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Jérôme Mouroux

Publications and source records attributed to Jérôme Mouroux.

17 recordsLinked to original sources
PubMed2006

Sarcoid-like lesions associated with the immune restoration inflammatory syndrome in AIDS: absence of polymerase chain reaction detection of Mycobacterium tuberculosis in granulomas isolated by laser capture microdissection.

Highly active antiretroviral therapy (HAART)-treated human immunodeficiency virus (HIV)-positive patients can develop granulomatous lesions within the first few weeks of initiating therapy. This immune syndrome, called immune restoration inflammatory syndrome (IRIS), can induce sarcoid-like lesions in tissues. The pathogenesis of these granulomas is currently unknown because no pathogen has been identified to date in the lesions using morphological and/or microbiological approaches. However, the role of certain microbes, such as Mycobacterium tuberculosis, is still debated. The aim of this study was to look for the presence of M. tuberculosis in sarcoid-like lesions occurring in 14 AIDS patients treated with HAART. We used the PCR DNA amplification method in granulomas microdissected from sections stained by hematoxylin-eosin from formalin-fixed, paraffin-embedded specimens. Results were compared to those obtained from microdissected tuberculosis (TB) granulomas (15 patients) and from microdissected sarcoidosis granulomas (12 patients). M. tuberculosis DNA was undetectable from the microdissected sarcoid-like granulomas, whereas DNA from M. tuberculosis was isolated in all the microdissected TB granulomas and was absent in the microdissected sarcoidosis granulomas. Taken together, these data showed that M. tuberculosis DNA is not associated with the presence of sarcoid-like lesions occurring in HIV-positive patients treated with HAART.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Anticipating pulmonary complications after thoracotomy: the FLAM Score.

OBJECTIVE: Pulmonary complications after thoracotomy are the result of progressive changes in the respiratory status of the patient. A multifactorial score (FLAM score) was developed to identify postoperatively patients at higher risk for pulmonary complications at least 24 hours before the clinical diagnosis. METHODS: The FLAM score, created in 2002, is based on 7 parameters (dyspnea, chest X-ray, delivered oxygen, auscultation, cough, quality and quantity of bronchial secretions). To validate the FLAM score, we prospectively calculated scores during the first postoperative week in 300 consecutive patients submitted to posterolateral thoracotomy. RESULTS: During the study, 60 patients (20%) developed pulmonary complications during the postoperative period. The FLAM score progressively increased in complicated patients until the fourth postoperative day (mean 13.5 +/- 11.9). FLAM scores in patients with complications were significantly higher (p < 0.05) at least 24 hours before the clinical diagnosis of complication, compared to FLAM scores in uncomplicated patients. ROC curves analysis showed that the cut-off value of FLAM with the best sensitivity and specificity for pulmonary complications was 9 (area under the curve 0.97). Based on the highest FLAM scores recorded, 4 risk classes were identified with increasing incidence of pulmonary complications and mortality. CONCLUSION: Changes in FLAM score were evident at least 24 hours before the clinical diagnosis of pulmonary complications.FLAM score can be used to categorize patients according to risk of respiratory morbidity and mortality and could be a useful tool in the postoperative management of patients undergoing thoracotomy.

Adolescent↗
PubMed2006

How to find the limit between station 2 and station 4 during mediastinoscopy?

During mediastinoscopy, the definition of the limit between station 2 and station 4 is arbitrary. We describe a simple technique based on computed tomographic scan evaluation to precisely define it. The technique is based on calculating the distance between the sternal notch and the upper aortic arch on computed tomographic scan (radiological station 2 lower limit), and subtracting a constant factor (at our institution, 20 mm) to compensate for modifications of mediastinal structures due to neck hyperextension during mediastinoscopy. This corrected distance (surgical station 2 lower limit) is labeled on the mediastinoscope. When the mediastinoscope is inserted to this distance with a lateral deviation of about 45 degrees, the point of contact with the mediastinum of the biopsy forceps is the limit between station 2 and station 4. We applied this technique in 15 consecutive patients submitted to video-assisted mediastinoscopy for lung cancer. The R2 lower limit was identified by positioning 2 surgical clips during mediastinoscopy. The position of the clips, verified by a chest roentgenogram, was excellent (on the upper aortic arch line) in 7 patients, good (at less than 5 mm from the line) in 6 patients, and acceptable (at 7 mm from the line) in 1 patient. In one case clips were not visible. The proposed technique is simple and precise. Due to the possible differences in patient positioning during mediastinoscopy in other institutions, this correcting factor (-20 mm) should be verified before using this technique to define the lower limit of station 2.

