Année 1999

(voir aussi 2004 2003 2002 2001 2000 1998 1997 1996 1995)

1.- CHAPITRES DE LIVRES sur invitation par Editeurs

2.- PUBLICATIONS DANS REVUES INTERNATIONALES

3.- PUBLICATION DANS DES REVUES NATIONALES

4.- PRESENTATION DANS DES CONGRES INTERNATIONAUX

5.- PRESENTATIONS DANS DES CONGRES NATIONAUX

6.- ENSEIGNEMENT

7.- THÈSES, MÉMOIRES...

1.- CHAPITRES DE LIVRES sur invitation par Editeurs

TECHNIQUES OF PNEUMONECTOMY : SLEEVE PNEUMONECTOMY
Philippe DARTEVELLE and Paolo MACCHIAIRNI
CHEST SURGERY CLINICS OF NORTH AMERICA. PNEUMONECTOMY, PART I (Jean Deslauriers and L. Penfield Faber, Guest Editors) Ed .WB Saunders Cy. Vol.9 N°2. May 1999; 407-417 (abstract)

2.- PUBLICATIONS DANS REVUES INTERNATIONALES

SURGICAL MANAGEMENT OF SUPERIOR SULCUS TUMORS
P. DARTEVELLE, P. MACCHIARINI
The Oncologist 1999;4:398-407 (abstract)

EFFECTS OF LOAD AND TONE ON THE MECHANICS OF ISOLATED HUMAN BRONCHIAL SMOOTH MUSCLE.
F.X. BLANC, S. SALMERON, C. COIRAULT, M. BARD, E. FADEL, E. DULMET, P. DARTEVELLE, Y. LECARPENTIER
Journal of Applied Physiology, 86(2):488-495, 1999 (abstract)

EXPERIMENTAL AND CLINICAL EVALUATION OF A SYNTHETIC, ABSORBABLE SEALANT TO REDUCE AIR LEAKS IN THORACIC OPERATIONS
P. MACCHIARINI, J. WAIN, S. ALMY, P. DARTEVELLE
J. Thorac Cardiovasc Surgery. 1999;117:751-758 (abstract)

CLAMSHELL OR STERNOTOMY FOR DOUBLE LUNG OR HEART-LUNG TRANSPLANTATION
P. MACCHIARINI, F. LE ROY LADURIE, J. CERRINA, E. FADEL, A. CHAPELIER, P. DARTEVELLE
Eur J. Cardio-Thorac Surg. 1999:15;333-339 (abstract)

PULMONARY THROMBOENDARTERECTOMY FOR CHRONIC THROMBOEMBOLIC OBSTRUCTION OF THE PULMONARY ARTERY IN PIGLETS.
E. FADEL, J.Y. RIOU, M. MAZMANIAN, P. BRENOT, E. DULMET, H. DETRUIT, A. SERRAF, EA. BACHA, P. HERVE, P. DARTEVELLE.
J. Thorac Cardiovasc Surg 1999; 117:787-793 (abstract)

SUBCLAVIAN ARTERY RESECTION AND RECONSTRUCTION FOR THORACIC INLET CANCERS
E. FADEL, A. CHAPELIER, E. BACHA, F. LE ROY LADURIE, J. CERRINA, P; MACCHIARINI, en P. DARTEVELLE
J. Vasc Surg 1999; 29:581-588 (abstract)

ANGIOSCOPIC VIDEO-ASSISTED PULMONARY ENDARTERECTOMY FOR POST-EMBOLIC PULMONARY HYPERTENSION
P. DARTEVELLE, E. FADEL, A. CHAPELIER, P. MACCHIARINI, J. CERRINA, F. PARQUIN, F. SIMONNEAU, G.SIMONNEAU
Eur J Cardio-Thorac Surgery 1999;16:38-43 (abstract)

CHARACTERIZATION OF A PIG-TO-GOAT ORTHOTOPIC LUNG XENOTRANSPLANTATION MODEL TO STUDY BEYOND HYPERCUTE REJECTION.
P. MACCHIARINI, R. ORIOL, A. AZIMZADEH, V. DE MONTPREVILLE, P. WOLF, P. DARTEVELLE
J. Thorac Cardiovasc Surg. 1999;118:805-814 (abstract)

