Algorithm for assisting medical diagnosis.

An algorithm for medical diagnosis assistance is described. In this algorithm, the patient is identified following the simultaneous evaluation of its degree of similarity with a given disease, as well as the extent of disagreement with the rest of diseases considered in the differential diagnosis. In an example the algorithm is applied to the diagnosis assistance of some neuropathies.

[Lung transplantation. Contraindications and new indications].

The authors review the recent changes observed in the indications for lung transplantation. Several classical contra-indications have been alleviated or even cancelled. Chronic infection presenting as cystic fibrosis has become one of the first indications for lung replacement.

[Electronic sectorial ultrasound endoscopy in benign and malignant tumoral pathology of the stomach. Results in 30 patients].

From October 1991 to July 1992, endoscopic ultrasound examination (EUS) was performed preoperatively in 30 patients with gastrointestinal disease with a new forward-view fiber optic gastroscope with a 5 and 7.5 MHz curved-array linear transducer mounted directly behind the lens. Before EUS examination, endoscopy with biopsy had established the diagnosis of gastric disease in 22 cases: 16 adenocarcinoma, 4 lymphoma, 1 carcinoid tumor and 1 gastric metastasis of a chorionic tumor.

Is lung cancer resection justified in patients aged over 70 years?

From January 1980 through January 1985, 452 consecutive patients underwent pulmonary resection for primary non-small cell bronchogenic cancer. Forty-seven patients (10.4%) were 70 years old or older: there were 45 men and 2 women, with a mean age of 72.

[Prognostic value of UICC-1987 classification in primary lung cancers].

In order to test the validity of the new 1987-UICC classification (4th ed.) for lung cancer, data from 456 patients who underwent pulmonary resection for bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. Overall survival rate was 32.

[Results of surgical treatment of persistent or recurrent pneumothorax].

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.

[Video-assisted pulmonary resection surgery. Technique, indications and first results].

Video-assisted thoracic surgery (VATS) is a compromise between conventional thoracic surgery performed via a thoracotomy of variable dimensions and surgical videothoracoscopy, which, using only small operating channels, requires the use of specific instruments, gives a field of vision exclusively by video camera and raises the delicate problem of extraction of the resection specimen. VATS is performed via a minithoracotomy, 3.5 to 5 cm long, using a video camera.

Esophageal carcinoma with doubtful extirpability. Value of preoperative chemotherapy plus radiotherapy.

To improve resectability for bulky esophageal tumors and/or tumors evolving close to the pharyngo-esophageal junction (PEJ), a combined preoperative chemotherapy plus radiotherapy (CT+RT) was given in 25 patients. There were 23 men and 2 women (mean age: 55 years); 21 had squamous cell carcinoma and 4 had adenocarcinoma. According to TNM classification based on computed tomography, the tumor was graded T3 in 20 cases, T4 in 2, T2 in 2 and T1 in 1.

Tracheobronchial healing after lung and heart-lung transplantation. A critical review of 64 anastomoses. The Joint Marseille-Montréal Lung Transplant Program.

The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80. Sixteen were excluded because of early postoperative death; none of these deaths was related to an airway complication.

[Bronchial cancer associated with atheromatous arteriopathy. Prognostic and therapeutic consequences in pulmonary excision].

Between January 1980 and January 1985, 462 consecutive patients underwent lung resection for bronchogenic carcinoma. Eighty of these patients (17.3 percent) had atherosclerosis involving mainly the coronary arteries (40 percent).

[Ectatic tumoral thrombosis of the superior vena cava revealing thyroid cancer].

Microscopic angio-invasion by carcinoma of the thyroid is known. Extension into the great veins is much more uncommon. Most of the cases which have been previously described were discovered on post-mortem examination.

[Extrapancreatic hypoglycemic tumors. Apropos of a case of pleural fibrosarcoma].

The authors report a case of pleural fibrosarcoma associated with severe hypoglycaemia. Chromatography of the patient's serum and tumour fragments revealed a substance with a high molecular weight and an insulin-like activity. Professor Poffengarger's laboratory identified this substance as Non Suppressible Insulin-Like Protein or NSILAp which induces insulin-like effects on various tissues.

Treatment of thymomas. A report of 67 cases.

From 1979 to 1989, 126 patients were treated for thymic tumors. Of these, 67 (53%) had thymomas occurring in 27 men and 40 women; the mean age was 46 years: 24 patients had no symptoms and myasthenia gravis was present in 21 cases. A complete resection was performed in 45 patients, associated in 22 with postoperative adjuvant treatment (radiotherapy, 2; radio- and chemotherapy, 20).

