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Competing Interests: Intérêts concurrents: Bram Rochwerg est un chercheur participant à un essai financé par une subvention des Instituts de recherche en santé du Canada qui évalue les effets des corticostéroïdes chez les patients atteints de la COVID-19. Aucun autre intérêt concurrent déclaré.

Competing Interests: Intérêts concurrents: Younsuck Koh, Bin Du et Yaseen Arab déclarent être les auteurs de Surviving Sepsis Campaign : Guidelines on the Management of Critically Ill Adults With Coronavirus Disease 2019, qui formule une recommandation en lien avec cette ligne directrice au sujet des corticostéroïdes dans le syndrome de détresse respiratoire aiguë. Bin Du déclare être l’investigateur principal d’un essai randomisé et contrôlé (ERC) prospectif en cours sur l’efficacité des corticostéroïdes chez les patients atteints de maladie à coronavirus 2019 (COVID-19) dans sa forme de modérée à grave, soutenu par la subvention de recherche n° 2020YFC0841300 du ministère des Sciences et de la Technologie de la République populaire de Chine. Srinivas Murthy et Robert Fowler déclarent être les investigateurs d’un essai bénéficiant d’une subvention des Instituts de recherche en santé du Canada (IRSC), pour évaluer l’effet des corticostéroïdes et des antiviraux (hydroxychloroquine et lopinavir-ritonavir) chez des patients atteints de COVID-19. Ning Shen déclare être investigateur pour un essai qui mesure l’effet de l’hydroxychloroquine chez des patients atteints de COVID-19, subventionné par le Centre des sciences de la santé de l’Université de Pékin. Neill Adhikari déclare être co-investigateur d’un projet subventionné par les IRSC sur les antiviraux chez les patients hospitalisés pour COVID-19 et d’un second projet subventionné par les IRSC sur divers traitements, y compris les corticostéroïdes, dans des cas critiques de COVID-19. Mark Loeb déclare avoir reçu une subvention et des honoraires personnels de l’Organisation mondiale de la santé (OMS) pour des travaux contractuels sur la grippe et la résistance aux antibiotiques, des honoraires de consultation et une subvention de Seqirus pour un ERC sur la grippe, des honoraires personnels à titre de membre du comité consultatif et un soutien non financier de Sanofi sous forme de don de vaccins en vue d’un ERC sur la grippe, et des honoraires à titre de consultant pour Pfizer et Medicago. Le Dr Loeb déclare aussi être investigateur pour un essai sur l’effet de la chloroquine-azithromycine chez les patients atteints de COVID-19, subventionné par le ministère de la Santé de l’Ontario, Bayer et Abbott. François Lamontagne et Bram Rochwerg déclarent être investigateurs d’un essai subventionné par les IRSC sur l’effet des corticostéroïdes et des antiviraux (hydroxychloroquine et lopinavir-ritonavir) chez des patients atteints de COVID-19. Aucun autre intérêt concurrent n’a été déclaré.

Management of pectus excavatum Congenital chest wall deformities are considered to be anomalies in chest wall growth related to excessive or insufficient growth (aplasia or dysplasia) of the osseous or cartilaginous structures or the rib cage. These deformities are associated in 95% to overgrowth leading into depression (pectus excavatum) or protuberance of the sternum (pectus carinatum). Pectus excavatum may lead to cardiopulmonary disorder or impact on patient's self-esteem. The management of pectus excavatum has evolved this last decade with minimal invasive repair.

Thirty percent of patients suffering from malignant disease will develop pulmonary metastases. Effective chemotherapy is lacking for many of these tumors. Many studies suggest survival benefit in selected patients when pulmonary metastasectomy allows complete resection. Several operative approach may be offered in order to achieve complete resection and maximal lung sparring. Pre-operative workup must assess the control of the primary tumor and the possibility of performing complete resection. Minimally invasive approaches may offer better quality life and equivalent oncologic outcomes than open approach.

