Evaluation of the spatial diffusion of methylene blue injected in vivo by bronchoscopy into non-small cell lung carcinoma.

Background: Due to smoking prevalence and the poor efficiency of current therapy, lung cancer is the leading cause of cancer death in developed countries, and its worldwide incidence is steadily increasing. Gene therapy by direct intratumoral injection of different types of gene constructs through a fiberscope has been suggested and evaluated in a few patients.

Objective: It was the aim of this study to observe the actual volume of diffusion within a lung tumor using a color marker.

New insights into the pathophysiology of flail segment: the implications of anterior serratus muscle in parietal failure.

Objective: The wisdom of surgery facing multiple and multi-focal ribs fractures (flail segment) remains controversial. By the present retrospective study, we sought to determine the advisability of surgery as well as the anatomical and biomechanical features of flail segment leading to secondary dislocation.

Method: From 1970 to 2000, 127 patients underwent flail segment osteosynthesis.

Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma.

The aim of this study was to determine whether perfusion-scintillation scanning, used as a predictive pre-operative index of lung functionality in patients with lung cancer, is affected by the level of pulmonary blood flow (PBF). Twenty patients with primary lung cancer underwent spirometry and a radionuclide-perfusion scan (macroaggregated albumin particles labelled with 99mTechnetium) both at rest and during the last minute of a ramp-like increase in work rate until exhaustion. On average, the perfusion of the lung with the tumour was significantly reduced by the same magnitude at rest and during exercise (mean+/-SD: -9+/-6% versus -10+/-4% of the cardiac output), regardless of the extent of the tumour.

[Lung transplantation: indications, techniques and results].

Lung transplantation is proposed for young patients with a severe disease that can be expected to be fatal within less than two or three years. The main indications are chronic respiratory failure induced by chronic obstructive lung disease, cystic fibrosis or pulmonary fibrosis, and severe primary or secondary (Eisenmenger syndrome) pulmonary hypertension. The type of transplantation, determined after an exhaustive work-up ruling out all contraindications, is generally a single lung transplantation if there is no bronchial infection or two-lung transplantation or heart-lung transplantation in case of bronchiectasis or pulmonary artery hypertension.

Predictive survival markers in patients with surgically resected non-small cell lung carcinoma.

Among patients with resected non-small cell lung carcinoma, about 50% will present a tumor recurrence. Thus, it would be of major importance to be able to predict and try to prevent these relapses by an active chemotherapy and/or radiotherapy. In an attempt to answer this question, the tumors of 227 patients with a surgically resected non-small cell lung carcinoma were evaluated as follows: tumors were classified as squamous cell carcinoma (n = 132) or adenocarcinoma (n = 95), and tumor differentiation was evaluated for each type.

Expression of retinoid receptor genes and proteins in non-small-cell lung cancer.

Background: Retinoids can suppress carcinogenesis in high-risk non-neoplastic bronchial lesions and can reduce the risk of second primary non-small-cell lung cancer (NSCLC). The effects of retinoids are mediated by nuclear receptors, i.e.

[False empyema after artificial pneumothorax. An original entity: type B non Hodgkin malignant lymphoma].

Malignant lymphoma developing in the lung after therapeutic pneumothorax is a rare condition in Europe. The authors report one case admitted after a 40-year history of pyothorax resulting from artificial pneumothorax for treatment of pulmonary tuberculosis. The diagnosis at admission was an infection of the chronic pyothorax associated with a lung mass.

The role of platelet-derived growth factor production by tumor-associated macrophages in tumor stroma formation in lung cancer.

Lung cancer is the most common cause of death by cancer in developed countries. Since a tumor cannot develop without the parallel expansion of a tumor stroma, a better understanding of its formation could lead to new therapeutical approaches. In this respect, since platelet-derived growth-factor (PDGF) is a chemotactic and growth factor for mesenchymal and endothelial cells, lung tumors of patients undergoing surgery for non-small cell lung cancer were evaluated for their replication rate using iododeoxyuridine incorporation, and for the expression of PDGF genes and the presence of PDGF A and B chains and of PDGF receptor alpha and beta subunits.

[Analgesia after thoracotomy by extrapleural administration of continuous bupivacaine].

This study was aimed to assess the efficiency and the side effects of a continuous administration of bupivacaine into the paravertebral space. Twenty patients, ranked ASA 2 or 3, with a mean age of 57.9 years, and having had a posterolateral thoracotomy for resection of lung tissue, were randomly assigned to one of two groups, B or C.

[Resection of lung neoplasm in patients aged 70 years and over. Apropos of a series of 193 resections].

Lung cancer in the elderly is an active cancer. Due to the poor tolerance of radiotherapy and chemotherapy, and the ever increasing life expectancy of patients over the age of 70 years, surgery remains the treatment of choice for these lesions. We report a series of 193 patients over the age of 70 years, the high postoperative mortality of 19% during the first month was counterbalanced by a 5-year survival of more than 20%.

[Antibioprophylaxis in pulmonary surgery: a randomized trial with cefamandole versus placebo].

A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery. It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups. Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia.

[Value of limited resections in the surgical treatment of lung cancers].

From 1969 to 1990, 88 limited lung resections were performed for the treatment of malignant lung tumours. These operations consisted of 73 typical resections (29 segmentectomies, 15 bisegmentectomies, 23 middle lobectomies, 6 lingulectomies) and 15 atypical resections. In 15 cases, they were completed by lymph node dissection.

[Pulmonary metastasis of a dermatofibrosarcoma].

Progressive and recurrent dermatofibrosarcoma, described by Darier and Ferrand in 1924, is a fibrous skin tumour with essentially local malignancy. The authors report a case with pulmonary metastasis, a rare event as only 13 cases of visceral metastases have been reported in the literature. The clinical course of this case was favourable (follow-up of 5 years), in contrast with the usually pejorative nature of metastatic disease (death after several months to one year following the discovery of the first metastasis).

