Nutritional Intake, Physical Activity and Quality of Life in COPD Patients.

In this study, we aimed to document the level of physical activity (PA), quality of life, depression status and nutritional data of 20 individuals with chronic obstructive pulmonary disease (COPD) (mean age 65.0±7.0 years) admitted in hospital for pulmonary rehabilitation and compare these data to those obtained in 20 similarly aged healthy individuals. Nutritional data were collected using a 3-day diet record. COPD patients engaged in significantly less PA than healthy individuals and achieved a significant higher score of Beck Depression Inventory (BDI) than the control group. Their Fat Free Mass Index (FFMI) was significantly lower when compared to the control group (p<0.05). Patients had significantly lower total caloric intake, Vitamins B6, B9, B12, Vitamin E, ß carotene and omega 3 than controls. Moreover, patients with low FFMI reported significantly lower mean intake of energy, carbohydrate, vitamin E and vitamin B6 than patients with normal FFMI. Because oxidative stress and inflammation are features of many lung diseases, nutrients with anti-oxidant and anti-inflammatory properties could be useful in prevention or treatment. Further work is needed to explore the possible relationship between the intake of B group vitamins, Vitamin E, n-3PUFAS and the development and progression of lung disease.

[Embryology of the heart walls]. / Embryologie des cloisons du cœur.

Although anatomically simple structures, the atrial septum and the ventricular septum have complex embryological origins. Recent findings in molecular biology allowed better comprehension of their formation. As soon as the heart tube is formed, cells migrate from several cardiogenic fields to take part in the septation. Elongation, ballooning, and later inflexion of the heart tube create chamber separating grooves, facing the future septa. The systemic venous tributaries conflate at the venous pole of the heart; it will partially involute while contributing to the atrial septum. The primary atrial septum grows from the atrial roof towards the atrioventricular canal. It fuses there with the atrioventricular cushions, while its upper margin breaks down to form the ostium secundum. Then a deep fold develops from the atrial roof and partly covers the ostium secundum, leaving a flap-like interatrial communication through the oval foramen. It will close at birth. The interventricular septum has three embryological origins. The ventricular septum primum, created during the ballooning process, origins from the primary heart tube. It will form the trabecular septum and the inlet septum. The interventricular ring, surrounding the interventricular foramen, will participate in the inlet septum and also form the atrioventricular conduction axis. The outflow cushions will separate the outflow tract in the aorta and pulmonary artery, and grow to create the outlet septum. After merging with the atrioventricular cushions, they will also be part of the membranous septum.

[Evolution of the early respiratory function after lung resection for cancer]. / Evolution de la fonction respiratoire postopératoire immédiate après résection pulmonaire pour cancer.

The assessment of the postoperative risk in lung resection is a major challenge for pneumologists and thoracic surgeons. Restrictive syndromes have been observed along with a disproportionate decrease of FEV1 in lobectomies. The purpose of the present study is to describe the early response of pulmonary function after thoracotomy and resection for lung cancer. In a prospective study, the authors included 31 patients (19 lobectomy patients: mean age 59+/-10 years and 12 pneumonectomy patients: mean age 56+/-9 years) without postoperative complications. Pulmonary function tests were performed before and after surgery on Days 1, 5 (D5), 10 and within the fourth month. The main aspect of the ventilation was an unexpected similarity in subgroups during the early perioperative period up to D5. When compared with the preoperative value, about a 50% decrease in the vital capacity and total lung capacity was observed. In both subgroups about a 40% decrease was noted in the inspiratory and expiratory reserve volume. In the lobectomy sub-group, the change in the forced expiratory volume in one second over forced vital capacity (FEV/FVC) ratio was found to be higher than predicted (52+/-16% at D5 versus 67+/-14% predicted). However, the FEV/FVC ratio did not change, attesting to major restrictive ventilation. Partial recovery of the FEV was dependant on the mobile volume and especially the inspiratory volume. These findings should have implications in patient management.

[Endovascular treatment of SVC syndrome from neoplastic origin: a review of 34 cases]. / Traitement endovasculaire du syndrome cave supérieur d'origine néoplasique: à propos de 34 patients.

