Lung cancer in combined pulmonary fibrosis and emphysema: a series of 47 Western patients.

INTRODUCTION: The syndrome of combined pulmonary fibrosis and emphysema (CPFE) is characterized by imaging features consisting of the association of centrilobular and/or paraseptal emphysema and pulmonary fibrosis. Virtually all patients are smokers and thus at high risk of developing lung cancer. METHODS: This retrospective multicentre study was conducted by the Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P). RESULTS: A total of 47 patients presenting with lung cancer and CPFE syndrome were identified. All patients were smokers, with a mean of 47 pack-years. A pathological diagnosis of lung cancer was obtained for 38 (81%) patients. Histological type was squamous cell carcinoma in 17 (36%) patients, adenocarcinoma in 14 (30%), non-small-cell lung cancer not otherwise specified in three (6%), small-cell lung cancer in three (6%), and sarcomatoid carcinoma in one (2%). Overall, 20 of the 47 patients could not receive standard-of-care treatment for lung cancer, as per international recommendations or guidelines; this limitation was considered to be directly related to the CPFE syndrome in eight (40%) cases. CONCLUSION: Lung cancer in patients with CPFE syndrome represents a specific entity with a poor prognosis, that further represents the most characteristic and severe model of tobacco-related disease.

Management of isolated non-traumatic renal artery dissection: report of four cases.

BACKGROUND: Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. PURPOSE: To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. MATERIAL AND METHODS: From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. RESULTS: Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. CONCLUSION: Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.

Endovascular treatment of eight renal artery aneurysms.

BACKGROUND: Renal artery aneurysms (RAA) are a relatively rare vascular entity. Treatment could be either surgical or via an endovascular route. The main aim of therapy is to prevent lethal rupture. PURPOSE: To evaluate the angiographic and clinical results after endovascular treatment (EVT) of eight renal artery aneurysms. MATERIAL AND METHODS: From January 2000 to June 2011, 18 patients presented with 18 renal artery aneurysms. One was classified as Rundback type I, 15 were type II, and two aneurysms were type III. Endovascular treatment was considered unsafe in 10 cases (all were Rundback type II), and were referred to surgery. The remaining eight aneurysms were treated endovascularly during altogether nine sessions. Among these, four patients were asymptomatic, three were hypertensive, and one presented with ipsilateral flank pains. Aneurysmal sac diameter varied between 12 and 50 mm. EVT included selective coil embolization in five cases, covered stents in two cases, and parent artery occlusion in one. RESULTS: Follow-up with CT angiography was obtained in all endovascularly treated aneurysms (range 6-54 months, mean 15 months). Complete durable occlusion was achieved in all aneurysms except one, which showed re-expansion after 20 months and was retreated with covered stent implantation. Clinically silent, branch occlusion occurred after four procedures with subsequent limited (less than 25%) ischemic parenchymal loss. All patients were discharged with preserved renal function. Clinical improvement was noted in all symptomatic patients. CONCLUSION: Endovascular treatment of renal artery aneurysms is an adequate treatment and can be proposed, if feasible, as first step.

[Acute aortic syndrome and endovascular treatment: good indications of stent-graft, stent and aortic fenestration]. / Syndromes aortiques aigus et traitement endovasculaire: les bonnes indications de la fenestration et des endoprothèses, couvertes ou non.

Acute aortic syndrome of the descending aorta can be treated with stent-graft thanks to technical and material development. Ruptured aneurysms, aortic dissection, wall hematoma and penetrating ulcers can be treated with stent-graft. According to the type of initial lesion, and the clinical tolerance, the emergency of treatment can be different. Non covered stent and aortic fenestration are used in case of visceral ischemia in aortic dissection, according to the type of ischemia.

Revascularization of traumatic renal artery dissection by endoluminal stenting: three cases.

Traumatic injury of renal arteries is rare and can induce renal dysfunction and hypertension. Management options include observation, nephrectomy, surgical repair, and, more recently, percutaneous angioplasty. We report three cases of renal artery thrombosis occurring in young multitrauma patients (mean age 28.7 years) treated with stenting. Immediate satisfactory results were obtained in all cases. Postprocedure anticoagulant and antiplatelet treatment were given according to associated contraindicating lesions. During follow-up, in-stent restenosis occurred in one patient and was treated successfully with a second stenting procedure. No renal dysfunction or hypertension was observed after 28.6 months follow-up. Percutaneous angioplasty is a valuable alternative to surgical treatment in selected patients.

