A silent gigantic solitary fibrous tumor of the pleura: case report

Solitary fibrous tumor of the pleura is a rare mesenchymal tumor, representing less than 5% of all neoplasms associated with the pleura. A 57-year-old man had general malaise without chest symptoms for 1 month. A chest roentgenogram and computed tomography showed a giant mass in the left thorax. Although the tumor compressed the descending aorta and other mediastinal structures strongly, thereby shifting them to the right side, the patient had no symptoms except malaise. The tumor was successfully resected via two separate thoracotomies. The tumor was measured (20 cm × 19 cm × 15 cm) and weighed (2150 g). The tumor was histologically and immunohistochemically diagnosed as benign. Although SFT is benign, a long follow-up period is essential as even patients with complete resection are at risk of recurrence many years after surgery

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Purpose:We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy.Methods:All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable.Results:A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16–0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049).Conclusion:The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy

Giant Solitary Fibrous Tumor of the Pleura: An Analysis of Five Patients

Ó The Author(s) 2010. This article is published with open access at Springerlink.com Background Solitary fibrous tumor of the pleura (SFTP) represents a clinical entity rarely encountered, especially in giant forms. Complete surgical resection for giant tumor of pleura is a challenge. The aim of this article is to present five new cases of giant SFTP, and to discuss their clinical characteristics and the treatment strategy of such neoplasms. Methods We performed a retrospective review of the clinical records of five patients who underwent surgery for a huge SFTP ([18 cm in diameter) between 2007 and 2009. Results Four patients were symptomatic. All five patients underwent angiography and embolization of the tumorsupplying vessels within 24 h of surgery. All giant tumors were removed completely by extended postlateral thoracotomy with moderate intraoperative bleeding. Two wedge resections and one lobectomy were performed in three cases where the parenchyma had been encroached. Tumors in three patients were pathologically benign; those in the other two were malignant. The symptoms disappeared in all cases after surgery. Conclusions Complete resection remains the mainstay of cure for giant SFTP. We recommend preoperative angiography and embolization for giant SFTP which can reduce the risk of hemorrhage and can contribute to piecemeal removal for radical excision

Espoirs et créations de la psychiatrie de secteur

Dans un entretien filmé accordé à de jeunes collègues, Jacques Fortineau retrace ici quelques unes des grandes lignes qui ont imprimé la traversée de plus de quarante années de pratique psychiatrique. Il restitue le contexte qui a vu naître sa vocation psychiatrique et les filiations qui l’ont porté. Au fil du discours, il dépeint le paysage du secteur psychiatrique en construction, où se font écho petite et grande histoire. Se dessinent alors les frontières annonçant la scission entre neurologie et psychiatrie. Au travers de cette trajectoire se définit une mise en perspective historique de la psychiatrie les années 1960 à nos jours, qui vient alimenter les débats actuels entre politique et psychiatrie, entre psychanalyse et neurobiologie