PURPOSE: To report our experience with the treatment of 34 patients with SVC syndrome from neoplastic origin using the Wallstent. MATERIALS AND METHODS: Thirty-four patients were treated between January 2000 and February 2007: 21 males and 13 females, aged 44-81 years, with non-small-cell lung carcinoma in 27 cases (79%), small-cell lung carcinoma in 5 cases (15%) and metastatic breast adenocarcinoma to the mediastinum in 2 cases (6%). All patients were treated using the stainless steel self-expanding Wallstent. A dual brachial-femoral access was used in all cases. RESULTS: Stent placement was possible in all cases. Per procedure acute respiratory distress occurred in 2 cases: 1 case of acute pulmonary edema and 1 case of tamponade. Symptoms resolved within 24 hours. Twenty-six patients died from disease progression, 8 during the first month, and 16 within 32-545 days post-procedure (mean: 213.4 days). Five patients with recurrent SVC syndrome underwent repeat treatment (restenosis in 3 cases, fracture in 1 case, thrombosis in 1 case), for primary and secondary patency rates of 81% and 100%. CONCLUSION: Palliative stent treatment of neoplastic SVC syndrome is reliable, safe and provides long-standing improvement in quality of life.

[Pulmonary artery intimal sarcoma]. / Sarcome intimal de l'artère pulmonaire.

Pulmonary artery sarcoma is a rare tumor. We present a case of intimal sarcoma arising from right pulmonary artery and left lower pulmonary vein observed in a 44-year-old man with a non-productive cough. Computed tomographic scans and magnetic resonance imaging showing filling defect enhancement contributed early, suggesting the diagnosis of primary vascular tumor, hypothesis confirmed by pathologist findings.

Salivary cortisol, heart rate and blood lactate during a qualifying trial and an official race in motorcycling competition.

AIM: The study aims to examine the physiological load on motorcycling competitors during a qualifying trial and an official race. METHODS: Twelve male riders participated in this study, in which their anthropometric data, heart rate, blood lactate (La) and salivary cortisol (C) concentrations were measured. Two saliva samples were taken on a resting day at 8 a.m. (30 min after awakening: [T(0)] and at 8 p.m. [T(1)] and 6 saliva samples were collected on the day of the qualifying trial and on the day of the official race [T(2) through T(7)]). RESULTS: During the race, as well as during the qualifying trial, heart rate was found to be >80-90% of the maximum heart rate. Blood La increased more than two-fold (peak 5.6+/-2.1 mM) as compared to resting values (2+/-0.1 mM). However, La were not statistically different between qualifying trial and race. C concentrations on the motorcycling day were found to be up to 3 times higher than those measured on the resting day. In fact, there was a progressive increase in the C concentrations on the motorcycling day, the values noted 10 min after the race being the highest. There was a significant decrease in C values 60 min after the race, but the concentration was maintained at a higher level for a longer period; the values reported at T(7) (8 p.m.; 4.3 h after the end of the race) were significantly higher than those reported at the same time on a resting day (T(1)). CONCLUSION: The examination of heart rate, blood La and salivary C concentrations in motorcycling on a circuit shows that this sport is highly stressful, and also that a metabolic involvement is required to control the motorcycle at a high speed. Thus, riders may benefit from a specific training program aimed at improving their cardiovascular fitness and strength.

Benign mature mediastinal dysembryoma with pulmonary extension revealed by recurrent hemoptysis in a young woman.

We report one case of mature mediastinal teratoma with pulmonary extension surgically diagnosed in a 22-year-old woman complaining of recurrent hemoptyses for which no etiological explanation could be found. Thoracic surgery was only decided on after three embolizations proved ineffective.

Evolution of healthy thoracic aortic segment diameter during follow-up of patients with aortic aneurysm or dissection: a magnetic resonance imaging study.

We studied the normal evolution over time of the diameter of the healthy descending aorta in patients suffering from aneurysm or dissection of the ascending aorta, in order to anticipate potential complications of endoprosthetic treatment in this aortic segment. During their follow-up (average 35.9 months), 52 patients suffering from aneurysm or dissection of the ascending aorta had 168 aortic MRI examinations (2-7; average 3). Measurements were taken according to conventional reference landmarks making it possible to study the evolution of the diameter of the supposed healthy descending thoracic aorta. The variations in diameter with time were on average 5 mm, and there was no significant variation in this diameter, either for early controls or for the controls carried out after more than 1 year or 3 years, whatever the age group. Thus according to our series it seems that patients with a descending aorta endoprosthesis are not exposed to graft endoleak due to inadequate contact of the prosthesis and aorta within the 5 years following its implantation.

Early CYFRA 21-1 variation predicts tumor response to chemotherapy and survival in locally advanced non-small cell lung cancer patients.

