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Biomedical subjects

G Massard

Publications and source records attributed to G Massard.

88 records · Page 5Linked to original sources
PubMed1992

[Lobectomy extended to the main bronchus in the treatment of bronchial cancer (seventy-three cases)].

Sleeve allow excision of bronchial carcinoma in patients not able to functionally tolerate pneumonectomy. Our series consists of 73 patients operated over the last thirty years. Implantation of the bronchus was treated either by wedge resection or by complete resection followed by reimplantation. This procedure was performed for respiratory functional reasons in 39 cases (53%), on principle in 27 cases (37%) and in palliative indications in 7 cases (10%). The high perioperative mortality (6.8%) and morbidity (20%) were related to bronchovascular complications which were eliminated over the last decade. Local recurrences (23%) were more frequent than following conventional resections. On the other hand, the survival, 80% at one year, 62% at 2 years, 54% at 3 years and 39% at 5 years, related more to metastatic dissemination than to local recurrence, was comparable to that of the control group of pneumonectomised patients. This procedure gave identical results in terms of survival, but should be reserved for patients with respiratory failure due to the increased risk of local recurrence.

Adult↗
PubMed1992

[Forgotten mediastinal goiter: seven cases].

The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.

Aged↗
PubMed1992

[Diaphragmatic hernia complicating omentoplasty after thoracic wall excision. Reflections apropos of 2 cases].

The authors relate two case-reports of diaphragmatic hernia occurring after antero-lateral chest-wall resection and repair with an omental flap. Both patients had undergone a prior lung resection for bronchogenic cancer, and the indication for chest-wall resection was parietal neoplastic recurrence. In both patients, the omental flap was brought up to the chest wall defect by a direct transdiaphragmatic route; prosthetic material was note used. The hernia presented once as early post-operative evisceration, and once as proximal obstruction due to gastric herniation. The causes of these two complications are analysed. Omentoplasty was justified twice, since the latissimus dorsi had been severed during the prior thoracotomy. Prosthetic material might have been useful to one of the patients, but not to the second who had undergone pneumonectomy. The transdiaphragmatic passage of the omentoplasty was certainly responsible for the herniae and should be avoided.

Aged↗
PubMed1992

[Results of surgery of non-small cell primary bronchial cancers. Retrospective analysis of 452 resections].

Data from 452 patients who underwent pulmonary resection for a non small cell bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. The operative mortality rate was 5.5%. Mortality was significantly increased in patients who underwent enlarged resections for T4 tumors (20%; p < or = 0.05), and in patients who were 70 years and older (12.8%; p < or = 0.05). The overall 5-years survival rate was 32.7% at 5 years. Prognosis in patients who were 70 years and older was similar to that in younger patients. No difference in survival was observed in patients with lymph node metastases with regard to the operative procedure (pneumonectomy versus lobectomy). Survival in patients without lymph node metastases who underwent a lobectomy was similar to those who underwent a conservative resection. Prognostic significance of the histologic cell type and the tumor formula (pTNM) was assessed by multivariable analysis. There were statistically significant differences between squamous cell carcinoma and both adenocarcinoma (p < or = 10(-5)) and undifferentiated carcinoma (p < or = 0.01). This study confirmed the validity of the TNM classification (4th ed) for the accurate prognosis evaluation. Lymph node involvement appeared to be the most pejorative factor (p < or = 10(-5)).

Adult↗
PubMed1991

Emergency repair of main stem bronchus disruption complicated by anastomotic stenosis: two cases of successful repair by resection and reanastomosis.

The case reports of two patients who developed complete bronchial stenosis after emergency repair of a left stem bronchus disruption are reported. Resection of the stenotic bronchus and reanastomosis restored a normal lung function in both patients. Arguments for a conservative approach, perioperative investigations, and technical data are discussed.

Accidents, Traffic↗
PubMed1991

[The risks of surgical training. A study apropos of 348 pneumonectomies].

On the basis of the retrospective study of a series of 348 pneumonectomies, the authors have attempted to assess whether the risks of postoperative complications were increased if the operation was carried out by trainee surgeons. All operations were performed for cancer, with a stapler being used for bronchial suture. The patients were classified in three groups according to the surgeon: 133 (38%) were operated by an University professor (group I, 2 surgeons), 171 (49%) by chief resident or hospital practitioner (group II, 3 surgeons) and 44 (13%) by an intern (group III, 14 surgeons). The homogeneity of the 3 groups was checked with alpha X2 test. The study dealt with the overall mortality as well as with the specific complications of pneumonia, namely empyema and bronchopleural fistulae. The overall postoperative mortality rate was similar in the 3 groups (respectively 8%, 8% and 5%), as well as the occurrence of empyema (respectively 4%, 3% and 5%). A difference that, though not significant statistically, is not negligible, appears for bronchopleural fistulae, which complicate 9% of the operations carried out by interns vs. 4% in the other 2 categories. These observations challenge a number of studies claiming that surgery performed by inexperienced surgeons is innocuous. However, pneumonectomy is an essential step in the training to thoracic surgery, so that no candidate with sufficient surgical maturity should be prevented from performing it.

Female↗
PubMed1986

[Induced labor. Indications and contra-indications].

The authors report all present and future indications of the induction of a term delivery, as well as their contra-indications. They present their experience in prophylactic delivery, and propose a comparative study of the incidence in the recent literature of the main indications of induction.

Female↗
PubMedDate not supplied

Imaging of chest wall disorders.

