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Objective: To summarize the diagnosis and treatment of acute rejection after lung transplantation and to discuss optimized immunosuppressive therapy., Methods: Between November 2002 and June 2006, 16 patients underwent operations on lung transplantation, 7 cases on single-lung transplantation and 9 cases on bilateral-lung transplantation. Immunosuppressive therapy was new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab., Results: Eight cases in new triple drug maintenance regimen with daclizumab. There is no acute rejection in 6 months. Except 2 of the 8 cases died of early post-lung transplantation sever pulmonary edema and dysfunction, 3 of the rest 6 cases underwent acute rejection incident about 21.4% (3/14)., Conclusion: In this group the new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab acquired beneficial effect in preventing acute rejection after lung transplantation.

Objective: To explore the "hemi-clamshell" approach to the resection of the apical chest tumors, and to evaluate its advantages of operative safety and completeness., Methods: We conducted a retrospective review of the records of 27 patients undergoing resection of the primary apical chest tumors from January 1995 to January 2001. Tumor type included NSCLC, sarcoma, neurofibromatosis, esophageal carcinoma. Data collected included clinical presentation, tumor type and involvement, type of resection, complication, and survival., Results: A clinical operation for gross-total resection of tumors and invaded structures was performed on six patients by means of a successful anterior approach. Among other 21 patients on whom a clinical operation was performed by posterior approach, only 13 patients obtained gross-total resection. There were significant difference between the two groups (P < 0.01). The mean duration for follow-up was 29 months, and the overall median survival was 21 months. Median survival in patients undergoing gross-total resection was 29 months, and this is significantly better than in incomplete resection group (P < 0.01)., Conclusions: The anterior "hemi-clamshell" approach is a successful technique for the exposure and resection of these tumors and invaded structures. Release of symptoms and long-term survival is acceptable if complete resection can be performed.

From 1973 to 1989, a total of 59 consecutive patients with recurrent lung cancer had completion pneumonectomy. Completion pneumonectomy was done on the right side in 35 patients and left side in 24. The median interval between the first pulmonary resection and completion pneumonectomy for patients was 35 months (5 m-9.5 y). In this series postoperative complications and mortality were comparable to those for routine pneumonectomy. The 1, 3, 5 and 10 year survival rates were 88.5%, 30.2%, 21.4% and 16.7% respectively. None of those patients with histologically proved gross tumor remaining in the hemithorax at the time of reoperation survived longer than 2 years. The authors emphasized that the planning for such an operation must be done meticulously but aggressively. It is obvious that incomplete surgical resection of bronchial carcinoma should be avoided either at initial operation or at completion pneumonectomy because of poor prognosis.

Sixty-five cases of chylothorax treated at the Shanghai Chest Hospital over the past 30 years are reviewed. The causes of chylothorax in this series were mainly traumatic and postoperative (47/65). Two cases were associated with chylopericardium and another 2 with chylous sputum. The authors believe that untreated chylothorax is a serious, often life-threatening entity and that the following principles are applicable in its management: (1) If daily chyle loss exceeds 1000 ml in adults with no tendency of subsidence, surgery is indicated especially in the effusion may lead to disastrous nutritional and immunologic consequences; (2) Ligation of the thoracic duct is effective by a mass ligature encircling all tissues between the azygos vein and the aorta. The most favorable site for ligation is immediately above the diaphragm. Over dissection of the thoracic duct should be avoided; (3) The proper surgical approach is on the side of the effusion in unilateral chylothorax, but right side approach is preferred in case of bilateral chylothorax or when the origin of chylous fistula is unknown; (4) Pleurodesis is indicated for those cases if the duct is not obviously present or chyle comes from the pleural lymphatics. Concentrated glucose solution with or without Talc suspension is recommendable.