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Biomedical subjects

J F Dumon

Publications and source records attributed to J F Dumon.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Lasers and endoprosthesis in bronchopneumology].

During the past decade lasers, especially the Neodymium: Yttrium-Aluminum-Garnet (Nd: YAG), have transformed interventional bronchoscopy. Recent improvements of tracheobronchial prostheses have further increased the therapeutic possibilities of endoscopy. Tracheobronchial obstruction by intraluminal tumeur, stenosis, or extrinsic compression can now be palliated successfully. The future of therapeutic bronchoscopy is bright. New techniques of optic spectroscopy will allow improved detection of laser induced tissue fluorescence. Refinements of laser technology and development of visualisation systems such as endoscopic echography and electronic videoendoscopy will lead to improved diagnostic and therapeutic capabilities.

Anesthesia, General↗
PubMed1990

Bilateral bronchial anastomosis in double lung and heart-lung transplantations.

During heart-lung or double lung transplantation, the airway anastomosis is usually made at the tracheal level. Healing of this anastomosis is one source of postoperative complications especially after double lung transplantation (DLT). In this series of 10 patients with cystic fibrosis undergoing DLT, the tracheas of donor and recipient were anastomosed with omental wrapping in 2 cases while the two main stem bronchi were joined without omental wrapping in 8. Endoscopy disclosed no sign of ischaemia in the patients with bilateral bronchial anastomoses. Three patients died on day 20, 21 and 35, respectively, after DLT. Two of these patients (one with a tracheal and the other with bronchial anastomoses) showed no complication at the level of the suture line. The third patient (with bronchial suture) suffered dehiscence of both anastomoses which was attributed to a misdosage of corticosteroids. Of the 6 patients alive after bronchial anastomosis, 3 recovered uneventfully and 3 who had required prolonged postoperative mechanical ventilation developed bronchomalacia. Bronchomalacia was treated by laser resection and stenting. Dehiscence did not occur in any of these six cases. This technique was based on the findings of 12 fresh cadaver dissections showing that collaterals between the bronchial arteries and the pulmonary arteries and veins extend up to the origin of the main stem bronchus. Bronchial suture without omental wrap may be used for double lung and heart-lung transplantation instead of tracheal suture.

Adolescent↗
PubMed1990

A dedicated tracheobronchial stent.

A dedicated tracheobronchial stent to be used in the treatment of external compression of the main airway is described. This stent is made of molded silicone. Its outside surface bears regularly placed studs to prevent displacement. First results are encouraging. So far, 118 prostheses have been placed in 66 patients. Tolerance was excellent and complications were rare. Migration occurred 12 times: in seven cases an early prototype that was poorly designed had been used. Obstruction was noted in two cases without major problems. Mean follow-up at the time of this writing is three months, with the longest follow-up 19 months.

Adult↗
PubMed1990

[A specific tracheobronchial endoprosthesis].

The author describes a dedicated tracheobronchial stent in treatment for the external compression of the main airway. The stent is made of moulded silicone and its outside surface has regular studs which are placed so as to prevent displacement. The first results are very encouraging. 146 prostheses have been positioned in 80 patients. Tolerance has been excellent and complications were rare. Unfortunately migration occurred 14 times: in 7 cases this was with one of the early prototypes which was poorly designed, and obstruction was noted in 4 cases without major problems. At the time of writing there has been a mean follow-up of 3 months, and the longest follow-up has been 21 months.

Adult↗
PubMed1989

Total cervical tracheal stenosis: treatment by laser, dilation, and stenting.

Twelve patients with total cervical tracheal stenosis were treated by endoscopic laser excision (neodymium:yttrium aluminum garnet or carbon dioxide laser), bronchoscopic dilation, and prolonged stenting with a silicone T-tube. All patients had previous traumatic or prolonged endotracheal intubation requiring a tracheotomy and presented with aphonia as the major complaint. Multiple laser and dilation treatments were necessary in ten patients. Average duration of T-tube placement was 6 months. Excellent results (decannulation and good voice) were achieved in eight patients with a follow-up of 9 months to 6 years. Persistent granulation tissue and some degree of fibrosis were the most common complications (eight of 12 patients). Two patients died of medical complications. A high success rate with this endoscopic technique justifies this approach as our initial therapy, with open surgical techniques reserved for failure.

Adult↗
PubMed1989

Teaching models for Nd:YAG laser bronchoscopy.

A number of groups have demonstrated the efficacy of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bronchoscopy for treatment of patients with selected tracheobronchial disorders. This therapy involves a new technology, the laser, and new adaptations of conventional rigid and flexible bronchoscopy that are unfamiliar to many bronchoscopists. We describe two teaching models for laser bronchoscopy that have been employed successfully in our laser courses. Using these models, bronchoscopists can become familiar with laser bronchoscopic equipment and appreciate the interaction of laser and soft tissue in a controlled setting in the laboratory before applying this therapy to patients.

Animals↗
PubMed1989

[Double lung transplantation. Report of the 1st French case and comments on the 5 subsequent cases].

