[Absorbable synthetic clips and pulmonary excision. Our clinical experience]. / Clips synthétiques résorbables et exérèses pulmonaires. Notre expérience clinique.

Analysis of the first 50 clinical cases confirmed conclusions of experimental studies in large animals with respect to the use of absorbable synthetic clips formed of lactomer and polydioxanone. The advantages of clips when compared with ligatures include rapidity and simplicity of use and ease of insertion, even in regions difficult to approach surgically with the fingers. The advantages of clips of the absorbable synthetic type over conventional metallic material are: safety and reliability due to their locking system and the conservation of sufficient residual resistance, improved behavior in biologic media, radio-transparency and total inertia in magnetic fields compatible with postoperative radiation and modern medical imaging procedures (CT scan, IRM), and finally progressive resorption predictable by simple hydrolysis and then total disappearance after 6 to 7 months. With staplers of the TA and GIA type these clips make sutures and ligatures during lung resection surgery entirely automatic.

[Absorbable synthetic clips and pulmonary excision]. / Clips synthétiques résorbables et exèréses pulmonaires.

From the beginning of this decade, two new, 2nd generation, resorbable synthetic materials--polydioxanone and lactomer--have been able to be molded into clips which, in contrast to metallic clips, are fitted with an original locking system preventing any slipping, either transversal or longitudinal, on the vessels. An experimental study was conducted to confirm their great reliability and perfect safety on large vessels (up to 8-9 mm) of large laboratory animals--both pulmonary and systemic vessels. Positive results justified their application to pulmonary vessels in humans during surgery, the pulmonary vessel being at a much lower pressure than in the main circulatory system. These new clips possess the advantages of metallic clips and resorbable synthetic threads without their inconveniences: rapidity, simplicity and ease of application, radio-transparency and complete inertia in magnetic fields enabling radiotherapy and modern postoperative investigations (scanner, NMR...) to be carried out.

[Assessment of 7 years of automatic suturing in pulmonary surgery]. / Bilan de sept années de suture automatique en chirurgie pulmonaire.

In 738 patients, the stapler-suturing methods were used in 2 main areas of concern: closure of the major hilar broncho-vascular structures (for smaller pulmonary vessels, we use absorbable ligating clips: Absolok from Ethicon and Polysurgiclip from USSC), suture of the lung parenchyma. Regarding pedicular sutures, our rate of bronchial fistula is 1,0% (or 4,4% if only pneumonectomies are taken into account: 1,4 on the left and 7,7 on the right). These rates are compared with those gathered from the literature, with emphasis on the right main bronchus. Regarding parenchymal sutures, we place TA and GIA on collapsed parenchyma for achieving a wide range of either intralobar or translobar procedures. We lay emphasis on: the conventional segmentectomies with stapling of the intersegmental surface, and the newer and more economical "non réglées" transsegmental resections in which the surgeon is anymore limited by segmental frontiers. The control of blood and air leakage from the cut surface is quite satisfactory, reducing significanthy the postoperative morbidity. For both major pedicular structures and fragile lung parenchyma, the stapler-suturing methods are very reliable and provide a quicker, simpler, safer, easier and more economical surgery in lung resections.

Preoperative chemotherapy in epidermoid bronchogenic carcinoma.

Palliative chemotherapy in cases of epidermoid bronchogenic carcinoma, initially judged to be inoperable, made it possible to perform operative resection in 50 cases. An association of cis-platinum and bleomycin was used, this combination having previously been considered synergistic. In certain cases the tumour seemed to have disappeared on macroscopic examination of the resected specimen, and in some instances no tumoral cells could be found on histological examination. This series brought out several positive features: chemotherapy made it possible to operate on patients previously judged to be inoperable; it ensured maximum local efficiency of drugs because of the absence of abnormal vascularity; and it made it possible to anticipate the cure of occult metastases. However, three negative aspects were also present: modification of postoperative TNM classification making it difficult to establish a prognosis; difficulty in determining therapeutic strategy for pNo; and inadequate long-term follow-up. On the whole the positive points appeared to outweigh the negative aspects, but a randomized study is necessary to confirm this.

