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Background Acute Severe Ulcerative Colitis (ASUC) may occur in up to 25% of patients with UC during their disease course. Despite intensive in-hospital management, some patients still require colectomy. We aimed to define the mucosal immune phenotypes related to ASUC that associate with treatment-outcomes. Methods Adult patients with ASUC (defined by Truelove and Witts criteria), (n=32) were recruited. UC patients (mild-moderate disease) (n=31) and normal volunteers (NV) (n=27) served as controls. Gastrointestinal (GI) biopsies from the left colon were analyzed by multiparameter flow cytometry (FC) for myeloid cells (classical and non-classical monocytes, dendritic cells), lymphoid cells (T cells, B cells) and innate (Natural Killer) cells. Therapeutic non-response was defined as surgery within 3 months of admission. Results Six of the ASUC patients (18.8%) required colectomy during index admission and 8 (25%) within 3 months of admission, i.e. non-responders. Only 14/32(44%) patients were bio naïve on admission. Clinical parameters significantly associated with treatment non-response included lower hemoglobin and albumin levels (Fig. 1A). Significantly higher frequency of classical (CD14+) and non-classical (CD16+) monocytes as well as proliferating CD4+ and CD8+ cells were seen in ASUC compared to NV and UC patients with Mayo 1, 2, 3 inflammation (Fig. 1B). Furthermore, ASUC patients who were non-responsive to medical treatment had higher frequencies of CD14+ monocytes and proliferating (Ki67+) CD4+ T cells in the colon compared to medical treatment responders (Fig 1C). Conclusion High frequencies of CD14+ monocytes and proliferating CD4+ T cells in the colon represent distinct immune signatures that relate to ASUC outcomes. Clinical trials targeting adverse clinical and immune phenotype-associated ASUC patients with combination therapies are warranted.

Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.

Background Homeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by chronic lung allograft dysfunction, an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling. Objective This study assessed whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling posttransplantation. Methods Microbiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post lung transplantation. Expression of a set of 11 genes encoding either matrix components or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively) was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture. Results We identified 4 host gene expression profiles, among which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by proinflammatory bacteria (eg, Staphylococcus, Pseudomonas, and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (eg, Prevotella, Streptococcus, and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact host macrophage-fibroblast activation and matrix deposition. Conclusions Host-microbes interplay potentially determines remodeling activities in the transplanted lung, highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome., Graphical abstract

Objectif Presenter un cas original et inhabituel d’intoxication au plomb apres une blessure par une munition speciale. Description Un homme de 38 ans sans antecedent connu de saturnisme a ete atteint par des fragments d’une munition qui a d’abord traverse une porte avant d’atteindre la victime. Les lesions initiales concernaient le thorax gauche, l’epaule gauche et le plexus brachial gauche. Hospitalise dans une unite hospitaliere securisee apres un sejour en reanimation, la premiere plombemie a ete realisee a j7 de la blessure. La symptomatologie presentee alors etait une sensation de fatigue extreme, de constipation et d’atteinte neurologique peripherique cubitale gauche. Un traitement par succimer et de l’EDTA a j14, j21, j44, j61 ainsi que l’extraction chirurgicale de morceaux de plomb a j52 a ete realise, apres amelioration de l’etat de sante initial. Depuis 3 ans, le patient presente un saturnisme chronique clinique et biologique necessitant des chelations iteratives. Methodes Les plombemies ont ete realisees par spectrometrie d’absorption atomique par four graphite (GF-AAS). La plombemie a j7 etait de 1048 μg/L avec un pic a 1566 μg/L a j11. Les autres marqueurs, a j11, etaient une hemoglobine a 11,6 g/dL, une protoporphyrine erythrocytaire a 1,911 μmol/L et un taux d’acide delta-aminolevulinique urinaire a 13 μmol/mmol de creatinine. Deux residus metalliques sous-cutanes et un echantillon de cheveux ont ete envoyes pour analyse par ICP-MS : ils ont confirme (i) que du plomb etait present dans les residus (817 et 841 mg par gramme), (ii) qu’il y avait incorporation recente de plomb dans les cheveux (63 ng/mg dans le segment distal et 119 ng/mg dans le segment proximal), (iii) et que le plomb dans les cheveux provenait de la meme origine que les balles (les rapports isotopiques etaient les memes : Pb 206/Pb 207 = 1,17, Pb 208/Pb 207 = 2,44, Pb 208/Pb 206 = 2,08). Conclusion Cette munition speciale contenait 30 g de plomb mou non protege par une enveloppe metallique. Elle n’etait pas destinee a etre utilise directement sur une cible vivante, mais a la destruction de serrures ou gonds de porte non renforcee. Une contamination aussi rapide, elevee et massive est liee a la charge en plomb (30 g) dans une balle non chemisee, au type de plomb (mou, plus sujet a fragmenter que le plomb durci), et a la localisation du reservoir en plomb dans le corps (plevre et epaule).