GALLIUM SCAN IN THE EVALUATION OF POST CHEMOTHERAPY MEDIASTINAL REDIDUAL MASSES OF AGGRESSIVE NON-HODGKIN'S LYMPHOMA.
A. ULUSAKARYA, J. LUMBROSO, O. CASIRAGHI, S; KOSCIELNY, JM. VANTELON, T. GIRINSKY, A. TARDIVON, J.H. BOURHIS, P. DARTEVELLE, J.L. PICO, JN MUNCK
Leukemia And Lymphoma 1999;35(5-6):579-586 (abstract)

3.- PUBLICATION DANS DES REVUES NATIONALES

RESULATS DE LA THROMBOENDARTERIECTOMIE PULMONAIRE SOUS VIDEOANGIOSCOPIE ET ARRET CIRCULATOIRE DANS L'HYPERTENSION ARTERIELLE PULMONAIRE POST-EMBOLIQUE.
P. DARTEVELLE, E. FADEL, A. CHAPELIER, P. MACCHIARINI,F. SIMONNEAU, F. PARENT, G. SIMONNEAU.
IXes Journées Européennes de la Société Française de Cardiologie. # C16; 1999

4.- PRESENTATION DANS DES CONGRES INTERNATIONAUX

RESECCION Y RECONSTRUCTION DE LA VENA CAVA SUPERIOR
P. DARTEVELLE
IV Reunion Internacional de CIRUGIA TORACICA - Barcelona 4-5 Marzo 1999

ENDARTERECTOMIA EN LA HIPERTENSON PULMONAR
P. DARTEVELLE
IV Reunion Internacional de CIRUGIA TORACICA - Barcelona 4-5 Marzo 1999

ALLOTRASPLANTE TRAQUEOESOFAGICO Y TRASPLANTE TRAQUEAL CON REVASCULARIZACION
P. DARTEVELLE
IV Reunion Internacional de CIRUGIA TORACICA - Barcelona 4-5 Marzo 1999

DARTEVELLE INCISION IN PANCOAST TUMOURS
P. DARTEVELLE
Turkish Thoracic Society - Istanbul 10-14 April 1999

SLEEVE PNEUMONECTOMY
P. DARTEVELLE
Turkish Thoracic Society - Istanbul 10-14 April 1999

PROLONGED DISCORDANT LUNG ORTHOTOPIC XENOGRAFT SURVIVAL
P. MACCHIARINI, R. ORIOL and P. DARTEVELLE
The American Association For Thoracic Surgery 79th Annual Meeting. New Orleans, April 18-21, 1999

LA VIA TRANSCLAVICULARE PER LA RESEZIONE DEI TUMORI MALIGNI CHE INVADONO LO STRETTO CERVICO-TORACICO
P. DARTEVELLE
I° Incontro Interdisciplinare di patologia Toracopolmonare. Bologne 23 Aprile 1999

PULMONARY VASCULAR REACTIVITY AFTER CHRONIC PULMONARY ARTERY OCCLUSION
E. FADEL, P. HERVE, B. BAUDET, H. DETRUIT, M. MAZMANIAN, P. DARTEVELLE
American Thoracic Society. International Conference. San Diego April 23-28, 1999

LUNG TRANSPLANTATION FOR PULMONARY VASCULAR DISEASES.
F. LE ROY LADURIE, J. CERRINA, PH. HERVÉ, A. CHAPELIER, F. PARQUIN and PH. DARTEVELLE.
American Thoracic Society. International Conference. San Diego April 23-28, 1999

SURGICAL MANAGEMENT OF POST-INTUBATION TRACHEOESOPHAGEAL FISTULA
P. MACCHIARINI, JP. VERHOYE, A. CHAPELIER, E. FADEL, P. DARTEVELLE
25th Annual Meeting of the Western Thoracic Surgical Association. Resort at the Squaw Creek, Olympic Valley (California) 23-26 June 1999

