Pierre-Yves Brichon

Chylothorax complicating Gorham’s disease

Gorhams disease is a rare disorder characterized by a proliferation of thin-walled lymphatic vessels (lymphangiectasia) resulting in an osteolysis. A chylothorax is present in about one-fifth of the patients and carries a poor prognosis. In this circumstance, surgery including thoracic duct ligation, pleurodesis, and excision of involved tissue is probably the treatment of choice. It is facilitated by a precise radiological assessment using a computed tomographic scanning coupled with a lymphography. We report such a case.

Postoperative systemic artery to pulmonary vessel fistula: analysis of three cases.

BACKGROUNDnSystemic artery to pulmonary vessel fistulas (SAPVF) occur through pleural adhesions from miscellaneous origin. We report 3 cases of acquired SAPVF that developed late after thoracotomy.nnnMETHODSnThere was one pleurectomy for pneumothorax, one sleeve main bronchial resection, and one lower-middle bilobectomy. These SAPVF were discovered 4, 18, and 21 years after surgery.nnnRESULTSnOne patient underwent two unsuccessful embolizations. One patient underwent an unsuccessful attempt at surgical treatment after a previous embolization. Both have persistent SAPVF with minimal clinical discomfort 5 and 13 years later. One patient remains without treatment.nnnCONCLUSIONSnIn the literature 13 cases of SAPVF have been reported after lung resection, pleural drainage, axillary abcess drainage, closed chest trauma, parietal pleurectomy, and talc poudrage. Potential treatments of SAPVF include embolization, resection of pleural adhesion, and artery ligation. The effectiveness of these techniques is uncertain and the follow-up is too short to draw any clear conclusions. Embolization seems to be a useful tool in case of a single afferent artery. Surgical treatment seems to achieve more durable results than embolization but carries a higher risk of bleeding in the case of large SAPVF. Because SAPVF are well tolerated and complications are uncommon, clinical follow-up may be warranted in most cases.

Imagerie des tumeurs carcinoïdes bronchiques : diagnostic et bilan d'extension loco-régionale

Resume Objectif Decrire l’aspect en imagerie des tumeurs carcinoides bronchiques. Preciser la place du scanner dans la strategie diagnostique et pre-therapeutique. Patients et methode Analyse retrospective de 54 tumeurs carcinoides bronchiques. Comparaison des donnees cliniques, radiologiques, scanographiques, fibroscopiques et anatomopathologiques. Resultats L’âge moyen des patients est de 48,5 ans (14-81 ans). La presentation clinique est liee a l’obstruction bronchique dans 55,7 % des cas ; les tumeurs sont majoritairement proximales (72 %). Leur densite est tissulaire avec calcifications (26 %) et rehaussement apres injection iodee (60 %). Les tumeurs carcinoides bronchiques typiques et atypiques different par leur taille, leur extension ganglionnaire, et non par leur topographie. L’apport principal de la TDM par rapport a la fibroscopie est de montrer les tumeurs proximales a developpement exo-bronchique (7,4 %), des lesions distales (20,4 %) et les complications pulmonaires en aval des tumeurs obstructives. Concernant le bilan d’extension ganglionnaire, la sensibilite et la valeur predictive positive de la tomodensitometrie sont tres faibles, respectivement de 28 et 20 %. Conclusion Le scanner est indispensable pour le diagnostic positif, la localisation topographique des tumeurs carcinoides bronchiques. Cependant, les faibles sensibilite et valeur predictive positive pour le bilan d’extension locale et ganglionnaire ne permettent pas, au terme du seul bilan scanographique, d’envisager une strategie therapeutique conservatrice reposant sur l’exerese tumorale endoscopique exclusive.

Giant intracardiac neoplasic thrombus of a large cell neuroendocrine carcinoma of the lung

Cardiac invasion by lung cancer is associated with a poor prognosis. We describe the case of a large cell neuroendocrine carcinoma of the lung with left intra-atrial extension in a patient presenting with a catastrophic nutritional status.

Correction of a Severe Pouter Pigeon Breast by Triple Sternal Osteotomy With a Novel Titanium Rib Bridge Fixation

We describe a technique of correction of a severe pouter pigeon breast. Three osteotomies were performed on the sternum, one resecting the curved fused angle of Louis. Multiples chondrotomies allowed to flatten the cartilage part. The reconstruction was firmly hardened with a STRATOS titanium device. The cosmetic result was satisfactory.

Medical and Economic Evaluation of FOREseal Bioabsorbable Reinforcement Sleeves Compared With Current Standard of Care for Reducing Air Leakage Duration After Lung Resection for Malignancy: A Randomized Trial.

Objective: The objective of this study was to determine the efficacy of alginate staple-line reinforcement of fissure openings as compared with stapling alone, with or without tissue sealant or glue, in reducing the incidence and duration of air leakage after pulmonary lobectomy for malignancy. Summary Background Data: No randomized trial evaluating alginate staple-line reinforcement has been performed to date. Methods: The Staple-line Reinforcement for Prevention of Pulmonary Air Leakage study was a multicenter randomized trial, with blinded evaluation of endpoints. Patients over 18 years of age scheduled for elective open lobectomy or bilobectomy for malignancy were eligible for enrollment. At thoracotomy, patients were deemed ineligible if an unanticipated pneumonectomy was indicated, or if air leakage occurred after the liberation of pleural adhesions. Otherwise, if the fissure was incomplete or the lung had an emphysematous appearance, patients were randomized to either standard management or interventional procedure consisting of fissure opening with linear cutting staplers buttressed with paired alginate sleeves (FOREseal). The number of eligible patients necessary in each randomization arm was estimated to be 190, and an outcomes analysis was performed on an intention-to-treat basis. Results: Of the 611 patients consented to study enrollment, 380 met the inclusion criteria and were randomized. Based on an intention-to-treat analysis, the primary endpoint of air leak duration was not different between the 2 groups: 1 day (range: 0–2 d) in the FOREseal group and 1 day (range: 0–3 d) in the control group (P = 0.8357). In addition, the 2 groups were similar in terms of the proportion of patients presenting with prolonged air leakage (7.8% in the FOREseal group vs 11.3% in the control group, P = 0.264) and the average duration of chest drainage (P = 0.107). Procedure costs were comparable for both groups. Conclusions: FOREseal did not demonstrate a significant advantage over standard treatment alone.

Unusual Migration of a Foreign Body From Sternal Notch to the Left Pleural Lateral Sulcus

2010 by The Society of Thoracic Surgeons ublished by Elsevier Inc osed and was treated by a chest tube. A chest roentgengram (Fig 1) and computed tomographic scan (Fig 2) evealed the presence of an intrapleural foreign body, pparently of metallic origin, with local pleurisy. Clinical valuation of the brachial plexus was normal. The comuted tomographic scan did not show a lesion of the rachea, esophagus, or great vessels, and there was not ny diaphragmatic palsy. We performed a left-sided ideo thoracoscopy, and the foreign body was successully removed. It proved to be a doorknob fragment ig 2.