[Evolution of pain during respiratory rehabilitation after major lung resection]. / Évolution de la douleur en soins de suites et rééducation après résection pulmonaire majeure.

INTRODUCTION: Lung resection for cancer is the cause of significant postoperative pain. The aim of this study was to determine whether pulmonary rehabilitation could induce a resurgence of pain. METHODS: In 2014 and 2015, pulmonary rehabilitation was offered to all patients referred to our institution after lung resection for cancer. Patients were assessed at entry and departure for nociceptive pain, neuropathic pain (DN4), for quality of life using questionnaire EORTC QlQ-C30 and for anxiety and depression (HAD questionnaire). Pain was studied before and after the sessions of cycloergometer, gym and massages. RESULTS: During the period, 99 patients were admitted to our institution following lung resection for cancer. Medians changed during pulmonary rehabilitation from 3 to 1 for nociceptive pain (p<0.001), 3 to 3 for DN4 (NS), 50 to 67 for the quality of life score (p<0.001), 7 to 5 for the anxiety (p<0.001) and 5 to 3 for depression (p<0.0001). Pain remained stable during the sessions of cycloergometer and gym, and decreased during massage. Patients undergoing thoracotomy or video-assisted thoracic surgery evolved identically. CONCLUSION: Postoperative pulmonary rehabilitation after lung resection for cancer was not harmful. It was associated with a decrease in nociceptive pain and was without effect on neuropathic pain.

[Impact of pulmonary rehabilitation after lung resection for cancer on patients' level of anxiety and depression]. / Impact de la réhabilitation respiratoire sur l'anxiété et la dépression après chirurgie thoracique pour cancer.

INTRODUCTION: Pulmonary rehabilitation (PR) for patients undergoing lung resection for cancer remains controversial. We studied the effects of PR, its impact on quality of life and the level of anxiety and depression. METHODS: In 2011 and 2012, PR was offered to all patients referred to our institution after lung resection for cancer. Patients were evaluated between admission and discharge by a 6 minutes walking test (6MWD), a Visual Analogue Pain Intensity Scale, a quality of life questionnaire (EORTC QLQ C30) and by the Hospital Anxiety and Depression Scale (HAD). The same questionnaires were mailed 6 months after completing PR. RESULTS: Between early 2011 and late 2012, 133 patients were admitted to our institution following lung resection for cancer. Of these, 59 (44%) patients completed PR and returned their questionnaires 6 months after discharge. During PR of these 59 patients, the mean quality of life score increased from 56.3 to 65.9 (P<0.05), the median anxiety score decreased from 5.5 to 4 (P<0.05) and that of depression from 3 to 2 (P<0.05). At 6 months post-discharge, the mean quality of life score remained stable at 66.3 (P=0.8), the median anxiety score reverted to 6 (P<0.05) and the median depression score reverted to 4.5 (P<0.05). CONCLUSION: This observational study during PR, showed that quality of life and the levels of anxiety and depression were improved at the end of the course. After returning home, the average quality of life score remained stable but the level of anxiety and depression increased.

[Intervention of psychological and ethical professionals of human science in obstetrical morbidity and mortality conferences]. / L'intervention des sciences humaines en psychologie et en éthique dans les revues de morbi-mortalité en obstétrique.

OBJECTIVE: To identify the defence mechanisms manifested by medical staff which could disturb the decision making, revealed by professionals of human science (PHS) in morbidity and mortality conferences (MMC). MATERIALS AND METHODS: Application of two methods of psychological intervention in MMC, conducted between March 1st, 2009 and November 30, 2010, in 20 randomized maternity among five perinatal networks: the method of inter-active problem solving targeted at the functioning of the teams and the method for developing professional practice centred on individual. The data collection was realized during analyse of case in MMC, with note-taking by two pair PHS. The oral expressions of RMM' participant were secondarily re-written, analyzed and classed by theme. RESULTS: Fifty-four MMC were performed. The mechanisms of defence have been identified by PHS intervention in MMC: denial of situation, pact of denegation, rift and overprotection. They were be identified by two PHS intervention methods, this consolidates these results. This intervention began staff medical to transformation at different level, in particular to improve the capacity of cooperation. CONCLUSION: The identification of the mechanisms of defence in MMC enables staff medical to improve communication and quality relationship between healthcare professionals. This could constitute an actual factor of practices improvement. However, complementary studies must be performed to confirm this hypothesis.

[Pulmonary rehabilitation after lung resection for tumor - a feasibility study]. / Intérêt de la réhabilitation respiratoire après résection pulmonaire pour tumeur.

