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Stockhammer P, Grant M, Wurtz A, Foggetti G, Chung S, Li F, Gettinger S, Politi K, Goldberg S. EP08.02-125 Tumor Suppressor Gene Alterations Identified at Disease Progression Impact Outcomes in Patients with EGFR-mutant Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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2
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Lipp M, Brodmann P, Pietsch K, Pauwels J, Anklam E, Börchers T, Braunschweiger G, Busch U, Eklund E, Eriksen FD, Fagan J, Fellinger A, Gaugitsch H, Hayes D, Hertel C, Hörtner H, Joudrier P, Kruse L, Meyer R, Miraglia M, Müller W, Philipp P, Pöpping B, Rentsch R, Sawyer J, Schulze M, van Duijn G, Vollenhofer S, Wurtz A. IUPAC Collaborative Trial Study of a Method To Detect Genetically Modified Soy Beans and Maize in Dried Powder. J AOAC Int 2020. [DOI: 10.1093/jaoac/82.4.923] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
This paper presents results of a collaborative trial study (IUPAC project No. 650/93/97) involving 29 laboratories in 13 countries applying a method for detecting genetically modified organisms (GMOs) in food. The method is based on using the polymerase chain reaction to determine the 35S promoter and the NOS terminator for detection of GMOs. Reference materials were produced that were derived from genetically modified soy beans and maize. Correct identification of samples containing 2% GMOs is achievable for both soy beans and maize. For samples containing 0.5% genetically modified soy beans, analysis of the 35S promoter resulted also in a 100% correct classification. However, 3 false-negative results (out of 105 samples analyzed) were reported for analysis of the NOS terminator, which is due to the lower sensitivity of this method. Because of the bigger genomic DNA of maize, the probability of encountering false-negative results for samples containing 0.5% GMOs is greater for maize than for soy beans. For blank samples (0% GMO), only 2 false-positive results for soy beans and one for maize were reported. These results appeared as very weak signals and were most probably due to contamination of laboratory equipment.
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Affiliation(s)
- Markus Lipp
- The National Physical Laboratory of Israel (INPL), Danciger A Bldg., Givat Ram, Jerusalem 91904, Israel, Tel: +972-2-6536534, Fax: +972-2-6520797
| | - Peter Brodmann
- Kantonales Labor Basel, Postfach, CH-4012 Basel, Switzerland
| | - Klaus Pietsch
- Chemische Landesuntersuchungsanstalt Freiburg, Bissierstrasse 5, D-79114 Freiburg, Germany
| | - Jean Pauwels
- European Commission, DG Joint Research Center, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Elke Anklam
- European Commission, DG Joint Research Center, Institute for Health and Consumer Protection, Food Products Unit, 1-21020 Ispra(Va), Italy
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Hastings K, Yu HA, Wei W, Sanchez-Vega F, DeVeaux M, Choi J, Rizvi H, Lisberg A, Truini A, Lydon CA, Liu Z, Henick BS, Wurtz A, Cai G, Plodkowski AJ, Long NM, Halpenny DF, Killam J, Oliva I, Schultz N, Riely GJ, Arcila ME, Ladanyi M, Zelterman D, Herbst RS, Goldberg SB, Awad MM, Garon EB, Gettinger S, Hellmann MD, Politi K. EGFR mutation subtypes and response to immune checkpoint blockade treatment in non-small-cell lung cancer. Ann Oncol 2019; 30:1311-1320. [PMID: 31086949 PMCID: PMC6683857 DOI: 10.1093/annonc/mdz141] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although EGFR mutant tumors exhibit low response rates to immune checkpoint blockade overall, some EGFR mutant tumors do respond to these therapies; however, there is a lack of understanding of the characteristics of EGFR mutant lung tumors responsive to immune checkpoint blockade. PATIENTS AND METHODS We retrospectively analyzed de-identified clinical and molecular data on 171 cases of EGFR mutant lung tumors treated with immune checkpoint inhibitors from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, University of California Los Angeles, and Dana Farber Cancer Institute. A separate cohort of 383 EGFR mutant lung cancer cases with sequencing data available from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, and The Cancer Genome Atlas was compiled to assess the relationship between tumor mutation burden and specific EGFR alterations. RESULTS Compared with 212 EGFR wild-type lung cancers, outcomes with programmed cell death 1 or programmed death-ligand 1 (PD-(L)1) blockade were worse in patients with lung tumors harboring alterations in exon 19 of EGFR (EGFRΔ19) but similar for EGFRL858R lung tumors. EGFRT790M status and PD-L1 expression did not impact response or survival outcomes to immune checkpoint blockade. PD-L1 expression was similar across EGFR alleles. Lung tumors with EGFRΔ19 alterations harbored a lower tumor mutation burden compared with EGFRL858R lung tumors despite similar smoking history. CONCLUSIONS EGFR mutant tumors have generally low response to immune checkpoint inhibitors, but outcomes vary by allele. Understanding the heterogeneity of EGFR mutant tumors may be informative for establishing the benefits and uses of PD-(L)1 therapies for patients with this disease.
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MESH Headings
- Aged
- Alleles
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- B7-H1 Antigen/metabolism
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/mortality
- Drug Resistance, Neoplasm/genetics
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/genetics
- ErbB Receptors/metabolism
- Female
- Genetic Heterogeneity
- Humans
- Lung/immunology
- Lung/pathology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/immunology
- Lung Neoplasms/mortality
- Male
- Middle Aged
- Mutation
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Programmed Cell Death 1 Receptor/metabolism
- Progression-Free Survival
- Retrospective Studies
- Tobacco Smoking/adverse effects
- Tobacco Smoking/epidemiology
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Affiliation(s)
| | - H A Yu
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - W Wei
- Yale School of Public Health, New Haven
| | - F Sanchez-Vega
- Human Oncology and Pathogenesis Program; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering, New York
| | - M DeVeaux
- Yale School of Public Health, New Haven
| | - J Choi
- Department of Genetics, Yale School of Medicine, New Haven
| | - H Rizvi
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York
| | - A Lisberg
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | | | - C A Lydon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - Z Liu
- Department of Pathology, Yale School of Medicine, New Haven
| | - B S Henick
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York; Department of Medicine, Columbia University Medical Center, New York
| | - A Wurtz
- Yale Cancer Center, New Haven
| | - G Cai
- Department of Pathology, Yale School of Medicine, New Haven
| | - A J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - N M Long
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - D F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - J Killam
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven
| | - I Oliva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven
| | - N Schultz
- Human Oncology and Pathogenesis Program; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering, New York; Department of Epidemiology and Biostatistics
| | - G J Riely
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - M E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - M Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | | | - R S Herbst
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - S B Goldberg
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - M M Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - E B Garon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - S Gettinger
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - M D Hellmann
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York.
| | - K Politi
- Yale Cancer Center, New Haven; Department of Pathology, Yale School of Medicine, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA.
