Service de chirurgie thoracique

Rabat, Morocco

Service de chirurgie thoracique

Rabat, Morocco
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Makris D.,University of Thessaly | Holder-Espinasse M.,University of Lille Nord de France | Wurtz A.,Service de Chirurgie Thoracique | Seguin A.,University Paris - Sud | And 7 more authors.
Chest | Year: 2010

Background: Radical resection of primary tracheal tumors may be challenging when more than one-half of the tracheal length is concerned. The present study evaluated the use of cryopreserved aortic allografts (CAAs) to replace long tracheal segments. Methods: Sixteen adult minipigs underwent tracheal replacement with a CAA. A silicone stent was used to splint the CAA for the first 12 months. Animals were followed-up using bronchoscopic evaluation and killed at predetermined times, for a period up to 18 months long. Results: Intense inflammation and progressive disappearance of typical histologic structures of the aorta were seen within the first 3 months. All animals studied for more than 3 months showed progressive transformation of the graft into a chimerical conduit sharing aortic and tracheal histologic patterns (eg, islands of disorganized elastic fibers/mature respiratory ciliated epithelium, respiratory glands, islets of cartilage). Stent removal was attempted after 12 months in 10 animals, and critical tracheal stenosis was found in six animals and moderate asymptomatic stenosis in four. Clinical course in these latter animals was uneventful until they were killed at 15 to 18 months. In situ hybridization showed that collagen2a1 mRNA was expressed in the cartilage islets at 1 year. Polymerase chain reaction analysis of the SRY gene demonstrated that the newly formed cartilage cells derived from the host. Conclusions: CAA may be considered as a valuable tracheal substitute for patients with extensive tracheal tumors. Prolonged stenting will be probably mandatory for the clinical application of the procedure in humans. © 2010 American College of Chest Physicians.

Pages P.-B.,Service de chirurgie thoracique | Abou Hanna H.,Service de chirurgie thoracique | Caillot D.,Service dhematologie | Bernard A.,Service de chirurgie thoracique
Revue de Pneumologie Clinique | Year: 2012

Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50-95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000. cells/μl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states - haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach. © 2012 Elsevier Masson SAS.

Blouquit-Laye S.,University of Versailles | Dannhoffer L.,University of Versailles | Braun C.,University of Versailles | Dinh-Xuan A.-T.,Service de Physiologie Explorations Fonctionnelles | And 2 more authors.
American Journal of Physiology - Lung Cellular and Molecular Physiology | Year: 2012

The airways of patients with cystic fibrosis (CF) exhibit decreased nitric oxide (NO) concentrations, which might affect airway function. The aim of this study was to determine the effects of NO on ion transport in human airway epithelia. Primary cultures of non-CF and CF bronchial and bronchiolar epithelial cells were exposed to the NO donor sodium nitroprusside (SNP), and bioelectric variables were measured in Ussing chambers. Amiloride was added to inhibit the Na+ channel ENaC, and forskolin and ATP were added successively to stimulate cAMP- and Ca2+ -dependent Cl -secretions, respectively. The involvement of cGMP was assessed by measuring the intracellular cGMP concentration in bronchial cells exposed to SNP and the ion transports in cultures exposed to 1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one, an inhibitor of the soluble guanylate cyclase (ODQ), or to 8Z, a cocktail of 8-bromo-cGMP and zaprinast (phosphodiesterase 5 inhibitor). SNP decreased the baseline short-circuit current (Isc) and the changes in Isc induced by amiloride, forskolin, and ATP in non-CF bronchial and bronchiolar cultures. The mechanism of this inhibition was studied in bronchial cells. SNP increased the intracellular cGMP concentration ([cGMP]i). The inhibitory effect of SNP was abolished by 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide, an NO scavenger (PTIO) and ODQ and was partly mimicked by increasing [cGMP]i. In CF cultures, SNP did not significantly modify ion transport; in CF bronchial cells, 8Z had no effect; however, SNP increased the [cGMP]i. In conclusion, exogenous NO may reduce transepithelial Na+ absorption and Cl- secretion in human non-CF airway epithelia through a cGMP-dependent pathway. In CF airways, the NO/cGMP pathway appears to exert no effect on transepithelial ion transport. © 2012 the American Physiological Society.

