[Parietal extension of diffuse malignant pleural mesothelioma after biopsy. Prevention by local radiotherapy].
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Biopsy↗
Biomedical subjects
C Boutin
Publications and source records attributed to C Boutin.
[Review of today's treatment of bronchial small cell anaplastic cancers (author's transl)].
The median survival time of untreated patients with small cell anaplastic carcinoma of the lung does not exceed three months. An important improvement in survival and disease-free period has been achieved by some new therapeutic combinations including chemotherapy alone or radiotherapy and chemotherapy. These recent results are reviewed in this paper, and a new treatment schedule is presented.
Antineoplastic Agents↗
[Double-blind study of an immunomodulator of bacterial origin (Biostim) in the prevention of infectious episodes in chronic bronchitis].
A double-blind trial was conducted to evaluate the capacity of an immunomodulator of bacterial origin (Biostim) to diminish the frequency of infectious episodes in chronic bronchitis. The study duration was 9 months, Biostim being administered orally initially, with follow-up examinations after 2 and 4 months. Of the 73 subjects selected, 38 received Biostim and 35 a placebo (no significant differences between the two groups). By the 9th month, the duration in days of infectious episodes and of antibiotic therapy was 13 +/- 1.3 and 11.5 +/- 1.4 days respectively for the group receiving Biostim, and 33 +/- 5.8 and 41 +/- 9.5 respectively for the placebo group (p less than 0.05). No signs of intolerance and particularly no immunotoxicity were observed: absence of elevation of IgE or anti-Biostim antibody titres. Pre-winter administration of Biostim to subjects at high risk would appear to significantly diminish the frequency of infectious episodes and thus the consumption of antibiotics.
Adjuvants, Immunologic↗
[Pleural pressure during thoracocentesis in patients with pleural neoplasms].
In 45 patients with cancerous pleural effusion, thoracocentesis was performed according to the following technique : after local anaesthesia (5 ml of 2% lidocaine) in the posterior part of the 6th intercostal space, thoracocentesis was carried out with a blunt trocar connected to a water manometer. The pleural pressure was measured before removal of the fluid (Po). Then three different techniques of drainage (active suction at -- 80 or -- 40 mmHg or underwater sealed drainage) were randomized. Pleural pressure was measured after removal of every 100 ml and at the end of the procedure (PT). The mean Po +/- SD was respectively -- 4.08 +/- 2.95, -- 3.81 +/- 3.12 and -- 2.53 +/- 2.42 cmH2O for the three different groups of drainage. After drainage, PT was decreased in the three groups, especially after -- 80 mmHg aspiration. In 14 patients, side effects occurred during thoracocentesis and the procedure was stopped. Symptoms, chiefly cough, occurred after a mean removal of 1.1 +/- 0.7 1. PT in these patients was statistically lower (-- 18 +/- 5.59 cmH2O) than in the 31 asymptomatic patients (--11.40 +/- 5.75 cmH2O) (p less than 0.001). In conclusion, the assessment of the pleural pressure during thoracocentesis seems to be convenient in order to prevent any complication of pleural evacuation : pleural evacuation should be stopped if the pleural pressure decreased below -- 18 cmH2O. A depression at -- 80 mmHg is too dangerous for pleural aspiration; -- 40 mmHg or under water sealed drainage are both convenient for a safe and complete evacuation.
Aged↗
[Clinical aspects and course of 38 cases of malignant pleural mesothelioma observed in the Marseilles region].
Epithelial or mixed mesotheliomas were detected in 38 patients in the region of Marseilles over a period of 9 years. Though an occupational element was involved in 80% of cases, no history of contact with asbestos could be obtained in certain of the patients. Confirmation of diagnosis requires wide pleural biopsies, because of the high level of false negatives and false positives from cytology and pleural needle biopsy. Hyaluronic acid levels are significant only when they are markedly enhanced. Local and regional tumor spread provides an aid to prognosis, but authentic metastases, with further worsening of prognosis, were detected in more than 75% of patients while still alive. Nodules appeared along the course of punctures of drainage tubes or in thoracotomy scars in 56% of cases, and appear to be a very frequent and characteristic feature of mesothelioma. Their therapy involves preventive irradiation.
Adult↗
[Thoracoscopy in 1980. A general review (author's transl)].
Examining the literature and their own experience, the authors reviewed the methods, the complications and indications of modern thoracoscopy. They considered the rigid cold light thoracoscope with diathermo-coagulation. The authors stressed the importance of the macroscopic appearance of the pleural cavity, and the need to take numerous biopsies. Several types of anesthesia can be used, although the authors prefer general anesthesia for the comfort of both the patient and the doctor. Complications are very rare, the main ones being hemorrhage, pulmonary perforation and contamination of the puncture route with cancer cells. The first two can be avoided by good technique and diathermo-coagulation. The latter can be prevented by systematic radiotherapy of the puncture route, in mesothelioma patients. Amongst the numerous indications mentioned, three are important: the etiological diagnosis of chronic effusion, where cancer is a major fear. In these cases, the authors get 97% of positive results. Spontaneous pneumothorax is also a good indication: thoracoscopy allows a useful separation of patients, into those who need surgical treatment, or those in whom local adhesion of the pleura with talcum powder would be effective. Finally, pulmonary biopsy via the thoracoscope is a reliable and effective technique in a large number of indications.
Anesthesia↗
[How to act, in the emergency service, in front of a patient with altered consciousness].
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Consciousness Disorders↗
Clinical course of human epithelial-type malignant pleural mesothelioma replicated in an orthotopic-transplant nude mouse model.
Malignant pleural mesothelioma is an aggressive tumor that is essentially unresponsive to standard medical and surgical therapies. Little is actually known about its biologic response to therapeutic interventions, in part because of a lack of a "patient-like" animal tumor model. Most experimental models thus far have been derived from inhalation or inoculation of asbestos fibers into animal subjects or by subcutaneous transplantation of human mesothelial cell lines into nude mice. These models are not representative of clinical malignant pleural mesothelioma. In this report, an animal model of human pleural malignant mesothelioma obtained by orthotopic transplantation of intact pleural tumor tissue into athymic nude mice is described. Pleural tumor obtained by thoracolscopy from a patient with epithelial-type malignant pleural mesothelioma was implanted as intact tissue by surgical orthotopic implantation (SOI) into the right pleural cavity of nude mice. Animals were sacrificed when moribund or 6 months after implantation. Tumor growth and regional spread in the mice evaluated at post-mortem examination mimicked the clinical pattern of progression of human disease. Histologic findings and the immunohistochemical profile were similar to those demonstrated on examination of thoracoscopic parietal pleural biopsy specimens and post-mortem examination of the original patient's tumor. This "patient-like" nude mouse model of epithelial-type malignant pleural mesothelioma, phenotypically similar to the original human tumor, should facilitate future investigation of tumorigenesis and metastatic potential of this neoplasm. The model should serve as a basis for assessing the impact of experimental and existing therapy on malignant mesothelioma.
Adult↗