Biomedical subjects
Publications and source records attributed to G Chapuis.
Pseudocysts complicating the evolution of pancreatitis are being recognized with increasing frequency at the subclinical stage. The authors' retrospective study covering 55 cases of pseudocyst brings out 5 criteria for prediction of the evolution of the disease, which should facilitate decision-making with regard to therapy.
Cardiac arrhythmias are a frequent complication after thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg/kg/h) after a loading dose (2 mg/kg) was tested in a randomized, placebo-controlled study in 30 patients using Holter monitoring during the first 72 hours after operation. A high incidence of atrial and complex ventricular arrhythmias was observed in the placebo-treated group, with a clear predominance in patients undergoing left thoracotomy. Antiarrhythmic drugs had to be added in 6 patients in the placebo-treated group (n = 16), but in none in the flecainide-treated group (n = 14) (p less than 0.01). The preventive effect of flecainide was observed at serum concentrations in the middle of the therapeutic range (409 ng/mL) without side effects. It is concluded that flecainide administration effectively reduced or prevented cardiac arrhythmias after thoracic operations.
The survival of patients with incurable carcinoma of the oesogastric junction is short. Amongst the various treatment options the choice must take into account the quality of survival offered to the patient. We think that surgery with oesogastric anastomosis offers the best palliation. To avoid both thoracotomy and cervicotomy we prefer palliative resection with oesogastric anastomosis through laparotomy alone.
Between 1979 and 1988, iterative surgery was performed on 13 patients for a germ-cell tumor. Apart from orchidectomy, surgery was not the first modality of treatment. On the other hand, 21 surgical procedures were performed for residual tumoral masses after chemotherapy or recurrences. In one third of the cases, only necrosis of fibrosis was resected. Out of 13 patients, 7 died of tumor; 6 are alive (3 with complete remission). Surgery is always indicated in stage IIA to IV nonseminomatous tumors in case of residual tumoral deposits after chemotherapy. For seminoma, surgery is carried out only for retroperitoneal residues larger than 3 cm in diameter. Surgery is also indicated for persistent pulmonary or mediastinal metastases following chemotherapy. Complete surgical excision of residual masses may be technically difficult but is of prime importance as combined chemotherapy and surgery doubles the complete remission rate in comparison to chemotherapy alone.
A severe or lengthy disturbance of immunity favors the development of malignant tumors. The increased incidence of lymphomas, leukemias and certain carcinomas in cases of congenital immunodeficiency, as well as of Kaposi's sarcoma and certain lymphomas in the acquired immunodeficiency syndrome (AIDS) are well known. In transplantees, patients undergoing immunosuppressive treatment for autoimmune disorders and cancer patients receiving chemotherapy, the occurrence of secondary neoplasias represents a phenomenon with a specific profile. We have seen 14 solid tumors in patients who were immunosuppressed for one of the 3 above-mentioned reasons. It is a heterogeneous group, both in terms of patient profile and tumor localisation. However, there are certain characteristics of these tumors which distinguish them from similar ones arising in the general population. The advent of more aggressive immunosuppressive therapies, the constant increase in organ transplants and the development of new cancer treatment modalities which influence the patients immune systems explain the importance of this phenomenon. Thus one must constantly be wary of these unusual tumors which occur independently of age and usual risk factors.
In 1986, a prospective study was started in CHUV on the squamous-cell carcinoma of the esophagus treated with a multimodality protocol associating preoperative chemotherapy and surgery. Nineteen patients are currently followed-up. Dysphagia is the main symptom and was found in 16 patients (84%). After chemotherapy, dysphagia disappeared completely in 7 cases (44%), regressed in 7 other cases and worsened in 1 case. Twelve patients were operated on, without operative mortality. Histologically, no tumor was found in one case (5%) after the preoperative treatment. Follow-up is currently too short to draw statistical conclusions. The rationale, advantages and perspectives of the multimodality treatment are presented and compared with different recent series.
The discovery of synchronous hepatic metastases from colorectal cancer poses a tactical problem ticklish to resolve. What are favourable circumstances for curative excision of hepatic metastases? When and how to operate them? To try to respond, we analysed a collective of 36 patients between 10. 1. 1985 and 30. 12. 1986. Of the patients staged Dukes B presenting synchronous hepatic metastases (less than 4, less than 50% of hepatic involvement by the tumour) without systemic involvement, excision at the first attempt is realizable and will be a benefit for the patient. For the others, excision is to be considered in the near future after having analysed (tumour grading and staging, CEA, ploidy of primary tumour). Patients presenting extrahepatic metastases will not benefit from hepatic resection. Surgery, associated or not to regional infusion chemotherapy is discussed.