TREATMENT OF TRACHEO OESOPHAGAL FISTULAS AFTER VENTILATORY ASSISTANCE
P. DARTEVELLE
XI° Brazilian Congress of Thoracic Surgery and III Pneumology Congress of the State of Bahia. Salvador 4-6 Septembre 1999

ANTERIOR TRANSCERVICAL THORACIC APPROACH FOR LUNG CANCER INVADING THE THORACIC INLET
P. DARTEVELLE
XI° Brazilian Congress of Thoracic Surgery and III Pneumology Congress of the State of Bahia. Salvador 4-6 Septembre 1999

TECHNIQUES AND RESULTS OF SUPERIOR VENA CAVA REPLACEMENT IN MALIGNANT MEDIASTINAL TUMORS
P. DARTEVELLE
XI° Brazilian Congress of Thoracic Surgery and III Pneumology Congress of the State of Bahia. Salvador 4-6 Septembre 1999

TRACHEAL SLEEVE RESECTION FOR LUNG CANCER
P. DARTEVELLE
XI° Brazilian Congress of Thoracic Surgery and III Pneumology Congress of the State of Bahia. Salvador 4-6 Septembre 1999

FACTORS AFFECTING LONG TERM SURVIVAL AFTER EN BLOC RESECTION OF LUNG CANCER INVADING THE CHEST WALL
A. CHAPELIER, E. FADEL, P. MACCHIARINI, F. LE ROY LADURIE, J. CERRINA, P. DARTEVELLE
13th Annual Meeting of the European Association For Cardio-Thoracic Surgery. Glasgow 5-8 September 1999

SURGICAL MANAGEMENT OF PULMONARY ASPERGILLOMA : A 39 YEAR EXPERIENCE
G. BABATASI, M. MASETTI, A. CHAPELIER, P. DARTEVELLE
13th Annual Meeting of the European Association For Cardio-Thoracic Surgery. Glasgow 5-8 September 1999

COMPLETION PNEUMONECTOMY
P. DARTEVELLE
European Respiratory Society. Annual Congress Madrid October 9-13, 1999

LIMITS AND RESULTS OF SURGERY FOR LUNG CANCER INVADING THE THORACIC INLET.
P. DARTEVELLE
European Respiratory Society. Annual Congress Madrid October 9-13, 1999

5.- PRESENTATIONS DANS DES CONGRES NATIONAUX

RESECTION ET REVASCULARISATION DE L'ARTERE SOUS-CLAVIERE DANS LES CANCERS ENVAHISSANT LE DEFILE CERVICO-THORACIQUE
E. FADEL, A. CHAPELIER, P. MACCHIARINI, P. DARTEVELLE
Société de Chirurgie Thoracique et Cardio-Vasculaire de Langue Francaise. Paris 8-9 Janvier 1999

EXERESES ELARGIES A LA VEINE CAVE SUPERIEURE DES TUMEURS MEDIASTINALES
A. CHAPELIER
Groupe Thorax. Schönried (Suisse), 15 Janvier 1999

6.- ENSEIGNEMENT

DIPLOME D'UNIVERSITE DE CARCINOLOGIE CERVICO-FACIALE - UFR Médicale de l'Université Paris-Sud - Institut Guastave Roussy
LES TUMEURS DE LA JONCTION CERVICO-THORACIQUE : P. DARTEVELLE

SEMINAIRE D'ENSEIGNEMENT DU COLLEGE DE CHIRURGIE THORACIQUE ET CARDIO-VASCLAIRE - Saclay 9 Octobre 1999
MALADIE THROMBO EMBOLIQUE : P. DARTEVELLE

DCEM2 - Université Paris Sud
- TRAUMATISMES THORACIQUES : P. DARTEVELLE
- ENSEIGNEMENT DES GESTES PRATIQUES AUX URGENCES. TRAUMATISME DU THORAX : A CHAPELIER

