Establishment and Characterization of a Stromal Cell Line Derived From a Patient With Thoracic Endometriosis.

Thoracic endometriosis (TE) syndrome is a clinical condition known as an extrapelvic form of endometriosis with the presence of functioning endometrial tissue involving lung parenchyma, pleura, chest wall, or diaphragm. In an effort to obtain an endometriosis ex vivo model, we established the spontaneously growing TH-EM1 cell line from endometriotic implants in lung parenchyma from a woman with TE. Maintained in long-term culture, the cells grew as large mesenchymal-like cells with a doubling time between 5 and 6 days. Treatment with medroxyprogesterone acetate (10-7 mol/L) inhibited the TH-EM1 cells growth and induced morphological changes to an epithelial-like cells. Strong expression of the nuclear estrogen receptors, progesterone receptors, and erytropoietin receptors were found in both the pulmonary implant and the TH-EM1 cells by immunohistochemical analysis. Consistent immunoreactivity of TH-EM1 cells for CD9, CD13, CD73, CD90, CD105, and CD157 was revealed by flow cytometry. Likewise, the embryonic markers, SRY-box 2 (SOX-2) and the Nanog molecules, were detected in 76% and 52% of the cells, while fetal hemoglobin and a-globin were detected in 76% and 65% of TH-EM1 cells, respectively. By RHG banding, normal metaphases were observed, while the microarray chromosomal analysis showed gains of DNA sequences located on the segments 8p23.1, 11p15.5, and 12p11.23. The described in vitro cellular model can serve as a useful tool to study the pathogenesis of endometriosis and to improve the knowledge of molecular mechanisms controlling the endometriotic cell dissemination potential.

Establishment and Characterization of a Stromal Cell Line Derived From a Patient With Thoracic Endometriosis.

Thoracic endometriosis (TE) syndrome is a clinical condition known as an extrapelvic form of endometriosis with the presence of functioning endometrial tissue involving lung parenchyma, pleura, chest wall, or diaphragm. In an effort to obtain an endometriosis ex vivo model, we established the spontaneously growing TH-EM1 cell line from endometriotic implants in lung parenchyma from a woman with TE. Maintained in long-term culture, the cells grew as large mesenchymal-like cells with a doubling time between 5 and 6 days. Treatment with medroxyprogesterone acetate (10-7 mol/L) inhibited the TH-EM1 cells growth and induced morphological changes to an epithelial-like cells. Strong expression of the nuclear estrogen receptors, progesterone receptors, and erytropoietin receptors were found in both the pulmonary implant and the TH-EM1 cells by immunohistochemical analysis. Consistent immunoreactivity of TH-EM1 cells for CD9, CD13, CD73, CD90, CD105, and CD157 was revealed by flow cytometry. Likewise, the embryonic markers, SRY-box 2 (SOX-2) and the Nanog molecules, were detected in 76% and 52% of the cells, while fetal hemoglobin and α-globin were detected in 76% and 65% of TH-EM1 cells, respectively. By RHG banding, normal metaphases were observed, while the microarray chromosomal analysis showed gains of DNA sequences located on the segments 8p23.1, 11p15.5, and 12p11.23. The described in vitro cellular model can serve as a useful tool to study the pathogenesis of endometriosis and to improve the knowledge of molecular mechanisms controlling the endometriotic cell dissemination potential.

[Pulmonary intralobar sequestration in adults: Evolution of surgical treatment]. / Séquestrations pulmonaires intralobaires de l'adulte : évolution du traitement chirurgical.

BACKGROUND: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years. METHODS: We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016. RESULTS: Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS9+10, 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group. CONCLUSIONS: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically.

[Surgical treatment of early stage non-small cell lung cancer by thoracoscopic segmental resection]. / Traitement chirurgical des cancers bronchiques non à petites cellules (CBNPC) de stade précoce par segmentectomie à thorax fermé : résultats préliminaires.