This is a retrospective study of 40 patients with pulmonary metastasis who underwent resection. Metastasis were solitary in 28, few in 12: seven in one lung and 5 bilateral. Most were asymptomatic and were discovered during routine follow-up examinations. The most frequent primary tumors were (in decreasing order) colorectal in 11, a sarcoma (bone or soft tissue) in 9, a non-seminoma testicular tumor in 5. Resection was either uni- or bilateral through a posterolateral thoracotomy or sternotomy. Postoperative mortality and morbidity were negligible. Our experience is not large enough to have a precise opinion, and resection of pulmonary metastasis, usually between chemotherapy administration, gives good long-term results.
Between 1976 and 1987, 183 patients with an invasive adenocarcinoma of the stomach were treated in the Department of Surgery of the CHUV in Lausanne. This study allows us to conclude: 1. The localisation, age, sex and the association with atrophic gastritis have no prognostic significance. 2. Histologic subtype does not influence prognosis. Eighty percent of patients with isolated cell carcinomas survived less than 2 years, as did 68% of those with intestinal cell carcinomas. 3. No patients with distant metastasis survived over 2 years: mean survival for these patients was 4.1 months. 4. Patients without distant metastasis had a survival of 24 months regardless of the type of operation and degree of stomach wall invasion. 5. Wide gastric resection seems wise to avoid local recurrence but in itself did not improve survival. 6. Wide lymph node resection should be offered to patients who can withstand the procedure by medicosurgical teams with low predictable morbidity and mortality. The improved survival seems clear for patients with stage T1N1 and T1N2 tumors. 7. These results need to be confirmed by a prospective study.
One hundred and ten patients with Barrett's esophagus were operated on between 1963 and 1986. Preoperative endoscopy showed active peptic disease in 94% of the cases and a stenosis or ulcer in 61%. An anti-reflux operation was performed in 102 cases and a resection in 8 cases. Operative mortality was 3.6% and the morbidity was 9%. After an average follow-up of 6.9 years, 83% of the patients were satisfied with their operation. Postoperative endoscopy was performed in 39 patients after an average of 5.4 years. No progression or regression of the columnar epithelium was found. Two patients developed an adenocarcinoma in spite of adequate reflux control.
Five patients were treated from May 1987 to April 1988 in CHUV, Lausanne, for a superior sulcus tumor (3 epidermoid, 2 undifferentiated carcinomas). Treatment consisted of preoperative radiotherapy (3000 cGy)-surgery-postoperative radiotherapy (1500-2500 cGy). Two patients died from metastases. Only one patient presented with a local recurrence. Surgical resection was carried out by combined cervical and thoracic exposure. The cervical approach allows separation of the tumor from the subclavian artery, brachial plexus and vertebrae. Then, by thoracotomy, the superior lobe with tumor and thoracic wall is removed. Technical aspects of the procedure are described.
Among the various surgical methods of treating exogenous morbid obesity, Mason's vertical gastroplasty has gradually become the method of choice throughout the world. The method is relatively simple and the operating time short, so that if offers the great advantage of maintaining normal digestive activity free of metabolic disturbances. Between December 1981 and December 1988 we treated 160 patients in this way, the mortality in the series being nil. The results obtained are encouraging, since among 75 patients followed up for at least 2 year, 50 (66%) had a weight index between 20 and 25, 15 (20%) a weight index between 25 and 30, while 10 patients (14%) failed to respond to the treatment.
The analgesia for patients suffering from incurable tumors is a major problem. The parenteral administration of opioids causes disagreable side effects. The development of completely implantable devices which permit the epidural administration of morphine offers higher quality analgesia with less side effects. Being easy to use, these devices allow cancer patients to remain at home, whereas otherwise they would need to be hospitalized for effective treatment of pain.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
776 patients seen in our emergency ward with abdominal pain for less than one week duration were prospectively analysed. In 49% of these patients no cause was found and 19% had acute appendicitis. Among 180 appendectomized patients, 147 (82%) had acute appendicitis whereas 33 (18%) had no inflammation of the appendix. Clinical presentation with a pain duration of less than 36 hours, steady abdominal pain, guarding in the right iliac fossa and a white cell count above 12,000/mm3 (12 g/l) were the best criteria for prediction of acute appendicitis versus a normal appendix. Perforated appendicitis was found in 18% of the patients with acute appendicitis but in only one patient for whom appendectomy had been deferred on the grounds of atypical presentation. Thus, in most cases, the perforation was preexistent to admission. We therefore recommended a 24-48-hour observation period for patients with uncertain diagnosis. Rates of normal appendices and perforated appendices of about 20% seem to be difficult to improve upon.
Explore the source record for details and available documents.