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Biomedical subjects

A Spiliopoulos

Publications and source records attributed to A Spiliopoulos.

At least 73 records · Page 4Linked to original sources
PubMed1998

Protective subpleural blanketing of intrathoracic esogastric anastomosis after esophagectomy.

Esophagectomy followed by intrathoracic anastomosis is threatened by leakage which may prove all the more serious that mediastinal contamination is extensive. In the technique presented, the esogastric anastomosis is slipped under the upper mediastinal pleura which is kept intact, after the azygos vein has been ligated and divided. This pleural 'blanket' may act as an efficient barrier against potential digestive spillage into the mediastinum.

Anastomosis, Surgical↗
PubMed1998

Successful combined lung and kidney transplantation for pulmonary lymphangioleiomyomatosis and renal angiolipomas.

Pulmonary lymphangioleiomyomatosis (LAM) and renal angiolipomas are rare but distinct clinical entities that share similar morphological features. Lung transplantation is considered as a valuable therapeutic modality in patients with end-stage pulmonary LAM. However, in some patients, renal complications due to bleeding angiomyolipomas and cyclosporin-induced nephropathy have become newly identified problems. This study reports the first case of combined lung and kidney transplantation for pulmonary lymphangioleiomyomatosis and renal angiolipomas. Two years after transplantation, renal and pulmonary function have remained stable and the patient has resumed a normal daily life, including a full-time professional activity.

Adult↗
PubMed1997

Successful single-lung transplantation after paraquat intoxication.

Severe acute lung injury frequently develops after poisoning by paraquat, and respiratory failure is the major cause of death in patients surviving more than 2 days after ingestion. We describe a 17-year-old man with confirmed paraquat intoxication by lung and muscle biopsy, in whom single-lung transplantation was performed 44 days after poisoning for end-stage lung disease. The patient was discharged from the hospital 122 days after ingestion of paraquat and 88 days after lung transplantation. Before 1996, repeated lung transplantation had been performed for patients with terminal respiratory insufficiency due to paraquat toxicity, but all died. This patient survived probably because transplantation was performed very late after paraquat ingestion.

Adolescent↗
PubMed1997

End-stage cystic fibrosis: improved diabetes control 2 years after successful isolated pancreatic cell and double-lung transplantation.

Over a period of years, insulin-dependent diabetes and respiratory insufficiency developed in a 35-year-old patient with end-stage cystic fibrosis. After waiting more than 4 years while receiving maintenance treatment with continuous liquid O2 and nasal ventilation, the patient underwent double-lung and pancreatic islet cell transplantation. Subsequently, the patient has enjoyed a normal life with full employment and much better control of his diabetes. Pancreatic islet cell transplantation is a simple and innocuous technique easily added to the end of lung transplantation. These new pancreatic cells, although locally injected, are still secreting more than 2 years later as assessed by repeated C-peptide measurements.

Acute Disease↗
PubMed1997

[Surgical resection of primary lung cancer. A 13-year experience in Geneva].

This retrospective study concerns 683 consecutive patients operated for primary non-small cell lung cancer between 1977 and 1989 (581 men and 102 women with a mean age of 60.3 years). Histology was as follows: squamous in 422 (62%), adenocarcinoma in 207 (30%), broncho-alveolar in 24 (4%) and large-cell in 30 (4%). According to the TNM classification, 304 tumors were graded as stage I (45%), 130 as stage II (19%), 157 as stage IIIA (23%), 62 as stage IIIB (9%) and 19 as stage IV (3%). Surgery consisted of lobectomies in 337 (49%), pneumonectomies in 210 (31%), segmentectomies and wedge resections in 42 (6%), bilobectomies in 41 (6%) and exploratory thoracotomies in 53 (8%). It was curative in 513 cases (75%) and palliative in 170 (25%). 49 patients died within 2 months of the operation (7.2%), while 209 suffered postoperative complications (31%). Mediastinal lymph node dissection was not routinely performed to in this series. However global outcome (30% 5 years survival and 18% at 10 years), compared favorably with that reported by centres that perform mediastinal lymphadenectomy systematically.

