Omentum Transplantation in Thorax to Cover Bronchial Stump as Treatment of Bronchopleural Fistula After Pulmonary Resection: Report of 6 Cases’ Experience

Background and objective Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method. Methods During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points. Results The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients’ bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months. Conclusion Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation

Initiation and variation of the dune fields in semi-arid China - with a special reference to the Hunshandake Sandy Land, Inner Mongolia

Sedimentary sequences occurring in desert dunes reflect changes in desert systems, and as such may contain signals useful for recognizing spatial and temporal changes of deserts and their response to regional or even global climate fluctuations. Geomorphological and palaeoenvironmental studies within the dune fields of the Asian middle-latitudes have provided some solid evidence for interpreting the history of these sand seas. Using the Hunshandake (Otindag) Sandy Land, a sandy area covered primarily by stabilized dunes and located in the semi-arid zone of eastern Inner Mongolia, China (Fig. 1), as an example, we studied the initiation and variation in the dune landscape in the eastern portion of the desert belt in northern China. On the basis of physical and biochemical indicators in the sediments and OSL chronology, we herein argue that this dune system in the middle latitudes of eastern Asia is much younger than previously assumed and that it has responded sensitively to climate change during the late Quaternary. Geological evidence from the Sandy Land suggests that most of the current dunes are of late Pleistocene or even Holocene age. Palaeosols intercalated in the aeolian sequences and their OSL chronology show that the climate of the Hunshandake was much wetter than today between 9.6 ka and 3 ka. This resulted in stabilization of the dunes in the eastern and central portions of the Sandy Land. Epochs of reworking or stabilization of the dunes are broadly consistent with the fluctuations in northern hemisphere solar radiation although with an obvious time lag. Because the increase rate of annual precipitation was not sufficient to fully stabilize the dunes in more arid part of the region, some active dunes persisted even during this long-lasting wetter epoch. We conclude that periods of Holocene dune stabilization due to palaeosol formation varied along the climate gradients across the various sandy lands of northern China, and in general it began earlier and lasted longer in the east than in the west. The general nature of the sandy lands and their counterparts in the western portion of the desert belt during the LGM and mid-Holocene climate optimum is discussed in comparison with their current states.</p