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Witte Pfister A, Baste JM, Piton N, Bubenheim M, Melki J, Wurtz A, Peillon C. [Thymomectomy by minimally invasive surgery. Comparative study videosurgery versus robot-assisted surgery]. Rev Mal Respir 2017; 34:544-552. [PMID: 28216170 DOI: 10.1016/j.rmr.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report the results of minimally invasive surgery in patients with stage I or II thymoma in the Masaoka classification. The reference technique is partial or complete thymectomy by sternotonomy. METHODS A retrospective single-center study of a prospective database including all cases of thymoma operated from April 2009 to February 2015 by minimally invasive techniques: either videosurgery (VATS) or robot-assisted surgery (RATS). The surgical technique, type of resection, length of hospital stay, postoperative complications and recurrences were analysed. RESULTS Our series consisted of 22 patients (15 women and 7 men). The average age was 53 years. Myasthenia gravis was present in 12 patients. Eight patients were operated on by VATS and 14 patiens by RATS. There were no conversions to sternotomy and no perioperative deaths. The mean operating time was 92min for VATS and 137min for RATS (P<0.001). The average hospital stay was 5 days. The mean weight of the specimen for the VATS group was 13.2 and 45.7mg for the RATS group. Twelve patients were classified Masaoka stage I and 10 were stage II. According to the WHO classification there were 7 patients type A, 5 type AB, 4 type B1, 4 type B2 4 and 2 type B3. As proposed by the Group ITMIG-IASLC in 2015 all patients corresponded to group I. The mean follow-up period was 36 months. We noted 3 major perioperative complications according to the Clavien-Dindo classification: one pneumonia, one phrenic nerve paralysis and one recurrent laryngeal nerve palsy. We observed one case of local recurrence at 22 months. Following surgery 4 patients were treated with radiotherapy and 2 patients with chemotherapy. CONCLUSIONS The minimally invasive route is safe, relatively atraumatic and may be incorporated in the therapeutic arsenal for the treatment of Masaoka stage I and II thymoma as an alternative to conventional sternotomy. RATS and VATS are two minimally invasive techniques and the results in the short and medium term are acceptable. The clinical advantages of one over the other are sifficult to establish. RATS could handle larger and more complex lesions in view of the weight and size of the operating instrument.
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Affiliation(s)
- A Witte Pfister
- Service de chirurgie générale et thoracique, centre hospitalier universitaire de Rouen, 76031 Rouen cedex, France
| | - J-M Baste
- Service de chirurgie générale et thoracique, centre hospitalier universitaire de Rouen, 76031 Rouen cedex, France
| | - N Piton
- Service d'anatomopathologie, CHU de Rouen, 76000 Rouen, France
| | - M Bubenheim
- Service d'informatique. CHU de Rouen, 76000 Rouen, France
| | - J Melki
- Service de chirurgie générale et thoracique, centre hospitalier universitaire de Rouen, 76031 Rouen cedex, France
| | - A Wurtz
- Service de chirurgie cardio-thoracique, centre universitaire de Lille, 59000 Lille, France
| | - C Peillon
- Service de chirurgie générale et thoracique, centre hospitalier universitaire de Rouen, 76031 Rouen cedex, France.
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Affiliation(s)
- A Wurtz
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France.,Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHULille, Lille, France
| | - I Hysi
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France
| | - E Kipnis
- Surgical Critical Care Unit-Department of Anesthesiology and Critical Care, Lille University Teaching Hospital, CHULille, Lille, France
| | - M C Copin
- Institute of Pathology, Lille University Teaching Hospital, CHULille, Lille, France
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Hysi I, Vincentelli A, Juthier F, Rousse N, Frapier J, Doguet F, Prat A, Wurtz A. 234-I * CARDIAC SURGERY AND REPAIR OF PECTUS DEFORMITIES: WHEN AND HOW? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Han E, Kim D, Zhang X, Liang X, Wurtz A, Hardee M, Penagaricano J, Vaneerat R, Morrill S. SU-E-T-83: Comparison of the Dosimetric Efficacy of Helical Dynamic Jaw Vs. Fixed Jaw of TomoTherapy HDA. Med Phys 2014. [DOI: 10.1118/1.4888413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Wurtz A, Kipnis E. Tissue-engineered airway in the clinical setting: a call for information disclosure. Clin Pharmacol Ther 2012; 91:973; author reply 974. [PMID: 22534865 DOI: 10.1038/clpt.2012.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Wurtz A, Hysi I, Zawadzki C, Copin MC. Reply to Martinod. Eur J Cardiothorac Surg 2012. [DOI: 10.1093/ejcts/ezr257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Wurtz A, Hysi I. [Tracheal replacement with aortic allografts in humans. Experimental prospects]. Rev Mal Respir 2011; 29:941-4. [PMID: 22980558 DOI: 10.1016/j.rmr.2011.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 08/24/2010] [Indexed: 12/17/2022]
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11
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Cavestri B, Wurtz A, Bart F, Nevière R, Aguilaniu B, Wallaert B. Exploration fonctionnelle à l’exercice des patients présentant un pectus excavatum. Rev Mal Respir 2010; 27:717-23. [DOI: 10.1016/j.rmr.2010.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
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12
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Klein C, Thébau E, Aubry E, Desfachelle A, Herbaux B, Wurtz A, Besson R, Bonnevalle M. Qualité de vie après une résection de paroi thoracique. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. BACKGROUND Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. VIEWPOINT AND CONCLUSIONS The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sutured in continuous layers to give a shortening effect. In the case of pectus excavatum the sternum is then secured anteriorly for about 6 months by a retrosternal metallic strut in an overcorrected position. The partially resected seventh cartilages are then sutured to the xiphoid. Other surgical techniques are described, including modified Ravitch's procedure, modelling osteochondroplasty, prosthetic reconstruction and Nuss's procedure. Results of the more important series are reported and discussed.
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Affiliation(s)
- M Conti
- Clinique de Chirurgie Thoracique, Hôpital Albert Calmette, CHU Lille, France
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14
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15
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Conti M, Porte H, Wurtz A. Management of tracheobronchial ruptures in critically ill patients. Minerva Anestesiol 2007; 73:443. [PMID: 17637592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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16
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Azorin JF, Bertin F, Martinod E, Melloni VB, Laskar M, Marquette CH, Wurtz A. [Surgery of the trachea: old problem, new possibilities]. Rev Mal Respir 2006; 23:10S103-10S105. [PMID: 17127979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- J-F Azorin
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, Bobigny, Université Paris XIII.