DES DE CHIRURGIE GENERALE - Séminaire Vasculaire et Thoracique.
- LES LIMITES CHIRURGICALES DE L'EXERESE PULMONAIRE : A. CHAPELIER

DIPLOME D'UNIVERSITE ANGIO-ANATOMIE HUMAINE. Université Paris Sud : A. CHAPELIER
- L'AORTE THORACIQUE
- L'AORTE ABDOMINALE : APPLICATION A LA CHIRURGIE
- LES VAISSEAUX PULMONAIRES : ARTERE, VEINE PULMONAIRE, ARTERES BRONCHIQUES : APPLICATIONS A LA TRANSPLANTATION.

PCEM2 - DCEM1 - Faculté de Médecine Pitié Salpétrière
- ENSEIGNEMENT DE L'ANATOMIE : E. FADEL

MAITRISE D'ANATOMIE ET D'EMBRYOGENESE Faculté de Médecine Pitié Salpétrière
E. FADEL

"Mise au Points et Perspectives Nouvelles dans le Syndrome d'Eisenmenger" : TRANSPLANTATION CARDIO-PULMONAIRE DANS LES CARDIOPATHIES CONGENITALES
A. CHAPELIER
Groupe Universitaire de Recherche sur les Maladies Vasculaires Pulmonaires UPRES (EA-980190). Hôpital Marie Lannelongue - Hôpital Antoine Béclère 12 Février 1999

TRAITEMENT CHIRURCICAL DU CŒUR PULMONAIRE CHRONIQUE POST-EMBOLIQUE
P. DARTEVELLE
Conférence de Pneumologie - CHU Poitiers 25 Février 1999

INDICATIONS ET RESULTATS DE LA TANSPLANTATION PULMONAIRE ET CARDIO-PULMONAIRE : P. DARTEVELLE
Séminaire "Thérapeutiques substitutives, transfusion sanguine et greffe". Faculté de Médecine Paris-Sud 20 Mai 1999

LA RÉANIMATION DES DONNEURS D'ORGANES EN VUE D'UN PRÉLÈVEMENT PULMONAIRE VUE PAR UN TRANSPLANTEUR ET UN RÉANIMATEUR : A. CHAPELIER, J. DURANTEAU
11ème Journée de Bicêtre. Les Prélèvements d'Organes en vue de transplantation. 17 Juin 1999

7ème FESTIVAL INTERNATIONAL DU FILM DE SANTE Aurillac 25-27 Mars 1999
P. DARTEVELLE Membre du Jury

ISCHEMIE REPERFUSION CHRONIQUE DU POUMON GAUCHE : E. FADEL
Laboratoire de Physiologie - Faculté de Médecine Henri Mondor - 26 Mai 1999

APPROCHE DIAGNOSTIQUE ET THÉRAPEUTIQUE DU SYNDROME DE PANCOAST-TOBIAS. LE POINT DU VUE DU CHIRURGIEN THORACIQUE : P. DARTEVELLE
Journées d'Etudes - Association de Pneumologie de la Côte Basque. Biarritz 18 septembre 1999

- L'HYPERTENSION ARTÉRIELLE PULMONAIRE POST-EMBOLIQUE : Une entité mal connue. quelle place pour la médecine, quelle place pour la chirurgie ?
- LA TRANSPLANTATION PULMONAIRE DANS LES MALADIES VASCULAIRES PULMONAIRES. Quel type de transplantation ? quelles indications ? quels résultats ?
- LES GOITRES ENDOHORACIQUES. Comment en faire le diagnostic ? faut-il les opérer ?
- LES CANCERS DU POUMON ENVAHISSANT LE DÉFILÉ CERVICO THORACIQUE ET RESPONSABLES DE SYNDROME DE PANCOAST ET TOBIAS. Comment en faire le diagnostic? quel traitement proposer ?
P. DARTEVELLE. Enseignement Post Universitaire de la FMC du Berry .Argenton-sur-Creuse. 17 Novembre 1999

