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Suresnes, France

It has been proved that lobectomy for lung cancer of less than 3 cm is superior to sublobar resection (segmentectomy and wedge resection) in the Lung Cancer Study Group trial published in 1995. Lobectomy is therefore recommended, with lymph node resection. Nevertheless, some publications have shown identical or close results after segmentectomy for tumors of less than 2 cm, and after wedge resection for tumors of less than 1 cm. It is likely that local recurrences are avoided by respecting a macroscopic margin of more than 2 cm around the tumor. A new trial comparing lobectomy and sublobar resection has been ongoing since 2007 for tumors of less than 2 cm. Persistent ground glass opacities are now often discovered after screening, either pure or with a small solid component, and correspond to an in situ or a micro-invasive adenocarcinoma, that can be removed with sublobar resection without recurrence.


Comperat E.,University Pierre and Marie Curie | Camparo P.,HOpital Foch
Diagnostic and Interventional Imaging | Year: 2012

Renal cancers account for approximately 3% of adult cancers and the mean age of diagnosis is 65, with men affected two to three times more frequently than women. However, an increase is being seen in kidney tumours also in young adults and in women. The classifi-cation of renal tumours includes both benign and malignant tumours, and is currently quite exhaustive, but may be even more extensive in the coming years, particularly for tumours in renal impairment. Except for certain specific entities (such as chromophobe carcinoma), two criteria are required to correctly classify malignant kidney tumours: the Fuhrman grade, and the pTNM stage, defining tumour extension. The stage and grade are applicable in the same way, regardless of the nature of the tumours; for a given group, they are the best prognostic factors. © 2012 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.


Boulin A.,HOpital Foch
Diagnostic and Interventional Imaging | Year: 2012

The lateral sellar compartment is a complex anatomical structure containing many different elements, any of which can be at the root of a pathological condition. MRI is the examination of choice for this region, and requires the use of specific protocols and systematic examination of each of these elements to produce a suitable diagnosis. © 2012 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.


Dupuy S.,French Institute of Health and Medical Research | Lambert M.,French Institute of Health and Medical Research | Zucman D.,HOpital Foch | Choukem S.-P.,AP HP | And 4 more authors.
PLoS Pathogens | Year: 2012

The contribution of innate immunity to immunosurveillance of the oncogenic Human Herpes Virus 8 (HHV8) has not been studied in depth. We investigated NK cell phenotype and function in 70 HHV8-infected subjects, either asymptomatic carriers or having developed Kaposi's sarcoma (KS). Our results revealed substantial alterations of the NK cell receptor repertoire in healthy HHV8 carriers, with reduced expression of NKp30, NKp46 and CD161 receptors. In addition, down-modulation of the activating NKG2D receptor, associated with impaired NK-cell lytic capacity, was observed in patients with active KS. Resolution of KS after treatment was accompanied with restoration of NKG2D levels and NK cell activity. HHV8-latently infected endothelial cells overexpressed ligands of several NK cell receptors, including NKG2D ligands. The strong expression of NKG2D ligands by tumor cells was confirmed in situ by immunohistochemical staining of KS biopsies. However, no tumor-infiltrating NK cells were detected, suggesting a defect in NK cell homing or survival in the KS microenvironment. Among the known KS-derived immunoregulatory factors, we identified prostaglandin E2 (PGE2) as a critical element responsible for the down-modulation of NKG2D expression on resting NK cells. Moreover, PGE2 prevented up-regulation of the NKG2D and NKp30 receptors on IL-15-activated NK cells, and inhibited the IL-15-induced proliferation and survival of NK cells. Altogether, our observations are consistent with distinct immunoevasion mechanisms that allow HHV8 to escape NK cell responses stepwise, first at early stages of infection to facilitate the maintenance of viral latency, and later to promote tumor cell growth through suppression of NKG2D-mediated functions. Importantly, our results provide additional support to the use of PGE2 inhibitors as an attractive approach to treat aggressive KS, as they could restore activation and survival of tumoricidal NK cells. © 2012 Dupuy et al.


Gayat E.,HOpital Foch | Gayat E.,French Institute of Health and Medical Research | Mongardon N.,HOpital Foch | Tui O.,HOpital Foch | And 4 more authors.
Acta Anaesthesiologica Scandinavica | Year: 2013

Background: CNAP® provides continuous non-invasive arterial pressure (AP) monitoring. We assessed its ability to detect minimal and maximal APs during induction of general anaesthesia and tracheal intubation. Methods: Fifty-two patients undergoing surgery under general anaesthesia were enrolled. Invasive pressure monitoring was established at the radial artery, and CNAP monitoring using a finger sensor recording was begun before induction. Statistical analysis was conducted with the BlandAltman method for comparison of repeated measures and intraclass correlation coefficient (ICC). Results: Patients' median age was 67 years [interquartile range (5976)], median American Society of Anesthesiologists score was 3 [interquartile range (23)]. Bias was 5 and-7 mmHg for peak and nadir systolic AP (SAP), with upper and lower limits of agreement of (42:-32) and (27;-42), respectively. The corresponding ICC values were 0.74 [95% confidence interval (CI) = 0.57 0.84] and 0.60 (95% CI = 0.440.73). Time lags to reach these values were 7.5 s (95% CI =-10.0 to 60.0) for the highest SAP and 10 s (95% CI =-12.5 to 72.5) for the lowest SAP. Bias, lower and upper limits of agreement for diastolic, and mean AP were-14 (-36 to 9) and-12 (-37 to 13) for the nadir value and-7 (-29 to 15) and-2 (-28 to 25) for the peak value. Conclusions: The CNAP monitor could detect acute change in AP within a reasonable time lag. Precision of its measurements is not satisfactory, and therefore, it could only serve as a clue to the occurrence of changes in AP. © 2013 The Acta Anaesthesiologica Scandinavica Foundation Published by Blackwell Publishing Ltd.

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