Surgery and chemotherapy. A new method of treatment for squamous cell bronchial carcinoma.

Between April, 1981, and December, 1982, 32 patients with squamous cell bronchial carcinoma were treated with a chemotherapy regimen followed by operation. The preoperative chemotherapeutic agents used were cisplatin, bleomycin, and mitomycin C. A thoracotomy was performed 3 to 4 weeks after the last day of the last treatment. Of the 29 undergoing resection, three (10.3%) had no tumor cells in the resected specimen and four (12.5%) had only a few neoplastic microcenters in tissue necrosis or fibrosis. We suggest that the use of this new chemotherapy combination with surgical resection provides excellent palliation, increases resectability, and has a potential for increasing the cure rate in squamous cell carcinoma of the lung.

[Radioisotope evaluation of the interaction between blood and vascular prostheses. Preliminary results]. / Evaluation radioisotopique de l'interaction sang-prothèses vasculaires. Résultats préliminaires.

In order to illustrate the phenomena which occur at the first contact between arterial prostheses and blood, an in vitro test is suggested which may be used to quantify the retention of the cruoric matrix using labelled compounds and confirming the nature by scan electron microscopy. Reorganisation of the cruoric matrix is dependent upon the scarring of polyesters which retain considerably more blood substances than microporous polytetrafluoroethylenes or the biological models dealt with, the course of which after implantation is closer to passivation.

[Evolution of myocardial temperature following cardioplegia with and without complementary pericardial cooling. Experimental study]. / Evolution des températures myocardiques après cardioplégie avec et sans refroidissement péricardique complémentaire. Etude expérimentale.

Myocardial temperatures were measured after cardioplegia during cardiac surgery with and without pericardial cooling by a cold bath. Eight animals (50 kg pigs) were placed on cardiopulmonary bypass using a protocol reproducing clinical operating conditions as closely as possible: myocardial mass, median sternotomy, general hypothermia at 25 degrees. Two injections of cardioplegic solution were administered, one at aortic clamping and the other, 30 minutes later. Four animals (Group A) were used as reference. The four animals in Group B underwent pericardial irrigation with serum at 4 degrees C. Myocardial temperatures were measured at 9 anatomical sites every 10 minutes, (a total of 1008 measurements) and compared statistically. The results in the control group showed that myocardial warming after cardioplegia was intense and rapid at all sites. The sub-epi and sub-endocardial temperatures rose from 7 to 24 degrees in 30 minutes, and in the first 10 minutes, a rewarming of 8,5 degrees was observed. When pericardial cooling was used with cardioplegia, myocardial refrigeration was improved. The temperature remained below 15 degrees C (p less than 0,05 compared with Group A). Only a 3 degrees rise in temperature was observed at the 10th minute after cardioplegia (p less than 0,001). The rise temperature was of 2 degrees at the 20th minute, and 1 degree at the 30th minute. All temperatures remained below 15 degrees C (p less than 0,01). The authors emphasise the benefits of pericardial irrigation associated with cardioplegia for constant, durable and stable myocardial protection by cooling.

[Solitary fibrous tumors of the visceral pleura. 5 cases]. / Tumeurs fibreuses solitaires de la plèvre viscérale. Cinq observations.

Five new cases of solitary fibrous mesothelioma of the visceral pleura support this review of the literature. Well encapsulated and usually pediculated, these tumours remain asymptomatic for a long time and are in most cases an incidental finding on radiographs of the chest. The precise site of the tumour can be identified by artificial pneumothorax. Some large tumours are accompanied by extrathoracic signs, i.e. hypoglycemia and hypertrophic pulmonary osteoarthropathy. Histological examination discloses whorls of collagen fibres with scattered spindle-shaped cells. Electron microscopy reveals characteristic features of both fibroblasts and mesothelial cells. Complete surgical removal is the best treatment of localized fibrous mesotheliomas of the visceral pleura. Post-surgical recurrences are rare, and late recurrences (up to 16 years after excision) are usually benign and of good prognosis.