CHIRURGIE DE L'HYPERTENSION ARTERIELLE PULMONAIRE : P. DARTEVELLE
Les Journées de Pneumologie de l''AFCPP "PIERRE BOURGEOIS" , Paris 26-27 Novembre 1999

THROMBO-ENDARTÉRIECTOMIE PULMONAIRE SOUS VIDÉOANGIOSCOPIE ET ARRÊT CIRCULATOIRE DANS L'HYPERTENSION ARTÉRIELLE PULMONAIRE POST-EMBOLIQUE
P. DARTEVELLE, E. FADEL, A. CHAPELIER, P. MACCHIARINI, G. SIMMONEAU
8ème Journée de la Recherche - Innovation Thérapeutique - Faculté de Médecine Paris-Sud 8 Décembre 1999

7.Thèses, Mémoires...

D.E.A. "Biologie et Physiologie de la circulation et de la Respiration"
ALTERATION DE LA VASOMOTRICITE PULMONAIRE APRES LIGATURE AIGUE OU CHRONIQUE DE L'ARTERE PULMONAIRE CHEZ LE PORC`
E. FADEL. 9 septembre 1999

THESE de Docteur en Médecine
COEUR PULMONAIRE CHRONIQUE POST EMBOLIQUE ET PRISE EN CHARGE CHIRURGICALE. A propos d'une observation.
Sandrine BETHOUART - Lille 23 Novemb re 1999

OBJECTIVES: To assess whether the use of video-assisted angioscopy would increase the outcome of pulmonary thromboendarterectomy (PTE). METHODS: PTE included a median sternotomy, intrapericardial dissection of the superior vena cava, institution of cardiopulmonary bypass, deep hypothermia and sequential circulatory arrest periods. It was always performed through two separate arteriotomies on both main intrapericardial pulmonary arteries, into which a rigid 5 mm angioscope connected to a video camera was introduced to increase the visibility and endarterectomies. RESULTS: From January 1996 to July 1998, 68 consecutive patients (35 males and 33 females) aged 54.3 +/- 13.5 years underwent PTE. Patients were in New York Heart Association (NYHA) class II (n = 2), III (n = 43) or IV (n = 23) with the following hemodynamics: mean pulmonary arterial pressure (PAP) 54 +/- 13 mmHg; cardiac output (CO): 3.8 +/- 0.8 l/min, and total pulmonary resistance (TPR): 1207 +/- 416 dyne x s x cm(-5). The cumulated circulatory arrest time was 23 +/- 12 min and postoperative length of ventilatory support 10 +/- 12 days. Nine patients died, for an overall in-hospital mortality of 13.2%. The functional outcome in surviving patients was significantly improved (P < 0.0001) both clinically (NYHA class 3.2 +/- 0.5 vs. 1.3 +/- 0.6) and hemodynamically (PAP (mmHg) 53.1 +/- 13 vs. 30.2 +/- 11.8, CI (l/min per m2) 2.1 +/- 0.5 vs. 2.8 +/- 0.6, TPR (dyne x s x cm(-5)) 1174 +/- 416 vs. 519 +/- 250). CONCLUSIONS: Video-assisted angioscopy improves the quality and degree of pulmonary endarterectomy expanding the indications to include patients with previously inaccessible distal disease.

OBJECTIVE: To evaluate the influence of either incision on the lungs and chest wall. METHODS: Ninety-two double lung (DLT) or heart-lung (HLT) transplantations were done since January 1990. There were 22 (24%) hospital deaths, leaving 70 patients with complete data for evaluation. We did 38 DLT and 32 HLT for end-stage chronic respiratory failure (n = 22) and primary (n = 34) or secondary (n = 14) pulmonary hypertension, using 37 fourth or fifth interspace clamshell incisions and 33 median sternotomies. RESULTS: The clamshell group included a higher percentage of DLTs (73 vs. 33%, P = 0.001) but recipient age, gender, preoperative diagnosis, bronchial anastomotic complications, number of cytomegalovirus infection, episode of acute rejection per patient-months and incidence of bronchiolitis obliterans were not statistically different between the two groups. At a follow-up time of 3.7 +/- 2 years, the overall 5-year survival of 57% was not influenced by the type of incision. The clamshell incision caused sternal over-riding in 12 (32%) patients, and eight surgical clamshell revision were necessary as compared with one median sternotomy (P = 0.02). The clamshell incision was associated with a significantly higher incidence of postoperative chronic pain (27 vs. 6%, P = 0.02). Postoperative mechanical properties of the chest wall were significantly (P < 0.0001) worse in the clamshell-group patients while the intrinsic properties of the airways were not different. CONCLUSIONS: The clamshell incision results in more postoperative deformity, chronic pain, and impaired function as compared with median sternotomy. A bilateral anterolateral thoracotomy without division of the sternum is proposed for the sequential bilateral lung transplantation technique.