Background The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease. Methods Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics. Results Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017). Conclusion NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

This study was designed as an external evaluation of the Steyerberg score in the prediction of different categories of postoperative mortality after esophagectomy on a large nationwide database of thoracic surgeons. Data collection was obtained from the Epithor national database encompassing the majority of thoracic procedures performed in France. We retrospectively compared the predicted to the observed postoperative 30-day (30DM), 90-day (90DM) and in-hospital mortality (IHM) rate in each decile of equal patient. Patients included in the study were operated for an esophageal cancer and Gastroesophageal junction (GEJ). Steyerberg score was determined according to its logarithmic formula obtained from a sum score including age, comorbidities, neoadjuvant treatment and hospital volume. Deviation of observed from theoretically expected number of deaths was investigated using the calibration test of Hosmer-Lemeshow. Discrimination of the score was determined using the measure of the area under the receiver operating characteristic curve (AUC) of each category of mortality. Over a 9-year period, 1039 consecutive patients underwent an esophagectomy over 42 centers. Among them, 18 centers were considered as intermediate or high-volume institutions, and 24 were low-volume institutions. There were 841 males (81%) with a mean age of 62.3 ± 10 years. Preoperative treatment was allocated to 420 patients (40%). Numbers of comorbidity was: 1 in 261 patients (25%), 2 in 264 patients (25%), 3 in 383 patients (36%) and 4 in 5 patients (1%). The 30DM, 90DM and IHM rate were, respectively, 5.6%, 9.2% and 9.6%. The main causes of postoperative deaths were related to pulmonary complications (44%), complications of the gastric interposition (28%), cardiologic and thromboembolism events (10%). For 30DM, there were significant differences between predicted/observed mortalities in four deciles, whereas there was no significant difference for 90DM and for IHM. In term of calibration, there was a fair agreement of the Steyerberg score with observed 30DM. Predictions were above 20% for seven deciles. Calibration seemed more adequate for 90DM and for IHM. Predictions were above 20% for only three deciles but deviations were not significant. In terms of discrimination, for the 30DM the Steyerberg score overpredicted, the observed mortality rate and AUC was 0.64 (CI 95%: 0.57-0.71). For the 90DM, AUC indicated 0.63 (CI 95%: 0.57-0.68). For the IHM, AUC indicated 0.63 (CI 95%: 0.58-0.68). Steyerberg scoring system seems to be a moderate risk score of the prediction of the IHM and 90DM. This score appears to have a fair discrimination for the 30DM. Nevertheless, because of its simplicity, we believe that this simple predictive score is relevant and transportable to others institution performing such surgery for benchmarking purposes. A reappraisal of the score adapted to current surgical cohort is required.

Initially double-lung transplantation (DLT) was performed with airway anastomosis at the tracheal bifurcation requiring a cardiopulmonary bypass (CBP). Complications related to ischemia of the bronchi and trachea around the carina prompted adoption of sequential single lung implantations as the method of choice for DLT. In different studies, CPB was associated with an increase in postoperative morbidity but this was probably due to the selection of more severe patients. Moreover, important progress in the technology of CPB has occurred. Therefore, the systematic use of CPB during sequential lung transplantation might have some interest by limiting the occurrence of ventilation and perfusion injuries. This article discusses the potential beneficial effects of CPB during double-lung transplantation.