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17
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Tricot S, Gastine T, Sendid B, Wurtz A, de Botton S, Alfandari S. [Pulmonary zygomycosis in a patient treated for invasive aspergillosis]. Med Mal Infect 2006; 36:118-21. [PMID: 16458464 DOI: 10.1016/j.medmal.2005.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 12/07/2005] [Indexed: 12/22/2022]
Abstract
We report a pulmonary mucormycosis due to Absidia corymbifera. It occurred in a leukemic patient treated for a probable aspergillosis regressing after voriconazole treatment. The patient responded to surgery and a combination of liposomal amphotericin B and itraconazole. He was alive and well after 7-months of follow up.
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Affiliation(s)
- S Tricot
- Service des maladies du sang, hôpital Huriez, CHRU, 59037 Lille, France
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18
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Abstract
Aortoesophageal fistulas are life-threatening conditions of which over half are secondary to thoracic aortic aneurysms. Four cases related to perforation of a Barrett's ulcer have been described so far, accounting for less than 1% of published aortoesophageal fistulas. We report a fifth case, which presented with severe hypotension, anemia and hematemesis. The patient underwent emergency esophagectomy and aortic closure but postoperatively required aortic endoprosthesis for residual bleeding. This case highlights the great diagnostic and therapeutic challenge associated with perforated Barrett's ulcer.
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Affiliation(s)
- P Guillem
- Department of Thoracic Surgery, University Hospital, Lille, France.
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Jaillard S, Nseir S, Métois D, Marquette CH, Darras J, Porte H, Wurtz A. Extensive corrosive injuries of the upper airways and gastrointestinal tract. J Thorac Cardiovasc Surg 2002; 123:186-8. [PMID: 11782774 DOI: 10.1067/mtc.2002.118273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Jaillard
- Clinique de Chirurgie Thoracique, Centre Hospitalier Universitaire de Lille, France.
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Abstract
STUDY AIM Mechanisms that modulate fetal pulmonary circulation and transitional circulation at birth are incompletely understood. The aim of this experimental study was to describe an animal model in order to study the perinatal pulmonary circulation. MATERIAL AND METHODS Pregnant ewes were operated on between 126 and 128 days gestation (term = 145 days). A skin incision was performed to the fetal lambs in utero and catheters were placed into the ascending aorta and the superior vena cava after insertion in the axillary artery and vein. Then, catheters were inserted into the left pulmonary artery (LPA), main pulmonary artery, and left atrium via a thoracotomy. Moreover, an ultrasonic flow transducer, and an inflatable vascular occluder were placed around the LPA and around the ductus arteriosus. During 10 days, studies were performed in utero (possibly continued when fetal lambs were delivered by caesarean section). This chronically prepared animal may be used to perform hemodynamic studies according to different protocols (drugs injection to the fetus or to the ewes, ductus arteriosus compression, oxygen test). The main pulmonary artery, aortic, left atrial and amniotic pressures, heart rhythm, and flow signal were continuously recorded. RESULTS Eighteen pregnant ewes were operated on and nine only could be used for experimentation. This ovine model permitted several studies, particularly about effects of catecholamines on the pulmonary circulation, and about effects of ductus arteriosus compression on the pulmonary circulation. CONCLUSION Chronically instrumented fetal lambs are an excellent model in order to study the perinatal pulmonary circulation.
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Affiliation(s)
- S Jaillard
- Clinique de chirurgie thoracique, hôpital Calmette, CHRU de Lille, 59037 Lille, France.
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21
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Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, Foucart A, Wurtz A. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg 2001; 71:981-5. [PMID: 11269485 DOI: 10.1016/s0003-4975(00)02509-1] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In recent case reports and limited series, adrenalectomy was recommended for an isolated adrenal metastasis from non-small cell lung cancer (NSCLC). METHODS We retrospectively studied patients with a solitary adrenal metastasis from NSCLC who had undergone potentially curative resection in eight centers. RESULTS Forty-three patients were included. Their adrenal gland metastasis was discovered synchronously with NSCLC in 32 patients, and metachronously in 11. It was homolateral to the NSCLC in 31 patients and contralateral in 12 (p < 0.01). Median survival was 11 months, and 3 patients survived more than 5 years. There was no difference between the synchronous and metachronous groups regarding recurrence rate or survival. Survival was not affected by the homolateral location of the metastasis, the histology of the NSCLC, TNM stage, any adjuvant and neoadjuvant treatment, or, in the metachronous group, a disease-free interval exceeding 6 months. CONCLUSIONS We confirm the possibility of long-term survival after resection of isolated adrenal metastasis from NSCLC, but no clinical or pathologic criteria were detected to identify patients amenable to potential cure.
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Affiliation(s)
- H Porte
- Clinique Chirurgicale, H pital A. Calmette Centre Hospitalier et Universitaire de Lille, France.
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Jaillard S, Pierrat V, Truffert P, Métois D, Riou Y, Wurtz A, Lequien P, Storme L. Two years' follow-up of newborn infants after extracorporeal membrane oxygenation (ECMO). Eur J Cardiothorac Surg 2000; 18:328-33. [PMID: 10973543 DOI: 10.1016/s1010-7940(00)00514-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit. METHODS Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Mean gestational age and birth weight were 38+/-2 weeks and 3200+/-500 g, respectively. Oxygenation index was 61+/-8. Both venovenous (n=28) or venoarterial ECMO (n=29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134+/-68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (100%), others 5/8). Follow-up at 2 years was available in 36 survivors. RESULTS Neurodevelopmental outcome was not related to the initial diagnosis: normal neurologic development (n=30), cerebral palsy (n=5), and neurologic developmental delay (n=1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal reflux. Respiratory and digestive sequelae were more frequent in the CDH group (P<0.01). Patency and flow of the repaired carotid artery was assessed in 20 infants at 1 year of age using Doppler ultrasonography: normal (n=10), <50% stenosis (n=9), and >50% stenosis (n=1). CONCLUSION ECMO increased survival of newborn infants with refractory hypoxemia. However, higher a survival rate and lower morbidity were found in non-CDH infants than in congenital diaphragmatic hernia.
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Affiliation(s)
- S Jaillard
- Department of Thoracic Surgery, A. Calmette Hospital, Centre Hospitalier Régional et Universitaire de Lille, Bd. du Professeur Leclercq, 59037 cedex, Lille, France.
