Elisabeth Dulmet

Centre Chirurgical Marie Lannelongue, Plessis-Robinson, Île-de-France, France

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Publications (35)115.75 Total impact

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    ABSTRACT: We investigated an association of the HLA-A locus in 78 French Caucasian patients with autoimmune myasthenia gravis (MG) and thymic epithelial tumours. The largest effect was a protection associated with HLA-A02 in MG patients with a B2 type thymoma (OR=0.323, 95% CI: 0.113-0.756, P=0.00041). The frequency of HLA-A25 was also increased in the whole group of patients (OR=3.62, 95% CI: 1.62-7.08, P=0.0041). Our findings emphasise the interest of the histological classification in the genetic study of thymomas.
    Journal of neuroimmunology 04/2009; 210(1-2):120-3. DOI:10.1016/j.jneuroim.2009.02.004 · 2.79 Impact Factor
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    ABSTRACT: To assess the histological bases of lymphadenomegaly, which has been reported as a frequent radiological finding in pulmonary veno-occlusive disease (PVOD), we have reviewed pulmonary and mediastinal lymph nodes resected during lung transplantations in 19 patients suffering from PVOD and related pulmonary capillary haemangiomatosis (PCH). Lymphatic congestion was common and was often obvious in subsegmental and segmental lymph nodes. Vascular transformation of the sinuses, intra-sinusal haemorrhage with erythrophagocytosis and lymphoid follicular hyperplasia were frequent especially in lobar, hilar and mediastinal lymph nodes. These lesions were very significantly less frequent in 33 cases of pulmonary hypertension unrelated to PVOD. Due to their thoracic location, these non-specific lesions could simulate other diagnoses such as Castleman disease or lymphangioleiomyomatosis. However, in the setting of pulmonary hypertension, they should suggest PVOD and PCH. They are probably secondary to venous congestion, veno-lymphatic shunts and angiogenetic factors associated with these diseases.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 07/2008; 453(2):171-6. DOI:10.1007/s00428-008-0636-3 · 2.56 Impact Factor
  • Vincent Thomas-de-Montpréville · Elisabeth Dulmet
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    ABSTRACT: Cysts of probable müllerian origin have recently been recognized in the mediastinum by Hattori (Virchows Arch. 2005;446:82-84; Chest. 2005;128:3388-3390). In a retrospective study, we found 9 such cases, accounting for 5.5% of a series of 163 consecutive mediastinal nonneoplastic cysts operated in our institution. These cysts occurred in 9 women aged 40 to 58 years (mean, 50.6 years). These women often had overweight (n=4) or various gynecologic history (n=5). Cysts were paravertebral (n=8) or prevertebral (n=1). They were initially classified as bronchogenic or unspecified benign serous cysts. Their diameter measured 1.3 to 5 cm. Their thin wall contained smooth muscle. They were lined by a simple cylindrical or cuboidal, nonmucinous, and often ciliated epithelium resembling uterine tubal epithelium. This epithelium expressed cytokeratin 7, epithelial membrane antigen and estrogen and progesterone receptors. It was negative for cytokeratin 5/6. In the same series, there were 66 bronchogenic cysts, 6 being paravertebral. In conclusion, cysts with müllerian differentiation account for a small proportion of mediastinal cysts and have a usual but nonspecific paravertebral location.
    Annals of Diagnostic Pathology 01/2008; 11(6):417-20. DOI:10.1016/j.anndiagpath.2006.12.011 · 1.11 Impact Factor
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    ABSTRACT: A 55-year-old female patient with Hermansky-Pudlak syndrome (albinism, thrombopathia and ceroid accumulation) underwent a single lung transplantation for pulmonary fibrosis. Examination of explanted lung showed usual interstitial pneumonia pattern associated with two unusual lesions: presence of numerous macrophages containing ceroid pigments within fibrosis and characteristic foamy swelling of pneumocytes. This later lesion, which has only been recently described, seems related to the mechanism of the disease by defect of surfactant secretion. This lesion allows the histological individualization of pulmonary fibrosis associated with Hermansky-Pudlak syndrome from idiopathic usual interstitial pneumonia.