PURPOSE: We previously described an original transcervical approach to resect primary or secondary malignant diseases that invade the thoracic inlet (TI). The purpose of this study was to evaluate the technical aspects and long-term results of the resection and revascularization of the subclavian artery (SA). METHODS: Between 1986 and 1998, 34 patients (mean age, 49 years) underwent en bloc resection of TI cancer that had invaded the SA. The surgical approach was an L-shaped transclavicular cervicotomy in 33 patients. In 14 of these patients, this approach was associated with a posterolateral thoracotomy (n = 10) or a posterior midline approach (n = 4). In one patient, the procedure was achieved with a single posterolateral thoracotomy approach. An end-to-end anastomosis was performed in 16 patients. In one patient, a subclavian-left common carotid artery transposition was performed. In one other patient, an end-to-end anastomosis was performed between the proximal innominate artery and the SA. The right carotid artery was transposed into the SA in an end-to-side fashion. In 16 patients, prosthetic revascularization with a polytetrafluoroethylene graft was performed. Thirty-three patients underwent postoperative radiation therapy. RESULTS: There were no cases of perioperative death, neurologic sequelae, graft infections or occlusions, or limb ischemia. There were two delayed asymptomatic polytetrafluoroethylene graft occlusions at 12 and 31 months. The 5-year patency rate was 85%. During this study, 20 patients died: 18 died of tumor recurrence (5 local and systemic and 13 systemic), one of respiratory failure, and one of an unknown cause at 74 months. The overall 5-year survival rate was 36%, and the 5-year disease-free survival brate was 18%. CONCLUSION: Tumor arterial invasion per se should not be a contraindication to TI cancer resection. This study shows that cancers that invade the SA can be resected through an L-shaped transclavicular cervicotomy, with good results with a concomitant revascularization of the SA.

OBJECTIVE: The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. METHODS: Multiple-curled coils and tissue adhesive were embolized in 6 piglets to induce complete obstruction of the left pulmonary artery, documented by angiography. After 5 weeks, the main pulmonary artery was repermeabilized by thromboendarterectomy during circulatory arrest. The left lung was reperfused ex vivo with autologous blood at constant flow, and patency of the pulmonary artery was evaluated on abarium angiogram. The endarterectomy-reperfusion procedure was also done in 6 nonembolized piglets that served as the controls. The severity of lung injury induced by 60 minutes of reperfusion was assessed on the basis of measurements of the lung filtration coefficient and of lung myeloperoxidase activity. RESULTS: Marked hypertrophy of the bronchial circulation was seen in the chronic pulmonary thromboembolism group. Thromboendarterectomy removed the organized obstructing thrombus that was incorporated into the arterial wall and restored patency of the pulmonary artery. Acute lung inflammation and high-permeability edema occurred after reperfusion, as indicated by a 1.5-fold increases in both lung filtration coefficient and lung myeloperoxidase values in the chronic pulmonary thromboembolism group; these 2 variables being correlated. CONCLUSIONS: Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury.