Better understanding of the pathogenesis of tissue fibrosis, and especially the pivotal role of the extracellular matrix components, shed new light on the use of several immunosuppressive drugs to treat systemic sclerosis. We review the recent experimental data demonstrating the specific antifibrotic effect of several immunosuppressive drugs, independent of their immunosuppressive action, in light of the clinical results obtained when treating severe systemic sclerosis patients. Refined analysis of the molecular mechanisms underlying the direct antifibrotic effects of these immunosuppressive drugs (rapamycin and mycophenolate mofetil) will contribute to improve the therapeutic strategy in systemic sclerosis patients.

Unlabelled: Prognostic factors in the treatment of local advanced hepatocellular carcinoma with radiotherapy, transcatheter arterial embolization and arterial infusion., Purpose: The treatment effects of radiotherapy and combination modality therapy for the local advanced hepatocellular carcinoma (HCC) were retrospectively reviewed., Material and Methods: Three hundred and fifty-six patients of HCC (187 recurrent cases after surgical resection) were treated by 1) radiotherapy only; 2) Bi-therapeutic method: hepatic artery ligation (HAL) and/or hepatic artery embolization (HAE) plus radiotherapy; and 3) tri-therapeutic method (bi-therapeutic method plus hepatic artery infusion) from 1975 to 1996. Kaplan-Meier method has been used to evaluate the survival rates., Results: There were no significant differences among these three treatment groups in the symptom relief rate, but the mean relief time period was much shorter in radiotherapy alone group (2.5 vs 44 months, P < 0.05). A lower tumor response rate was found in the radiotherapy alone group (P < 0.05), although that was similar for both primary or recurrent tumors (P > 0.05). There were evident differences in five-year survivals among these three treatment groups: 0% for radiotherapy alone, 22.8% for bi-therapeutic method and 38.8% for tri-therapeutic method (P < 0.01). The prognosis was influenced by Okuda classification., Conclusion: Non-resectable local advanced HCC can be treated by the combination modality therapy, including radiotherapy, with a quite high cure rate. Radiotherapy alone can relief the symptoms.

Video-assisted thoracic surgery (VATS) combines a 5 cm mini-thoracotomy and videoscopic control using a camera. This technique is designed to reduce surgical invasiveness. From January 1993 to March 1994, we operated on 60 patients by 61 VATS. The conversion rate to classical thoracotomy was 8%. The cases treated included 18 lung cancers, 20 cases of pulmonary emphysema, 6 cases of non-malignant pulmonary nodules, 2 cases of bronchectasies and 10 operations on the pleura, pericardium or thoracic sympathetic nerves. We performed 12 lobectomies, 24 atypical segmentectomies and 10 other operations. The hospital mortality rate was 2/60 (3.5%), the mean thoracic drainage duration was 3.2 days, and the mean hospital stay was 9.2 days. VATS provides certain analgesic and esthetic benefits but the functional benefit must be studied in more detail. VATS can be applied to segmentectomies and lobectomies for T1 or T2 lung cancers; but the benefits relating to malignancy must be precisely identified by long-term studies.

Treatment reproducibility is a major criterion of quality assurance in radiation therapy. During each course, the same dose should be delivered in the same volume of irradiation. Today, portal imaging devices can be used routinely to check and correct patient positioning before much of the daily irradiation has been delivered. In this study we used the Portal Vision Varian (PVV) system during pelvic irradiation in 16 patients. This device can automatically acquire portal images in the first seconds of each course. Observed discrepancies are directly classified by the radiation oncologist according to their type (cranio-caudal, lateral, antero-posterior) and severity (correction of patient positioning is necessary or not). In case of error, patient positioning is corrected before the end of irradiation. Of the 922 portals analysed with PVV, 901 could be analysed (97%). Two hundred and ninety-nine positioning discrepancies were observed (33%) with 59 of them leading to correction (6%). Most of the time, these errors concerned antero-posterior portals. Finally, each patient had an average of 18 to 19 discrepancies which were mainly of no importance for treatment quality. Nevertheless, real errors leading to correction were observed in 14 patients (88%) with an average of four per patient. In some patients many errors occurred, while in others only a few. These shifts were not related to patient weight and thickness but probably a portal dimension. In summary, we think that during pelvic irradiation a portal imaging device should be used daily to improve treatment quality. This system can help the radiation oncologist to discover many positioning errors (an average of four) in the majority of patients (88%) and to correct them before the end of irradiation.