Actuarial Analysis↗
PubMed1997

[Protection of intrathoracic anastomosis by pleural tent methods after Ivor-Lewis esophagectomy].

PURPOSE OF THE STUDY: Description of a technical procedure to diminish the risk of spillage into the mediastinum in case of leakage from an intrathoracic anastomosis after partial esophagectomy. METHOD: In Ivor-Lewis procedures for cancer of the middle or lower third of the esophagus, the esogastric anastomosis is slipped under ther upper mediastinal pleura which is kept intact. From 1989 to 1997, this technique has been used in 43 consecutive patients (squamous carcinoma in 22, adenocarcinoma in 21). Three patients died postoperatively (7%) and complications (in 38%) were mostly pulmonary and cardiac. No anastomotic leak was detected on routine Gastrografin swallow performed on the 7th postoperative day. Three patients required dilation for stenosis. DISCUSSION AND CONCLUSION: Subpleural blanketing of intrathoracic anastomoses after esophagectomy is safe and easy to do, and should help diminish the consequences of possible anastomotic leakage.

Adult↗
PubMed1996

Osteoporosis in patients undergoing lung transplantation.

The occurrence of osteoporotic fractures may seriously compromise the quality of life of lung transplant recipients. However, at present, the true risk of osteoporosis in such patients is unknown. We therefore prospectively evaluated bone mass changes in patients undergoing pulmonary transplantation. Bone mineral density (BMD) of lumbar spine (LS), femoral neck (FN) and femoral shaft (FS), as well as whole body bone mineral content (WB-BMC) were measured in 21 consecutive candidates for lung transplantation (9 males and 12 females; mean+/-SD age 47+/-11 yrs). Twelve of the patients had their BMD remeasured within 6 months after surgery, and nine again after 1 year. Before transplantation, BMD at all sites as well as WB-BMC were significantly decreased as compared to the values in young healthy adults, FN being the most affected (FN -25+/-2%; LS, -12+/-4%; FS -9+/-2%, WB-BMC -15+/-4% (mean+/-SEM)). Seven out of 20 adult patients (35%) fulfilled World Health Organization (WHO) criteria for osteoporosis, i.e. BMD more than 2.5 SD below peak bone mass, whereas three had previously been diagnosed as having osteoporotic fractures of the spine or femoral neck. Within 6 months after transplantation, significant bone loss occurred, mostly at the LS level (-4.0+/-1.7%; p=0.04), despite calcium and vitamin D supplementation. Furthermore, two patients had new osteoporotic vertebral fractures. After 1 year, no further bone loss or new osteoporotic fractures were observed. In conclusion, evaluation of bone mass and prevention of bone loss should be considered early before lung transplantation. Further studies are needed to determine the efficacy of antiresorptive drugs on the prevention of accelerated bone loss and vertebral fractures after transplantation.

Adult↗
PubMed1996

[Thoracic surgery for non-small cell lung cancer. Cost-benefit of its management in specialized intermediate care].

In 1989, we reorganized acute and rehabilitation cares for patients operated for non small cell lung cancer (NSCLC) in order to decrease costs by setting up a specialised intermediate care unit (SICU). This report deals with the postoperative complications and the total cost of these cares (SICU, acute and rehabilitation cares) as well as their cost/benefit. From 1990 to 1994, we performed 95 thoracotomies, 7 exploratory and 88 with lung resection (24 pneumonectomies, 8 bilobectomies, 48 lobectomies and 8 segmentectomies or wedge resections). The postoperative staging was I in 52, II in 17, III a in 15, S III b in 2, IV in 2. Patients 30-days postoperative mortality was 2/95 (2.1%). We had in 11 patients respiratory complications (12%; 3 bronchopleural fistulas, 3 pneumonias, 3 pneumothorax > 7 days, 1 empyema, 1 chronic hypoxemia), in 15 patients cardiac arrhythmias which were easily controlled by medication and in 2 general complications (1 hemiplegia, 1 transitory stupor state). The total duration of hospital stay, including SICU, acute and rehabilitative cares, was 32 +/- 10 (3-70) days with a mean total cost of 14,722 Sfr. per case. In conclusion, surgery for NSCLC can be safely performed in intermediate cares without intensive care unit at low costs and with a low morbidity and mortality provided they are staffed by a specialised and well trained team.