Chiral ligand-exchange chromatography of amino acids using porous graphitic carbon coated with a dinaphthyl derivative of neamine.

In this paper, we describe the preparation and the evaluation of a porous graphitic carbon (PGC) column coated with a new dinaphthyl derivative of neamine for chiral ligand-exchange (LE) chromatography. It was shown that the graphitic surface/dinaphthyl anchor system efficiently (1.15 micromol/m(2)) and stably (three months of intensive use) adsorbs the neamine template onto the chromatographic support. The resulting coated PGC stationary phase showed appreciable LE-based enantioselective properties towards several native amino acids.

[Vascular interventional procedures in oncology]. / Radiologie vasculaire interventionnelle en oncologie.

Indications for interventional radiology have increased, and various arterial and venous procedures are nowadays possible in oncology. Besides emergency procedures, scheduled palliative or curative procedures require multidisciplinary cooperation emphasizing on cautions related to iodine contrast media and concerning immunosuppresion, hemostasis disorders, analgesia, and the choice of the adequate approach. Diagnostic endovascular biopsies and venous sampling may be performed. Embolisation procedures are useful for achieving hemostasis, tumor devascularisation, or chemo-embolisation. Revascularisation procedures concern central vein obstructions, catheter occlusion or arterial stenoses and occlusions. Vena cava filtering, retrieval of intravascular foreign bodies and percutaneous implantation of ports can also be indicated, as well other treatments of central venous access complications. The principles, technical aspects, results, and indications of these various endovascular procedures are described in this review.

Palliative transarterial embolization of renal tumors in 20 patients.

OBJECTIVES: The aim of this study is to evaluate immediate technical and clinical results of palliative transarterial renal embolization in patients with symptomatic renal tumors. METHODS: Parenchymal embolization of 20 renal tumors was performed in 20 symptomatic patients with hematuria and/or lumbar pain and/or para-neoplastic syndrome. Seven patients were inoperable because of poor general condition, and 15 patients had metastatic lesions. RESULTS: Immediate technical success was observed, with post-infarction pain in all patients requiring analgesia in 12 cases (which was successful in 90%); 8 patients had transitory fever. With a median follow up of 8.1 (range 4-27) months, recurrent hematuria was noted in two patients for which partial embolization was initially chosen; pain did not recur in any patients. CONCLUSIONS: Palliative embolization of advanced symptomatic renal tumors is easy to accomplish with low morbidity. It helps to alleviate invalidating symptoms in a multidisciplinary management of advanced renal tumors.

Chiral resolution of histidine using an anti-D-histidine L-RNA aptamer microbore column.

In this paper, we report a new anti-amino acid aptamer chiral stationary phase (CSP). The enantiomers of histidine were separated using an immobilized histidine-specific L-RNA aptamer (40-mer) and an aqueous buffer as mobile phase. The effects of the variation of different operating parameters, including the mobile phase pH and the MgCl2 concentration as well as the column temperature, on the solute retention were assessed. The results suggested that (i) the protonated form of histidine was involved in the stereospecific RNA binding and (ii) Mg2+ was essential for the target enantiomer binding to the specific aptamer sites. From a practical point of view, it appeared that the baseline resolution in a minimum analysis time can be achieved at a column temperature of 35 degrees C for an eluent containing 10 mM of MgCl2, pH 5.5.

Enantiomeric separation using an l-RNA aptamer as chiral additive in partial-filling capillary electrophoresis.

In this paper, we report the chiral resolution of arginine using an anti-arginine l-RNA aptamer chiral selector in partial-filling CE. The effects of the capillary temperature, sample load, and aptamer plug length on the enantiomeric separation were assessed. Very high chiral resolving capability was observed at low or moderate capillary temperatures (the target peak being not detected in the separation window), whereas the practical chiral resolution was achieved only at high enough temperatures (50-60 degrees C). Over this high-temperature range, the electrophoretic behavior of the target enantiomer appeared to result from a combination of binding site heterogeneity, slow desorption kinetics, and concentration overload of aptamer binding sites. From additional thermal UV melting experiments, three RNA conformations were identified for the 50-60 degrees C temperatures. It was suggested that the presence of these different RNA conformations was a plausible source of the binding site heterogeneity.