Pathologic processes that may involve the chest wall include congenital and developmental anomalies, inflammatory and infectious diseases, and soft-tissue and bone tumors. Many of these processes have characteristic radiologic appearances that allow definitive diagnosis. Sternal deformities can be visualized at radiography and their severity quantified with computed tomography (CT). In cervical rib, CT with multiplanar reconstruction may demonstrate relevant anatomic detail and the relationship between bone deformity and arterial compression. In Poland syndrome, radiography reveals an area of hyperlucency on the affected side, whereas CT demonstrates the absence of the greater pectoral muscle and clearly depicts associated musculoskeletal anomalies. Tuberculosis typically manifests at radiography and CT as osseous and cartilaginous destruction and soft-tissue masses with calcification and rim enhancement. Aspergillosis involving the chest wall manifests as pulmonary consolidations and permeative osteolytic changes of the rib and spine at CT and as an area of increased signal intensity at T2-weighted magnetic resonance (MR) imaging. Neurogenic tumors and hemangiomas also typically have high signal intensity at T2-weighted MR imaging. Apparent mass extension or unequivocal bone destruction seen at CT or MR imaging may indicate chest wall involvement by lymphoma. Radiologically, soft-tissue sarcomas typically appear as areas of soft-tissue density or attenuation, often associated with necrotic areas of low density or attenuation. At radiography, plasmacytoma typically manifests as well-defined, "punched-out" lytic lesions with associated extrapleural soft-tissue masses. Chondrosarcoma frequently appears as a large, lobulated excrescent mass arising from a rib with scattered flocculent calcifications characteristic of its cartilaginous mix. Familiarity with these radiologic features facilitates accurate diagnosis and optimal patient treatment.

Adolescent↗
PubMedDate not supplied

[Iatrogenic tracheobronchial lesions during intubation. 5 cases and review of the literature].

The authors report about a personal series of 5 cases of tracheal injuries during intubation. One lesion was caused by a Carlens' tube and it was discovered and repaired during thoracotomy. Four wounds resulted from the use of ordinary tubes. Three of them affected only the tracheal membrane. The diagnosis was established with fiberendoscopy after subcutaneous emphysema occurred while the patient was awakening. Two patients underwent surgical repair, and a watch-and-wait policy was applied for another one. The outcome was favorable for these 4 patients. The last patient had a tracheoesophageal wound in a context of irradiated cervical neoplastic recurrence. The diagnosis was suggested by the discovery of major ampents of air in the small bowel during laparotomy for jejunostomy. The outcome was fatal. These cases have been compared with a compilation of the literature, gathering 8 wounds caused by ordinary tubes and 25 caused by Carlens-type tubes.

Adult↗
PubMedDate not supplied

[Radiologic double-contrast aspects of small esophageal cancers. 38 cases].

Double contrast radiological features of thirty eight small esophageal carcinoma are described. Double contrast study is essential in the detection of small esophageal carcinomas: localized thickening of the folds (29%), localized wall stiffness (23.6%), superficial ulcers (13%), discrete superficial nodule (42%), nodularity (15.7%), and ulcerated nodule (15.7%). In our series, six carcinomas arising from reflux esophagitis have the nodular appearance. As in the majority of the cases, small esophageal carcinomas are asymptomatic, when radiologic study of esophagus is performed in patients over 40 years with heavy alcohol and tobacco use, it is imperative to use the double contrast method and to carefully search for minor mucosal abnormalities.

Adenocarcinoma↗
PubMedDate not supplied

Efficacy of OKT3 therapy for acute rejection in isolated lung transplantation.

The purpose of this study was to evaluate the efficacy of muromonal-CD3 (Orthoclone OKT3) in the treatment of acute lung rejection. Criteria for its administration were (1) steroid-resistant acute rejection, (2) first-line therapy for grade III or higher acute rejection, and (3) second relapse after tapering off steroid treatment of acute rejection. During the period between May 1990 and May 1992, 41 patients had a total of 101 episodes of acute rejection. OKT3 (5 mg/kg for 7 to 10 days) was administered to 28 patients, of whom 19 responded (68%). Nine patients had either nonresponsive episodes or relapses immediately after completion of OKT3 therapy. Age, gender, cytomegalovirus status, underlying diseases, and type of procedure did not influence the outcome. Timing of OKT3 administration, however, was important; 16 (89%) of 18 patients responded to OKT3 therapy when administered during the first 6 months after transplantation, whereas 3 (30%) of 10 patients responded only beyond 6 months (p < 0.01). Infectious complications occurred after six treatments (21%), in which high-dose steroids were used concurrently (three Aspergillus, two Pseudomonas, and one cytomegalovirus pneumonia). Two patients also taking high-dose steroids had lymphoproliferative disorders. Three allergic reactions developed: one case of edema, one case of hypotension, and one case of arthralgia-myalgia syndrome. Serum antibody titers against OKT3 were persistently negative despite repeat (up to four times) therapy. We conclude that OKT3 is an effective and relatively safe therapy for steroid-resistant, high-grade, or relapsing acute lung rejection during the first 6 months. Antimicrobial prophylaxis must be considered when OKT3 is administered.

Acute Disease↗
PubMedDate not supplied

Single lung transplantation for cystic fibrosis: is it an option? Cystic Fibrosis Transplant Study Group.

A 15-year-old girl with end-stage lung disease from cystic fibrosis underwent a bilateral lung transplantation. Infarction of the left lung allograft required its removal on day 10. The patient went on to have an uneventful recovery except for a prolonged air leak from the right allograft of approximately 29 days. The left pleural cavity opacified with time with no clinical or radiologic evidence of empyema. The patient was discharged on day 35 in good condition. On a follow-up examination 6 months after transplantation, she appeared to be functioning extremely well with a single lung allograft. This case report challenges the conventional wisdom that bilateral pneumonectomy and single lung transplantation are not an option to be considered for patients with cystic fibrosis or bronchiectasis.

Adolescent↗