Technical failure of the EZ-blocker™ causing serious adverse events during one lung ventilation: a case series.

We present a case series of intra-operative adverse events while using a specific type of bronchial blocker, designed to facilitate device positioning and minimise the risk of dislocation. The Rüsch® EZ-blocker™ (Teleflex Life Sciences Ltd., Athlone, Ireland) is a Y-shaped catheter equipped with two separately inflatable cuffs at the tip - one for each bronchial lumen. In this report, we describe four cases where the use of the EZ-blocker was associated with the development of high airway pressures, hypoxaemia and expansion of the non-dependent lung. Bronchoscopic evaluation showed spontaneous inflation of the cuff within the dependent (i.e. ventilated) bronchus, causing bronchial obstruction, and volume loss of the cuff within the non-dependent (i.e. unventilated) bronchus, causing unintended expansion of the non-dependent lung. After removal of the bronchial blocker, the catheter showed no visible defect, but a bench test revealed a functional connection inside the catheter which allowed air to pass slowly from one bronchial cuff to the other. This technical defect relates to the unique design of the EZ-blocker as it is the only bronchial blocker equipped with two bronchial cuffs. Clinicians should be aware of this inherent risk since complications may develop insidiously and affect both lungs simultaneously. Early recognition and prompt intervention can prevent life-threatening intra-operative deterioration.

[Bernard van den Corput, a Belgian doctor of the XIXth century]. / Bernard van den corput, un médecin belge du XIXe siècle.

Issued from a patrician family, Bernard van den Corput was professor of therapy at the Medical School from the Université libre de Bruxelles. He accomplished a very brilliant academic career and was member of many Belgian and foreign scientific associations. He is the author of a very large number of publications, not only in the field of medicine, and his strong personality is at the origin of many exceptional events.

[Henri Tagnon, initiator of the clinical oncology at the Institut Jules Bordet]. / Henri Tagnon, un homme hors du commun, innovateur de la cancérologie clinique à l'lnstitut Jules Bordet.

The career of Henri Tagnon, medical doctor of the "Université libre de Bruxelles", is devoted to medical oncology. Trained in the United States, he accomplished a brilliant career in the United States before coming back to Brussels where he created, in 1953, the first medical oncology department in Belgium at the Institut Bordet, cancer center of the Université libre de Bruxelles. He was the initiator of the European Organization for Research and Treatment of Cancer.

[Fifty years ago, the International Academy Of Cytology was founded in Brussels. An opportunity to remind the contribution of our university in the field of clinical cytology]. / Il y a 50 ans était fondée, à Bruxelles, L'Academie Internationale de Cytologie (AIC). Cet anniversaire permet de rappeler l'apport de notre université dans le domaine de la cytologie clinique.

Fifty years ago, the International Academy of Cytology, a scientific society devoted to the promotion of clinical cytology and the publication of a bimonthly journal, was founded in Brussels. The choice of Brussels did not happen by chance: the quality and the importance of the scientific work of the Belgian school of clinical cytology, particularly the one of the Université Libre de Bruxelles, justified this choice.

[Jules Bordet Institute: past, present and future]. / L'Institut Jules Bordet: son histoire et son avenir.

Since the end of the 19th century, the Université Libre de Bruxelles and the Conseil des Hospices, in charge of health problems in the city of Brussels, assume the responsibility of cancer patients. A first cancer clinic is organized in 1906 followed in 1925 by the building of a cancer pavilion on the site of the Hôpital Brugmann. In 1935 the building of a new more important cancer institute is decided by the Commission d'Assistance Publique and the Université Libre de Bruxelles. The Institut Bordet was inaugurated in 1939. In 1950, the appointment of Albert Claude, future Nobel Prize, as scientific director of the Institute inaugurated a period of important and growing medical and scientific activities. The Institute became a multidisciplinary center with medical departments (clinical biology, medicine, pathology, radiodiagnosis, radiotherapy, surgery) and investigation laboratories. There is a project to build a new Institute on the campus of the Hôpital Erasme.

[Cervical-vaginal smears: an unpopular test!]. / Le frottis cervico-vaginal: un mal aimé!