Humans↗
PubMed2005

Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study.

BACKGROUND: This study seeks to evaluate results regarding the repair of diaphragmatic eventration using video-assisted thoracic surgery (VATS). METHODS: We performed a prospective observational study including patients referred to us for surgical treatment of diaphragmatic eventration during a 12-year period. Clinical, radiologic, and functional data were prospectively recorded. VATS was performed with two thoracoports and a 4-cm mini-thoracotomy. Diaphragmatic plication was performed using two nonresorbable running sutures from periphery to the cardio-phrenic angle. Follow-up data (clinical examination, chest roentgenogram, lung function tests at 3, 6, 12 months, and annually thereafter) were also prospectively recorded. RESULTS: Twelve patients (4 male adults, mean age 57.7 +/- 14.8 years) were operated on between 1992 and 2003. The left side was involved in 8 patients and the mean height of diaphragm elevation was 7.5 +/- 1.8 cm. All patients experienced symptoms related to the disease; in 2 patients the operation was carried out to achieve weaning from mechanical ventilation. The etiologic mechanism could be identified in 11 out of 12 patients (trauma, n = 9; Charcot-Marie disease, n = 1; calcified para-aortic nodes, n = 1). Mean operative time, drainage output, and hospital stay were 77 +/- 15 minutes, 0.8 +/- 04 L, and 3.4 +/- 0.7 days, respectively. No mortality was observed; 1 patient experienced postoperative pneumonia, which was treated using antibiotics. All patients experienced amelioration of symptoms and long-term lung function tests revealed a marked improvement of both the forced volume capacity and the forced expiratory volume at 1 second. No relapses were observed at follow-up chest roentgenogram. CONCLUSIONS: Treatment using VATS is a safe and effective alternative to conventional surgery. Functional improvement persists at long-term follow-up.

Adult↗
PubMed2005

Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax?

OBJECTIVE: Thoracic echography easily detects the sign of 'pleural sliding', due to the movement of the visceral pleura on the parietal pleura. This sign is absent when pleurodesis is present. This study was designed to test thoracic echography in the assessment of difference in pleurodesis obtained after abrasion or pleurectomy performed for spontaneous pneumothorax, mainly based on the presence or absence of the 'pleural sliding' sign. METHODS: The population was composed by 10 patients, 5 submitted to VATS complete pleurectomy and 5 to VATS pleural abrasion. Thoracic ultrasonography was performed 4-6 weeks after surgery by an anesthesist trained in thoracic echography blinded to the pleurodesis technique used. Pleurodesis was defined as excellent if pleural sliding was absent in all the 9 considered points, effective when it was present in less than 3 points, poor when it was present in 3 points or more. RESULTS: Pleurodesis was excellent in all the pleurectomy patients and in 1 abrasion patient. In one case, pleural sliding was present at one single explored point and in the last 3 cases there were two contiguous points of pleural sliding. Interestingly, one of these patients developed partial recurrence of pneumothorax 3 weeks after echography exactly at the level of recorded pleural sliding. CONCLUSIONS: Thoracic echography for the postoperative evaluation of pleurodesis is feasible and simple. An ideal pleurodesis is more likely after pleurectomy than after pleural abrasion. Areas of persisting pleural sliding are probably at risk of recurrence.