Mordant P.,Service de chirurgie thoracique | Arame A.,Service de chirurgie thoracique | Foucault C.,Service de chirurgie thoracique | Dujon A.,Center Chirurgical du Cedre | And 2 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: Malignant cells in the pleural fluid or pleural metastases are now classified stage IV in lung cancer and alter the treatment. Our purpose was to question the role of surgery in such patients. Methods: The clinical records of 4668 patients, who underwent lung cancer surgery, were reviewed. In some, an undiagnosed pleural malignant disease (M1a) was discovered during thoracotomy. When feasible, selected patients underwent complete surgical resection of the primary tumor and pleural nodules. We analyzed the epidemiology, pathology, and prognosis characteristics of that group (study group), as compared with the population undergoing pulmonary resection in a curative attempt (overall population) or exploratory thoracotomy in case of unexpected disseminated carcinomatous pleuritis (control group). Results: The study group included 32 patients (25 males), mean age 59 ± 8.8 years, who underwent pneumonectomy (n= 9) or lobectomy (n= 23), associated with mediastinal lymph nodes dissection and surgical resection of associated pleural nodules. There were 21 adenocarcinomas, seven squamous cell carcinomas, two undifferentiated large cell carcinomas, and two miscellaneous tumors. Pathological node (pN) was: N0 in 10 patients (31.3%), N1 in four (12.5%), and N2 in 18 (56.3%). Five-year survival rate was 16% after resection, and 21% if the resection was a lobectomy. Conclusion: Complete surgical resection of non-small-cell lung cancer (NSCLC) associated with limited metastatic pleural involvement is associated with long-term survival in 16% of the cases. A review of the published data, together with the results of this series, may justify the inclusion of surgery in multimodality treatment of NSCLC patients with metastatic pleural extension. © 2011 European Association for Cardio-Thoracic Surgery.

Video-assisted thoracic surgery (VATS) is recommanded for early stage lung cancer. R0 resection quality and lymph node dissection are comparable to thoracotomy. VATS lobectomy offers similar overall survival and disease free interval compared with thoracotomy. VATS lobectomy is associated with fewer complications (10 % to 30 %).Catastrophic intraoperative complications are uncommon and represent 1 % of VATS. VATS cause less pain and shorter length of stay. For these reasons, VATS is becoming a gold standard for small size lung tumors.Benefits of robot-assisted lobectomy is not yet demonstrated. More comparative studies with thoracoscopy and thoracotomy are needed to conclue.Segmentectomy can be performed safely in selected patients with preoperative reduce lung function or comorbidities. Overall survival and disease free intervall are worse than lobectomy especially in case of lymphatic permeation. VATS segmentectomy could be performed for small size tumors by trained surgeons with similar results to thoracotomy. © 2013 Elsevier Masson SAS.

Surgical resection remains the only curative treatment of lung cancer. Until then, there was no official reference for assessing the quality of the act. Since 2008, the publication of evidence-based recommendations, the SFCTCV, has identified a set of good practice. These recommendations relate to the act itself, ie: the incision, the type of parenchymal resection, lymph node expertise, but also the infrastructure which the act takes place and finally the activity surgeon. Quality criteria have been defined. They relate to the morbidity and the mortality after surgery, quality of resection, number of lymph nodes dissection and survival in the long term. The participation of every thoracic surgeon to a national database (EPITHOR) allows to define thresholds for each criterion. Thus, each surgeon has the opportunity to compare his work to national data updated annually. © 2011 Société de Pneumologie de Langue Française (SPLF).

