Les nouveautés apparues ces dernières années dans le traitement chirurgical du cancer thyroïdien sont présentées. La chirurgie robotisée n’a actuellement que l’intérêt de latéraliser la cicatrice ...dans des sites moins exposés (régions axillaires et péri-aréolaire). Les voies d’abord mini-invasives du médiastin (TEMLA, VAXY) sont de réelles avancées techniques. La pratique de plus en plus fréquente de la cytoponction et la classification de Bethesda ont permis une standardisation des pratiques. Le curage ganglionnaire central prophylactique unilatéral pourrait être une alternative nuancée entre les partisans d’un curage central systématique et l’absence de curage ganglionnaire central.
New developments in surgical treatment of thyroid carcinoma are presented. Nowadays, the main interest of robotic surgery is to avoid skin incision in the neck by transposing it in the armpit and in the nipple. Mini-invasive surgery of the mediastinum (TEMLA, VAXY) are authentic progress. Decision making of the physicians are more standardized by standardization of fine needle aspiration biopsy and Bethesda classification. Unilateral prophylactic central lymph node dissection may be an alternative between systematic bilateral and any lymph node central dissection for thyroid carcinoma.
Pleuroparenchymal fibroelastosis (PPFE) has no currently available specific treatment. Benefits of lung transplantation (LT) for PPFE are poorly documented.
We conducted a nation-wide multicentric ...retrospective study in patients who underwent lung or heart-lung transplantation for chronic end-stage lung disease secondary to PPFE between 2012 and 2022 in France.
Thirty-one patients were included. At transplantation, median age was 48 years IQR 35–55. About 64.5% were women. Twenty-one (67.7%) had idiopathic PFFE. Sixteen (52%) had bilateral LT, 10 (32%) had single LT, 4 (13%) had lobar transplantation and one (3%) had heart-lung transplantation. Operative mortality was 3.2%. Early mortality (<90 days or during the first hospitalization) was 32%. Eleven patients (35.5%) underwent reoperation for hemostasis. Eight (30.8%) experienced bronchial complications. Mechanical ventilation time was 10 days IQR 2–55. Length of stay in intensive care unit and hospital were 34 IQR 18–73 and 64 IQR 36–103 days, respectively. Median survival was 21 months. Post-transplant survival rates after 1, 2, and 5 years were 57.9%, 42.6% and 38.3% respectively. Low albuminemia (p = 0.046), FVC (p = 0.021), FEV1 (p = 0.009) and high emergency lung transplantation (p = 0.04) were associated with increased early mortality. Oversized graft tended to be correlated to a higher mortality (p = 0.07).
LT for PPFE is associated with high post-operative morbi-mortality rates. Patients requiring high emergency lung transplantation with advanced disease, malnutrition, or critical clinical status experienced worse outcomes.
NCT05044390.
Abstract Background In the current practice of lung transplantation, donor and recipient genders are neither directly considered nor matched. However, some data have suggested a possible effect of ...gender combinations on survival following lung transplantation. Methods A total of 249 adult lung transplant recipients at a single center between February 1988 and December 2008, were analyzed retrospectively for donor-recipient gender matching. We compared the mortality by calculating one-term survival rates after transplantation using the Kaplan-Meier method with comparisons using the log-rank (Mantel-Cox) test. Statistical significance of the mean effects of size matching was assessed by paired Student t tests and Wilcoxon signed rank tests. Results Kaplan-Meier survival analysis shown that male compared to female recipients did not have an effect on outcomes after lung transplantation at 5 years ( P = .5379), 10 years ( P = .107), 15 years ( P = .0841), 20 years ( P = .0711). No effect of gender on lung transplantation outcomes was observed with donor-recipient gender mismatches at 5 years ( P = .1804), 10 years ( P = .1457), 15 years ( P = .0731), or 20 years ( P = .0629). Similarly, no differences were observed for each gender combination. The degree of size matching was defined as the ratio of donor-to-recipient predicted total lung capacity. The ratios were similar for the donor-recipient gender match and significantly different for the donor-recipient gender mismatch. Conclusions These analyses suggested that gender was not a significant independent risk factor affecting survival after lung transplantation. Size mismatch caused by gender mismatch did not increase mortality.
Estimer l’activité cumulée (AC) thérapeutique à partir d’un TEP-scan diagnostique, en prenant un exemple théranostique publié chez le petit animal, et évaluer l’extension du calcul à la pratique ...clinique.
(1) Données immunoTEP/SPECT publiées chez la souris pour le 64Cu-/177Lu-cétuximab, anticorps diagnostique/thérapeutique dirigé sur l’EGFR du carcinome épidermoïde de l’œsophage 1 ; (2) Modèle cinétique publié, donnant AC pour un radiopharmaceutique quelconque en fonction de ses constantes de captation (K) et de relargage (kR) dans un tissu donné : AC=K/(l+kR) AUCIF où AUCIF est l’aire sous la courbe de la fonction d’entrée et l est la constante de décroissance radioactive du marqueur.
AC théorique est estimée à 2,3 10(10)/4,1 10(12) désintégrations/g (tumeur TE-8 ; 64Cu-/177Lu-cétuximab ; pour 3,70/12,95 MBq injectés), à comparer avec AC expérimentale estimée à 2,5 10(10)/5,3 10(12) désintégrations/g.
L’exemple du 64Cu-/177Lu-cétuximab montre qu’il est possible d’estimer AC thérapeutique (ici du 177Lu-cétuximab) : (1) en calculant K et kR et donc AC (ici du 64Cu-cétuximab) à partir d’un TEP-scan diagnostique et (2) en connaissant le rapport moyen des activités cumulées entre diagnostique/thérapeutique. L’application de cette approche en pratique clinique dépendra des incertitudes de mesure de AC thérapeutique, qui devront être déterminées à partir de données expérimentales additionnelles, animales puis humaines.