    Annales de Pathologie 01/2007; 26(6):445-9. · 0.29 Impact Factor
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    ABSTRACT: Heart tumors are rare lesions with variegated histological types. Their clinicopathological features could be more comprehensively categorized. This is a 19-year retrospective study of 17 infants/toddlers (<2 years of age) and 42 patients aged between 14 and 79 years (mean = 51.5) in a surgical center. Congenital tumors (n = 17; 29%), including rhabdomyomas (n = 9), ventricular fibromas (n = 6), and hemangiomas (n = 1), required surgery mainly because of mass effect. Familial myofibromatosis was the only embolic congenital lesion. Acquired benign tumors (n = 28; 47%) included myxomas (n = 21), fibroelastomas (n = 3), myofibroblastic inflammatory tumors (n = 2), and lipomas (n = 2). Eight (29%) were revealed by systemic embolization. These benign noncongenital tumors were all treated by complete resection, except for an incompletely resected lipoma of the mitral valve. Postoperative arrhythmia (n = 1) and pericardial effusion (n = 3) were the only complications. Primary sarcomas (n = 8; 14%) were mostly vascular tumors (five of eight), and patients with high-grade tumors had a mean survival of 15 months (n = 5). Cardiac metastases (n = 6; 10%) were from carcinomas (n = 3) or sarcomas (n = 3); apart from a necrotic metastasis, all patients died (mean survival of 6 months). This study shows that, regardless of patients' age, heart tumors can be classified as: (a) congenital lesions, which are spontaneously nonprogressive or regressive lesions possibly requiring surgery mainly because of mass effect; (b) acquired benign tumors, which are lesions requiring surgery often because of embolization risk; and (c) primary and secondary malignant tumors, which are lesions with globally poor prognosis but with some indications for resection.
    Cardiovascular Pathology 01/2007; 16(1):22-8. DOI:10.1016/j.carpath.2006.05.008 · 2.34 Impact Factor
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    ABSTRACT: A 55-year-old female patient with Hermansky-Pudlak syndrome (albinism, thrombopathia and ceroid accumulation) underwent a single lung transplantation for pulmonary fibrosis. Examination of explanted lung showed usual interstitial pneumonia pattern associated with two unusual lesions: presence of numerous macrophages containing ceroid pigments within fibrosis and characteristic foamy swelling of pneumocytes. This later lesion, which has only been recently described, seems related to the mechanism of the disease by defect of surfactant secretion. This lesion allows the histological individualization of pulmonary fibrosis associated with Hermansky-Pudlak syndrome from idiopathic usual interstitial pneumonia.
    Annales de Pathologie 12/2006; 26(6):445-449. DOI:10.1016/S0242-6498(06)70753-2 · 0.29 Impact Factor
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    ABSTRACT: A 4-cm paravertebral mediastinal tumor was resected in a 70-year-old male patient treated for hypertension. The tumor displayed both paraganglioma and ganglioneuroma areas that were in equal proportion and often merged one into the other. Paraganglioma areas contained synaptophysin and chromogranin-positive chief cells and PS100-positive sustentacular cells. Ganglioneuroma areas contained neurofilament-positive mature ganglion cells and PS100-positive Schwann cells. Such pheochromocytoma-ganglioneuroma has not been previously reported in the mediastinum and appears as the adrenal and aorticosympathetic counterpart of gangliocytic paraganglioma described in other anatomic sites.
    Annals of Diagnostic Pathology 05/2005; 9(2):110-4. DOI:10.1016/j.anndiagpath.2004.12.010 · 1.11 Impact Factor
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    ABSTRACT: Isolated intact human pulmonary arteries and veins were used to determine the acetylcholinesterase (AChE) or butyrylcholinesterase (BChE) activities in the absence or presence of two selective cholinesterase (ChE) inhibitors, iso-OMPA or BW284c51, respectively. These results were compared with the mRNA levels for each enzyme in human pulmonary vessels. Total ChE activities measured in presence of acetylthiocholine (ACTI, 1 mM) in intact vascular preparations were 45+/-04 and 114+/-07 mU/g tissue in human pulmonary arteries (n=14) and veins (n=14), respectively. These activities were completely abolished in presence of 10 microM neostigmine. In both types of vessels AChE and BChE activities were observed. These activities were at least 2-fold higher in human pulmonary veins when compared with arteries and were correlated with the accumulation of the corresponding transcripts (n=8). In each type of vessel, similar total ChE activities were detected in homogenized and intact preparations, while in human bronchial preparations this activity was 5-fold higher in homogenates than in intact preparations. Together these results provide evidence that the ChE activities in human pulmonary vessels may be extracellular and that the higher activity measured in veins as compared to arteries was associated with the differential accumulation of the corresponding transcripts.