Reversal of the enantiomeric elution order of some aromatic amino acids using reversed-phase chromatographic supports coated with the teicoplanin chiral selector.

In this paper, two chiral stationary phases were prepared by coating the surface of both C8 and C18 high-performance liquid chromatography (HPLC) supports with the teicoplanin chiral selector. The hydrophobic C11 acyl side chain, attached to the D-glucosamine group of teicoplanin, served as anchor moiety for the immobilization of the chiral selector on the apolar support material. The retention and enantioselectivity of these coated stationary phases were studied using some aromatic amino acids as probe solutes and an aqueous solution as mobile phase. It was found that the enantiomer elution order on the modified C8 and C18 stationary phases was reversed (L>D) relatively to that classically observed with a teicoplanin covalently immobilized on a silica support (D>L). Such a dynamic coating on the reversed-phase supports was found to be of interest since the apparent enantioselectivity was not significantly changed by the use during an extended period of time or following a long-term storage of the columns.

A L-RNA aptamer chiral stationary phase for the resolution of target and related compounds.

In this paper, we report for the first time an aptamer-based chiral stationary phase (CSP) able to resolve racemates of both target and various related compounds. The enantiomers of tyrosine and analogues (11 enantiomeric pairs) were separated using an immobilized tyrosine-specific L-RNA aptamer as CSP and an aqueous buffer (8 mM Tris-HCl buffer, 25 mM NaCl, 5 mM MgCl2; pH 7.4) as mobile phase, at a column temperature of 10 degrees C. It appeared that the carboxylic and amino groups as well as the aromatic side chain of amino acid controlled the stereospecific recognition. Modifications on the polar groups were strongly detrimental for enantioselectivity while the replacement of the phenolic group by some bicyclic aromatic residues of different polarity, size or shape did not impair the enantioselective interaction. In addition, the effects of the mobile phase composition and column temperature upon the retention and stereoselective properties of the CSP were assessed. Finally, it was found that the immobilized RNA aptamer could be used under hydro-organic mobile phase conditions without alteration of the stationary phase stability.

Chiral stationary phase based on a biostable L-RNA aptamer.

An immobilized anti-L-arginine d-RNA aptamer, used as a target-specific chiral stationary phase (CSP), was found to be very quickly degraded by RNases under usual chromatographic utilization and storage. To overcome this severe limitation for a practical use, a CSP based on the L-RNA aptamer, that is, the mirror image of the D-RNA aptamer, was created. It was shown that this mirror-image approach was a very simple and powerful strategy to develop a highly stable stationary phase due to the intrinsic insensitivity of l-RNA to the RNase degradation. In addition, such an approach allowed one to reverse the enantiomer elution order relative to that obtained with the corresponding d-RNA CSP.

Thermodynamic origin of the chiral recognition of tryptophan on teicoplanin and teicoplanin aglycone stationary phases.

The D-, L-tryptophan binding and the chiral recognition properties of the teicoplanin and teicoplanin aglycone (TAG) chiral stationary phase (CSPs) were compared at various column temperatures. The solute adsorption isotherms (bi-Langmuir model) were determined for both the two CSPs using the perturbation method. It was demonstrated that the sugar units were involved in the reduction of the apparent enantioselectivity through two phenomena: (i) the inhibition of some enantioselective contacts with low-affinity binding regions of the aglycone and (ii) a decrease in the stereoselective properties of the aglycone high-affinity binding pocket. The phenomenon (ii) was governed by both a decrease in the ratio of the enantiomer adsorption constant and a strong reduction of the site accessibility for D- and L-tryptophan. In addition, a temperature effect study was performed to investigate the chiral recognition mechanism at the aglycone high-affinity pocket. An enthalpy-entropy compensation analysis derived from the Grunwald model as well as the comparison with the literature data demonstrated that the enantioselective binding mode was dependent on an interface dehydration process. The change in the enantioselective process observed between the TAG and teicoplanin CSP was characterized by a difference of ca. 2-3 ordered water molecules released from the species interface.