The rate of segmental resection for early stage non-small cell lung carcinoma (NSCLC) is increasing. However, the indications remain controversial. The aim of this study is to analyze the preliminary results of thoracoscopic segmental resection in early stage NSCLC in terms of morbidity, oncological validity and survival. We report the preliminary results of a consecutive series of 226 thoracoscopic segmentectomies for suspicion of early stage NSCLC. PATIENTS AND METHODS: Between 2007 and 2016, we performed 322 thoracoscopic anatomical sublobar resections (ASLR). Two hundred and twenty six of these were for suspicion of early stage NSCLC in 222 patients. Data were recorded prospectively and analysed retrospectively on an intent-to-treat basis. Overall and disease-free survivals were estimated on a Kaplan-Meier curve and differences were calculated by a log-rank test. RESULTS: Twenty-two patients were upstaged (10.4%), in 10 cases to T3 or T4, in 6 cases to N1 and in 6 others to N2 for metastasis. Out of the 6 N1 cases, 3 were discovered at frozen section and resulted in a switch from segmentectomy to lobectomy. There were 10 conversions to thoracotomy (3.9%). Seventeen patients had a more extensive resection than initially planned (7.5%), most often for oncological reasons: invasion of intersegmental lymph nodes (n=3) or insufficient resection margin at frozen section (n=7). Morbidity and mortality were 25.7% and 1.3 % respectively. For pT1aN0 carcinomas, overall and disease-free survivals were 87.1% and 80.6%, respectively. For pT1bN0 carcinomas, overall and disease-free survivals were 88.8 %, and 75.3% respectively. CONCLUSION: For early stage NSCLC, thoracoscopic ASLR allows reduced perioperative morbidity while offering satisfactory survival. However, a rigorous technique must be applied to reduce the rates of conversion to thoracotomy and extension to lobectomy when required for oncological reasons.

[Cystic mediastinal schwannoma appended to the vagus nerve]. / Schwannomes kystiques du médiastin développés au dépend du nerf vague.

INTRODUCTION: Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. CASE REPORTS: We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. CONCLUSION: Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.

[Anesthesia for experimental surgery in swine]. / Anestezia pentru chirurgia experimentala la porci.

New surgical techniques cannot be safely and widely performed in human subjects unless they are first applied to large animal models. Experimental model using swine as surgical practice subject is one of the most reliable and widely practiced, taking into consideration the similarity between human and swine anatomy. Based on our large experience (around 100 pigs) we hereby present important aspects of handling and anesthesia procedures for pigs. Our goal is to share our experience with young surgical and anesthesia investigators who are planning investigations using pig as an experimental animal.

[Thoracoscopic splanchnicectomy--a method of pain palliation in non-resectable pancreatic cancer and chronic pancreatitis]. / Splanhnicectomia toracoscopica--metoda de paliatie a durerii în cancerul pancreatic nerezecabil si pancreatita cronica.

Severe upper abdominal pain is a dominant and distressing feature in advanced pancreatic cancer and in chronic pancreatitis. A way of palliation needs to be practiced in the non-resectable pancreatic cancer in order to control the pain. Between the many methods of palliation the thoracoscopic splanchnicectomy seems to be the best due its simplicity, no risk to the patient and the good results. In the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute we have practiced 50 thoracoscopic splanchnicectomies in a number of 49 patients during a period of 3 years. The morbidity was 2% and the mortality 0. We noticed a significant improvement in the pain score, the quality of sleep and the overall quality of life and consecutively a quick social reintegration of these patients. The quality of life is greatly improved (with a significant reduction of the pain score in 92% of the cases) after this minimally invasive procedure, a fact the qualifies this procedure as the technique of choice in these patients.

[Our experience regarding a series of adrenal surgical diseases]. / Experienta noastra în legatura cu o serie de afectiuni chirurgicale ale glandelor suprarenale.