    Life Sciences 04/2005; 76(19):2211-20. DOI:10.1016/j.lfs.2004.10.037 · 2.30 Impact Factor
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    ABSTRACT: With improvements in surgical techniques for resection and reconstruction of the chest wall, pathologists are confronted with complicated surgical specimens. There are no currently available guidelines specifically dedicated to the handling of these specimens. Extended resections of lung carcinoma chest wall invasions may change the clinical value of some TNM subsets. We reviewed a series of 107 consecutive malignant tumors involving the chest wall and resected in our institution during a 3-year period. The 107 patients included 39 females and 68 males aged 6 to 80 years (mean, 53 years). Ninety-eight cases (92%) were en bloc resection. There were 55 invasions by lung carcinomas including 19 Pancoast tumors. With the current TNM classification, five lung carcinomas, treated with vertebral body resection because of vertebral foramina invasion, were T3. Four lung carcinomas were N3 or M1 only because of supraclavicular or chest wall lymph node invasion. Other tumors included 20 primary soft-tissue tumors, 13 primary skeletal tumors, 12 metastases, four local invasions by breast tumors, and three miscellaneous lesions. Resected structures included one to six ribs (mean, 2.6; n = 89), thoracic inlet (n = 24), three or four vertebral bodies (n = 13), sternum (n = 17), clavicles (n = 15), shoulder blade (n = 4), upper limb (n = 2), skin (n = 29), lung (n = 64), diaphragm (n = 2), and mediastinum (n = 2). Ten cases were incomplete resections including five because of vertebral body or vertebral foramina tumor invasion. The study of surgical specimens resulting from resection of malignant tumors of the chest wall is complicated because of the variety of both tumor histologic types and involved anatomic structures. Specimen radiograms have a great informative value. Assessment of surgical margins, especially vertebral foramina, is imperative. In lung carcinomas invading the chest wall, we suggest that vertebral foramina invasion could be classified T4 and that the prognostic value of chest wall lymph nodes isolated invasions should be assessed for a possible N1 classification.
    Annals of Diagnostic Pathology 09/2004; 8(4):198-206. DOI:10.1053/j.anndiagpath.2004.04.002 · 1.11 Impact Factor
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    ABSTRACT: Myofibromatosis is a rare infantile benign neoplasia, which may involve the heart in the rare and usually fatal generalized form of the disease. Diagnosis of endocardial myofibromas was made on two surgically excised lesions of the mitral valve that were reveled by a cerebral embolization in a 12-month-old female infant. Surprisingly, the patient had no other obvious lesion of myofibromatosis. However, her father had a histologically proven neonatal history of myofibromatosis. This case confirms the likely autosomal dominant mode of inheritance of myofibromatosis. It highlights the embolization risk of the previously unreported endocardial location. We suggest that these clinically isolated non-invasive endocardial myofibromas did not represent a true visceral form of myofibromatosis. They were, rather, similar to the frequent intravascular growth of the disease.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 04/2004; 444(3):300-3. DOI:10.1007/s00428-003-0938-4 · 2.56 Impact Factor
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    ABSTRACT: We hypothesized that gene transfer of vascular endothelial growth factor (VEGF) mediated by an adenovirus vector might induce pulmonary artery angiogenesis in a lamb model of pulmonary artery hypoplasia. Thirteen fetal lambs had left pulmonary artery banding at 106 days of gestation. Following birth, 3 groups were divided: VEGF group (n = 5) and beta-GAL group (n = 4) received an adenoviral vector encoding respectively for human VEGF165 and for galactosidase A. A control group (n = 4) had neither gene nor virus. Viral suspensions were selectively instilled in the left bronchus 6.5 days after birth. Five nonoperated lambs constituted the normal group. Euthanasia was performed at 30 days of age. Gene transfer was confirmed by blue coloration of left lung obtained with Xgal solution in an additional experiment. Histomorphometric evaluation was performed. All groups were compared with ANOVA test and paired test was used to compare right and left lung in each animal. Left lung was similarly hypoplastic in all operated lambs. Left pulmonary artery hypoplasia present in all operated groups was significantly less pronounced in VEGF group. The number of pleural arteries was similarly increased in left lung of all operated lambs. Left lung arterial density was higher in VEGF group than in all other groups. The percentage of parenchyma of left lung was lower in beta-GAL group than in all others, partially returned to normal in VEGF group. In this model, transbronchial VEGF gene transfer induces pulmonary angiogenesis, proximal pulmonary artery growth and contributes to lung parenchyma recovery.
