Biomedical subjects
Publications and source records attributed to C Deschamps.
Solitary pulmonary nodules continue to challenge all diagnostic skills. Herein we describe video-assisted thoracic surgical intervention, a new, minimally invasive technique that aids physicians in obtaining a definitive histologic diagnosis in a select group of patients with an indeterminate solitary pulmonary nodule.
Between December 1984 and September 1991, a total of 68 palliative esophageal intubations were performed in 57 patients. The mean age was 64 years, there were 40 males and 17 females. The more frequent causes of esophageal obstruction were malignant tumors of the esophagus (49%), lung (23%) and cardia (19%). Total dysphagia (24.5%), dysphagia to liquids (47%) and esophagotracheal aspiration (14%) were present in these patients. In 65% of patients insertion of the prosthesis was the first attempt at palliation, in the remaining patients it followed the failure of another type of palliation. The decision to palliate esophageal obstruction was established preoperatively in 86% of patients, in the remaining 14% it was decided at the time of surgery. The intubation by pulsion (Atkinson) [1] was successful in 57% of patients and by traction (Celestin) [2] in 86% of patients. The associated morbidity was 36% for the Atkinson prosthesis and 13% for the Celestin prosthesis, although the latter required a laparotomy. The in hospital mortality was 12.5%. The mean survival was 85 days. A normal or semi-solid diet was tolerated by over 60% of patients following intubation. Palliation of esophageal obstruction by intubation improves the quality of life but is associated with a high morbidity.
Ten patients with documented scleroderma were assessed before and after antireflux operations over a twelve year period. The approach was through the left chest in 9 of 10 patients (7 short Nissen, 1 Collis Nissen, 1 Collis Belsey) and through the abdomen for 1 (vagotomy, antrectomy and Roux en Y). Clinically, 5 of 10 patients still mention episodes of heartburn. Dysphagia, which was present in 8 patients before the operation, has been replaced by a slow emptying impression in five. Endoscopically five patients had a columnar lined esophageal mucosa. Four more were considered to have ulcerative esophagitis and stricture which proved to be also Barrett's esophagus in the postoperative assessment. Three patients had preoperative 24 h pH assessment when the technique became available. Their postoperative control studies revealed persistent acid exposure but to a lesser degree. All ten patients had 24 h pH studies in their postoperative assessment and 5 out of 10 still show abnormal exposure to acid. Esophageal motility studies did not reveal significant changes to the hypomotility of the distal esophageal body and to the decreased tone of the Lower Esophageal Sphincter area. Both radiologically and using esophageal transit scintigrams the esophagus shows atony and poor emptying before the operation. Retention is increased following the creation of an antireflux technique at the esophagogastric junction. The success rate of antireflux operations in scleroderma patients is limited. The ideal procedure to use in this condition remains unclear.
Bronchogenic cysts are closed sacs considered to be the result of an abnormal budding of the respiratory system. They are lined by ciliated epithelium and have focal areas of hyaline cartilage, smooth muscle, and bronchial glands within their walls. They are seldom seen in the adult, and most are thought to be asymptomatic and free of complications. During a 20-year period, 86 patients underwent resection of a bronchogenic cyst of the mediastinum (66 patients) and lung (20 patients). There were 47 women and 39 men whose ages ranged from 16 to 69 years. Seventy-two percent of patients (67% with mediastinal cysts and 90% with cysts of the lung) were symptomatic at the time of operation, and the majority had two or more symptoms. Despite extensive investigations, which in some cases included computed tomographic scanning (n = 12) and angiography (n = 22), a positive diagnosis was never made preoperatively even if it was suspected in 57% of patients. In nearly all patients, the operative approach was that of a posterolateral thoracotomy. All but two mediastinal bronchogenic cysts could be locally excised, but all bronchogenic cysts of the lung required pulmonary resection (lobectomy, 13; limited resection, 6; pneumonectomy, 1). Major operative difficulties were encountered in 35 patients, all of whom were symptomatic preoperatively. Thirty-three patients had a complicated cyst; the complications consisted of fistulization (n = 16), ulcerations of the cyst wall (n = 13), hemorrhage (n = 2), infection without fistulization (n = 1), and secondary bronchial atresia (n = 1). Overall, 82% of patients had a bronchogenic cyst that was either symptomatic or complicated or both.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of cerebral air embolism sustained during replacement of the mitral valve resulted in postoperative coma and seizures. Hyperbaric treatment, begun 30 hours after the occurrence of the air embolism, resulted in good immediate and long-term recovery. Mild deficits of the left hemisphere were present at follow-up 53 days after the embolus was sustained, and lesser, minimal residua were present at 14-month follow-up. Hyperbaric treatment is the definitive therapy for cerebral air embolism. Although it is most effective when administered early, the outcome may be excellent even with late treatment.
