title: [Progressive paralysis of the diaphragm following intra-abdominal chemotherapy].
abstract: BACKGROUND
  In patients presenting with intra-abdominal tumor and peritoneal carcinomatosis, cytoreductive surgery associated with hyperthermic chemotherapy may offer improved survival. We describe a case of diaphragmatic paralysis following that kind of procedure.
  
  
  METHODS
  A 60-year-old woman presented with respiratory insufficiency following cytoreductive surgery and intra-abdominal hyperthermic chemotherapy performed for pseudomyxoma intraperitonei. Pulmonary function assessment demonstrated a restrictive pattern. Three successive chest CT-scans demonstrated a thinning diaphragm muscle. Respiratory insufficiency eventually led to the death of our patient.
  
  
  CONCLUSIONS
  We conclude in favor of a muscular degeneration of the diaphragm consecutive to the combined effect of cytoreductive surgery and intraperitoneal chemotherapy. Owing to the unusual nature of this complication, we did not consider it as a hypothesis at an early point in this patient's management. We think physicians should be aware of such a complication in order to consider it in a timely way. We recommend performing a biopsy of the diaphragm for pathology examination to assess muscular degeneration.
authors.affiliation: Service de chirurgie thoracique, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, place de l'Hôpital, 67098 Strasbourg cedex, France; EA 7293, SVTT, fédération de médecine translationnelle, université de Strasbourg, 67412 Illkirch, France.
authors.forename: S
authors.initials: S
authors.lastname: Guinard
authors.affiliation: Service de chirurgie thoracique, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, place de l'Hôpital, 67098 Strasbourg cedex, France; EA 7293, SVTT, fédération de médecine translationnelle, université de Strasbourg, 67412 Illkirch, France. Electronic address: anne.olland@chru-strasbourg.fr.
authors.forename: A
authors.initials: A
authors.lastname: Olland
authors.affiliation: Service de radiologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Ohana
authors.affiliation: Service de chirurgie thoracique, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, place de l'Hôpital, 67098 Strasbourg cedex, France.
authors.forename: P-E
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: EA 7293, SVTT, fédération de médecine translationnelle, université de Strasbourg, 67412 Illkirch, France; Service de pneumologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
authors.forename: R
authors.initials: R
authors.lastname: Kessler
authors.affiliation: Service de chirurgie thoracique, hôpitaux universitaires de Strasbourg, nouvel hôpital civil, place de l'Hôpital, 67098 Strasbourg cedex, France; EA 7293, SVTT, fédération de médecine translationnelle, université de Strasbourg, 67412 Illkirch, France.
authors.forename: G
authors.initials: G
authors.lastname: Massard
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D002277:Carcinoma / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003964:Diaphragm / Q000187:drug effects / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007263:Infusions, Parenteral; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000628:therapy*; D012133:Respiratory Paralysis / Q000139:chemically induced* / Q000175:diagnosis
keywords: Adverse effects; Chirurgie; Complications; Drug therapy; Effets indésirables; Surgery; Toxicity; Toxicité; Traitement médicamenteux