    The Annals of Thoracic Surgery 03/2004; 77(2):458-63; discussion 463. DOI:10.1016/j.athoracsur.2003.08.005 · 3.63 Impact Factor
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    ABSTRACT: The proopiomelanocortin (POMC) gene is occasionally expressed in nonpituitary tumors leading to Cushing's syndrome. Bronchial carcinoid tumors, one of the most frequent source for ectopic ACTH secretion, often display numerous features of the corticotroph phenotype. To identify new markers of corticotroph differentiation in these tumors, we compared the pattern of gene expression in ACTH-secreting (ACTH+) and nonsecreting (ACTH-) bronchial carcinoids by differential display/RT-PCR. Using groups of ACTH+ and ACTH- tumors, we initially selected approximately 300 differentially expressed genes. Fifteen were considered differentially expressed after further characterization by RT-PCR on a larger series of 8 ACTH+ and 12 ACTH- bronchial carcinoids; 11 were restricted to--or overexpressed in--ACTH+ and four in ACTH- tumors. In ACTH+, beside the expected POMC gene, we identified cFos, and KIAA1775, a large expressed sequence tag encoding a putative protocadherin-related protein. On the other hand, the tetraspanin TM4SF5 gene was specifically expressed in ACTH-. Dot blot analysis confirmed the specific expression of KIAA1775 in ACTH+ bronchial carcinoids. However, the expression of most of the differential genes, including KIAA1775, was detected by RT-PCR in pituitary or lung tumors, whether secreting ACTH or not, excepted for TM4SF5, which was only detected in some nonendocrine lung tumors. Our results show that corticotroph differentiation of bronchial carcinoid tumors is accompanied by induction and repression of specific genes. The nature of some of these genes, identified here, underlines the importance of cell-cell or cell-extracellular matrix interactions in the establishment of neoplastic corticotroph phenotype. These genes should help to better characterize ACTH+ bronchial carcinoids as well as other bronchial carcinoid subtypes.
    Journal of Clinical Endocrinology &amp Metabolism 12/2002; 87(11):5015-22. DOI:10.1210/jc.2002-020598 · 6.31 Impact Factor
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    ABSTRACT: Hepatopulmonary syndrome (HPS) is characterized by intrapulmonary vascular dilatations and an increased alveoloarterial oxygen difference (AaPO(2)). These abnormalities are related to augmented pulmonary nitric oxide (NO) production, dependent primarily on increases in the expression and activity of inducible NO-synthase (iNOS) within pulmonary intravascular macrophages and, to a lesser extent, of endothelial NOS (eNOS). Production of iNOS by pulmonary intravascular macrophages might be related to translocated gut bacteria present in the pulmonary circulation. To test this hypothesis, we determined whether macrophage sequestration, lung iNOS expression and activity, and HPS severity were decreased after norfloxacin was given for 5 weeks to prevent Gram-negative bacterial translocation in rats with common bile duct ligation-induced cirrhosis. Norfloxacin decreased the incidence of Gram-negative translocation from 70 to 0% and the percentage of pulmonary microvessels containing more than 10 macrophages from 52 +/- 7 to 21 +/- 8% (p < 0.01). AaPO(2) and cerebral uptake of intravenous (99m)Tc-labeled albumin macroaggregates (reflecting intrapulmonary vascular dilatations) were intermediate to those of untreated cirrhotic and sham-operated rats. The activity and expression of lung iNOS, but not eNOS, were reduced to normal. Norfloxacin may reduce HPS severity by inhibiting Gram-negative bacterial translocation, thereby decreasing NO production by pulmonary intravascular macrophages. Bacterial translocation may be the key to the pathogenesis of HPS.