No screening test for cancer in asymptomatic patients can match the performance level of the Pap smear, yet no other screening test has been so strongly criticized in the popular press. For a large part, this paradoxical situation, greatly influenced by public opinion in the United States, has arisen from a utopic desire for a "perfect" screening system. Actually, though the Pap smear will never be 100% effective, it has made it possible to greatly reduce the prevalence of invasive cervical cancer. The fact that total eradication has not been achieved is not a sign of poor performance, but rather a signal for further improvement. Public education should be reinforced so the entire population, especially high risk groups of older women and those living in socially underprivileged conditions, can benefit from Pap smear screening programs. Clinicians and cytologists must also continue their efforts to assure quality smears and cytopathological examinations. In France, the Association for quality assurance in anatomy and pathological cytology, the Centers for collecting information on anatomy and pathological cytology, and the High Counsel for Public Health have taken innovative steps in this direction. The cytology report must also be written in a clear language, including a statement regarding the adequacy of the specimen, the description of the cells observed, a diagnosis and the use of an internationally accepted classification. Finally, patient follow-up is mandatory since the Pap smear technique is a screening method and cannot provide a definitive diagnosis. All positive smears must be confirmed by colposcopy and histologic assessment. Correctly used, the Pap smear remains the method of choice for the eradication of cervical cancer.

Cisplatin combined with carboplatin: a new way of intensification of platinum dose in the treatment of advanced ovarian cancer. Belgian Study Group for Ovarian Carcinoma.

We performed a phase I-II trial of escalating doses of cisplatin (CDDP: 50-100 mg/m2 per course) plus carboplatin (CBDCA: 300-400 mg/m2 per course) as a potential way in which to maximize platinum doses without causing excessive toxic effects in patients with advanced ovarian cancer. Thirty-three patients with nonoptimally debulked disease of FIGO (International Federation of Gynecology and Obstetrics) stages IIc-IV [median age: 60 yr; median WHO (World Health Organization) performance status: 2; no prior chemotherapy] received a median of six courses of therapy. CBDCA was infused on day 1 and CDDP on day 2 with an aggressive 48-hour hydration regimen. Myelosuppression was dose-limiting: at the highest dose levels, WHO grade 4 neutropenia and thrombocytopenia led to dose reduction and/or treatment delay in 45% of the patients. Nonhematologic toxic effects included acute nausea and vomiting (97% of the patients), mild alopecia (45%), ototoxic effects (39%), neurotoxic effects (21%), and renal toxic effects (serum creatinine greater than 1.5 mg/dL: 12.5%). The pathologic complete response rate was 22%. We conclude that CBDCA and CDDP can be given safely in combination at reasonably high doses (CBDCA at 300 mg/m2 per course and CDDP at 100 mg/m2 per course) over a 6-month period, provided a close hematologic follow-up is conducted. Randomized clinical trials are needed to define whether this regimen is any better than standard combination chemotherapy.

Identification of Campylobacter pylori in gastric biopsy smears.

The use of gastric biopsy imprint smears to diagnose Campylobacter pylori was compared with the use of tissue sections and cultures. Multiple gastric biopsies were taken from the mucosa of 42 patients during endoscopy. Imprint smears were prepared from the samples used to make tissue sections; other samples were used for microbiologic culture. There was a good concordance (93%) between the morphologic diagnosis of C pylori in the air-dried, Giemsa-stained smears and the tissue sections; the cytologic preparations were clearly positive in six cases (14%) whose sections contained low numbers of the organisms. There was a concordance of 83% between the combined morphologic techniques and the bacteriologic culture. Six positive cases were detected only by the morphologic techniques while one positive case was detected only by bacteriologic culture. C pylori was identified in one or more preparations of the antral biopsy specimens in 23 (55%) of the 42 cases, including 23 (74%) of the 31 cases with a final diagnosis of gastritis or ulcer. These results show the usefulness of the cytologic study of gastric biopsy smears in diagnosing C pylori infections.

Correlation between nuclear cytomorphometric parameters and estrogen receptor levels in breast cancer.

