Increased innervation of forebrain targets by midbrain dopaminergic neurons in the absence of FGF-2.

Fibroblast growth factors (FGFs) regulate development and maintenance, and reduce vulnerability of neurons. FGF-2 is essential for survival of midbrain dopaminergic (DA) neurons and is responsible for their dysplasia and disease-related degeneration. We previously reported that FGF-2 is involved in adequate forebrain (FB) target innervation by these neurons in an organotypic co-culture model. It remains unclear, how this ex-vivo phenotype relates to the in vivo situation, and which FGF-related signaling pathway is involved in this process. Here, we demonstrate that lack of FGF-2 results in an increased volume of the striatal target area in mice. We further add evidence that the low molecular weight (LMW) FGF-2 isoform is responsible for this phenotype, as this isoform is predominantly expressed in the embryonic ventral midbrain (VM) as well as in postnatal striatum (STR) and known to act via canonical transmembrane FGF receptor (FGFR) activation. Additionally, we confirm that the phenotype with an enlarged FB-target area by DA neurons can be mimicked in an ex-vivo explant model by inhibiting the canonical FGFR signaling, which resulted in decreased extracellular signal-regulated kinase (ERK) activation, while AKT activation remained unchanged.

[Creation of software to help cardiac surgeons: CordaBase].

BACKGROUND: The writing of surgical and hospitalization reports is time-consuming and does not necessarily enable the increment of a statistical database, tool that is indispensable nowadays to evaluate unit activity or to carry out scientific studies. In order to prevent this double data capture, a computer tool, named CordaBase, has been developed by surgeons and set up in a cardiac surgery unit. MATERIALS AND METHODS: CordaBase is an interactive software that stores medical data. Thanks to its intuitive interface, CordaBase stores data which is classified chronologically in the following categories: past medical history, preoperative assessment, operating gesture, stay in intensive care unit, stay in wards and evolution/monitoring after discharge. This date, stored in an Access base, are then used in the creation of personalized surgical and hospitalization reports. All the data is permanently available and can be used for the carrying out of scientific works or for the evaluation of the unit activity. RESULTS: From March 2009 to December 2010, 2617 consecutive patients operated on in a Cardiac Surgery Unit were recorded prospectively in the software. All of this stored data assisted the surgeon in his or her administrative tasks, thanks to personalized surgical and hospitalization reports, immediately at the secretariat's disposal. The database, which is requisitely filled by administrative work, enables the carrying out of any statistical study on all unit activity. CONCLUSION: With a hindsight of almost 2 years, CordaBase has proven its usefulness in an active cardiac surgery unit, both on an administrative and scientific level. The computerized reports have lightened the medical secretariat's workload and statistical studies have now become possible without having to take the paper medical files out again. In the years to come, the accumulation of medical data prospectively or retrospectively stored will surely confirm the potential of the use of such a software.

Epidemiology and prevention of surgical site infections after cardiac surgery.

Deep sternal wound infection is the major infectious complication in patients undergoing cardiac surgery, associated with a high morbidity and mortality rate, and a longer hospital stay. The most common causative pathogen involved is Staphylococcus spp. The management of post sternotomy mediastinitis associates surgical revision and antimicrobial therapy with bactericidal activity in blood, soft tissues, and the sternum. The pre-, per-, and postoperative prevention strategies associate controlling the patient's risk factors (diabetes, obesity, respiratory insufficiency), preparing the patient's skin (body hair, preoperative showering, operating site antiseptic treatment), antimicrobial prophylaxis, environmental control of the operating room and medical devices, indications and adequacy of surgical techniques. Recently published scientific data prove the significant impact of decolonization in patients carrying nasal Staphylococcus aureus, on surgical site infection rate, after cardiac surgery.