    American Journal of Respiratory and Critical Care Medicine 08/2002; 166(4):514-7. DOI:10.1164/rccm.200201-027OC · 11.99 Impact Factor
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    ABSTRACT: Thymomas with the characteristic pattern of small epithelial nodules separated by an abundant lymphoid tissue have been recently described with divergent interpretations. These thymomas are not specified in currently used classification systems. We present six such thymomas, including three that represented 1.38% of a series of 217 consecutive cases. These thymomas were totally encapsulated (Masaoka stage I, n=1) or minimally invasive (stage II, n=5). The epithelial cells of the nodules were oval and bland-appearing. In one case, these cells formed rosettes. Cysts, that were present in four cases, showed a strong linear expression of EMA and were associated with foci of glandular differentiation. The lymphoid tissue was composed of large immature (CD1a and CD99-positive) T-cell areas (with epithelial cells restricted to small foci of residual thymus) and of B-cell (CD20-positive) areas with germinal centers. Mature T-cells were also present. Furthermore, one case, associated with myasthenia gravis, had an important WHO type B2 (cortical) component. Such a combined case has not been previously reported. Our study demonstrates that so-called micronodular thymomas are rare, usually have clinical and pathological features of WHO type A (medullary) thymomas, and that the lymphoid component is hyperplastic corresponding to both immature T-cell lymphoid tissue and B-cell lymphoid hyperplasia with germinal centers.
    Annales de Pathologie 07/2002; 22(3):177-82. · 0.29 Impact Factor
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    ABSTRACT: The aim of this paper is to study clinical characteristics, surgical treatment and outcome of patients with solitary fibrous tumor of the pleura operated in our institutions in a 20-year period. Clinical records of all patients operated for solitary fibrous tumors of the pleura between 1981 and 2000 were reviewed retrospectively. Tumors were classified as malignant in the presence of at least one of the following criteria: (1) high mitotic activity; (2) high cellularity with crowding and overlapping of nuclei; (3) presence of necrosis; (4) pleomorphism; otherwise they were considered as benign. Sixty patients (mean age 55 years) were operated in this period. None had asbestos exposure. Symptoms were present in 31 cases. Surgical approaches included thoracotomy (n=53), video-assisted thoracoscopy (n=6), and median sternotomy (n=1). Tumors originated from visceral pleura in 48 cases, from parietal, mediastinal or diaphragmatic pleura in seven, two and three cases, respectively; their mean diameter was 8.5 cm. Tumors could be resected with their implantation basis in 49 patients. In the remaining 11, extended resections were performed, including lung parenchyma (lobectomy, n=4, pneumonectomy, n=2), osteomuscular chest wall structures (n=2), diaphragm (n=2), and pericardium (n=1). Two postoperative deaths (due to myocardial infarction and pulmonary embolism, respectively) occurred. Tumors were pathologically benign in 38 cases and malignant in 22 cases. Mean follow-up was 88 months. Resection was complete in all the patients with benign tumors and no recurrence occurred. Resection was considered as complete in 21/22 malignant tumors. Local recurrence was observed in two cases. Both could be successfully managed by iterative exeresis (no extended resection had been initially performed). Metastatic disease (responsible for patient's death) was observed following the only incomplete resection. Actuarial 5- and 10-year survival rates were 97% for benign tumors and 89% for malignant ones. Surgical resection provided cure in all the patients with benign tumors. As insufficiency of exeresis is associated with all recurrences in malignant tumors, completeness of resection is in our experience the best prognostic factor in these forms.