Using a modified version of the technique described by the Toronto group, the Marseille group has performed 6 double lung transplantation procedures. In 6 cases the underlying disease was cystic fibrosis. Four patients are currently alive. The technique was modified in two ways. First anastomosis was made on the two main stem bronchi in order to rule out the risk of ischemic complications. Second a special postoperative care technique in which the patient is regularly turned from one side to the other was applied to avoid lymph stasis during the first postoperative weeks.

Adolescent↗
PubMed1989

[Surgical treatment of benign laryngotracheal stenosis. Apropos of 12 cases].

The authors report a series of twelve benign laryngotracheal strictures. In almost every case, these lesions were secondary to tracheal intubation and consisted of extensive, circumferential and almost complete stenosis. All were treated surgically. The authors obtained enlargement of the airway be means of an interposed cartilaginous graft and an intraluminal prosthesis which was left in place. In nine cases, this procedure was combined with posterior cricotomy. One eight month old infant died during the postoperative period. Ten patients had an uneventful postoperative course with a satisfactory anatomical and functional result.

Adolescent↗
PubMed1987

Techniques, results and complications of oesophageal dilatation.

The scope of therapeutic endoscopy, especially in the context of oesophageal dilatation, has greatly expanded in recent years. In this chapter we have described the currently used wire-guided systems and their dilatation technique. This technique can be used with most dilatation instrumentation now on the market. Perforation, the major risk of dilatation, is now rare (0.22% out of 909 dilatations with Savary-Gilliard bougies). Finally, we have presented the results of our own comparative studies for the Eder-Puestow, Savary Gilliard and Biomed systems and those of other authors for systems with which we have had no experience. In our opinion Savary-Gilliard bougies are the best, not only because of their greater flexibility and progressivity but also because of the improved safety tip of the guide wire.

Catheterization↗
PubMed1985

[Endoscopic resection in bronchology using the YAG laser. Evaluation of a 5-year experience].

The authors describe their experience with 1222 tracheobronchial endoscopic laser resections. The technique uses the thermal effects of the YAG laser which can be set to produce coagulation and vaporization. In most cases, the rigid bronchoscope under general anesthesia was preferred to the flexible fiberscope under local anesthesia. The main reason for this preference is that the rigid system allows management of hemorrhage should it occur. The technique is described with special attention to prevention of hypoxia, the major hazard. Inoperable malignant tumors accounted for 50% of the procedures. The other indications were tumors with uncertain prognosis, benign tumors, tracheal stenosis, and miscellaneous lesions. Results depend greatly on location. No fatality was recorded during the procedure, but two deaths did occur in the 48 hours thereafter. The authors conclude that endoscopic laser resection is a very effective modality for obstructive lesions in the main airways. It can be repeated as many times as needed and may be associated with other forms of therapy.

Aluminum Silicates↗
PubMed1985

A new method of esophageal dilation using Savary-Gilliard bougies.

A new method of esophageal dilation has been developed for tight, firm esophageal strictures. The Savary dilating system was evaluated in 300 patients by two groups of investigators who concluded that the Savary dilators were easier to use and more efficacious than the Eder-Puestow dilators.

Adolescent↗
PubMed1985

Endoscopic treatment of tracheobronchial malignancy. Experience with Nd-YAG and CO2 lasers in 506 operations.

Laser technology and the endoscope have been combined for the palliation of obstructive tracheobronchial malignant lesions. The neodymium-yttrium-aluminum-garnet (Nd-YAG) laser was used to treat 249 patients (447 operations), and the CO2 laser was used on 34 patients (59 operations). Hemorrhage, the major complication in both groups of patients, was more easily controlled with the Nd-YAG laser. One patient in the CO2 laser group died, and one patient in the group being treated with Nd-YAG laser bronchoscopy died. The Nd-YAG laser can be applied more efficiently through a fiber system, with better optic control and secure hemostasis. The commonest indications for treatment were dyspnea, obstructive pneumonia, and hemoptysis. Extrinsic compression was the most frequent reason for failure. The Nd-YAG laser, most often applied through open rigid bronchoscopes under general anesthesia, has become our treatment of choice for the palliation of tracheobronchial malignancy.

Adenocarcinoma↗
PubMed1984

Principles for safety in application of neodymium-YAG laser in bronchology.

The YAG laser is being used more often in cases of nonresectable bronchogenic cancer and in some cases is called on in lieu of surgery for tracheal stenosis. Patient safety hinges first on the endoscopist's technical skill and second on his understanding of the dangers involved in laser therapy. This report is based on experience gleaned from a 1,503 case series of endoscopic YAG laser treatments on 839 patients. These treatments were carried out by seven endoscopists in four teams using exactly the same equipment and techniques. In spite of the use of this high-risk technique in a high-risk patient population comprising a majority of major airways malignancy, the mortality rate was only 0.4 percent (six deaths: all in the postoperative period). We attribute this success to careful screening prior to resection, whenever possible, and above all to our methodology which not only emphasizes prevention but also enables rapid response.

Adult↗