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Abstract
OBJECTIVE To study the results of surgical treatment of primary lung sarcoma. METHODS Between 1982 and 1998, we performed 18 macroscopically complete resections for primary sarcomas of the lung. The records of all patients were reviewed, as were pathological slides. Presence of symptoms, tumour size (more or less than 5 cm), complete resection, TNM stage and histology grade were analyzed for predictors of survival. RESULTS Patients comprised 11 women and seven men whose age ranged from 19 to 73 years (mean 50 years). Mean tumour diameter was 8.05 cm (range 2.5-15 cm) There were one grade 1, eight grade 2 and nine grade 3 tumours. Tumours in two patients were unresectable at first presentation, and another was of doubtful resectability according to computed tomography scan. These three patients received pre-operative chemotherapy, with a partial response in the two unresectable patients allowing macroscopically complete resection in both cases. We performed 12 lobectomies (extended to the chest wall in two cases and to the diaphragm in two cases) and six pneumonectomies (extended to the chest wall in one case and the superior vena cava in one case). Operative and 30 days post-operative mortality were nil. Resection margins were invaded in two cases. Six patients received post-operative chemo- or radiotherapy and three others underwent repeat resections for pulmonary sarcoma recurrence. No patients were lost to follow-up. Pulmonary sarcomas recurred in eight patients (44%) leading to death in five cases after a mean period of 17 months. Overall median survival was 48 months, and actuarial 5-year survival 43%. Only TNM stage correlated with significantly increased survival. CONCLUSION As complete resection is the best therapeutic option for obtaining an acceptable survival rate in primary pulmonary sarcoma, pre-operative chemotherapy can be a useful adjunct in increasing the resectability of these tumours.
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Affiliation(s)
- H L Porte
- Department of Thoracic Surgery, Lille University Hospital, Hôpital Calmette, 1 Rue du Professeur J. Leclercq, 59037 Cédex, Lille, France.
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24
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Abstract
Mucous cells in the respiratory tract contribute to the maintenance of the normal epithelial cell population via mechanisms of cell proliferation and differentiation. Mucous cell hyperplasia often occurs as a basic response to injury in the tracheobronchial epithelium. These cells are also thought to be involved in the histogenesis of epidermoid metaplasia. A typical biochemical feature of these cells is mucus secretion. Aberrant glycosylation or under-glycosylation of mucins is well known in cancer; however, the specific role played by mucin genes is at present unclear. To provide information regarding the expression of these genes in squamous metaplasia and squamous cell carcinoma, we analyzed and compared the expression of MUC1-MUC7 genes by in situ hybridization in control respiratory mucosa and lesions associated with neoplasia (hyperplasia, metaplasia and dysplasia) and squamous cell carcinomas. MUC4 was expressed independently of mucus secretion since it was expressed weakly by basal cells and probably by ciliated cells as well as collecting ducts, epidermoid metaplasia with complete squamous cell differentiation, and most of epidermoid carcinomas even well differentiated and keratinized. In squamous metaplasia and dysplasia, MUC4 gene expression was diffuse and less intense than in normal epithelium. MUC5AC was overexpressed in dysplasia as well as in mucous cell and basal cell hyperplasia and undetectable when squamous differentiation was achieved.
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Affiliation(s)
- M C Copin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital A. Calmette, CHRU Lille, France
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25
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Porte H, Metois D, Finzi L, Lebuffe G, Guidat A, Conti M, Wurtz A. Superior vena cava syndrome of malignant origin. Which surgical procedure for which diagnosis? Eur J Cardiothorac Surg 2000; 17:384-8. [PMID: 10773559 DOI: 10.1016/s1010-7940(00)00376-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Since some malignancies causing superior vena cava syndrome (SVCS) are only sensitive to a specific treatment regimen, it is crucial to diagnose the underlying pathology in such cases. The aim of the present study was to review the surgical procedures used to establish the aetiology of SVCS of a malignant origin. METHODS This retrospective study was based on a series of 88 patients referred to surgeons for SVCS, for whom biological and/or endoscopic procedures had failed to establish the diagnosis. On the basis of the results of clinical examination, biological tests and CT-scan presentation, we performed 99 sampling procedures to obtain a diagnosis for all 88 patients. These procedures were the following: biopsy of peripheral adenopathy (n=11), CT-guided biopsy (CTGB; n=23), axial mediastinoscopy (MDS; n=23), anterior mediastinotomy (n=26), anterior mediastinoscopy (n=6), biopsy of the suprascapular mass (n=3), pericardioscopy (n=3), thoracoscopy (n=1), thoracotomy (n=2) and sternotomy (n=1). RESULTS Per-operative morbidity consisted of one case of massive venous bleeding during MDS requiring a salvage sternotomy to achieve hemostasis. The diagnoses finally established for the 88 patients were non-Hodgkin's lymphoma (NHL) for 36, small cell lung cancer for 25, non-small cell lung cancer for 17, Hodgkin's disease for five, thymoma for three, germ cell tumour for one and sarcoma for one. For the diagnosis of lung cancer, the sensitivities of CTGB and MDS were 85 and 100%, respectively. For the diagnosis of NHL, the sensitivity of anterior mediastinotomy was 95%. CONCLUSION The surgical diagnostic procedure, chosen on the basis of the clinical presentation and CT-scan, can be performed safely in the case of SVCS, with the same accuracy as in the absence of this syndrome. Among the patients referred to surgeons, NHL is the most frequent aetiology of SVCS, together with small cell lung cancer.
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Affiliation(s)
- H Porte
- Division of Thoracic Surgery, Calmette Hospital, Lille University Hospital, 59037, Lille, France
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26
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Delebecq TJ, Porte H, Zerimech F, Copin MC, Gouyer V, Dacquembronne E, Balduyck M, Wurtz A, Huet G. Overexpression level of stromelysin 3 is related to the lymph node involvement in non-small cell lung cancer. Clin Cancer Res 2000; 6:1086-92. [PMID: 10741738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Proteases contribute to tumor invasion and metastasis via their potential to degrade basement membranes and extracellular matrix. Our aim was to compare the level of several proteases: urokinase-type plasminogen activator (u-PA), matrix metalloproteinase 2 (MMP-2; 72-kDa type IV collagenase, also known as gelatinase A), MMP-11 [also known as stromelysin 3 (STR3)], and cathepsins B and L in resected non-small cell lung cancer. Between June 1996 and March 1998, samples of lung tumor tissues were taken from 119 surgically treated patients. Thirty out of the 119 tumor samples were matched with corresponding adjacent normal tissue. u-PA was measured by a commercially available immunoluminometric assay. Metalloproteinases and cathepsins have been evaluated at the RNA level by Northern blot and quantified with a PhosphorImager. Expression of these proteases was compared to the following clinicopathological parameters: pathological diagnosis, tumor size, exposure to asbestos, radiotherapy, neo-adjuvant chemotherapy, tumor-node-metastasis stage, lymph node involvement, presence of metastasis. u-PA, MMP-2, MMP-11/STR3, and cathepsin B were significantly increased in tumor (the tumor:normal ratio was on average increased by 5.4-, 2.2-, 83.5-, and 2.2-fold, respectively). The tumor:normal ratio of MMP-11/ STR3 was found to be significantly linked to the lymph node involvement (P < 0.05). Our results suggest that several proteases are involved in the invasive potential of non-small cell lung cancer and that the quantification of MMP-11/ STR3 could represent an useful prognostic marker.
