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Biomedical subjects

A Wurtz

Publications and source records attributed to A Wurtz.

At least 19 recordsLinked to original sources
PubMed1998

The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy.

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.

Adolescent↗
PubMed1998

Combined tracheal resection and aortic valve replacement with a cryopreserved aortic valve allograft.

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.

Aged↗
PubMed1998

Tuberculin-induced delayed-type hypersensitivity reaction in a model of hu-PBMC-SCID mice grafted with autologous skin.

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.

Animals↗
PubMed1998

Overexpression of stromelysin-3, BM-40/SPARC, and MET genes in human esophageal carcinoma: implications for prognosis.

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.

Adenocarcinoma↗
PubMed1997

Postpneumonectomy interatrial right-to-left shunt: successful percutaneous treatment.

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.

Aged↗
PubMed1997

Progressive dysphonia and acute respiratory failure: revealing a bronchogenic cyst.

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.

Acute Disease↗
PubMed1997

[Diagnosis of adenopathies and retroperitoneal masses by surgical endoscopy. Apropos of 93 cases].

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.

Adolescent↗
PubMed1997

Retroperitoneoscopy for the diagnosis of infiltrating retroperitoneal lymphadenopathy and masses.

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.

Adolescent↗
PubMed1996

Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients.

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.

Adolescent↗
PubMed1996

Ten-year experience with extraperitoneal pelvioscopy for the lymph node staging of pelvic cancers.

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.

Adult↗
PubMed1996

Sliding thin slab, minimum intensity projection technique in the diagnosis of emphysema: histopathologic-CT correlation.

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.

Adult↗
PubMed1996

[Total pancreatectomy for diffuse and malignant mucinous ductal ectasia of the pancreas. Apropos of 2 cases].

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.

Aged↗
PubMed1995

A pilot study of adjuvant hepatic arterial infusion chemotherapy, associating 5-fluorouracil and leucovorin, after resection of colorectal cancer liver metastases.

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.

Aged↗