Isotonic and isometric properties of nine human bronchial smooth muscles were studied under various loading and tone conditions. Freshly dissected bronchial strips were electrically stimulated successively at baseline, after precontraction with 10(-7) M methacholine (MCh), and after relaxation with 10(-5) M albuterol (Alb). Resting tension, i.e., preload determining optimal initial length (Lo) at baseline, was held constant. Compared with baseline, MCh decreased muscle length to 93 +/- 1% Lo (P < 0.001) before any electrical stimulation, whereas Alb increased it to 111 +/- 3% Lo (P < 0.01). MCh significantly decreased maximum unloaded shortening velocity (0.045 +/- 0.007 vs. 0.059 +/- 0.007 Lo/s), maximal extent of muscle shortening (8.4 +/- 1.2 vs. 13.9 +/- 2.4% Lo), and peak isometric tension (6.1 +/- 0.8 vs. 7.2 +/- 1.0 mN/mm2). Alb restored all these contractile indexes to baseline values. These findings suggest that MCh reversibly increased the number of active nactomyosin cross bridges under resting conditions, limiting further muscle shortening and active tension development. After the electrically induced contraction, muscles showed a transient phase of decrease in tension below preload. This decrease in tension was unaffected by afterload levels but was significantly increased by MCh and reduced by Alb. These findings suggest that the cross bridges activated before, but not during, the electrically elicited contraction may modulate the phase of decrease in tension below preload, reflecting the active part of resting tension.

Superior sulcus tumor refers to any primary lung cancer presenting with constant pain in the nerve distribution of the eighth cervical, first and second thoracic nerve roots and Horner's syndrome caused by invasion of the stellate ganglion. The pain is steady, severe, and unrelenting, involving the shoulder, the vertebral margin of the scapula and ulnar distribution of the arm to the elbow and finally to the ulnar surface of the forearm, and the small and ring fingers of the hand (Pancoast-Tobias syndrome). Weakness and atrophy of the hand muscles can also occur as the lesions spreads to involve the first and second ribs and vertebrae. Radiologically, there is a small shadow at the extreme apex of the lung with rib and possible vertebral body invasion. Pulmonary symptoms are less frequent because of the peripheral location of the lesions. Since Shaw and Paulson approached superior sulcus tumors in 1961 by using preoperative radiation-therapy (30 to 45 Gy in four weeks including the primary tumor, mediastinum and supraclavicular region) followed by surgical resection, this radiosurgical approach shortly became the standard treatment yielding better disease control and survival than that offered by other treatment modalities. It has now become evident that en bloc resection of the chest wall, involved adjacent structures as well as lobectomy must be considered the standard surgical approach for superior sulcus tumors combined with external radiation (preoperative, postoperative, or both). The goal of the operation is the complete and en bloc resection of the upper lobe in continuity with the invaded ribs, transverse processes, subclavian vessels, T1 nerve root, upper dorsal sympathetic chain and prevertebral muscles.

BACKGROUND: A pig-to-goat orthotopic lung xenograft model was developed to test whether depletion of goat xenoreactive antibodies against pig red blood cells would prolong pig lung xenograft survival. METHODS: Adult goats with anti-pig xenoreactive antibodies underwent left pneumonectomy followed by orthotopic transplantation of pig left lung (group 1) or immunodepletion of their xenoreactive antibodies by extracorporeal right pig lung perfusion before transplantation without (group 2) or with (group 3) complete clampage of the right pulmonary artery. In group 4, goat left lungs were orthotopically transplanted into pigs and served as negative controls (pig serum does not have anti-goat xenoreactive antibodies). Each study group included 5 animals. Immunosuppression in surviving recipients included cyclosporine and azathioprine. RESULTS: Group 1 recipients died 7 +/- 3 hours after xenograft reimplantation of severe pulmonary hypertension and dysfunction and vasogenic shock, with little evidence of histologic xenograft injury. Group 2 xenografts had a stable circulatory and respiratory function on reperfusion and survived 9 +/- 4 days. Group 3 animals also tolerated complete occlusion of the right pulmonary artery, and xenografts assured the total respiratory support for 4 +/- 1 days. After immunodepletion, goat serum showed no detectable titers of xenoreactive antibodies, which began to reappear by postoperative day 2, where xenografts showed histologic stigmata of acute (humoral and cellular-mediated) rejection that evolved to a complete xenograft necrose at death. Group 4 xenografts showed scattered features of acute rejection 5 +/- 1 days after the operation. CONCLUSIONS: Pig left lung xenografts can provide prolonged and complete respiratory support after depletion of goat xenoreactive antibodies, but they ultimately necrose once recipient xenoreactive antibodies return to pretransplantation values.

