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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. Source

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. Source

Thomas P.,Service de chirurgie thoracique
Revue des Maladies Respiratoires Actualites | Year: 2014

Ageing of the population conduces to ask the adequacy of the surgical indication in earlystage NSCLC in this fragile subjects. This decision must be discussed case by case, based on pre-operative extended assessment and the "physiological" age. Management have to be multidisciplinary, axed on the prevention of confusional syndrome. This conditions associated with a strict respect of the operative contraindications permits to provide similar outcome than general population in the early stages NSCLC. © 2014 Elsevier Masson SAS. Source

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. Source

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). Source

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