Les luxations sternoclaviculaires sont rares, concernent généralement le sujet jeune et résultent le plus souvent de choc violent. À travers une revue de la littérature, les auteurs font le point sur ...l’épidémiologie, les mécanismes, les signes cliniques, l’imagerie et les traitements des luxations sternoclaviculaires d’origine traumatique. Les instabilités chroniques ne sont pas discutées.
Sternoclavicular joint dislocations are rare and generally occur in young adults as a consequence of a high-energy trauma. In this article, the authors review the epidemiology, the physiopathology, the clinical presentation, the radiology, and the treatment of acute sternoclavicular joint dislocations. Chronic instability is not discussed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Only few reports of surgical approach to T4 lung carcinoma invading the heart have been reported in the medical literature. It is also controversial if such cancer should be treated by surgery. The ...aim of this review is to assess the current risk/benefit ratio of the surgical management of non-small cell lung cancer (NSCLC) invading the left atrium, especially in the light of a multidisciplinary approach. We also expose our surgical experience and the procedure we have developed in order to increase our rate of complete resection as this criterion appears to be mandatory as well as patients' nodal status in order to increase life expectancy.
Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and ...usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.
Purpose
Preclinical data pointed to
99m
Tc-NTP 15-5 as a good candidate for single photon emission computed tomography (SPECT) imaging of cartilaginous disease. We set out to investigate and quantify
...99m
Tc-NTP 15-5 ex vivo uptake by human articular cartilage relative to bone
99m
Tc-hydroxymethylene diphosphonate (HMDP) radiotracer.
Methods
Three osteoarthritic human tibial plateaux and four tibiofemoral joints were incubated with
99m
Tc-NTP 15-5 and
99m
Tc-HMDP for 2 h. Affinity of tracers for cartilage was determined by visual analysis of SPECT/CT acquisitions and measurement of cartilage to cortical bone uptake ratios.
Results
Cartilage to cortical bone uptake ratios were 3.90 ± 2.35 and 0.76 ± 0.24, respectively, for
99m
Tc-NTP 15-5 and
99m
Tc-HMDP radiotracers. Visual analysis of fused SPECT/CT slices showed selective, intense
99m
Tc-NTP 15-5 accumulation in articular cartilage, whereas
99m
Tc-HMDP binding was low. Interestingly, a cartilage defect visualized on CT was clearly associated with focal decreased uptake of
99m
Tc-NTP 15-5.
Conclusion
The tracer
99m
Tc-NTP 15-5 is of major interest for human cartilage molecular imaging and could find clinical applications in osteoarthritis staging and monitoring.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Preclinical data pointed to ^sup 99m^Tc-NTP 15-5 as a good candidate for single photon emission computed tomography (SPECT) imaging of cartilaginous disease. We set out to investigate and quantify ...^sup 99m^Tc-NTP 15-5 ex vivo uptake by human articular cartilage relative to bone ^sup 99m^Tc-hydroxymethylene diphosphonate (HMDP) radiotracer. Three osteoarthritic human tibial plateaux and four tibiofemoral joints were incubated with ^sup 99m^Tc-NTP 15-5 and ^sup 99m^Tc-HMDP for 2 h. Affinity of tracers for cartilage was determined by visual analysis of SPECT/CT acquisitions and measurement of cartilage to cortical bone uptake ratios. Cartilage to cortical bone uptake ratios were 3.90±2.35 and 0.76±0.24, respectively, for ^sup 99m^Tc-NTP 15-5 and ^sup 99m^Tc-HMDP radiotracers. Visual analysis of fused SPECT/CT slices showed selective, intense ^sup 99m^Tc-NTP 15-5 accumulation in articular cartilage, whereas ^sup 99m^Tc-HMDP binding was low. Interestingly, a cartilage defect visualized on CT was clearly associated with focal decreased uptake of ^sup 99m^Tc-NTP 15-5. The tracer ^sup 99m^Tc-NTP 15-5 is of major interest for human cartilage molecular imaging and could find clinical applications in osteoarthritis staging and monitoring.PUBLICATION ABSTRACT
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
A retrospective monocentric study of consecutive patients with superior sulcus tumor non-small cell lung cancer (SS-NSCLC), treated by induction concurrent chemoradiotherapy (CRT), article ...management.
From 1994 to 2005, 36 patients (15 T3, 21 T4 tumors, including N2-N3 node involvement) received induction CRT with cisplatin/vinorelbine/fluorouracil combined with 44 Gy radiotherapy (5 daily 2 Gy fractions/week). After CRT completion, RECIST evaluation and operability were assessed. In resectable patients, surgery was performed one month after CRT. Patients with unresectable disease followed CRT up to 66 Gy. The median of follow-up period was 38.6 months 2-206.
Induction CRT was completed for 94.4% with 71% radiological objective response (OR). Sixteen patients (44%) underwent surgical resection, and pathologic complete resection was performed in 93.8%. There were 7 patients (44%) with pathologic complete response. The median disease-free survival (DFS) time was 12.9 months with DFS rates at 1 and 2 years 53.6% and 39.1% respectively. The median overall survival (OS) was 46.4 months. The OS rates at 2 and 5 years were 68.8% and 37.5% respectively with no difference between T3 and T4 tumors. In unresectable disease, the median DFS time was 8.1 months. The DFS rate at 1 year was 25.2%. The median OS was 9.1 months. The OS rates at 1 and 2 years were 45% and 16.9% respectively. Recurrences were found in 72% of patients. Brain metastasis was the most common site of recurrence. Prognostic factors for OS were the response to induction treatment, the possibility of surgery, and pathologic complete response.
This trimodality treatment regimen confers a survival outcome in agreement with previous studies. Patients with pretreatment N3 lymph node should be included in trimodality treatment.