Resume Introduction En France, l’âge moyen du diagnostic du cancer bronchique est de 64 ans. Il est de 76 ans dans la population des plus de 70 ans, son incidence etant liee a l’augmentation avec l’âge du risque intrinseque de developper un cancer et au vieillissement de la population. Les methodes de diagnostic ne different pas chez le sujet âge et chez le sujet plus jeune, et la fibroscopie bronchique reste notamment la pierre angulaire du diagnostic, avec des taux de complications comparables. Etat des connaissances Le bilan d’extension a ete profondement modifie ces dernieres annees avec l’avenement du TEP-Scan, qui semble de plus en plus devenir l’examen de reference et permet de limiter les interventions chirurgicales inutiles, a fortiori chez les sujets âges. L’exploration encephalique par scanner ou mieux par IRM est egalement imperative avant de proposer un acte chirurgical. Avant la decision therapeutique l’evaluation de l’etat de sante du sujet âge est une etape fondamentale. Elle repose sur le concept de l’evaluation geriatrique : l’evaluation geriatrique standardisee de depistage (Geriatric Multidimentionnal Assessment) , et l’evaluation geriatrique approfondie (Comprehensive Geriatric Assessment) qui releve de la competence geriatrique. Perspectives C’est une approche globale du malade qui permet notamment de preciser et de hierarchiser les differents problemes du malade et leur impact fonctionnel sur les activites de la vie quotidienne, l’environnement social du malade… Certaines variables geriatriques (IADL, BADL, MMSE, IMC, etc.) peuvent etre predictives du taux de survie apres chimiotherapie ou du taux de complications postoperatoires apres une chirurgie thoracique. Les grands principes therapeutiques du cancer bronchique sont applicables chez le sujet âge ; la survie a long terme sans recidive apres resection chirurgicale est independante de l’âge. Que la strategie oncologique soit curative ou palliative, le malade âge atteint d’un cancer bronchique doit beneficier de soins de support. Ils s’integreront dans une demarche palliative si tel est le cas. En fait, l’âge seul n’est pas le facteur permettant de recuser une prise en charge oncologique optimale. Conclusions L’elaboration du programme personnalise de soins d’un malade âge atteint d’un cancer bronchique devrait etre basee sur le couplage : evaluation oncologique – evaluation geriatrique approfondie.

Resume Les voies d'abord anterieures du thorax sont les voies d'abord d'election de la chirurgie mediastinale, de la chirurgie cardiaque et des transplantations pulmonaire et cardiopulmonaire. La thoracotomie posterolaterale a toujours ete consideree comme la voie d'election de la chirurgie pulmonaire. Pour la chirurgie cardiovasculaire, la bithoracotomie avec sternotomie transversale etait initialement la voie d'abord d'election. Celle-ci allait etre supplantee secondairement par la sternotomie sous l'impulsion de Julian en 1957. L'apport de la technique videoassistee autour des annees 1990 allait faire evoluer les conceptions concernant les voies d'abord avec, en particulier, une attention au delabrement parietal. La bithoracotomie avec sternotomie transversale allait reapparaitre avec les veritables debuts de la transplantation pulmonaire autour des annees 1990 sous l'impulsion de Cooper. Elle permet un meilleur acces a l'ensemble des deux cavites pleurales. Dans cet article, les auteurs decrivent la technique chirurgicale avec details de la sternotomie mediane, la thoracotomie anterieure, la mediastinotomie anterieure, la sternotomie partielle avec thoracotomie anterolaterale et la bithoracotomie avec sternotomie transversale. Le texte est illustre de schemas. Il est precise l'indication de la voie d'abord, les possibilites d'agrandissement, la fermeture et les complications inherentes a chacune de ces voies d'abord chirurgicales.

Resume En un peu plus d'un demi-siecle, la pneumonectomie est passee du traitement curatif incontournable du cancer bronchique a l'une des interventions reglees les plus redoutees en raison de sa morbidite et de sa mortalite. Si elle est responsable d'une mortalite hospitaliere de 6 a 7 % dans les centres specialises, celle-ci peut aller jusqu'a 12 % apres le troisieme mois postoperatoire. Une meilleure selection et preparation des patients, une amelioration technique indiscutable, ont permis de stabiliser ces resultats. Il est cependant a prevoir une augmentation de ces risques compte tenu du vieillissement de la population et de l'association plus frequente de traitements combines radio- et/ou chimiotherapiques. La pneumonectomie obeit a des regles tres strictes que ne saurait ignorer tout chirurgien thoracique pour pouvoir a la fois poser l'indication, mener a bien l'acte operatoire mais egalement gerer les suites. Dans cet article, les auteurs font un expose detaille de la technique operatoire de la pneumonectomie et la pleuropneumonectomie, tout en precisant les indications et les complications postoperatoires.