Compromiso cardiovascular en la enfermedad de Fabry / Cardiovascular involvement in Fabry disease

La enfermedad de Fabry es una patología de origen genético que se produce por el depósito, a nivel lisosomal, de diferentes productos como globotriazolceramida, glicoesfingolípidos neurales y diagalactosilceramida a nivel sistémico, como consecuencia de la actividad deficiente de la enzima alfa-galactosidasa A. Las manifestaciones clínicas se inician desde la infancia pero son sutiles y suelen confundirse con otras patologías, razón por la cual en la mayoría de los casos la enfermedad se detecta en grados avanzados. En los adultos los órganos más afectados son corazón, riñones y cerebro. El compromiso cardiaco es de gran importancia por tratarse de una de las principales causas de morbi-mortalidad. El depósito de estas moléculas ocurre en todos sus componentes celulares. Genera hipertrofia e isquemia y remodelación miocárdica, o ambas.En la actualidad existe tratamiento específico con agalasidasa A y B recombinante, con el cual se logra una disminución en los depósitos lisosomales. Se recomienda aumentar la vigilancia de la enfermedad para detectar los casos e iniciar el tratamiento lo más temprano posible.

[A rare cause of myocardial infarction: papillary fibroelastoma of the aortic valve]. / Cause rare d'infarctus du myocarde: le fibro-élastome papillaire de la valve aortique.

Papillary fibroelastoma is a rare, benign endocardial tumour usually located on the cardiac valves. Before echocardiography, these tumours were chance findings either at surgery or at autopsy. With the advent of echocardiography, the diagnosis has become commoner and they are often the cause of systemic embolism justifying surgical ablation. In this case, an aortic valve papillary fibroelastoma presented with myocardial infarction in a 78 year old woman with normal coronary angiography. The diagnosis was strongly suspected at echocardiography and confirmed by histological analysis of the surgically excised tumour.

Resection of bronchopulmonary cancers invading the left atrium--benefit of cardiopulmonary bypass.

AIMS: Cardiopulmonary bypass (CPB) for extended lung resections involving great vessels and other mediastinal organs remains controversial, especially due to CPB-related haemorrhagic and immunological issues. Here, we will retrospectively analyse the results obtained with such procedure. MATERIAL AND METHODS: Between January 1994 and February 2001, four patients underwent surgery under CPB for lung carcinoma in our department. Three patients were male and one female; mean age was 58.8 +/- 6.3 years. The patients suffered from malignant pulmonary lesions involving the left atrium (T4 or stage IIIb) - two epidermoid carcinoma, one adenocarcinoma and one large-cell carcinoma. Procedures were performed under complete CPB with aortic cross-clamping in all but one patient who underwent hypothermic ventricular fibrillation. Mean CPB duration was 86.7 +/- 26.5 min. RESULTS: There were no hospital mortalities (D30). Mean duration for assisted ventilated support was 9.5 +/- 2.5 hours, 2.5 +/- 1 days for ICU stay and 14.3 +/- 1 days for hospital stay. Operation-related complications were rare. Two patients presented with transient postoperative atrial fibrillation. Only one patient had to undergo reoperation for compressive haemopericardium drainage at D23. The mean quantity of transfused packed red blood cell packs was 2.7 +/- 1.7. Two patients survived over three years after surgery and one patient is still alive at 72 months without any recurrent symptom. CONCLUSION: In some cases of T4 lung cancer considered inoperable, CPB permits extended lung resections offering significant hope for survival at an acceptable operative risk.

Retrospective clinical comparison of Celsior solution to modified blood Wallwork solution in lung transplantation for cystic fibrosis.

OBJECTIVE: To compare the preservative effects of Celsior solution and modified blood Wallwork solution in lung transplantation. METHODS: From 1989 to 2000, 44 lung transplantations for cystic fibrosis were performed: 26 grafts were preserved with modified blood Wallwork solution and 18 with Celsior solution. RESULTS: Preoperative status of the 2 groups was similar. The ratio of arterial oxygen to fraction of inspired oxygen and the pulmonary vascular resistance on the first postoperative day did not differ significantly between the 2 groups. Early death was 4% (SD, 20%) in the Wallwork group versus 11% (SD, 32%) in the Celsior group (not significant). No death was related to graft failure. The forced expiratory volume in 1 second during the first month after transplantation was 63% (SD, 19%) in the Wallwork group versus 63% (SD, 16%) in the Celsior group (not significant). CONCLUSION: Because the solution does not need to be prepared on site and does not require blood from the donor, Celsior seems better than Wallwork solution for preserving lung grafts.