[5 new cases of solitary fibrous mesothelioma of the visceral pleura]. / Cinq nouvelles observations de mésothéliome fibreux solitaire de la plèvre viscérale.

Five new cases of solitary fibrous mesothelioma of the visceral pleura support this review of the literature. Well encapsulated, mostly pedunculated, the implantation on the visceral pleura remains asymptomatic for a very long time and is more likely to be an incidental finding on a chest radiograph. Two extrathoracic signs are associated with certain huge tumors : hypoglycemia and osteoarthropathy. Histologic examination discloses whorls of collagen with scattered spindle-shaped cells. Electron microscope reveals characteristic features of both fibroblasts and mesothelial cells. Complete surgical removal is the best treatment for localized fibrous mesotheliomas of the visceral pleura. Recurrences after resection are rare and late recurrence, as long as 16 years after initial excision, usually behaves in a benign fashion.

[Thermal isolation of the heart by means of a plastic foam pad during surgical cooling of the heart: experimental study]. / Isolation thermique du coeur par patin de mousse plastique au cours de la réfrigération chirurgicale du coeur. Etude expérimentale.

Maintenance of myocardial cooling during aortic clamping is a problem encountered currently during heart surgery. A plastic foam isolation pad was studied. Eight animals (pigs weighing 50 kg) were placed on extracorporeal circulation, 4 of them constituting the control group (A). Two coronary injections of a cardioplegic solutions were administered, the first at the time of aortic clamping and the second 30 minutes later. The myocardium of the 4 animals in the treated group (B) was isolated with the foam pad, and this significantly prolonged the "cold" effect of the cardioplegic. Ten minutes after injection of the cardioplegic, temperature of the total myocardial mass with isolation was between 10.7 and 12 degrees C, as against 16 to 18 degrees C in the reference group (p less than 0.05). By the 20th minute, the isolated myocardium was at approximately 15 degrees C as against 22 degrees C in group A (p less than 0.01). Finally, by the 30th minute, temperature in group B was 17 degrees C as against 23 degrees C in group A (p less than 0.01). Reheating of the heart was significantly slowed by thermal isolation, though the limit of 15 degrees C was reached by the 20th minute. To ensure that myocardial temperature remains below this limit when the foam pad is employed, further injections of cardioplegic solutions are necessary every 20 minutes.

[Possibilities and limits of angiographic exploration of the deep femoral artery using posteroanterior projections as described by Dos Santos. Radiological and therapeutic consequences (author's transl)]. / Possibilités et limites de l'exploration angiographique de l'artère fémorale profonde par les incidences de face selon la technique de Dos Santos. Conséquences radiologiques et thérapeutiques.

The study concerns 36 patients treated by an aortobifemoral shunt operation. The decision to operate followed conventional posteroanterior arteriography using the technique described by Dos Santos. Surgical exploration of 54 deep femoral arteries (DF) was conducted during the approach to the femoral tripod. Anatomical findings were 40 significant stenoses of the DF, 4 complete obstructions, and 10 normal arteries. These observations were compared with radiological findings: in 34 cases there was correlation between the results, in 13 cases a false negative was noted, arteriography underestimating the lesions, and in 6 cases a false positive result overestimated the extent of the atheromatous lesion. The lack of sensitivity of standard examinations of the deep femoral arteries means that it is essential to conduct oblique projections in most cases. In certain special cases, however, the authors feel that these complementary examinations can be avoided, thus eliminating their constraints. In fact, when posteroanterior angiography suggests the need for operation by an aorto-bifemoral shunt, systematic exploration of the femoral tripods can, according to the authors, replace oblique projection images. Apart from these favourable cases, oblique projections are essential during pre-operative investigations. They are also necessary to exclude any possibility of direct revascularization.