Feasibility of percutaneous radiofrequency ablation for pulmonary malignancies in the hands of the surgeon.

AIM: To assess the feasibility of percutaneous pulmonary radiofrequency ablation (RFA) executed by a single surgeon. MATERIALS AND METHODS: Between 2007 and 2010, 15 procedures were performed in 11 patients during 13 sessions. Sex, age, pulmonary localisation and tumor diameter are discussed. Metastatic lesions as well as pulmonary primitive malignancies were treated. For metastatic lesions, the primitive tumor was considered as completely treated. Surgery was refused because of impaired pulmonary function or due to patient's refusal. All interventions were carried out by a single thoracic surgeon under CT-guidance in the department of radiology. RESULTS: RFA was completed in all patients without perprocedural complications. There was no significant perioperative morbidity. Pneumothorax was the most frequent complication but none of the patients needed thoracic drainage. Hospital stay decreased progressively since the start of this series. Follow-up was complete. Most lesions were stable or diminishing in size. CONCLUSION: These early results show that pulmonary RFA is a safe and feasible technique in the hands of the surgeon. Longer follow-up and larger series will be welcome to confirm the results and position of this procedure which might become an important tool for the surgeon and not only for radiologists.

Preliminary results of carotid artery stenting in a non-academic hospital.

INTRODUCTION: A review of our experience with CAS in a non-academic hospital is presented. MATERIALS AND METHODS: A consecutive series of 18 CAS-interventions between 2003 and 2005 is studied retrospectively. Indication, medical history, preoperative carotid imaging, operative technique and results were studied for each patient. RESULTS: CAS was used 12 times in men and six (33.3%) times in women between 2003 and 2005. Five (27.8%) symptomatic stenoses, 12 (66.6%) asymptomatic stenoses and one (5.6%) arterio-venous fistula were treated. One permanent postoperative ipsilateral ischaemic neurologic deficit occurred (5.6%). The mean duration of hospital stay was 4.9 days (range : 2-9 days). CONCLUSIONS: Our study shows that CAS is feasible in non-academic hospital settings, with acceptable early results. Participating in larger studies should confirm our results.

Management of hepatic artery aneurysm. Case report and literature review.

The authors report the case of a 72-year-old man with new but vague epigastric pain. CT scan and selective coeliac trunk angiography demonstrated a common hepatic artery aneurysm (HAA). He was treated surgically by ligation and excision without revascularization. Asymptomatic hepatic aneurysm should be treated aggressively because the natural course seems to be progression to rupture associated with a high mortality rate. The authors discuss the clinical scenario of patients with HAA and stress the importance of the early treatment. In addition the therapeutic options are explored.

[Gallbladder volvulus]. / Le volvulus de la vésicule biliaire.

We report two new cases of gallbladder volvulus. This rare condition principally affects elderly patients but is due to a congenital malformation related to the presence of a long mesocyst. Various factors such as kyphoscoliosis, multiparity and peristalsis of neighbouring organs favorise the occurrence of volvulus, the role of lithiasis is debatable. The diagnosis may be suggested on ultrasound but is most often confirmed at laparotomy. Diagnosis should be made rapidly in order to avoid progression towards a potentially fatal secondary peritonitis. Certain clinical elements such as the presence of a "floating mass" on palpation may suggest the diagnosis.

[Interaction of polymorphonuclear leukocytes, bradykinin and carragenin. Transference reaction in the rat]. / Interaction polynucléaires, bradykinine et carragénine. La réaction de transfert chez le rat.

1. Injected in the paw of the rat, polymorphonuclear leucocytes do not increase the oedematogen action of bradykinin, but increase the action of lambda carrageenan. 2. This potentiation of carrageenan action is not modified when PG biosynthesis in leucocytes is inhibited by indomethacin or aspirin. It does not appear in rats previously treated by indomethacin or aspirin. 3. Our results suggest that rat polymorphonuclear leucocytes increase the inflammatory reaction, when they are stimulated by carrageenan, by the release of a phospholipase A2 activity which induces PG biosynthesis in rat paw tissues.