Resume La complexite de la region cervicothoracique necessite au prealable une parfaite connaissance anatomique de celle-ci avant tout abord chirurgical. Ce chapitre a pour but a la fois de decrire en detail les techniques chirurgicales des abords cervicothoraciques, mais egalement de faire la synthese des differentes ameliorations techniques qui ont ete decrites. Nous envisagerons successivement l'abord cervicothoracique de Cormier-Dartevelle-Grunenwald, la cervicomanubriotomie, l'abord combine videoassiste par thoracoscopie et la mediastinoscopie. Le choix de la voie d'abord cervicothoracique est decide en fonction des circonstances d'urgence ou de chirurgie reglee, de necessite d'un acces combine a la fois a la region cervicale et mediastinale et/ou axillaire ou a des abords separes en deux temps. Aucune technique ne permet d'acceder facilement et dans le meme temps aux trois regions cervicale, axillaire et mediastinothoracique. Cette complexite rend parfois la realisation de l'abord chirurgical plus longue a effectuer que le geste pour lequel l'intervention est decidee. L'expertise chirurgicale est recommandee pour le choix et la technique de ces voies d'abord cervicothoracique. Le probleme specifique du syndrome de la traversee thoracobrachiale ne sera pas aborde.

The degree of penetration of an antibiotic into the infection site is an important factor for its therapeutic efficacy, particularly in respiratory tract infections. In the present study, we examined the lung tissue diffusion of moxifloxacin at a dose of 400 mg administered intravenously or orally once-daily, and the results were correlated to microbiological data to estimate the clinical efficacy of moxifloxacin in lower community-acquired respiratory infections. This was a prospective, randomized, parallel-group trial, open-label, single-center study. Patients undergoing lung surgery for bronchial cancer which necessitates the removal of an anatomical piece of lung tissue were randomized into twelve treatment groups, dependent upon the time of surgery and the moxifloxacin formulation, i.v. or oral, administered. During surgery, one blood sample was taken at the time of tissue collection to determine moxifloxacin plasma concentration. At the same time, tissue samples were taken by pulmonary exeresis. A validated new high performance liquid chromatography assay was used to determine moxifloxacin concentrations in plasma and lung tissue. A total of 49 patients (25 for i.v. administration, 24 for oral administration, 44 men and 5 women, mean age, 61 years, mean body weight, 72 kg, mean creatinine clearance was 84 ml/min/1.73 m2) were enrolled. The mean +/- SD steady-state moxifloxacin ratios between lung and plasma concentrations were respectively: 3.53 +/- 1.89 and 4.36 +/- 1.48 for i.v. and oral administration. The mean steady-state moxifloxacin maximal lung concentrations (Cmax) were respectively 12.37 microg/g and 16.21 microg/g for i.v. and oral administration. Moxifloxacin both intravenously and orally exhibits high penetration in lung tissue, with tissue concentrations far above the MIC90s for most of the susceptible pathogens commonly involved, thus underlining its suitability for the treatment of community-acquired, lower respiratory tract infections.

Resume Les nouveautes apparues ces dernieres annees dans le traitement chirurgical du cancer thyroidien sont presentees. La chirurgie robotisee n’a actuellement que l’interet de lateraliser la cicatrice dans des sites moins exposes (regions axillaires et peri-areolaire). Les voies d’abord mini-invasives du mediastin (TEMLA, VAXY) sont de reelles avancees techniques. La pratique de plus en plus frequente de la cytoponction et la classification de Bethesda ont permis une standardisation des pratiques. Le curage ganglionnaire central prophylactique unilateral pourrait etre une alternative nuancee entre les partisans d’un curage central systematique et l’absence de curage ganglionnaire central.

