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Biomedical subjects

A Spiliopoulos

Publications and source records attributed to A Spiliopoulos.

At least 19 recordsLinked to original sources
PubMed1992

Predictability of FEV1 after pulmonary resection for bronchogenic carcinoma.

The aim of this study was to review the reliability of prediction of postoperative FEV1 in patients with bronchogenic carcinoma using a Tc-99m perfusion scan and simple spirometry. Over a 27-month period, 40 patients without known recurrent disease had their FEV1 measured. One quarter of the postoperative values for FEV1 differed from predicted values by less than 5% (2/11 pneumonectomies, 5/23 lobectomies, 3/6 segmental resections) and half differed by no more than 10% of predicted FEV1 (4/11 pneumonectomies, 12/23 lobectomies, 3/6 segmentectomies). One tenth of the predicted values differed by more than 30% and up to 760 mls (1/11 pneumonectomies, 2/23 lobectomies, 1/6 segmentectomy). Disease recurrence, phrenic nerve paralysis, exacerbation of obstructive pulmonary disease and poor collaboration during spirometry explained the most severe erroneous results. Age, preoperative smoking, tumour stage and histology, absence of symptoms at the time of diagnosis and adjuvant radiotherapy showed no statistically significant effect on predictability. Twenty-one patients had a postoperative Tc-99m pulmonary scan simultaneous to the spirometric control. Overestimation of postoperative FEV1 was associated with heterogeneous distribution of ventilation and perfusion.

Adenocarcinoma↗
PubMed1992

Leiomyosarcoma of the pulmonary hilar vessels.

Leiomyosarcomas are uncommon tumors. They have a predilection for deep soft tissues, with a rare group arising in medium-sized or large veins, far less frequently in arteries. We report a case of a 63-year-old man, with an enlarging mass located in the left pulmonary hilar region which was discovered on a routine chest radiograph. Cytology of the sputum and bronchoscopic biopsies did not reveal any malignant cells. Over 5 months observation, there was a clear progression of the mass, and the patient finally underwent a left pneumonectomy which allowed the diagnosis of an intravascular leiomyosarcoma partially destroying major arteries and veins in the hilar region. A review of the literature reveals 67 cases of leiomyosarcoma involving the pulmonary artery. None of these cases had an associated venous pathology. The disease is found mainly in adult women. Clinical diagnosis is very difficult because most of the cases have no specific clinical signs; the major differential diagnosis is that of pulmonary thrombo-embolism. Prognosis depends on histological degree of the tumor and extent of the disease, metastases occur mainly in the liver, lung, and brain and less frequently in regional lymph nodes. Treatment is always surgical, chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Sarcomas of hilar blood vessels have a very poor prognosis with a one year survival estimated, from the onset of symptoms, at 20%.

Humans↗
PubMed1992

[Asymptomatic mediastinal masses: prognosis, attitude and impact of thoracic radiography].

Mediastinal masses remain an interesting diagnostic and therapeutic problem for the clinician. Recent advances in imaging techniques and the increased use of chest roentgenograms in medical practice contribute to early screening of asymptomatic mediastinal masses. From 1965 to 1990, 290 patients with a primary mediastinal cyst or neoplasm were operated and treated in our institution. Among those, 80 patients presented with asymptomatic mediastinal masses. The prognosis of these asymptomatic lesions was evaluated and compared to that of symptomatic ones. Overall, two third of patients who were asymptomatic at diagnosis had a neoplasm, which proved to be malignant in half of the cases. A significantly greater number of patients with malignant neoplasms were asymptomatic at the time of diagnosis during the recent period. The prognosis of these asymptomatic lesions appeared to be better in selected tumoral types (e.g. thymomas, lymphomas) although it was difficult to completely avoid statistical bias. Early radiological detection of mediastinal tumors could improve their prognosis in selected cases. Incidental diagnosis of mediastinal masses by radiological examination should lead to early aggressive diagnostic procedure and treatment.

Adolescent↗
PubMed1992

[Kidney retransplantation: results and prognostic factors].

