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Biomedical subjects

G Morand

Publications and source records attributed to G Morand.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Postoperative intensive care after thymectomy for myasthenia gravis].

The post-operative management of the myasthenic patient after thymectomy through sternotomy has changed in the last decades. After years of routine preoperative tracheostomies followed by routine prolonged intubation nowadays it is possible to wean the patients from the ventilation and to extubate them early after surgery while reintroducing the acetylcholinesterase inhibitors therapy. A series of 15 patients operated on between 1985 and 1988 for removal of thymic rests or thymoma is presented and confirms this evolution. The clinical and gazometric criteria allowing an early weaning from the ventilator are analyzed. However certain patients with the most severe forms of myasthenic still need prolonged ventilatory support.

Adult↗
PubMed1990

[Development of 62 typical carcinoid tumor of the bronchi surgically treated. Prognostic value of histopathological features].

The pathological and clinical features of 62 carcinoid tumours of the bronchus operated between 1975 and 1987 were reviewed in order to determine the prognostic value of certain parameters: limit of proliferation, vascular invasion, lymph node involvement. This series corresponded to 36 central tumours and 25 peripheral tumours, all treated surgically. One patient was lost to follow-up, 3 developed recurrences, 56 are still alive without recurrence and 3 died from intercurrent causes. The histological appearance of the tumours was homogeneous and typical. Twenty-eight lesions were strictly intrabronchial, 34 invaded the lung with incomplete limits in twenty cases. The tumour showed signs of vascular invasion in ten cases and the adjacent lymph nodes were invaded in eight cases. The local recurrence was undoubtedly related to an excessively conservative primary resection, as the primary tumour did not demonstrate any unusual features. The two tumours which metastasized showed vascular invasion: one metastasized to a hilar node, but these features were observed in other cases which retained a benign course. The standard histological diagnosis of typical carcinoid tumour does not appear to raise any particular difficulties; it is reliable. The course of the disease is sometimes malignant but no histological parameter is able to accurately predict this outcome.

Adult↗
PubMed1990

[Perfusion scintigraphy and surgical excision of bronchial cancers].

In a series of 1,800 operated lung cancers, 93 had a unilateral perfusion scan less than or equal to 20% (36 perfusions = 0, 15 between one and 10% and 42 between 11 and 20%). Major amputations were more frequent on the left side and constituted a pejorative but non-decisive factor for surgical nonintervention although was not synonymous with inoperability. The extent of the resection increased with the severity of the amputation.

Carcinoma, Bronchogenic↗
PubMed1990

[Outcome of 100 necessary exploratory thoracotomies for bronchial cancer].

The outcome of one hundred exploratory thoracotomies for lung cancer (9.1% of operations) was studied. There were 4 postoperative deaths. After the operation, 6 patients did not receive any further treatment, 62 received radiotherapy, 25 received a combination of radiotherapy and chemotherapy and 3 received chemotherapy. The disease-free interval was very short with development of metastases (55 cases) and local recurrences (29 cases). The survival was also short: less than 10% at 2 years; it was significantly poorer than that observed in a group of non-operated patients with an equivalent stage of lung cancer. These findings suggest the need for stricter evaluation of operative indications.

Aged↗
PubMed1989

Immunotherapy as an adjuvant to surgery in carcinoma of bronchus. Results in three randomised trials.

The results of non-specific immunotherapy adjuvant to surgery in the treatment of non-small cell lung cancer were studied in three separate randomised clinical trials involving 344 patients. The first study involved 126 patients. In 73, intrapleural BCG was given according to McKneally's technique. They were compared to a control group of 63 patients. In the second trial, levamisole was administered to 43 patients who, in addition to surgery, also had radiotherapy. These were compared with 43 control patients. In the third study, 60 patients underwent surgical operation for limited lesions and in addition received Isoprinosine. These were compared with a control group of 60 patients. All patients in the control groups of the three studies had similar surgical operations to their treated counterpart. The overall results showed no difference between those who received immunotherapy and the control groups of patients and that the use of these agents did not alter either the course of the disease or the incidence of its recurrence.

Adenocarcinoma↗
PubMed1989

[Bronchiolo-alveolar carcinoma. Anatomo-pathological and evolutional study of a series of 52 operated cases].