INTRODUCTION: To investigate the safety, feasibility and effectiveness of an inpatient pulmonary rehabilitation program (i-PR) after lung resection (LR) for cancer. METHODS: Between January 2007 and December 2009, we conducted a prospective observational study on patients admitted in our institution. An i-PR was offered to all patients. They completed respiratory function tests and a quality of life (QoL) questionnaire at the start and after completing the i-PR. RESULTS: During the study, 154 out of 175 patients who underwent LR and who were admitted in our center followed an i-PR. The remaining 21 patients were excluded because of emergency re-hospitalisation (10 patients), anticipated departure (six patients) or refusal to participate (five patients). Most functional parameters in the 154 treated patients improved between the beginning and the end of their stay: FVC (69.9% versus 79.6%; P<0.0001); FEV(1) (61.2% versus 69.9%; P<0.0001); timed walk-6MWT (356 m versus 444 m; P<0.0001) and constant work cycle ergometry test (281 s versus 683 s; P<0.0001). Also, the EORTC QLQ-C30 and the EORTC QLQ-LC13 improved during the stay, especially global health status (50.5 versus 64.5; P<0.0001). CONCLUSION: Postoperative PR is safe and could positively impact on functional status and QoL among this population.

[Results of FDG-PET scanning in the pre-operative staging of broncho-pulmonary tumors]. / Résultats de la TEP [18F]-FDG dans la stadification préopératoire des tumeurs pulmonaires.

BACKGROUND: Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) has recently established itself as an important imaging strategy in the management of respectable non-small cell bronchial carcinoma (NSCLC). In this study we report our experience of the impact of FDG-PET in the pre-operative assessment of NSCLC. METHODS: In a single centre retrospective study between 01 January 2000 and 31 Dec 2002, 108 FDGPET scans were performed during the preoperative assessment of histologically proven or strongly suspected NSCLC. RESULTS: The sensitivity, specificity and accuracy of FDG-PET for the characterization of a parenchymatous opacity were 96%, 71% and 92% respectively (4 false negatives, 5 false positives). The sensitivity, specificity and accuracy for mediastinal node involvement were 62%, 94% and 84% respectively (10 false negatives and 4 false positives). The sensitivity, specificity and accuracy for the characterization of adrenal nodules were 88%, 100% and 97% (1 false negative) and for satellite pulmonary nodules 50%, 75% and 64% (2 false negatives and 3 false positives). CONCLUSION: FDG-PET is a useful imaging modality in the pre-operative management of NSCLC but is limited particularly in the characterization of lesions less than 10 mm in diameter and in the evaluation of mediastinal lymph nodes.

Perioperative analysis of biopsies issued from mediastinoscopy.

BACKGROUND: The objective of this study was to evaluate frozen sections of samples obtained at mediastinoscopy for their clinical usefulness. METHODS: This study retrospectively reviewed the records of all patients who underwent mediastinoscopy with perioperative frozen sections in a 1-year period. RESULTS: A total of 123 consecutive patients underwent the procedure. There were no false-positive results. Of the 71 malignant proliferations, 67 were diagnosed from frozen sections. The technique never failed to establish the absence of mediastinal nodal involvement in patients with suspected or proven lung tumors and enlarged nodes (n = 18) who underwent immediate thoracotomy. Frozen sections allowed recognition (n = 36) or strong suspicion (n = 4) of N2 disease in patients subsequently treated by induction chemotherapy. The technique never failed to establish the nonresectability of lung cancer in patients for whom this condition was suspected perioperatively (clinical stage IIIb; n = 10). CONCLUSIONS: Mediastinoscopy with frozen sections remains an extremely useful tool for the management of paratracheal or subcarinal mediastinal disease.

[Catamenial pneumothorax. Failure of videothorascopic treatment]. / Pneumothorax cataménial. Echec du traitement par vidéothoracoscopie.

INTRODUCTION: Catamenial pneumothorax occurs in women during the menses. It is frequently associated with diaphragmatic fenestrations or episodes of pleural endometriosis. OBSERVATION: We report the case of a patients who had presented 25 episodes of right pneumothorax despite treatment with videothorascopy initiated after the 10th episode. These episodes coincided with menstruation. Diagnosis of catamenial pneumothorax was evoked and thoracic surgery was indicated. Exploration of the pleural fossa did not reveal symphysis but 7 diaphragmatic orifices, which were sutured before conducting mechanical pleurodesis. No relapse of pneumothorax was reported following surgery. COMMENTS: Around one hundred cases of catamenial pneumothorax have been reported in the literature. They represent 2.8 to 5.6% of spontaneous pneumothroax in women. Diagnosis is evoked on the occurrence of recurrent pneumothorax appearing 24 to 72 hours after the onset of menstruation. The pathogeny is uncertain and several mechanisms are frequently evoked. In the prevention of relapses, treatment consists in closing the diaphragmatic orifices with thoracotomy, resection of eventual bubbles, and pleural symphysis. Videothorascopy does not appear adapted to treatment.