We have evaluated CYFRA 21-1 serum level variations as an indicator of tumor response and survival in 44 consecutive patients with locally advanced non-small cell lung cancer (NSCLC) treated with induction chemotherapy (IC). Irrespective of the initial CYFRA 21-1 serum concentration, a more than 65% decrease in the serum level after the first chemotherapy course was significantly predictive of an objective tumor response (p = 0.0022). In addition, a more than 80% decrease in this level significantly predicted a better disease-free survival (p = 0.039). In patients with initial CYFRA 21-1 serum levels > 3.3 ng/mL (n = 29), a more than 80% decrease after the first IC course was the most significant predictor of overall survival (p = 0.025) in a Cox analysis including initial staging, tumor response and surgery. We conclude that early monitoring of CYFRA 21-1 serum levels may be a useful prognostic tool for tumor response and survival in stage III NSCLC patients treated by induction chemotherapy.

Normal diameter of the thoracic aorta in adults: a magnetic resonance imaging study.

To determine the evolution of the diameter of the thoracic aorta with age in order to detect dilatation more reliably by imaging, we performed a retrospective analysis of the MRI examinations of the normal thoracic aorta of 66 subjects aged 44.1+/-19.1 years (range 19.1-82.4 years) obtained between 1991 and 2000 on a Magnetom SP 42 1T apparatus (Siemens) using T1-weighted spin echo sequences with electrocardiographic synchronization. Sixteen measurements were made in the axial plane, the oblique sagittal plane in the axis of the aortic arch, and the oblique frontal plane perpendicular to the latter at the level of the ascending aorta, the arch and the descending thoracic aorta. We found an increase in the thoracic aorta diameter and a significant relationship between this diameter and the age of our subjects, wherever the measure was performed. However, there was no systematic correlation between aortic diameter and age. The aortic diameter evolved with age and a marked difference seemed to exist in measurements made in groups younger and older than 40 years. This study, conducted on a small population of 66 patients, thus helps to define a normal aortic diameter, thereby making the diagnosis of pathological dilatation of the aorta more reliable.

Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves.

The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

Vocal cord dysfunction after left lung resection for cancer.

OBJECTIVES: To evaluate the prevalence, the impact-related postoperative complications and the risk factors of vocal cord dysfunction (VCD) after left lung resection for cancer. METHODS: From February 1996 to April 1999, a review of prospectively gathered data was performed on 99 consecutive patients who underwent a pneumonectomy (n=50) or a lobectomy (n=49) with a mediastinal lymph node dissection. A fiber optic laryngeal examination was performed preoperatively for all patients and within the first week postoperatively in patients with symptom(s) or sign(s) of VCD or respiratory complications. RESULTS: Thirty-one patients (31%) had a postoperative VCD (group VCD) and 68 (68%) did not (group non-VCD). Mortality rate was 19% in group VCD and 9% in group non-VCD (P=0.13). Group VCD patients developed more pulmonary complications (P=0.014) and cardiac complications (P<0.001) compared to group non-VCD patients. A higher rate of reintubation (P=0.005), pneumonia (P=0.06), arrhythmia (P=0.002), cardiac failure (P<0.001) was noticeable in group VCD and may account for the higher rate of complications in this group. Using multivariate analysis, preoperative radiotherapy (P=0.001) and pneumonectomy (P=0.008) were predictive of postoperative VCD. Hospital stay was 22+/-16 days in group VCD and 13+/-9 days in group non-VCD (P<0.002). CONCLUSION: VCD is a frequent event that can lead to dramatic pulmonary complications. We would recommend to track it and to treat it as early as possible.

Influence of the mode of load carriage on the static posture of the pelvic girdle and the thoracic and lumbar spine in vivo.

The influence of various modes of carrying a load of 16 kg (15.69 DaN) on the static positioning of the pelvic girdle and the thoracic and lumbar segments of the spine was examined in seven male subjects. The displacement of cutaneous markers attached to easily palpable skeletal landmarks was recorded using 4 CCD cameras; the data acquired were analysed using an optoelectronic technique (SAGA3). The subjects stood upright on an AMTI biomechanical force platform, from which the ground reaction forces enabled displacements of the centre of gravity axis and thus the moment of the mass carried to be determined. The modes of load carriage examined were: 1) in a case in the left hand; 2) in a case in the right hand; 3) equally in two cases; 4) on the head; 5) in a rucksack; and 6) in an anterior bag. The results showed displacements of the pelvic girdle, the caudal and cranial lumbar segments, and the caudal and cranial thoracic segments in the three orthogonal planes (sagittal, frontal and transverse). The influence of the moment created by the load was seen in the statokinesigrams. The use of external markers using an optoelectronic technique, in association with the ground reaction forces, enables the mode of load carriage to be determined. The results show that the influence of the moment exerted by the mode of load carriage on the gravity axis has important ergonomic consequences.

