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H Le Brigand

Publications and source records attributed to H Le Brigand.

At least 19 recordsLinked to original sources
PubMed1988

[Thymomas and associated diseases. Apropos of a series of 255 surgically treated thymomas].

The authors report on a series of 255 thymomas and the associated diseases most often auto-immune, myasthenia is the disease most frequently encountered (61% of cases). Next, but with a much reduced frequency of around 2%, come other diseases such as hypogammaglobulinaemia, erythroblastopenic anaemia, and disseminated lupus erythematosis. The authors analyse the effect of ablating the thymoma on the associated disease; those with myasthenia are the principal beneficiaries of thymic ablation, 83% in this series experiencing a good response. Besides myasthenia only erythroblastopenic anaemia obtained some benefit from thymic ablation; in all the other cases surgery to the thymic tumour had no benefit on the associated disease. In the light of their own experience the authors made a review of the literature of the different diseases associated with thymomas and made the point of the efficacy of thymectomy in the different diseases.

Agammaglobulinemia↗
PubMed1984

[Long-term survival of patients operated on for primary bronchial cancers (excluding anaplastic cancers)].

The results of a retrospective study of patients operated upon for primary bronchial carcinoma (small-cell type excluded) are reported. The survival rates of 1285 patients who underwent tumoral excision between 1960 and 1973 were calculated by the actuarial method after exclusion of post-operative deaths. The overall survivals at 5 years' intervals were 31%, 18%, 11% and 8%. The excess mortality due to cancer was significant up to 15 years. Among 159 patients who survived for more than 10 years, relapses or new growths, sometimes amenable to surgical treatment, were relatively common. The cardiorespiratory status, living conditions and social rehabilitation of 149 patients who survived for more than 5 years showed good adaptation in most cases. The long-term prognosis was unrelated to age, sex or side of the tumour. The influence of the histological type depended on differentiation. Among surgical operations, lobectomy had the best prognosis. In patients who had simple pneumonectomy there was no significant difference between pneumonectomies performed on account of tumour of the main bronchus and the others. The place of enlarged pneumonectomy is defined. Of paramount importance for survival are the T.N.M. classification (UICC coding modified by Renault in 1975) and Carr's grading into 3 stages of increasing severity, notably the size and site of the tumour (T1 to T3) and the presence of pedicular or mediastinal lymph node involvement (N1-N2-N3). Early diagnosis is essential. Prospective studies involving several parameters (especially treatments combined with surgery) appear to be needed.

Carcinoma, Bronchogenic↗
PubMed1984

Anti-AChR antibodies, thymic histology, and T cell subsets in myasthenia gravis.

The relationship between the titers of antibody against acetylcholine receptor (AChR) and T helper/suppressor balance (assessed by the OKT4/OKT8 ratio) were investigated in 74 patients with myasthenia gravis (MG). All patients with elevated AChR antibody titers (greater than 100 nM) had hyperplastic thymuses, while most patients with low or negative antibody titers (less than 1 nM) had involuted thymuses. All patients with thymoma had positive, though not very high, antibody titers. No correlation was found between anti-AChR antibody levels and OKT4/OKT8 ratios except for patients with thymoma. Thus, it appears that AChR antibody titers are more closely related to thymic pathology than to peripheral T cell imbalance. These results are consistent with the hypothesis giving a central role to thymic lymphocytes in the AChR antibody production, either as antibody producer B cells or helper T cells.

Acetylcholine↗
PubMed1983

Depletion of helper/inducer T cells after thymectomy in myasthenic patients.

Using monoclonal anti-T-cell antibodies, we have studied peripheral blood T-cell subsets in 53 patients with myasthenia gravis before and after thymectomy (Tx). Before Tx, the mean OKT4/OKT8 ratio was higher in patients than in controls. Furthermore patients showed a high number of cells reacting simultaneously with the OKT4 and OKT8 antibodies. Shortly after surgery, the helper/suppressor ratio was increased in most of the patients, and the doubly reactive subset decreased to normal levels. However, 6 to 12 months after Tx the OKT4/OKT8 ratio was significantly decreased, particularly in patients showing clinical improvement. The percentage of total T cells was slightly but significantly reduced. A group of 14 patients studied more than 2 years after Tx presented very low OKT4/OKT8 ratios. Thymectomy in MG appears to lead to a gradual decrease of the T-helper subset which could contribute to its favorable effect on the course of the disease.

Adult↗
PubMed1982

[Tracheal resection for tracheal tumors (excluding cancer)].

Tracheal resection was performed in 10 patients with non-malignant tracheal tumors. Clinical, histological, and technical features are discussed, particular emphasis being given to long-term results. These tumors, mostly cylindromas (7 out of 10 cases in this series) are amenable to very wide surgical resection of the resection-anastomosis type. Suggested treatment for cylindromas should include systematic postoperative irradiation, as this considerably improves long-term (10 and 15 years) results.

Adult↗
PubMed1981

[Combined cervical and thoracic approach to the removal of tumours responsible for the Pancoast and Tobias syndrome (author's transl)].

The authors review the various treatments of the Pancoast and Tobias syndrome and propose a new surgical approach in two stages. The first, cervical stage involves resection of the internal half of the clavicle and of the first rib and dissection of the vessels and nerves lying in the supraclavicular fossa, so that the tumour can be lowered in one piece and exposed. The second stage consists of posterolateral thoracotomy with exeresis of the lung. The wide cervicotomy has several advantages: the tumour can be biopsied for extemporaneous histological examination, and its extension to the lymph nodes, thoracic wall and mediastinum can be assessed; freeing the nerves relieves pain and considerably facilitates the second stage of the operation.

Humans↗
PubMed1981

Evaluation of T cell subsets in myasthenia gravis using anti-T cell monoclonal antibodies.

Functional T cell subsets have been evaluated in the peripheral blood of patients with myasthenia gravis using monoclonal anti-T cell antibodies and a suppressor cell assay based on the suppression of the mixed-lymphocyte reaction by concanavalin A-activated lymphocytes. A significant decline of suppressor cells was found in a large proportion of patients, both by direct count using the anti-suppressor-cytotoxic T cell antibody (OKT8) and by the suppressor assay. Patients also showed an increase in immature T cells defined by their simultaneous reaction with the anti-helper cell (OKT4) and anti-suppressor cell (OKT8) antibody. Thymectomy tended to enhance the deficit in suppressor cells, and to induce the disappearance of double-labelled cells.

Adolescent↗
PubMed1980

[Surgical treatment of myasthenia by thymectomy. A report on 248 cases (author's transl)].

Good results were obtained in 80 p. cent of 248 patients seen after more than 15 months following the operation. Results are grouped as a function of the different characteristic features of the patients and three groups can be defined: failures, improvement, remissions. These results contradict those who assert that thymectomy is of no value for severe cases. Cervicotomy is performed for non-tumoral forms or for small tumors; sternotomy is reserved for large median thymomas; anterolateral thoracotomy for laterally located thymomas and tracheotomized patients. Postoperative tracheotomy is very rarely needed. Patients are followed-up by clinical signs and ergodynamometric tracings. The prognosis for the myasthenia is not affected by the presence or absence of germinating centres in the non-tumoral thymus, or by the benign nature of the thymoma. Small undiagnosed tumors may be discovered during operation. Treatment of recurrences is difficult. The myasthenia may be associated with other auto-immune affections. The indication for operation in the purely ocular forms is debatable. Thymectomy may produce total remission even in severe cases, and may improve the results of medical treatment. Even in case of failure it can reduce the severity of the course of the disease.

Adolescent↗