Endovascular treatment of chronic mesenteric ischemia: results in 14 patients.

We evaluated immediate and long-term results of percutaneous transluminal angioplasty (PTA) and stent placement to treat stenotic and occluded arteries in patients with chronic mesenteric ischemia. Fourteen patients were treated by 3 exclusive celiac artery (CA) PTAs (2 stentings), 3 cases with both Superior Mesenteric Artery (SMA) and CA angioplasties, and 8 exclusive SMA angioplasties (3 stentings). Eleven patients had atheromatous stenoses with one case of an early onset atheroma in an HIV patient with antiphospholipid syndrome. The other etiologies of mesenteric arterial lesions were Takayashu arteritis (2 cases) and a postradiation stenoses (1 case). Technical success was achieved in all cases. Two major complications were observed: one hematoma and one false aneurysm occurring at the brachial puncture site (14.3%). An immediate clinical success was obtained in all patients. During a follow-up of 1-83 months (mean: 29 months), 11 patients were symptom free; 3 patients had recurrent pain; in one patient with inflammatory syndrome, pain relief was obtained with medical treatment; in 2 patients abdominal pain was due to restenosis 36 and 6 months after PTA, respectively. Restenosis was treated by PTA (postirradiation stenosis), and by surgical bypass (atheromatous stenosis). Percutaneous endovascular techniques are safe and accurate. They are an alternative to surgery in patients with chronic mesenteric ischemia due to short and proximal occlusive lesions of SMA and CA.

Streptavidin chiral stationary phase for the separation of adenosine enantiomers.

In this paper, a microbore column packed with streptavidin particles was used, at various temperatures (0-24 degrees C), to separate the adenosine enantiomers by HPLC. Using an aqueous mobile phase, the apparent enantioseparation was high for a small molecule, varying from 11.5 at 0 degrees C to 6.2 at 24 degrees C. From the experiments carried out with a streptavidin-biotin complex stationary phase, it was demonstrated that the blockage of the biotin sites of the immobilized streptavidin was responsible for a strong decrease in the enantioselectivity via a direct and/or an indirect effect. From the analysis of the concentration dependencies of the solute retention factor, it was also shown that a reduction of the D-adenosine specific binding sites occurred at the lowest temperature. The thermodynamic parameters determined from the van't Hoff plots indicated that the D-adenosine binding to the streptavidin specific sites was enthalpically driven.

Immobilized DNA aptamers as target-specific chiral stationary phases for resolution of nucleoside and amino acid derivative enantiomers.

Recently, we described the use of a DNA aptamer as a new target-specific chiral stationary phase (CSP) for the separation of oligopeptide enantiomers (Michaud, M.; Jourdan, E.; Villet, A.; Ravel, A.; Grosset, C.; Peyrin, E. J. Am. Chem. Soc. 2003, 125, 8672). However, from a practical point of view, it was fundamental to extend the applicability of such target-specific aptamer CSP to the resolution of small (bioactive) molecule enantiomers. In this paper, immobilized DNA aptamers specifically selected against D-adenosine and L-tyrosinamide were used to resolve the enantiomers by HPLC, using microbore columns. At 20 degrees C, the adenosine enantioseparation was similar to that classically reported with imprinted CSPs (approximately 3.5) while a very high enantioselectivity was observed for the tyrosinamide enantiomers (the nontarget enantiomer was essentially nonretained on the CSP). The influence of temperature on solute binding and chiral discrimination was analyzed. The binding enthalpic contributions were determined from linear van't Hoff plots. Very large DeltaH values were obtained for the target enantiomers (-71.4 +/- 0.7 kJ/mol for D-adenosine and -139.4 +/- 2.0 kJ/mol for L-tyrosinamide). Such values were consistent with the formation of a tight complex between these analytes and the aptamer CSPs. This work demonstrates that target-specific aptamer CSPs constitute a powerful tool for the resolution of small (bioactive) molecule enantiomers.