48 non primary renal transplants were performed in 40 recipients during the 1973-1990 period in our institution (40 second grafts, 6 third grafts and 1 four and fifth grafts). Despite poor HLA matching our second graft survival rates compare favorably with others (80% and 70%, 1 and 5 year graft survival rates). The type of immunosuppression (including ciclosporine A or not) and the duration of the first graft had an influence on the outcome of second grafts. Our experience with repeated retransplantation is limited, but graft survival appears to be poor: most of the grafts were rejected within 2 years (or less). However patient survival was not affected by overimmunosuppression following multiple grafts.

Adolescent↗
PubMed1991

[Multinodular pulmonary type AL amyloidosis. Report of a case and review of the literature].

A multinodular lung lesion was discovered in a healthy 56 year-old man on routine chest X-rays. Histology revealed multinodular amyloidosis which histochemically was found to correspond to the AL type. This type of amyloidosis raises the differential diagnosis ith a lung neoplasm. In our case, no cell dyscrasia was observed. The patient was treated by surgery as recommended in the literature.

Aged↗
PubMed1991

[Incidence of primary mediastinal lesions: change in the profile and therapeutic implications].

The pattern of occurrence of mediastinal masses has to be taken into account when treating and approaching these lesions. In most reported series tumors of neural or germinal origin and thymomas are predominant. We reviewed the records of 277 patients operated for primary mediastinal lesions over the last 25 years (1965-1989) in our center. Surprisingly (Hodgkin's and non-Hodgkin's) lymphomas (24-25%) were found to emerge as the most common tumors in our series, whereas tumor of neural (11%) and germinal (65%) origins were relatively rare and decreasing in incidence. Thymomas (17%) and mediastinal cysts (14%) occurred as predicted in the literature. Consequently the malignancy rate was high (53%) even in asymptomatic patients (18%). Similar findings have been described recently by others. Factors responsible for this new distribution are difficult to identify. The therapeutic implications of the changes are discussed.

Adolescent↗
PubMed1990

[Epidermoid cancer of the esophagus: overview].

Numerous extrinsic factors are involved in the pathogenesis of esophageal cancer. The disease exhibits clinical symptoms only at the advanced stage, often when no further curative possibilities exist; this delay is one of the main causes of the poor prognosis still associated with esophageal cancer. To secure early diagnosis, contrast GI series and endoscopy should be performed immediately whenever esophageal symptoms are present. Initial assessment of esophageal cancer should in any case include thoraco-abdominal scan. Bronchoscopy is indicated when the tumor is localized in the middle third of the organ. Surgery has long been considered the only valid treatment for esophageal cancer. However, the rule today is a multidisciplinary approach which offers either curative or palliative treatment designed to optimize therapy and minimize side effects. Promising results have recently been obtained with a combination of radiotherapy-chemotherapy followed by esophagectomy.

Bronchoscopy↗
PubMed1990

[Pulmonary aspergilloma].

Pulmonary aspergillomas usually arise from colonization of Aspergillus in preexisting lung cavities. Between 1972 and 1988, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our institution. Eight patients had simple aspergilloma and ten had complex aspergilloma. Hemoptysis was the most frequent complication. Tuberculosis was the most common underlying lung disease. Patients presenting with complex aspergilloma usually had associated factors potentially reducing their immune competence. Patients with simple aspergilloma tolerated surgery quite well and the outcome was satisfactory. By contrast operative mortality was 30% (3 deaths) in patients with complex aspergilloma and complications occurred in 8 patients (80%). Treatment of pulmonary aspergilloma must be individualized to take into account the patient's overall health and the risks attendant with each treatment modality.

Adult↗
PubMed1989

[Surgical treatment of pulmonary metastases].

From 1973 to 1988, 58 patients underwent operation for pulmonary metastases in our institution. The operative mortality was low (1-2%). The primary tumor was a melanoma in 7 cases, a sarcoma in 7 cases and a carcinoma in the remaining 44 cases. The overall 5-year patients survival was 30% and compares favorably with other series. Radical surgical excision significantly affects survival. Repeated or bilateral surgical excisions are sometimes needed. With the increased effectiveness of chemotherapy the role of surgery is changing. Surgical treatment of pulmonary metastases is indicated in selected cases.