We report two cases of pulmonary aspergilloma (PA) in a cavity formed after percutaneous radiofrequency ablation (PRFA), a rare complication that has only been described once in the literature. The ...first patient was a 59-year-old white woman treated for a secondary lung nodule of an advanced hepatocellular carcinoma. One month after PRFA, a consolidation of a cavity was noticed with an “air crescent sign,” and aspergilloma serology was highly positive. A bisegmentectomy was performed due to the proximity of the lesion to mediastinal vessels and the absence of significant regression after antifungal treatment. Histological examination confirmed the diagnosis of PA. The second patient was a 61-year-old white man followed-up for a non-small-cell lung cancer. A cavitation with thick margins in the ablation zone was noticed 6 months after PRFA. A biopsy was performed, and aspergilloma was diagnosed. Medical treatment with itraconazole was administered for 13 months, and there was significant regression.
SUMMARY
This study was designed as an external evaluation of the Steyerberg score in the prediction of different categories of postoperative mortality after esophagectomy on a large nationwide ...database of thoracic surgeons. Data collection was obtained from the Epithor national database encompassing the majority of thoracic procedures performed in France. We retrospectively compared the predicted to the observed postoperative 30-day (30DM), 90-day (90DM) and in-hospital mortality (IHM) rate in each decile of equal patient. Patients included in the study were operated for an esophageal cancer and Gastroesophageal junction (GEJ). Steyerberg score was determined according to its logarithmic formula obtained from a sum score including age, comorbidities, neoadjuvant treatment and hospital volume. Deviation of observed from theoretically expected number of deaths was investigated using the calibration test of Hosmer–Lemeshow. Discrimination of the score was determined using the measure of the area under the receiver operating characteristic curve (AUC) of each category of mortality. Over a 9-year period, 1039 consecutive patients underwent an esophagectomy over 42 centers. Among them, 18 centers were considered as intermediate or high-volume institutions, and 24 were low-volume institutions. There were 841 males (81%) with a mean age of 62.3 ± 10 years. Preoperative treatment was allocated to 420 patients (40%). Numbers of comorbidity was: 1 in 261 patients (25%), 2 in 264 patients (25%), 3 in 383 patients (36%) and 4 in 5 patients (1%). The 30DM, 90DM and IHM rate were, respectively, 5.6%, 9.2% and 9.6%. The main causes of postoperative deaths were related to pulmonary complications (44%), complications of the gastric interposition (28%), cardiologic and thromboembolism events (10%). For 30DM, there were significant differences between predicted/observed mortalities in four deciles, whereas there was no significant difference for 90DM and for IHM. In term of calibration, there was a fair agreement of the Steyerberg score with observed 30DM. Predictions were above 20% for seven deciles. Calibration seemed more adequate for 90DM and for IHM. Predictions were above 20% for only three deciles but deviations were not significant. In terms of discrimination, for the 30DM the Steyerberg score overpredicted, the observed mortality rate and AUC was 0.64 (CI 95%: 0.57–0.71). For the 90DM, AUC indicated 0.63 (CI 95%: 0.57–0.68). For the IHM, AUC indicated 0.63 (CI 95%: 0.58–0.68). Steyerberg scoring system seems to be a moderate risk score of the prediction of the IHM and 90DM. This score appears to have a fair discrimination for the 30DM. Nevertheless, because of its simplicity, we believe that this simple predictive score is relevant and transportable to others institution performing such surgery for benchmarking purposes. A reappraisal of the score adapted to current surgical cohort is required.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Better biomarkers for prediction of ulcerative colitis (UC) development and prognostication are needed. Anti-integrin αvβ6 (anti-αvβ6) autoantibodies have been described in patients with UC. We ...tested for the presence of anti-αvβ6 antibodies in the preclinical phase of UC and studied their association with disease-related outcomes after diagnosis.
Anti-αvβ6 autoantibodies were measured in 4 longitudinal serum samples collected from 82 subjects who later developed UC and 82 matched controls from a Department of Defense preclinical cohort (PREDICTS Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects). In a distinct, external validation cohort (Crohn’s and Colitis Canada Genetic Environmental Microbial project cohort), we tested 12 pre-UC subjects and 49 matched controls. Furthermore, anti-αvβ6 autoantibodies were measured in 2 incident UC cohorts (COMPASS Comprehensive Care for the Recently Diagnosed IBD Patients, n = 55 and OSCCAR Ocean State Crohn's and Colitis Area Registry, n = 104) and associations between anti-αvβ6 autoantibodies and UC-related outcomes were defined using Cox proportional hazards model.
Anti-αvβ6 autoantibodies were significantly higher among individuals who developed UC compared with controls up to 10 years before diagnosis in PREDICTS. The anti-αvβ6 autoantibody seropositivity was 12.2% 10 years before diagnosis and increased to 52.4% at the time of diagnosis in subjects who developed UC compared with 2.7% in controls across the 4 time points. Anti-αvβ6 autoantibodies predicted UC development with an area under the curve of at least 0.8 up to 10 years before diagnosis. The presence of anti-αvβ6 autoantibodies in preclinical UC samples was validated in the GEM cohort. Finally, high anti-αvβ6 autoantibodies was associated with a composite of adverse UC outcomes, including hospitalization, disease extension, colectomy, systemic steroid use, and/or escalation to biologic therapy in recently diagnosed UC.
Anti-integrin αvβ6 autoantibodies precede the clinical diagnosis of UC by up to 10 years and are associated with adverse UC-related outcomes.
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