    European Journal of Cardio-Thoracic Surgery 07/2002; 21(6):1087-93. DOI:10.1016/S1010-7940(02)00099-4 · 2.81 Impact Factor
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    ABSTRACT: To characterize the muscarinic receptors on human pulmonary veins associated with the acetylcholine (ACh)-induced relaxation, isolated venous and arterial preparations were pre-contracted with noradrenaline (10 μM) and were subsequently challenged with ACh in the absence or presence of selective muscarinic antagonists. ACh relaxed venous preparations derived from human lung with a pD2 value of 5.82±0.09 (n=16). In venous preparations where the endothelium had been removed, the ACh relaxations were abolished (n=4). ACh relaxed arterial preparations with a pD2 value of 7.06±0.14 (n=5). Atropine (1 μM), the non selective antagonist for muscarinic receptors, inhibited ACh-induced relaxations in human pulmonary veins. The affinity value (pKB value) for atropine was: 8.64±0.10 (n=5). The selective muscarinic antagonists (darifenacin (M3), himbacine (M2,M4), methoctramine (M2) and pFHHSiD (M1,M3)) also inhibited ACh-induced relaxations in venous preparations. The pKB values obtained for these antagonists were not those predicted for the involvement of M2–5 receptors in the ACh-induced relaxation in human pulmonary veins. The pKB value for darifenacin (1 μM) was significantly greater in human pulmonary arterial (8.63±0.14) than in venous (7.41±0.20) preparations derived from three lung samples. In human pulmonary veins, the pKB values for pirenzepine (0.5 and 1 μM), a selective antagonist for M1 receptors, were: 7.89±0.24 (n=7) and 8.18±0.22 (n=5), respectively. In the venous preparations, the pKB values derived from the functional studies with all the different muscarinic antagonists used were correlated (r=0.89; P=0.04; slope=0.78) with the affinity values (pKi values) previously published for human cloned m1 receptors in CHO cells. These results suggest that the relaxations induced by ACh are due to the activation of M1 receptors on endothelial cells in isolated human pulmonary veins. British Journal of Pharmacology (2000) 130, 73–78; doi:10.1038/sj.bjp.0703301
    British Journal of Pharmacology 04/2000; 130(1):73 - 78. DOI:10.1038/sj.bjp.0703301 · 4.99 Impact Factor
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    ABSTRACT: Objective: The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. Methods: Multiple-curled coils and tissue adhesive were embolized in 6 piglets to induce complete obstruction of the left pulmonary artery, documented by angiography. After 5 weeks, the main pulmonary artery was repermeabilized by thromboendarterectomy during circulatory arrest. The left lung was reperfused ex vivo with autologous blood at constant flow, and patency of the pulmonary artery was evaluated on a barium angiogram. The endarterectomy-reperfusion procedure was also done in 6 nonembolized piglets that served as the controls. The severity of lung injury induced by 60 minutes of reperfusion was assessed on the basis of measurements of the lung filtration coefficient and of lung myeloperoxidase activity. Results: Marked hypertrophy of the bronchial circulation was seen in the chronic pulmonary thromboembolism group. Thromboendarterectomy removed the organized obstructing thrombus that was incorporated into the arterial wall and restored patency of the pulmonary artery. Acute lung inflammation and high-permeability edema occurred after reperfusion, as indicated by a 1.5-fold increases in both lung filtration coefficient and lung myeloperoxidase values in the chronic pulmonary thromboembolism group; these 2 variables being correlated. Conclusions: Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury. (J Thorac Cardiovasc Surg 1999;117:787-93)
    Journal of Thoracic and Cardiovascular Surgery 05/1999; 117(4-117):787-793. DOI:10.1016/S0022-5223(99)70300-4 · 3.99 Impact Factor
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    ABSTRACT: Pulmonary infections with formation of bacterial granules are rare. We reviewed the clinical and pathologic data from 18 cases diagnosed using surgical specimens in our department during the last 10 years. Three clinicopathologic forms were observed: endobronchial infections complicating tuberculous sequelae or bronchiectases (n = 7), tumor-like lesions (n = 8), and diffuse pneumonia (n = 3). The two latter forms contrasted with the former by a male predominance, association with general debilitating conditions and inflammatory syndrome, and pathologically by smaller granules often located in parenchymal abscesses or excavations. The pathologic examination of the bacteria forming the granules permitted the diagnoses of actinomycosis (n = 10), botryomycosis (n = 7), or nocardiosis (n = 1). The latter case corresponded to an endobronchial infection. Both actinomycosis and botryomycosis were encountered in every clinicopathologic form. At present, pulmonary actinomycosis and related infections rarely seems to present with chest wall invasion. On the contrary, purely endobronchial forms represented a large proportion of our cases. Cultures are often difficult and the clinical appearance is not specific. However, pathologic examination with special stains must indicate the type of involved microorganism.