Sleeve pneumonectomy is a technically demanding procedure, the indications of which include non-small bronchogenic tumors extending to the tracheobronchial bifurcation without diseased mediastinal nodes. Right sleeve pneumonectomies are best approached through an ipsilateral thoracotomy in the fifth (or fourth) intercostal space. Median sternotomy for left sleeve pneumonectomy gives outstanding exposure to the tracheobronchial bifurcation, and less incisional discomfort and ventilatory restriction than an ipsilateral thoracotomy. If a tracheobronchial anastomosis is under tension, excessive tracheobronchial and mediastinal dissection and perioperative fluid overload are avoided, then the most common and often fatal early (noncardiogenic pulmonary edema) and late (anastomotic dehiscence) complications are significantlylowered. If these guidelines are respected, this operation generates 5-year survival rates exceeding 40%.

BACKGROUND: Air leaks after pulmonary resections may contribute to increased patient morbidity, delayed removal of chest drainage tubes, and prolonged hospitalization. OBJECTIVE: The purpose of this study was to investigate the effects of a new synthetic, absorbable sealant on the healing of healthy bronchial and lung tissues (experimental study) and its safety and efficacy to stop air leaks after lung resection (clinical study). METHODS: Fifteen large white pigs underwent a left upper lobectomy. All parenchymal surgical sites were sealed; the bronchial stump was either stapled, sealed, or both (n= 5 each). In the clinical study, 26 consecutive patients were prospectively randomized, intraoperatively, to standard closure of parenchymal surgical sites with (n = 15) or without (n = 11) the sealant. RESULTS: In the experimental study, no postoperative air leaks occurred, with intact bronchial closures and normal tissues at death. In the clinical study, 100% of intraoperative leaks were sealed versus 18% of control patients (P =.001). Although 77% (n = 10) of treated patients remained leak-free from the end of the operation to chest tube removal versus 9% (n = 1) of control patients (P =.001), there was no statistical difference in the duration of postoperative chest tube time, hospital stay, or cost. There were no acute or late undesirable side-effects related to the sealant application. CONCLUSIONS: The surgical adhesiveinvestigated here demonstrated a compelling safety profile and significant clinical efficacy to stop air leaks after lungresections.

Optimal evaluation of residual masses of non Hodgkin's lymphomas (NHL) after chemotherapy is of major importance, and gallium scan (GS) is routinely used for this purpose, particularly for mediastinal sites. However, sensitivity and specificity of GS in this setting has been diversely appreciated and needs to be more accurately defined especially if radiotherapy is not planned. A retrospective analysis selected all the patients treated in a single institution for aggressive NHL who presented a residual mass in the mediastinum after chemotherapy and who were evaluated by GS. The value of GS for distinguishing true complete responses (CR) from partial responses (PR) was analyzed in patients who were either submitted to resection of their residual mass or followed up without further treatment after GS. A residual mass with mean perpendicular diameters measuring 4.1 cm x 2.8 cm was found in 42 patients and was GS positive in 8 cases and negative in 34 cases. After GS, radiotherapy was delivered to 10 patients, but 12 patients underwent resection of their residual mass and 20 were followed up without further treatment. In the patients who did not receive radiotherapy, 3 false positive and 6 false negative GS results were disclosed. The specificity and the sensitivity of GS were 88% and 25%, and its positive predictive value and negative predictive value 40% and 78%, respectively. GS was not sufficiently reliable to evaluate post chemotherapy residual masses. Surgical resection of residual masses should be considered particularly in young patients. Patients in true CR should be spared pointless radiotherapy and its late side effects, while patients in PR may benefit from further intensified chemotherapy followed by radiotherapy.