To report the results of minimally invasive surgery in patients with stage I or II thymoma in the Masaoka classification. The reference technique is partial or complete thymectomy by sternotonomy.
A ...retrospective single-center study of a prospective database including all cases of thymoma operated from April 2009 to February 2015 by minimally invasive techniques: either videosurgery (VATS) or robot-assisted surgery (RATS). The surgical technique, type of resection, length of hospital stay, postoperative complications and recurrences were analysed.
Our series consisted of 22 patients (15 women and 7 men). The average age was 53 years. Myasthenia gravis was present in 12 patients. Eight patients were operated on by VATS and 14 patiens by RATS. There were no conversions to sternotomy and no perioperative deaths. The mean operating time was 92min for VATS and 137min for RATS (P<0.001). The average hospital stay was 5 days. The mean weight of the specimen for the VATS group was 13.2 and 45.7mg for the RATS group. Twelve patients were classified Masaoka stage I and 10 were stage II. According to the WHO classification there were 7 patients type A, 5 type AB, 4 type B1, 4 type B2 4 and 2 type B3. As proposed by the Group ITMIG-IASLC in 2015 all patients corresponded to group I. The mean follow-up period was 36 months. We noted 3 major perioperative complications according to the Clavien-Dindo classification: one pneumonia, one phrenic nerve paralysis and one recurrent laryngeal nerve palsy. We observed one case of local recurrence at 22 months. Following surgery 4 patients were treated with radiotherapy and 2 patients with chemotherapy.
The minimally invasive route is safe, relatively atraumatic and may be incorporated in the therapeutic arsenal for the treatment of Masaoka stage I and II thymoma as an alternative to conventional sternotomy. RATS and VATS are two minimally invasive techniques and the results in the short and medium term are acceptable. The clinical advantages of one over the other are sifficult to establish. RATS could handle larger and more complex lesions in view of the weight and size of the operating instrument.
L’hypoxie tumorale signe l’agressivité de la lésion et peut être définie par des traceurs spécifiques en TEP. Cependant, il existe peu de données comparant les différents traceurs de l’hypoxie. Nous ...avons étudié la bio-distribution des volumes hypoxiques définis par TEP-FMISO et FAZA chez 10 patients pris en charge pour un cancer bronchique non à petites cellules (CBNPC) avant chirurgie.
Les patients traités par chirurgie pour un CBNCP bénéficiaient d’une TEP FDG puis d’une TEP FMISO et une TEP FAZA selon un ordre aléatoire (acquisition à 180minutes post-injection, imageries centrées sur le thorax) dans la semaine précédant la chirurgie. L’ensemble des images était transféré sur une station Dosisoft® puis recalé selon un recalage manuel centré sur la tumeur. Les paramètres volumes et SUV étaient analysés pour l’ensemble des tumeurs.
Huit hommes et 2 femmes ont été inclus dans cette étude pour un âge moyen de 67 ans (±7). Le délai moyen entre la TEP FDG et la première TEP de l’hypoxie est de 5jours (±4,7) et de 2,1jours (±2) entre les deux TEP utilisant les traceurs de l’hypoxie. Le volume moyen par TEP FDG pour un seuillage fixe à 40 % est de 25 cc (±5,5) pour un SUVmax à 1,4 (±6,6). Le SUVmax FMISO est de 3,18 (±1,2) et celui du FAZA de 2,3 (±0,6) (p=0,05). Le rapport tumeur sur bruit de fond (SUV moyen aortique) est de 2,4 (±1) pour le FMISO et de 1,3 (±0,3) pour le FAZA (p=0,003). Le volume hypoxique moyen défini par FMISO est de 8,5 cc (±9,4) soit 34 % du volume métabolique et de 5,5 cc (±5,1) pour le FAZA soit 22 % du volume FDG (p=0,3).
Ces résultats préliminaires montrent que la fixation du FMISO est supérieure à celle du FAZA que ce soit le SUVmax ou le rapport du signal tumeur sur bruit de fond médiastinal. Ces données dans les CBNPC semblent contradictoires avec celles des cancers ORL, mais devront être confirmées sur l’ensemble de la population cible (20 patients). Une analyse des bio-distributions spatiales des deux traceurs et leurs corrélations aux données de marqueurs immuno-histochimiques de l’hypoxie est en cours.