Objectif Estimer l’activite cumulee (AC) therapeutique a partir d’un TEP-scan diagnostique, en prenant un exemple theranostique publie chez le petit animal, et evaluer l’extension du calcul a la pratique clinique. Methodes (1) Donnees immunoTEP/SPECT publiees chez la souris pour le 64Cu-/177Lu-cetuximab, anticorps diagnostique/therapeutique dirige sur l’EGFR du carcinome epidermoide de l’œsophage [1] ; (2) Modele cinetique publie, donnant AC pour un radiopharmaceutique quelconque en fonction de ses constantes de captation (K) et de relargage (kR) dans un tissu donne : AC = [K/(l + kR)] AUCIF ou AUCIF est l’aire sous la courbe de la fonction d’entree et l est la constante de decroissance radioactive du marqueur. Resultats AC theorique est estimee a 2,3 10(10)/4,1 10(12) desintegrations/g (tumeur TE-8 ; 64Cu-/177Lu-cetuximab ; pour 3,70/12,95 MBq injectes), a comparer avec AC experimentale estimee a 2,5 10(10)/5,3 10(12) desintegrations/g. Discussion et conclusion L’exemple du 64Cu-/177Lu-cetuximab montre qu’il est possible d’estimer AC therapeutique (ici du 177Lu-cetuximab) : (1) en calculant K et kR et donc AC (ici du 64Cu-cetuximab) a partir d’un TEP-scan diagnostique et (2) en connaissant le rapport moyen des activites cumulees entre diagnostique/therapeutique. L’application de cette approche en pratique clinique dependra des incertitudes de mesure de AC therapeutique, qui devront etre determinees a partir de donnees experimentales additionnelles, animales puis humaines.

Background: Surgery of the trachea is one of the noble activity in thoracic surgery because disorders involving the trachea are relatively uncommon and so it is difficult for most surgeon to acquire a large amount of personal experience in this area. Success in tracheal resection does not rely only on technical aspects of the operation and failure can rapidly lead to death.

We report two cases of pulmonary aspergilloma (PA) in a cavity formed after percutaneous radiofrequency ablation (PRFA), a rare complication that has only been described once in the literature. The first patient was a 59-year-old white woman treated for a secondary lung nodule of an advanced hepatocellular carcinoma. One month after PRFA, a consolidation of a cavity was noticed with an "air crescent sign," and aspergilloma serology was highly positive. A bisegmentectomy was performed due to the proximity of the lesion to mediastinal vessels and the absence of significant regression after antifungal treatment. Histological examination confirmed the diagnosis of PA. The second patient was a 61-year-old white man followed-up for a non-small-cell lung cancer. A cavitation with thick margins in the ablation zone was noticed 6 months after PRFA. A biopsy was performed, and aspergilloma was diagnosed. Medical treatment with itraconazole was administered for 13 months, and there was significant regression.

Initially double-lung transplantation (DLT) was performed with airway anastomosis at the tracheal bifurcation requiring a cardiopulmonary bypass (CBP). Complications related to ischemia of the bronchi and trachea around the carina prompted adoption of sequential single lung implantations as the method of choice for DLT. In different studies, CPB was associated with an increase in postoperative morbidity but this was probably due to the selection of more severe patients. Moreover, important progress in the technology of CPB has occurred. Therefore, the systematic use of CPB during sequential lung transplantation might have some interest by limiting the occurrence of ventilation and perfusion injuries. This article discusses the potential beneficial effects of CPB during double-lung transplantation.

Lung inflammatory myofibroblastic tumor is an uncommon cause of solitary lung nodule (0.7 % of lung tumors). The principal site of inflammatory pseudotumor is the lung, but it can also occur elsewhere in various organs. Although benign, they may be locally very aggressive. Recurrent and multifocal forms have been described. Since they are likely to mimic malignant neoplasms, accurate histopathologic diagnosis is necessary in order to guide appropriate surgical excision and avoid aggressive treatments. We report a case of lung involvement in a young adult with radiologic and pathologic correlations.

To define the role of interventional radiology and surgery respectively, in the treatment of massive haemoptysis. GENERAL CONSIDERATIONS: For the management of massive haemoptysis in non-terminal pathologies an intensive care facility and a multi-disciplinary team are necessary. It is of paramount importance to identify rapidly the pulmonary or bronchial source of the bleeding. CT scanning and bronchoscopy are essential to localise the bleeding and determine its cause. Initial management. An attempt to control the initial bleeding to allow localisation of its origin and determine the treatment.Bronchial or systemic embolisation and surgery are the only effective medium and long-term treatments. Embolisation achieves excellent results in bleeding from bronchial or parietal systemic arteries prior to surgery and may be the only technique possible in the presence of major co-morbidity. Surgery is necessary in the case of failure, in certain specific conditions, and in the case pulmonary artery haemorrhage from a proximal lesion. Various surgical techniques are available depending on the type of lesion encountered and the facilities for post-operative care. Emergency surgery carries a high risk and deferred surgery gives better results.The management of massive haemoptysis should be multi-disciplinary. Intensive care, respiratory and radiological diagnosis, Surgical management and interventional radiology should be combined to improve the prognosis of this grave condition. Pulmonary arterial haemorrhage from a necrotic tumour constitutes a surgical emergency and should be operated on without delay.