Adolescent↗
PubMed2005

Combined video-assisted mediastinoscopy and thoracoscopy in the management of lung cancer: a five-year experience.

OBJECTIVE: The aim of this study was to assess the usefulness of combined video-assisted mediastinoscopy (VM) and video-assisted thoracoscopy (VT) in the management of patients with lung cancer. METHODS: A prospective observational study was performed over a 5-year period. Indications for combined VM and VT included inconclusive findings from imaging techniques concerning locoregional extension and resectability; possible involvement of different structures not accessible to a single procedure; and failure to obtain a histologic diagnosis with a single technique. RESULTS: An indication for combined exploration was established in 30 patients, representing 2.6% of all the patients referred to us for diagnosis, staging, and/or resection of lung cancer. Combined VM and VT was completed in 28 patients, as pleural carcinosis was found at VT in 2 cases. There was no mortality or morbidity in our series. Histologic diagnosis was obtained in 12/13 patients without preoperative histologic typing. In all the evaluated patients, combined VM and VT was useful in clinical decision-making, leading to immediate surgery (n=10), induction treatments (n=8), or nonsurgical therapy (n=12). Among the patients who underwent immediate surgery, combined VM and VT never failed to assess the T factor. The N factor was correctly evaluated in 8/10 patients, and in 2 patients it failed to recognize a minimal N2 disease. CONCLUSION: Combined VM and VT is a safe and useful tool in the management of selected patients with lung neoplasms. Both the extent of primary tumor and the possible intrathoracic spread can be thoroughly evaluated.

Aged↗
PubMed2004

[Disseminated pulmonary infection due to Cryptococcus neoformans in a non immunocompromised patient].

We report a case of a primary pulmonary infection due to Cryptococcus neoformans developed in a 40 Year old immunocompetent and HIV negative man. Radiologic findings consisted in diffuse, bilateral reticular and nodular opacities. Bronchoscopy was normal and bronchoalveolar lavage showed numerous macrophages without associated pathogens. A thoracovideoscopy with an open lung biopsy showed numerous cryptococci, free in the alveoli or located within the macrophages. They were associated with an inflammatory infiltrate in the interalveolar spaces, predominantly composed of mononuclear cells. Ultrastructural study showed yeasts with numerous intracytoplasmic organites, a nucleus, a wall and a thick capsule. Pulmonary cryptococcosis is rare in immunocompetent hosts and can be difficult to diagnose since clinicoradiologic features observed in this cryptococcal infection mimic other infectious or neoplastic diseases.

Adult↗
PubMed2003

Usual and unusual locations of intrathoracic mesothelial cysts. Is endoscopic resection always possible?

OBJECTIVE: Mesothelial intrathoracic cysts are congenital lesions classically located in the anterior cardiophrenic angle (pleuro-pericardial cysts). Locations elsewhere in the thorax are infrequent. The aim of the study was to describe a 10-year, single-institution experience with endoscopic management of mesothelial cysts by video-assisted thoracoscopy (VT) or video-assisted mediastinoscopy (VM), regardless of their location. METHODS: From January 1992 to December 2002, 13 patients (four males and nine females, mean age 49.9 years, range 22-75) underwent surgery for a mesothelial cyst. Information on past history, clinical and radiological presentation, indications for surgery, the surgical procedure and postoperative outcome were collected retrospectively and inserted in a dedicated database. A follow-up visit was performed on December 2002 in all of the patients. RESULTS: In five patients the cyst was in the right cardio-phrenic angle, in three cases it was in the left cardiophrenic angle. Five cysts were located in the mediastinum (right paratracheal space in two cases, anterior mediastinum in one case, paravertebral mediastinum in two cases). Mean lesion diameter was 7.5 cm (+/-4) x 5 cm (+/-2). Cyst density ranged between 1 and 10 Hounsfield units (HU) in 11 patients. It was respectively 38 and 52 UH in the other two patients. All patients were classed ASA 1 or 2 according to the guidelines of the American Society of Anesthesiologists (ASA). Indications for surgery included the presence of symptoms, uncertain diagnosis, practice of a particular sport or professional activity, and radiological evidence of compression of the superior vena cava (namely for the two paratracheal lesions). Eleven patients were operated on by VT. Two patients with a right paratracheal lesions were operated on by VM. Mean operating time was 60+/-14 min (range 45-80). No postoperative complications were recorded. The mean postoperative stay was 4.3+/-1.2 days (5 days for VT and 2.5 days for VM). Pathology studies confirmed the diagnosis of mesothelial cyst in all cases. CONCLUSIONS: Mesothelial cysts have a heterogeneous distribution within the thorax, and nearly 40% are located elsewhere than in the cardiophrenic angle. Endoscopic resection by VT or VM can be proposed as the treatment of choice even for mesothelial cysts in unusual locations.

