Pulmonary Kaposi's sarcoma revealed by a solitary nodule in a patient with acquired immunodeficiency syndrome.

Kaposi's sarcoma is very common in patients with AIDS. Usually, skin lesions are associated with various visceral involvements. A homosexual patient with AIDS presented with cough and dyspnea, which were followed months later by hemoptysis. He had no skin lesions or endobronchial Kaposi's sarcoma at any time. His chest radiograph showed only an irregular solitary nodule. It exhibited very slow development over time. Surgery was performed, and this solitary nodule proved to be pulmonary Kaposi's sarcoma. Pulmonary Kaposi was the sole manifestation of this associated AIDS sarcoma. This very unusual case report of pulmonary Kaposi sarcoma indicates that this diagnosis should be considered in patients with AIDS presenting with a solitary pulmonary nodule.

Enlarged mediastinal lymph nodes in bronchogenic carcinoma: assessment with dynamic contrast-enhanced MR imaging. Work in progress.

PURPOSE: To determine whether dynamic contrast material-enhanced magnetic resonance (MR) imaging can help differentiate between malignant and benign mediastinal lymph nodes (MLNs) in bronchogenic carcinoma. MATERIALS AND METHODS: Nine patients with biopsy-proved lung carcinoma underwent dynamic contrast-enhanced MR imaging before undergoing thoracic surgery. MR studies included spin-echo, electrocardiographically gated axial and coronal sequences and transaxial gradient-echo breath-hold sequences, which were performed after administration of a bolus of gadoterate meglumine. The enhancement curves were established on the basis of mean signal intensities from regions of interest at the level of tumor and the enlarged MLN. MR images were compared with pathologic specimens obtained at surgical resection. RESULTS: Metastatic MLNs exhibited their peak enhancement at 60-80 seconds, with a slow decrease until 6 minutes. Granulomatous and anthracotic lymph nodes displayed a slight enhancement, with no peak within 6 minutes (P < .01). CONCLUSION: Dynamic contrast-enhanced MR images may provide informative data about the nature of enlarged MLNs in the preoperative assessment of lung carcinoma. Further studies are needed to investigate its usefulness in clinical practice.

Interpleural analgesia with bupivacaine following thoracotomy: ineffective results of a controlled study and pharmacokinetics.

STUDY OBJECTIVE: To evaluate intrapleural analgesia with bupivacaine following partial pulmonary resection and to determine pharmacokinetic parameters of bupivacaine with epinephrine. DESIGN: Prospective, randomized study. SETTING: Thoracic surgical clinic of a university-affiliated general hospital. PATIENTS: Eighteen consecutive patients (13 men, 5 women) scheduled for pulmonary surgery by posterolateral thoracotomy. INTERVENTIONS: Bupivacaine was administered through an intrapleural catheter as a bolus dose of either 40 ml of 0.25% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 10) or 20 ml of 0.5% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 8) up to three times daily for a maximum time of 4 days. MEASUREMENTS AND MAIN RESULTS: Subjective evaluation of pain was performed using the visual analog scale (VAS) before and after each injection by response to spontaneous pain, coughing, deep breathing, and incision palpation. Maximum peak concentration (C Max) and maximum time to reach the peak concentration (T Max) were assessed after the first and last injections. Although VAS pain score decreased significantly, pain relief was not sufficient. C Max and T Max after the first and last injections were not significantly different between the two groups. In each group, C Max after the last injection was significantly higher than after the first injection. CONCLUSIONS: Intrapleural analgesia conducted with 40 ml of 0.25% bupivacaine with epinephrine or 20 ml of 0.5% bupivacaine with epinephrine was insufficient for pain, despite high plasma bupivacaine concentration.

[Different aspects of surgery of cancer developing after severe bullous pulmonary emphysema]. / Aspects différents de la chirurgie du cancer développé sur emphysème pulmonaire bulleux sévère.

The authors report the case of a 64-year-old patient with a peripheral tumour of the left upper lobe developing in a context of bilateral major lesions of bullous emphysema with predominance on the right. Surgery first enabled the resection of large dystrophic compressive bullae of the right upper lobe, then, secondly, atypical resection of the culmen for excision of the peripheral tumour and dystrophic bullae of the left upper lobe. Twelve months later, a tumour recurrence led to left total pneumonectomy. Two radically different surgical approaches for carcinoma in a context of severe bullous emphysema are illustrated by this same patient. While the objective of functional improvement was associated with the oncological quality of excision at the time of the first stage of treatment, it was subsequently possible to perform major excision surgery with notable loss of functional capacity thanks to the benefits of the first operation.

Penetration of cefpodoxime proxetil in lung parenchyma and epithelial lining fluid of noninfected patients.

The pulmonary disposition of cefpodoxime was studied in 12 patients with pulmonary opacities after a single oral dose of 260 mg of cefpodoxime-proxetil, which is equivalent to 200 mg of cefpodoxime. Blood and lung tissue samples were collected during surgery, and bronchoalveolar lavage was carried out 3 h (group A) or 6 h (group B) after drug administration. Urea was used as an endogenous marker for measurement of the volume of epithelial lining fluid (ELF). Concentrations were measured by using a microbiological assay. The mean concentrations of cefpodoxime in plasma, ELF, and lung tissue were, respectively, 1.85 +/- 0.82 mg/liter, 0.22 +/- 0.13 mg/liter, and 0.89 +/- 0.80 mg/kg of body weight in group A and 1.40 +/- 1.25 mg/liter, 0.12 +/- 0.14 mg/liter, and 0.84 +/- 0.61 mg/kg in group B. Concentrations in lung parenchyma 6 h after dosing were at least equal to or above the MICs for 90% of the strains of most organisms commonly found in respiratory tract infections, whereas data for ELF suggest levels of drug insufficient to inhibit bacteria.

[Reimplantation of a non-functioning lung. Report of a case]. / Réimplantation d'un poumon non fonctionnel. Rapport d'un cas.

The authors present the case of a patient with a carcinoid tumor of the left main bronchus. Conservative surgery by sleeve resection without pulmonary resection was performed. The underlying lung which was considered to be nonfunctioning during pre-operative evaluations, completely recovered within a year following surgery.