Chylothorax is a rare but generally severe complication of surgery of congenital heart disease. The authors report the clinical history of a young boy with complex congenital heart disease operated on several occasions and who developed severe and recurrent unilateral chylothorac after a bicavo-bipulmonary derivation. Conservative treatment followed by continuous somatostatin infusion was ineffective. Diagnostic Lipiodol lymphography was required before the chylothorax was cured. The authors describe management of this difficult case and discuss the therapeutic possibilities with reference to a brief review of the literature.

Zenker's diverticulum can be treated surgically or endoscopically. The aim of this study was to assess results of surgical approach with cervicotomy and diverticulectomy.We retrospectively studied the data of 73 patients (50 men and 23 women; mean age, 69 ans; extrêmes: 43-98) consecutively operated on for a Zenker's diverticulum between 1987 and 2000. Surgical procedure included diverticulectomy associated with a large myotomy and oesophageal calibration. Both early and long-term results were compared with those of published series of patients treated by stapled esophagodiverticulostomy.Clinical manifestations were: dysphagia (97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung infection (21%), or halitosis (3%). No patient died postoperatively. The early morbidity rate was 4% (3 patients). The mean delay for return of oral feeding and the mean length of hospital stay were respectively 6 and 8 days. At follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients (99%) were satisfied and 1 patient felt partially improved. Analysis of published results of series of endoscopic treatment revealed shorter lengths of hospital stay but less favourable long-term results.Early morbidity of surgical treatment of Zenker's diverticulum is low. Long term functional results could be better after surgical diverticulectomy with myotomy than after endoscopic stapled esophagodiverticulostomy.

The Authors report a retrospective analysis of 29 patients who underwent thoracoplasty between 1990 and 1999. The mean follow-up period was 30 months. The median age was 55 years. The peri-operative mortality rate was 6.8%. The control of space obliteration, space infection and closure of the bronchopleural fistula was achieved in 27 patients. This article also discusses surgical history of thoracoplasty, technique adopted and its current application.

A 68-year-old woman presented chest pain and exercise-induced dypnea for one year. Diagnosis was a thoracic solitary fibrous tumor. These tumors are very rare. Clinical outcome is generally good except in 13% of the cases with a malignant component. Complete surgical resection is required.

We describe the first case of infected mediastinitis associated with central venous catheter insertion. The rare occurrence of this complication may be explained by the fact that it results from central venous catheter-related bloodstream infection and catheter perforation of superior vena cava. The symptoms of this complication (chest pain, dyspnoea) are not specific. Diagnosis should be confirmed by chest x-ray and computerized tomography which show hydromediastinum and pleural effusion. Removal and subsequent culture of the catheter tip will confirm infection. Appropriate antibiotic therapy, guided by sensitivities of the cultured organisms, should be commenced. Any pleural effusion should be drained by thoracocentesis, and the pleural fluid cultured. In case of fever, bacteraemia or shock, a thoracotomy to drain mediastinal and pleural effusions may be considered.

Since January 1988 to December 1998, by the Department of Thoracic Surgery, Haut-Lévêque Hospital, University of Bordeaux, 68 consecutive patients were operated for myasthenia gravis. The aim of our study was to evaluate the results obtained in a group of patients who underwent a thymectomy for myasthenia gravis, in order to contribute for the determination of the prognostic factors which can influence the post-operative course. This series consists on 68 patients. Females were predominant, 41 patients (60.2%) versus 27 males (39.7%). The age extended between 15 and 80 years, average of 45.2 years. The follow-up concerned 52 patients (76.4%); out of there, 8 are in complete remission (15.3%), 31 (59.6%) are in a phase of clinical improvement, 11 patients did not benefit from thymectomy (21.1%), 1 patient died immediately after the surgical operation, I patient died some years after the surgical operation for another reason. In conclusion the thymectomy is a beneficial procedure for myasthenia gravis patients.

