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Biomedical subjects

D Grunenwald

Publications and source records attributed to D Grunenwald.

65 records · Page 4Linked to original sources
PubMed1994

Surgical resection of pulmonary metastases. Up to what number?

Specific results on the surgical resection of a large number of pulmonary metastases (PM) are currently unavailable, and the risk-benefit ratio of this aggressive approach may appear questionable. A systematic review of the records of 456 adult patients who underwent thoracic surgery for PM between 1979 and 1990 led to the identification of 44 patients who underwent at least one resection of eight or more PM (range eight to 110), of whom 33 (75%) had PM from osteogenic or soft tissue sarcoma. These 44 patients underwent a total of 77 operations, of which 47 (61%) were bilateral and nine (12%) incomplete resections. The 3- and 5-yr probabilities of survival after the first resection of eight or more PM were 36 and 28%, respectively, and were not significantly different from those of the 412 other patients who underwent surgery for PM over the same period. In this small group of patients, only the quality of resection (complete or incomplete) was found to be a highly significant prognostic factor (p < 0.01). A critical analysis of the reported data supports the view that, at least in patients with osteogenic or soft tissue sarcoma, the prognostic value of the number of PM seems to be more dependent on associated resectability than on the number per se and that, after careful preoperative patient selection, PM that can be resected should be resected, whatever their number.

Adult↗
PubMed1994

[Preventive bronchial omentoplasty and myoplasty in pulmonary resection. Technical aspects and results].

Extended pulmonary resections with complete dissection of mediastinal lymph nodes, and the growth in neoadjuvant therapies, led us to define preventive methods to promote uncomplicated bronchial healing. Nineteen patients were operated on in conditions of high risk of impaired bronchial healing. They underwent bronchial revascularization either by omentopexy (12), or intercostal pedicle flap (7). 10/12 preventive omental pedicle flaps permitted correct healing, 7 preventive intercostal pedicle flaps permitted only 3 good results. This short series confirmed experimental data, and encouraged us to increase preventive bronchial omentopexy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Main drug- and carcinogen-metabolizing enzyme systems in human non-small cell lung cancer and peritumoral tissues.

To better understand the importance of drug-metabolizing enzymes in carcinogenesis and anticancer drug sensitivity of human non-small cell lung cancer, we studied the main drug-metabolizing enzyme systems in both lung tumors and their corresponding nontumoral lung tissues in 12 patients. The following enzymes were assayed by Western blot analysis: cytochromes P-450 (1A1/A2, 2B1/B2, 2C8-10, 2E1, 3A4); epoxide hydrolase; and glutathione S-transferase isoenzymes (GST-alpha, -mu, and -pi). The activity of the following enzymes or cofactor were determined by spectrophotometric or fluorometric assays: glutathione S-transferase (GST); total glutathione; UDP-glucuronosyltransferase; beta-glucuronidase; sulfotransferase; and sulfatase. Results showed the presence of cytochrome P-450 1A1/1A2 in both tumoral and nontumoral tissues. P-450 1A1/1A2 levels were 3-fold lower in tumors compared to corresponding nontumoral tissues (P < 0.05). None of the other probed cytochromes P-450 were detected in either tumoral or nontumoral lung tissues. For the glutathione system, no significant difference between tumoral and nontumoral tissues was observed (GST activity, glutathione content, GST-alpha, -mu, and -pi). A positive linear correlation was observed between GST activity and GST-alpha or GST-pi. No significant difference was observed for the glucuronide and the sulfate pathways and their corresponding hydrolytic enzymes. Epoxide hydrolase was significantly decreased in tumors compared to nontumoral lung tissues (P < 0.05). In conclusion, these results showed differences between non-small cell lung tumors and nontumoral tissues for cytochrome P-450 1A1/1A2 and epoxide hydrolase. These differences between tumors and peritumoral tissues with regard to these drug-metabolizing enzymes could reflect differences occurring after malignant transformation and may play a role in drug sensitivity to anticancer drugs.

Adult↗
PubMed1993

Thrombolysis for life-threatening pulmonary embolism 2 days after lung resection.

Early postoperative severe pulmonary embolism is usually considered an indication for surgical embolectomy because thrombolytic agents cannot be used. Severe pulmonary embolism was diagnosed 2 days after lung resection in two patients, including one with hypercapnia during spontaneous breathing, perhaps a unique feature of massive embolism on a single lung. Although emergency surgical embolectomy was available, both patients were given a bolus infusion of thrombolytic agents, with an immediate (within 1 h) clinical and hemodynamic improvement and a favorable outcome despite delayed major bleeding in one patient. The reported data and an analysis of the available literature support the view that recent surgery should be considered a relative rather than absolute contraindication to thrombolysis and that decision making in this setting should be based on a careful case-by-case evaluation of the expected benefits and risks of the various available treatments.

Aged↗
PubMed1991

Right atrial extension of an embryonal carcinoma of the testis.

A case of embryonal carcinoma of the testis extending into the inferior vena cava and the right atrium is presented. Tumor extension was demonstrated preoperatively by computed axial tomography. Successful resection of the intravascular and right atrial extension was achieved using extracorporeal circulation. It is concluded that intravascular and right atrial extension is not a contraindication to radical surgery. This type of metastasis raises the same therapeutic and prognostic problems as those raised by tumor masses in the lungs or lymph nodes found after chemotherapy for malignant nonseminomatous germ cell tumor of the testis.

Adult↗
PubMed1989

[Intraoperative use of fibrin sealant in pulmonary surgery. A prospective study on a series of 124 procedures].

Following lung resection, there is often important air leakage. Application of fibrin sealant on the parenchymal sutures or sites stripped of visceral pleura improves airtightness. The author reports a prospective series of 124 operations complicated by important air leakage, which was treated by application of fibrin sealant. This group is compared to another similar group of patients in which fibrin sealant was not used. All operations were done by the same surgeon. The time of post-operative thoracic drainage is markedly reduced (mean two days), and the post-operative hospital stay time is also reduced. It seems that intra-operative use of fibrin sealant helps to improve the post-operative course in the surgical unit.

Adolescent↗
PubMedDate not supplied

[Value and limits of surgery in stage IIIB non-small-cell bronchial cancers].

According to the TNM staging system for lung cancers, stage III is divided into IIIA and IIIB. This division was based upon the principle that patients with IIIA disease could theoretically benefit from complete resection, contrasting with IIIB patients for whom surgery is not feasible. The poor prognosis of stage IIIB is largely due to its classical inoperability. From the surgical point of view, stage IIIB can be subdivided into four subgroups: 1) N3 where resection is possible in selected patients through median sternotomy; 2) T4 where extended surgery can be considered in selected patients; 3) N3 + T4; 4) malignant pleural or pericardial effusion contraindicating any radical surgery. Criteria for resectability could be defined to include some IIIB patients in multimodality protocols in which surgery would become possible after induction therapy: definitive inoperability excludes any possibility of surgery, even in cases in which radiotherapy alone or combined with chemotherapy leads to complete remission; immediate inoperability allows patients to be included in protocols evaluating induction treatments designed to render tumours resectable.

Carcinoma, Bronchogenic↗