[The presence of 6-oxo-PGF1alpha and thromboxane B2 in peritoneal exudates released by iota-carrageenan in the rat]. / Sur la présence de 6-oxo PGF1 alpha et de thromboxane B2 dans les exsudats péritonéaux déclenchés par la carragénine iota chez le rat.

The wash fluid of the peritoneal cavity of the rat contains large amounts of 6-oxo PGF1 alpha. The peritoneal exudate induced two hours previously by iota carrageenan contains thromboxane B2 but its level in 6-oxo PGF1 alpha is not increased.

Consumption of pentane by hepatic microsomes and consequences on pentane measurement in exhaled gases.

Pentane measurement in exhaled gases was proposed as a safe method to evaluate the importance of lipoperoxidation in vivo, in man and in animals. However we have observed that pentane, which arises from lipoperoxide decomposition, is significantly consumed by cytochrome P-450-rich liver microsomes. This pentane consumption is completely inhibited after heating the microsomes at 100 degrees C, and is considerably reduced by metyrapone, a cytochrome P-450 inhibitor. Hepatic metabolism of pentane, particularly after cytochrome P-450 induction, constitutes a risk of error, when pentane exhalation is taken as an index of lipoperoxidation in vivo.

Laparoscopic adjustable gastric banding.

We introduced open adjustable silicone gastric banding (ASGB) for treatment of morbid obesity in our institution in 1991. It was done in a prospective study comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight loss. After 200 cases of open ASGB and 210 VBG procedures and the encouraging weight loss results, we started laparoscopic placement of the adjustable silicone band. The initial work was done in an animal laboratory program where a new surgical protocol has been established. Details of the laparoscopic dissection around the stomach in a deep operative field and fatty atmosphere have been developed, and a laparoscopically implantable version of the adjustable silicone band (LAGB) has been devised. The first human laparoscopic ASGB procedure was performed in our institution on September 1, 1993. Altogether 350 patients had undergone adjustable silicone gastric banding (LASGB) procedures by May 1997 (277 women, 73 men). All the patients were morbidly obese, with an average preoperative weight of 118 kg (92-200 kg). The mean BMI was 43 kg/m2 (36-65 kg/m2). The conversion rate to laparotomy has been low (1.4%). Early complications have been rare, and pouch dilatation and stomach slippage have been the only significant late complications. The rate of these complications has been considerably improved by reducing the pouch volume and using more gastrogastric sutures. Evaluation of postoperative weight loss of LASGB patients compared with our VBG and ASGB (open) patients showed a similar curve.

Exercise induces pentane production and neutrophil activation in humans. Effect of propranolol.

The effect of beta-adrenergic receptor blockade on exercise-induced lipid peroxidation in man has been examined by measuring the production of pentane in expired air. For this purpose, five healthy male subjects were subjected to dynamic exercise of graded intensity on a cycle ergometer (10 min at 45%, 5 min at 60% and 75% maximal oxygen uptake 1 h after ingestion of either a placebo or 40-mg propranolol. At rest, mean pentane concentration [( pent]) with placebo was 4.13 pmol.l-1, SD 2.14. After exercise, this value significantly increased by 310% (17.1 pmol.l-1, SD 7.73, P less than 0.01). Oral administration of 40-mg propranolol significantly lowered the mean resting [pent] to 1.75 pmol.l-1, SD 0.77, P less than 0.05. After exercise, the increase of [pent] was much smaller (240%) and was less significant (P less than 0.2) than with the placebo. The mechanism of this inhibitory effect of propranolol remains to be elucidated. However, as indicated by the measurement of plasma myeloperoxidase concentration, it can be concluded that the antioxidant property of propranolol cannot be attributed to the inhibition of neutrophil activation, a possible source of free radicals during exercise.