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Affiliation(s)
- T J Delebecq
- Laboratoire de Biochimie, Hôpital Claude Huriez, Lille, France
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27
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Lipp M, Brodmann P, Pietsch K, Pauwels J, Anklam E, Börchers T, Braunschweiger G, Busch U, Eklund E, Eriksen FD, Fagan J, Fellinger A, Gaugitsch H, Hayes D, Hertel C, Hörtner H, Joudrier P, Kruse L, Meyer R, Miraglia M, Müller W, Phillipp P, Pöpping B, Rentsch R, Wurtz A. IUPAC collaborative trial study of a method to detect genetically modified soy beans and maize in dried powder. J AOAC Int 1999; 82:923-8. [PMID: 10490320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
This paper presents results of a collaborative trial study (IUPAC project No. 650/93/97) involving 29 laboratories in 13 countries applying a method for detecting genetically modified organisms (GMOs) in food. The method is based on using the polymerase chain reaction to determine the 35S promotor and the NOS terminator for detection of GMOs. reference materials were produced that were derived from genetically modified soy beans and maize. Correct identification of samples containing 2% GMOs is achievable for both soy beans and maize. For samples containing 0.5% genetically modified soy beans, analysis of the 35S promotor resulted also in a 100% correct classification. However, 3 false-negative results (out of 105 samples analyzed) were reported for analysis of the NOS terminator, which is due to the lower sensitivity of this method. Because of the bigger genomic DNA of maize, the probability of encountering false-negative results for samples containing 0.5% GMOs is greater for maize than for soy beans. For blank samples (0% GMO), only 2 false-positive results for soy beans and one for maize were reported. These results appeared as very weak signals and were most probably due to contamination of laboratory equipment.
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Affiliation(s)
- M Lipp
- Institute for Health and consumer protection, Food Products unit, Ispra(Va), Italy
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Brichet A, Verkindre C, Dupont J, Carlier ML, Darras J, Wurtz A, Ramon P, Marquette CH. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J 1999; 13:888-93. [PMID: 10362058 DOI: 10.1034/j.1399-3003.1999.13d32.x] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The optimal management of postintubation tracheal stenosis is not well defined. A therapeutic algorithm was designed by thoracic surgeons, ear, nose and throat (ENT) surgeons, anaesthetists and pulmonologists. Rigid bronchoscopy with neodymium-yttrium aluminium garnet (Nd-YAG) laser resection or stent implantation (removable stent) was proposed as first-line treatment, depending on the type of stenosis (web-like versus complex stenosis). In patients with web-like stenoses, sleeve resection was proposed when laser treatment (up to three sessions) failed. In patients with complex stenoses, operability was assessed 6 months after stent implantation. If the patient was judged operable, the stent was removed and the patient underwent surgery if the stenosis recurred. This algorithm was validated prospectively in a series of 32 consecutive patients. Three patients died from severe coexistent illness shortly after the first bronchoscopy. Of the 15 patients with web-like stenosis, laser resection was curative in 10 (66%). Among the 17 patients with complex stenoses, three remained symptom-free after stent removal. Bronchoscopy alone was thus curative in more than one-third of the patients. Six patients underwent surgery, two after failure of laser resection and four after failure of temporary stenting. Surgery was always performed with the patient in good operative condition. Palliative stenting was the definitive treatment in nine cases. Tracheostomy was the definitive solution in two cases. This approach, including an initial conservative treatment, depending on the type of the stenosis, appears to be applicable to almost all patients and allows secondary surgery to be performed with the patient in good condition.
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Affiliation(s)
- A Brichet
- Clinique des Maladies Respiratoires, Hôpital A. Calmette, CHRU de Lille, France
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29
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Porte H, Triboulet JP, Kotelevets L, Carrat F, Prévot S, Nordlinger B, DiGioia Y, Wurtz A, Comoglio P, Gespach C, Chastre E. Overexpression of stromelysin-3, BM-40/SPARC, and MET genes in human esophageal carcinoma: implications for prognosis. Clin Cancer Res 1998; 4:1375-82. [PMID: 9626453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Molecular markers can improve staging and predict aggressive clinical behavior in esophageal cancer, thus helping to define appropriate therapeutic protocols and to identify patients who will benefit from surgery. We therefore characterized, by Northern blot and/or immunohistochemistry, the relative expression of three effectors involved in the invasion, angiogenesis, and dissemination of tumor cells in esophageal cancer versus nontumoral mucosae: (a) stromelysin-3 (ST3), a member of the metalloproteinase family; (b) basement membrane 40/secreted protein acidic and rich in cysteine (BM-40/SPARC), an extracellular matrix-associated protein involved in angiogenesis; and (c) the hepatocyte growth factor receptor MET, which triggers the scattering of epithelial cells. Results were analyzed in relation to clinicopathological parameters (cpTNE) including tumor size (T), lymph node status (N), periesophageal tissue invasion (E), disease recurrence, and overall survival. The ST3, BM-40/SPARC, and MET genes were found to be overexpressed in tumor samples compared to control mucosa. BM-40/SPARC and MET mRNA levels were not linked to any one of the cpTNE, indicating that this overexpression occurs at an early stage of neoplastic progression. In contrast, ST3 expression, identified by immunohistochemistry in fibroblastic cells surrounding neoplastic islets, correlated with tumor size and periesophageal tissue invasion. Of the 36 patients studied, those with high ST3 levels had shorter disease-free survival than those with low levels, but there was no relationship between the cpTNE and disease recurrence or survival. Our study demonstrates that ST3, BM-40/SPARC, and MET are involved in different steps of esophageal carcinogenesis and that ST3 overexpression is a marker of aggressive clinical behavior. We conclude that in esophageal cancer, ST3 might help to assess survival and the risk of recurrence after surgical resection.