The authors studied the relationships existing between various cytomorphonuclear parameters recorded on 25 primary breast cancers and their estrogen receptor (ER) content. Cell image analyses of Feulgen-stained imprint smears, allowing determination of morphologic, densitometric, as well as textural parameters, were assessed by using the SAMBA 200 system (TITN, France). The ER levels were measured by the conventional dextran-coated charcoal assay. The authors then divided the 25 cancers into three categories: (1) "ER-negative or poorly positive tumors," i.e., those having less than 50 fmol ER/mg protein; (2) "ER-positive tumors," i.e., those containing between 50 and 150 fmol ER/mg protein; and (3) "ER highly positive tumors," i.e., those having more than 150 fmol ER/mg protein. The authors' results show that ER-negative or poorly positive breast cancers possess cells with bigger nuclei and higher DNA content, related to higher proliferation index than ER-rich tumors. Furthermore, the chromatin pattern of cells from ER-negative or poorly positive breast cancers is significantly more condensed than the thinly textured chromatin of ER highly positive tumors. Cell image analysis of Feulgen-stained imprints is proposed as an additional tool for grading malignancy.

Comparison of biochemical and immunoenzymatic macromethods and a new immunocytochemical micromethod for assaying estrogen receptors in human breast carcinomas.

Estrogen receptors (ERs) were assayed in 23 breast carcinomas by: (1) the conventional biochemical assay with dextran-coated charcoal (DCC); (2) the immunoenzymatic assay using a monoclonal antibody (MAb), ER-EIA (Abbott); and (3) an original cytochemical method using another MAb, ER-ICA (Abbott). The first two techniques were performed on biopsy samples, whereas the last was carried out on fine needle aspiration (FNA) samples. The ER contents in aspirates were evaluated by: (1) scaled proportions of colored neoplastic cells; (2) scaled coloration intensity; (3) total grading (= proportion plus intensity); (4) product grading (= proportion times intensity); and (5) a new index (NI) described in this paper. The ER-EIA assay correlated best, with a high statistical significance, with the NI (P less than .001); NI was also the only index that significantly correlated (P less than .05) with the DCC results. The results show that the ER-ICA assay offers the great advantages of being applicable to FNA specimens and of producing rapidly available results. This new technique enriches the panel of MAbs for the diagnosis of adenocarcinomas and offers a new tool for the therapeutic follow-up of breast cancer patients. Our preliminary results suggest that the anti-ER MAbs might be helpful for measuring the hormone dependence of small lesions not assayable by DCC, even under endocrine therapy, thus avoiding false-negative assays.

Cold thyroid nodules in childhood: is surgery always necessary?

In children who present with a cold thyroid nodule the current recommendation is that surgery immediately be performed in view of the high probability of thyroid cancer. Because the incidence of thyroid cancer in children may be decreasing and because extensive experience has been gained in adults with thyroid echography and fine-needle aspiration cytology, we evaluated three consecutive children with cold thyroid nodules by means of these non-surgical techniques. The diagnoses were: thyroid cancer in one patient, thyroid abscess in one and haemorrhagic cyst of the thyroid in one. In the latter two patients, fine-needle aspiration was both diagnostic and therapeutic. We conclude that thyroid echography and fine-needle aspiration of thyroid nodules deserve more extensive evaluation in the paediatric age group.

Effects of aminoglutethimide plus hydrocortisone on the genital tract of postmenopausal women with advanced breast cancer. A clinical and cytologic survey.

In this study we compared the effects of either Aminoglutethimide (AGL) or Tamoxifen (TAM) therapy on the genital tract of postmenopausal women with advanced breast cancer. Thus, 15 patients treated with AGL, and 10 patients treated with TAM underwent gynaecological examination, during which vaginal smears were taken. All smears were reviewed in blind by one pathologist for determination of karyopycnotic indices (KI). Under TAM, no significant clinical abnormality was observed, except in one patient who had a small (histologically benign) endocervical polyp, easily removed during the examination. As reported by others, smears made under TAM therapy were generally characterized by high KI, indicating that an hormonal, estrogen-like stimulation remained present in these patients. On the contrary, most women under AGL had some evidence of vulvovaginal atrophy, which was unvariably associated with low KI on smears. Among the latter, four had severe dystrophic lesions consisting of leukoplasia (1), kraurosis (2) or lichen sclerous and atrophicus (1). It is therefore recommended not to neglect the systematic practice of gynaecological examination in patients with advanced breast cancer under endocrine therapy. These observations also indicate that AGL and TAM exert entirely opposite effects on the vaginal mucosa, which is a very sensitive estrogen-target tissue. In good agreement with former endocrine studies, AGL acts as a potent suppressor of estrogens resulting in severe mucosal atrophy. On the contrary, TAM seems nearly always to display some agonistic hormonal stimulation.

Immunohistochemical distribution of glial fibrillary acidic protein, neurofilament polypeptides and neuronal specific enolase in the human cerebellum.

