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Biomedical subjects

C Boutin

Publications and source records attributed to C Boutin.

At least 163 records · Page 9Linked to original sources
PubMed1986

[Pleurisy in blood diseases: value of thoracoscopic poudrage].

Twenty-five pleural effusions which occurred in 21 lymphoma patients (mean age: 50.6 +/- 4.6 years) were treated by pleural poudrage during thoracoscopy. The effusion was either serofibrinous (32%) or haemorrhagic (41%) or chylous (27%). The mean amount of fluid removed before poudrage was 5.2 +/- 0.6 litres. Thoracoscopy confirmed direct pleural invasion in 95.5% of the cases. Permanent pleural symphysis was obtained in all but 2 patients: one who required one single puncture withdrawing 400 cc, the other with mesothelioma on cured Hodgkin's disease, which was a failure. The mean duration of drainage was 4.8 +/- 0.2 days. The results obtained were identical with those reported with pleurisy in solid tumours.

Adolescent↗
PubMed1986

[Asbestos and cancer of the larynx].

Two hundred subjects were evaluated using a standardised questionnaire in order to determine possible exposure to asbestos: 50 patients with a carcinoma of the larynx (mean age: 59.2 +/- 1.6 years), 50 patients with a carcinoma of the bronchus (mean age 61.2 +/- 1.5 years) and 100 controls. Rates concerning exposure to asbestos were 27.8%, 23.4% and 4% respectively. The difference between the carcinoma patients and the controls was significant (p less than 0.001). The mean time lapse between the first exposure to asbestos and the development of malignant disease was shorter for the larynx (28.5 +/- 4 years) than for the lung (46.2 +/- 4.2): p less than 0.01. This study confirms the aetiological role of asbestos in the pathogenesis of carcinoma of the larynx as well as carcinoma of the lung, and raises the problem of their medicolegal compensation.

Alcoholism↗
PubMed1986

Bilateral pleural plaques in Corsica: a non-occupational asbestos exposure marker.

The North-East quarter of Corsica being rich in asbestos deposits, we checked the chest radiographs of 1721 patients born in North Corsica, without occupational exposure to asbestos, in order to show an excess of asbestos pleural plaques in those born in the N.E. quarter. Of the 56/1710 patients with bilateral plaques, 53 were born in N.E., and three in N.W. The incidence of plaques was thus respectively 3.7% and 1.2% (p less than 0.05). The site of birth of these 56 patients was compared to that of 213 matched control patients without plaques, born in North Corsica. The percentage of patients with plaques born in villages with asbestos deposits was 94.6 per cent, versus 58.2 per cent for the control patients; the relative risk index is 12.7. This work is the first report of environmental asbestos plaques in Western Europe.

Aged↗
PubMed1985

[Yield of the thoracoscopic biopsy in experimental pulmonary infections in the immunosuppressed rabbit].

Using thoracoscopy lung biopsy we investigated the bacteriological diagnostic yield in immunodepressed and/or infected NZ rabbits. 84 rabbits were used: 18 controls, 30 immunodepressed rabbits and 36 rabbits immunodepressed and then infected with Aspergillus fumigatus. Candida albicans or B.C.G. The thoracoscopy technique was the one we designed for humans, the instruments were adapted to the size of animals. Thoracoscopy biopsy results were compared to those of surgical biopsies made in the same animals. The results of both techniques were similar: indeed, the sensitivity of thoracoscopy biopsy was 88.9% in immunodepressed rabbits (versus 100% with surgical biopsies), 86% in the group of rabbits infected with B.C.G. (versus 86%), 90.1% in rabbits infected with Aspergillus fumigatus (versus 100%) and 88.9% in rabbits infected with Candida albicans (versus 100%). The indications for thoracoscopic lung biopsy in immunodepressed patients with infectious lung diseases are drawn from these experimental data, from our experience and the known mortality and morbidity of surgical lung biopsy.

Animals↗
PubMed1984

[Value of thoracoscopy].

Formerly used in active tuberculosis to divide pleuro-pulmonary adhesions and to complete therapeutic pneumothorax, thoracoscopy has now become the object of renewed interest. By introducing, after pneumoserosa and usually through the axilla, a fine trocar into the chest, the whole thoracic cavity, including parietal pleura, diaphragm, lung and lung fissures, mediastinum and pericardium, can be explored. This technique, performed under local rather than general anaesthesia or under neuroleptanalgesia, is innocuous, fairly cheap and effective. In addition, the patient is immobilized for only 4 or 5 days on average and surgery, which is much heavier, can be avoided in many cases. Thoracoscopy nowadays is mostly used: (1) to determine the cause of a chronic pleurisy unexplained after 3-4 weeks (positive results: 95-97% for cancer, 92% for tuberculosis); (2) to dry up pleural effusions by talc and drainage (satisfactory results in 90% of the cases); (3) to establish the pathophysiological diagnosis of spontaneous pneumothorax (bullae, blebs, adhesions, fistulae), to treat it with talc and with coagulation of small "bullae", or to decide in favour of surgery; (4) to perform lung biopsies which clinch the diagnosis in 95-97% of cases of diffuse interstitial pneumonia. The same technique is also used methodically and efficiently for optic and electronic microscopy, bacteriological or mycological examination, immunofluorescence, hormone receptor detection and study of organic particles or minerals. Thoracoscopy lies half-way between pure medical practice and surgery and deserves to be widely used again by pneumologists, provided they learn to master its technique by regular, assiduous and sufficient practice. Pneumologists do not become thoracoscopists at a moment's notice; it is a skill which must be included in their training.

