In vivo nonspecific macrophage chemotaxis in cancer patients and its correlation with extent of disease, regional lymph node status, and disease-free survival.

We have used a test to evaluate macrophage migration in vivo, derived from the technique of Rebuck. The test is based on counting the absolute number of macrophages that migrate into an inflammatory site determined by a standardized superficial skin abrasion. It was applied to the study of macrophage migration in cancer patients in different clinical situations. Macrophage migration was virtually abolished in patients with metastatic cancer as compared to healthy controls. In patients with resectable breast and lung tumors, the test performed preoperatively correlated closely with lymph node status as determined by pathological examination after operation. Patients without lymph node involvement showed a significantly stronger response than did controls, whereas those with lymph node involvement had a diminished or even an abolished response. Distinctive subgroups were characterized among patients both with and without lymph node involvement on the basis of their macrophage response, and these subgroups proved to have distinctly different prognoses, particularly the patients without lymph node involvement with a poor macrophage response who had an unusually poor prognosis. It is concluded that this test shows potential for predicting the prognosis among categories of patients hitherto considered as homogeneous, although further evaluation in larger numbers of patients is necessary.

Assessment by dipyridamole-thallium-201 myocardial scintigraphy of coronary risk before peripheral vascular surgery.

From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.

[The association of lung cancer and atheromatous arterial disease]. / Etude de l'association cancer broncho-pulmonaire et arthériopathie athéromateuse.

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.

[Lymphoscintigraphy and internal breast curettage in breast cancer. Comparison of results. 32 cases]. / Lymphoscintigraphie et curage mammaire interne dans le cancer du sein. Confrontation des résultats. 32 observations.

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.

[Evaluation by myocardial thallium-201 scintigraphy using dipyridamole of the coronary risk in peripheral vascular surgery]. / Evaluation par la scintigraphie myocardique au thallium 201 avec dipyridamole du risque coronarien de la chirurgie vasculaire périphérique.

From October 1983 to January 1985, 46 patients (38 men and 8 women; mean age 60 years, range 37-83) underwent peripheral vascular surgery either of the internal carotid artery or of arteries of the lower limbs. All patients had thorough clinical examination, ECG and thallium dipyridamole myocardial scanning before operation, as a result of which they were divided into 20 with, and 26 without chronic ischemic heart disease. Three major cardiac events were noted during or following a period of one month after surgery: two deaths due to a cardiac ischemic event and one post-operative unstable angina pectoris. The three patients with these complications were classified in the coronary group (NS). When the patients were reclassified according to the presence or absence of thallium redistribution on serial images after dipyridamole, 14 had redistribution and 32 had no redistribution. The three major cardiac events were found to have occurred in the group with redistribution (P less than 0.04). Our study suggests that patients with redistribution have a high incidence of postoperative ischemic events. They should be considered for a particular pre-operative coronary management to avoid post-operative major cardiac events and to improve survival.

[Adenoid cystic carcinoma of the trachea. Treatment by combined laser therapy and surgery]. / Carcinome adénoïde kystique de la trachée. Traitement par l'association laser-chirurgie.

In the group of adenomas of the trachea and bronchi, cystic adenocarcinomas or cylindromas are malignant tumours, whose outcome is much slower than those of the usual type of cancer. An unusual case is reported in which treated was firstly carried out with laser therapy and then surgery.

[Biopsy of the internal mammary lymph node by anterior thoracotomy (author's transl)]. / Biopsie de la chaîne mammaire interne par thoracotomie antérieure (pour bilan pronostique du cancer du sein).

The authors suggest a new technique of biopsy of the internal mammary lymph node by anterior thoracotomy, through the large pectoral respecting entirely the costal presentation. After a presentation of different operating cycles, they report their results.

[Thoracic wounds. Therapeutic approach. Apropos of 77 cases]. / Plaies thoraciques. Attitudes thérapeutiques. A propos de 77 cas.

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.

[About double drainage empyema treatment with bronchial fistula afer pneumonectomy (author's transl)]. / Le double drainage dans le traitment des pyothorax avec fistule bronchique après pneumonectomie.

We have resumed the files concerning the twenty patients treated these last eight years at Medico-Surgical center of Villiers Saint Denis for empyema with bronchial fistula after pneumonectomy, out of more than five hundred patients treatment for empyema of all origins. On that occasion, we explained the principals and the technique of double drainage which enabled us to cure 10 patients, the other ten died of a progressive resumption of cancer in the process of being treated. The direct treatment of fistula through endoscope has completed the action of pleural baths seven times. We also needed to resort to a complementary thorachoplasty seven times, in order to collapse a pouch already very reduced and disinfected by double draining, which had enabled us to block the fistula as well.

[Pericardioscopy: definition, value and limitation]. / La péricardoscopie: définition, intérêt et limite.

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.

[Thoracic splenosis]. / Splénose thoracique.

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.

[Plasmacytoma of the mediastinum. A new case]. / Plasmocytome du médiastin. Un nouveau cas.

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.

[Post-pneumonectomy pyothorax with and without broncho-pleural fistula]. / Pyothorax post-pneumonectomies avec ou sans fistule broncho-pleurale. Diagnostic et traitement.

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.

[Primary lymphoma on a pouch following collapse therapy]. / Lymphome primitif sur poche séquellaire de collapsothérapie.

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.