AIMS: The problems of positive and differential clinic-pathologic diagnosis, the optimal therapeutic decision and importance of surgery in a series of patients with adrenal gland (AG) diseases was studied. MATERIAL AND METHODS: Between 1987-1999, 91 patients (pts.) with adrenal diseases were operated on. Sex ratio was 63 f/28 m and the medium age 42.3 years (extremes 14 and respectively 75 years old). The lesions were localized in medullar, cortical and in the both components of AG. 1) The cortical determinations were represented by 40 (44%) pts. with: a) Cushing's syndrome 37 pts. histologically grouped: 24 pts. (63%/37) with benign, diffuse hyperplasia of cortico-adrenal glands; 4 pts. with cortical benign adenoma; 7 adenocarcinoma; 2 with borderline lesions. b) Conn syndrome--3 pts. 2) Medullary lesions (Phaeochromocytoma)--30 pts. (33%/91) with following microscopically lesions: 22 typical phaeochromocytoma; 3 benign adenoma; 5 carcinoma and 1 medullo-adrenal paraganglioma. One patient have had bilateral medullo-adrenal lesions: left carcinoma and right benign adenoma). 3) Non functioning tumors (Incidentaloma)--21 pts. (23%/91) (17 malignant and 5 benign). The distribution of the whole group of 91 pts. was: 62 with benign lesions (diffuse hyperplasia or tumors), 26 malignant tumors, 1 both of them and 2 borderline lesions. The diagnosis was the result of clinically, biochemical-hormonal tests and imagery examinations (computed tomography especially) with postoperative pathological confirmation. The surgery applied was:--bilateral adrenalectomy 16 pts.;--right adrenalectomy 20 pts.;--left 26 pts. (two through laparoscopic approach);--tumor exeresis 26 and--3 biopsy of the tumors. The dimensions of the operatory specimens were: < 10 cm--67 pts.; 10-20 cm--16 pts.; > 20 cm--2 pts.; undetermined 6 pts. For malignant lesions the main parameters (in various associations) were: neighborhood invasion--18 pts.; distant metastasis--5; metastatic lymphnodes--13; the microscopic grading (G1-1; G2-9; G3-7 pts.). Three cases imposed iterative interventions for a recurring adenoma of the cortically AG or for restant tissue in Cushing's syndrome. There were necessary 28 supplementary operative (partially or totally) organs exeresis. All pts. with malignant lesions were postoperative treated with chemio- or/and radiotherapy. RESULTS: Postoperative morbidity: 18 (20%) pts.; depending of the surgery 8 pts., secondary of the patient general status 12. General postoperative mortality 4 (4.8%) pts. determined by severe cardio-vascular complications. CONCLUSIONS: 1--The surgical diseases of adrenal glands are difficult to diagnose and are based primarily on the clinical information's and confirmed by the hormonal and imagery examinations (errors are possible). 2--Operatory indications, especially for hyperplasic bilateral forms in Cushing's syndrome (one step or two steps surgery) must be very well documented and carefully established. 3--There are cases which impose recurrent operations. 4--A correct operative indication and technical surgery procedure are followed by good results. 5--The laparoscopic approach of the surgical lesions of the AG is a good alternative for the open surgical approach with the condition of a very correct indication. 6--Postoperative, the malignant lesions must be mandatory submitted to the adjuvant treatment.

[Pyogenic liver abscess]. / Abcese hepatice piogene. Evaluarea schimbarilor aparute în etiologie, diagnostic, tratament si evolutie.

The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.

[Insulinomas--nesidioblastomas. Clinical experience]. / Insulinoamele--nesidioblastoamele. O experienta clinica.

Between 1980 and 1996, 16 patients (10 women) with pathologically confirmed insulinomas were operated on; they represents a median of 0.9 per year and 1.1 per cent from the total of pancreatic tumors. Median age was 47.2 (+/- 22.8) years old (range 23-68). Insulinomas occurred with following frequency in: head--2 patients, body and tail--11 patients and diffuse forms (nesidioblastomas)--3 patients. The specific clinical forms only with tumoral syndrome (without hypoglycemic manifestations) and one was an intraoperative discovery. In the case of the four patients two presented with splenic-portal hypertension +/- upper digestive haemorrhages and the other two only tumoral syndrome. The surgical approach was: the midline (ten), uni- or bilateral subcostal (five), and other incisions one. There were performed tumor exeresis through: enucleation (three), segmentary pancreatectomies (two), spleno-left-pancreatectomies (nine) and the extension of an anterior pancreatectomy (one). In one case biopsy alone was done. The tumors were not intraoperatively identified in three cases (blind left spleno-pancreatectomies). The malignancy index was 4/16 (25 per cent). Postoperative mortality rate was 12.5 per cent (two patients: one acute necrotizing pancreatitis and one pulmonary embolism).