Adult↗
PubMed1996

Combined islet-lung transplantation in a cystic fibrosis patient.

The prevalence of insulin-dependent diabetes mellitus (IDDM) in cystic fibrosis patients ranges from 2 to 8% and glucose intolerance up to 15%. In recent years, lung transplantation has helped to prolong life expectancy of cystic fibrosis patients and represents 10 to 30% of all indications for lung transplantation. The postoperative need for immunosuppressive therapy using diabetogenic agents has decompensatory effects on glucose regulation and will probably increase the number of insulin-dependent cystic fibrosis patients. We report the case of an insulin-dependent cystic fibrosis patient transplanted with a combined islet-lung allograft. The pre-transplantation C-peptide level was below 0.04 nmol/l and preoperative insulin requirement was some 100 U per day. A sequential bipulmonary lung transplantation was performed and, using the pancreas of the same donor, we isolated and purified the islets of Langerhans by a modified automated method. We obtained 232,200 islets equivalent, which were injected into the liver by portal embolization. The postoperative course was uncomplicated, the insulin requirement decreased to 50% of the preoperative need and the C-peptide value increased to normal values and remained with the normal range during a follow-up period of 15 months. In conclusion, we believe that, besides type I diabetic patients, insulin-dependent cystic fibrosis patients with a negative C-peptide value could also be good candidates for combined islet-lung allotransplantation.

Adult↗
PubMed1996

[Esophageal perforation: which treatment under which situation?].

Six disruptions of the thoracic esophagus were treated in our unit between 1979 and 1995. Three were iatrogenic and three spontaneous. Five were operated upon, and one treated conservatively. Surgical repair consisted of reinforced sutures (in two), direct fistulae (in two), and exclusion-diversion (in one). One leak occurred 6 days after direct closure, which was treated in turn with success by a directed fistula. There was one death. The five patients who survived resumed normal oral feeding in eleven days. Directed fistulization using a small T-tube appeared as a safe option when it could be done within 24 hours. Exclusion coupled with diversion was successful in one case which appeared desperate at first.

Adult↗
PubMed1995

Combined chemotherapy and radiotherapy, followed or not by surgery, in squamous cell carcinoma of the esophagus.

BACKGROUND: This study was designed to evaluate the feasibility of a neo-adjuvant combined chemo-radiotherapy in patients with localized squamous cell carcinoma of the esophagus. PATIENTS AND METHODS: Forty-two patients with squamous cell carcinoma of the esophagus, stages II and III (or stage I if considered to be poor candidates for immediate curative surgery), age less than 70 years and WHO performance status 0 to 2, were enrolled in a study of radiotherapy combined with chemotherapy, consisting of 2 (operated patients) or 3 (nonoperated patients) courses of cisplatin, vindesine, mitomycin-C or cisplatin, vinblastine. Surgery was routinely proposed to patients. RESULTS: Thirty-seven patients (88%) received full preoperative therapy. Of 30 patients responding to this preoperative therapy, 12 had a third cycle of treatment and 15 had esophagectomy. Three of the operated patients had no pathological evidence of residual tumour. Median survival of all 42 patients is 11 months and the 2-year survival rate is 29%. There is no difference in survival among responding operated or non-operated patients. Our group represents 95% of all eligible cases of squamous cell carcinoma of the esophagus occurring in Geneva during the study period. CONCLUSION: Our series gives a realistic view of the median survival of a population of patients eligible for neo-adjuvant therapy of esophagus cancer, and suggests that secondary surgery might not improve the patient survival. Furthermore, non-selected patients are at high risk for therapy-related death.

Adult↗