[Contribution of a 3% solution of boric acid in the treatment of deep wounds with loss of substance].

The correct application of antiseptics to major surgical wounds must comply with appropriate protocols. Compliance with the protocol established by the CHRU of Nancy was evaluated by means of a questionnaire assessing the understanding of the protocol by the nursing staff and by a survey in the wards in which it was applied. The defects observed cannot be explained by a lack of efficacy for superficial wounds and deep wounds, as a randomised study of 42 wounds demonstrated the superiority of the protocol in relation to the use of another product which is widely used in the wards.

[Treatment of deep wounds with loss of tissue. Value of a 3 percent boric acid solution].

Following the finding of dramatic improvement in a deep wound with loss of substance treated with a 3 percent boric acid solution, 31 patients hospitalized in a surgical intensive care unit and holding such a wound initially unimproved by classical treatments were subjected, in 1987-88, to a short-time use of this solution. A case-control study retrospectively performed with 12 of the patients demonstrated that after wound granulation was obtained they returned to a normal care unit about three times more rapidly than patients receiving conventional antiseptics (means: 20 and 55 days respectively). This reduction in intensive care duration of stay for these 12 patients saved approximately 2 millions francs.

Perianal ulcer: an unusual presentation of Wegener's granulomatosis. Report of a case.

A 46-year-old man, without remarkable past medical history, had a perianal ulcer that appeared spontaneously two months before presentation. At admission, the ulcer was painless, measuring 4 to 5 cm in diameter and showing detachment and a slightly papillomatous aspect at the edge but without induration of the base. Microscopic examination revealed cutaneous ulceration with a well-developed inflammatory response, a few small vessels with intraluminal thrombosis or necrotizing walls, and isolated microscopic granulomata.

[Plastic surgery of the thoracic wall (malformations and tumors) using a sliding splint-stapler].

Chest wall instability, created surgically by correction of a chest deformity (funnel chest or, more rarely, pigeon chest) or by resection of a tumour of the chest wall, is serious as it can jeopardize the immediate vital prognosis because of paradoxical respiration and, in the long term, the functional and aesthetic prognosis due to progressive impaction of the unstable segment of the wall. The polyvalent and adaptable material which we have developed (sliding splint-staple) and which we also use in thoracic traumatology (thoracic flaps), has allowed us to perform audacious corrections for deformities or wide resections for tumours since 1980. We have used this material on 13 occasions for contention after sternochrondroplasty, with an excellent result in each case both in terms of the immediate stability and in terms of the aesthetic result.

[Clinical and bacteriologic course of wounds as a function of various protocols of local antisepsis].

Antiseptics are drugs, and they must be prescribed by physicians. A correct use allows a favourable evolution of the wounds, and could avoid some amputations. The authors have realized a randomized study, to compare the reliability of a sequence using Eosine and an antiseptic (Chlorhexidine or polyvinylpyrolidone (PVP) iodine) to a more usual sequence using chlorhexidine of PVP iodine alone according with the initial pH of the wound.

Dorsal vascular network of the first web space. Anatomical bases of the kite flap.

Thirty dissections were performed on adult non embalmed cadavers, after vascular injection with MICROFIL or Methylene blue. In contrast to the classical descriptions of a single dorsal metacarpal artery, this study shows the existence of a vascular network with 1 or 2 vessels running over or under the deep aponeurosis. Direct cutaneous arteries provide blood supply to the kite flap when the only dorsal metacarpal vessel of the first web space is in a deep situation.

[Metachronous bronchial neoplasm. 20 cases surgically treated].

The authors present a series of twenty metachronous lung carcinomas operated upon in the Thoracic Surgery Unit of Nancy between 1975 and 1987. These lesions occur after a first lung tumor resected for stade 1 TNM in 19 cases, with a 59 month's mean free interval and they are surgically treated by 14 controlateral lobectomies and 6 completion pneumonectomies. In spite of 4 post-operative deaths, the survival rates reach 51% at 3 years and 32% at 5 years.

[Anatomic variations of the vascular network of the first dorsal commissure. Uses of the kite flap].

Thirty dissections were performed on fresh, unfixed, adult cadavers after vascular injection of silastic or methylene blue. Analysis of the results led to replacement of the concept of a single dorsal intermetacarpal artery, the constant pedicle of the kite flap, by that of an intermetacarpal vascular system composed of one or two supra- and/or sub-aponeurotic vessels. The existence of distinct direct skin branches of this intermetacarpal vascular system is defined.

[In vivo study of human tumor cell proliferation, by histo-immunodetection of 5-iododeoxyuridine incorporated into DNA].

5 Iododeoxyuridine (IDU) was administered, (2.4 g by continuous infusion for 24 hrs.) without adverse effect, to 18 patients bearing thoracic tumours.

[Anatomic characteristics of the pelvis in children].

Growth characterizes the pelvic modifications until adult maturity is reached. Recollection of pelvic ossification is done insisting upon the primary ossification points, the triradiate cotyloid cartilage and the secondary ossification points. The socket's neonatal particular morphology with it's cartilaginous roof and it's fibrocartilaginous acetabular labrum finds it's application in ultrasonography.

Anatomic basis for the orthopedic treatment of bladder exstrophy: anatomic study of the sacrosciatic ligaments in the newborn.

Anatomic study of the pelvis of 30 fetuses and newborn children, yielded a precise relationship between the sacrotuberous ligaments and size of the gluteal region. At birth, the distance between the posterior superior iliac spine and the ischium is 40 mm. Closure of the anterior defect in bladder exstrophy sometimes requires an orthopedic surgical procedure.