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Affiliation(s)
- H Porte
- Unité Institut National de la Santé et de la Recherche Médicale (INSERM) 482, Hôpital Saint-Antoine, Paris, France
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Tsicopoulos A, Pestel J, Fahy O, Vorng H, Vandenbusche F, Porte H, Eraldi L, Wurtz A, Akoum H, Hamid Q, Wallaert B, Tonnel AB. Tuberculin-induced delayed-type hypersensitivity reaction in a model of hu-PBMC-SCID mice grafted with autologous skin. Am J Pathol 1998; 152:1681-8. [PMID: 9626072 PMCID: PMC1858436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We have developed an animal model to study human delayed-type hypersensitivity reactions. Previous studies in humans have shown after tuberculin injection the presence of a mononuclear cell infiltration, with almost no eosinophils, associated with a preferential Th-1-type cytokine profile. Human skin graft obtained from tuberculin-reactive donors was grafted onto the back of severe combined immunodeficient mice. After healing, mice were reconstituted intraperitoneally with peripheral mononuclear cells. Tuberculin and diluent were injected intradermally, and skin biopsies were performed 72 hours later. Skin grafts were divided into two parts, one for immunohistochemistry and one for in situ hybridization studies. Immunohistochemistry was performed on cryostat sections using the alkaline phosphatase anti-alkaline phosphatase technique. In the tuberculin-injected sites as compared with the diluent-injected sites, there were significant increases in the number of CD45+ pan leukocytes and CD4+, CD8+, CD45RO+ T cells but not in CD68+ monocytes/macrophages and EG2 or MBP+ eosinophils. The activation markers CD25 and HLA-DR were up-regulated in the tuberculin-injected sites. In situ hybridization was performed using 35S-labeled riboprobes for interleukin (IL)-2, interferon (IFN)-gamma, IL-4, and IL-5. After tuberculin injection, a preferential Th-1-type cytokine profile was observed with significant increases in the numbers of IL-2 and IFN-gamma mRNA-expressing cells. These results are similar to those reported after tuberculin-induced delayed-type hypersensitivity in humans, suggesting that this model might be useful to study cutaneous inflammatory reaction.
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31
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Porte H, Langlois M, Maquette CH, Dupont J, Anselin JM, Wurtz A. Successful esophageal tracheobronchoplasty for combined tracheal and bronchial traumatic rupture. J Thorac Cardiovasc Surg 1998; 115:1216-8. [PMID: 9605095 DOI: 10.1016/s0022-5223(98)70425-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H Porte
- Clinique Chirurgicale, Hopital Albert Calmette CHRU Lille, France
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Prat A, Vincentelli A, Porte H, Wurtz A. Combined tracheal resection and aortic valve replacement with a cryopreserved aortic valve allograft. Eur J Cardiothorac Surg 1998; 13:606-8. [PMID: 9663547 DOI: 10.1016/s1010-7940(98)00080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A 69-year-old patient presented with an association of tracheal squamous cell carcinoma and severe aortic valve stenosis. As there was no evidence of metastatic spread a potentially curative resection could be considered. The patient underwent tracheal resection and aortic valve replacement in a one-stage procedure. In light of the potential risk of infection to a prosthetic valve, a cryopreserved aortic valve homograft was implanted. The patient made a full recovery and is doing well after 2 years of follow-up.
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Affiliation(s)
- A Prat
- Department of Cardiovascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire, Lille, France.
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Abstract
OBJECTIVE The reported experience of axial mediastinoscopy (MDS) performed in a diagnostic purpose only (rather than prognostic) is limited. Therefore, we designated the present study to clarify morbidity, sensitivity and accuracy of MDS performed to diagnose various mediastinal lesions. METHODS We prospectively performed 400 MDS in a diagnostic purpose on 398 patients for: (1) isolated mediastinal adenopathies in 271 patients (group 1), and (2) mediastinal adenopathies associated with a pulmonary or a hilar lesion of unknown aetiology in 127 patients (group 2). In group 1, most of the patients were suspected to have a sarcoidosis, a tuberculosis or a lymphoma. In group 2, most of the patients were suspected to have a lung cancer. In both groups, the other current diagnostic procedure usually used in each pathology had failed to give an accurate diagnosis. RESULTS A total of 76% of the samples were performed in the right laterotracheal lymph node station, 12.5% in the lower subcarinal and superior subcarinal lymph node station and 7.8% in the left laterotracheal lymph node station. The per- and post-operative mortality rates were nil. The per-operative morbidity accounted for six cases (1.5% of the examinations). The post-operative morbidity accounted for three cases (0.75% of the examinations). MDS data radically modified the pre-operative suspected diagnosis in 74 patients (18.5% of the patients). There were 17 false negative results (4.3% of the patients). The global sensitivity of MDS was 94%, the global specificity was 100% and the accuracy was 95%. In group 1, the sensitivity was 96% and in group 2 it was 92%. CONCLUSION According to the results, the few contraindications of the procedure and its low cost, we confirm that MDS is still the first choice procedure to diagnose lesions located in the axial mediastinum.
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Affiliation(s)
- H Porte
- Clinique Chirurgicale, Hopital Albert Calmette, CHRU de Lille, France
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Abstract
We report the case of a 17-year old girl presenting a 3-month history of progressive dysphonia, and ultimately acute respiratory failure. CT scan and bronchoscopy showed severe extrinsic compression of the carina and of the left main stem bronchus. Emergency thoracotomy was performed permitting complete resection of an intra mural oesophageal bronchogenic cyst. The post operative course was uneventful except a persistent dysphonia. Dysphonia is an exceptional early symptom of bronchogenic cyst located in the oesophageal wall.
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Affiliation(s)
- P Guillem
- Clinique Chirurgicale Ouest, Albert Calmette Hospital, Lille University Hospital (CHRU de Lille), France
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35
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Porte H, Copin MC, Eraldi L, Roumilhac D, Jaillard-Thery S, Puech P, Bauters F, Gosselin B, Wurtz A. Retroperitoneoscopy for the diagnosis of infiltrating retroperitoneal lymphadenopathy and masses. Br J Surg 1997. [DOI: 10.1002/bjs.1800841026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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36
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Porte H, Copin MC, Eraldi L, Roumilhac D, Jaillard-Thery S, Puech P, Bauters F, Gosselin B, Wurtz A. Retroperitoneoscopy for the diagnosis of infiltrating retroperitoneal lymphadenopathy and masses. Br J Surg 1997; 84:1433-6. [PMID: 9361607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Retroperitoneoscopy (RPS) is a form of direct vision endoscopy, used to explore the retroperitoneal space, and was first described by Bartel in 1969. METHODS RPS was performed prospectively to diagnose infiltrating retroperitoneal lymphadenopathy or masses when needle aspiration biopsy under computed tomographic guidance (NABCT) failed to establish a definite diagnosis. RESULTS From May 1985 to August 1995, RPS was performed in 118 patients (121 procedures). Mean hospital stay was 2.4 (range 2-5) days. The peroperative and perioperative morbidity rate was 6.6 per cent of the procedures. A precise diagnosis was obtained in 108 of the 118 patients. The sensitivity was 84 per cent for malignant lymphoma, 94 per cent for Hodgkin's lymphoma, 95 per cent for metastatic lymph nodes of carcinomas and 100 per cent for primary retroperitoneal tumours. The overall sensitivity was 91.5 per cent. CONCLUSION RPS is an alternative procedure to NABCT when aspiration biopsy is not technically feasible because a lesion is too small to sample or failed to establish a precise histopathological diagnosis.