The postoperative outcome of bronchiolo-alveolar epithelioma (EBA) is unpredictable. We question whether a study of the anatomo-pathological structures would enable us to detect prognostic indicators. The clinical characteristics, histopathology and outcome of 52 cases of EBA were studied. 31 tumours were detected in a systematic fashion; 50 patients had excision of the tumour and in 39 cases there was no invasion of the lymphatics. 10 were of the multicentric variety and 42 were of the nodular variety and 9 of these were the centre of an inflammatory lympho-plasmocytic reaction. 20 cases revealed mucinous differentiation and 32 were non-mucinous. In the latter cases nucleo-cytoplasmic anomalies were only slightly increased or even absent. Blood vessel invasion was present in 12 cases and metastases to the air spaces in 20. The overall survival was 83% in the first year, 65% in the second year, 42% at five years and 26.5% at 10 years. The nodular lesions were compatible with a significantly better survival than the diffuse forms. Other characteristics such as whether the tumour was mucinous or not, inflammatory, showed nuclear anomalies, blood vessel invasion and airborne metastases did not seem to affect survival.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1989

[Paraplegia caused by extradural spinal hematoma after radical pulmonary lobectomy in cancer].

The authors report a case of spinal cord complication after surgery for lung cancer. Amongst the 12 cases published in the literature, only one reports spinal cord ischaemia secondary to a compressive mechanism by spinal extradural haematoma. In the present case, due to an identical mechanism, paraplegia developed as a result of intraoperative meningeal rupture during extension of a pulmonary lobectomy for cancer to the adjacent vertebrae. The diagnosis was established by CT scan combined with emergency myelography. Certain preventative measures are proposed based on analysis of the mechanisms of this complication.

Hematoma, Epidural, Cranial↗
PubMed1987

[Thymoma. Analysis of a series of 42 cases].

The authors have treated 42 patients with thymoma and report on their experience. The mode of discovery, and notably the thymoma-myasthenia association in 8 cases (20%), the diagnostic approach and the management of the disease--surgery alone : 18 cases, surgery combined with radiotherapy : 24 cases and/or with chemotherapy : 5 cases--were analyzed. The thymomas were classified according to the G.E.T.T. system after re-examination of the histological sections. The course of the disease was studied. The overall survival rate, which depends on tumoral stage, was 71% at 4 years and 69% at 10 years; 5 patients died of the disease and 9 of other causes, including 5 who presented with a blood disease. This series is compared with other published series. The frequency of myasthenia and the respective prognostic values of anatomico-surgical, histological and histo-immunological classifications are discussed.

Adolescent↗
PubMed1986

[Repeated surgery in primary bronchial cancer. Apropos of 18 cases].

Primary lung cancer treated by surgery may re-develop on another site. Eighteen patients were re-operated upon over a 14-year period (1970-1983) in the Thoracic Surgery Unit of Strasbourg (Prof. J. P. Witz) for a second cancerous localization. Complications and post-operative mortality were more frequent with ipsilateral excisions (8 cases) than with contralateral excisions (10 cases); this may be due to the technical difficulties associated with complementary pneumonectomy in a previously affected hemithorax. The diagnosis, usually obtained by radiography of the chest, resulted from regular, long-term surveillance of patients operated upon for lung cancer. In spite of the small number of cases in this series (1.5% of excisions for lung cancer during that period), there is no doubt that to re-operate patients with a new localization of cancer is the best therapeutic solution.

Aged↗
PubMed1986

[Value of a plan for surveillance of patients operated on for bronchial cancer].

The modalities and results of surveillance of 578 patients operated upon for bronchial cancer are reported. Planned surveillance, introduced in 1981, is compared with the surveillance carried out from 1977 to 1980. The plan includes 4 radiological and clinical examinations during the 1st year, 3 during the 2nd year, 2 during the 3rd year and 1 per year thereafter. Bronchial fibroscopy is performed 9 and 18 months after surgery. In the 3rd post-operative month 10% of the patients had died, 4% had been lost sight of, and 86% had presented themselves for control examination. Regularity in attending control sessions has improved since planned surveillance was introduced: on average, the number of examinations is complied with, without modifications in the out-patient/in-patient ratio. Endoscopies are performed in 70% of the cases. Multiplying control examinations does not noticeably increases the number of pathological findings. Many relapses diagnosed on symptomatic grounds were, in fact, inaccessible to radiology and endoscopy. Five out of 19 local-regional relapses were diagnosed by fibroscopy. It is concluded that there is no need to increase the number of consultations, and that the complementary examinations performed should be more carefully selected.

Bronchial Neoplasms↗