The human normal cerebellar cortex has been investigated using paraffin-embedded sections and a panel of antibodies against GFAP, NSE, NF 70 Kd and 200 Kd triplet proteins. The study has shown that: antiserum to GFAP labelled all and only astroglial elements; antibodies to NSE, NF 70 Kd and 200 Kd stained the perikaryon of all neurons, with two noticeable exceptions: Purkinje cells, which remained unresponsive to all 3 reagents, and basket cells which only became labelled with the NSE antiserum; the staining of dendrites and axons was exquisitely selective with both the NF and the NSE antibodies, each of which displayed unique binding patterns. These immunohistochemical features, first to be described in man, are compared with those so far reported in rodents.

S-100 protein expression in satellite and Schwann cells in neuroblastoma. An immunohistochemical and ultrastructural study.

Immunohistochemical evidence has recently been provided that in the normal adrenal medulla as well as in autonomic ganglia, satellite cells and Schwann cells react with S-100 protein antiserum. In the light of these data, we investigated primary peripheral neuroblastoma and ganglioneuroblastoma to determine firstly whether both cell populations actually exist in the malignancies, using the definite criteria of electron microscopy for their identification, and secondly whether they express S-100 protein using on immunohistochemical technique and light microscopy. The results indicate that in both neuroblastoma variants, satellite and Schwann cells are present and specifically express the S-100 antigen.

Burkitt lymphoma. EBV nucleoid-like structures and lack of capsids in lymphoblasts.

Burkitt lymphoma biopsies and the CSF malignancy have been investigated ultrastructurally. The tumor cells were found to contain vermicellar bodies formed by rod-like structures similar to those suggested to represent HSV nucleoids in HSV encephalities. But, unlike the HSV disease and BL in culture, no nucleocapsids nor empty capsids were detected. It is suggested that the rods in the Burkitt lymphoblasts may well represent EBV nucleoids and that the absence of capsids may be another characteristic of the EBV in BL in situ.

[Endometrial biopsy in hormonal imbalance]. / La biopsie d'endomètre au cours des déséquilibres hormonaux.

Despite the new techniques of biochemical evaluation of steroid hormones in the plasma and urines, the endometrial biopsy remains an easy valuable method of evaluation of ovarian activity. The clinical indications of the endometrial biopsy are mainly a history of sterility or an abnormal uterine bleeding if we exclude the diagnosis of cancer. Different technical procedures should be followed carefully in order to get a valuable answer. The biopsy should be taken at the right time of the cycle which means 10 to 12 days after ovulation. The danger of interrupting a pregnancy is minimal but in a case of sterility, the biopsy can be performed 4 to 6 days after ovulation to prevent any interference with a early pregnancy. Proper fixation, embedding and staining must be the rule. A fragment of the middle layer of the functionalis must be present to evaluate accurately the hormonal stimulation. Isthmic or cervical tissues are unsuited for functional diagnosis. The existence of an endometritis or the administration of steroid hormones are clinical circumstances which prevent any functional evaluation. The normal menstrual cycle can be divided into different functional phases: the early, the middle and the late proliferative phases, and the early and late secretory phases followed by the menstruation period. The different cellular components of the endometrial mucosa will exhibit various changes corresponding to each of the phases. The interpretation of the endometrial biopsy lies in the correlation between the observed image and the image corresponding to that date of the cycle. The functional disturbances are associated with absent, deficient or excessive function of the ovarian hormonal secretion. The endometrial mucosa will reflect these anomalies revealing atrophic, hypoplastic or hyperplastic conditions of the glandular and stromal components. It is essential to obtain the clinical informations including the knowledge of any hormone administration to provide a valuable diagnosis. Properly interpreted, the endometrial biopsy remains a very useful technique in the study of hormonal ovarian disturbances.

Burkitt's lymphoma--a correlated light and electron microscopic study on the malignancy in the CSF.

In a sporadic case of primary maxillar Burkitt's lymphoma and secondary spinal epidural dissemination, the massive malignancy in the CSF was investigated by light and electron microscopy. At both levels the CSF tumor cells were strikingly similar, with the undifferentiated lymphoblasts that characterize Burkitt's lymphoma in tissue. However, the starry-sky appearance in the CSF was produced more often by degenerating malignant cells than by histiocytes as classically described in tissue with Burkitt's lymphoma.