[Results of surgery of non-small cell primary bronchial cancers. Retrospective analysis of 452 resections].

Data from 452 patients who underwent pulmonary resection for a non small cell bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. The operative mortality rate was 5.5%.

[Ectatic tumoral thrombosis of the superior vena cava revealing thyroid cancer].

Microscopic angio-invasion by carcinoma of the thyroid is known. Extension into the great veins is much more uncommon. Most of the cases which have been previously described were discovered on post-mortem examination.

[Non-malignant esophagotracheal fistulas in adults. Experience with 35 cases].

Esophagotracheal fistula always constitutes a serious, life-threatening complication. Fistulae occurring during medical intensive care with mechanical ventilation are currently the most frequent. Their diagnosis was strongly suspected by clinical examination of the patient, but was always confirmed by endoscopy which revealed their exact site in relation to the vocal cords or carina, essential information for the choice of incision when it is decided to perform surgery.

[Prolonged epidural analgesia following thoracotomy. Clinical study and serum levels over five days].

Prolonged continuous epidural analgesia allows perithecal infusion with fentanyl and bupivacaine for 5 postoperative days after thoracic surgery. This study included 27 thoracotomized patients randomised into two groups: group X consisted of 15 subjects, group Y consisted of 12 subjects. Each patient received 33 micrograms/hr or fentanyl for 48 hours, associated with 0.

[Danger to spinal cord arterial vascularization during surgery for neurogenic tumors of the posterior mediastinum].

The authors report one case of posterior mediastinal neurinoma with a Adamkiewicz artery arising at an atypical site. They stress the spinal cord complications following thoracic surgery. The value of spinal cord arteriography during preoperative examinations and for prevention of complications is discussed.

The relation between seborrheic keratoses and malignant solid tumours. A case-control study.

In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-called Leser-Trelat sign, we conducted a case control study in which the number and features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neither numbers nor features of seborrheic keratosis differed significantly in patients and controls. Eruptive seborrheic keratosis was noted in only one patient and one control.

[The danger present to the spinal cord arterial vasculature during surgery of nerve-tissue tumors of the posterior mediastinum].

The authors report one case of posterior mediastinal neurinoma with a Adamkiewicz artery arising at an atypical site. They stress the spinal cord complications following thoracic surgery. The value of spinal cord arteriography during preoperative examinations and for prevention of complications is discussed.

Inoperable nonmetastatic squamous cell carcinoma of the esophagus managed by concomitant chemotherapy (5-fluorouracil and cisplatin) and radiation therapy.

Thirty-five patients with nonmetastatic squamous cell carcinoma of the esophagus were treated with chemotherapy (5-fluorouracil, cisplatin) and concomitant split-course radiation therapy. All of the patients presented with dysphagia. Treatment consisted of two courses of chemotherapy with 5-FU (1 g/m2/day in continuous infusion for 5 days [days 1 to 5 and days 29 to 33] ) and cisplatin (70 mg/m2 intravenous bolus at days 2 and 30).

[Preoperative staging of central bronchopulmonary cancer. X-ray CT-MRI-pulmonary digital subtraction angiography and surgery].

In order to evaluate the reliability of medical imaging methods in the assessment of mediastinal invasion by lung cancers, a prospective study was conducted in 30 patients undergoing preoperative computed tomography (CT), magnetic resonance imaging (MRI) and pulmonary digital subtraction angiography. MRI improved the sensitivity of detection of surgically confirmed mediastinal lymphadenopathy, but its specificity in relation to histological results was poor and identical to that of CT. In terms of extension to vascular structures, MRI and CT gave comparable results for the pulmonary artery and vein with two false positives for the pulmonary veins and left atrium with the two methods.

[Pleural fibroma: apropos of a case].

The authors report a case of a pleural fibroma occurring in a 72 year old woman. The tumour presented with both an osteoarthropathy and hypoglycaemia. An X-ray revealed an abundant associated pleural effusion.

[Gastroesophageal reflux and respiratory manifestations: diagnostic approach, therapeutic indications and results].

The authors report a study of 140 patients presenting with a non-allergic respiratory tract disease (121 cases of asthma--19 cases of spasmodic cough). Gastro-oesophageal reflux was detected by 24-hour pHmetry in 86 of these patients. In 34 of them (i.