Partial anomalous pulmonary venous connection: correction by intra-atrial baffle and cavo-atrial anastomosis.

The creation of intracaval conduits to repair partial anomalous pulmonary venous connection of the right lung into the superior vena cava can be complicated by arrhythmias and superior vena cava and pulmonary vein obstruction. An intra-atrial baffle, combined with cavo-atrial anastomosis, has been proposed to avoid these complications. The authors report their recent experience with this operative technique. From January 1997 to December 2000, 7 patients with a mean age of 13.5 +/- 9 (2-31) years were operated according to this technique. Only one child did not have an associated atrial septal defect. The mean number of pulmonary veins connected to the superior vena cava was 2.5 +/- 0.5. The immediate postoperative course was uneventful for the seven patients. The mean follow-up was 20 +/- 17 months. No patient developed arrhythmia or superior vena cava or pulmonary vein obstruction at echocardiography. This surgical technique appears to constitute an attractive alternative when pulmonary veins drain abnormally into the superior vena cava above the cavo-atrial junction.

One-stage repair of aortic isthmus atresia, aortic arch hypoplasia and ascending aorta aneurysm via midline sternotomy and normothermic perfusion.

One-stage repair of aortic isthmus atresia, aortic arch hypoplasia and ascending aorta aneurysm was performed via a standard midline sternotomy. Ascending aortoplasty was performed during a 19-min cardiac arrest. With the heart beating and continuous normothermic perfusion of the upper and lower part of the body, the aortic arch was then enlarged using the Amato technique and the harvested ascending aorta wall as autologous patch. A classical Crafoord procedure then restored continuity between the aortic arch and the descending thoracic aorta.

[Surgery in heart failure (without transplantation)]. / Chirurgie dans l'insuffisance cardiaque (hors transplantation).

Cardiac transplant remains the treatment of reference for end-stage cardiac insufficiency. The very great disparity between the number of grafts available and the number of patients eligible to be included on the transplant list drives some of them to contemplate a surgical alternative in order to improve their clinical condition and to delay as much as possible the date of transplant. The objective is to treat surgically one or several of the lesions causing the cardiac insufficiency. It could be valvular surgery, coronary surgery or a combination of both, ventricular remodelling or cardiomyoplasty. It is coronary revascularisation surgery which gives the most spectacular results on condition that it is aimed at the myocardial zones for which viability has been demonstrated by stress echocardiography or a PET scan.

Left bronchial disruption and aortic rupture after blunt chest trauma.

A 25-year-old male who had been involved in a traffic accident presented with a neurological disorder, bilateral pneumothoraces, and pneumomediastinum. Bronchoscopy revealed a complex rupture of the left bronchial tract. MRI revealed a sinus valsalva aneurysm. The bronchial lesion was first repaired via left thoracotomy. 10 days later, the aorta was repaired via sternotomy. In cases of combined bronchial and aortic lesion, a concomitant repair is not mandatory, at least when the aortic lesion appears limited and shows no signs of dissection.

Varix of the heart.

A 76-year-old patient was operated on for an asymptomatic primary tumor of the heart located in the right atrium. The tumor was detected during a preanesthetic check-up for a transurethral resection of a prostate adenoma, showing a 3/6 systolic murmur. The mass was resected. The postoperative course was uneventful but the histologic result was surprising: varix of the heart.

pH paradox and neonatal heart.