The Authors report a case of extraskeletal Ewing's sarcoma of thoracic wall in a 15-year-old sport-man, who complained about pain in the left upper extremity. The diagnosis was performed by radiology (ultrasound study, TC, RM) and pre-operative needle-aspiration biopsy. The patient was treated by neoadjuvant chemotherapy, wide surgical resection and, then, radiotherapy. Neither local recurrence nor metastases have developed for 8 months.

Known for its reliability, transoesophageal echocardiography is an investigation which is increasingly used in cardiology, cardiac surgery and intensive care units. It is a semi-invasive investigation of which oesophageal perforation is a very rare but serious complication. Two cases of oesophageal perforation after transoesophageal echocardiography are reported out of a series of 87 oesophageal perforations treated between January 1981 and February 1999. In both cases, transoesophageal echocardiography was performed in conscious patients without known pre-existing oesophageal pathology. The presentations were acute. Both patients underwent emergency surgery. One patient is alive and the other one died one month after a second operation related to the perforation. Nine cases of oesophageal perforation have been reported after transoesophageal echocardiography. The pathogenesis, means of prevention and treatment of oesophageal perforation are discussed.

Adult mediastinal lymphangiomas are rare lesions the diagnosis of which is difficult based on imaging studies. A retrospective study of CT, MR, and pathologic findings of mediastinal lymphangioma was performed in order to correlate pathological and imaging findings. Nine cases of adult lymphangiomas were identified in the records of our institution over a 12-year period. The CT, MR, and pathologic findings were reviewed. Lesions were classified pathologically as unilocular, cavernous, and intermediate types. Pathologic examination identified six cases of unilocular lesion, two cases of cavernous type, and one intermediate type. The CT features (n = 9) included a smoothly marginated non-enhancing mass of water attenuation (n = 7), a non-enhancing mass of soft tissue attenuation (n = 1), and an enhancing multiseptated mass (n = 1). Lesions were located in the anterior mediastinum (n = 2), right paratracheal (n = 4), subcarinal (n = 1), aortopulmonic window (n = 1) areas, and below the left hilum extending into the posterior mediastinum (n = 1). The MR features (n = 3) were characterized by an enhancing multicystic and multiseptated appearance, evocative of a cavernous type in two cases. The CT appearance of mediastinal thoracic lymphangioma is variable depending on the pathologic type. The most common unilocular type is a non-enhancing thin-walled mass on CT. A less frequent cavernous type can be suggested based on a multiseptated and loculated mass on CT and/or MR examination.

The aim of this study was to develop a high-performance liquid chromatographic (HPLC) assay for the determination of moxifloxacin in human plasma and lung tissue. The assay was based on HPLC with a Supelcosil ABZ+ column and ultraviolet detection set at a wavelength of 296 nm. The extraction procedure was characterized by a fully automated liquid–solid extraction using an OASIS column for the solid phase. The assay has been found to be linear and validated over the concentration range 3.2 to 0.025 μg/ml for moxifloxacin in plasma and from 16 to 0.25 μg/g for moxifloxacin in lung tissue. In future, the assay will support the pharmacokinetic study of the penetration of moxifloxacin in human lung tissue.

The Thiersch technique for treatment of rectal prolapsus has been largely abandoned because the metallic or non-resorbable wire is poorly tolerated and non-extensible. Silastic can fulfil these requirements and was used in 11 patients, including two who underwent reoperations. Good results were obtained in 9. This technique is simple and can be proposed when the general status of the patient does not allow surgical cure of the prolapsus.

The authors report a series of 217 non-neoplastic stenoses of the upper airways operated in the period 1978-1991. One hundred and twenty patients with tracheal stenoses underwent tracheal resection and end-to-end anastomosis, with 117 excellent results and 3 deaths. The treatment of 97 patients with laryngotracheal stenoses was much more complex and difficult to manage: Fifty-nine underwent tracheal and subglottic resection-anastomosis with 58 successes and 1 death--Seven had resection-anastomosis with total cricoidectomy and stenting. They were 6 successes and 1 death--Three had supraglottic resection-anastomosis with 3 successes--Twelve underwent laryngeal enlargement over a T-tube with successes in 11 cases and failure in 1 case. Sixteen had complex combinations of resection and modeling with 13 successes, 2 failures, and 1 death. In this series under the same therapeutic options, the results were successful in 96% of cases, with 4% of failures (7% of them resulting in death). The anatomical type, tracheal or laryngotracheal, length of the stenosis, neuropsychological sequelae, and overall poor respiratory status of the patients must be taken into account before deciding the therapeutic strategy. Old age is not a contraindication to tracheal resection, but is certainly a risk factor for morbidity and mortality. The key to success is undoubtedly careful preoperative preparation, treatment of local infection and inflammation, as well as meticulous mucomucosal approximation of healthy margins at the anastomosis.