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Affiliation(s)
- H Porte
- Clinique Chirurgicale, Hôpital Calmette, Lille, France
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37
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Porte H, Copin MC, Eraldi L, Roumilhac D, Jaillard-Thery S, Puech P, Bauters F, Gosselin B, Wurtz A. Retroperitoneoscopy for the diagnosis of infiltrating retroperitoneal lymphadenopathy and masses. Br J Surg 1997. [DOI: 10.1111/j.1365-2168.1997.02808.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This report describes the case of a 67-year-old man in whom atrial right-to-left shunt developed after a right pneumonectomy, leading to dyspnea with severe arterial desaturation. Transcatheter occlusion of the patent foramen ovale was successfully performed using a buttoned device. Review of literature and mechanisms of these atrial right-to-left shunts are discussed.
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Affiliation(s)
- F Godart
- Hôpital Cardiologique and Clinique Chirurgicale, Hôpital Calmette, Centre Hospitalier Régional Universitaire de Lille, France
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Defebvre L, Destée A, Caron J, Ruchoux MM, Wurtz A, Remy J. Creutzfeldt-Jakob disease after an embolization of intercostal arteries with cadaveric dura mater suggesting a systemic transmission of the prion agent. Neurology 1997; 48:1470-1. [PMID: 9153501 DOI: 10.1212/wnl.48.5.1470] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- L Defebvre
- Department of Neurology A, Hôspital R. Salengro, Lille, France
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40
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Mizrahi D, Ernst O, Leteurtre E, Wurtz A, Gosselin P, Lemaitre L. [Intrapancreatic accessory spleen. X-ray computed tomographic and MRI imaging]. J Radiol 1997; 78:145-7. [PMID: 9113160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report MRI and CT findings of an intrapancreatic accessory spleen. The lesion was hypervascular on CT and isointense to the spleen on MRI. This uncommon localisation may simulate a pancreatic mass. If the diagnosis is suspected, it can be confirmed by scintigraphy.
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Wurtz A, Porte H, Jaillard Thery S, Roumilhac D, Rémy Jardin M. [Unknown cause of superior caval syndrome: the innominate vein compression syndrome]. Presse Med 1997; 26:83. [PMID: 9082420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Porte H, Wurtz A, Gambiez L, Jaillard Thery S, Chambon JP, Bauters F, Gosselin B. [Diagnosis of adenopathies and retroperitoneal masses by surgical endoscopy. Apropos of 93 cases]. Chirurgie 1997; 121:631-5. [PMID: 9138322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lumboscopy is an endoscopic surgical technique providing direct visualization of the retroperitoneal space from the kidney hilium to the iliac bifurcation. We report our 10-year experience with this technique used to diagnose masses in the retroperitoneal space. This method is not very invasive and the morbidity is low. The sensitivity is greater than needle biopsy under CT guidance.
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Affiliation(s)
- H Porte
- Clinique Chirurgicale Ouest, Hôpital Calmette, CHRU Lille
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43
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Porte H, Wurtz A, Jaillard-Thery S, Vincentelli A, Eraldi L, Roumilhac D. Ten-year experience with extraperitoneal pelvioscopy for the lymph node staging of pelvic cancers. Surg Endosc 1996; 10:1145-9. [PMID: 8939831 DOI: 10.1007/s004649900267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In view of the surgical lymphadenectomy morbidity and of the low accuracy of the preoperatory radiological investigations, minimal access surgery procedures are needed to assess lymph node involvement in pelvic cancers. METHODS Extraperitoneal pelvioscopy (EPP) is a direct vision endoscopy permitting the exploration of the retroperitoneal space of the pelvic area. Beginning 1/05/1995, 235 patients with apparently resectable tumors underwent EPP for lymph node staging of 133 bladder, 89 prostate, 12 cervix, and one endometrium cancers. RESULTS Lymph node involvement was discovered in 68 cases; the absence of lymph node involvement was demonstrated in 155 cases; and there were 12 false-negative results of the procedure. The feasibility was of 98.3%. The global sensitivity and accuracy were, respectively, 85% and 94%. CONCLUSION This study demonstrates that EPP is a safe and accurate procedure to evaluate the lymph node status of pelvic cancers.
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Affiliation(s)
- H Porte
- Clinique Chirurgicale, Hôpital Calmette, Boulevard du Professeur J. Leclercq, 59037 Lille Cedex, France
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44
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Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A, Ducloux G. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation 1996; 94:1635-41. [PMID: 8840855 DOI: 10.1161/01.cir.94.7.1635] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although previous small series have documented the utility of pericardioscopy for accurate etiologic diagnosis of pericardial effusion, this technique remains underused. The aim of our study was to assess the benefits and risks of surgical pericardioscopy in a large prospective series. METHODS AND RESULTS One hundred forty-one consecutive patients with unexplained pericardial effusion underwent 142 pericardioscopies with a rigid mediastinoscope. For each patient, the etiologic data obtained by pericardioscopy (visualization of pericardium, guided biopsies, subxiphoid window biopsy, and fluid analysis) were compared with the results that would have been obtained with only conventional surgical drainage and biopsy (subxiphoid window biopsy and fluid analysis). After complete workup, a specific cause was found in 69 cases (48.6%); the other 73 cases were considered idiopathic effusions (51.4%). Procedural and in-hospital mortality was 8 of 141 patients (5.6%). No death was directly attributable to pericardioscopy. During long-term follow-up (median duration, 24 months; range, 6 to 96), a previously unrecognized cause was discovered in 6 patients (4%). By comparing the areas under the receiver-operating characteristic curves, the diagnostic advantage of pericardioscopy was significant for the whole series (pericardioscopy, 0.98 +/- 0.011; conventional surgical drainage, 0.89 +/- 0.029; P < .001). The increase in sensitivity was more marked for some types such as neoplastic (21%), radiation-induced (100%), or purulent (83%) effusions. CONCLUSIONS Our data demonstrate that pericardioscopy increases the diagnostic sensitivity of surgical pericardial drainage and biopsy without specific risk.