Several sulfur containing antioxidants have been used for therapeutic use as hepatoprotectors and radioprotectors. In particular the dithiolthione SULFARLEM, used as anticholestatic drug for more than 40 years, is shown to be antioxidant; preliminary pharmacokinetic data in man are presented, and hepatoprotective and radioprotective effect in mice are demonstrated.
The in situ lengths of muscle bundles of the crural and three regions of the costal diaphragm between origin and insertion were determined with a video roentgenographic technique in dogs. At total lung capacity (TLC) in both the prone and supine positions, the length of the diaphragm is not significantly different from the unstressed excised length, suggesting that the diaphragm is not under tension at TLC and that there is a hydrostatic gradient of pleural pressure on the diaphragmatic surface. Except for the ventral region of the costal diaphragm, which does not change length at lung volumes greater than 70% TLC, all other regions are stretched during passive deflations from TLC. Therefore below TLC the diaphragm is under passive tension and supports a transdiaphragmatic pressure (Pdi). The length of the diaphragm relative to its unstressed length is not uniform at functional residual capacity (FRC) and does not follow a strict vertical gradient that reverses when the animal is changed from the supine to the prone position. By inference, the length of muscle bundles is determined by factors other than the vertical gradient of Pdi. During mechanical ventilation, regional shortening is identical to the passive deflation length-volume relationship near FRC. Prone and supine FRC is the same, but the diaphragm is slightly shorter in the prone position. In both positions, during spontaneous ventilation there are no consistent differences in regional fractional shortening, despite regional differences in initial length relative to unstressed length.
Explore the source record for details and available documents.
During a 13-year period, multiple primary lung cancers were diagnosed in 80 consecutive patients. Forty-four patients had metachronous cancers. The initial pulmonary resection was lobectomy in 36 patients, bilobectomy in 3, pneumonectomy in 1, and wedge excision or segmentectomy in 4. The second pulmonary resection was lobectomy in 16 patients, bilobectomy in 2, completion pneumonectomy in 7, and wedge excision or segmentectomy in 19. There were two 30-day operative deaths (mortality rate, 4.5%). Actuarial 5- and 10-year survival rates after the first pulmonary resection for stage I disease were 55.2% and 27.0%, respectively. Five-year and 10-year survival rates for stage I disease after the second pulmonary resection were 41.0% and 31.5%, respectively. The remaining 36 patients had synchronous cancers. The pulmonary resection was lobectomy in 18 patients, bilobectomy in 3, pneumonectomy in 10, and wedge excision or segmentectomy in 8. There were two 30-day operative deaths (mortality rate, 5.6%). Actuarial overall 5- and 10-year survival rates after pulmonary resection were 15.7% and 13.8%, respectively. We conclude that an aggressive surgical approach is safe and warranted in most patients with multiple primary lung cancers and that the presence of synchronous primary cancers is ominous.
The purpose of this study was to evaluate tracheal viability and to document histological changes in an autograft implanted in the abdominal wall after a 1-week period of cryopreservation. A 5-cm segment of cervical trachea was resected in 6 dogs. One-half of the segment was cryopreserved and stored in liquid nitrogen at -196 degrees C for 1 week. The other half was immediately implanted in an abdominal pouch fashioned from the rectus abdominis muscle (control). One week later, the cryopreserved segment was thawed and then implanted in a similar contralateral muscular pouch. Five weeks later, the control and cryopreserved autografts were removed and compared with the in situ trachea. Ciliary beat frequency was assessed by transmitted light technique. Histology was evaluated by light microscopy. Gross anatomy and mucus production were maintained after cryopreservation. Histologically the cryopreserved segment displayed both normal epithelium and smooth muscle cells, but the cartilage was abnormal as characterized by empty lacunae. Mean ciliary beat frequency of in situ, control, and cryopreserved segments was 13.3 +/- 1.8, 13.5 +/- 1.5, and 13.3 +/- 1.1 beats per second (+/- the standard deviation), respectively. We conclude that smooth muscle, epithelium with mucus production, and ciliary function were retained after cryopreservation and reimplantation. Histological changes, however, were suggestive of early cartilage ischemia. These findings support further evaluation of cryopreserved canine tracheal grafts.
