Biomedical subjects
Publications and source records attributed to G de Saint-Florent.
Thoracic splenosis is the autotransplantation of splenic tissue in the thorax after an injury of the spleen with a tear of the hemi-diaphragm. Usually, there is no symptom and it is unfrequent. A scintigraphy with 99 m. Tc. sulfur colloid and a scan with 99 m. Tc. tagged-heated red cells give the diagnosis. For now, it is no necessary to operate these patients to remove these thoracic nodules.
This work is based on the retrospective study of the case history of 26 patients who were treated between September 1979 and January 1987 in the department of thoracic and vascular surgery at the Avicenne Hospital--and who were all suffering from both lung cancer and atheromatous arterial disease. It is now well established by all the epidemiologic research that the link between lung cancer and atheromatous arterial disease is smoking tobacco. The risks involved in the misunderstanding of such an association are not without danger for the patient, particularly the risk of severe complication of possible coronary or carotid lesions, threatening survival; from this derives the necessity to decide automatically for a minimum of pre-surgery vascular investigations in the case of patients suffering from lung cancer. The therapeutic strategy in this association must be thorough, considering that there are three priorities in the vascular field which must absolutely be treated before the lung itself: --the coronary and carotid lesions which are likely to be complicated cancer after surgery and any state of emergency in the other vascular territories. The fight against tobacco smoking must also be considered as a priority aim.
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This study reports the experience of the medical centre of Villiers Saint-Denis, where about 40 cases of pyothorax with or without broncho-pleural fistula were seen between 1975 and 1981. The authors describe their method to drain and wash the pleural cavity. They use a single chest tube with an irrigation system in simple empyema and two chest tubes with an irrigation system when they must close a broncho-pleural fistula. With this method, the infection was eradicated in 90% of the cases, and the broncho-pleural fistula closed within about 4 months in 80% of the cases. This method is compared with other methods used to treat pyothorax.
We report the case of a 61-year old man in whom ablation of a hilar tumour enabled us to diagnose a mediastinal plasmacytoma. Plasmacytomas are rarely found in the mediastinum and sometimes evolve towards myelomas. The best treatment seems to be surgery combined with radiotherapy. The effectiveness of chemotherapy against this tumour is questionable.
We have led over a four year period, from 1981 to 1985, a prospective study on all cases of penetrating chest wounds (77 cases) in the intensive Care unit and the Department of Thoracic Surgery at the Avicenne Hospital. These wounds, involving young males, are fortunately mostly benign. Their seriousness is based on the abdominal or mediastinal hemorrhage as well as lesions to the vital organs which need an emergency intervention. The latter, nevertheless, with the help of the mobile reanimation service for transfering the patient, has diminished the mortality rate to 2.6 per cent. Following their experiment and after a review of the literature, the authors expose their method of management of the penetrating chest wounds.
The development, often after a long delay, of cancer in post-pneumothorax pouches is well known. A case of lymphoma developed on such a pouch is reported. Although cases of lymphoma developed on pulmonary scars have been published, we were unable to find in the literature cases of lymphoma developed on a sequela of old therapeutic pneumothorax.
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After thoracoscopy and mediastinoscopy, pericardioscopy now completes the endoscopic techniques available for exploration of the pericardial cavity. During one year, we systematically associated pericardioscopy with pericardial drainage, using a mediastinoscope. Pericardioscopy visualizes the pericardium and guides biopsies. We report here this one-year experience of 12 pericardioscopies, describing the technique and listing its indications.
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Using a technique developed in our department, we studied the macrophage chemotactic response "in vivo" to a non-specific stimulus in 125 patients with operable lung cancer and 56 patients with operable breast cancer. The response was compared to that of 45 normal controls and 54 patients with metastatic cancer. The results of the preoperative test were correlated with lymph node status determined postoperatively by pathologic examination and also with prognosis. The follow-up on these patients has now reached 60 months. The chemotaxis test has revealed subgroups with different prognoses among both the N+ and N- groups. Patients with N- status (both lung and breast) and a strong preoperative chemotactic response had a very high recurrence rate, above that of N+ patients. Among the N+ patients a subgroup with very limited lymph node involvement and a strong chemotactic response had a significantly better prognosis that the N group as a whole.
Thirty-two women with breast cancer considered in active phase underwent, successively: internal mammary lymphoscintigraphy with 99m rhenium sulfide, chemotherapy and Pathey-type mastectomy with dissection of the axillary and internal mammary lymph nodes. Lymphoscintigraphy was successful in 97% of the cases, without complications. Its specificity was 0.88 (range: 0.76--0.99) and the sensitivity 0.6 (range: 0.19--0.92). Internal mammary lymph node dissection was technically successful in 87.5% of the cases; one patient developed chondritis. Thus, lymphoscintigraphy is usually successful, without morbidity and specific. However, it cannot pretend to provide a complete answer, as does internal mammary producing invaded lymph nodes.
Gentamicin diffusion in pulmonary parenchyma was studied in 10 adult patients with normal renal functions before undergoing thoracic surgery. This aminoside was given in a one time dose of 120 mg directly and by way of IV route in 10 min time; blood samples from peripheral and pulmonary sources were drawn at regular intervals between the 10 min period and the 8th hr; parenchymal samples were collected 1 and 2 hrs after drug administration. After separation of residual blood by centrifugation at high speed, the tissues are grinded and homogenized. The assay was performed with an immunological method using a fluorescent polarized detection system. Tissue levels were low in all the patients (0.5 to 2.75 micrograms/g of fresh tissue) and this in spite of the high level of blood collected throughout the administration protocol. As a rule, the relation between tissue/blood is lower than those discussed in literature concerning bronchial secretion. Beside this, the concentrations are similar in peripheral and pulmonary blood collected. Practical conclusions are drawn for therapeutic purpose.
A new case of carcinoid tumour of the thymus is reported. Such tumours are extremely rare and of somber prognosis when accompanied by local or regional metastases or metastases in other organs.
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