.92±3.17. The differences are all statistically significant(t=27.11、6.85、5.30、10.05、7.51,P<0.05).Conclusion The self-care management model can effectively improve treatment compliance and self-care capacities for TB patients among floating population.

Expert Forum

Investigation in continuation development of tuberculosis specialist hospital

CHEN Shan-hao,FAN Li-hong,XIAO He-ping,MEI Jian

Journal of Tuberculosis and Lung Health. 2013, 2(1):  55-58. 

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The TB specialist (designated) hospital plays an important part in the national TB control program, and has made significant contribution to the TB control and prevention in China for long time. However, a series of problems encountered in the development process, including unfair input policies, a shortage of funding for infrastructure, low level of physician qualifications, low competitiveness of the whole hospital and the operating loss. The introduction of new medical reform program and the National TB Control Program (2011—2015) , is bound to impact on the development of medical institutions. The TB specialist hospital will usher in this historical development opportunity. Government departments can make investment or subsidy in infrastructure and equipment, human resource development, and policy adjustments.

Review Articles

Status and progress of CT-guided percutaneous radiofrequency ablation in lung cancer

LIU Bao-dong, ZHI Xiu-yi

Journal of Tuberculosis and Lung Health. 2013, 2(1):  59-63. 

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The incidence and mortality of lung cancer ranks first in China, and surgery operation is the only way to cure lung cancer. However, only 20%to 30% of patients are suitable for curative resection. In recent years, tumor physical targeted therapies are widely used in clinic. Tumor physical therapy targeting technology means under the minimally invasive condition, setting the tumor as the goal, to maximize the eradication of target tumor cells and normal tissue around 1cm, to ensure the radical cure and maximum protection of normal lung tissue. This technology has the advantages of minimal invasion, safe, conformal, less complications, local anesthesia, simple operation, fast recovery, repeatable, reliable effect, and is easily accepted by patients, which has been proved to be a promising therapeutic tool. At present, the lung cancer physical target includes cryoablation, radiofrequency ablation, microwave ablation and radioactive seed implantation, the status and progress of the CT-guided radiofrequency ablation in the treatment of non-small cell lung cancer was reviewed.

Status and progress of the surgical treatment of spinal tuberculosis

WANG Chuan-qing

Journal of Tuberculosis and Lung Health. 2013, 2(1):  64-68. 

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Spinal tuberculosis is one of the most common extra-pulmonary tuberculosis, the increase of complex cases brings more difficulties for the treatment. In the past 10 years, although the surgical treatment of spinal tuberculosis has made tremendous progress in China, the diversified understanding of clinical issues results in the lack of consistency in indications,timing and the approach of surgery, and the neglect of the chemotherapy. Internal fixation technique plays an important role in maintenance and reconstruction of spinal stability, however it is over-used and the non-standard treatment may result in recurrence or even disability. The author made a review on the status and progress of the surgical treatment of spinal tuberculosis in order to unify the understanding to a certain extent and improve the treatment level of spinal tuberculosis.