Adult↗
PubMed2003

[Value of PCR amplification from formalin-fixed paraffin-embedded tissues in the diagnosis of Mycobacterium tuberculosis infection].

Mycobacterium tuberculosis infection remains a major health problem throughout the world. In France, tuberculosis is endemic, particularly in the Paris area (Ile-de-France) and in the south (Provence Alpes côte d'Azur) where immigration is greater than in other countries in northern Europe. Culture is the gold standard for diagnosis of tuberculosis and is the only method enabling a study of strain sensitivity to treatment. Histology contributes to diagnosis in most cases by revealing typical necrotizing granulomatous lesions. The diagnosis is then confirmed by the detection of acid-fast bacilli with Ziehl-Neelsen staining. However, the Ziehl-Neelsen stain is not sensitive and does not allow identification of different species. The polymerase chain reaction (PCR) DNA amplification method has been used to detect M. tuberculosis in formalin-fixed paraffin-embedded tissues. The aim of the present study was to investigate the value of this method for the diagnosis of M. tuberculosis infection. The results obtained with PCR assay were compared to those obtained with histological and microbiological methods (direct examination and culture). Sixty-three specimens (mainly lymph node and lung specimens) exhibiting a positive culture for M. tuberculosis were analyzed. Tuberculosis granulomas were noted in 32/63 cases, tuberculoid granulomas in 18/63, pyoepitheloid granuloms in 10/63, and non-specific inflammation in 3/63. Ziehl-Neelsen staining was positive in 11/63 cases. PCR assay on tissue sections was positive for M. tuberculosis in 58/63 cases. Controls of the PCR method (granulomas due to other mycobacterial species, foreign body granulomas, sarcoidosis granulomas) were all negative. This study shows that PCR from deparaffinized sections, 1) greatly increases the sensitivity of diagnosis of tuberculosis, 2) enables the diagnosis of M. tuberculosis infection. However, although this method reduces the time to diagnosis, culture remains the gold standard for identification of the mycobacterium and for determining the sensitivity of the isolated strain to treatment.

Adult↗
PubMed2003

[Liposarcoma of the pleura: an exceptional tumor. A study of two cases].

Primitive intrathoracic liposarcomas are rare tumors mostly located in the mediastinum or in lung parenchyma. Primitive liposarcomas of the pleura are exceptional and show a dramatic clinical course. These tumors are treated by surgery sometimes associated with radiotherapy. We report 2 cases of primitive liposarcoma of the pleura occurring in 2 women of 19 and 62 years of age. Histological examination showed in both cases a low-grade myxoid liposarcoma. In one case, ultrastructural study confirmed the diagnosis.

Adult↗
PubMed2002

Splenic hydatidosis complicated by a splenothoracic fistula: report of a case.

The intrathoracic rupture of a splenic hydatid cyst is very unusual. We report herein the case of a 29-year-old man who presented with a left-sided pleural effusion associated with fever and chest pain. The patient underwent laparotomy and splenectomy en bloc with a portion of gastric wall and diaphragm, followed by irrigation of the pleural cavity with a hypertonic solution through a phrenotomy. His outcome was favorable and there was no recurrence at 2-year follow-up.

Adult↗