Adult↗
PubMed1989

[Exploratory thoracotomies for unresectable lung cancer].

We analysed 55 exploratory thoracotomies undertaken in the Thoracic Surgery Service of the Geneva University Hospital between 1977 and 1987, to determine the preoperative examinations to prevent exploratory thoracotomy, a gesture that brings no benefits at all for the patients. We concluded that the most helpful preoperative examination is the CT-scan.

Adult↗
PubMed1989

Transthoracic approach in the thoracic outlet syndrome: an alternate operative route for removal of the first rib.

This retrospective study compares the results of two surgical procedures, a transaxillary and a transthoracic (that is, anterolateral thoracotomy) approach, in the treatment of the thoracic outlet syndrome by first rib resection. After transaxillary first rib removal (13 cases), initially our procedure of choice, 84% of conditions were improved, 8% were unchanged, and 8% were worse after 1 year. One permanent, disabling brachial plexus injury occurred after this operation. Transthoracic first rib resection (18 cases), presently our preferred technique, resulted in improvement in 87% of cases, with 13% of symptoms unchanged after 1 year. Although two female patients felt mild paresthesia of the mammary gland, no one has been made worse following this route. These two approaches have achieved similar results in the surgical management of this syndrome. Nevertheless, when first rib resection is indicated, our favored and recommended procedure is transthoracic, because this route appears less hazardous for brachial plexus damage.

Adult↗
PubMed1987

Pulmonary blastoma. Immunohistochemical and ultrastructural studies of a case.

The immunohistochemical and ultrastructural features of a case of pulmonary blastoma in a 39-year-old woman are documented. Three types of cells were observed: epithelial, mesenchymal and 'blastomatous'. The latter stained with intermediate filament antibodies similar to those of mesenchymal and epithelial elements, thus supporting the hypothesis that this tumour is derived from a pluripotent undifferentiated element.

Adult↗
PubMed1985

Tomographic imaging of the human thyroid with a positron camera before and after partial thyroidectomy.

A high-density avalanche chamber positron camera was used for tomographic imaging of the human thyroid before and after partial thyroidectomy. Images were made between 6 and 24 h after oral administration of the positron-emitting radionuclide, Na-124I with activities varying between 0.1 and 0.3 mCi before the surgical intervention and with activities between 0.03 and 0.05 mCi following partial thyroidectomy. The results of thyroid imaging performed on 50 patients and their surgical relevance are discussed; as an illustration, one typical case is presented. As a consequence of the high spatial resolution of the camera (2.5 mm full width at half maximum), the functional volume of the thyroid may be estimated from the transaxial tomographic sections before and following partial thyroidectomy, correct to about 10%. The thyroid surface, defined by the contours from each transaxial section, may be displayed using three-dimensional shaded-graphics techniques. This new imaging technique makes possible a fully three-dimensional description of the thyroid in vivo and contributes significantly to the surgical follow-up.

Goiter, Nodular↗
PubMed1985

[Thymomas].

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Adolescent↗
PubMed1979

[Renal artery stenosis following kidney transplantation -- an avoidable complication?].

Many etiologies have been proposed for renal artery stenosis following renal transplantation. Incorrect operative technique is the most frequent cause, but the condition is often due to vascular parietal lesions resulting from traction on the vessels during removal of kidneys, which causes dislocation of arterial parietal structures. Such traction is inevitable if kidneys are removed separately due to difficulties arising during deep mobilization of the kidneys. Furthermore, this technique involves direct flushing into the renal artery, and this may cause damage to the intima due to the canula. Canula and traction are the major causes of stenosis. The authors present their own cases and propose that kidneys be removed "en bloc". This is the only way to prevent traction on vessels, and it permits flushing through the aorta for cooling.

Adult↗