Not all patients with cervicopharyngeal pain related to the stylohyoid apparatus can be diagnosed as having Eagle's syndrome. An attempt is therefore made to classify these patients according to etiology. First, a diagnosis of Eagle's syndrome is applied to symptomatic patients in whom elongated, ossified styloid processes develop within a period of time posttraumatically. Second, a diagnosis of stylohyoid syndrome is applied to patients in whom elongated styloid processes and/or stylohyoid chain ossification develop early in life as an anatomic anomaly, and in whom symptoms later develop. Last, a diagnosis of pseudostylohyoid syndrome is applied to patients in whom, because of aging, a tendinosis at the junction of the stylohyoid ligament and the lesser horn of the hyoid bone develops. It is hoped that such a simplified classification may lead to a global understanding of the causes of such symptomatology, a more practical approach to treatment, and less confusion among the professions in regard to terminology.
It has been estimated that between 2% and 4% of the general adult population has radiographic evidence of an ossification of the stylohyoid chain. In an effort to prove that this is also the case in children and adolescents, 150 panoramic radiographs were examined at the Department of Pedodontics of St. Justine's Hospital in Montreal, Quebec, Canada. A total of 300 styloid processes and stylohyoid chains were evaluated and measured radiographically. The patients' mean age was 11 years. The mean length of the styloid processes was 10 mm. Forty percent of the population without symptoms studied showed some evidence of stylohyoid ligament ossification. Sixty percent of these were males; 40% were females. It was also found that 65.6% had no history of cervicopharyngeal trauma on review of the medical and dental histories.
A biplane videofluorographic system was used to track the position of metallic markers affixed to the abdominal surface of the left hemidiaphragm in supine anesthetized dogs. Regional shortening was determined from intermarker distances of rows of markers placed along muscle bundles in the ventral, middle, and dorsal regions of the costal diaphragm and of one row on the crural diaphragm. Considerable variability of regional shortening was seen in a given row, which was reproducible on repeat study in individual dogs but which differed between mechanical ventilation and spontaneous breathing. There were no consistent patterns among dogs. Regional shortening obtained from the change in length of rows extending from chest wall to central tendon showed no consistent differences among dogs during spontaneous breathing. At equal tidal volumes, all regions (except the ventral costal diaphragm) shortened more during spontaneous breathing than during mechanical ventilation.
The volume displacements of the rib cage and abdomen of relaxed seated subjects were measured as functions of pleural pressure with the chest wall expanded by airway pressure and with the chest wall distorted by an external force applied to the rib cage. From the measured displacements for the two independent loads, the three compliances that describe the mechanical properties of the relaxed chest wall modeled as a linear elastic system with two degrees of freedom were obtained. The cross compliance that describes the coupling between the rib cage and abdomen was found to be small and positive, 0.01-0.02 1/cmH2O. The displacement of the rib cage by the external force was consistent with the displacement predicted by use of standard methods for calculating the mechanical advantage of the force.
Lateral thoracotomy with pleural abrasion and application of talc was performed on 8 adult beagle dogs. The dogs had no effusion detectable on roentgenogram at the time of study, and obliteration of the pleural space was later confirmed by autopsy. With the dogs under pentobarbital anesthesia, lung mechanics and gas exchange were studied before and 5 wk after surgery. Total lung capacity decreased to 78% of control value (p less than 0.05). After the operation, pressure-volume curves of the respiratory system were shifted down, along with significantly decreased compliance. Maximal flow at constant lung volume was not significantly increased. Arterial O2 and CO2 tensions were not significantly different. Rebreathing DLCO normalized for lung volume was unchanged. The slope of phase III of a single-breath nitrogen test was increased (p less than 0.05) after surgery. Unilateral surgical obliteration of the pleural space results in a pure restrictive pattern. It does not affect the gas exchange surface. The increase in the slope of phase III is suggestive of a nonhomogeneous distribution of ventilation.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
28 patients with lung cancer had pulmonary function studies before and 3 months to 3 years after pneumonectomy or bilobectomy. Preoperative profiles showed a slight obstructive pattern with air trapping and perturbated gas exchange. The obstructive pattern was not related to endoscopy findings, but the alveoloarterial gradient oxygen gradient was smaller in those with complete lobar occlusion. After surgery, the volume loss was related to the amount resected, being greater after right pneumonectomy than after left pneumonectomy and least after bilobectomy. The obstructive pattern remained unchanged. Diffusion of carbon monoxide decreased significantly less than volumes after pneumonectomy but proportionally after bilobectomy. Those with increased alveoloarterial oxygen gradient or increased physiologic dead space experienced a significant improvement of their gas exchange after surgery.