From January 1 1980 to December 1993, 210 patients underwent exeresis of a cancer of the cardia or the lower third of the oesophagus. There were 193 males and 17 females (mean age 63.5 years, range 18-84). Cancers were in an advanced stage in 56.6% (stage 0, 0.95%; stage 1, 9.04%; stage 3, 43.3%; stage 4, 6.19%). Postoperative morbidity was 21% and hospital mortality was 3.81%. Actuarial survival rate at 1, 3, 5 and 10 years were 64.1%, 23.9%, 17.7% and 12.8% respectively. The advent of the CT scan, better patient selection and improved nutrition management and postoperative care have greatly improved hospital mortality (7 deaths for 118 operations before 1987, i.e. 5.93% and 1 death for 92 operations since 1987, i.e. 1.08%. Creating a circumferential instead of radial phrenotomy and the possibility of raising the anastomosis to upper thorax or in combination with left access and cervicotomy have led to excellent immediate results and confirm our choice in this method.

Between February 1988 and January 1992, 61 patients have undergone bilateral lung transplantations (42 heart-lung and 19 double-lung) in Bordeaux. The underlying diseases were primary or secondary hypertension (20), emphysema (22), or other diseases including cystic fibrosis, pulmonary fibrosis, silicosis, and sarcoidosis (19). Actuarial survival for double-lung and heart-lung transplant recipients was 66% and 72% at 1 year and 57% and 53% at 3 years, respectively. Forty-two patients were still alive 6 months after operation, and we studied their pulmonary function at the short and long term. All parameters except arterial carbon dioxide tension had improved dramatically at 6 months (p0.0001). Vital capacity, forced expiratory volume in 1 second, and forced expiratory flow rate between 25% and 75% of vital capacity were at 79% +/- 3%, 92% +/- 5%, and 105% +/- 8% of the predicted values, respectively. Arterial oxygen tension was 88 +/- 3 mm Hg. Nine months after operation, a slight decrease in forced expiratory volume in 1 second and forced expiratory flow rate between 25% and 75% of vital capacity appeared but values remained more than 75% predicted. This was related to the occurrence of obliterative bronchiolitis in 6 patients (14%). At 9 months, flow rates and oxygen tension of these 6 patients were highly different from those of patients free of obliterative bronchiolitis (p0.0002 for flow rates and p0.01 for oxygen tension). Only 1 patient required retransplantation. The others are living an almost normal life. Our results are discussed in view of the published reports on single-lung transplantation. Short-term results of bilateral lung transplantation are thus excellent and maintained on a long-term basis. Therefore, in our opinion, bilateral lung transplantation is the therapy of choice for pulmonary hypertension and emphysema.

The author report a case of isolated choriocarcinoma of the lung revealed in a young woman by a tumoral syndrome of the right base with haematoma. The diagnosis of isolated pulmonary choriocarcinoma was based on the lack of previous gynaecological history and tumour, on the singleness of the lung tumour at CT, and on the high initial beta-CGH level (3,300 ng/ml) in the absence of pregnancy. Surgical resection confirmed the diagnosis and lowered the beta-CGH level to 7 ng/ml. The various aetiopathogenic theories put forward and their relations with the prognosis disparity found in the literature are reviewed. The authors compare the prognosis of isolated pulmonary choriocarcinoma in a non-nulliparous woman to that of placental choriocarcinoma.

Two cases of catamenial pneumothorax are reported, a rare condition characterized by its sudden occurrence in a female patient between the ages of 30 and 40 years, always at the onset of the menstrual cycle. Its exact origin is unknown, but the frequent co-existence of endometriosis and a defect in the diaphragm suggests that endometriosis may be important in the etiology both of the pneumothorax and the diaphragmatic lesion. Pelvic endometriosis was present in both our patients, one of whom also had diaphragmatic endometriosis. The treatment of the pneumothorax in both our cases consisted of pleural decortication with excellent results so far.