A pulsed electron paramagnetic resonance (EPR) spectroscopic ruler for oligonucleotides was developed using a series of duplex DNAs. The spin-labeling is accomplished during solid-phase synthesis of ...the oligonucleotides utilizing a palladium-catalyzed cross-coupling reaction between 5-iodo-2‘-deoxyuridine and the rigid spin-label 2,2,5,5-tetramethyl-pyrrolin-1-yloxyl-3-acetylene (TPA). 4-Pulse electron double resonance (PELDOR) was then used to measure the intramolecular spin−spin distances via the dipolar coupling, yielding spin−spin distances of 19.2, 23.3, 34.7, 44.8, and 52.5 Å. Employing a full-atom force field with explicit water, molecular dynamic (MD) simulations on the same spin-labeled oligonucleotides in their duplex B-form gave spin−spin distances of 19.6, 21.4, 33.0, 43.3, and 52.5 Å, respectively, in very good agreement with the measured distances. This shows that the oligonucleotides adopt a B-form duplex structure also in frozen aqueous buffer solution. It also demonstrates that the combined use of site-directed spin-labeling, PELDOR experiments, and MD simulations can yield a microscopic picture about the overall structure of oligonucleotides. The technique is also applicable to more complex systems, like ribozymes or DNA/RNA−protein complexes, which are difficult to access by NMR or X-ray crystallography.
To facilitate the measurement of intramolecular distances in solvated RNA systems, a combination of spin-labeling, electron paramagnetic resonance (EPR), and molecular dynamics (MD) simulation is ...presented. The fairly rigid spin label 2,2,5,5-tetramethyl-pyrrolin-1-yloxyl-3-acetylene (TPA) was base and site specifically introduced into RNA through a Sonogashira palladium catalyzed cross-coupling on column. For this purpose 5-iodo-uridine, 5-iodo-cytidine and 2-iodo-adenosine phosphoramidites were synthesized and incorporated into RNA-sequences. Application of the recently developed ACE chemistry presented the main advantage to limit the reduction of the nitroxide to an amine during the oligonucleotide automated synthesis and thus to increase substantially the reliability of the synthesis and the yield of labeled oligonucleotides. 4-Pulse Electron Double Resonance (PELDOR) was then successfully used to measure the intramolecular spin-spin distances in six doubly labeled RNA-duplexes. Comparison of these results with our previous work on DNA showed that A- and B-Form can be differentiated. Using an all-atom force field with explicit solvent, MD simulations gave results in good agreement with the measured distances and indicated that the RNA A-Form was conserved despite a local destabilization effect of the nitroxide label. The applicability of the method to more complex biological systems is discussed.
Site directed spin labeled RNA duplexes with different interspin distances were synthesized. The radical 2,2,5,5-tetramethyl-pyrrolin-1-yloxyl-3-acetylene (TPA) was introduced during the solid-phase ...synthesis through a Sonogashira cross-coupling with 5-iodo-uridine. T
m
and CD studies showed that the spin label does not to disturb significantly the A-form of these duplexes. 4-Pulse Electron Double Resonance (PELDOR) was then used to measure intramolecular spin-spin distances of 19.3, 33.0 and 40.9 Å, which are in very good agreement with the calculated values of 17.6, 32.1 and 39.1 Å, obtained from Molecular Dynamics (MD) simulations.
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BFBNIB, DOBA, GIS, IJS, IZUM, KILJ, KISLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Background During the early 1970s, satisfactory long-term treatment of the severe pain associated with metastatic cancer was not available. Spinal cord stimulation introduced a few years ...earlier in 1967 had not proven to be effective in treating nociceptive pain. We describe our pioneering experience using an implanted device to infuse local anesthetics into the epidural space and provide pain relief to the patient. Methods Increasing doses of systemic opioids were unsuccessful in treating the intractable pain of spinal metastases in our patient. We devised an analgesic delivery system by modifying equipment usually used for ventriculoperitoneal shunts. A lumbar epidural catheter was inserted in the patient’s spine, then tunneled subcutaneously across the flank to the anterior abdominal wall, and subsequently connected to a modified Ommaya reservoir with ventriculoperitoneal shunt tubing. This was filled with local anesthetic and injected into the patient’s epidural space by manual compression. Results The system was used for several months with intermittent addition of local anesthetic to the reservoir with satisfactory control of the patient’s pain. Conclusions We describe the first use of an implanted epidural catheter system for long-term relief of pain due to terminal cancer that occurred at Peter Bent Brigham Hospital in Boston. We contend that this event played an important role in the cascade of devices that followed and connect it to the changes in the attitude of health care providers toward treatment of cancer pain.
L'aspersion antigel exige, pour etre efficace, une verification reguliere des installations et des mesures de temperature fiables. En Provence Alpes Cote d'Azur on experimente l'aspersion sous ...frondaison
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