Le genre dans The Rocky Horror Picture Show ou la liberté préservée par la perversionFrank-N-Furter, le délirant protagoniste du Rocky Horror Picture Show, bouscule par ses jeux érotiques les normes ...hétéronormées de la société bourgeoise. Son goût apparent pour la violation des règles doxales en fait un parangon de perversion, non pour répandre le vice mais pour ébranler la bien-pensance et inciter à discuter ses limites sans les considérer comme acquises. Ainsi, la transgression se fait la garante d’une perpétuelle remise en cause idéologique, au risque d’engendrer l’ennemi qui peut l’anéantir. En refusant d’appartenir à une catégorie définie de genre, Frank-N-Furter pose sa résistance comme un acte militant qui, par-delà l’identité sexuelle, se veut délibérément libertaire.
Objectives: To evaluate the prevalence, the impact-related postoperative complications and the risk factors of vocal cord dysfunction (VCD) after left lung resection for cancer. Methods: From ...February 1996 to April 1999, a review of prospectively gathered data was performed on 99 consecutive patients who underwent a pneumonectomy (n=50) or a lobectomy (n=49) with a mediastinal lymph node dissection. A fiber optic laryngeal examination was performed preoperatively for all patients and within the first week postoperatively in patients with symptom(s) or sign(s) of VCD or respiratory complications. Results: Thirty-one patients (31%) had a postoperative VCD (group VCD) and 68 (68%) did not (group non-VCD). Mortality rate was 19% in group VCD and 9% in group non-VCD (P=0.13). Group VCD patients developed more pulmonary complications (P=0.014) and cardiac complications (P≪0.001) compared to group non-VCD patients. A higher rate of reintubation (P=0.005), pneumonia (P=0.06), arrhythmia (P=0.002), cardiac failure (P≪0.001) was noticeable in group VCD and may account for the higher rate of complications in this group. Using multivariate analysis, preoperative radiotherapy (P=0.001) and pneumonectomy (P=0.008) were predictive of postoperative VCD. Hospital stay was 22±16 days in group VCD and 13±9 days in group non-VCD (P≪0.002). Conclusion: VCD is a frequent event that can lead to dramatic pulmonary complications. We would recommend to track it and to treat it as early as possible.
Étudier l’évolution des pressions inspiratoire et expiratoire maximales (PIM et PEM) après lobectomie pulmonaire.
Lors d’une étude prospective unicentrique, PIM, PEM, performance en spirométrie ...incitative (SI), exploration fonctionnelle respiratoire, dyspnée et douleur d’un groupe patient (n=10) étaient évaluées en préopératoire (Préop), entre le cinquième et septième jour postopératoire (j5–7) et à un mois de la sortie (j41). Dès le premier jour postopératoire (j1), techniques de désencombrement, SI et reprise d’activité étaient associées.
PIM et PEM étaient respectivement à 103±25 % et 120±30 % des théoriques en préopératoire, puis chutaient à j5–7 respectivement de 30±14 % et 32±22 % (p<0,05). La récupération était complète pour PIM et partielle pour PEM à j41 (p<0,05).
PIM et PEM chutent significativement après lobectomie pulmonaire. La SI en postopératoire est bien tolérée mais son effet sur les performances inspiratoires reste à préciser.
Niveau II.
Study maximal inspiratory and expiratory pressures (MIP and MEP) evolution after lung lobectomy.
During a unicentric prospective trial, MIP, MEP, incentive spirometry (IS) performance, lung function test, dyspnea and pain in a patient group (n=10) were assessed preoperatively (Preop), between the 5th and 7th postoperative day (D5–7) and one month after discharge (D41). From the first postoperative day (D1), chest physiotherapy, IS and return to activities of daily life were associated.
PIM and PEM were respectively at 103±25% and 120±30% of theoretical values at Preop, and decreased on D5-7 respectively of 30±14 % and 32±22% (P<0.05). The recovery was complete for PIM and partial for MEP on D41 (P<0.05).
MIP and MEP decrease significantly after lung lobectomy. Postoperative IS shows its excellent tolerance, nevertheless, its effect on inspiratory performances remains to be specified.
Level II.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Whether prophylactic tracheotomy can shorten the duration of mechanical ventilation (MV) in high risk patients eligible for lung cancer resection. The objective was to compare duration of MV and ...outcome in 39 patients randomly assigned to prophylactic tracheotomy or control.
Prospective randomized controlled, single-center trial (ClinicalTrials.gov Identifier: NCT01053624). The primary outcome measure was the cumulative number of MV days after operation until discharge. The secondary outcome measures were the 60 days mortality rate, the ICU and the hospital length of stay, the incidence of postoperative respiratory, cardiac and general complications, the reventilation rate, the need of noninvasive ventilation (NIV), the need of a tracheotomy in control group and the tracheal complications.
The duration of MV was not significantly different between the tracheotomy group (3.5±6 days) and the control group (4.7±9.3 days) (P=0.54). Among patients needing prolonged MV >4 days, tracheotomy patients had a shortened duration of MV than control patients (respectively 11.4±7.1 and 20.4±9.6 days, P=0.04). The rate of respiratory complications were significantly lower in the tracheotomy group than in the control group (28% vs. 51%, P=0.03). Six patients (15%) needed a postoperative tracheotomy in the control group because of a prolonged MV >7 days. Tracheotomy was associated with a reduced need of NIV (P=0.04). There was no difference in 60-day mortality rate, cardiac complications, intensive care unit and hospital length of stay. No death was related with the tracheotomy.
Prophylactic tracheotomy in patients with ppo FEV1 <50% who underwent thoracotomy for lung cancer resection provided benefits in terms of duration of prolonged MV and respiratory complications but was not associated with a decreased mortality rate, ICU and hospital length of stay and non-respiratory complications.
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