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Affiliation(s)
- O Nugue
- C Division of Cardiology, Heart Hospital, France
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45
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Delcambre F, Pruvot FR, Ramon P, Noël C, Pol A, Jaillard-Théry S, Dupont J, Declerck N, Gosselin B, Rémy-Jardin M, Wurtz A, Laffite JJ. Primary bronchogenic carcinoma in transplant recipients. Transplant Proc 1996; 28:2884-5. [PMID: 8908109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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46
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Remy-Jardin M, Remy J, Gosselin B, Copin MC, Wurtz A, Duhamel A. Sliding thin slab, minimum intensity projection technique in the diagnosis of emphysema: histopathologic-CT correlation. Radiology 1996; 200:665-71. [PMID: 8756912 DOI: 10.1148/radiology.200.3.8756912] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the accuracy of sliding thin slab, minimum intensity projection technique in the detection of emphysema. MATERIALS AND METHODS In 29 patients without radiographic evidence of emphysema and who were undergoing lung resection, focal spiral computed tomography (CT) was performed in the lobe to be resected. Ten contiguous 1-mm-thick CT scans and sliding thin slab, minimum intensity projection images with slab thicknesses of 3-, 5-, and 8 mm were generated. From each image, the presence and extent of emphysema were recorded before histopathologic analysis was performed. To familiarize readers with the appearance of normal lung parenchyma on sliding thin slab, minimum intensity projection images, five asymptomatic volunteers underwent scanning with a similar protocol. RESULTS Emphysema was present on both thin-section CT scans and sliding thin slab, minimum intensity projection images in 13 patients. In all cases, sliding thin slab, minimum intensity projection images improved conspicuity of small areas of hypoattenuation. When thin-section CT scans were negative (n = 16), sliding thin slab, minimum intensity projection images enabled identification of focal zones of hypoattenuation in four cases with histologic confirmation of emphysema. Sensitivity of thin-section CT (62%) and sliding thin slab, minimum intensity projection technique (81%) were significantly different (P < .01); specificity for both was 100%. Emphysema was easier to detect on 8-mm-thick slabs because of better suppression of vascular structures. CONCLUSION The sliding thin slab, minimum intensity projection technique enabled improved detection of mild forms of emphysema.
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Affiliation(s)
- M Remy-Jardin
- Department of Radiology, Hôpital Calmette, Lille, France
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47
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Quandalle P, Dewailly-Toniut S, Vandenhaute B, Lecomte-Houcke M, Saudemont A, Wurtz A. [Total pancreatectomy for diffuse and malignant mucinous ductal ectasia of the pancreas. Apropos of 2 cases]. Ann Chir 1996; 50:886-91. [PMID: 9183873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cases of mucinous duct ectasia are reported. Epithelial changes were spread along the pancreatic duct and ductal ectasia was diffuse. Multi focal infiltrating carcinoma was observed in one case, microinvasive carcinoma located in the head of the pancreas was observed. Morphologic features by computed tomography, endoscopic ultrasonography pancreatography were useful for preoperative diagnosis of mucinous pancreatic duct ectasia. In one case, malignancy was suggested by measurement of tumor markers in cystic fluid aspirated during percutaneous pancreatography. Total duodenopancreatectomy was performed in both cases. The two patients were alive and disease-free with a follow-up in both cases of 18 and 36 months.
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Affiliation(s)
- P Quandalle
- Sèrvice de Chirurgie Adultes Ouest, Hôpital Claude-Huriez, Lille
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Porte H, De Moulins H, Gambiez L, Wurtz A, Quandalle P. A pilot study of adjuvant hepatic arterial infusion chemotherapy, associating 5-fluorouracil and leucovorin, after resection of colorectal cancer liver metastases. Surg Oncol 1995; 4:317-22. [PMID: 8809954 DOI: 10.1016/s0960-7404(10)80044-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We initiated a pilot study of adjuvant hepatic arterial infusion chemotherapy (AHAIC) using 5-fluorouracil (5-FU) and leucovorin. Hepatic arterial infusion ports were placed in 15 consecutive patients undergoing curative resection of colorectal liver metastases. The chemotherapy regimen consisted of a weekly infusion of 5-FU (12 mg m 2 per day) and leucovorin (200 mg m 2 per day) for 12 months. The mean follow-up was 22 months (range 3-62 months, SD 21-37 months). There were no clinical or biological complications related to chemotherapy, except for sharp epigastric burns in four patients immediately after 5-FU infusions. Catheter irreversible occlusions led to early cessation of the treatment in three patients. Four of the 15 evaluable patients developed recurrent disease. The site of relapse was the liver in two patients and extra-hepatic sites in the two remaining patients. Three of these four patients died of their recurrent disease. These results suggest that 5-FU and leucovorin can be combined for AHAIC in a long duration regimen with a very low rate of side-effects. This protocol could be safely employed in a prospective randomized study in combination with 5-FU systemic infusions.
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Affiliation(s)
- H Porte
- Hôpital Calmette, Clinique chirurgicale, Lille, France
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49
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Remy-Jardin M, Duyck P, Remy J, Petyt L, Wurtz A, Mensier E, Copin MC, Riquet M. Hilar lymph nodes: identification with spiral CT and histologic correlation. Radiology 1995; 196:387-94. [PMID: 7617850 DOI: 10.1148/radiology.196.2.7617850] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the appearance of normal hilar lymph nodes and associated soft tissue at spiral computed tomography (CT). MATERIALS AND METHODS At spiral CT in 50 healthy patients, peribronchovascular hypoattenuated areas of 42 right and 45 left hila were systematically evaluated. Histologic results were correlated in five additional cases. RESULTS Hilar lymph nodes were depicted (a) in the right hilum (lateral to A2 [n = 33 (79%)], medial [n = 29 (69%)] or lateral [n = 11 (26%)] to the interlobar pulmonary artery, and medial to the lower-lobe pulmonary artery [n = 30 (71%)], A7 [n = 9 (21%)], and A8-10 [n = 8 (19%)]; and (b) in the left hilum (lateral to A2 [n = 22 (49%)], medial to the interlobar pulmonary artery [n = 45 (100%)], and the lower-lobe pulmonary artery [n = 27 (60%)], and in the angles of bifurcation of A7 + 8 and A9 + 10 [n = 18 (40%)]). Hilar lymph nodes were seen to be triangular or linear and to be less than 3 mm wide except around the left-lower-lobe pulmonary artery. CONCLUSION Spiral CT accurately depicts normal hilar lymph nodes and their major anatomic relationships.
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Affiliation(s)
- M Remy-Jardin
- Department of Radiology, Hôpital Calmette, Lille, France
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50
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Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 1994; 116:999-1004; discussion 1004-5. [PMID: 7985108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Most abnormal parathyroid glands can be removed through the neck, but those deep in the chest have required sternotomy or thoracotomy. To avoid the morbidity of these open procedures, ectopic parathyroid glands deep in the chest were removed with video-assisted thoracoscopy. METHODS Two patients with persistent primary and two with persistent secondary hyperparathyroidism had technetium-thallium scintigraphy and computed tomography of the chest to localize their ectopic glands. Video-assisted thoracoscopy was used for operative removal of these glands in each patient. RESULTS Parathyroid scans identified a mediastinal gland that was confirmed and localized precisely by the computed tomography scan. An enlarged ectopic gland weighing 1 to 2 gm was removed from each patient with normalization of serum calcium level. Glands were found by the main pulmonary artery, aortopulmonary window, ascending aorta, and aortic arch. One patient had recurrent disease 9 months later. CONCLUSIONS Removal of parathyroid glands deep in the chest with video-assisted thoracoscopy is a safe and successful alternative to median sternotomy.
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Affiliation(s)
- R A Prinz
- Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill 60612
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