BACKGROUND: To evaluate the functional status of the Na+/H+ exchanger in the neonatal heart. METHODS: On the Langendorff system, isolated neonatal rabbit hearts were arrested by using cardioplegia with or without a specific Na+/H+ exchanger blocker, 5-(N,N dimethyl) amiloride (DMA) (20 microM). Ischemic period was 40 minutes at 37 degrees C or 120 minutes at 20 degrees C before 30 minutes of reperfusion at 37 degrees C. When DMA was added to the cardioplegia solution, it was also added to the reperfusate for the first 5 minutes of reperfusion (20 microM). RESULTS: Postischemic developed pressure was 50.3+/-7.1 mmHg in the DMA group versus 25.9+/-6 mmHg in the control group (p<0.05) at 37 degrees C and 74.8+/-14.6 mmHg in the DMA group versus 60.6+/-11.5 mmHg in the control group (p<0.05) at 20 degrees C. Postischeimic diastolic pressure was 40.4+/-3.3 mmHg in the DMA group versus 28.4+/-7 mmHg in the control group (p<0.05) at 37 degrees C and 9.6+/-3.1 mmHg in the DMA group versus 15+/-3.7 in the control group (p<0.05) at 20 degrees C. Creatine kinase washout was 296+/-97 IU/L in the DMA group versus 1253+/-537 IU/L in the control group (p<0.05) at 37 degrees C and 370+/-156 IU/L in the DMA group versus 524+/-104 IU/L in the control group (p<0.05) at 20 degrees C. CONCLUSIONS: 1) The Na+/H+ exchanger is active in the neonatal heart. 2) The Na+/H+ exchanger plays a key-role in the pathogenesis of reperfusion injury of the neonatal myocardium. 3) This exchanger is sensitive even for low H+ transmembrane gradients and even under hypothermic conditions.

Resection of hepatic and pulmonary metastases in patients with colorectal cancer.

The resection of liver and lung metastases is now regarded as valid therapy, although the surgical procedure of both metastatic sites has not been clearly defined. Nine consecutive patients who underwent resection of both liver and lung metastases from colorectal cancer (5 Dukes' stage B, 3 C, 1 D) between 1986 and 1999 were studied retrospectively. A total of 19 resections were performed: 8 hepatectomies, 2 liver wedge resections, and 9 lung lobectomies. No operative or hospital deaths occurred, and mean postoperative hospital stay per procedure was 12 days. Mean survival after resection of the primary colorectal tumor was 66.3 (range: 26-96) months. The median interval was 24.2 (range: 2-39) months from resection of the liver metastasis and 30.4 (range: 3-45) months from resection of the lung metastasis. At the last follow-up, 6 patients were still alive, 4 of whom were free of recurrence 59, 69, 74, and 76 months, respectively, after resections. Three patients died with metastases. Aggressive treatment of liver and lung secondaries from colorectal cancer was performed without hospital mortality and acceptable morbidity. Longer survival times warrant the use of this alternative therapy for selected patients. In association with new effective chemotherapies, it will be possible to select patients who will benefit from surgery.

[Cure of superacute eosinophilic myocarditis treated by temporary circulatory assistance]. / Guérison d'une myocardite suraiguë à éosinophiles traitée par assistance circulatoire temporaire.

The authors report the case of a 31 year old woman, admitted as an emergency for acute myopericarditis, in cardiogenic shock. Echocardiography showed severe left ventricular dysfunction associated with concentric biventricular hypertrophy with increased echogenicity of the myocardial walls. Poor response to treatment with intravenous inotropic drugs led to referral for biventricular circulatory assistance with a Biomedicus pump, which was withdrawn on the 9th day after recovery of normal left ventricular function. Myocardial biopsies showed massive interstitial inflammation with a predominance of eosinophilic cells suggesting a hypersensitivity reaction. Steroid therapy was prescribed when the results of biopsy were known and stopped after 6 months. This case emphasises the value of echocardiography and myocardial biopsy in diagnosis and treatment of acute myocarditis with cardiogenic shock.

[Right atrial intracardiac varices. Review of the literature and case report]. / Varices intracardiaques auriculaires droites. Revue de la littérature à propos d'une observation.

Right atrial varices are rare. They were described for the first time by anatomo-pathologists at the end of the 19th century and beginning of the 20th century. They are situated in the lower part of the inter-atrial septum and rarely exceed 2 cm in diameter. Descriptions have been from post-mortem studies which have led to epidemiological analyses and have given rise to nosological controversies. The authors report a case characterised by the exceptional volume of the varices. This could have enabled the diagnosis to be suspected at transoesophageal echocardiography before surgery. Thoracic CT scan and MRI completed the iconography. In the literature, two other cases of cardiac varices diagnosed at echocardiography have been published: they were small tumours on the lower part of the interatrial septum and the diagnosis before surgery was that of a myxoma. These formations seem to correspond to chance findings and do not appear to give rise to symptoms.