Anesthesia↗
PubMed1984

[Diagnosis of localized pulmonary opacities by transbronchial biopsy].

In order to assess the value of transbronchial biopsy (BTB) in the diagnosis of local pulmonary opacities, we have carried out a prospective study from October 1981 to August 1982 on 180 patients with a localised pulmonary opacity radiographically. 73 presented with a tumour visible fibreoptically in whom the diagnosis was made by bronchial biopsy. In 56 patients the clinical and biological picture were not suggestive of a malignancy and the lesion disappeared in 15 days on antibiotic treatment. Finally in 51 subjects the cancerous nature of the opacity was strongly suspected and the indication for a BTB were met. We obtained the following results: among 51 patients 11 were suffering from the sequelae of non-progressive disease and 40 of progressive disease; namely a sensibility of 80% and a specificity of 100%. The results vary as a function of the size of the tumour and its localisation. The best results were obtained for tumours with a diameter of greater than 3 cm, in the middle third of the lung (diagnosed by BTB 9 times out of 10). Thus transbronchial biopsy seems to be the first invasive examination to contemplate in the diagnosis of localised pulmonary opacities.

Adenocarcinoma↗
PubMed1982

Thoracoscopic lung biopsy. Experimental and clinical preliminary study.

We have investigated thoracoscopic lung biopsy (TLB) as an alternative to surgical biopsy. TLB was performed under mild general anesthesia, with two openings: one for the telescope, and one for a 5 mm in diameter biopsy forceps connected to diathermocoagulating device. TLB was first tested on 14 dogs (22 TLB) and then on 75 subjects (77 TLB): 35 patients with pleural diseases and 40 patients with undiagnosed lung diseases despite previous investigations including transbronchial biopsy. TLB yielded a high rate of adequate samples (up to 5 x 5 x 5 mm) in both experimental (95 percent) and clinical series (96 percent). Overall sensitivity equalled 923 percent, ranging from 70 percent in peripheral localized lesions to 100 percent in diffuse lung diseases. The mean period of systematic drainage was 3.4 +/- 0.3 days, and the main complications we encountered were one transient blood-streaked sputum specimen and eight localized pneumothoraces during drainage. TLB is indicated when other medical procedures have failed, and has thus proved, in this series, to be as sensitive as surgical biopsy with less morbidity and no mortality.

Animals↗
PubMed1981

Thoracoscopy in malignant pleural effusions.

In a consecutive series of 1,000 patients admitted since 1970 for pleural effusions, 215 with undiagnosed chronic effusions (with previous negative cytologic and needle biopsy results) underwent thoracoscopy. The investigation was usually performed under general anesthesia, originally with a 9-mm diameter cold light laparoscope, but, since 1978, with a 7-mm diameter thoracoscope of our design with biopsy forceps connected to a diathermocoagulating device. Thoracoscopy diagnosed 131 of 150 malignant effusions in the series. We observed no false positive results. A repeat pleural cytology and needle biopsy performed the day before thoracoscopy yielded only 41% positive results. The higher yield by our new thoracoscope (97% positive results, versus 78% with the laparoscope) can be accounted for by a better visualization of the pleural space, easier handling of biopsy material, and the systematic use of diathermocoagulation. Complications were rare, minor, and not life-threatening.

Biopsy, Needle↗
PubMed1981

[Current indications for thoracoscopy].