Origin and initial course of the renal arteries: a radiological study.

The aim of this study was to determine the topography of the origin, implantation angle and initial course of the renal arteries in the transverse and frontal planes, from a prospective analysis of angiograms and helical CT-scans of 40 patients. In the frontal plane, the implantation angles of the right and left renal arteries were 73.8 +/- 17 degrees and 65.6 +/- 16 degrees respectively; 17.9% of the right renal arteries were straight compared with only 5% of the left ones. The first sinuosity was observed to be at a distance greater than the aortic diameter for 43.6% of right renal arteries and at a distance less than the aortic diameter for 62.5% for the left renal a. In the transverse plane, the right renal a. had an implantation angle of 65.6 +/- 15.7 degrees compared with 95.7 +/- 16.85% for the left renal a. The artery was rectilinear in 2.6% of the cases on the right side, and in 2.5% of the cases on the left. The first sinuosity occurred before the lateral margin of the spine was reached in 60.5% of right renal arteries and after the margin of psoas major muscle for 55% of left renal arteries. A knowledge of the anatomy of the origin and initial course of the renal arteries is important when considering vessel dilatation and the implantation of stents in the renal arteries. No correlation was observed between the origin, sinuosity or angulation of the renal arteries which could aid interventional procedures.

Concomitant type I thyroplasty and thoracic operations for lung cancer: preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury.

OBJECTIVES: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection. METHODS: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice. RESULTS: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice. CONCLUSIONS: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

Visualisation of the portal flows by porto-scanner.

This study presents a retrospective analysis of 15 portal vein CT scans, conducted for the evaluation of hepatic metastasis in patients suffering from colorectal cancer, with the aim of verifying in vivo the presence of laminar flow as reported by Pironcof. After selective catheterization of the superior mesenteric artery, CT scans were performed during opacification of the portal vein. Different flows were identified by the incomplete opacification they induced in the portal vein. Splenic flows could always be identified, however right colic and superior mesenteric flows were only seen in 3 cases (20%) and gastrocolic flow in 2 (13.6%). Even though incremental (i.e. slower than helical) the CT acquisitions allowed the flows to be viewed by modifying the visualisation window. In vivo evidence of laminar flow is provided which supports Pironcof's experimental observations.

Pleural and pericardial effusion as the first sign of multiple myeloma.

We report a case of IgA-kappa multiple myeloma in a 68-year-old woman that was revealed by concomitant pleural and pericardial effusion. These effusions were found to be caused by myeloma and were verified by cytological examination of the pleural fluid and pericardial biopsy. The patient had neither osteolytic lesions nor Bence-Jones proteinuria. After a pericardiocentesis, her condition improved with a melphalan and prednisolone treatment. As far as we know, such a phenomenon is rare and has never been reported yet as a way of diagnosing multiple myeloma.

Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.

BACKGROUND: Hypoxemia usually occurs after thoracotomy, and respiratory failure represents a major complication. METHODS: To define predictive factors of postoperative hypoxemia and mechanical ventilation (MV), we prospectively studied 48 patients who had undergone lung resection. Preoperative data included, age, lung volume, force expiratory volume in one second (FEV1), predictive postoperative FEV1 (FEV1ppo), blood gases, diffusing capacity, and number of resected subsegments. RESULTS: On postoperative day 1 or 2, hypoxemia was assessed by measurement of PaO2 and alveolar-arterial oxygen tension difference (A-aDO2) in 35 nonventilated patients breathing room air. The other patients (5 lobectomies, 9 pneumonectomies) required MV for pulmonary or nonpulmonary complications. Using simple and multiple regression analysis, the best predictors of postoperative hypoxemia were FEV1ppo (r = 0.74, p < 0.001) in lobectomy and tidal volume (r = 0.67, p < 0.01) in pneumonectomy. Using discriminant analysis, FEV1ppo in lobectomy and tidal volume in pneumonectomy were also considered as the best predictive factors of MV for pulmonary complications. CONCLUSIONS: These results suggest that the degree of chronic obstructive pulmonary disease in lobectomy and impairment of preoperative breathing pattern in pneumonectomy are the main factors of respiratory failure after lung resection.