Multimodal treatment of pleural mesothelioma, which is reserved for specialised centres for epithelial forms without node involvement, must include preliminary laparoscopy, thoracoscopy and mediastinoscopy. Following chemotherapy, in our opinion surgical removal via pleuropneumonectomy should be performed without resection of the diaphragm and the pericardium, because of the risks of seeding and postoperative complications. Our limited experience with 15 patients has confirmed the feasibility of this with no deaths. High-dose radiotherapy of the whole pneumonectomy cavity appears essential, but the optimal technique is debatable. Only five homogeneous series of more than 40 patients incorporating hemithoracic radiotherapy have been published. © 2011 Elsevier Masson SAS.

Legras A.,Service de Chirurgie Thoracique | Guinet C.,Service de Radiologie | Alifano M.,Service de Chirurgie Thoracique | Lepilliez A.,Service de Chirurgie Thoracique | Regnard J.-F.,Service de Chirurgie Thoracique
Chest | Year: 2012

Scimitar syndrome is one of the large congenital pulmonary venolobar syndromes and is defined as hypogenetic lung associated with partial anomalous pulmonary venous return. We report the case of a 25-year-old man with complex and exceptional variant scimitar syndrome. A chest CT scan with three-dimensional (3-D) reconstruction led us to identify hypoplastic right lung with homolateral hemidiaphragm agenesis and hypogenetic right pulmonary artery. There was a large and sinuous systemic arterial supply and anomalous venous return directed into the left atrium (venous return being usually directed into the right atrium or inferior vena cava in scimitar syndrome). Hyperoxia test showed no shunt. This variant scimitar syndrome has been previously reported and anomalous venous return called "meandering" pulmonary vein. Diagnosis and management of these patients with complex congenital anomalies are difficult because of their exceptional condition. Chest CT scan with 3-D reconstruction offers an accurate noninvasive diagnosis. © 2012 American College of Chest Physicians.

Mordant P.,Service de chirurgie thoracique | Le Pimpec-Barthes F.,Service de chirurgie thoracique | Riquet M.,Service de chirurgie thoracique
Revue de Pneumologie Clinique | Year: 2010

In adults, mediastinal neurogenic tumours constitute the third group of mediastinal tumours, after thymomas and lymphomas. If the group of neurogenic tumour is frequent, each type of tumour is relatively unusual in everyday's clinic. Among them, nerve sheath tumours are the more frequent, followed by tumour of the autonomic system. Askin tumour remains uncommon. Treatment of this tumour requires complete preoperative work-up, including standard radiography, CT-scan, MRI, and sometimes nuclear imaging. In most cases, the treatment is based on surgical resection, and may be associated with radiotherapy or chemotherapy in case of malignant tumour or incomplete resection. Better understanding of these tumours, including their molecular abnormalities, may lead to new changes in their classifications, and to their management. © 2009 Elsevier Masson SAS. All rights reserved.

Bernaa P.,Service de Chirurgie Thoracique | Cazesb A.,Service dAnatomo Pathologie | Baganc P.,Chirurgie Thoracique | Riquetc M.,Chirurgie Thoracique
Interactive Cardiovascular and Thoracic Surgery | Year: 2011

We examined retrospectively the characteristics and the outcomes of intralobar sequestrations (ILS). We reviewed data we obtained from the medical records of patients with ILS who underwent surgery at Laennec, Georges Pompidou European, and Amiens South Hospital. From 1985 to 2010, 26 consecutive adults patients underwent surgery for ILS. There were 14 males and 12 females. The average age was 37.3 years. The ILS was right-sided in 11 patients (42.3%) and left-sided in 15 patients (57.7%). A systemic artery supply was found during the preoperative period in 11. Surgery consisted of lobectomy (ns20), bilobectomy (ns1), segmentectomy (ns4), and pneumonectomy (ns1). There were no postoperative deaths, and the postoperative course was uneventful in 20 patients. All patients were alive and faring well at long-term follow-up (mean follow-up 36.5±7.2 months). Surgery consisted of lobectomy in most cases. The arterial supply came from the descending thoracic and abdominal aorta. Hemoptysis andyor recurrent infections were present in 14/26 (54%) of patients. These are the same symptoms as those leading to the diagnosis of bronchectasis. This suggests, for similar reasons, that ILS in adults should be nosologically very similar to acquired lesions, such as bronchectasis. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

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