    Annals of Diagnostic Pathology 05/1999; DOI:10.1016/S1092-9134(99)80032-X · 1.11 Impact Factor
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    ABSTRACT: 1. Iloprost and cicaprost (IP-receptor agonists) induced relaxations in the histamine- (50 microM) contracted human bronchial preparations (pD2 values, 6.63+/-0.12 and 6.86+/-0.08; Emax values, 90+/-04 and 65+/-08% of the papaverine response for iloprost (n=6) and cicaprost (n=3), respectively). 2. Prostaglandin E2 (PGE2) and misoprostol (EP-receptor agonist) relaxed the histamine-contracted human bronchial preparations (pD2 values, 7.13+/-0.07 and 6.33+/-0.28; Emax values, 67+/-04 and 57+/-08% of the papaverine response for PGE2 (n=14) and misoprostol (n=4), respectively). In addition, both relaxations were inhibited by AH6809 (DP/EP1/EP2-receptor antagonist; 3 microM; n=5-6). 3. The PGE2-induced relaxations of human bronchial preparations were not modified by treatment with AH23848B (TP/EP4-receptor antagonist; 30 microM; n=4). 4. The contracted human bronchial preparations were significantly relaxed by prostaglandin D2 (PGD2) or by BW245C a DP-receptor agonist. However, these responses did not exceed 40% of the relaxation induced by papaverine. In addition, the relaxations induced by PGD2 were significantly inhibited by treatment with a DP-receptor antagonist BWA868C (0.1 microM; n=3). 5. These data suggest that the relaxation of human isolated bronchial preparations induced by prostanoids involved IP-, EP2- and to a lesser extent DP-receptors but not EP4-receptor.
    British Journal of Pharmacology 03/1999; 126(4):867-72. DOI:10.1038/sj.bjp.0702392 · 4.99 Impact Factor
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    ABSTRACT: Objective: Our experience with the use of frozen section (FS) was reviewed in order to assess its interest and limits, during minimally aggressive mediastinal surgery for staging of lung carcinomas and biopsy of primary lesions. Methods: The retrospective study was based on a series of 420 consecutive mediastinal biopsies with FS performed through cervicotomy (n=12), mediastinoscopy (n=345), mediastinotomy (n=43), manubriotomy (n=13) or videothoracoscopy (n=7), in 417 patients, aged 8–86 years (mean: 52.5±15.6). The FS diagnoses were compared with the final diagnoses and consequences of the FS analyses were analyzed. Results: Biopsies with FS had a 99.4% (351/353) efficiency rate for a precise definitive diagnosis (excluding normal lymph nodes). However, two patients required a second operation: one for typing a lymphoma and the other to correct a FS misdiagnosis of small cell carcinoma on a crushed normal lymph node. The sensitivity for detection of carcinoma lymph node metastases was 99% (200/202). The two false negative FS diagnoses, including one post-chemotherapy, were related to micrometastases. There were 46 correct FS diagnoses of non-metastatic lymph node which were followed by an immediate thoracotomy during the same anesthesia, for benign lung lesions (n=9) or for carcinomas (n=37), including 30 lung carcinomas that were immediately resected and proved to have no mediastinal involvement (n=24), or only a limited involvement in a non-biopsied site (n=6). In the 51 cases of primary mediastinal tumors excluding carcinomas, FS indicated a resectable lesion with a sensitivity of 87.5% (7/8) and a specificity of 97.7% (43/44). Five lesions were immediately resected: one Castleman’s disease, one intrathoracic goiter, two of six thymomas and a Hodgkin’s disease, which was diagnosed as thymoma on FS. An invasive thymoma was resected during a second operation after a FS diagnosis of carcinoma. FS had a sensitivity of 100% in the 62 cases of sarcoidosis and a sensitivity of 90% in the 20 cases of infectious lesions. One of the 18 cases of tuberculosis and an infectious pseudo-tumor of the anterior mediastinum had no microbiologic study because of FS diagnoses of tumor necrosis and lymphoma. Conclusions: FS efficiently secures the adequacy of the samples and guides the surgeon’s decision making for the resection of lung carcinomas, but is less effective for a precise diagnosis of some primary mediastinal lesions, which may have close histologic appearances.
    European Journal of Cardio-Thoracic Surgery 03/1998; 13(2-13):190-195. DOI:10.1016/S1010-7940(97)00325-4 · 2.81 Impact Factor