Thoracoscopy is performed at best with a rigid apparatus and a cold light source using a single or double site of entry into the chest. Biopsy under direct vision requires a double-spoon biopsy forceps that can be connected to diathermy to insure haemostasis and prevent any air leak age. Some authors prefer a local anaesthesia but a light general anaesthesia with or without intubation allows a safe and painless examination. Numerous biopsies can be obtained for subsequent examinations, like light or electron microscopy, immunofluorescence, bacteriology and mineral studies as well as search for hormonal receptors sites on tumours. Complications are rare and fatalities exceptional (4 cases in a review of the literature covering 3.384 cases. 2 of which occurred in a small series of 150 cases). In chronic pleurisies secondary to cancer, a diagnosis was made in 92% of cases. In suspected pleural mesothelioma, thoracoscopy allows both diagnosis and staging. In pleural tuberculosis, a diagnosis is obtained in 93% of cases. Talc pleurodesis in the treatment of chronic recurrent malignant pleural effusions is successful in 80%. In the treatment of spontaneous pneumothorax with a mean follow up of 10 years, only 6.6% recurred after talc poudrage, and functional sequelae were minimal; no talcomas induced mesotheliomas were seen in a review of 151 cases. Thoracoscopic lung biopsy has an 87 to 94% success rate depending on series, and is thus comparable to surgical biopsy with a markedly smaller morbidity and mortality. It should thus be used more widely by pneumologists.

Biopsy↗
PubMed1981

[Lung biopsy by thoracoscopy (author's transl)].

60 patients had 1 to 7 biopsies during thoracoscopy under light anaesthesia without tracheal intubation. Biopsies were performed under direct vision using a separation puncture. Double-spoon biopsy forceps (5 mm in diameter) connected to a 120 watt diathermy apparatus avoided any air leak age and ensured haemostasis as the biopsy was taken. The dry weight of the biopsies ranged between 5 and 40 mg, allowing appropriate studies with light or electron microscope, for bacteriological and mineral analysis, and for hormone receptors search in cancer cases. A size 20 to 30 Charrière drain was left for a mean of 3 days. No serious complications arose. Ten patients had a 38 degrees C fever for a few hours. In one case early in the study a drain had to be changed on the third day. An histopathological diagnosis was made in 12 out of 14 patients with localised pulmonary opacities and in all 14 cases with diffuse opacities. In 32 cases of pleural involvement the presence or absence of concomitant lung involvement could be demonstrated. Asbestos fibres counts by electron microscopy correlated fairly with previous exposure to asbestos. The sensibility of the technique was 96% (percent of true positives) and the specificity 100% (percent of true negatives). Thoracoscopic lung biopsy may thus be compared very favourably to techniques of lung biopsy and deserves a larger studies in order to confirm its low morbidity.

Adolescent↗
PubMed1981

[The metrology of mineral fibres in thoracoscopic lung and pleural biopsies. Preliminary results (author's transl)].

Metrology of mineral fibres by electron microscopy was carried out in thoracoscopy specimens ("normal" parietal pleura, pleural plaque, tumour, lung) obtained from different sites in 19 patients: 9 exposed to asbestos and 10 non-exposed controls. With regard to results concerning the parietal pleura, the differences in exposure of the patients (as revealed by history) were not reflected by metrological characteristics (nature and number of fibres, size, topographical distribution) and it was impossible to distinguish the exposed cases from the controls. The number of fibres ("non-measurable presence" being 130.10(3) fibres/g) did not differ significantly between the two "exposed" and "non-exposed" groups. By contrast, the number of fibres found in lung biopsies was in general very high in exposed patients (up to 379.10(3) fibres/g.) In 3 non-exposed patients, there was no asbestos in the lung. Broadly speaking, metrological data were similar to those previously obtained in other cases and using surgical or autopsy specimens. This reinforces the validity of the method of metrology in thoracoscopic specimens and confirms the complexity and difficulties of assessment of pleural involvement. The advantages of study of early pleural specimens obtained under thoracoscopic control in comparison with surgical or autopsy specimens remains to be determined in a larger number of cases. The safety of the method should be emphasized, no complications having been seen in this series.

Asbestos↗
PubMed1981

[Intrapleural talc in malignant pleural effusions (author's transl)].

Intrapleural talc poudrage was carried out at the end of thoracoscopy in 77 patients after complete aspiration of fluid with uniform insufflation over the whole surface area of the pleura of 4 to 5 ml of pure talc, asbestos free. A continuous suction drain was left in place for 3 to 6 days. Amongst these patients, there were 57 cases of pleural effusion due to metastases and 20 mesotheliomas. A satisfactory result was obtained in 70 patients (91%). There were 7 failures. Fourteen mesotheliomas in which talc was used were compared with 14 further cases operated upon by pleurectomy. Both series were compared retrospectively in terms of age, sex, exposure to asbestos, histological type and the interval between the first symptom and treatment. In the talc series, there were 11 excellent results, 2 moderate and 1 nil. In the operated series there were 10 excellent results, 1 nil and 3 postoperative deaths. Survival of the patients was 395 +/- 55 days after the application of talc and 315 +/- 65 days after pleurectomy. There was thus a slight benefit in favour of the talc technique but this was not statistically significant. A figure of approximately 90% of satisfactory results is found in other series of the use of intrapleural talc published. This technique is thus effective and free of danger, and may be used in malignant effusions when techniques of local instillation of various substances and systemic chemotherapy have failed.

Aged↗