[Surgical treatment of pulmonary metastases of colorectal cancers. 8-year survival and main prognostic factors]. / Traitement chirurgical des métastases pulmonaires des cancers colorectaux. Survie à 8 ans et principaux facteurs pronostiques.

OBJECTIVE: In order to achieve a better definition of the indications for surgical excision of pulmonary metastases in colorectal cancer (CCR), a retrospective study of the eight year survival of patients who had been operated on was carried out with reference to the principal prognostic factors. METHODS AND RESULTS: Between May 1986 and December 1997, 38 patients had an excision for pulmonary metastases for CCR. The mean delay between diagnosis of the metastases and surgical treatment of the CCR was 39 +/- 24 months (0-98). Thirty two patients (84%) had a single pulmonary metastasis. The mean diameter of the metastasis was 38 +/- 22 mm. Twenty metastases had a diameter < 30 mm. Five patients had a locoregional recurrence of their CCR before pulmonary surgery. Fourteen patients had an abnormally elevated level of carcinoembrionic antigen (ACE-CEA) before the pulmonary excision. Five pneumonectomies, 23 lobectomies, 1 bilobectomy and 11 atypical resections were carried out. A lymph node clearance was performed in 25 cases. Six patients (16%) had an associated excision of an hepatic metastasis. The in-hospital mortality was 2.6%. Chemotherapy was associated with a pulmonary excision in 17 patients (46%). The mean survival was 2.7 years (0.13-8.7 years). The survival at one year was 89 +/- 5.2% and at five years 35.2 +/- 10.1% and at eight years 18.8% +/- 10.3%. Age, sex, histological stage of the primary tumor, the size and the delay in appearance in the pulmonary metastases, the number of metastases, the preoperative CEA, the operative technique and the perioperative chemotherapy did not influence the levels of survival at five years. At the same time associated excision of an hepatic metastasis did not worsen the prognosis at five years. CONCLUSION: Complete excision of pulmonary metastases in a colorectal cancer allows for significantly longer survival. This study associated with a literature review may help in advancing towards better selection of surgical candidates.

[Mucoviscidosis: lung transplantation is always in order]. / Mucoviscidose: la transplantation pulmonaire toujours d'actualité.

THE ONLY SOLUTION: Despite significant progress in the management of patients with multiple sclerosis, lung transplantation remains the only chance for survival in those with severe respiratory failure. WAITING LIST INCLUSION CRITERIA: Lung function tests, the patientís general states and psychological and familial factors all contribute to determining inscription on lung transplantation waiting lists. TECHNICAL ASPECTS: Heart-lung, monoblock two-lung and sequential two-lung transplantations are detailed according to the respective advantages and disadvantages. RESULTS: Hospital mortality is about 5% and 5-year survival about 50%. However, only 10% of the patients on waiting lists due to the lack of organs survive for 2 years. PERSPECTIVES: The number of grafts must be increased by developing lobular grafts from live donors using the bipartition technique. Nevertheless, xenografts remain the most promising perspective for increasing the number of patients who can benefit from this therapy.

Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer.

OBJECTIVE: Bronchopleural fistula after pneumonectomy is a very serious complication, occurring in 1-4% of cases, regardless of the bronchial stump closure technique adopted. The objective of this study was to report a bronchial stump closure technique in pneumonectomy by manual suture (polypropylene running suture) and to study the incidence of bronchopleural fistula. METHODS: Between January 1988 and December 1997, 209 patients (186 men and 23 women, mean age = 60.5 years) were operated by the same operator. The indication for surgery was lung cancer in all cases. RESULTS: The incidence of bronchopleural fistula was 2.4%; four fistulas during the first postoperative month and another occurred at 6 months; four were located on the left side and one was situated on the right. The bronchial stulnp was covered in only two of these five cases; 40% died of this complication. Neoadjuvant treatment (chemotherapy and/or radiotherapy) was found to increase the risk of development of bronchopleural fistula (40% vs. 7.2%) and this difference was statistically significant (P = 0.046). CONCLUSIONS: Manual closure of the bronchial stump by running suture, performed on an open bronchus, is a reliable technique with a low incidence of bronchopleural fistula. Those results could be further improved by systematically covering the right and the left bronchial stumps.